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We report the case of a 36‒year‒old man who was treated with S‒1 plus oxaliplatin(SOX)therapy for gastric cancer with disseminated intravascular coagulation(DIC). The patient visited our hospital for the treatment of an unresectable type 4 advanced gastric cancer. He had respiratory distress at the first visit. A chest CT scan revealed ground‒glass shadows as well as interstitial and septal thickening diffusely located in both the lungs, which suggested cancerous lymphangiopathy. Moreover, based on blood test results, DIC was diagnosed. After the administration of SOX in combination with recombinant human soluble thrombomodulin, the patient recovered from DIC, and the values of the tumor markers(CEA and CA19‒9) were normalized. After more than 14 months post treatment, the patient has survived without relapse. There are several reports that chemotherapy for gastric cancer is effective for DIC; however, there are no reports on regimens using oxaliplatin. Regimens using this drug may improve the prognosis of gastric cancer complicated by disseminated myelocarcinomatosis and DIC.

The patient was a 69-year-old woman.Upper gastrointestinal endoscopy showed a protruding tumor in the mid-thoracic esophagus, and biopsy revealed small cell carcinoma in November 2012. Four courses of neoadjuvant chemotherapy comprising CDDP and CPT-11 were administered, and radical resection was performed in March 2013.I n March 2014, chest computed tomography revealed the recurrence of mediastinal lymph nodes; thus, we administered chemoradiotherapy comprising 5- FU and CDDP, and the size of the recurrent tumors decreased.However, in February 2015, positron emission tomographycomputed tomography revealed liver metastases.Therefore, we switched to a new chemotherapy regimen containing CDDP and VP-16.Although the treatment was very effective and the liver metastases significantly decreased in size, it was discontinued after 9 courses owing to neurotoxicity.Next, 7 courses of chemotherapy comprising amrubicin, which is administered for treating small cell lung carcinoma, were administered, which suppressed tumor growth for approximately 8 months.However, the tumor then re-grew.Chemotherapy comprising S-1 was administered; however, the tumor gradually progressed.The patient died 51 months after the initial treatment.

An octogenarian female patient underwent implantation of pacemaker for sick sinus syndrome. Seventeen days after implantation, she came back to our hospital with pain and redness of the skin around the pacemaker generator. It was difficult to differentiate the infection from a subcutaneous hemorrhage. She did not have high fever. The blood test showed only a slight elevation of C-reactive protein(CRP). Cefazolin was administered after readmission. Five days after readmission, the report of the blood culture showed nontuberculous Mycobacterium positive. We immediately removed the generator and the leads completely. Antibiotics were changed to clarithromycin and ciprofloxacin. The culture reports of blood, generator, leads, and subcutaneous tissue were first Mycobacterium peregrinum( M. peregrinum) but was later corrected to be Mycobacterium mageritense (M. mageritense). Twenty-seven days after the removal of the device, she was transferred to another hospital near her family and antibiotics were ceased due to allergic reaction the day after transfer. Ten days after transfer, a new device was implanted, and she does not have any signs of infection now. The possibility of mycobacterial infection, including nontuberculous mycobacterial infection, should be considered for device contamination, especially for the aging population, and quick and proper treatments are required.

It has been reported that docetaxel, cisplatin, and 5-FU combination chemotherapy(DCF)is effective for advanced esophageal cancer. However, we often encounter severe hematotoxicity during DCF therapy. Here, we retrospectively analyzed the data of patients with advanced esophageal cancer treated with DCF at our department, and assessed the efficacy of pegfilgrastim and the issues associated with its use. According to the results, pegfilgrastim may reduce the severe hematotoxicity associated with DCF therapy and may contribute to the maintenance of the intensity of DCF. However, neutropenia had already occurred before pegfilgrastim administration on day 7 in most patients. Therefore, the appropriate timing of pegfilgrastim administration in DCF must be determined in a future prospective study.

