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ABSTRACT: We describe a case of interspousal transmission of hepatitisC virus (HCV) infection after 30years of marriage which was
confirmed by gene analysis. A 60-year-old man was referred to our hospital because of severe hepatic dysfunction. Laboratory
findings showed that HCV-Ab titer and qualitative Amplicor HCV were both positive in low levels. Because the patient regularly
consumes various health foods, it was initially difficult to rule out drug-induced hepatopathy, but the patient was diagnosed
with acute hepatitisC when HCV antibody titer increased 4months later. Because his wife also tested positive for HCV antibody,
interspousal transmission was suspected, and gene analysis was performed. Both husband and wife had HCV 1b, and the base sequence
homology of 1087 base pairs (bp) in the NS5B region was 98.6% (99.4% at the amino acid level). In addition, upon analysis
of the E1 and E2 junctional region sequence (268bp) including hypervariable region 1 (HVR-1), a close relationship (89.2–99.6%)
between clones obtained from each spouse was observed, thus confirming that the source of infection was his wife. Thorough
medical history taking suggested that sexual intercourse was the most likely route of infection. In previous large-scale clinical
studies, the frequency of HCV infection between married couples has been extremely low, but it is important to obtain informed
consent regarding the potential risk of infection.
Clinical Journal of Gastroenterology 04/2012; 3(1):50-56.
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Tetsu Akimoto,
Toshiya Otake,
Akira Tanaka,
Hideaki Takahashi, Toshihiko Higashizawa,
Makoto Inoue,
Katsuhiko Nishino,
Osamu Saito,
Norio Isoda,
Shigeaki Muto,
Kentaro Sugano,
Eiji Kusano
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ABSTRACT: Although the clinical benefits of antiviral treatment in the management of membranous nephropathy (MN) in patients with chronic hepatitis B virus (HBV) infection have been suggested, it should be evaluated more carefully. In this report, we present two cases with quiescent HBV who were administered lamivudine for either the initial treatment of MN or to control the reactivation of HBV during treatment with corticosteroids. No clinical benefit of lamivudine as an initial treatment was observed in one patient, which obliged us to commence administration of prednisolone (PSL). On the other hand, lamivudine seemed to play a pivotal role in the remission of an acute exacerbation of hepatitis B during treatment with PSL and mizoribine in the other patient. These two patients seemed to tolerate administration of PSL with or without an immunosuppressive agent well, since gradual and prompt improvements of nephrotic status were confirmed within a few months, thus suggesting the potential benefit of steroid treatment. There is little consensus regarding the optimal choice of steroids and immunosuppressants for the treatment of MN with chronic HBV infection, due to the potential for stimulation of viral replication and precipitation of hepatic flares. Our observations, however, suggest that treatment with PSL still should be reserved for quiescent HBV carriers with MN. Further studies will be required to determine the optimal timing and appropriate duration of antiviral treatment in such patients requiring long-term immunosuppression.
Clinical and Experimental Nephrology 04/2011; 15(2):289-93. · 1.37 Impact Factor
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ABSTRACT: There are numerous clinical applications for photodynamic therapy in the GI tract. The principal reason for the wide variety of lesions amenable to photodynamic therapy is the ability to treat large areas of mucosa without the need for complete visualization. This report describes observed hemodynamic and histologic changes in rabbit auricles after photodynamic therapy and the feasibility of photodynamic therapy for esophageal varices.
Porfimer sodium and an argon-dye laser (630 nm, 300 mW/cm(2)) were used. Twenty rabbits were grouped according to porfimer sodium dose: group 1 (2.0 mg/kg, n = 10); group 2 (1.0 mg/kg, n = 6); group 3 (0.2 mg/kg, n = 4). Rabbit auricular veins were classified according to time duration of laser illumination: V(0), no illumination; V(5), 5 minutes; V(10), 10 minutes; V(15), 15 minutes. Hemodynamic changes were observed with a laser Doppler blood flow meter. Histologic changes were evaluated by light microscopy.
