Purpose: Acute hemorrhagic rectal ulcer (AHRU) commonly occurs in elderly who are bedridden for long time due to severe underlying diseases such as cerebral and myocardial infarction and their complications. However, it is uncommon in end-stage cancer patients receiving palliative care. We report a rare AHRU case in his forties who had lung cancer with paraplegia due to tumor invasion. Case: A male lung cancer patientwas admitted to our hospital for new-onset paraplegia caused by spinal cord invasion. On 25th day after admission, he suffered from a little rectal bleeding. From that day, a painless rectal bleeding becomes gradually increased. On 37th day, a massive bleeding was occurred. Endoscopy showed that there was no active bleeding but an exposed vessel and partial circumferential ulcer in the lower part of rectum, which was compatible with the finding of AHRU. The lesion was successfully treated by clipping and no re-bleeding was observed after clipping. He was discharge on 103rd day. Conclusion: AHRU should be considered in the differential diagnosis of a massive melena in end-stage cancer patients. Prompt diagnosis and therapy is important because this disease is curable even in the terminal stage to improve their quality of life. Palliat Care Res 2011; 6(1): 308-312

Tohoku Medical and Pharmaceutical University Hospital uses an information form created by doctors and pharmacists to provide postoperative information to patients who undergo nephrectomy at the Department of Urology. The form recommends that patients' physicians change prescriptions and adjust medication doses considering post-nephrectomy deterioration of renal function in patients with a single remaining kidney. Of the 7 patients who used this information form, prescription changes were made in 4 patients. An information form jointly created by a physician and pharmacist may affect prescription changes.

In concequence of the rapid extension of the average life expectancy of the Japanese after World War II, this country has realized a society of longevity. Although longevity is in itself something to be celebrated, many people have misgivings about health in their old age. Advances in medical technology, one of the factors which promoted the society of longevity, continued overcoming various diseases while bringing about many patients troubled with after effects. Also the number of old people suffered from chronic diseases has been increasing gradually.Today, people wish healthy long life from the heart, not simply longevity. Nagano Prefecture has come to be known as the area eminent for long healthy life expectancy in recent years. Behined this, there are various activities aimed at healthier life by citizens. In this paper, we report one of the activities carried out at “Yachiho village” (as a result of the affiliation with Saku machi in 2005 renamed Sakuho machi) located in the eastern part of Nagano Prefecture.The health care program for all villagers, which the government of Yachiho village started in 1959 with cooperation of Saku Central Hospital, produced fruit while breeding many voluntary activities by citizens. We explored the practices of the group worked on the improvement of nutrition, and studied about the essential conditions which have enabled the formation of health promotion activities by citizens.
Longevity ; Health Promotion ; Activities ; Life Expectancy ; Today

Background/Aims: Asymptomatic esophageal eosinophilia (aEE), characterized by eosinophil infiltration in the esophagus without clinical symptoms, has been reported as a precursor of eosinophilic esophagitis (EoE). Nevertheless, no report exists on the long-term clinical course of the disease. Therefore, this study aimed to investigate the long-term clinical course of aEE over 5 years, including the symptomatic conversion rate and the effect of treatments. Methods: We reviewed 28 patients with aEE who had been followed up for over 5 years with endoscopic monitoring. The basal characteristics of patients were compared with those of 58 patients diagnosed with EoE during the same period. Patients’ clinicopathological findings were collected and examined. Results: No significant differences in basal characteristics and histopathological findings were observed between the patients with aEE and those with EoE. The median follow-up duration was 64 months. Among the 28 patients with aEE, seven were treated with proton pump inhibitor or potassium-competitive acid blocker and the remaining 21 opted for follow-up with no medication.Among the treated patients, six (85.7%) exhibited endoscopic and pathologic improvements.Among the cases followed up without medication, the findings worsened in two (9.5%), improved spontaneously in seven (33.3%), and were unchanged in 12 (57.1%), and three (14.3%) developed symptoms at a mean time of 40 months. Symptoms developed in cases where endoscopic and pathologic findings remained unchanged or worsened during follow-up. Conclusions Some patients with aEE had improved findings without treatment, whereas others developed symptoms, emphasizing the importance of long-term monitoring and individualized treatment decisions.

Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions.
Anesthesia, General ; Deglutition ; Endoscopy, Gastrointestinal ; Gastrointestinal Tract ; Humans ; Hypopharynx ; Male ; Minimally Invasive Surgical Procedures* ; Pharyngeal Neoplasms ; Respiration ; Uvula*

Background/Aims: Thiopurines are key drugs for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Recently, NUDT15 polymorphism (R139C, c.415C > T) has been shown to be associated with thiopurineinduced adverse events in Asian populations. In patients with the C/T genotype, low-dose thiopurine treatment is recommended, but its long-term efficacy and tolerability remain unclear. This study aimed to uncover the long-term efficacy and appropriate dosage of thiopurine for IBD patients with the C/T genotype. Methods: A total of 210 patients with IBD (103 UC and 107 CD) determined to have NUDT15 R139C variants were enrolled. Clinical data were retrospectively reviewed from medical records. Results: Of 46 patients (21.9%) with the C/T genotype, 30 patients (65.2%) were treated with thiopurines. Three of whom (10.0%) discontinued thiopurine treatment due to adverse events and 27 of whom continued. The median maintenance dosage of 6-mercaptopurine was 0.25 mg/kg/day (range, 0.19–0.36 mg/kg/day), and 6-thioguanine nucleotides level was 230 (104–298) pmol/8 × 108 red blood cells. Cumulative thiopurine continuation rates for 120 months for patients with the C/C and C/T genotypes were not significantly different (P= 0.895). Cumulative non-relapse rates in the patients with UC treated with thiopurine monotherapy and surgery-free rates in CD patients treated with combination therapy (thiopurines and anti-tumor necrosis factor-α agents) for maintenance remission were not significantly different at 60 months (C/C vs. C/T, P= 0.339 and P= 0.422, respectively). Conclusions Low-dose thiopurine treatment is an effective and acceptable treatment for patients with C/T genotype.

Background/Aims: Asymptomatic esophageal eosinophilia (aEE) is considered to be a potential precursor of eosinophilic esophagitis (EoE). However, there are few clinical parameters that can be used to evaluate the disease. Therefore, we aimed to clarify the factors involved in the symptoms of EoE by examining the clinicopathological differences between aEE and EoE. Methods: We reviewed 41 patients with esophageal eosinophilia who underwent endoscopic ultrasonography and high-resolution manometry. They were divided into the aEE group (n=16) and the EoE group (n=25) using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease score. The patients’ clinicopathological findings were collected and examined. Results: The median Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease score was 3.0 in the aEE group and 10.0 in the EoE group. There was no significant difference in patient characteristics, endoscopic findings and pathological findings. The cutoff value for wall thickening was 3.13 mm for the total esophageal wall thickness and 2.30 mm for the thickness from the surface to the muscular layer (total esophageal wall thickness: 84.0% sensitivity, 75.0% specificity; thickness from the surface to the muscular layer: 84.0% sensitivity, 68.7% specificity).The high-resolution manometry study was abnormal in seven patients (43.8%) in the aEE group and in 12 (48.0%) in the EoE group. The contractile front velocity was slower in the EoE group (p=0.026). Conclusions The esophageal wall thickening in the lower portion of the esophagus is an important clinical factors related to the symptoms in patients with EoE.

