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Endoscopic Hemostasis of Nonvariceal Gastrointestinal Bleeding  [PDF]
Yoshihiro Inoue, Yasuhisa Fujino, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Hisaho Sato, Masahiro Kojika, Shigeatsu Endo
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.519147
Abstract: We investigated 2668 patients with non-variceal upper gastrointestinal bleeding and 660 patients with lower gastrointestinal bleeding treated between 1987 and 2011 in our hospital. Upper gastrointestinal bleeding was associated with gastric ulcer, duodenal ulcer, Mallory-Weiss syndrome, esophageal disease, and others. Endoscopic hemostasis was performed in approximately 67% of all cases with upper gastrointestinal bleeding and approximately 90% of cases with ulcer. The hemostasis success rate was over 90% for ulcer bleeding, and was also generally high for other diseases. The total number of patients with lower gastrointestinal bleeding was lower, with it being approximately 20% of those with upper gastrointestinal bleeding. Endoscopic hemostasis was performed in approximately 30% of the patients with lower gastrointestinal bleeding. The hemostasis success rate was generally high, but treatment switch to surgery or interventional radiology (IVR) was observed in some cases with colorectal diverticular bleeding.
A Study of Mallory-Weiss Syndrome Secondary to Upper Gastrointestinal Bleeding  [PDF]
Yoshihiro Inoue, Yasuhisa Fujino, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Hisaho Sato, Hironobu Noda, Masahiro Kojika, Yasushi Suzuki, Shigeatsu Endo
Open Journal of Clinical Diagnostics (OJCD) , 2014, DOI: 10.4236/ojcd.2014.43021

Background: In Mallory-Weiss Syndrome (MWS), vomiting causes the mucous membrane and submucosa near the esophagogastric mucosal junction to tear and bleed. Thus, MWS can arise after heavy drinking and as a complication of endoscopic upper gastrointestinal examinations or procedures. However, there has been no report of MWS secondary to upper gastrointestinal bleeding thus far. Case Subjects: Of 79 MWS cases over a 10-year period from 2002 to 2011, we identified and studied 6 cases, in which MWS was probably caused by another lesion causing upper gastrointestinal bleeding. Results: There were 2 cases, each of gastric ulcers, duodenal ulcers, and varicose veins. In 3 cases, MWS was discovered during treatment of the primary lesion and was simultaneously treated. In the other 3 cases, patients were treated for MWS according to endoscopic diagnosis, and the primary lesion was overlooked; in these cases, the primary lesion was identified and treated after the bleeding recurred. One patient with cirrhosis died of hepatic failure. Conclusion: Care should be taken when dealing with MWS because it can occur as a result of vomiting caused by hematemesis or as a complication of endoscopic examination and treatment. When assessing MWS, other hemorrhagic lesions may be overlooked.

A Case of Multiple Hemorrhagic Gastric Ulcers Developed via a Mechanism Similar to Water-Immersion Restraint Stress  [PDF]
Yoshihiro Inoue, Yasuhisa Fujino, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Hisaho Sato, Hironobu Noda, Masahiro Kkojika, Yasushi Suzuki, Shigeatsu Endo
Open Journal of Clinical Diagnostics (OJCD) , 2015, DOI: 10.4236/ojcd.2015.54022
Abstract: In rats, water-immersion restraint stress is a model of experimental ulceration. We encountered a case in which multiple hemorrhagic gastric ulcers formed in the stomach in a setting similar to water-immersion restraint stress. The patient was a 54-year-old man who was found wet on a riverbank and transported by ambulance. Because of hypothermia and renal failure, hemodialysis was performed. Tarry stools were noted and endoscopy revealed the presence of multiple hemorrhagic gastric ulcers; thus, hemostasis was performed end oscopically. During the course, pseudo membranous colitis also developed and was ameliorated with vancomycin. Further, the renal failure and gastric ulcers improved, and the patient was discharged from hospital 25 days later. The reason why he survived more than 2 weeks was the hot summer season and he was not soaked in the river water throughout.
Multiple Transverse Colonic Perforations Associated with Slow-Release Nonsteroidal Anti-Inflammatory Drugs and Corticosteroids: A Case Report
Nobuki Shioya,Shigehiro Shibata,Masahiro Kojika,Shigeatsu Endo
Case Reports in Critical Care , 2011, DOI: 10.1155/2011/824639
Abstract: The patient was a 36-year-old woman with sarcoidosis and Sjogren's syndrome, and had been prescribed slow-release diclofenac sodium and prednisolone for the treatment of pain associated with uveitis and erythema nodosum. She was admitted to our emergency center with abdominal pain and distention. A chest X-ray showed free air under the diaphragm on both sides, and an emergency laparotomy was performed for suspected panperitonitis associated with intestinal perforation. Laparotomy revealed several perforations on the antimesenteric aspect of the transverse colon. The resected specimen showed 11 punched-out ulcerations, many of which were up to 10 mm in diameter. The microscopic findings were non-specific, with leukocytic infiltration around the perforations. She showed good postoperative recovery, as evaluated on day 42. The present case highlights the need for exercising caution while prescribing slow-release nonsteroidal anti-inflammatory drugs with corticosteroids to patients with autoimmune diseases, as such treatment may exacerbate intestinal epithelial abnormalities.
