P-CAB achieved rapid artificial ulcer healing with promotion of granulation tissue formation. However, conventional PPI with initial intravenous infusion might be sufficient for prevention of postoperative bleeding following gastric ESD.
Background/Aims: Intraoperative bleeding remains a challenge during endoscopic submucosal dissection (ESD). Forceps-coagulated cut (FCC) was found to be effective to reduce this bleeding. However, this involved frequent device replacement, and therefore, knife-coagulated cut (KCC) might ensure an easier and smoother procedure. We aimed to assess the effectiveness of KCC with Flushknife-BT at a super-low-output setting. Methods: In this prospective study, we compared the hemostasis condition during ESD in 40 pairs of gastric lesions treated by FCC (Group F) or KCC (Group K). The primary outcome was frequency of major bleeding with an analysis by tumor location. The secondary outcomes included frequency of exchanging devices, procedure time, en bloc resection rate, and adverse event rate. Results: In terms of the frequency of major bleeding, there was no significant difference between Group F and K (0.95 ± 0.12 vs. 0.88 ± 0.17, p = 0.282). Lesions located on the upper third of the stomach involved repeated hemostasis (p = 0.012). The frequency of exchanging devices was higher in Group F than in Group K (6.95 ± 0.42 vs. 0.88 ± 0.17, p = 0.000). Procedure time was reduced in Group K by 15.6%. Other aspects were the same in both groups. Conclusion: KCC prevented intraoperative bleeding just as FCC did. But it decreased device replacement and saved time and only a low risk was involved. This technique could ensure the conduct of a smooth and safe procedure during gastric ESD. UMIN000017229.
The authors report a rare case of non-functioning pituitary carcinoma with spinal cord metastasis. A 37-year-old female presented with a 2-month history of right retro-orbital ache and vomiting. She had a pituitary adenoma removed 3 years prior to admission. Neuroradiologically, a mass lesion was demonstrated in the right middle cranial fossa. The tumor was removed through craniotomy and was histologically diagnosed as pituitary carcinoma. One week after the operation, tetraplegia developed and CT scans demonstrated a spinal canal lesion. Although the tumor was removed through C3-C7 laminectomies, she gradually deteriorated and died. At autopsy, a tumor was disclosed in the right temporal lobe and basal ganglia. Moreover, the tumor invaded into the middle cranial fossa and the parasellar region.
We have examined O6-methylguanine-DNA methyltransferase (O6-MT) activity of rat brain tumour cell strains with reference to cellular resistance to antitumour nitrosoureas, 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (nimustine, ACNU) and methyl-6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-alpha-D-glucopyrano side (ramustine, MCNU). The values of O6-MT activity were 52 and 160 fmol/mg protein extract in 9L and C6 rat brain tumour cells, respectively; while HeLa S3 cells, as a methyl excision repair positive (Mer+) cell strain, revealed a rather high value of 488 fmol/mg. 9L cells indicative of a low O6-MT activity showed 13 microM for ACNU and 18 microM for MCNU at a 10% survival dose (SD10), determined by a clonogenic cell assay as an index of cellular resistance. In contrast to this, C6 cells revealed a SD10 value of 67 microM and 36 microM for ACNU and MCNU, respectively, indicating higher resistance than 9L cells. HeLa S3 cells showed the highest SD10 value as follows: 84 microM for ACNU and 73 microM for MCNU. The relationship between the O6-MT activity and the cellular resistance was almost linear, with relatively resistant cell lines exhibiting the higher levels of the O6-MT activity. This correlation between the O6-MT activity and the cellular resistance to nitrosoureas as ACNU and MCNU was not observed among other antitumour drugs, which included bleomycin (BLM), neocarzinostatin (NCS), cis-diamminedichloroplatinum (II) (CDDP), and etoposide (VP-16) in clinical use for brain tumour chemotherapy. This indicates that O6-MT activity can be an indicator of cellular resistance to antitumour nitrosoureas in the chemotherapy of brain tumours.
<b><i>Background:</i></b> The use of antithrombotic agents for the prevention of cerebro-cardioembolic events has increased, and recent guidelines have recommended the continued administration of low-dose aspirin (LDA) during endoscopic procedures with a high risk of bleeding. However, the influence of LDA on intraoperative bleeding control status during Endoscopic submucosal dissection (ESD) remains unclear. <b><i>Methods:</i></b> We examined 293 consecutive patients who underwent ESD for gastric cancers between January 2014 and February 2018. Patients administered with LDA (<i>n</i> = 52) were compared with those without antithrombotic therapy (<i>n</i> = 241; control) by propensity-score matching (PSM) concerning outcomes of ESD. <b><i>Results:</i></b> PSM analysis yielded 50 matched pairs. Comparison showed similar values for frequency of intraoperative major bleeding: 1 (0–4) times (median [range]) in the LDA group and 0 (0–5) in the control group respectively (<i>p</i> = 0.710). Others (frequency of preventive coagulation, procedure time, decrease of hemoglobin levels, en bloc resection, complete resection) were the same with a few adverse events including perforation (0%), and thromboembolism (0%). Postoperative bleeding rate was 1.9% in LDA group. Multivariate analysis indicated that location U and circumference on the posterior wall were associated with for multiple major intraoperative bleeding. <b><i>Conclusion:</i></b> The study suggests that gastric ESD can be safely accomplished without cessation of LDA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.