Lenalidomide (LD) was reported to increase the risk of thromboembolism when it was used along with dexamethasone (DEX). Prophylactic administration of antithrombotic drugs against thromboembolism has been recommended for proper use of LD, but none of the recommendation is stated in the package insert. The purpose of this study was to elucidate the usage of acetylsalicylic acid (ASA) for lenalidomide medication in patients withmultiple myeloma. We used the MDV analyzer to investigate clinical data retrospectively. The investigation period was from October 1, 2016 to September 30, 2017. Subjects were outpatients aged 20 years or older who were recorded in clinical data as multiple myeloma. There were 7,590 outpatients with multiple myeloma. They were divided into 4 groups by the combined use situation of LD and DEX: LD/DEX non-use group (n＝5,462), DEX alone group (n＝632),LD alone group (n＝203), and LD/DEX together group (n＝1,293), respectively. The prevalence rate of thromboembolism was 7.3% in the DEX alone group and 16.9% in the LD/DEX together group (p＜0.0001). Among the LD/DEX together group, ASA was prescribed at 63.6% in the group without thromboembolism (n＝1,074). The prevalence rate of thromboembolism was higher in the LD/DEX combined group than in the DEX alone group. Considering these findings, risk management for thromboembolism caused by administration of antithrombotic drugs should be considered. It is necessary to create more evidence concerning the necessity of administration of antithrombotic drug in combination with LD/DEX medication.

Objective：To investigate the physical functions of peripheral arterial disease (PAD）patients undergoing endovascular treatment (EVT), and their association with physical activity before EVT.Methods：One hundred and one PAD patients underwent EVT. Physical functions were specified as grip strength, walking speed, and the weight ratio of knee extension isometric muscle strength (KEIS). We divided the patients into 3 groups, based on the amount of physical activity per week：(a) low activity (0 kcal/week：n＝52), (b）moderate activity (0 kcal to less than 500 kcal/week：n＝22), and (c) high activity (more than 500 kcal/week：n＝27). Physical activity data were collected using an international standardized physical activity questionnaire. A multivariate regression analysis (cumulative logit model) was used to evaluate the association between physical activity (low activity, moderate activity, high activity) and KEIS＜0.4 kgf/kg.Results：The averages of the physical functions were：grip strength (kg；Men 28.1, Women 16.6), walking speed (m/s；Men 1.10, Women 0.96), KEIS (kgf/kg；Men 0.42, Women 0.28). The prevalence of KEIS＜0.4 kgf/kg was 56.4％ (n＝57). KEIS＜0.4 kgf/kg was not significantly different between low and moderate activity groups (Odds：0.99, p＝0.98). However, KEIS＜0.4 kgf/kg was significantly different between low and high activity groups (Odds：5.02, p＝0.007).Conclusion：Physical functions were lower in PAD patients undergoing EVT than in healthy adults of the same age, and KEIS was related to physical activity before EVT.

Objective：To investigate the physical functions of peripheral arterial disease (PAD) patients undergoing endovascular treatment (EVT), and their association with physical activity before EVT.Methods：One hundred and one PAD patients underwent EVT. Physical functions were specified as grip strength, walking speed, and the weight ratio of knee extension isometric muscle strength (KEIS). We divided the patients into 3 groups, based on the amount of physical activity per week：(a) low activity (0 kcal/week：n＝52), (b) moderate activity (0 kcal to less than 500 kcal/week：n＝22), and (c) high activity (more than 500 kcal/week：n＝27). Physical activity data were collected using an international standardized physical activity questionnaire. A multivariate regression analysis (cumulative logit model) was used to evaluate the association between physical activity (low activity, moderate activity, high activity) and KEIS＜0.4 kgf/kg.Results：The averages of the physical functions were：grip strength (kg；Men 28.1, Women 16.6), walking speed (m/s；Men 1.10, Women 0.96), KEIS (kgf/kg；Men 0.42, Women 0.28). The prevalence of KEIS＜0.4 kgf/kg was 56.4％ (n＝57). KEIS＜0.4 kgf/kg was not significantly different between low and moderate activity groups (Odds：0.99, p＝0.98). However, KEIS＜0.4 kgf/kg was significantly different between low and high activity groups (Odds：5.02, p＝0.007).Conclusion：Physical functions were lower in PAD patients undergoing EVT than in healthy adults of the same age, and KEIS was related to physical activity before EVT.