Showing papers in "The Japanese journal of gastro-enterology in 2006"

[Pancreatic stellate cells: molecular mechanism of pancreatic fibrosis].

Abstract: Pancreatic stellate cells (PSC) are known to play a crucial role in pancreatic fibrogenesis in chronic pancreatitis and in the desmoplastic reaction of pancreatic cancer. When PSC are stimulated by oxidative stress, the phenotype of quiescent fat-storing cells converts to myofibroblast-like activated PSC that then produce extracellular matrix (ECM), adhesion molecules, and various chemokines in response to inflammatory cytokines, chemokines, and growth factors. Platelet-derived growth factor (PDGF) is a potent stimulator of PSC proliferation, and transforming growth factor-β, PDGF, and basic fibroblast growth factor stimulate ECM synthesis by PSC. As induction of acinar cell apoptosis and necrosis is a major mechanism in the pathogenesis of mild to severe acute pancreatitis, the rapid removal of apoptotic acinar cells may be helpful in preventing the release of toxic intracellular materials, preventing further progression of the inflammation, and restoring normal tissue homeostasis. Although PSC are not professional phagocytes, we have demonstrated that PSC engulf apoptotic polymorphonuclear neutrophils (PMN) and necrotic acinar cells. Apoptotic PMN are ingested into the cytoplasm of the PSC, and troglitazone induces a dose-dependent increase in both phagocytic activity and expression of CD36, which is a representative scavenger receptor for phagocytic function. Engulfment of necrotic acinar cells by PSC induced PSC death and inhibited PSC activation in an in vitro study, suggesting that engulfment of necrotic acinar cells by PSC may inhibit the progression of fibrogenesis. These findings suggest that engulfment of damaged cells by PSC may be one of the mechanisms that prevent the progression of pancreatitis and restore tissue homeostasis.

A case of MALT lymphoma of the liver treated by RFA and Rituximab

Abstract: A 69 years old man was admitted to our hospital for further examinations of the liver tumor October, 2003. No underlying liver disease was found. Two tumors in the liver, 2cm in diameter respectively, were detected by abdominal ultrasonography and MRI scan. Ultrasonogram-guided needle biopsy from the liver tumor showed diffuse infiltration of CD20 positive, small lymphocytes. A distinct single band demonstrating clonal JH gene rearrangement was detected by southern blot analysis using tissues by needle biopsy. Thus, the patient was diagnosed with primary hepatic MALT lymphoma in the normal liver. These tumors were treated with percutaneus radiofrequency ablation (RFA), followed by Rituximab administration. No relapse has been noted until September, 2005.

Colorectal cancer in patients with ulcerative colitis

Abstract: Colorectal cancer in patients with ulcerative colitis. Jayne Eaden, Gastrointestinal Research Unit, Leicester General Hospital. The magnitude of the colorectal cancer (CRC) risk in ulcerative colitis (UC) was determined in the first meta-analysis of all 116 studies reporting the risk. For any patient with UC the risk was 2% at ten years, 8% at twenty years and 18% after thirty years. The risk was greater in children, varied geographically and has fallen since 1955. A case-control study of 204 patients across the United Kingdom demonstrated regular aminosalicylate therapy reduced cancer risk by 75% (p<0.00001). Mesalazine was particularly effective reducing risk by 81% (p=0.006). Visiting a hospital doctor more than twice a year and attending regular colonoscopies also reduced risk (84% and 78%). A family cancer history increased risk five fold. A reliable, self administered questionnaire measuring patient knowledge was developed. No correlation was found between patient knowledge and the risk of developing CRC. A randomized controlled trial compared the efficacy of a video (scripted and produced by the author) vs. an information leaflet on patient knowledge. This established that both media improved knowledge (71% and 49%) but neither intervention was significantly more effective than the other. The first nationwide audit of surveillance practices amongst gastroenterologists ascertained 94% of consultants practiced surveillance but it was extremely disorganized and considerable disagreement existed concerning the management of dysplasia. An inter-observer variation study (examining histological slides) found specialist gastrointestinal and general pathologists were equally poor at grading dysplasia (Kappa =0.30 and 0.28 respectively). A new immunohistochemical marker for dysplasia (CYP1B1) was investigated. Although CYP1B1 showed faint staining in dysplastic tissues, it was inconsistent and presently would not improve identification of dysplasia. The CRC risk in UC is significant and may be modified through regular consumption of aminosalicylates. Resources may be better allocated at improving compliance with such medication and targeting surveillance on high risk patients. Standardization of surveillance through national guidelines is needed urgently.

