Analysis of Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasms

Aim. Delayed bleeding after endoscopic submucosal dissection (ESD) for gastric epithelial neoplasms is a major complication. We investigated factors related to post-ESD bleeding to identify preventive measures. Methods. The study included 161 gastric epithelial neoplasms in 142 patients from June 2007 to September 2010. Post-ESD bleeding was defined as an ulcer with active bleeding or apparent exposed vessels diagnosed by an emergency endoscopy or a planned follow-up endoscopy. We analyzed associations between bleeding and the following factors: age, sex, morphology, pathology, tumor depth, ulcer presence/absence, location, size of the resected lesion, duration of the procedure, the number of times bleeding occurred during ESD, and the use of anticoagulants and/or antiplatelet drugs. Subsequently, we examined characteristics of bleeding cases. Results. Post-ESD bleeding occurred in 21 lesions. Univariate analysis of these cases showed that ulcer presence/absence (P < 0.001), middle or lower third lesions (P = 0.036), circumference (P = 0.014), and a post-ESD ulcer with an extended lesser curve (P = 0.009) were significant predictors of bleeding. Multivariate analysis showed that ulcer presence/absence (OR 9.73, 95% CI 2.28–41.53) was the only significant predictor. Conclusion. Ulcer presence/absence was considered the most significant predictor of post-ESD bleeding

Monocyte chemiluminescence and macrophage precursors in the aged.

Age-related alterations in the host defense system have been vigorously investigated because of increased susceptibility to infection and neoplasms in the aged. Although monocyte-macrophages form a major part of the cellular defense against microorganisms, the majority of investigations has been limited to neutrophils and lymphocytes. The present study, designed to determine the influence of age on mononuclear phagocytes, revealed no significant decrease in the absolute number of blood monocytes, but did reveal a tendency for the chemiluminescence of blood monocytes to decrease (p less than 0.10) and a significant decrease in the numbers of macrophage precursors (p less than 0.05) in the aged (over 70 year old), in comparison with controls (under 40 years old). On the basis of these findings, functional alterations of monocyte-macrophages seem to participate in the increased susceptibility to infection in the aged.</p

Aclarubicin in the treatment of elderly patients with acute nonlymphocytic leukemia.

Thirteen previously untreated patients aged 70 and above with acute nonlymphocytic leukemia were treated with aclarubicin (ACR) alone. Among 10 cases (3, acute myelocytic leukemia; 4, acute myelomonocytic leukemia; 2, acute monocytic leukemia; and one, acute erythroleukemia) in which an evaluation was possible, 5 cases (3, acute myelomonocytic leukemia; and 2, acute monocytic leukemia) obtained complete remission (CR). The CR rate was 83% in 6 patients with acute myelomonocytic leukemia or acute monocytic leukemia. The median CR duration and survival was 7.5 and 10 + months, respectively. Although side effects of the drug on digestive system such as nausea, vomiting and anorexia were observed in all patients, they were controllable by conventional treatments. The results suggest that ACR is effective for the clinical management of elderly patients with acute nonlymphocytic leukemia, especially those with acute myelomonocytic leukemia or acute monocytic leukemia.</p

Sprague-Dawleyラットの脂質代謝およびケミカルメディエーター放出能に及ぼすヨード卵およびDHA強化卵卵黄粉末の摂食効果

To clarify whether DHA-enriched or iodine egg has anti-allergic effect or not, Sprague-Dawley rat were fed with egg yolk powder of these health oriented eggs at the 10% level and the effects on chemical mediator releasing activity of peritoneal exudate cells. LTB_4 releasing activity of the cells was lowest in the group fed casein and soybean oil, and anti-allergic effect was not observed in the group fed egg yolk powders. In histamine release, its accumulation in the cells was significantly inhibited in normal egg group, while an increasing tendency of the histamine level was observed in DHA enriched and iodine egg groups. In amino acid analysis of liver phospholipids, significant decrease in the proportion of arachidonic acid was observed only in the DHAenriched egg group in phosphatidylcholine. On the contrary, the proportion was higher in all egg yolk powder fed groups than in casein and soybean oil fed group. These results indicate that feeding of egg yolk of DHA-enriched or iodine egg at the 10% level can not induce the decrease of LTB_4 releasing activity, but that feeding of soybean oil containing α-linolenic acid can do.DHA強化卵およびヨード卵の抗アレルギー作用の有無を明らかにするため,これらの健康志向卵の卵黄粉末を10%レベルでSprague-Dawleyラットに摂食させ,腹腔滲出細胞のケミカルメディエーター放出能に及ぼす影響を検討した.腹腔滲出細胞のLTB_4放出能はカゼインおよび大豆油を投与した群で最も低く,卵黄粉末投与群では抗アレルギー効果は認められなかった.ヒスタミン放出については,通常卵群で腹腔滲出細胞のヒスタミン蓄積が有意に抑制されたが,DHA強化卵およびヨード卵群ではかえって促進される傾向が認められた.肝臓リン脂質のアラキドン酸の割合は,ホスファチジルコリンではDHA強化卵群で有意に低い値を示したが,ホスファチジルエタノールアミンではすべての卵黄粉末投与群で有意に高い値が得られた.これらの結果は,DHA強化卵およびヨード卵卵黄粉末を10%レベルで投与してもLTB_4放出能の低下を誘導できないが,α-リノレン酸を含む大豆油の投与によりLTB_4放出能の低下を誘導しうることを示している