Zinc, an essential trace element, affects immune responses, skin metabolism, hormone composition, and some sensory function, so that the deficiency presents various symptoms such as immunodeficiency and taste obstacle. Further, the zinc deficiency also considers as a risk of various diseases. Recent reports demonstrated that -20% of the Japanese population was marginally zinc deficiency, and over 25% of the global population is at high risk of zinc deficiency. In gastrointestinal disorders, zinc plays an important role in the healing of mucosal and epithelial damage. In fact, polaprezinc, a chelate compound of zinc and L-carnosine, has been used for the treatment of gastric ulcer and gastritis. We describe here the therapeutic effect of zinc on gastrointestinal disorders.

Nanoparticle albumin-bound paclitaxel(nab-PTX)was approved for the treatment of gastric cancer without a large-scale clinical trial in Japan. Its safety and efficacy should be validated in clinical practice. We retrospectively investigated prognostic factors related to time to treatment failure(TTF)in 11 patients with unresectable or recurrent gastric cancer treated with nab- PTX in our hospital. In univariate analysis, Onodera's prognostic nutritional index(PNI)and the time from the start of first-line chemotherapy to the start of nab-PTX were related to TTF. In multivariate analysis, Onodera's PNI was identified as an independent predictive factor for TTF (hazard ratio 0.056, p=0.022). PNI could contribute to adequate patient selection and the improvement of nab-PTX therapy efficacy ingastric cancer.

Accurate endoscopic diagnosis including pit pattern observation is necessary for performing definite endoscopic therapy. Endoscopic mucosal resection (EMR) is performed worldwide for early colorectal cancers 20 mm in diameter. Hyaluronic acid solutions as an injection solution have been used to achieve sustained mucosal elevation, definitive en-bloc resection, and complete resection. In Japan and some other Western and Asian countries, endoscopic submucosal dissection (ESD) is reported to be an efficient treatment with a high rate of en bloc resection for large early colorectal cancers and it is considered less invasive than laparoscopic colectomy. Two knives such as a tip-typed knife and a scissor type are used for safe ESD procedure. In this review, we have demonstrated the efficacies of EMR and ESD for early colorectal cancers.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic and recurrent inflammatory disorder of the intestinal tract. It has been demonstrated that sleep disturbances are involved in the pathogenesis of the patients with IBD. In addition, it has been shown that melatonin, which is a hormone produced by the pineal gland and maintains circadian rhythm, plays an important role as regulators of inflammation as well as a player in proper immune system and antioxidant system in the intestinal disorders. In this review, we present what is currently known regarding sleep disturbances and the role of melatonin in intestinal inflammation.

In this study, we assessed mid-term results of surgical ventricular restoration (SVR) for dilated cardiomyopathy. The study subjects were 107 patients who underwent SVR for both ischemic (ischemic cardiomyopathy:ICM, n=57) and non-ischemic (dilated cardiomyopathy:DCM, n=50) dilated cardiomyopathy. In 49(86%)patients ICM was associated with New York heart Association(NYHA) class III or more. Preoperative left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension(LVDd)were 22±6% and 67±9 mm, respectively. Hospital mortality was 14% and 5-year mortality was 40%. In contrast, 46( 92%) of the DCM patients presented with NYHA class III or more. Preoperative LVEF and LVDd were 20±6% and 74±9 mm, respectively. Hospital mortality was 28% and 5-year mortality was 63%. For NYHA class III or less, however, 5-year mortality rates were 23% and 39% in those with ICM and DCM, respectively. For those with NYHA functional class III or less, SVR was associated with a satisfactory survival rate and is recommended. For those with severe heart failure, however, ventricular assist devices or heart transplantation may have to be indicated.

A 45-year-old man was admitted to our hospital because of disseminated intravascular coagulation syndrome (DIC) and severe pain in his back and lumbar. Abdominal CT scan demonstrated lymph node enlargement in the whole body. FDG-PET revealed abnormal uptake of FDG in the thickening wall of the descending colon and the entire skeleton. Colonoscopy was performed continuously and revealed a poorly-differentiated adenocarcinoma of the descending colon. He was treated with the systemic chemotherapy of modified FOLFOX6 (mFOLFOX6). After one course of the treatment, DIC was resolved and severe back pain and lumbargo were improved.