A case of gastrointestinal stromal tumor with liver and bone metastases effectively treated with radiofrequency ablation and imatinib mesylate

Abstract: A 58-year-old man was admitted because of perforation of the small intestine by a gastrointestinal stromal tumor (GIST). First, the small intestine including a GIST was resected; and then 2 month later, a part of the liver (S5) conforming to metastatic lesion was surgically removed. Twelve months later, another liver metastases was found, and surgical treatment was recommended; but the patient requested non-surgical therapy, so a radiofrequency ablation (RFA) was successfully performed. After that, recurrence of liver metastasis was not observed, but another metastasis was observed on the fifth lumbar vertebra; so administration of imatinib mesylate was started. 28 months after the initial administration the metastatic liver lesion was still invisible, and the bone metastatic lesion had not grown. The patient is alive with good performance status. This report shows that multi-modality therapy by surgery, RFA and imatinib mesylate was effective for liver and bone metastases of GIST.

Two cases of intractable hepatic hydrothorax successfully treated with nasal CPAP

Abstract: Hepatic hydrothorax is often resistant to various treatments. A failure in the treatment for hepatic hydrothorax may be associated with poor prognosis. We report two cases of intractable hepatic hydrothorax successfully treated by combining chemical pleurodesis using OK-432 with nasal continuous positive airway pressure. Combination therapy may provide a minimally invasive and effective treatment for intractable hepatic hydrothorax.

[A case of exacerbation of ulcerative colitis induced by combination therapy with PEG-interferon alpha-2b and ribavirin for chronic hepatitis C].

Abstract: A 55-year-old man with chronic hepatitis C had diarrhea with bloody stool in July, 2003 and ulcerative colitis was suspected. However, he quickly improved. He was treated with percutaneous radiofrequency ablation therapy for adenomatous hyperplasia in S5 of the liver in December, 2004. After the ablation therapy, he was treated with combination therapy of PEG-interferon alpha-2b and ribavirin for chronic hepatitis C. Because exacerbation of ulcerative colitis appeared 10 weeks after beginning of the treatment for hepatitis C, the combination therapy of PEG-interferon and ribavirin was discontinued. He was treated with mesalazine and steroid therapy for ulcerative colitis, and improved. We report the first case in Japan of the exacerbation of ulcerative colitis induced by the combination therapy of PEG-interferon and ribavirin for chronic hepatitis C.

[A case of radiation-induced rectal cancer].

Abstract: We report a case of radiation-induced rectal cancer, which is thought to originate from dysplasia due to radiation colitis. The patient is a 73 year-old woman, who underwent radical hysterectomy and radiotherapy for uterine cervical cancer 31 years ago. She visited to our hospital complaining of hematochezia. Colonoscopy in January 2004 disclosed redness of the rectal mucosa accompanied with contact bleeding and pathological study of the biopsy specimen revealed severe dysplasia. However, colonoscopy showed an ulcerative lesion of the rectum in December 2004, and pathological findings of the biopsy specimen disclosed moderately differentiated adenocarcinoma. She underwent a rectal resection in January 2005. Pathological study of resected specimen revealed fibrous change induced by radiation. Predominant histological type of the tumor was moderately differentiated carcinoma followed by well differentiated type. However, multiple dysplasias were found around the main tumor or in the mucosa which was treated with radiotherapy.

リン酸オセルタミビル(タミフル®)が誘因と考えられた急性出血性腸炎の1例

Abstract: A 23-year-old woman had lower abdominal pain, diarrhea and bloody stool was admitted and given a diagnosis of influenza B. Her home doctor had started treatment by neuraminidase inhibitor (oseltamivir) the previous day. Colonoscopic examination revealed an area of hemorrhage and erosion in the left transverse colon. After halting oseltamivir treatment these symptoms disappeared and her colonoscopic findings improved. A drug-induced lymphocyte stimulation test was positive for oseltamivir. This case is the first reported case of acute hemorrhagic colitis induced by oseltamivir.