A Case of Secondary Aortoesophageal Fistula Inserted a Covered Self-Expanding Esophageal Stent to Control Gastrointestinal Bleeding
Makoto Onodera,Yoshihiro Inoue,Yasuhisa Fujino,Satoshi Kikuchi,Shigeatsu Endo
Case Reports in Gastrointestinal Medicine , 2013, DOI: 10.1155/2013/857135
Abstract: A 73-year-old man presented with melena. After a thorough workup including esophageal endoscopy, computed tomography scans, and esophagography, the diagnosis of secondary aortoesophageal fistula was made. Two years previously, he had undergone endovascular stent-graft repair for the dissection of his descending thoracic aorta. Because of the generally poor condition of the patient and the high risk of any aggressive surgical intervention, we inserted a covered self-expanding esophageal stent on postadmission day 18. Esophagography after insertion did not show any evidence of a leak of contrast medium. Despite treatment with antibiotics, he developed sepsis and expired on day 52, but rebleeding did not occur in this period. We consider insertion of a covered self-expanding esophageal stent as a feasible option in the management of secondary aortoesophageal fistula in high-risk patients. 1. Introduction Secondary aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) is relatively rare [1–6], with a reported incidence of 1.7% to 1.9% [4, 7]. Treatment options are very limited, as these patients are usually not candidates for open surgery. Outcomes with conservative management are almost always fatal due to recurrent hemorrhage or chronic mediastinitis. Of note, there are no treatments to manage spontaneous, recurrent hemorrhage. In this paper, we describe a case of secondary AEF with insertion of a covered self-expanding esophageal stent to control gastrointestinal bleeding. 2. Case Presentation A 73-year-old man presented with melena. He had a history of endovascular stent-graft repair for the dissection of a descending thoracic aorta at the age of 71 and a stent-graft repair for a pseudoaneurysm sac of the distal aortic arch at the age of 72. He was hemodynamically unstable, and the bulbar conjunctiva showed evidence of anemia at presentation. Esophago-gastro-duodenoscopy (EGD) on admission revealed a white polyp in the midesophagus but no signs of acute bleeding. Colonoscopy was unremarkable. A blood transfusion failed to raise the hematocrit. On postadmission day five, the patient had hematemesis, prompting repeat EGD. Closer inspection of the previously seen esophageal polyp showed that the white material at the base was in fact the wall of the aortic interposition graft (Figure 1). Chest computed tomography (CT) scans revealed a high-density spot in contact with the esophagus and low-density spots in the vicinity of the stent graft. Esophagography showed a fistulous tract toward the stent graft (Figure 2). We concluded that
Green Urine Discoloration due to Propofol Infusion: A Case Report
Nobuki Shioya,Yoriko Ishibe,Shigehiro Shibata,Hideyuki Makabe,Shigenori Kan,Naoya Matsumoto,Gaku Takahashi,Yasuhiko Yamada,Shigeatsu Endo
Case Reports in Emergency Medicine , 2011, DOI: 10.1155/2011/242514
Abstract: We present a 19-year-old man who excreted green urine after propofol infusion. The patient was admitted to our hospital for injuries sustained in a traffic accident and underwent surgery. After starting continuous infusion of propofol for postoperative sedation, his urine became dark green. Serum total bilirubin and urine bilirubin were both elevated. We believe that the green discoloration of the urine was caused by propofol infusion and was related to impaired enterohepatic circulation and extrahepatic glucuronidation in the kidneys.
Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report
Nobuki Shioya, Yoriko Ishibe, Shigenori Kan, Takayuki Masuda, Naoya Matsumoto, Gaku Takahashi, Hideyuki Makabe, Yasuhiko Yamada, Shigeatsu Endo
BMC Emergency Medicine , 2012, DOI: 10.1186/1471-227x-12-7
Abstract: A 61-year-old man with poorly controlled diabetes mellitus presented to our emergency department with low back pain, high fever, and a painful mass over his left SCJ. He had received two epidural blocks over the past 2?weeks for severe back and leg pain secondary to lumbar disc herniation. He did not complain of weakness or sensory changes of his lower limbs, and his bladder and bowel function were normal. He had no history of shoulder injection, subclavian vein catheterization, intravenous drug abuse, or focal infection including tooth decay. CT showed an abscess of the left SCJ, with extension into the mediastinum and sternocleidomastoid muscle, and left paraspinal muscle swelling at the level of L2. MRI showed spondylodiscitis of L3-L4 with a contiguous extradural abscess. Staphylococcus aureus was isolated from cultures of aspirated pus from his SCJ, and from his urine and blood. The SCJ abscess was incised and drained, and appropriate intravenous antibiotic therapy was administered. Two weeks after admission, the purulent discharge from the left SCJ had completely stopped, and the wound showed improvement. He was transferred to another ward for treatment of the ongoing back pain.Diabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.
Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group
Kaoru Kudo, Kotaro Otsuka, Jin Endo, Tomoyuki Yoshida, Hisayasu Isono, Takehito Yambe, Hikaru Nakamura, Sachiyo Kawamura, Atsuhiko Koeda, Junko Yagi, Nobuo Kemuyama, Hisako Harada, Fuminori Chida, Shigeatsu Endo, Akio Sakai
BMC Psychiatry , 2010, DOI: 10.1186/1471-244x-10-4
Abstract: The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC)", "hospitalization in the psychiatry ward (HIPW)", or "non-hospitalization (NH)", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome.The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS), general health performance (GAS), psychiatric symptoms (BPRS), and life events (LCU), while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care.There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a support system to convince them of the risks of attempting suicide and to take a problem-solving approach to specific issues.General hospitals with an advanced critical care center along with a psychiatry emergency department and a psychiatry ward are annually visited by large numbers of those attempting suicide. They play central
Extendibility Evaluation of Industrial EUV Source Technologies for kW Average Power and 6.x nm Wavelength Operation  [PDF]
Akira Endo
Journal of Modern Physics (JMP) , 2014, DOI: 10.4236/jmp.2014.55039

Interests in the extendibility are growing after the introduction of the LPP (Laser Produced Plasma) EUV source technology in the semiconductor industry, towards higher average power and shorter wavelength, based on the basic architecture of the established LPP EUV source technology. It is discussed in this article that the power scaling of the 13.5nm wavelength source is essentially possible by a slight increase of the driving laser power, CE (Conversion Efficiency) and EUV collection efficiency by some introduction of novel component technologies. Extension of the EUV wavelength towards BEUV (Beyond EUV), namely 6.x nm is discussed based on the general rule of the UTA (Unresolved Transition Arrays) of high Z ions, and development of multilayer mirrors in this particular wavelength region. Technical difficulties are evaluated for the extension of the LPP source technology by considering the narrower mirror bandwidth and higher melting temperature of the candidate plasma materials. Alternative approach based on the superconducting FEL is evaluated in comparison with the LPP source technology for the future solution.

Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report
Yutaka Nakamura, Yu Utsumi, Naomi Suzuki, Yoshio Nakajima, Okinori Murata, Nobuhito Sasaki, Hiroo Nitanai, Hiromi Nagashima, Shinya Miyamoto, Jun Yaegashi, Tomoki Hatakeyama, Yoshihiro Shibano, Kyoko Yarita, Katsuhiko Kamei, Toshihide Nakadate, Shigeatsu Endo, Yasuo Terayama, Kohei Yamauchi
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-526
Abstract: We report the case of a 59-year-old Japanese woman who was a survivor of a tsunami in northeastern Japan and who had lung and brain abscesses caused by S. apiospermum. Initially, an aspergillus infection was suspected, so she was treated with micafungin. However, computed tomography scans of her chest revealed lung abscesses, and magnetic resonance images demonstrated multiple abscesses in her brain. S. apiospermum was cultured from her bronchoalveolar lavage fluid, and antimycotic therapy with voriconazole was initiated. Since she developed an increase in the frequency of premature ventricular contractions, an adverse drug reaction to the voriconazole was suspected. She was started on a treatment of a combination of low-dose voriconazole and liposomal amphotericin B. After combination therapy, further computed tomography scans of the chest and magnetic resonance images of her brain showed a demarcation of abscesses.Voriconazole appeared to have a successful record in treating scedosporiosis after a near drowning but, owing to several adverse effects, may possibly not be recommended. Thus, a combination treatment of low-dose voriconazole and liposomal amphotericin B may be a safe and effective treatment for an S. apiospermum infection. Even though a diagnosis of scedosporiosis may be difficult, a fast and correct etiological diagnosis could improve the patient's chance of recovery in any case.Tsunami lung occurs when a person who is overwhelmed by tsunami waves inhales saltwater contaminated by mud and microorganisms. Some microorganisms regarded as harmless saprophytes are, with increasing frequency, being reported to cause serious or lethal infections, even in immunocompetent individuals. Scedosporium apiospermum is increasingly recognized as a cause of localized and disseminated mycotic infections in near-drowning victims. This ubiquitous fungus is present in soil, manure, sewage, and polluted waters. Here, we describe the case of a patient with both lung and bra
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