Plasma brain natriuretic peptide as a surrogate marker for cardioembolic stroke

<p>Abstract</p> <p>Background</p> <p>Cardioembolic stroke generally results in more severe disability, since it typically has a larger ischemic area than the other types of ischemic stroke. However, it is difficult to differentiate cardioembolic stroke from non-cardioembolic stroke (atherothrombotic stroke and lacunar stroke). In this study, we evaluated the levels of plasma brain natriuretic peptide in acute ischemic stroke patients with cardioembolic stroke or non-cardioembolic stroke, and assessed the prediction factors of plasma brain natriuretic peptide and whether we could differentiate between stroke subtypes on the basis of plasma brain natriuretic peptide concentrations in addition to patient's clinical variables.</p> <p>Methods</p> <p>Our patient cohort consisted of 131 consecutive patients with acute cerebral infarction who were admitted to Kagawa University School of Medicine Hospital from January 1, 2005 to December 31, 2007. The mean age of patients (43 females, 88 males) was 69.6 ± 10.1 years. Sixty-two patients had cardioembolic stroke; the remaining 69 patients had non-cardioembolic stroke (including atherothrombotic stroke, lacunar stroke, or the other). Clinical variables and the plasma brain natriuretic peptide were evaluated in all patients.</p> <p>Results</p> <p>Plasma brain natriuretic peptide was linearly associated with atrial fibrillation, heart failure, chronic renal failure, and left atrial diameter, independently (F_4,126= 27.6, p < 0.0001; adjusted R²= 0.45). Furthermore, atrial fibrillation, mitral regurgitation, plasma brain natriuretic peptide (> 77 pg/ml), and left atrial diameter (> 36 mm) were statistically significant independent predictors of cardioembolic stroke in the multivariable setting (Χ²= 127.5, p < 0.001).</p> <p>Conclusion</p> <p>It was suggested that cardioembolic stroke was strongly predicted with atrial fibrillation and plasma brain natriuretic peptide. Plasma brain natriuretic peptide can be a surrogate marker for cardioembolic stroke.</p

A case of early gastric cancer with difficulty in achieving hemostasis after endoscopic submucosal dissection

　症例は80歳代，男性．貧血の精査目的で当科受診し，上部消化管内視鏡検査で前庭部小弯に早期胃癌を認めた．内視鏡的粘膜下層剥離術（ESD）を施行し，治癒切除であった．その後，ESD 後潰瘍からの出血を繰り返し，内視鏡的止血術を計９回，経カテーテル的動脈塞栓術を計３回行った．潰瘍からの再出血予防のためポリグリコール酸シート（以下 PGA シート）とフィブリン糊を貼付した．その後は出血なく潰瘍の上皮化を確認した．PGA シートとフィブリン糊を用いた内視鏡的粘膜欠損被覆法は，ESD の後出血予防における有用性に関していくつかの報告がされており，出血リスクが高いと思われる症例に関しては PGA シートによる被覆法を検討する必要がある．　The patient was a man in his 80s. He was referred to our department for anemia. He was diagnosed with early gastric cancer in the lesser curvature of the antrum confirmed by upper gastrointestinal endoscopy and underwent endoscopic submucosal dissection (ESD). Histopathological examination was curative resection. Afterward, recurrent bleeding from an ulcer led to endoscopic hemostasis nine times and transcatheter arterial embolization three times. We covered the base of the ulcer with a polyglycolic acid sheet and fibrin tissue adhesive to prevent bleeding. Subsequently, he passed without rebleeding, and the ulcer became epithelial. There have been some reports on the effectiveness of covering an ulcer with a polyglycolic acid sheet and fibrin tissue adhesive. We may consider using polyglycolic acid sheets for patients with hemorrhage high risk for post-ESD bleeding