A case of successful treatment with transcatheter arterial embolization for a ruptured aneurysm of the gastroduodenal artery presenting with a hemosuccus pancreaticus

Abstract: A 55-year-old male heavy drinker was taken to another hospital because of loss of consciousness. Laboratory data showed anemia and endoscopy of the upper gastrointestinal tract disclosed intraduodenal bleeding from the ampulla of Vater. Further examinations were scheduled. However, three days later, he was given emergency admission to our hospital because of massive rectal bleeding and circulatory shock. Abdominal contrast-enhanced CT showed a pseudoaneurysm in a pseudocyst in the head of the pancreas. Emergency angiography revealed a ruptured pseudoaneurysm of the gastroduodenal artery 15 mm in diameter. He was successfully treated with transcatheter arterial embolization. ERCP demonstrated the pseudocyst communicating from the main pancreatic duct in the pancreatic head. The final diagnosis was ruptured pseudoaneurysm of the gastroduodenal artery into a pseudocyst, presenting with hemosuccus pancreaticus, secondary to chronic pancreatitis.

A case of autoimmune pancreatitis complicated with immune thrombocytopenia

Abstract: A 80-year old man was referred to our hospital because of an elevation of serum amylase level. Diffuse enlargement of the pancreas was detected by abdominal computed tomography, and also diffuse narrowing of the main pancreatic duct was revealed using endoscopic retrograde cholangiopancreatography. The serum level of IgG was elevated to 3450mg/dl. Besides, on the 10th hospital day, petechia developed and the platelet level decreased to 1.5 x 10(4)/microl. The platelet-associated IgG, antiplatelet antibody and antinuclear antibody in serum were positive. The levels of serum complements were low. From all these findings the patient was diagnosed as autoimmune pancreatitis complicated with immune thrombocytopenia. The treatment with prednisolone was started, which was effective on each disease. The medication was suspended a year ago, and so far there is no data suggesting the recurrence of autoimmune pancreatitis or immune thrombocytopenia.

A case of alcoholic liver cirrhosis associated with intramuscular hematoma

Abstract: We reported a rare case of spontaneous intramuscular hematoma associated with alcoholic liver cirrhosis patient A 60-year-old man with alcoholic liver cirrhosis was admitted to our hospital for pneumonia It was improved by conservative treatments, however, he was complaint of severe pain in right hip and thigh MRI revealed intramuscular hematoma at acute phase Resting and anticoagulant therapy reduced it, but liver functions were not improved After a few months, he received another intramuscular hematoma in the left thoracic muscles, and then died because of liver failure It seems important to consider intramuscular hematoma as a complication of alcoholic liver cirrhosis

A case of primary gastric malignant lymphoma perforated immediately after administration of chemotherapy

Abstract: A 77-year-old man was admitted to our hospital with complaints of abdominal pain and body weight loss. Esophagogastroduodenoscopy on admission revealed large ulcerative tumor in the entire region from upper to lower body of the stomach. We diagnosed gastric malignant lymphoma, diffuse large B-cell type and determined stage IV according to the Lugano International Conference classification. Due to gastric perforation occurred on day 4 of chemotherapy, total gastrectomy and partial resection of the transverse colon were performed. Complete remission was achieved by 2 cycles of postoperative chemotherapy together with rituximab.

[A case of recurrent biliary cystadenocarcinoma successfully treated with 5FU/CDDP systemic chemotherapy].

Abstract: We report a case of biliary cystadenocarcinoma which recurred 41 months postoperatively. A 60-year-old woman was admitted for further examination of multiple metastatic tumors and a large amount of ascites. Systemic administration of 5FU and CDDP caused her CEA level to decrease gradually and abdominal computed tomography revealed considerable reduction of the metastatic tumors and ascites. Since her general condition had improved, chemotherapy was continued in the outpatient clinic.

