An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.
Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment.This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis.The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing.In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80-14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09-0.88, p = 0.035).In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis-related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.
Splenosis is an ectopic growth of splenic tissue disseminated by splenectomy or trauma. We report a case of splenosis occurring in the pelvis and diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The case was a 52-year-old man with a past history of splenectomy and left nephrectomy due to traffic trauma. Abdominal computed tomography revealed a 38-mm mass lesion on the left side of the rectum. Endoscopic ultrasonography was performed, and a mass with a well-aligned margin and uniform hypoechoicity was found outside the rectum. EUS-FNA was performed. Pathological results showed a collection of lymphocytes and erythrocytes with no atypia. A diagnosis of splenosis was made.
Pathological histology examination involves handling a variety of specimens that are cut according to regulations and placed in cassettes. Tissue fragments in the cassettes are then diagnosed after processing, embedding, thin sectioning, staining and other procedures using a processing machine. Maintaining tissue fragment order and orientation during these processes is important for accurate diagnosis. In this study, we present a method of maintaining tissue fragment order and orientation using a thin film of ultra-high-strength agar and evaluate its usefulness during tissue sectioning.Cassettes were prepared, each containing three pieces of porcine liver, and compared embedding time with and without agar thin films (ATFs). Embedding was performed by three medical laboratory scientists with different levels of experience.To enable one-step tissue sample embedding, ATFs were integrated with samples in the cassettes. This resulted in an average reduction of 6.22 s of embedding time per cassette compared with traditional embedding methods.Through the use of ATFs, tissue fragment order and orientation is maintained, and embedding process time shortened. Additionally, ATFs are easily prepared and stored in 10% neutral buffered formalin over extended periods, allowing for immediate use during sectioning. This method is ideal to implement in busy pathology laboratories.
An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.
A 77-year-old man presented with a spinal cord tumor at the cervical 7/thoracic 1 level and pain and weakness in the right hand. Blood tests revealed anemia, renal dysfunction, and hyperproteinemia. Immunoelectrophoresis revealed the M-protein component of immunoglobulin G gamma globulin. Bone marrow aspirate contained an increased number of atypical plasma cells. He was diagnosed with symptomatic myeloma and treated with radiation therapy, chemotherapy, and extradural tumor resection. Upper gastrointestinal endoscopy, performed because of anemia progression, revealed a 5-mm submucosal tumor-like elevated lesion in the upper thoracic esophagus. On white light observation, the lesion appeared whitish with a central redness. Our patient was diagnosed with extramedullary multiple myeloma. Extramedullary lesions are rare in the gastrointestinal tract. To our knowledge, this case is the first of multiple myeloma with esophageal involvement.
Abstract Background and Aim Although no specific sedation recommendations exist in early‐stage gastric cancer (ESGC) for endoscopic submucosal dissection (ESD), dexmedetomidine (DEX) is useful along with benzodiazepines and analgesics. Furthermore, DEX is used for endoscopic treatment requiring lengthy sedation. However, it is unclear which patients should be administered DEX. We examined the factors that determine when DEX should be added for sedation during ESD for ESGC. Methods Of 316 patients undergoing ESD for ESGC at our hospital between January 2017 and December 2020, we examined 310 receiving intravenous anesthesia. Preoperative patient factors and treatment outcomes were retrospectively examined according to the sedation method. Results Among patients with ESGC undergoing ESD at our hospital, DEX was more frequently used alongside sedation in men, those undergoing gastrectomy, those with a lesion diameter ≥20 mm, and those with preoperative ulcers. In the standard group, patients whose treatment duration exceeded 120 min typically had a lesion diameter ≥20 mm, preoperative ulcers, lesions located outside the L region, and were treated by junior physicians. Conclusion It is important to evaluate specific preoperative factors (lesion diameter ≥20 mm, preoperative ulcers, lesion located outside the L region, and having a junior physician as the treating physician) in patients undergoing ESD for ESGC to determine whether the combined use of DEX in sedation is necessary.
Endoscopic biliary stenting is widely used, but cases in which stent removal was forgotten and long-term stent placement was required were reported. The present case was a 42-year-old woman who underwent endoscopic stone removal for common bile duct stones and biliary plastic stent placement 10 years before. She self-interrupted her visit; thus, the stent was left in place. The patient developed acute cholangitis 10 years later and was urgently hospitalized. After removal of the stent, cholangiography revealed numerous stones filling the bile ducts. Complete stone extraction was performed endoscopically. This case demonstrates that long-term stent placement can cause multiple stone formation, and stents should always be removed when no longer necessary.
Prophylactic treatment for bleeding is indicated for esophageal varices if the varices are F2 or greater, or if the red-color sign is positive [1] [2]. In Japan, endoscopic treatment is the first choice of treatment for bleeding esophageal varices. Endoscopic injection sclerotherapy (EIS) includes the "EO method," where 5 % ethanolamine oleate (EO) is injected intravascularly, and the "AS method," where 1 % aethoxysklerol is injected extravascularly. The EO method involves endoscopic varicealography during injection sclerotherapy, with the esophageal varices and their supply tracts being occluded under fluoroscopic guidance; however, endoscopic puncture of esophageal varices and the holding of the needle tip in the blood vessel require advanced techniques. Thin varices are difficult to puncture and, even after they are punctured successfully, respiratory fluctuations, esophageal peristalsis, and the patient's body movements can dislodge the needle. Therefore, we developed a transparent cap with a slit to facilitate puncture and needle fixation in this situation ([Fig. 1]).
