Retention of Capsule Endoscopy at the Site of NSAIDs-induced Intestinal Ulcer ―Lessons to Learn―

A 77-year-old man with a history of non-steroidal anti-inflammatory drugs (NSAID) use was admitted to our hospital due to anemia and hypoalbuminemia. Radioisotope scintigraphy indicated protein loss from the small intestine. The patient underwent capsule endoscopy, which was later found to be retained in the ileum. Double-balloon endoscopy showed multiple strictures with ulcers in the small intestine. The capsule was found in proximal to one of the stenosis, and was removed by doubleballoon enteroscopy. Based on endoscopic findings, NSAID-induced enteritis was diagnosed. Although anemia and hypoalbuminemia improved after discontinuing NSAID, the patient developed ileus and underwent partial resection of the ileum. Multiple diaphragm-like strictures were present in the resected intestine. The current case highlights the importance of screening for intestinal strictures when NSAID ulcer is suspected

Evaluation of Surgical Resection for Ampullar Carcinoma at Japanese Single Cancer Institute

Surgical resection is the only radical treatment option for duodenal ampullar carcinoma (AC) that results in an improved patient prognosis. Method: We examined the demographics, surgical records, and outcome in 23 patients with AC undergoing pancreaticoduodenectomy (PD). Results: Of 23 patients, 17 underwent pylorus preserving PD (PPPD) and 6 underwent PD, including subtotal stomach-preserving PD in 5. D2 lymphadenectomy was performed in 17 patients and D3 lymphadenectomy was performed in 6. The combined resection of the superior mesenteric vein was performed in 1 patient. Postoperative cancer recurrence was observed in 32%, and 6 patients died of cancer. The 3-year tumor-free survival rates were not different between the final stages (p=0.64) and the 5-year cancer-related overall survival rates were not different between stages either (p=0.28). Tumor size?3cm resulted in significantly poorer survival rate compared to smaller tumors (p=0.032). Node metastasis at Group 2, and moderately or poorly differentiated adenocarcinoma were significantly associated with poor survival (p<0.05); however, cancer infiltration at cut-end margin, degree of node dissection and curability were not associated with overall prognosis. Conclusions: Radical surgical resection showed good patient prognosis; however, new adjuvant chemotherapy is a promising modality to improve patient survival in AC patients with poor prognostic factors

A Novel ATM/TP53/p21-Mediated Checkpoint Only Activated by Chronic γ-Irradiation

Different levels or types of DNA damage activate distinct signaling pathways that elicit various cellular responses, including cell-cycle arrest, DNA repair, senescence, and apoptosis. Whereas a range of DNA-damage responses have been characterized, mechanisms underlying subsequent cell-fate decision remain elusive. Here we exposed cultured cells and mice to different doses and dose rates of γ-irradiation, which revealed cell-type-specific sensitivities to chronic, but not acute, γ-irradiation. Among tested cell types, human fibroblasts were associated with the highest levels of growth inhibition in response to chronic γ-irradiation. In this context, fibroblasts exhibited a reversible G1 cell-cycle arrest or an irreversible senescence-like growth arrest, depending on the irradiation dose rate or the rate of DNA damage. Remarkably, when the same dose of γ-irradiation was delivered chronically or acutely, chronic delivery induced considerably more cellular senescence. A similar effect was observed with primary cells isolated from irradiated mice. We demonstrate a critical role for the ataxia telangiectasia mutated (ATM)/tumor protein p53 (TP53)/p21 pathway in regulating DNA-damage-associated cell fate. Indeed, blocking the ATM/TP53/p21 pathway deregulated DNA damage responses, leading to micronucleus formation in chronically irradiated cells. Together these results provide insights into the mechanisms governing cell-fate determination in response to different rates of DNA damage

Recovery from Fulminant Hepatic Failure and Prolonged Deep Coma without Liver Transplantation

The overall mortality of fulminant hepatic failure without liver transplantation is around 70%. However, the most critical problem in the management of fulminant hepatic failure is the indication of liver transplantation because this disease is sometimes reversible without such treatment. We encountered a 27-year old patient with acute type fulminant hepatic failure and deep coma (grade V hepatic encephalopathy). Electroencephalography showed generalized low voltage activity in all leads, but cranial computed tomography revealed no diffuse brain edema. The patient was treated with artificial liver support without liver transplantation, and finally recovered without any neurological deficits. The indications for liver transplantation in patients with deep coma are still controversial because the reversibility of severe coma cannot be accurately predicted before the transplantation. Therefore, more data are needed for the correct therapeutic management (with or without liver transplantation) of fulminant hepatic failure