A case of the extrahepatic bile duct carcinoid tumor

Abstract: A 76-year-old man presented with back discomfort and jaundice. CT and MRI of the abdomen revealed a mass in the common bile duct. Cytology of the bile juice obtained by percutaneous transhepatic cholangio-drainage revealed class V. The patient underwent laparotomy and pancreatoduodenectomy. Pathology showed a carcinoid tumor of the biliary tract, 14 x 10 mm in size. Grimelius staining demonstrated the presence of argyrophilic granules. On immunochemistry, the tumor stained positive for chromogranin A and synaptophysin. He had two liver metastases 8 months postoperatively.

[A case of Turner syndrome complicated with Crohn's disease, erythema nodosum and Hashimoto disease].

Abstract: A 26-year-old woman, who had had Turner syndrome from age 10 years old, had diarrhea, fever, joint pain, and erythema in the lower left leg. She was given a diagnosis of Crohn's disease, erythema nodosum, and Hashimoto disease. Systemic steroid therapy was very effective for both intestinal and skin lesions. It has been reported that half of inflammatory bowel disease patients with Turner syndrome have 46XiX (q) type chromosome abnormality, and this case also has this type of abnormality.

高年男性に発症した嚢胞成分を認めないsolid-pseudopapillary tumor (SPT) の1例

Abstract: We encountered a solid pseudopapillary tumor (SPT) without any cyst component in an elderly man. A literature survey of SPT without cystic component suggested that the size and vascularity of a tumor were related to lack of cystic component. The prognosis of this disease was comparatively good, but elderly or middle aged case and cases without capsule seem to have high malignant potential.

A case of gastric arteriovenous malformation forming faded depression

Abstract: A 48-year-old man was referred to our hospital because of anemia. Upper gastrointestinal endoscopy showed discolored depressive lesion like gastric cancer, 30mm in diameter, in the greater curvature of the upper gastric body. During the endoscopic examination, pulsative bleeding from the lesion was occurred and we performed clipping hemostasis. We diagnosed a gastric arteriovenous malformation by endoscopic ultrasonograph and angiography. A pylorus preserving-gastrectomy was performed and Pathohistological examination revealed arterio-venous connection in the submucosal layer of the gastric wall.

A case of liver cystis wlud Em18-WB was useful for differential diagnosis

Abstract: A 72-year-old woman with multilocular liver cysts was admitted. This lesions seemed to be an alveolar hydatid disease. Two methods of Western blotting were used for serologic diagnosis. One method recognizes antigens of crude extracts of Echinococcus multilocularis (EM). The other method recognizes a purified antigen (Em18) of EM. Her serum only reacted with the former method and never reacted with Em18 antigen. Eighteen months after first admission, she had an operation. The resected specimen was diagnosed with simple cysts. Western blotting using Em18 antigen could greatly facilitate the differential diagnosis of simple liver cyst and alveolar hydatid disease.

Clinical course of 4 cases of hepatic peribiliary cysts and a summary of the 38 clinical cases reported in Japan

Abstract: We encountered 4 cases of hepatic peribiliary cysts (HPBC) in our hospital Two were asymptomatic, one was complicated by a choledocholithiasis, and one by cholangitis and sepsis Based on a review of the 38 cases of HPBC clinically diagnosed in Japan, the main problem associated with this disease seemed incorrect preoperative diagnosis leading to an unnecessary hepatectomy Another problem was concomitant cholangitis, which tended to recur and in some cases needed aggressive treatment using drainage

[A case report: Severe bone marrow suppression caused by 6-mercaptopurin in Crohn's disease patient].

Abstract: A 23-year-old man was admitted for treatment of acute exacerbation of ileitis and perianal abscess caused by Crohn's disease. After incision and drainage of the abscess, coupled with antibiotic therapy, 6-mercaptopurine (6-MP) was commenced. His white blood cell (WBC) count on day 12 after initiation of 6-MP was not decreased. However, on day 24 he was re-admitted because of severe myelosuppression (WBC: 300/microl), which was complicated by the recurrence of the perianal abscess. Myelosuppression was prolonged and required the administration of granulocyte colony stimulating factor (G-CSF). G-CSF was continued for 17 days to achieve recovery of his WBC count to a normal level.

[Bezafibrate alone is an effective first-line therapy for primary sclerosing cholangitis: a case report].

