Background : Guidelines for the management of anticoagulation and antiplatelet therapy during endoscopic procedures have been established by the Japanese Circulation Society and the Japan Gastroenterological Endoscopy Society. However, these Japanese guidelines are not in accordance with those of the American Society for Gastrointestinal Endoscopy (ASGE). The ASGE guidelines indicate that aspirin and warfarin may be continued for endoscopic procedures associated with a low risk of bleeding. In contrast, the Japanese guidelines recommend cessation of antithrombotic agents before endoscopy, even if the procedure is classified as low risk. In this trial, we investigate the feasibility of performing esophagogastroduodenoscopy (EGD) with biopsy without the cessation of antithrombotic agents in Japanese patients, in accordance with the ASGE guidelines.
Methods and Results : This investigation is a prospective, non-randomized, multicenter trial of patients who undergo scheduled EGD with biopsy while under antithrombotic therapy. Patients will either continue to take antithrombotic agents (group A) or discontinue their use (group B). Control subjects not under antithrombotic therapy will also be recruited (group C). The primary endpoint is gastrointestinal hemorrhage and the secondary endpoint is a cardiovascular event.
Summary : This is the first multicenter trial in Japan to investigate the safety of continuing antithrombotic therapy during EGD with biopsy.

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We herein report two cases of an acute exacerbation of pulmonary fibrosis in the syndrome of combined pulmonary fibrosis and emphysema (CPFE) following lung surgery, and also review the relevant literature. One is a 76-year-old man, who had been diagnosed with CPFE and lung cancer and undergone lobectomy. He was admitted to our hospital because of aggravation of dyspnea 50 days after lung surgery. The other is a 69-year-old man who had been diagnosed with pulmonary bulla, pulmonary emphysema and idiopathic interstitial pneumonia at 53 years old and was complicated by lung cancer. He underwent right lower lobectomy and presented with slight fever and desaturation 18 days after lung surgery. In both cases, chest computed tomography showed diffuse bilateral ground-glass opacities superimposed on preceding reticular opacities in the lower lung field. They were diagnosed as acute exacerbation of pulmonary fibrosis in CPFE. A strict follow-up is required, because the prevalence of lung cancer may be higher, and acute exacerbation may occur following lung surgery in CPFE patients. HRCT plays an important role in evaluating the occurrence of lung cancer at an early stage and for determining whether there is an acute exacerbation of pulmonary fibrosis in CPFE patients.

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Medullary thyroid carcinoma (MTC) is a relatively rare phenomenon. We report three cases of MTC over the past 14 years in our department. Two cases were determined out by hypercarcinoembryonic antigenemia, and one by hypercarcinoembryonic antigenemia and abnormal uptake by fluorodeoxyglucose-positron emission tomography (FDG-PET) examination. The serum calcitonin level was high in each of the three cases. It was difficult to diagnose MTC by imaging findings or fine needle aspiration in our cases. We diagnosed sporadic MTC in these cases by family history and endocrinological findings. Thyroid lobectomy was performed in one case, and subtotal thyroidectomy in two cases because of concomitant adenomatous goiter in the contralateral thyroid lobe.
The preoperative calcitonin-to-carcinoembryonic antigen (CEA) ratio seems to be useful as a prognostic factor. As the ratios in our cases were above 10, their prognosis will be good. A strict follow-up study is nessesary.

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