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Yasunobu Yamashita,Kazuki Ueda,Yuki Kawaji,Takashi Tamura,Masahiro Itonaga,Takeichi Yoshida,Hiroki Maeda,Hirohito Magari,Takao Maekita,Mikitaka Iguchi,Hideyuki Tamai,Masao Ichinose,Jun Kato 거트앤리버 소화기연관학회협의회 2016 Gut and Liver Vol.10 No.4
Background/Aims: Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Methods: Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wiregrasping method, forceps in the duodenum grasps a guidewire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. Results: In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). Conclusions: The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.
( Toshihiko Hata ),( Ken Ueda ),( Hiroshi Maruyama ),( Toshiki Takaya ),( Hiroshi Kuraishi ),( Kenji Maeda ),( Hiroki Tomita ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: In super acute phase after the Great East Japan Earthquake (11 March 2011), Disaster medical association team (DMAT) consisted of emergency physicians acted in disaster areas in the East Coast of Japan. On the other hand, these areas needed chronic care support by general physicians because of the enormous destructions of the medical facilities by the tsunami. So then, the Japanese Red Cross Society had sent disaster emergency outpatient assistance doctors to Isinomaki Red Cross Hospital, was intact because it was moved away from the Pacifi c Ocean three years ago. Methods: Determination of specialism by direct hearing and information from home page of each Red Cross Hospitals. Results: Cumulative 81 medical doctors were 38 internal medicine physicians, trainees 15, emergency physicians 12, surgeon 6, pediatrician 3, orthopedic surgeon 3, anesthesiologist 2, obstetrician 2, from April to August 2011. At fi rst 6 dispatched doctors were resident and did emergency outpatient work in Ishinomaki Red Cross Hospital for 6 days and dipatched. A lot of Cases of pneumonia and bronchial asthma due to debris and rubble by Tsunami were seen. All dispatch doctors corresponded to primary surgery including fractures and trauma, pediatric diseases, and posttraumatic stress disorder due to earthquake itself, tsunami damage, and radiation problem of Fukushima. Conclusions: The role of general physicians is very important in chronic phase of disaster medical assistance. Medical facilities in the area with many earthquakes should be moved apart from the sea in order to avoid the damage of tsunami.
Takashi Tamura,Yasunobu Yamashita,Kazuki Ueda,Yuki Kawaji,Masahiro Itonaga,Shin-ichi Murata,Kaori Yamamoto,Takeichi Yoshida,Hiroki Maeda,Takao Maekita,Mikitaka Iguchi,Hideyuki Tamai,Masao Ichinose,Jun 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.4
Background/Aims: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone. Methods: Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison. Results: The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06). Conclusions: ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.
Keiji Hirai,Saori Minato,Shohei Kaneko,Katsunori Yanai,Hiroki Ishii,Taisuke Kitano,Mitsutoshi Shindo,Haruhisa Miyazawa,Kiyonori Ito,Yuichirou Ueda,Yoshio Kaku,Taro Hoshino,Tatsuro Watano,Shinji Fujino 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.3
Background: We investigated the relationship between serum total carbon dioxide (CO2) and bicarbonate ion (HCO3 -) concentrations in pre-dialysis chronic kidney disease (CKD) patients and devised a formula for predicting low bicarbonate (HCO3 - < 24 mmol/L) and high bicarbonate (HCO3 - ≥ 24 mmol/L) using clinical parameters. Methods: In total, 305 samples of venous blood collected from 207 pre-dialysis patients assessed by CKD stage (G1 + G2, 46; G3, 50; G4, 51; G5, 60) were investigated. The relationship between serum total CO2 and HCO3 - concentrations was analyzed using Pearson’s correlation coefficient. An approximation formula was developed using clinical parameters correlated independently with HCO3 - concentration. Diagnostic accuracy of serum total CO2 and the approximation formula was evaluated by receiver operating characteristic curve analysis and a 2 × 2 table. Results: Serum total CO2 correlated strongly with HCO3 - concentration (r = 0.91; P < 0.001). The following approximation formula was obtained by a multiple linear regression analysis: HCO3 - (mmol/L) = total CO2 - 0.5 × albumin - 0.1 × chloride - 0.01 × (estimated glomerular filtration rate + blood glucose) + 15. The areas under the curves of serum total CO2 and the approximation formula for detection of low bicarbonate and high bicarbonate were 0.981, 0.996, 0.993, and 1.000, respectively. This formula had superior diagnostic accuracy compared with that of serum total CO2 (86.6% vs. 81.3%). Conclusion: Serum total CO2 correlated strongly with HCO3 - concentration in pre-dialysis CKD patients. An approximation formula including serum total CO2 showed superior diagnostic accuracy for low and high bicarbonate compared with serum total CO2.
( Toshihiko Hata ),( Hiroyuki Sato ),( Ako Machino ),( Mai Wakabayashi ),( Morito Kise ),( Hiroki Ohashi ),( Daisuke Yamashita ),( Kaoru Sakural ),( Toru Matsubayashi ),( Masahiko Hatao ),( Ken Ueda ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
31yrs. old female known to have hypertension and dyslipidemia for 1 yr.presented with h/o weight loss around 10 kg for 1 yr,palpiations,diaphoresis and hypertensive urgencyBp 210/110 mmhg)and also found to have diabetes (newly diagnosed)further investigations shows large adrenal mass (left side)suspicion of phaechromocytoma and urine catecholamoines was high, urology was consulted and she underwent left adrenalectomy and biopsy confi rm the diagnosis of malignant phaechromcytoma. Repeat Urine catecholamines which was quite high on presentation later normalized after surgey. Now she is under active follow up with endocrinologist and on antihypertensive medications very minimal doses and for her diabetes she is not on any medications as well after surgery.