Abstract: The patient was a 58-year-old female. Though she had been in good health, increased hepatobiliary enzymes were detected in a health examination. She visited our hospital for close examination. The serum IgG4 level was normal, but ERCP and MRCP showed band-like stricture and beaded appearance of the bile ducts. A diagnosis of primary sclerosing cholangitis (PSC) was made. Since hyperlipidemia was also observed, oral administration of bezafibrate (400mg/day) alone was performed as the initial treatment, and transaminase, ALP, and GGT rapidly decreased. These results suggested that the initial administration of bezafibrate alone is effective against PSC.

A case of hepatosplenic cat scratch disease

Abstract: A 43-year-old man was admitted with idiopathic fever. Abdominal ultrasonogram demonstrated multiple hypoechoic lesions in the spleen. Abdominal CT scan showed multiple hypodense lesions in the liver and spleen. The patient had a cat in his house, and the presence of a very high serous antibody titer for Bartonella henselae led to the diagnosis of hepatosplenic cat scratch disease. It is important to consider this disease in the differential diagnosis of idiopathic fever when multiple lesions are detected in the liver and spleen.

[Superior mesenteric arterial thrombosis complicating ulcerative colitis: A case report].

Abstract: 36-year-old men with ulcerative colitis was attacked by the colic. The thrombus in superior mesenteric artery was revealed by computed tomography. Because the effect of the thrombolysis under intrarterial angiography was insufficient, thrombectomy was enforced under the laparotomy in the same day. The arterial thrombosis is extremely rare in the complication of ulcerative colitis. The activity of ulcerative colitis as one of factors of the appearance of thrombus was suggested.

A case of endocrine cell carcinoma (small cell carcinoma) of duodenum

Abstract: Extra-ampullary duodenal endocrine cell carcinoma is extremely rare. A 65-year-old woman visited our hospital, complaining of epigastralgia, anorexia and vomiting. She was admitted for suspected duodenal or pancreas head tumor by abdominal CT. Fiberscopic examination revealed a circumferential tumor in the extra-ampullary duodenal second portion. Histopathological findings of biopsy specimen showed a small cell carcinoma, and positive immunohistochemical staining for synaptophysin revealed this tumor to be endocrine cell carcinoma. Pylorus-preserving pancreaticoduodenectomy with partial transversocolectomy was performed, and intraoperative washing cytology detected tumor cells in the peritoneal cavity. Although she discharged from hospital uneventfully, she died 11 months later of multiple liver metastases and peritoneal dissemination. This case showed the high malignant potential of this tumor.

Manifestation of liver metastasis 13 years after gastrectomy for gastric GIST

Abstract: A 58-year-old Japanese man underwent partial gastrectomy in 1991 for a tumor showing extra-gastric growth measuring 18 x 16.5 x 8.8 cm in size. An immunohistochemical study yielded a diagnosis of gastric GIST with few mitoses. In 2004, abdominal CT showed a solitary liver metastasis without extrahepatic recurrence and right hepatic lobectomy was performed. No adjuvant treatment has been done and he is alive without recurrence 1 year after the hepatectomy. Long term follow-up of more than 10 years is required after resection of primary tumors if they are diagnosed as high risk GISTs with few mitoses.

[Clinical evaluation of covered self-expandable metallic stent for unresectable malignant stomach pyloric region and duodenal obstruction].

Abstract: We evaluated palliative treatment for unresectable malignant stomach pyloric region and the duodenal obstruction using covered self-expandable metallic stent (SEMS). Fifty-seven patients (26 stomach pyloric stenosis, 31 duodenal stenosis) were underwent palliative treatment using covered SEMS. The covered SEMS was Ultraflex stent for esophageal obstruction. The covered SEMS was successfully indwelled in the target region in 56 patients. The patients became able to ingest orally after a mean of 2 days, and 96% of the patients (54/56) became able to eat solid or semi-solid diets later. The SEMS obstruction by tumor ingrowth or hyperplasia was not occurred, so SEMS was maintenance-free. We concluded covered SEMS was useful palliative treatment because it prevented SEMS obstruction by tumor ingrowth or hyperplasia and it was maintenance-free.