Clinical study on polypoid lesions of the colon

1986年4月から1990年2月末までの間に岡山大学医学部附属病院三朝分院で経験した早期大腸癌を含む大腸ポリープ90例（107病変）を対象に，年齢，臨床症状，便潜血反応，病変存在部位について検討を行い，以下の成績を得た。(1)大腸検査総数の22.4％にポリープが発見された。ポリープの77％は腺腫，5％は腺癌（早期癌）であった。(2)便潜血反応はポリープ例の75.9％に陽性であり，右側大腸ポリープでの陽性率は高かったが，S状結腸および直腸ポリープでは70％程度であった。(3)若年者では右側結腸にポリープが発見されることは稀であるが，50才以上では18％程度に認められた。高齢者では右側結腸も内視鏡で検査することが重要である。(4)免疫学的便潜血検査法の導入により大腸ポリープの発見効率が改善するものと考え られた。This report is concerned with clinical study on 90 patients with polypoid lesions (107 lesions) which we have encountered in Misasa Hospital, Okayama University in the past 4 years. Following results were obtained : (1) Polypoid lesions were detected in 90 (22.4%) and advanced adenocarcinoma (mostly resectable) in 22 (5.5%) of 402 patients who were examined by sigmoidoscopy and barium enema ; (2) Histological examination of the polypoid lesions showed adenoma in 77.2%, hyperplastic polyp in 8.7%, inflammatory polyp in 7.6%, neurinoma in 0.3% and early cancer (adenocarcinoma) in 5.4% ; (3) It was impossible to differentiate benign and malignant polypoid lesions on the basis of endoscopic and X-ray findings alone ; (4) Forty-two percent of the polypoid lesions was detected in the sigmoid colon, 30% in the rectum, 16.8% in the descending colon, 9.3% in the ascending colon, 0.9% in the caecum ; (4) Patients younger than 50 years of age showed only one polypoid lesion in the right hemicolon, whereas elder patients showed as many as 17 polypoid lesions ; (5) Among the 90 patients with polypoid lesions, 40 presented with abdominal pain, 20 with no symptoms (annual health check-up), 17 with irregular bowel habits, and 10 with melena ; (6) Among the 90 patients, occult blood in stool was positive in 75.8% with a lower positive rate in the lesions of the sigmoid and rectum ; (7) Among 5 asymptomatic patients with lesions and with a negative hemoccult test, 3 patients with a polypoid lesion were examined because of the patients' request, 1 patient with a polypoid lesion because of a positive family history, and the remaining 1 patient in a search for the primary lesion of the metastatic liver cancer ; (8) Among patients with a positive hemoccult test, the detection rate of polypoid lesions was 41.9% with use of an immunological method, whereas it was 19.7% with use of a chemical method. In conclusion, (1) detection of colonic polypoid lesions can lead to the detection of early cancer, although only histological examination can confirm the accurate diagnosis ; (2) a hemoccult test in stool with an immunological method is an effective method for screening asymptomatic colonic polypoid lesions, although it must be admitted that negative results may occasionally occur ; (3) macroscopic observation of the stool mass is important before sampling, because lesions of the sigmoid colon or the rectum may show scanty blood only on the limited area of the surface of the stool ; (4) patients elder than 50 years of age should be examined more carefully for the whole colon preferably with an endoscope, because they show a high incidence of small polypoid lesions in the right hemicolon

Study of the preparation with sodium picosulfate and PEG intestinal lavage solution for total colonoscopy.

Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった｡腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった｡腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である｡以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用であることが示された。The following results were obtained from a total colonoscopic study of 50 patients who received preparation with 20mℓ of sodium picosulfate (Laxoberon®) and PEG intestinal lavage solution (Niflec®) prior to the examination. (l) The present method in combination with a mean of 1230mℓ of PEG intestinal lavage solution allowed colonic cleaning for which observation was available in 48 of 50 patients. (2) With this method. no adverse reactions were observed except for mild abdominal pain, nausea, and rugitus in a few patients. (3) This method was particularly as a preparation for colonoscopic examination in elderly patients. Thus, we conclude that preparation with 20mℓ of sodium picosulfate and PEG intestinal lavage solution is useful for colonoscopic examination

Diagonosis of pancreatic cyst using post-ERCP CT examination.

ERCP直後にCTを撮影するERCP後CTはERCPの際に膵内に注入された造影剤をCTで検出するため,ERCPでは得られない情報が得られる利点がある｡われわれはERCP後CTが診断や治療方針の決定に有用であった膵嚢胞の4例を経験した｡膵嚢胞では主膵管との連絡,嚢胞の部位,性状診断にERCP後CTは有用な検査法であり,文献的考察を含めて報告した｡Post-ERCP CT (computed tomography (CT) examination performed immediately after endoscopic retrograde cholangiopancreatography) detects the contrast medium injected into the pancreatic duct and cystic lesions at the time of ERCP and, therefore, has the advantage of obtaining information which cannot be obtained by ERCP alone. We have experienced four cases of pancreatic cysts in which post-ERCP CT was useful for diagnosis and in deciding on treatment plans. The post-ERCP CT was proved to be a useful method for examining the site and characteristics of the cysts which communicated with the main pancreatic duct

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)

Background and purposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 and published in the Journal of JSICM, [2017; Volume 24 (supplement 2)] https://doi.org/10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ) and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (> 66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation, and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty-seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for five CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals