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Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis

World Journal of Gastroenterology 2013年第17期19卷 2718-2722页

作者： Hideo Suzuki Tsuyoshi Kaneko Yuji Mizokami Toshiaki Narasaka shinji endo Hirofumi Matsui Akinori Yanaka Aki Hirayama Ichinosuke Hyodo Department of Gastroenterology Institute of Clinical Medicine University of Tsukuba Graduate School Center of Integrative Medicine Tsukuba University of Technology

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI). Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P endoscopic Matts grade decreased from 3.4 ± 0.5 to 2.2 ± 0.8 (P = 0.02). Six of 7 patients who were on prednisolone upon enrollment in the study were able to discontinue this corticosteroid. Electron spin resonance revealed that Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation.

关键词： Qing Dai Herbal medicine Ulcerative colitis Hydroxyl radical Electron spin resonance

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Two-stage treatment of an unusual haemobilia caused by intrahepatic pseudoaneurysm

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World Journal of Hepatology 2010年第1期2卷 52-54页

作者： Kazuhisa Takeda Kuniya Tanaka Itaru endo shinji Togo Hiroshi Shimada Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine

A 84-year-old man with a surgical history of subtotal gastrectomy for gastric cancer was transferred to our department because of a disorder of consciousness. Septic shock due to obstructive suppurative cholangitis secondary to choledocholithiasis was diagnosed. Anemia was also present,and upper gastrointestinal tract endoscopy revealed blood emerging from the Papilla of Vater.The cause of the anemia was identified as haemobilia.Angiography showed a small aneurysm over the artery on segment 3(A3) .The cause of the haemobilia was suspected to be the bleeding into the biliary tree from this aneurysm.Because the patient's general condition was poor,minimally invasive therapy was needed.Transcatheter arterial embolization(TAE) was selected initally.Later,lateral sectionectomy was performed in order to remove the aneurysm on A3. No surgical complication occurred and,after surgery,no haemobilia was identified.In conclusion,a twostage treatment,namely,surgery following TAE,is recommended for patients in a physically poor condition who have haemobilia due to intrahepatic aneurysm.

关键词： Two-stage treatment Haemobilia Intrahepatic pseudoaneurysm

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Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

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World Journal of Gastroenterology 2010年第40期16卷 5084-5091页

作者： Yutaka Suzuki Seryna Tamez Akihiko Murakami Akihiko Taira Akihiro Mizuhara Akira Horiuchi Chie Mihara Eiji Ako Hirohito Muramatsu Hitoshi Okano Hitoshi Suenaga Kazuaki Jomoto Junya Kobayashi Katsunari Takifuji Kazuhiro Akiyama Koh Tahara Koji Onishi Makoto Shimazaki Masami Matsumoto Masashi Ijima Masato Murakami Masato Nakahori Michiaki Kudo Michio Maruyama Mikako Takahashi Naohiro Washizawa Shigeru Onozawa Satoshi Goshi Satoyoshi Yamashita Shigeki Ono Shin Imazato shinji Nishiwaki Shuichirou Kitahara Takao endo Takao Iiri Takeshi Nagahama Takuto Hikichi Tatsuya Mikami Tetsuo Yamamoto Tetsushi Ogawa Tomoko Ogawa Tomoyuki Ohta Toshifumi Matsumoto Toshiroh Kura Tsutomu Kikuchi Tsuyoshi Iwase Tsuyotoshi Tsuji Yukio Nishiguchi Mitsuyoshi Urashima Department of Surgery International Universi-ty of Health and Welfare Hospital Department of Molecular Epidemiology Jikei University School of Medicine endoscopy Unit Iwate prefectural Central Hospital Department of Internal Medicine Tsuyama Chuo Hospital Department of Surgery Higashi Washi-nomiya Hospital Digestive Disease Center Showa Inan General Hospital Department of Neurology Ebina Medical Sup-port Center Department of Surgery Sumitomo Hospital Department of Gastroenterology Kiyota Hospital Department of Gastroenterology Okano Clinic Department of Geriatrics Hitachikoh Hospital Department of Internal Medicine Jomoto Gastroenteric and Internal Medical Clinic Department of Surgery Fujiyoshida Munici-pal Hospital 2nd Department of Surgery Wakayama Medical University Hospital Department of Surgery Tokatsu-clinic Hospital Department of Surgery Kure Kyosai Hospital Department of Internal Medicine Matsue Sei-kyo Genaral Hospital Department of Gastroenterology Hirano General Hospital Department of Internal Medicin Nara Prefectural Gojo Hospital Department of Internal Medicine Isesaki Mu-nicipal Hospital Department of Internal Medicine Muraka-mi Memorial Hospital Digestive endoscopy Center Sendai Kousei Hospital Department of Surgery Onishi Hospital Department of Surgery Tokyo Metropoli-tan Ohkubo Hospital Department of Internal Medicine Tsuruoka Kyoritsu Hospital Nutritional Therapy Center Toho Uni-versity Omori Medical Center Home Care Department Kameda Medical Hospital endoscopic Treatment Center Japan Labour Health and Welfare Organization Niigata Rousai Hospital Department of Gastroenterology and Hepatology Social Insurance Shimonoseki Welfare Hospital Department of Gastroenterology Ako City Hospital Percutaneous endoscopic Gastrostomy Center Oita Kensei Hospital Department of Internal Medicine Nishimino Kosei Hospital Department of Pediatric Surgery Nagano Red Cross Hospital Department of Internal Medicine Sapporo Shirakaba-dai hospital Department of Gastroenterology Tachikawa

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

关键词： Percutaneous endoscopic gastrostomy Enteral nutrition Comorbidity Survival Risk factor

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