Search

Capsule endoscopy (CE) and double-balloon endoscopy (DBE) have revolutionized the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB). Although CE and DBE provide access to the small bowel and OGIB can be effectively treated by the identification of specific bleeding lesions, some patients experience rebleeding after small bowel investigation. There are no definite algorithms to determine the best follow-up period for patients with OGIB. The purpose of this study was to investigate the long-term outcomes and risk factors for rebleeding and to develop a follow-up strategy for patients with overt OGIB. Among 386 patients who underwent CE for OGIB at Nagoya University Hospital between June 2004 and December 2015, 318 patients with overt OGIB were enrolled in this retrospective study. The clinical characteristics and risk factors for rebleeding were analyzed, and a predictive model for the same was developed. Rebleeding occurred in 45 patients (14.2%) during a median follow-up period of 16.8 months. Multivariable regression analysis identified the following factors as significant independent predictors of rebleeding:vascular lesions seen during CE, transfusion requirement, and patients aged ≥60 years. The predictive model for rebleeding was developed using these factors to identify patients who had a high risk of rebleeding and to provide useful information to physicians in clinical practice. The C-statistic of the predictive model was 0.698. A risk-based approach to follow-up patients with OGIB can help clinicians determine a follow-up period for patients after small bowel investigation.

The activity of type I and IV collagenase was measured in thyroid tissue obtained from 6 non-diseased thyroids, 4 patients with Graves' diseases, 5 with follicular adenoma, 6 with papillary carcinoma and 4 with follicular carcinomas. The relationship between these enzyme activities and invasion or metastasis of the original tumors was studied. The activity of type I collagenase in papillary carcinomas and follicular carcinomas was higher than in non-diseased thyroids, Graves' disease and follicular adenoma. Carcinoma tissue with invasion beyond the capsule in particular had higher type I collagenase activity. Type IV collagenase activity in carcinoma with lymph node metastasis was higher than in non-diseased thyroids, Graves' disease and follicular adenoma, and especially higher than carcinoma without lymph node metastasis. These findings suggest that increased type I collagenase activity plays an important role in local invasion in thyroid carcinoma, and that increased type IV collagenase activity plays an important role in lymph node metastasis.

Surgical materials obtained from 5 normal human thyroids and 19 diseased tissues (4 with Grave's disease, 4 adenomatous goiters, 3 follicular adenomas, 2 papillary carcinomas, 4 follicular carcinomas and 2 undifferentiated carcinomas) were investigated immunohistochemically using the avidin-biotin-peroxidase complex technique with anti-proliferating cell nuclear antigen (PCNA) antibody and epidermal growth factor receptor (EGFR) antibody. The results of this study suggested the following: (1) Labeling indexes of PCNA positive cell nuclei were shown in high grade malignant cases accompanied by capsular invasion and lymph node metastasis, in undifferentiated carcinoma cells, and in proliferative lesions of benign diseases. These results suggest that PCNA is indicative of proliferative ability in thyroid diseases. (2) On thyroid tumors, EGFR regions with strong positive staining showed many PCNA positive cell nuclei. EGF appears to have a significant association with proliferative ability in thyroid diseases.