Risk factors for the first and second inappropriate implantable cardioverter-defibrillator therapy

Introduction: Various risk factors for the first inappropriate implantable cardioverter-defibrillator (ICD) therapy event have been reported, including a history of atrial fibrillation/atrial flutter (AF/AFL), younger age, and multiple zones. Nonetheless, which factors are concordant with real-world data has not been clarified, and risk factors for the second inappropriate ICD therapy event have not been well examined. This study aimed to clarify the risk factors for the first and second inappropriate ICD therapy events. Methods: We conducted a post-hoc secondary analysis of data from a multicenter, prospective observational study (the Nippon Storm Study) designed to clarify the risk factors for electrical storm. Results: The analysis included data from 1549 patients who received ICD or cardiac resynchronization therapy with defibrillator (CRT-D). Over a median follow-up of 28 months, 293 inappropriate ICD therapy events occurred in 153 (10.0%) patients. On multivariate Cox regression analysis, the risk factors for the first inappropriate ICD therapy event were younger age (hazard ratio [HR], 0.986; p = 0.028), AF/AFL (HR, 2.324; p = 0.002), ICD without CRT implantation (HR, 2.377; p = 0.004), and multiple zones (HR, 1.852; p = 0.010). "No-intervention" after the first inappropriate ICD therapy event was the sole risk factor for the second inappropriate ICD therapy event. Conclusions: Risk factors for the first inappropriate ICD therapy event were similar to those previously reported. Immediate intervention after the first inappropriate ICD therapy event could reduce the risk of the second inappropriate event

スイカン ヒユゴウ ニ ガッペイ シタ スイカンナイ ニュウトウ シュヨウ ノ イチセツジョレイ

We report a case of partial pancreas divisum with Intraductal Papillary Mucinous Tumor (IPMT) that was performed pancreatic segmentectomy. A 68-year-old woman was admitted to our hospital because she was pointed out a cystic tumor of the pancreatic body by near doctor. Abdominal ultrasonography and endoscopic retrograde pancreaticography showed a partial pancreas divisum and cystic tumor with small elevated lesion. Based on these various examinations a diagnosis partial pancreas divisum with IPMT was determined. Then we performed a minimal invasive operation, and underwent pancreatic segmentectomy. After the operation there were no major complications and she discharged on 34th post operative days. In a review of the Japanese literature, only three such cases including our case have been reported so far

ステロイド チョウキ トウヨ カンジャ ニオケル シュウジュツキ ステロイド カバー

In patients receiving chronic corticosteroid therapy, the adrenocortical function has decreased because of suppression of the hypothalamic-pituitary-adrenal axis. Under such a condition, it is easy to fall into a serious acute adrenocortical insufficiency during surgical stress. Corticosteroid supplementation is done as prevention of adrenocortical insufficiency. It is changing from corticosteroid supplementation of high dose into that of low dose that based on extrapolation from what constitutes a normal cortisol response to stress in recent years. On the other hand, some authors reported that patients receiving therapeutic doses of corticosteroids who undergo a surgical procedure do not routinely require corticosteroid supplementation so long as they continue to receive their usual daily dose of corticosteroid. Therefore, furthermore investigation should be necessary

Donor-specific tolerance induced by simultaneous allogeneic islet transplantation with CD4+CD25+ T-cells into hepatic parenchyma in mice

Background. The allogeneic islets transplantation is an ideal therapeutic strategy for patients with diabetes mellitus. However, it has been difficult to induce immunological tolerance against islets grafts. TheCD4+CD25+ regulatory T-cells (Treg) play a role in suppressing T-cell activation. Thus, we evaluated whether Treg can regulate donor-specific T-cell tolerance that received allogeneic islets into the hepatic parenchyma (ITxHP) along with Treg. Methods. C3H/He mice were used as donors and streptozotocin-induced diabetic BALB/c mice were recipients. The protocol included three groups : Group A recipients received only 300 IE islets Group B was given 300 IE islets and whole splenocytes Group C was given 300 IE islets and Treg purified from peripheral lymph nodes. Results. For all mice in Groups A and B, the fasting blood sugar exceeded 250mg/dl and graft rejection was observed. GVHD was observed earlier in Group B than in Group A. In contrast graft survival exceeded 30 days for two mice in Group C (50%, mean POD 28.5±24.0, Plt0.05). Mixed lymphocyte reaction showed that T-cells from tolerant mice had very weak responses against spleen cells from C3H mice. Conclusions. The simultaneous ITxHP with CD4+CD25+ T-cells administration prolonged islet graft survivals and induced donor-specific hyporesposiveness

Poorly differentiated neuroendocrine cell carcinoma of the rectum : report of a case and literal review

