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Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art
Naoki Muguruma,Shinji Kitamura,Tetsuo Kimura,Hiroshi Miyamoto,Tetsuji Takayama 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.2
Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidityand mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis withgreater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regardingthe management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasisfails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without anydelay for evaluation regarding the appropriateness of emergency interventional radiology or surgery. Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.
Naoki Okano,Yoshinori Igarashi,Ken Ito,Saori Mizutani,Hiroki Nakagawa,Kouji Watanabe,Yuuto Yamada,Kensuke Yoshimoto,Yuusuke Kimura,Susumu Iwasaki,Kensuke Takuma,Seiichi Hara,Yuui Kishimoto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed toinvestigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for preventionof bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopicpapillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in thesimple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7%(96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8%(3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates ofpositive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions: HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopicpapillectomy for ampullary tumors.
DC Output Wind Generator with Modified Trapezoidal Modulated Converter and Solid-State Transformer
Noriyuki KIMURA,Naoki KAWABATA,Toshimitsu MORIZANE,Hideki OMORI 전력전자학회 2019 ICPE(ISPE)논문집 Vol.2019 No.5
This paper proposes the Modified Trapezoidal Modulation (MTM) as a new modulation technique for a voltage source converter (VSC) for the wind power generator with HVDC transmission. The experimental results show that the MTM is more effective than the conventional sinusoidal modulation (SM) for the reduction of the VSC cost and the switching loss. It is also expected to reduce the torque ripple by optimizing the rectangular ratio in the MTM to reduce the disadvantage of generated harmonic currents. Simulation and experimental results show the good feasibility of using MTM. It is expected to use solid-state transformer (SST) to have galvanic isolation in the proposed system. MPPT simulation with SST shows the good performance of the total unit.
Twin Rectal Tonsils Mimicking Carcinoid or Mucosa-Associated Lymphoid Tissue Lymphoma
Masanori Takehara,Naoki Muguruma,Shinji Kitamura,Tetsuo Kimura,Koichi Okamoto,Hiroshi Miyamoto,Yoshimi Bando,Tetsuji Takayama 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.5
The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
Yui Kishimoto,Naoki Okano,Ken Ito,Kensuke Takuma,Seiichi Hara,Susumu Iwasaki,Kensuke Yoshimoto,Yuto Yamada,Koji Watanabe,Yusuke Kimura,Hiroki Nakagawa,Yoshinori Igarashi 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Background/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whetherthe lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determiningthe prognosis of IPMNs. Methods: POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during thefollow-up. Results: A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and theprotrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time ofPOPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and1 (5%) patient had a positive margin. Conclusions: In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. Thediagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightlyelevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, carefulfollow-up is necessary.
( Ken Hatogai ),( Naoki Hosoe ),( Hiroyuki Imaeda ),( Jean Francois Rey ),( Sawako Okada ),( Yuka Ishibashi ),( Kayoko Kimura ),( Kazuaki Yoneno ),( Shingo Usui ),( Yosuke Ida ),( Nobuhiro Tsukada ),( 대한소화기학회 2012 Gut and Liver Vol.6 No.2
Background/Aims: A flexible spectral imaging color enhancement system was installed in new capsule software for video capsule endoscopy. Contrast image capsule endoscopy (CICE) is a novel technology using light-emitting diodes selected for the main absorption range of hemoglobin. We assessed the feasibility and diagnostic effi cacy for small bowel surveillance in patients with polyposis syndromes. Methods: Six patients with polyposis syndromes, four with familial adenomatous polyposis and one each with Cowden syndrome (CS) and Cronkhite-Canada syndrome (CCS) were examined using CICE. We conducted three evaluations to assess the effect on the numbers of the detected polyps; compare polyp diagnostic rates between adenoma and hamartoma; and assess polyp visibility. Results: The numbers of detected polyps and diagnostic accuracy did not differ signifi cantly between pre-contrast and contrast images. However, 50% of the adenomatous polyps displayed enhanced visibility on contrast images. CICE contrast images exhibited clearly demarcated lesions and improved the visibility of minute structures of adenomatous polyps. Hamartomatous polyp micro-structures in patients with CS and CCS were more clearly visualized on contrast than pre-contrast images. Conclusions: CICE is an effective tool for enhancing the visibility of polyps in patients with polyposis syndrome. (Gut Liver 2012;6:218-222)
Ito Ken,Okano Naoki,Takuma Kensuke,Iwasaki Susumu,Watanabe Koji,Kimura Yusuke,Yamada Yuto,Yoshimoto Kensuke,Hara Seiichi,Kishimoto Yui,Matsuda Takahisa,Igarashi Yoshinori 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.4
Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
Hara Susumu,Tsuchiya Mitsuo,Kimura Tetsuya,Akai Naoki 대한전기학회 2023 Journal of Electrical Engineering & Technology Vol.18 No.3
Recently, many studies have presented on realizing novel mobility technologies with consideration for aging society. The aim of these studies is to establish autonomous driving technology (ADT). The objects of ADT are mainly four-wheel motor vehicles. On the other hand, ADT for motorcycles has not been fully addressed yet. Motorcycles have straight-line stability in the state of high-speed driving. However, their stability tends to diminish when being driven at extremely low speed. This study addresses how a motorcycle should be stabilized under low-speed driving. From the viewpoint of actual use, including high-speed driving, major structural changes should be avoided. In order to obtain a linearized motorcycle model without skidding, a model based on SPACAR, a finite element method computation program, is introduced. Furthermore, velocity-dependent gain-scheduling control is applied to utilize the feedback control gains obtained by the linearized model with respect to velocity. Following the deceleration simulation success in the authors’ previous paper, we mainly verify the experimental investigation of the above model and control system design. The gain-scheduling method is improved from that in the previous simulation study. The experimental responses show stable driving at 1.5 km/h.
( Takuya Yoshino ),( Minoru Matsuura ),( Naoki Minami ),( Satoshi Yamada ),( Yusuke Honzawa ),( Masamichi Kimura ),( Yorimitsu Koshikawa ),( Ali Madian ),( Takahiko Toyonaga ),( Hiroshi Nakase ) 대한장연구학회 2015 Intestinal Research Vol.13 No.3
Background/Aims: Early use of biologics in patients with Crohn`s disease (CD) improves quality of life. However, the effects of the early use of immunomodulators on long-term outcomes remain unclear. This study aimed to evaluate the effects of immunomodulatorsin patients with CD. Methods: Between January 2004 and December 2011, 47 biologic-naive CD patients treated with thiopurines alone for remission maintenance were analyzed. The patients were classified into 2 groups depending on the presence or absence of digestive complications. We evaluated the efficacy of and predictive factors for thiopurine use for remission maintenance. Results: The cumulative relapse rates at 24 and 60 months were 13.7% and 35.4%, respectively. Regarding patient characteristics, there was a significant difference in patient history of surgery between the non-relapse and relapse groups (P =0.021). The cumulative relapse rate was lower in patients without a history of surgery than in those with such a history (27.2% and 52.9% at 60.0 months, respectively). Multivariate analysis suggested that the prevalence of stricturing and penetrating complications is an independent factor for relapse. The cumulative relapse rate in patients without a history ofsurgery was significantly lower in the non-stricturing and non-penetrating group than in the stricturing and penetrating group (11.8% at 85.0 months vs. 58.5% at 69.0 months; P =0.036). Conclusions: Thiopurine use might be beneficial for the long-term maintenance of remission in biologic-naive Crohn`s disease patients without digestive complications and a history of surgery. (Intest Res 2015;13:266-273)