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Background: Esophageal eosinophilia is classified as either eosinophilic esophagitis (EoE) or proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE), depending on the response to PPI treatment. The aim of this study was to compare the clinical, endoscopic, and histopathological findings of EoE and PPI-REE in Japanese patients. In addition, the characteristics of these cases were compared with those of reflux esophagitis (RE) cases.Methods: Eleven patients diagnosed with EoE, 16 with PPI-REE, and 39 with RE, who were all consecutively examined from 2005 to 2015 at Shimane University Hospital, were enrolled. Clinical, endoscopic, and histopathological esophageal findings in these groups were retrospectively examined and compared.Results: The differences in the clinical characteristics of EoE and PPI-REE were not remarkable, though patients with EoE and PPI-REE were younger, presented a higher prevalence of allergic comorbidities, and complained of symptoms of dysphagia more frequently than those with RE. The only noteworthy differences between EoE and PPI-REE were more frequent reports of asthma (36.4 vs. 2.6 %) and food allergy (27.3 vs. 0 %) by patients with EoE (P < 0.05, P < 0.05, respectively). Endoscopic findings in patients with EoE and PPI-REE were similar, with the presence of esophageal erosions in a small percentage of PPI-REE cases being the only difference. There were no histopathological differences between EoE and PPI-REE.Conclusions: Comparisons of clinical, endoscopic, and histopathological findings between EoE and PPI-REE showed that these two types have similar characteristics, though EoE patients showed a higher atopic background. Predicting PPI responsiveness in cases with esophageal eosinophilia is difficult and requires further investigation. [ABSTRACT FROM AUTHOR]

The article discusses research on the effectiveness of a portable and percutaneous cardiopulmonary bypass system for rewarming of patients with accidental severe hypothermia. The study subjects included patients from an emergency medical center and trauma center in Kanagawa, Japan. A Seldinger technique was used to attempt percutaneous cannulation.

Eosinophilic esophagitis (EoE) is an allergic inflammatory disorder that is characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. 1,2 Its prevalence has been increasing rapidly in both Western and Asian countries. In Japan, most of the cases of esophageal eosinophilia (EE) are found in an upper endoscopy examination for gastric cancer screening performed during a comprehensive health check-up. 3,4 Indeed, we frequently encounter patients with asymptomatic EE showing typical endoscopic findings, such as linear furrows, as well as histologic findings compatible with EoE. However, the current clinical guidelines for EoE diagnosis include symptoms related to esophageal dysfunction, thus patients without symptoms do not fulfill the diagnostic criteria. 1,2 The clinical characteristics remain to be fully elucidated, 5 thus we aimed to clarify clinical features of asymptomatic EE as compared with those of EoE., (Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Objective: To determine parameters that could assist emergency medical services (EMS) or triage personnel in identifying patients with central vertigo (cerebellar stroke)., Methods: The medical records at a university-based emergency department (ED) were retrospectively analyzed. The study patients comprised of 23 patients who were transported by EMS between April 2011 and March 2012 with a chief complaint of vertigo. We reviewed their medical records, including their symptoms, vital signs, review of systems, and past medical histories, to identify several parameters that could be used by paramedics to recognize central vertigo (cerebellar stroke)., Results: Of the 23 patients, 4 had central vertigo (2 had cerebellar infarction and 2 had cerebellar hemorrhage) and 19 had peripheral vertigo. High blood pressure and lack of horizontal component of nystagmus were found to be good predictors of central vertigo (cerebellar stroke) in these patients. Using a systolic blood pressure of more than 160 mmHg and lack of horizontal component of nystagmus as parameters, we can predict central vertigo (cerebellar stroke) with 100% sensitivity, 84% specificity, 57% positive predictive value and 100% negative predictive value (P = 0.0035)., Conclusion: Using limited sample data, high blood pressure and lack of horizontal component of nystagmus were identified as good out-of-hospital parameters that could be used by paramedics to recognize central vertigo (cerebellar stroke).

Objective: Estrogen seems to contribute to glucose homeostasis in women. The objective of this study was to examine the effects of hormone replacement therapy (HRT) on HbA(1c) levels in Japanese postmenopausal women and to determine whether the effects varied with age., Research Design and Methods: We studied 99 postmenopausal women taking HRT (mean +/- SD age 56.5 +/- 6.9 years, BMI 21.5 +/- 2.3 kg/m(2)) and 101 postmenopausal women not on HRT (51.4 +/- 6.1 years, 21.3 +/- 2.4 kg/m(2)). HRT consisted of continuous conjugated equine estrogen (CEE; 0.625 mg/day) and medroxyprogesterone acetate (MPA; 2.5 mg/day) for >2 years., Results: HbA(1c) levels are positively associated with age and BMI in women who use HRT as well as in those who do not use HRT. After adjusting for age and BMI, HRT showed no effects on HbA(1c) levels. However, HbA(1c) levels were significantly lower in postmenopausal women aged 40-49 years who were taking HRT than in women of similar age who were not taking HRT (mean +/- SE 4.776 +/- 0.092 vs. 5.096 +/- 0.078%, P < 0.05). No differences in HbA(1c) levels between women who did and did not use HRT were observed in those older than 50 years., Conclusions: Oral HRT involving CEE combined with MPA may decrease HbA(1c) levels in women aged 40-49 years and is likely to have no adverse effects on HbA(1c) levels in women older than 50 years.