AIM To evaluate the feasibility and reliability of endoscopic transpapillary bile duct biopsy for the diagnosis of biliary strictures.METHODS A total of 360 patients(241 men) who underwent endoscopic ...retrograde cholangiopancreatography for biliary strictures with biopsy from April 2012 to March 2016 at Tokyo Medical University Hospital were retrospectively reviewed. This study was approved by our Institutional Review Board(No. 3516). Informed consent was obtained from all individual participants included in this study. The biopsy specimens were obtained using a novel slim biopsy forceps(Radial Jaw 4P, Boston Scientific, Boston, MA, United States).RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 69.6%, 100%, 100%, 59.1%, and 78.8%, respectively. The sensitivity was 75.6% in bile duct cancer, 64% in pancreatic cancer, 61.1% in gallbladder cancer, and 57.1% in metastasis. In bile duct cancer, a lower sensitivity was observed for perihilar bile duct stricture(68.7%) than for distal bile duct stricture(83.1%). In terms of the stricture lengths of pancreatic cancer, gallbladder cancer, and metastasis, a longer stenosis resulted in a better sensitivity. In particular, there was a significant difference between pancreatic cancer and gallbladder cancer(P < 0.05). One major complication was perforation of the extrahepatic bile duct with bile leakage. CONCLUSION Endoscopic transpapillary biopsy alone using novel slim biopsy forceps is feasible and reliable, but restrictive. Biopsy should be performed in consideration of the stricture level, stricture length, and cancer type.
Background: For the investigation of transfusion-transmitted bacterial infection and transfusion-related acute lung injury (TRALI), examination of residual transfused blood is essential. However, ...methods for the collection of residual transfused blood have not been fully implemented at respective hospital level. Therefore, the causes of these reactions are not being fully investigated. Methods: We developed a procedure for investigating the cause of acute transfusion reactions, including a method for collecting residual blood. Using this method, we investigated serious acute transfusion reactions at 50 large hospitals between 2005 and 2006. Results: Transfusion was performed using 283,636 bags of red cell concentrate, 183,591 bags of fresh frozen plasma and 141,538 bags of platelets concentrate at these facilities during the investigation period. Transfusion-transmitted bacterial infection was diagnosed in two cases and suspected in 12 cases. Three cases met the diagnostic criteria for TRALI and one case was identified as possible TRALI. Transfusion-associated circulatory overload was diagnosed in one case. Five patients demonstrated deterioration of clinical condition after transfusion during treatment of acute lung injury. Four patients demonstrate dyspnea without pulmonary edema. Severe allergic reactions were detected in 15 cases and febrile non hemolytic transfusion reaction in one case. The cause was not precisely known in two cases. Conclusion: This type of investigation is useful for detecting the cause of acute transfusion reactions, such as allergic reactions, TRALI and transfusion-transmitted bacterial infection. The frequency of acute transfusion reactions will be clarified by increasing the number of participating facilities, thereby contributing to hemovigilance.
In national university hospitals, nationwide records have been maintained of the transfusion side effects occurring each year. After the recommended criteria for transfusion-related acute lung injury ...(TRALI) were established during the TRALI Consensus Conference held in 2004, cases of respiratory failure were re-examined. Thirty-four cases of respiratory failure were reported by 44 facilities during the fiscal year 1998 to 2003. Eight cases were diagnosed as TRALI and three cases as possible TRALI according to the recommended criteria. The antileukocyte antibody was positive in 63% (7/11) of cases that met the recommended criteria, although the anti-HLAclass II antibody was tested in only three cases. One case showed signs of acute lung injury (ALI) before transfusion, and 22 cases that did not show bilateral infiltrate on the chest radiograph were excluded. Twenty-two cases with no bilateral infiltrate on the chest radiograph seemed to be the result of an allergic reaction or condition similar to TRALI. Seven deaths occurred in cases involving TRALI, which was the most important serious complication related to transfusion during the investigational period.
