A diagnosis of GERD, treatment and resume of Helicobacter pylori eradication have also changed by progress of endoscope equipment, development and improvement of a drug in recent years. The increased tendency wasn't judged from consideration at this hospital in these several years about GERD, but appropriate use of PPI as the first selective drug may be needed by appearance of VPZ about treatment. The eradication rate was a high price clearly by eradication resume of treatment with VPZ about Helicobacter pylori eradication. Improvement development of endoscope equipment and medicine seems also more developed from now on. It seemed necessary to get enough communication each other in the respective fields to correspond appropriately.
Background: Arterial stiffness is a predictor of cardiovascular disease and is associated with atherosclerotic risk factors. The effects of atherosclerotic risk factors on vascular age and subsequent change were investigated in patients scored according to the cardio-ankle vascular index (CAVI).
Methods: Patients comprised 181 men and 116 women scored according to the CAVI twice at our center. All were divided into the following 3 groups based on vascular age as evaluated according their CAVI score: low vascular age (LVA); equivalent vascular age (EVA); or high vascular age (HVA). They were then divided into the following 3 groups by comparing vascular age evaluated one year later with that obtained at the initial evaluation: change upward; no change; or change downward. The mean values of atherosclerotic risk factors and changes were compared among each group. Atherosclerotic risk factors comprised atherosclerosis-related diseases (hypertension, dyslipidemia, and diabetes), age, height, weight, Body Mass Index (BMI) score, abdominal circumference, Risk Factor (RF) score (number of atherosclerotic risk factors), metabolic score (propensity to metabolic syndrome), blood pressure (BP), cholesterol, triglyceride, fasting blood sugar (FBS), HbA1c, and smoking score.
Results: In men, the LVA group showed a lower RF score, metabolic score, BP, FBS, and HbA1c, and a higher HDL-cholesterol (HDL-C) score. Vascular age changed upward with increasing HDL-C and downward with increasing abdominal circumference. In women, the LVA group showed a higher BMI score.
Conclusions: The effects of atherosclerotic risk factors on vascular age were greater in men. In women, the BMI score was associated with vascular age.
Background: Patients with gastrointestinal cancer tend to develop thrombotic diseases. Endoscopic submucosal dissection (ESD) to treat gastrointestinal lesions is thought to put patients at possible risk for thrombosis because the same posture must be maintained for long periods.
Objectives: We aimed to clarify the incidence of thrombosis and hypercoagulation after ESD to treat gastrointestinal neoplasms.
Methods: We selected 565 consecutive patients with esophageal (76 patients), gastric (274 patients) or colorectal (215 patients) neoplasms that were treated by ESD between April, 2010 and October, 2018. We determined the prevalence of thrombosis at six months after ESD from medical charts and compared plasma d-dimer values (when available) before and immediately after ESD.
Results: Thrombotic events did not arise in any patients after ESD. Pre- and postoperative ddimer was found in 100 patients. Values for d-dimer were high before, and significantly elevated after ESD in 24 and 35 of 100 patients, respectively. Multivariate analysis associated antithrombotic agents and age ≥75 years with high preoperative d-dimer values, and identified upper gastrointestinal lesions and underlying chronic kidney disease as significant factors related to elevated ddimer level.
Conclusions: We found that ESD is safe and that early-stage gastrointestinal cancer is not a high risk for thrombosis. Upper gastrointestinal lesions and chronic kidney disease seem to be predisposing factors for hypercoagulation states, indicating that endoscopists should consider the possibility of thrombosis after ESD in such patients.
Background: Sleep apnea syndrome (SAS) is accompanied by decreased alveolar ventilation due to upper airway stenosis and obstruction during sleep. This in turn induces a combination of hypoxemia and hypercapnia, a state in which the arterial partial pressure of carbon dioxide can be used as a key index for ascertaining patient condition and clinical course under treatment. Patients with SAS are also suspected to exhibit alveolar hypoventilation when awake. To thoroughly evaluate patients in an awake state at SAS diagnosis or at the start of treatment, we non-invasively measured the arterial partial pressure of carbon dioxide and investigated the usefulness of this approach.
Methods: Using the TOSCA 500TM a device for measurement of partial pressure of arterial transcutaneous carbon dioxide (PtcCO2), we determined PtcCO2 and investigated its correlation with the severity of SAS on initial examination in an awake state.
Results: PtcCO2 correlated weakly but non-significantly with severity and BMI, and was maintained within normal range even in severe cases.
Conclusion: Severe SAS patients keep PtcCO2 within normal range.