Showing papers by "Keiko Shiratori published in 2010"

The revised Japanese clinical diagnostic criteria for chronic pancreatitis

Abstract: In Japan, we are now using the clinical diagnostic criteria for chronic pancreatitis (CP) that were revised in 2001 to add the findings of magnetic resonance cholangiopancreatography to the criteria compiled by the Japan Pancreas Society (JPS) in 1995. Because the current criteria are set for diagnosing advanced CP, they are unlikely to improve patients' prognoses. In addition, they seem unsuitable for current clinical practice because exocrine pancreatic function tests, which have become obsolete in Japan, are included in the diagnostic factors. For these reasons, the Research Committee on Intractable Pancreatic Diseases supported by the Ministry of Health, Labour and Welfare of Japan, the JPS and the Japanese Society of Gastroenterology have revised the criteria. The revised criteria are unique in that they contain an introduction to the concept of early CP. It is a challenge aimed at improvement of the long-term prognosis of CP patients by early diagnosis and therapeutic intervention in this disease. We need to determine and clarify the clinico-pathological outcome of early CP by a prospective long-term follow-up of the patients in this category.

Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma caused by chronic hepatitis C.

Abstract: Background This study was performed to clarify the outcomes and recurrence of hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) in comparison with the data for HCC caused by hepatitis C virus (HCV) infection.

Differentiation between autoimmune pancreatitis and pancreatic carcinoma based on endoscopic retrograde cholangiopancreatography findings

Abstract: We have reviewed the endoscopic retrograde cholangiopancreatography (ERCP) images of patients with autoimmune pancreatitis (AIP) and pancreatic carcinoma (Pca) in an attempt to identify findings that would facilitate making a differential diagnosis between AIP and Pca. The study cohort consisted of 39 patients diagnosed with AIP and 62 patients diagnosed with Pca. The ERCP findings in the pancreatic duct and biliary tract were compared between the two groups. The ERCP images revealed that AIP patients had a higher prevalence of narrowing of the main pancreatic duct (MPD) for ≥3 cm of its length and a higher prevalence for the presence of side branches in the narrowed portion of the MPD than Pca patients (p 5 cm of its length and the presence of side branches. Among our patient cohort, the ERCP findings in terms of the length of the narrowed portion of the MPD, the presence of side branches, and maximal diameter of the upstream MPD enabled differential diagnosis between AIP and Pca in most of the cases. However, it must be borne in mind that some Pca patients have ERCP findings similar to those of AIP patients.

Engulfment of gram-positive bacteria by pancreatic stellate cells in pancreatic fibrosis.

Abstract: Objectives:We previously reported the finding that pancreatic stellate cells (PSCs) have a phagocytic function. The aim of the present study was to investigate whether engulfment of gram-positive bacteria by PSCs plays any role in the pathogenesis of pancreatic fibrosis.Methods:Rat PSCs were culture

Comparing enhancement and washout patterns of hepatic lesions between sonazoid-enhanced ultrasound and contrast-enhanced computed tomography

Abstract: To compare sonazoid-enhanced ultrasound (SEUS) and contrast-enhanced computed tomography (CECT) enhancement and washout patterns in hepatic lesions. Enhancement and washout patterns on SEUS were compared with those on CECT for 61 lesions. There were 36 hepatocellular carcinomas, three intrahepatic cholangiocarcinomas, three metastatic lesions, eight focal nodular hyperplasias, two angiomyolipomas, and nine undetermined benign lesions. Diagnosis was based on histopathology, or CECT and tumor markers, or findings on 2-year follow-up. All 61 lesions (100%) showed arterial enhancement on both SEUS and CECT. The “washout/no washout” agreement between SEUS and CECT for the 61 lesions was 93.4% (κ coefficient: 0.816). Of the 42 malignant lesions, 38 lesions (90.5%) showed washout on both SEUS and CECT. The remaining four malignant lesions, of which three lesions contained fibrosis (two intrahepatic cholangiocarcinomas and one scirrhous hepatocellular carcinoma), showed washout on SEUS but not on CECT. For the 19 benign lesions, agreement between SEUS and CECT was 100% (κ coefficient: 1), with seven lesions showing washout with both methods and 12 lesions showing no washout with both methods. The overall concordance rate between SEUS and CECT was good, but some differences were seen in the washout patterns of malignant lesions.

Two case of pancreatic cancer with pseudocyst successfully treated by EUS-guided drainage

Abstract: A 58-year-old man complaining of jaundice was diagnosed with advanced cancer in the head of the pancreas and pancreatic pseudocyst. After the placement of a 7Fr plastic biliary stent, endoscopic ultrasonography-guided pseudocyst drainage was successfully performed. The cytology of pseudocyst fluid was class V. The jaundice and abdominal pain improved. The patient underwent FOLFILINOX chemotherapy without major complaints. Here, we report a case of pancreatic pseudocyst associated with pancreatic cancer that was successfully treated with endoscopic pseudocyst drainage, and chemotherapy. J Saitama Medical University 2016; 43: 1 -6 (Received May 9, 2016 / Accepted July 19, 2016)

Pancreatic physiological and clinical investigation

Abstract: 膵疾患の病態解明には膵機能とその調節機構の理解が重要である．膵外分泌は神経と消化管ホルモン（セクレチン，コレシストキニン（CCK））により制御される．胃酸はセクレチン遊離の生理的因子であり，膵切除術に伴う胃・十二指腸切除はセクレチン動態にも影響を及ぼす．防御因子系抗潰瘍薬にセクレチン遊離作用を発見し薬理作用の一端を解明した．空腸への成分栄養剤投与によるセクレチンとCCKの血中動態，膵液分泌に対する影響を検討し，経腸栄養が膵刺激性の少ない安全で生理的な栄養管理であることを証明し急性膵炎での臨床応用を進めた．膵島インスリンが膵液分泌を促進させ，慢性膵炎モデルでインスリン抵抗改善薬が膵外分泌機能を回復させたことから膵内外分泌相関の意義を証明した．膵機能研究から得られた知見から，膵疾患の病態解明，治療法の提案や開発にヒントとアイデアが提供された．近い将来，未知の膵機能が膵臓病克服に繋がることを期待したい．