A 36 year-old man had suffered from psoriasis vulgaris for about 25 years. He had received corticosteroids ointment and PUVA therapy with partial response. In 1987, he was diagnosed as having ...aplastic anemia (AA) and treated with various medications, but failed to respond. He received an allogeneic bone marrow transplantation (BMT) from his histocompatible sister in 1993. Conditioning regimen of BMT consisted of total lymphoid irradiation (7.5 Gy) and cyclophosphamide (200 mg/kg). Cyclosporin A and methotrexate were given for prophylaxis of graft-versus-host disease. On day 24, bone marrow examination disclosed normocellular marrow and karyotypic analysis completely confirmed the donor's origin. Before BMT, he had systemic psoriatic plaques with scales, together with nail involvement. After BMT, psoriatic plaques disappeared and nail deformity improved. He has remained in remission of his AA and completely free of psoriasis in the absence of immunosuppressive or other treatments. The cause of psoriasis is thought to be an immune-mediated disorder. Our case supports the observation that changing the host's immune system through allogeneic BMT can achieve remission of psoriasis. It is suggested that allogeneic BMT may be one strategy for the treatment of intractable immune-mediated disorders.
In the transfusion sections of local hospitals, safety and economy is an important problem. In this study, we established a system for massive blood transfusion and improved communication among ...clinicians, blood section and blood center (BC). Among characteristics of this system, the BC is able to understand the emergency and the possibility of additional ordering besides quantitative information on a continuous basis. Physicians can easily understand the time required to obtain the ordered blood. Cardiovascular operations accounted for 94% of 99 resisted cases. Additional blood was ordered in 30%, with no problem seen in the blood supply. Use of the massive blood transfusion system was increased, and the optimism of the surgeons was improved to 82%. Moreover, cancellation of ordered blood was significantly decreased, and the waste ratio calculated from the pharmaceutical units and that calculated from cost decreased from 1.6% to 0.4%. These results clarified the importance of the transfusion section in hospitals and local area.
ABO-incompatible transfusion due to human error is the most important cause of adverse events during transfusion. The National Survey on the present status of ABO-incompatible blood transfusions in ...Japan was conducted by the Japanese Society of Blood Transfusion. The survey targeted 1,355 hospitals. Data were collected by an anonymous questionnaire-based survey. Reports of ABO-incompatible transfusion in the 5-year period between January 2000 and December 2004 were analyzed. Target blood products included whole blood, red cell concentrates and fresh-frozen plasma (FFP) and platelet concentrates (PC). Among the 1,355 hospitals surveyed, responses were obtained from 829 (61.2%). Sixty cases of ABO-incompatible transfusion were reported, involving major mismatch of red cell concentrates in 22 cases, minor mismatch of red cell concentrates in 9, FFP in 19, PC in 8 and unknown products in 2. The main causes of transfusion error were identification error between patient and blood product in 27 (45%), phlebotomy error in 2 (3%), prescription error in 8 (13%), testing error by doctors in 10 (17%), laboratory error by technicians in 10 (17%) and other error in 3 (5%). Outcomes in patients transfused with ABO-incompatible blood were recorded as deceased in 8, in 4 of whom the cause of death could nevertheless not be distinguished as due to the ABO-incompatible transfusion or the underlying disease. Incorrect blood recipient identification at the patient's bedside remains the main cause of ABO-incompatible transfusion.
: Peripheral blood progenitor cells are collected effectively by leukapheresis of a large volume of peripheral blood. However, protection must be taken for patients or donors from hypocalcemia due to ...continuous infusion of citric acid. We found a tendency for hypocalcemic symptoms in patients or donors to occur more often on the second day than the first day of the sequential 2 days of leukapheresis. The doses of calcium gluconate supplement and the acid citrate dextrose‐A solution administration significantly increased on the second day compared to that of the first day. The blood levels of c‐terminal parathormone (PTH), phosphorus, and alkaline phosphatase did not show remarkably abnormal change. However, urine calcium excretion just after leukapheresis was higher than in the period before or after leukapheresis compared to the phosphorus or creatinine excretion. These findings indicate that the cause of a higher tendency to hypocalcemic symptoms on the second day of the sequential 2 days of leukapheresis is due to the higher metabolism of calcium being excreted in the urine during leukapheresis.
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