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ABSTRACT: A 50-year-old man with chronic HCV infection had been received the injections of 12MU of Consensus-Interferon (C-IFN) three times a week in a previous hospital. Six months later, C-IFN therapy was terminated because of fever and massive ascites. Diuretics and antibiotics had not been effective against these symptoms. In the meantime, skin symptoms of purpura and giant ulcers in the extremities developed, and he was transferred to our hospital. Because skin biopsy revealed vasculitis and serum MPO-ANCA was positive, the diagnosis of ANCA associated vasculitis was made. Methylpredonizoron pulse therapy improved skin symptoms and massive ascites, and the skin ulcers eventually disappeared. ANCA is suggested to be responsible for this rare complication.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2009; 105(12):1787-93.
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ABSTRACT: Hepatitis-associated aplastic anemia (HAA) has been reported to show a successful outcome following immunosuppressive treatment. On the other hand, the long-term prognosis of HAA has not been sufficiently clarified. Herein we report a patient with HAA who had been treated with cyclosporine for one year, and maintained complete remission without treatment. Ten years later, acute non-A, non-B, and non-C hepatitis reccurred followed by bone marrow aplasia. A second immunosuppressive treatment with antithymocyte globulin and cyclosporine was effective. This case might provide useful information for the long-term follow-up of patients with HAA.
Internal Medicine 02/2008; 47(19):1733-7. · 0.94 Impact Factor
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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.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 07/2006; 103(6):655-60.
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ABSTRACT: Motilin and ghrelin have been recognized as important endogenous regulators of gastrointestinal motor function in mammals, mediated respectively by the motilin receptor and by the closely related ghrelin receptor. The aims of this study were to explore the distribution of motilin and ghrelin receptors along the human gastrointestinal tract and to establish the molecular nature of the human motilin receptor.
Post mortem and surgical human tissue specimens with no hemorrhage, necrosis, or tumor were obtained from various parts of the gastrointestinal tract. We analyzed levels of expression of mRNA for motilin and ghrelin receptors and examined their molecular identities. Portions of some specimens were also studied by immunohistochemistry for expression of the motilin and ghrelin receptor.
The long form of the motilin receptor, but not the short form, was expressed in all parts of the gastrointestinal tract, and expressed at higher levels in muscle than in mucosa. Motilin receptor immunoreactivity was present in muscle cells and the myenteric plexus, but not in mucosal or submucosal cells. In contrast, ghrelin receptor mRNA was expressed equally in all parts of the gastrointestinal tract, with similar levels of expression in mucosal and muscle layers.
Both the motilin and ghrelin receptors are expressed along the human gastrointestinal tract, but they have clearly distinct distributions in regard to both level and layer. The diffuse muscle expression of the motilin receptor, at both the levels of the gene and the protein product, along the entire gastrointestinal tract makes it a useful potential target for motilide drugs for dysmotility.
Journal of Gastroenterology 04/2006; 41(3):223-30. · 4.16 Impact Factor
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ABSTRACT: We investigated the alteration of nutritional status in 144 patients who were treated for the first time with endoscopic sclerotherapy or endoscopic variceal ligation during their therapies. The serum levels of albumin, cholinesterase and total cholesterol were compared before and after treatment. The serum level of cholinesterase declined significantly. To investigate the impact of aging on the changes of nutritional status we divided all patients into two groups: (1) under 65 years, and (2) over 65 years. The decline of serum albumin of elderly patients (n=65) was significantly greater than that of younger patients (n=79). A branched-chain amino acid (BCAA)-enriched nutrient mixture for nutritional treatment significantly suppressed the decline of serum albumin in elderly patients. Nutritional treatment with a BCAA-enriched nutrient mixture should be considered during endoscopic therapy for esophageal varices, especially in elderly patients.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 08/2005; 102(7):880-7.
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Eiji Takeshita,
Hidetaka Matsui,
Naozumi Shibata,
Shinya Furukawa,
Tomoyuki Yokota,
Hidehiro Murakami,
Yoshiou Ikeda,
Yoichi Hiasa,
Bunzo Matsuura,
Kojiro Michitaka,
Morikazu Onji
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ABSTRACT: Variceal bleeding is a common, life-threatening complication of primary biliary cirrhosis (PBC). Recently, several reports have suggested that the existence of esophageal varices in patients with PBC is a significant factor in the assessment of disease prognosis. However, there have been no reports on the recurrence of esophageal varices following treatment in patients with PBC. In this study, we investigated the recurrence of esophageal varices in PBC patients and attempted to identify predictive factors for the recurrence of esophageal varices.
