Colonoscopic follow-up following Surgery for colon cancers

Endoscopic examination following surgery for the treatment of carcinoma of the colon and rectum in the postoperative follow-up is evaluated on the basis of clinical experience. 1) Postoperative constriction at anastomosis was remarkable in the rectum rather than in the colon. However, there was no clinical significance in terms of symptoms. 2) Surgeons should pay attention to new growth of second tumor as well as to the presence of local recurrence at early stage by means of periodic intervals of colonoscopy

Cytoprotective roles of GSH, SOD and solcoseryl against ischemic damage and reperfusion injury to warm ischemic lung. Study of Canine warm ischemic lung.

This study was performed to clarify the roles of reduced glutathion (GSH), superoxide dismutase (SOD), and solcosaryl in ischemic damage and reperfusion injury to the warm ischemic lungs of experimental animals. Fifty-one warm ischemic canine lungs were made by hilar stripping and clamping of the left PA, PV and bronchus for 2-3 hours. In the Non-perfusion group, GSH (50mg/ kg, I. V.: Group II) and solcoseryl (50mg/kg, I. V.: Group III) were administered. In the perfusion group, Euro-Collins (E-C) solution (20ml/kg) was perfused (Group IV) and GSH (1mg/ml in E-C solution: Group V) and SOD (15mg/l in E-C solution : Group VI) were used for anti-oxidative drugs. The pulmonary arterial pressure and aortic pressure were measured and also blood gas analysis was made during the preischemic period , immediately after, one hour and 3 days after reperfusion. Small parts of pulmonary tissues were taken for pathological examination one hour and 3 days after reperfusion. Chest X-ray films were teken at 3 days after the operation. GSH, SOD, and solcoseryl effectively act as scavengers of active oxygen species (AOS) , especially in terms of oxygenation. In the group with anti-oxidative drugs, cytoprotective effects of the pathological and chest X-ray findings on ischemic damage and reperfusion injury were much more manifest rather than those in control groups

Graft Function Associated with Oxygen Free Radicals Immediately after Transplantation

Free radical formation on lung allografts was estimated in macrophages of the bronchoalveolar space, and monocytes of the pulmonary artery and pulmonary vein in terms of the different immunosuppressive drugs of cyclosporine and azathioprine. It is elucidated that free radical formation is facilitated by macrophages of the bronchoalveolar space. It is of interest to emphasize that cyclosporine plays a cytoprotective role in prevention of free radical formation

Graft Rejection in Tems of Oxygen Free Radicals

Oxygen free radical formation in macrophages of bronchoalveolar lavage and monocytes of the pulmonary artery and vein was assessed in terms of the pathogenesis of rejection with or without pneumonia on lung allografts on the condition of the use of cyclosporine and azathioprine. It was clearly observed that oxygen free radicals are activated after transplantation. However, the immunosuppressive drugs of cyclosporine and azathioprione individually revealed a different behavior for the activation of oxygen free radicals. There was not close correlation between the activation of oxygen free radicals and occurrence of rejection with or without pneumonia

Tumor-containing CEA in Colon Cancers

Carcinoembryonic antigen (CEA) in serum and fresh cancer tissue taken at surgery was measured and analyzed in terms of the disease stage. The CEA level in serum (s-CEA ) has become higher with advance in the disease stage. However, in stage V it was lowered as well as CEA level in cancer mass (ca-CEA). It is suggested that S-CEA is influenced by cancer invasion into the vessel wall, tumor necrosis and/or degeneration which ca-CEA may well be migrated from the tumor cells

Primary malignant tumors of the small intestine

From 1967 through 1987, 43 of primary malignant tumors of the small intestine were experienced at the First Department of Surgery, Nagasaki University Hospital and affiliated hospital, and clinically analysed. 1) Carcinoma, leiomyosarcoma and malignant lymphoma occupied one third in number. The preferable location of carcinomas and malignant lymphomas was lower part of the small bowel although that of leiomyosarcoma was upper part. 2) Diagnosis was mainly made by means of laparotomy which was carried out by clinical signs of obstruction or peritonitis. poor prognosis attributed to extension of a disease to nodes and liver. An early and accurate diagnosis of small bowel tumors is necessary for improving the survival rate

Clopidogrel Monotherapy After 1-Month DAPT in Patients With High Bleeding Risk or Complex PCI

BACKGROUND: High bleeding risk (HBR) and complex percutaneous coronary intervention (PCI) are major determinants for dual antiplatelet therapy (DAPT) duration. OBJECTIVES: The aim of this study was to evaluate the effects of HBR and complex PCI on short vs standard DAPT. METHODS: Subgroup analyses were conducted on the basis of Academic Research Consortium-defined HBR and complex PCI in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Verulam's-Eluting Cobalt-Chromium Stent-2) Total Cohort, which randomly compared clopidogrel monotherapy after 1-month DAPT with 12-month DAPT with aspirin and clopidogrel after PCI. The primary endpoint was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (Thrombolysis In Myocardial Infarction [TIMI] major or minor) endpoints at 1 year. RESULTS: Regardless of HBR (n = 1, 893 [31.6%]) and complex PCI (n = 999 [16.7%]), the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (HBR, 5.01% vs 5.14%; non-HBR, 1.90% vs 2.02%; P interaction = 0.95) (complex PCI, 3.15% vs 4.07%; noncomplex PCI, 2.78% vs 2.82%; P interaction = 0.48) and for the cardiovascular endpoint (HBR, 4.35% vs 3.52%; and non-HBR, 1.56% vs 1.22%; P interaction = 0.90) (complex PCI, 2.53% vs 2.52%; noncomplex PCI, 2.38% vs 1.86%; P interaction = 0.53), while it was lower for the bleeding endpoint (HBR, 0.66% vs 2.27%; non-HBR, 0.43% vs 0.85%; P interaction = 0.36) (complex PCI, 0.63% vs 1.75%; noncomplex PCI, 0.48% vs 1.22%; P interaction = 0.90). The absolute difference in the bleeding between 1- and 12-month DAPT was numerically greater in patients with HBR than in those without HBR (-1.61% vs -0.42%). CONCLUSIONS: The effects of 1-month DAPT relative to 12-month DAPT were consistent regardless of HBR and complex PCI. The absolute benefit of 1-month DAPT over 12-month DAPT in reducing major bleeding was numerically greater in patients with HBR than in those without HBR. Complex PCI might not be an appropriate determinant for DAPT durations after PCI. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498)

Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Percutaneous Coronary Intervention: From the STOPDAPT-2 Total Cohort

[Background:] The benefit of clopidogrel monotherapy after 1-month dual antiplatelet therapy (DAPT) compared with 12-month DAPT with aspirin and clopidogrel was demonstrated in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2), but not in the STOPDAPT-2 acute coronary syndrome (ACS); however, both trials were underpowered based on the actual event rates. [Methods:] We obtained the prespecified pooled population of 5997 patients as the STOPDAPT-2 total cohort (STOPDAPT-2: N=3009/STOPDAPT-2 ACS: N=2988; ACS: N=4136/chronic coronary syndrome [CCS]: N=1861), comprising 2993 patients assigned to 1-month DAPT followed by clopidogrel monotherapy, and 3004 patients assigned to 12-month DAPT with aspirin and clopidogrel after percutaneous coronary intervention. The primary end point was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or any stroke) or bleeding (Thrombolysis in Myocardial Infarction major/minor) end points at 1 year. [Results:] One-month DAPT was noninferior to 12-month DAPT for the primary end point (2.84% versus 3.04%; hazard ratio [HR], 0.94 [95% CI, 0.70–1.27]; Pnoninferiority=0.001; Psuperiority=0.68). There was no significant risk-difference for the cardiovascular end point between the 1- and 12-month DAPT groups (2.40% versus 1.97%; HR, 1.24 [95% CI, 0.88–1.75]; Pnoninferiority=0.14; Psuperiority=0.23). There was a lower risk of the bleeding end point with 1-month DAPT relative to 12-month DAPT (0.50% versus 1.31%; HR, 0.38 [95% CI, 0.21–0.70]; Psuperiority=0.002). One-month DAPT relative to 12-month DAPT was associated with a lower risk for major bleeding regardless of ACS or CCS (ACS: HR, 0.46 [95% CI, 0.23–0.94]; P=0.03, and CCS: HR, 0.26 [95% CI, 0.09–0.79]; P=0.02; Pinteraction=0.40), while it was associated with a numerical increase in cardiovascular events in ACS patients, but not in CCS patients, although not statistically significant and without interaction (ACS: HR, 1.50 [95% CI, 0.99–2.27]; P=0.053, and CCS: HR, 0.74 [95% CI, 0.38–1.45]; P=0.39; Pinteraction=0.08). [Conclusions:] Clopidogrel monotherapy after 1-month DAPT compared with 12-month DAPT with aspirin and clopidogrel had a benefit in reducing major bleeding events without being associated with increase in cardiovascular events

Variation in in-hospital mortality and its association with percutaneous coronary intervention-related bleeding complications : A report from nationwide registry in Japan.

Large-scale registries have demonstrated that in-hospital mortality after percutaneous coronary intervention (PCI) varies widely across institutions. However, whether this variation is related to major procedural complications (e.g., bleeding) is unclear. In this study, institutional variation in in-hospital mortality and its association with PCI-related bleeding complications were investigated. We analyzed 388,866 procedures at 718 hospitals performed from 2017 to 2018, using data from a nationwide PCI registry in Japan. Hospitals were stratified into quintiles according to risk-adjusted in-hospital mortality (very low, low, medium, high, and very high). Incidence of bleeding complications, defined as procedure-related bleeding events that required a blood transfusion, and in-hospital mortality in patients who developed bleeding complications were calculated for each quintile. Overall, 4,048 (1.04%) in-hospital deaths and 1,535 (0.39%) bleeding complications occurred. Among patients with bleeding complications, 270 (17.6%) died during hospitalization. In-hospital mortality ranged from 0.22% to 2.46% in very low to very high mortality hospitals. The rate of bleeding complications varied modestly from 0.27% to 0.57% (odds ratio, 1.95; 95% confidence interval, 1.58–2.39). However, mortality after bleeding complications markedly increased by quintile and was 6-fold higher in very high mortality hospitals than very low mortality hospitals (29.0% vs. 4.8%; odds ratio, 12.2; 95% confidence interval, 6.90–21.7). In conclusion, institutional variation in in-hospital mortality after PCI was associated with procedure-related bleeding complications, and this variation was largely driven by differences in mortality after bleeding complications rather than difference in their incidence. These findings underscore the importance of efforts toward reducing not only bleeding complications but also, even more importantly, subsequent mortality once they have occurred