It is necessary for some conditions to occur at the same time so that NSAIDs-induced gastrointestinal ulcers occur. The definite condition that is necessary for the development of ulcers by NSAIDs is the direct injury with NSAIDs and the presence and influences of the luminal factors, including gastric acid, bacteria, and bile acids. The pathologic central mechanism is the inhibition of cyclooxygenase, the disturbance of microcirculation and pro-apoptotic signaling. At all events, it is a theme for gastroenterologists to establish a mean to prevent the gastrointestinal ulcers induced by NSAIDs.

NSAIDs have been associated with gastrointestinal (GI) toxicity. Proton pump inhibitors (PPIs) may be the first line in the treatment as well as in the prevention of NSAIDs-induced ulcers. Although there are no definite differences among three PPIs(omeprazole, lansoprazole, and rabeprazole) in the clinical field, it should be considered to inhibit gastric acid secretion rapidly and strongly in case of the treatment with acute gastric ulcer in patients who should be continued to be NSAIDs treatment. Recently, the serious problem of NSAID-induced small intestinal damage has become a topic of great interest to gastroenterologists, since capsule endoscopy and balloon enteroscopy are available for the detection of small intestinal lesions. Further understanding of the pathogenesis of NSAID-induced intestinal ulcers is important to enable the development of novel and effective preventive strategies.

It is necessary for some conditions to occur at the same time so that aspirin induced gastric mucosa injury occurs. The definite condition that is necessary for the development of gastric mucosa injury by aspirin is the direct injury with the aspirin and the presence of the gastric acid. The pathologic central mechanism is the inhibition of cyclooxygenase, the disturbance of microcirculation and pro-apoptotic signaling. At all events, it is a theme for gastroenterologists to establish a mean to prevent the gastric mucosa injury induced by aspirin.

The peroxisome proliferator activated receptor-gamma (PPARgamma) is a nuclear receptor highly expressed in the gastrointestinal tract and playing a key role in inflammation. Several natural and synthetic PPARgamma ligands have been the focus of extensive research effort as potent anti-inflammatory agents in gastrointestinal diseases. In the last decade, accumulative experimental evidence has further suggested that PPARgamma is involved in several inflammatory signaling pathways associated with acute and chronic inflammation. The aims of this review are to discuss the potential roles of PPARgamma in the pathophysiology of the gastrointestinal tract, as well as the emerging therapeutic strategies targeting this receptor.

Reactive oxygen species are important for many life sustaining processes of cells and tissues, but they can also induce cell damage and death. If their production and levels within cells are not effectively controlled, then the detrimental effects of oxidative stress can accumulate. Oxidative stress is widely thought to underpin many ageing processes, and the oxidative stress theory of ageing is one of the most widely acknowledged theories of ageing. As well as being the major source of reactive oxygen species, mitochondria are also a major site of oxidative damage. The purpose of this review is a concise and current review of the role of oxidative stress in ageing process. Emphasis is placed upon the roles of mitochondrial proton leak, the uncoupling proteins, and the anti-ageing effects of caloric restriction.

As a mechanism of the ageing becomes clear by the scientific study, it has been believed that oxidative stress is an accelerator of the ageing. Still it is too critical to take antioxidants in large quantities for anti-ageing, and it should be needed to clarify the efficacy of anti-oxidative therapy by the scientific evidence. In this chapter, we explained it to positioning of the antioxidant for general anti-ageing strategy, Sara about the present conditions of the molecular mechanism elucidation study on effects of the antioxidant.

Based on the results of a retrospective review of clinical data on inpatients with ischemic colitis treated at our hospital, we created a clinical pathway and evaluated its usefulness. We used the clinical pathway for 21 inpatients, and the patient who fulfilled the criteria consisted of 18 inpatients. The fasting period after the onset and the duration of hospitalization were compared with those of 60 patients before implementation of the clinical pathway. The fasting period after the onset before and after implementation were 6.20+/- 3.42 days (mean+/- SD), and 5.28+/- 1.27 days, respectively. The duration of hospitalization before and after implementation was 10.37+/- 7.32 days, 8.37+/- 2.89 days, respectively. The clinical pathway is useful for shortening the duration of hospitalization, enhancing the uniformity of treatment and controlling the treatment risk.

