Background/Aims: We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation. Methods: We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE). Results: We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively). Conclusions LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

Background/Aims: We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation. Methods: We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE). Results: We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively). Conclusions LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

Background/Aims: We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation. Methods: We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE). Results: We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively). Conclusions LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

When performing aortic valve replacement in young patients, mechanical valves are recommended due to their durability. However, because mechanical valves require lifelong use of warfarin and carry risks such as easy bleeding, bioprosthetic valve replacement may be performed in some cases even in young patients. In this report, we describe a case of a patient who underwent bioprosthetic aortic valve replacement with aortic annular enlargement in anticipation of TAV in SAV and had a good postoperative course. The patient is a 51-year-old male. He was referred to our hospital for surgical treatment of severe aortic stenosis. The patient strongly preferred a bioprosthetic valve due to the disadvantage of taking warfarin. Therefore, we considered the possibility of TAV in SAV due to his young age, and decided to perform aortic annular enlargement if necessary. Intraoperatively, after resection and decalcification of the valve, a sizer was inserted, but the 19 mm sizer could not pass through, so we decided to perform aortic annular enlargement. Aortic annular enlargement was performed by suturing a Dacron patch and implantation of a 23 mm bioprosthetic valve. The patient had no major postoperative problems and was discharged home on the 14th day after surgery. In order to avoid PPM in the future when TAVI is performed, aortic annular enlargement should be considered in young patients undergoing aortic valve replacement using a bioprosthetic valve if TAV in SAV is considered to be difficult.

Pericardial pacing wire placement may occasionally result in intravascular or intratracheal wire migration, infective endocarditis, and sepsis; reportedly, the incidence of complications is approximately 0.09 to 0.4%. We report a case of a retained epicardial pacing wire that migrated into the pulmonary artery. A 66-year-old man underwent coronary artery bypass grafting for angina pectoris, with placement of an epicardial pacing wire on the right ventricular epicardium, 6 years prior to presentation. Some resistance was encountered during wire extraction; therefore, it was cut off at the cutaneous level on postoperative day 8. Computed tomography performed 6 years postoperatively revealed migration of the pacing wire into the pulmonary artery, and it was removed using catheter intervention. Surgeons should be aware of complications associated with retained pacing wires in patients in whom epicardial wires are retained after cardiac surgery.

BACKGROUND: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). PARTICIPANTS AND METHODS: A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. RESULTS: Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a "feeling of weakness" and "chronic numbness or pain" significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW. CONCLUSION Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.
Adolescent ; Adult ; Arsenic ; analysis ; toxicity ; Cross-Sectional Studies ; Dietary Exposure ; adverse effects ; Dose-Response Relationship, Drug ; Drinking Water ; adverse effects ; chemistry ; Female ; Groundwater ; chemistry ; Humans ; Male ; Middle Aged ; Myanmar ; epidemiology ; Peripheral Nervous System Diseases ; chemically induced ; epidemiology ; physiopathology ; Sensation Disorders ; chemically induced ; epidemiology ; physiopathology ; Water Pollutants, Chemical ; analysis ; toxicity ; Young Adult

We report two cases with postoperative sternal osteomyelitis after coronary artery bypass graft (CABG), in whom successful two-stage reconstruction was performed via negative pressure wound therapy (NPWT) and pectoralis major myocutaneous flaps. Two patients underwent CABG using bilateral internal thoracic arteries, after which they had surgical site infection (SSI). The intractable wound did not heal with irrigation and NPWT. Then, sternal osteomyelitis was observed via magnetic resonance imaging (MRI), so we planned two-stage reconstruction. The first stage of treatment consisted of complete debridement (including removal of sternal wires and necrosectomy of soft tissue and sequestrum) and application of NPWT until the remission of inflammation. The second stage consisted of wound closure with pectoralis major myocutaneous advancement flaps. After wound closure, the two patients were given 2 months of oral antibiotics, and the postoperative results were good. Two-stage reconstruction with NPWT and pectoralis major myocutaneous flaps results in excellent clinical outcome. In the first stage, the key to the successful management of postoperative sternal osteomyelitis is infection control. This includes surgical debridement and wound-bed preparation with NPWT. The pectoralis major myocutaneous flap technique is brief and does not require a second cutaneous incision or an intact internal thoracic artery. In conclusion, the pectoralis major myocutaneous flap is a useful option in two-stage reconstruction after CABG.

We report two cases of total arch replacement with open stent graft for the aberrant right subclavian artery (ARSA). Case 1 was a thoracic artery aneurysm with an ARSA. We thought it would be difficult to perform in-situ reconstruction of ARSA via median sternotomy, so we performed total arch replacement with the open stent-grafting technique. Therefore the right axillary artery was reconstructed by extra-anatomical bypass and coil embolization of the ARSA proximal to the vertebral artery to achieve complete thrombosis of the ARSA. The postoperative course was uneventful. Case 2 was a Stanford type A acute aortic dissection involving an ARSA with the entry located near the ARSA. Total arch replacement was performed using the open stent-grafting technique to close the entry site and origin of the ARSA. Then the right axillary artery was reconstructed by extra-anatomical bypass and coil embolization of the ARSA. The postoperative course was uneventful. The open stent-grafting technique might be an effective alternative management of thoracic aortic disease with ARSA.

BACKGROUND/AIMS: Few reports have described the long-term treatment outcomes of the anti-tumor necrosis factor-α antibody for Japanese Crohn’s disease (CD) patients. The aim of this study was to evaluate them and clarify the clinical factors that affect the long-term prognosis of the anti-tumor necrosis factor-α treatments. METHODS: This was a retrospective, observational, single-center cohort study. Japanese CD patients treated with either infliximab or adalimumab as a first-line therapy were analyzed. The cumulative retention rates of the biologics, relapse-free survival, and surgery-free survival were analyzed using Kaplan-Meier methods. The clinical factors associated with the long-term outcomes were estimated by both the log-rank test and Cox proportional hazard model. RESULTS: The cumulative retention rate was significantly higher in the group with a concomitant elemental diet of ≥900 kcal/day, baseline C-reactive protein (CRP) levels < 2.6 mg/dL, and baseline serum albumin levels ≥3.5 g/dL, respectively. The baseline serum albumin levels were also associated with both relapse-free and surgery-free survival. The lack of concomitant use of an elemental diet ≥900 kcal/day was identified as the only independent risk factor for the withdrawal of the biologics. CONCLUSIONS: Baseline CRP levels and serum albumin levels could affect the long-term outcomes in CD patients. Concomitant elemental diet of ≥900 kcal/day could have a positive influence on clinical treatment course.
Adalimumab ; Antibodies ; Asian Continental Ancestry Group ; Biological Products ; C-Reactive Protein ; Cohort Studies ; Crohn Disease ; Food, Formulated ; Humans ; Infliximab ; Necrosis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Serum Albumin

A 71-year-old man underwent a medical checkup at another hospital with principal complaint of chest discomfort, and was diagnosed by computed tomography (CT) to have a left subclavian artery aneurysm. The CT revealed a 33-mm saccular aneurysm that was located at the proximal portion of the left subclavian artery. Because of the high risk of surgery, we planned to insert a stent graft into the left subclavian artery. We could not avoid occluding the ostium of the left vertebral artery with commercially-available stent grafts, and so decided to insert a surgeon-modified stent graft, in which the fabric of the distal portion of the stent graft was stripped away. The surgeon-modified stent graft was inserted from the conduit of the left axillary artery. Postoperative course was uneventful and the postoperative examination confirmed complete exclusion of the aneurysm and patency of the left vertebral artery.