A case of pancreatic mucinous cystic neoplasm that enlarged during pregnancy and was resected after childbirth.

A 28-year-old pregnant woman presented with an abdominal mass at 12 weeks' gestation. Magnetic resonance imaging revealed a 7 cm cystic lesion arising extrinsically from the pancreatic head, which was diagnosed as a mucinous cystic neoplasm. Although we recommended surgical excision during the second trimester, the patient refused the procedure and chose to continue her pregnancy. We monitored the lesion and noted that it gradually grew to 13 cm over the course of the pregnancy. Subsequently, we enucleated it after childbirth. Histopathological examination was compatible with high-grade dysplasia and confirmed the diagnosis of mucinous cystadenoma of the pancreas.

[Two cases of dabigatran-induced esophageal ulcer indicating the usefulness of drug administration guidance].

Here we report two cases of dabigatran-induced esophageal ulcer. Case 1 was a 67-year-old man who presented with heartburn that developed a month after dabigatran administration. Case 2 was an 81-year-old woman who presented with epigastralgia that developed within a few days of dabigatran administration. Endoscopic findings were similar in both cases, including shallow esophageal ulcers covered with a thin whitish membrane. The patients were advised to consume the drug with plenty of water during meals and to remain in a sitting position for 30 min after consumption. This method successfully decreased their symptoms and ulcers, indicating that drug administration guidance is extremely effective in managing dabigatran-induced esophageal injury.

Exposed blood vessels of more than 2 mm in diameter are a risk factor for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcer.

BACKGROUND AND AIM: There are few clinical studies on the risk factors for rebleeding based on the endoscopic hemostatic procedure carried out, including ulcer characteristics such as exposed blood vessels. The present study aims to clarify the risk factors for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcers. METHODS: A retrospective study was carried out with data collected during the 10-year period from January 2000 to December 2009 for 312 consecutive patients with hemorrhagic gastroduodenal ulcer. Two hundred and ninety-three patients (216 men and 77 women; mean age, 67.0 ± 15.0 years) who underwent endoscopic clipping as the initial hemostatic treatment were analyzed. The risk factors for rebleeding were determined by comparing 271 patients who did not rebleed after initial treatment with 22 patients who developed rebleeding. RESULTS: The success rate of initial clipping hemostasis was 100%; however, rebleeding occurred in 7.5% (22/293) and a multivariate analysis identified exposed blood vessels of more than 2 mm in diameter as independent risk factors for rebleeding (P = 0.0124, odds ratio 6.25 [95% CI: 1.53-13.62]). CONCLUSIONS: Endoscopic clipping monotherapy is effective for hemorrhagic gastroduodenal ulcers; however, exposed blood vessels of more than 2 mm in diameter in the initial endoscopic procedure are a risk factor for rebleeding.

Characteristics of serious complicated gastroduodenal ulcers in Japan.

BACKGROUND/AIMS: Even in Japan where the incidence of H. pylori infection is high, patients with gastroduodenal ulcers caused by NSAIDs are on the increase. A prospective study was conducted to elucidate the characteristics of gastroduodenal ulcers complicated with ulcerous hemorrhage and perforation among Japanese. METHODOLOGY: The subjects were 305 consecutive cases with hemorrhaging ulcers and 76 consecutive cases with perforated ulcers basis at Kagawa Prefectural Central Hospital between January 2000 and December 2008. These subjects were divided into 3 groups (lowdose aspirin, non-aspirin NSAIDs and non-NSAIDs) and were further stratified by the presence of an H. pylori infection. RESULTS: The 76 perforating ulcers were composed of 54 non-NSAIDs ulcers and 22 NSAIDs-related ulcers. The 305 hemorrhaging ulcers were composed of 156 non-NSAIDs ulcers, 94 non-aspirin NSAIDs ulcers and 55 on low-dose aspirin. The mortality for the non-aspirin NSAIDs group (12.8%, 12/94) and for the low-dose aspirin group (10.9%, 6/55) was significantly higher (p<0.01 and p<0.05, respectively) than the corresponding figure (2.6%, 4/156) for the non-NSAIDs group. The causes of death were exacerbation of or complications from the background diseases (Charlson Co-morbidity Index 3≤) (Odds ratios (OR) 6.01, 95% CI (1.98-18.89)). CONCLUSIONS: Approximately 50% of the gastroduodenal ulcers with complications found in Japanese are NSAIDs-related and may take a fatal turn. It is necessary to take measures to prevent the complicated ulcers corresponding to risk factors such as the severity of background diseases.

Identification of blood biomarkers of aging by transcript profiling of whole blood.

Immunological changes that inevitably occur with aging are related to the onset of various diseases including autoimmune diseases, immunodeficiency, as well as other age-reflecting (AR) diseases. They are becoming serious problems in the global trend of longevity. To understand the AR changes, we searched for genes whose expression profiles in the whole peripheral blood change dramatically as a function of age using the Agilent whole human genome 44K microarray. After examining two cohorts consisting of 154 healthy people between age 23 and 77, we discovered 16 transcripts strongly and reproducibly correlated with age. Analysis using a publicly available gene expression dataset for a variety of human immune cells revealed that some of these transcripts were highly expressed in specific cell types whose number and function are known to change with age. This analysis shed light on the molecular mechanism of AR immunological system changes. Because of its simplicity, the assay system is expected to be useful for understanding individual health conditions.

Endovascular repair and pharmacotherapy of an inflammatory abdominal aortic aneurysm complicated by primary aortoduodenal fistula.