A 56-year-old man was admitted to our hospital because of anal bleeding. Colonoscopy and barium enema revealed type 4 tumor in the rectum. Biopsy revealed poorly differentiated adenocarcinoma. Low anterior resection with total mesorectal excision and lymph node dissection was performed. In immunohistochemical staining, chromogranin A and synaptophysin were positive at major lesion, and CEA were focal positive. The resected tumor was diagnosed pathologically as neuroendocrine cell carcinoma. The Ki-67 labeling index (LI) was 87.8%, so proliferative activity and potential malignancy was very high. Multiple metastatic tumors appeared in pelvis and lung eight months after operation. Treatment for neuroendocrine cell carcinoma of the rectum was controversial. Surgical resection and adjuvant chemotherapy might be one of the methods for gastrointestinal neruroendocrine cell carcinoma

Squamous Cell Carcinoma of the Descending Colon: Report of a Case and Literature Review

It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. An 89-year-old man was treated in 2001 with chief complaints of anorexia, abdominal pain, and low grade fever. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon because except in the colon no malignant lesions were found by systemic CT. Surgical complete resection was performed. However, he died three months after surgical resection because of hepatic metastasis and cachexia. The prognosis of this disease seems to be worse than that of adenocarcinoma

microRNA デ カガク ホウシャセン リョウホウ ノ コウカ オ ヨソクスル

While global microRNA（miRNA）expression patterns of many embryologic, physiologic, and oncogenic processes have been described, description of the role of miRNAs for preoperative chemoradiotherapy（CRT）in rectal cancer is lacking. Our purpose of this study was to define the expression pattern of miRNAs for prediction of response to chemoradiotherapy in rectal cancer. Rectal cancer patients（n＝22）who underwent preoperative CRT（40Gy radiotherapy combined with S-1）were studied. S-1 is a novel oral fluoropyrimidine inhibitory for dihydropyrimidine dehydrogenase and has potent radiosensitizing property. RNA harvested from biopsy specimens of rectal cancer before preoperative CRT was hybridized to miRNA microarrays（８２１genes）. Response to CRT was determined by histopathologic examination（Japanese Society for Cancer of the Colon and Rectum）of surgically resected specimens and RECIST. Groups were classified as responders（ grade 2 or 3, CR or PR）or nonresponders（grade 0 or 1, SD or PD）, respectively. Response to CRT determined by histopathologic examination of surgically resected specimens and RECIST were as follows : responders（grade 2 or 3, n＝15）,（PR, n＝１４）, nonresponders（grade 0 or 1, n＝7）（, SD, n＝8）. Response rate was６８％（grade 2 or 3）and 63％（PR）. Two miRNAs（miR- 142, 223）with increased expression were identified that correctly differentiated responders from nonresponders of CRT by histopathologic examination. One overexpressed（miR-223）and 4 underexpressed miRNAs（miR-17, 20, 92, 106）differentiated responders from nonresponders of CRT by RECIST. Rectal cancer may have a distinct miRNA expression to predict pathological response to preoperative chemoradiotherapy

GSRS ガ リックンシトウ ニヨル ショウカキ ショウジョウ ノ QOL カイゼン ノ ヒョウカ ニ ユウヨウ デアッタ 1レイ

We report here an effective case of Rikkunshi-to（TJ-43）for who had gastrointestinal symptoms,nausea and diarrhea, and a usefulness of GSRS for evaluation of quality of life（QOL）ingastrointestinal symptoms. A 78 year-old male developed nausea and vomitting, and was foundwith a well to moderately differentiated adenocarcinoma of the rectum（Ra, type2, cT2, cN0, cM0,cStageⅡ）. He would be done with neoadjuvant chemoradiotherapy following transverse colostomy.However, he had heart burn and diarrhea after colostomy. Rikkunshi-to improved thesesymptoms. In GSRS, pre-and post-treatment of the total score decreased 3.9 to 2.0. The GSRS isa good relationship to QOL in gastrointestinal symptoms

シンコウ イガン ニ タイスル フククウキョウ ケンサゴ ニ SIADH オ ハッショウシタ 1レイ

We report here a case of advanced gastric cancer complicated by Syndrome of Inappropriate Secretion of Antidiuretic Hormone（SIADH）following staging laparoscopy. A ５５ year-old male developed nausea, and was found with a poorly differentiated adenocarcinoma of stomach（UE, type4, cT 3, cN2, cM0, cStage ⅢB）. He was done with staging laparoscopy. The serum sodium concentration decreased from１３８mEq/l to１１４mEq/l after operation. SIADH was diagnosed on the basis of hyponatremia with corresponding serum hypoosmolality and an inappropriate high urinary osmolality due to continued sodium excretion. Fluid restriction and sodium supplement resulted in an appropriate rise in the serum sodium level to１２８mEq/l in ４ days