Role of a forward-viewing echoendoscope in fine-needle aspiration

AbstractA prototype forward-viewing echoendoscope has been developed for therapeutic endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The hard tip of the forward-viewing echoendoscope, which is shorter than that of the convex type echoendoscope, can be maneuvered flexibly. Using the forward-viewing echoendoscope, the gastrointestinal wall can be vertically punctured along the same axis as the scope, and this process is done more easily than with an oblique-viewing echoendoscope. The diagnostic accuracy of EUS-FNA with the forward-viewing echoendoscope is 97.4%, which is not significantly different to that of the oblique-viewing echoendoscope. The forward-viewing echoendoscope may be useful in situations where the location and procedure are difficult with the oblique-viewing scope, The forward-viewing echoendoscope is able to puncture the gastrointestinal wall vertically with minimal effort, therefore allowing therapeutic EUS procedures such as pseudocyst and abscess drainage, biliary drainage, and pancreatic duct drainage to be performed easily. However, a significant difference between the forward-viewing and oblique-viewing echoendoscopes in pseudocyst drainage has been reported recently. In the future, the forward-viewing and oblique-viewing echoendoscopes will probably be selectively used depending on not only lesion site but also the procedure required in individual patients, thereby facilitating various processes including puncture, tissue collection, and diagnosis, as well as therapeutic procedures

Pathway to psychiatric care in Japan: A multicenter observational study

<p>Abstract</p> <p>Background</p> <p>This study examines pathways to psychiatric care in Japan using the same method as the collaborative study carried out in 1991 under the auspices of the World Health Organization.</p> <p>Methods</p> <p>Thirteen psychiatric facilities in Japan were involved. Of the 228 patients who contacted psychiatric facilities with any psychiatric illness, eighty four visiting psychiatric facilities for the first time were enrolled. Pathways to psychiatric care, delays from the onset of illness to treatment prior to reaching psychiatrists were surveyed.</p> <p>Results</p> <p>Thirty three patients (39.4%) directly accessed mental health professionals, 32 patients (38.1%) reached them via general hospital, and 13 patients (15.5%) via private practitioners. The patients who consulted mental health professionals as their first carers took a longer time before consulting psychiatrists than the patients who consulted non-mental health professionals as their first carers. The patients who presented somatic symptoms as their main problem experienced longer delay from the onset of illness to psychiatric care than the patients who complained about depressive or anxiety symptoms. Prior to the visit to mental health professionals, patients were rarely informed about their diagnosis and did not receive appropriate treatments from their physicians. Private practitioners were more likely to prescribe psychotropics than physicians in general hospitals, but were less likely to inform their patients of their diagnosis.</p> <p>Conclusion</p> <p>This first pathway to psychiatric care study in Japan demonstrated that referral pathway in Japan heavily relies on medical resources. The study indicates possible fields and gives indications, underlining the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders presenting with somatic and depressive symptoms in the general health care system and by private practitioners.</p

Recent Advances of Biliary Stent Management

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations

Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs

BACKGROUND: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography. PATIENTS AND METHODS: Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. RESULTS: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. CONCLUSIONS: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI

Influence of Obstructive Sleep Apnea on Diastolic Heart Failure

Heart failure is frequently complicated by obstructive sleep apnea, which raises blood pressure and arrhythmiaand worsens prognosis. However, the incidence and influence of obstructive sleep apnea in patientswith diastolic heart failure is unknown. We hypothesized that patients with diastolic heart failurecomplicated by obstructive sleep apnea may have a worse outcome compared to those without obstructivesleep apnea. The study included 49 patients with an ejection fraction &#8805; 50 %, of whom 34 had diastolic heartfailure and 15 did not have diastolic heart failure. The patients were examined in a sleep study and byechocardiography. Brain natriuretic peptide (BNP) levels were determined at admission and 1, 6 and 12months thereafter. The prevalence of obstructive sleep apnea in patients with diastolic heart failure( 18/34,53 %) was significantly higher than that in those without diastolic heart failure (3/15, 20 %)(p=0.032).BNP levels were high at admission in patients with diastolic heart failure, but then decreased gradually inthose without obstructive sleep apnea. However, BNP in patients with diastolic heart failure and obstructivesleep apnea remained high and was significantly elevated compared to the level in patients without obstructivesleep apnea at 6 and 12 months after admission. Patients with diastolic heart failure and obstructivesleep apnea showed prolongation of elevated BNP, indicating that complication of diastolic heart failure byobstructive sleep apnea may aggravate cardiac function