Background: Atrial fibrillation (AF) is a common complication of cardiac operation. For the development of postoperative AF, various risk factors have been identified over the years. In a recent study, it was detected that low serum magnesium levels was an independent predictor of AF after coronary artery bypass grafting (CABG). The purpose of this study was to assess the prophylactic effect of intravenous magnesium infusion on postoperative AF., Methods: A total of 62 consecutive patients who had elective, first time cardiac operation on cardiopulmonary bypass were prospectively categorized to 2 group. In the treatment group, 30 patients received 8.3 mmol of magnesium sulfate in 100 ml of saline solution that was administered over 4 hours, preoperatively, just after admission in the ICU, and at the postoperative day 1, 2, 3, and 4., Results: Postoperative AF occurred in 3/30 (10.0%) patients in the treatment group and in 14/32 (43.8%) patients in the control group (p<0.01). The arrhythmia developed on the 2.9 postoperative day on average. The postoperative length of hospital stay was significantly shortened in the treatment group (15.9 +/- 4.0 days) than that in the control group (20.5 +/- 7.0, p < 0.01)., Conclusion: Our findings indicate that magnesium sulfate infusion is effective for the prophylaxis of post operative AF.

A 60-year old man admitted our hospital due to abdominal pain, melena and arthralgia. There was purpura on his legs. On admission, the abdominal CT showed segmental mural thickening of terminal ileum and ascites. On the 4th hospital day, the abdominal CT showed severe mural thickening of the third portion of duodenum. On the 8th hospital day, the abdominal CT showed severe mural thickening of terminal ileum. We reported a rare case of Henoch-Schönlein purpura with relapse of ileitis and duodenitis for a short period which could be examined on the abdominal CT.

A 2.8 kg-female newborn diagnosed as hypoplastic left heart syndrome was transferred to our hospital after resuscitation against systemic circulatory failure due to closure of the ductus arteriosus. Her systemic circulation was stabilized after alprostadil (lipo-PGE1) and inotorpic agent infusion along with mechanical ventilation support. On admission, signs of a pulmonary high-flow and low systemic perfusion were evident. Impaired coagulation aspect was gradually noted. Because a surgical palliation with cardiopulmonary bypass was considered to be at high-risk, a bilateral pulmonary artery banding was indicated. Through a median sternotomy, the right and left pulmonary arteries were individually banded. The patient was continued on the same ventilation strategy. Cardiac, hepatic and renal dysfunctions were improved over next few days and the patient weaned from ventilatory support. She underwent combined Norwood stage I and II repair at 4 months of age with weight of 4.8 kg. Postoperative course has been uneventful and the patient is now followed up in preparation for Fontan operation.

Recent reports have demonstrated significantly higher expression levels of interleukin-8 (IL-8) in patients with gastroesophageal reflux disease (GERD) including non-erosive reflux disease (NERD). The levels of IL-8 mRNA expression were significantly decreased after proton pump inhibitor. The esophageal expression of CINCs, rat IL-8-like chemokines, was markedly enhanced in the models of acute or chronic esophagitis in rats. The production of IL-8 from esophageal mucosal cells was enhanced by the exposure to bile acid. These results suggest that IL-8 chemokine may play a major role in the pathogenesis of esophageal inflammation in GERD.

The patient was a 71-year-old man whose chief complaints were staggering and fatigue. As a result of various examinations, he was diagnosed with advanced gastric cancer, Borrmann 3, with disseminated intravascular coagulation (DIC) and bone metastases. The DIC was treated with oral administration of TS-1 (120 mg/day). Furthermore, both the primary gastric tumor and metastatic bone lesions were reduced in size by the treatment with TS-1. TS-1 appears to be an effective therapeutic agent for advanced gastric cancer with DIC or bone metastases.