Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding.

BACKGROUND: Three hundred and forty-five patients who underwent urgent colonoscopy for acute hematochezia during the past 20 years (from 1976 to 1995) were retrospectively analyzed. METHODS: Urgent colonoscopy was defined as endoscopy performed within 24 h after a bleeding episode. Preparation was initially minimal with a water or glycerine enema. Recently, however, polyethylene glycol is used. RESULTS: The overall diagnostic accuracy for bleeding site detection was 89.1% (307 cases). Successful insertion was made to the ileocecal region in 193 cases (55.9%). The disease most frequently discoverd by urgent colonoscopy was transient ischemic colitis (62 cases). Negative urgent colonoscopy specimens (18 cases) were later diagnosed by other methods as being small intestinal bleeding foci. In 10 cases, initial colonoscopy failed to detect the bleeding foci. Endoscopic hemostasis was performed in 48 cases. Permanent hemostasis succeeded in 32 cases (66.7%). Complications of urgent colonoscopy were fever after the examination (22 cases) and hypotension during endoscopy (7 cases). CONCLUSION: Urgent colonoscopy is considered to be a safe and useful examination for acute lower gastrointestinal bleeding and hemostasis.

[Clinical significance of serum and urinary neopterins after transcatheter arterial embolization for hepatocellular carcinoma].

To elucidate the immunological effects of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC), serum and urinary neopterins were measured using the radioimmunoassay in patients with HCC before and after TAE (n = 11), and compared with one shot arterial injection (AI)(n = 8). At the third day after TAE, serum and urinary neopterin levels were maximally elevated up to 164% and 158% from their respective baselines (p < 0.01). By contrast, these levels were unaffected after AI. In considering the changes of natural killer cell activity, C-reactive protein, transaminase and alpha-fetoprotein, these results suggest that the determination of neopterin levels after TAE may be not only valuable to assess the necrotic effect of TAE, but also be useful for evaluating cellular immunity after TAE.

Serum and urinary neopterin levels in patients with chronic active hepatitis B treated with interferon.

Serum and urinary neopterin levels and serum 2',5'-oligoadenylate synthetase and DNA polymerase activities were measured in 14 patients with HBeAg-positive chronic hepatitis B treated with interferon. Treatment with interferon brought about a threefold increase over basal levels in serum and urinary neopterin levels one week after the start of treatment. Both neopterin levels remained significantly elevated during treatment but rapidly returned to basal levels after the completion of treatment. Serum and urinary neopterin levels changed with a pattern similar to that of serum 2',5'-oligoadenylate synthetase activity and with a mirror image to serum DNA polymerase activity. It is indicated that measurement of serum and urinary neopterin can be used as a marker for cell-mediated immunity during interferon therapy for chronic hepatitis B, but can not be used to predict the short-term clinical effects of interferon treatment as in the case of serum 2',5'-oligoadenylate synthetase.

Clinical significance of serum and urinary neopterin levels in patients with various liver diseases.

Serum and urinary neopterin levels were measured by radioimmunoassay in 120 healthy controls, 16 asymptomatic HBsAg carriers, 12 patients with acute hepatitis, 13 with chronic inactive hepatitis, 35 with chronic active hepatitis, 46 with liver cirrhosis, 18 with hepatocellular carcinoma, and 6 with alcoholic liver disease. Serum and urinary neopterin levels were significantly higher in almost all patients than in normal subjects. Neopterin levels were highest in acute hepatitis and correlated with the results of liver function tests, but did not show this correlation in chronic liver disease. In chronic liver disease, the levels of serum neopterin in non-A non-B viral patients was significantly increased, compared with those in B viral and alcoholic patients. The rate of abnormal urinary neopterin levels in chronic liver disease was higher than the rate of abnormal serum neopterin levels, but no difference was observed between the rates of abnormal serum and urinary levels in acute hepatitis and asymptomatic HBsAg carriers. These results indicate that serum and urinary neopterin levels may be useful markers for cell-mediated immunity in liver disease, and that the immune system response in chronic liver disease may be different for different pathogens.

Results of malleostapediopexy.

In the eight years from 1973 to 1980, we performed tympanoplasty on approximately 350 cases, in 50 of which malleostapediopexy was undertaken. Postoperative hearing improvement occurred in 86%. Hearing further improved as compared with that at the third postoperative week occurred in 17 of 31 long-term follow-up cases (55%). Malleostapediopexy proved satisfactory in that it could be applied if the malleus and stapes were intact, it was technically simple, requiring no higher skill, and produced good improvement of hearing.