The Japanese Society of Internal Medicine Acta Medica Okayama 0918-2918 59 21 2020 Continued Aspirin Treatment May Be a Risk Factor of Delayed Bleeding after Gastric Endoscopic Submucosal Dissection under Heparin Replacement: A Retrospective Multicenter Study 2643 2651 EN Kenta Hamada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiromitsu Kanzaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masafumi Inoue Department of Gastroenterology, Japanese Red Cross Okayama Hospital Shuhei Ishiyama Department of Internal Medicine, Okayama Saiseikai General Hospital Kenji Yamauchi Department of Gastroenterology, Mitoyo General Hospital Koji Miyahara Department of Internal Medicine, Hiroshima City Hospital Tatsuya Toyokawa Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center Takao Tsuzuki Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital Jiro Miyaike Department of Internal Medicine, Saiseikai Imabari Hospital Minoru Matsubara Department of Internal Medicine, Sumitomo Besshi Hospital Sakuma Takahashi Department of Gastroenterology, Kagawa Prefectural Central Hospital Mamoru Nishimura Department of Internal Medicine, Okayama City Hospital Ryuta Takenaka Department of Internal Medicine, Tsuyama Chuo Hospital Naoko Yunoki Department of Internal Medicine, Akaiwa Medical Association Hospital Shinichiro Hori Department of Endoscopy, National Hospital Organization Shikoku Cancer Center Sayo Kobayashi Department of Internal Medicine, Fukuyama City Hospital Yasushi Yamasaki Department of Endoscopy, Okayama University Hospital Yoshiro Kawahara Department of Endoscopy, Okayama University Hospital Hideki Ishikawa Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Objective Gastric endoscopic submucosal dissection (ESD) under heparin replacement (HR) of warfarin reportedly has a high risk of delayed bleeding (24-57%). It is possible that the delayed bleeding risk may have changed over the years. We evaluated the current risk of delayed bleeding after gastric ESD under HR of anticoagulant agents. </br> Methods We retrospectively reviewed the delayed bleeding rate and analyzed the risk factors for delayed bleeding. </br> Patients Consecutive patients who underwent gastric ESD under HR of anticoagulant agents from July 2015 to June 2017. </br> Results A total of 32 patients with a solitary early gastric cancer and taking anticoagulant agents were analyzed, including 24 patients on warfarin (the warfarin group) and 8 patients on direct oral anticoagulants (the DOAC group). Three (9.4%) patients experienced delayed bleeding: three (12.5%) patients in the warfarin group and no patients in the DOAC group. Continued aspirin treatment was identified to be a risk factor of delayed bleeding (p=0.01). </br> Conclusion Careful management may be required for patients undergoing gastric ESD under continued aspirin treatment in addition to HR of anticoagulant agents; although the delayed bleeding risk after gastric ESD under HR of anticoagulant agents might have decreased over the years. No potential conflict of interest relevant to this article was reported.

日本内科学会 Acta Medica Okayama 0918-2918 59 21 2020 Adult T-cell Leukemia-lymphoma with Primary Breast Involvement: A Case Report and Literature Review 2757 2761 EN Hiroki Kobayashi Department of Hematology and Oncology, Okayama University Hospital Noboru Asada Department of Hematology and Oncology, Okayama University Hospital Takuro Igawa Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masaya Abe Department of Hematology and Oncology, Okayama University Hospital Yusuke Meguri Department of Hematology and Oncology, Okayama University Hospital Daisuke Ennishi Department of Hematology and Oncology, Okayama University Hospital Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Hospital Nobuharu Fujii Department of Transfusion Medicine, Okayama University Hospital Ken-ichi Matsuoka Department of Hematology and Oncology, Okayama University Hospital Tadashi Yoshino Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Hospital Breast involvement of Adult T-cell leukemia-lymphoma (ATLL) is extremely rare, and the data on the characteristics are limited. We herein describe a 49-year-old woman who presented with skin involvement of ATLL. Positron emission tomography/computed tomography showed bilateral breast lesions. Although the patient once achieved a complete metabolic response, a relapse of her ATLL occurred. The patient received subsequent allogeneic hematopoietic stem cell transplantation (HSCT). To our knowledge, only four cases of ATLL with breast involvement have previously been reported, and the prognoses have generally been poor. Breast lesions of ATLL have aggressive features, and intensive systemic chemotherapy and HSCT are required to improve survival. No potential conflict of interest relevant to this article was reported.