We report five-metallic stent placement cases for malignant duodenal stenosis. Two of them received a placement of Ultraflex by over-the-wire (OTW) procedure, and the other three received a placement of WallFlex by through-the-scope (TTS) procedure. We assessed the baseline characteristic of the patient, procedural time and food intake after the stent placement for both OTW and TIS groups. OTW GROUP CASE 1: A 93-year-old woman with cancer of the ampulla of Vater, 60 min. in procedure time and low-residue diet after stent replacement. OTW GROUP CASE 2: A 76-year-old man with pancreatic cancer, 90 min. in procedure time and low-residue diet after stent replacement. TTS GROUP CASE 1: A 56-year-old man with recurrent postoperative bile duct cancer and gallbladder cancer, 16 min. in procedure time and full diet after stent replacement. TTS group case 2: A 79-year-old woman with pancreatic cancer, 40 min. in procedure time and liquids only after stent placement. TTS GROUP CASE 3: A 64-year-old woman with pancreatic cancer, 17 min. in procedure time and liquids only after stent placement. In comparison with OTW, TTS placement was much easier and it took a shorter procedural time. However, we consider that a selection of suitable stents and an assessment of the location for good food intake after stent placement are more important.
SUMMARY Helicobacter suis hosted by hogs is the most prevalent gastric non- Helicobacter pylori Helicobacter species found in humans. Recent studies suggest that the H. suis infection has already induced many cases of gastric disease. However, the infection period and route of H. suis from hogs remain unclear. Because diagnostic methods based on the urease activity of H. suis often yield negative judgments, there is no reliable method for diagnosing H. suis infection in clinical practice without gastric biopsy specimens. We developed the world’s first ELISA to simultaneously diagnose H. suis and H. pylori infection in a single test. The area under the ROC curve was 0.9648 or 0.9200 for identifying H. suis or H. pylori infection, respectively. The sensitivity, specificity, and positive and negative predictive values for identifying H. suis infection were 100%, 92.6%, 76.9%, and 100%, and those for identifying H. pylori infection were 88.2%, 87.5%, 65.2%, and 96.6%, respectively. (150 words)
Background The incidence of ocular candidiasis (OC) in patients with candidemia varies across different reports, and the issue of whether routine ophthalmoscopy improves outcomes has been raised. This study investigated the incidence of OC and evaluate whether the extent of OC impacts the clinical outcomes. Methods This retrospective study included non-neutropenic patients with candidemia who underwent treatment at one of 15 medical centers between 2010 and 2016. Chorioretinitis without other possible causes for the ocular lesions and endophthalmitis was classified as a probable OC. If signs of chorioretinitis were observed in patients with a systemic disease that causes similar ocular lesions, they were classified as a possible OC. Results In total, 781 of 1089 patients with candidemia underwent an ophthalmic examination. The prevalence of OC was 19.5%. The time from the collection of a positive blood culture to the initial ophthalmic examination was 5.0 ± 3.9 days in patients with OC. The leading isolate was Candida albicans (77.9%). Possible OC was associated with unsuccessful treatments (resolution of ocular findings) (odds ratio: 0.354, 95% confidence interval: 0.141–0.887), indicating an overdiagnosis in patients with a possible OC. If these patients were excluded, the incidence fell to 12.8%. Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients. Conclusion Even when early routine ophthalmic examinations were performed, a high incidence of advanced ocular lesions was observed. These results suggest that routine ophthalmic examinations are still warranted in patients with candidemia.
For patients with coronavirus disease 2019 (COVID-19) requiring hospitalization, extending isolation is warranted. As a cautious protocol, ending isolation based on polymerase chain reaction cycle threshold (Ct) value was introduced for patients requiring therapy for >20 days after symptom onset.We compared a Ct-based strategy using Smart Gene® between March 2022 and January 2023 with a preceding control period (March 2021 to February 2022) when two consecutive negative reverse transcription-polymerase chain reaction tests using FilmArray® were required for ending isolation. Ct was evaluated on day 21, and ending isolation was permitted in patients with Ct ≥ 38. Although patients with Ct 35-37 were transferred to a non-COVID-19 ward, isolation was continued.The duration of stay on a COVID-19 ward in the Ct group was 9.7 days shorter than that in controls. The cumulative number of tests was 3.7 in controls and 1.2 in the Ct group. There was no nosocomial transmission after ending isolation in either group. The number of days from symptom onset to testing was 20.7 ± 2.1 in Ct group, and five patients had Ct < 35, nine Ct 35-37, and 71 Ct ≥ 38. No patients were moderately or severely immunocompromised. Steroid use was an independent risk factor for prolonged low Ct (odds ratio 9.40, 95% confidence interval 2.31-38.15, p = 0.002) CONCLUSIONS: The efficacy of ending isolation based on Ct values could improve bed utilization without the risk of transmission among patients with COVID-19 requiring therapy for >20 days after symptom onset.
The effect of intravenous administration of disopyramide (total dose 100 mg, bolus 20 mg every 5 minutes) was compared with that of propranolol (total dose 10 mg, bolus 2 mg every 5 minutes) in a patient with hypertrophic obstructive cardiomyopathy. Left ventric ular pressure gradient (LVPG) was assessed by continuous wave Doppler flowmetry. LVPG markedly decreased (97 to 16 mmHg), and preejection period (PEP) increased with an increase in heart rate (HR) during disopyramide injection. No changes were observed in LVPG and PEP, and a decrease occurred in HR during propranolol adminis tration. These results indicate that disopyramide produced greater effects on the reduction of LVPG than propranolol, a negative inotropic agent, did.
We have experienced 2 cases of so-called Küttner tumor. Both were located at the submandibular gland; the one was bilateral and the other unilateral. Abnormal autoimmunity seemed to be involved in the onset in both cases. The bilateral case was complicated with gastric cancer. The etiology of this disease is not clear and it seems to be necessary to make an immnological examination and to investigate the findings and complications seen in autoimmune disease to elucidate the etiology of this disease. In addition, we considered that surgical resection should be performed in principle in the treatment of this disease.
