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Factors associating with oxygenation of lower-limb muscle tissue in hemodialysis patients

World Journal of Nephrology 2016年第6期5卷 524-530页

作者： Haruhisa Miyazawa Susumu Ookawara Kiyonori Ito Katsunori Yanai Hiroki Ishii Taisuke Kitano Mitsutoshi Shindo Yuichiro Ueda Yoshio Kaku Keiji Hirai taro hoshino Kaoru Tabei Yoshiyuki Morishita Division of Nephrology First Department of Integrated Medicine Saitama Medical Center Jichi Medical University Department of Internal Medicine Minami-uonuma City Hospital

AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle *** Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals(nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen(rS O_2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C(Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rS O_2 and clinical *** The r SO_2 values were significantly lower in patients undergoing HD than in healthy individuals(50.0%± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle r SO_2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle r SO_2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lowerlimb muscle r SO_2 was independently associated with serum inorganic phosphate(standardized coefficient: 0.27) and serum albumin concentrations(standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle r SO_2 between diabetic and nondiabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lowerlimb muscle r SO_2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing

关键词： Regional saturation of oxygen Lower-limb muscle Sarcopenia Protein-energy wasting Nutritional status Inorganic phosphate Albumin Hemodialysis

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A Case of Simultaneous Triple Primary Cancers of the Hypopharynx, Esophagus, and Stomach Which Were Dissected by Endoscopic Laryngo-Pharyngeal Surgery Combined with Endoscopic Submucosal Dissection

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Open Journal of Gastroenterology 2018年第3期8卷 94-102页

作者： Kenro Kawada taro Sugimoto Ryuhei Okada Kazuya Yamaguchi Yuudai Kawamura Masafumi Okuda Yuuichiro Kume Andres Mora Tairo Ryotokuji Takuya Okada Akihiro hoshino Yutaka Tokairin Yasuaki Nakajima Yusuke Kiyokawa Fuminori Nomura Yoshuke Ariizumi Shohei Tomii Takashi Ito Takahiro Asakage Yusuke Kinugasa Tatsuyuki Kawano Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan Department of Head and Neck Surgery Tokyo Medical and Dental University Tokyo Japan Department of Human Pathology Tokyo Medical and Dental University Tokyo Japan

A 65-year-old man was admitted to our hospital following 6 months of dysphagia. At first, conventional endoscopy showed a reddish and depressed lesion in the stomach and an elevated lesion in the posterior wall of the hypopharynx. An endoscopic biopsy showed adenocarcinoma in the stomach, and squamous cell carcinoma in the hypopharynx. On the further examination, trans-nasal endoscopy with narrow band imaging (NBI) was performed. During the trumpet maneuver, a huge protruded lesion was observed and it reached to the orifice of the esophagus. Other superficial lesion located at left pyriform sinus was detected by NBI system as brownish area with brown dots. Furthermore, superficial esophageal cancer in the cervical esophagus was detected. Finally, 4 carcinomas in upper gastrointestinal tract were detected. Among them, the hypopharyngeal cancer was the most advanced (T3N0). The patient hoped to preserve his voice and swallowing function, endoscopic laryngo-pharyngeal surgery (ELPS) was performed for the hypopharyngeal cancer. Endoscopic mucosal resection (EMR) was performed for the esophageal cancer, and Endoscopic submucosal dissection (ESD) was performed for the gastric cancer. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en-bloc. The histopathological findings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial invasion, 29 × 28 × 4.2 mm. The others were diagnosed as mucosal cancers. The patient is currently alive with no recurrence at 28 months after the surgery;there is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal surgery for the tumor of pharyngo-esophageal junction can provide a less invasive treatment.

关键词： Endoscopic Laryngopharyngeal Surgery Hypopharyngeal Cancer Multiple Primary Cancer Trumpet Maneuver Endoscopic Submucosal Dissection

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