Between April 1993 and August 2003, 138 patients with esophageal varices who had been treated by endoscopic variceal ligation (EVL; 96 men and 42 women; age, 33-83 years; mean, 62.6 +/- 10.1 years), were enrolled in the present study. The diagnosis of esophageal varices was made by upper gastrointestinal endoscopy, and the varices were graded according to the criteria of the Japanese Research Society for Portal Hypertension. The relationship between the recurrence of esophageal varices and factors such as biochemical and hematological parameters, as well as the etiology of the liver disease, was analyzed using the Kaplan-Meier method and the multivariate Weibull regression model.
PBC patients had an earlier recurrence of esophageal varices compared to non-PBC patients, and two factors, prothrombin time and etiology (PBC/non-PBC), were indicative of significantly earlier recurrence of esophageal varices.
We should be extra careful in the follow-up of patients with PBC after therapy for esophageal varices.
Journal of Gastroenterology 12/2004; 39(11):1085-9. · 4.16 Impact Factor
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Naozumi Shibata,
Hidetaka Matsui, Eiji Takeshita,
Tomoyuki Yokota,
Yuichi Kobayashi,
Yoshiou Ikeda,
Yoshihiro Yakushijin,
Takaaki Hato,
Bunzo Matsuura,
Norio Horiike,
Morikazu Onji
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ABSTRACT: A 21-year-old man with an 8-year history of acquired immunodeficiency syndrome (AIDS) presented with abdominal pain, jaundice and dark urine. Laboratory data on admission revealed cholestasis. The total bilirubin concentration was 10.0 mg/dL. Alanine transaminase and aspartate transaminase were 198 IU/L and 195 IU/L, respectively. The serum alkaline phosphatase level was 2724 IU/L. γ-Glutamyl transferase was 1770 IU/L. Abdominal ultrasonography and computed tomography revealed dilation of the common bile duct and intrahepatic ducts without gallstones. Endoscopic retrograde cholangiopancreatography showed dilation of the common bile duct up to the level of the ampulla of Vater with partial stenosis. Endoscopic sphincterotomy was performed. The abdominal pain and jaundice resolved immediately and the liver function tests were significantly improved. The patient developed a subarachnoid hemorrhage and died of respiratory arrest 2 months after the endoscopic sphincterotomy.
Digestive Endoscopy 06/2004; 16(3):234 - 236. · 1.19 Impact Factor
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2004; 100(12):1400-4.
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ABSTRACT: Primary biliary cirrhosis (PBC) is usually classified as either asymptomatic PBC (a-PBC) or symptomatic PBC (s-PBC). Although the proportion of a-PBC versus s-PBC patients has been consistently increasing, it is not clear whether the present criteria for the staging of PBC are optimal or not. We investigated the clinical stage of PBC patients from the standpoint of esophagogastric varices (EGV).
One hundred and nine PBC patients were enrolled in this retrospective study. We investigated the clinical features of PBC based on laboratory data, histological stage, symptoms, and existence of EGV. In addition, the clinical course and prognosis in patients who were periodically followed up were also studied.
(1) EGV was detected in a-PBC patients, and there was no difference in the grade of EGV between a-PBC and s-PBC patients. (2) a-PBC patients with EGV had more liver damage than those without EGV, and a-PBC patients with EGV had a poorer prognosis than those without EGV. (3) Three of 11 patients who progressed from a-PBC to s-PBC within 3 years had EGV. (4) One of 3 a-PBC patients with EGV had progressed to s-PBC at 3-year follow-up.
These results indicate that EGV is one of the most important factors for evaluating PBC. Therefore, we would like to propose that a-PBC patients with EGV should either be included in the presently defined s-PBC class, or that new prognostic classes of PBC be created that include EGV as a prognostic factor.
Journal of Gastroenterology 02/2003; 38(11):1060-5. · 4.16 Impact Factor