An inflammatory abdominal aortic aneurysm complicated by primary aortoduodenal fistula was successfully treated by stent grafting. Pharmacotherapy with octreotide after endovascular aneurysm repair was also performed with the expectation of spontaneous and rapid closure of the fistula. Gastrointestinal endoscopy performed 10 days after endovascular aneurysm repair showed closure of the large aortoduodenal fistula, and oral intake was started on the operative day 16. To date, 16 months after the initial operation, the patient is doing well without any symptoms or signs of infection and without any antibiotic therapy.

[A case of hemolytic uremic syndrome after adjuvant chemotherapy with gemcitabine in a patient with pancreatic cancer].

A 63-year-old man with Stage IVa pancreas tail cancer was admitted for a distal pancreatectomy and splenectomy; adjuvant chemotherapy with gemcitabine was also administered. The chemotherapy was terminated after 16 courses due to hemolytic anemia, thrombocytopenia and renal dysfunction. Plasma exchange was performed; however the patient's renal function was diminished, requiring chronic hemodialysis. Physicians should be cautious of hemolytic uremic syndrome as a possible adverse reaction to gemcitabine and be aware that tests are needed for its early detection.

Basal protrusion of ulcers induced by endoscopic submucosal dissection (ESD) during treatment with proton pump inhibitors, and the suppressive effects of polaprezinc.

BACKGROUND/AIMS: When a peptic ulcer is treated with proton pump inhibitors (PPI), protrusion of the ulcer base is sometimes noted during ulcer healing. To clarify the incidence of ulcer base protrusion in ulcers induced by endoscopic submucosal dissection (ESD), and whether the addition of polaprezinc, a cytoprotective agent used for treatment of gastric ulcer, to the PPI regimen helps to suppress it. METHODOLOGY: One hundred sixty-three patients on which ESD was performed were randomly allocated to either two groups: one treated with lansoprazole (30mg/day) and the other with lansoprazole (30mg/day) plus polaprezinc (150mg/day) for the treatment of ESD-induced ulcer. The condition of the ESD-induced ulcer was blindly assessed two months after ESD by two physicians. RESULTS: Lansoprazole plus polaprezinc group showed significantly better ulcer healing (p < 0.0001) and protrusion of the ulcer base was recognized in only 1.3% (1/77), an incidence significantly lower than that in lansoprazole group (20.7%, 16/77, p = 0.0001). Polaprezinc was the only significant factor (p = 0.0001) differentiating patients who had ulcer base protrusion (n = 17) from those who did not (n = 137). CONCLUSIONS: Polaprezinc prevents protrusion of the ulcer base during the healing of ESD-induced ulcer with PPI.

Incidence of serious upper gastrointestinal bleeding in patients taking non-steroidal anti-inflammatory drugs in Japan.

Upper gastrointestinal bleeding is a major adverse event of non-steroidal anti-inflammatory drugs (NSAIDs), and co-administration of proton pump inhibitors and H2 receptor antagonists has been established as a means of preventing such an effect. However, the incidence of bleeding associated with NSAID-induced ulcers under conditions where such strong anti-acid agents are used for prevention has yet to be clarified. We aimed to determine the annual incidence of serious upper gastrointestinal ulcer bleeding among Japanese patients in whom NSAIDs were used in our hospital. Before commencing the study, we recommended to all the physicians in our hospital the best method for caring for NSAID users, focusing on the concomitant use of proton pump inhibitors or H2 receptor antagonists. We conducted a cohort study involving 17,270 patients for whom NSAIDs had been newly prescribed. Bleeding from gastric ulcers was observed in 8 of the 17,270 patients using NSAIDs (0.05%). The pooled incidence rate for bleeding was calculated as 2.65 (95% confidence interval, 2.56-2.74) and 1.29 (1.27-1.31) per 1,000 patient years for low-dose aspirin and non-aspirin NSAID users, respectively. None of the bleeding ulcer patients required blood transfusion or were in serious condition. In conclusion, gastric ulcer bleeding occurred in low-dose aspirin or non-aspirin NSAID users, but its incidence was low and outcomes were not serious when adequate preventive measures were taken.

[A case of gastric arteriovenous malformation forming faded depression].

A 48-year-old man was referred to our hospital because of anemia. Upper gastrointestinal endoscopy showed discolored depressive lesion like gastric cancer, 30mm in diameter, in the greater curvature of the upper gastric body. During the endoscopic examination, pulsative bleeding from the lesion was occurred and we performed clipping hemostasis. We diagnosed a gastric arteriovenous malformation by endoscopic ultrasonograph and angiography. A pylorus preserving-gastrectomy was performed and Pathohistological examination revealed arterio-venous connection in the submucosal layer of the gastric wall.

[Effect of antiulcer agents on the urea breath test--Comparison between rebamipide and ecabet sodium].

In this study, we assessed whether standard doses of antiulcer drugs rebamipide, and ecabet sodium influence the accuracy of the urea breath test (UBT). Without medication, values of UBT estimated with nondispersive isotope-selective infrared spectrometry did not significantly change during follow-up (average 4.4 months). Then, we randomized 21 H. pylori-positive patients without serious disease to receive either rebamipide or ecabet sodium for 28 days. UBT was performed at baseline, on day 14, on day 28, and 2 weeks after cessation of drugs. On day 14, the median value of UBT declined significantly (p = 0.0113) compared to baseline with ecabet sodium but not with rebamipide. This caused a false-negative result of UBT in one of 11 patients who received ecabet sodium. The decline of UBT resolved 2 weeks after drug cessation. In addition, we performed a crossover study in 11 H. pylori-positive volunteers with these drugs, and ecabet sodium but not rebamipide significantly reduced UBT values (p = 0.0058). These findings indicate that ecabet sodium adversely influences the accuracy of UBT and that the withdrawal of this drug before testing appears to be necessary to avoid false-negative results.