Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration

Background/Aims This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. Methods Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. Results The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). Conclusions The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes

Comparison and Analysis of Delirium Induced by Histamine H2 Receptor Antagonists and Proton Pump Inhibitors in Cancer Patients

Objective: H2 blockers have been reported to be responsible for drug-induced delirium. We compared the incidence of delirium between two groups of patients who were treated with H2 blockers (H2 group) or proton pump inhibitors (PPI group) for anastomotic ulcer prevention following surgical treatment of esophageal cancer. Method: The incidence and severity of delirium were retrospectively compared in patients of the H2 group (30 cases; age, 65.2 ± 8.1 years) and the PPI group (30 cases; 65.2 ± 6.5 years). The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. Delirium severity was rated on the Delirium Rating Scale (DRS). Results: The incidence of delirium was significantly lower in the PPI group than in the H2 group (p = 0.047). In the 11 patients from the H2 group who developed delirium, discontinuation of H2 blockers resulted in a significant reduction in the DRS score (p = 0.009). In three patients for whom H2 blockers were discontinued, DRS scores decreased by 50% or more three days after discontinuation compared to the prediscontinuation score. Conclusions: These results suggested that switching antiulcer drugs from H2 blockers to PPIs reduced delirium and thus provided an appropriate coping method for drug-induced delirium from antiulcer drugs

Seasonal Evolution of Cape Darnley Bottom Water Revealed by Mooring Measurements

This study examines the seasonal evolution of Cape Darnley Bottom Water (CDBW), using the results of mooring and hydrographic measurements in the slope region off Cape Darnley in 2008-2009 and 2013-2014. Newly formed CDBW began reaching the western and nearshore part of the slope region off Cape Darnley in April, spread to the offshore and eastern part in May, and reached the easternmost part in September. The potential temperature and salinity decreased and the neutral density increased when newly formed CDBW reached mooring sites. Potential temperature-salinity properties of CDBW changed over time and location. The salinity of the source water of CDBW estimated from potential temperature-salinity diagrams started to increase at a nearshore mooring in late April, which is about 2 months after the onset of sea-ice production, and continued to increase during the ice production season. It is most probable that the accumulation of brine in the Cape Darnley polynya produces the seasonal variation of potential temperature-salinity properties of CDBW. Two types of CDBW were identified. Cold and less saline CDBW and warm and saline CDBW were present in Wild and Daly Canyons, respectively. This indicates that the salinity of the source water of CDBW increased in the westward direction. CDBW exhibited short-term variability induced by baroclinic instability

コンピテンシーが高いスポーツ科学部初年次学生の特徴

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