For groups 1 and 2, there was a significant decrease in blood flow for V(15) after photodynamic therapy, but not in group 3. There was a significant difference in the grade of thrombus between V(5) and V(15) in groups 1 and 2, and between V(10) and V(15) in group 2. There was a significant difference in the grade of venous dilation (congestion) for V(15) between groups 1 and 3 (p < 0.05, Kruskal-Wallis test).
Endoscopic photodynamic therapy could possibly improve the outcome for endoscopic treatment of esophageal varices beyond that achieved by sclerotherapy or band ligation alone.
Gastrointestinal Endoscopy 04/2002; 55(3):420-4. · 4.88 Impact Factor
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ABSTRACT: The introduction of a guidewire through bile duct strictures may facilitate transpapillary bile duct biopsy and subsequent biliary drainage.
Endoscopic bile duct biopsy was attempted in 61 patients with bile duct strictures. After the introduction of a guidewire into the bile duct, biopsy forceps were inserted via the papilla. Both devices were inserted through the working channel (3.2 mm in diameter) of a conventional duodenoscope. After the procedure, an endoscopic naso-biliary drainage catheter was advanced along the guidewire. The success rate of inserting the biopsy forceps, the sensitivity of the biopsy, and the success rate of endoscopic biliary drainage after the biopsy were analyzed prospectively.
The final diagnosis was malignant strictures in 50 patients and benign strictures in 11. The success rate of inserting biopsy forceps without performing endoscopic papillary balloon dilation was 85%. The sensitivity of the biopsy for primary bile duct cancer (83%) was significantly higher (P < 0.05) than that of pancreatic cancer (47%). All patients had successful endoscopic biliary drainage after the procedure.
A previously placed guidewire facilitates insertion of biopsy forceps and endoscopic biliary drainage. The histological diagnosis of cancer is more likely with bile duct cancer than with pancreatic cancer.
Journal of Gastroenterology and Hepatology 03/2002; 17(3):332-6. · 2.87 Impact Factor
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ABSTRACT: Background: The introduction of a guidewire through bile duct strictures may facilitate transpapillary bile duct biopsy and subsequent biliary drainage.Methods: Endoscopic bile duct biopsy was attempted in 61 patients with bile duct strictures. After the introduction of a guidewire into the bile duct, biopsy forceps were inserted via the papilla. Both devices were inserted through the working channel (3.2 mm in diameter) of a conventional duodenoscope. After the procedure, an endoscopic naso-biliary drainage catheter was advanced along the guidewire. The success rate of inserting the biopsy forceps, the sensitivity of the biopsy, and the success rate of endoscopic biliary drainage after the biopsy were analyzed prospectively.Results: The final diagnosis was malignant strictures in 50 patients and benign strictures in 11. The success rate of inserting biopsy forceps without performing endoscopic papillary balloon dilation was 85%. The sensitivity of the biopsy for primary bile duct cancer (83%) was significantly higher (P < 0.05) than that of pancreatic cancer (47%). All patients had successful endoscopic biliary drainage after the procedure.Conclusion: A previously placed guidewire facilitates insertion of biopsy forceps and endoscopic biliary drainage. The histological diagnosis of cancer is more likely with bile duct cancer than with pancreatic cancer.© 2002 Blackwell Science Asia Pty Ltd
Journal of Gastroenterology and Hepatology 02/2002; 17(3):332 - 336. · 2.87 Impact Factor
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ABSTRACT: Because biopsy forceps tend to turn towards the right hepatic duct during endoscopic retrograde cholangiopancreatography
(ERCP), selective access to the left hepatic duct is difficult. Methods. In this study, we managed to insert biopsy forceps selectively into the left hepatic duct, by using a looping technique,
in three patients. Biopsy forceps were inserted into the right hepatic duct by the conventional method. The elevator of the
endoscope was kept down, and the shaft of the biopsy forceps was then advanced to the duodenal cavity until it formed a loop
between the endoscope and the papilla. During the procedure, the tip of the forceps was kept at the hepatic hilus. Results. In this condition, we were able to slowly rotate the tip of the forceps and direct the forceps towards the left. Sufficient
material from the left hepatic duct was obtained in all patients. Conclusions. The looping technique was useful for selective access to the left hepatic duct.
Journal of Gastroenterology 06/2001; 36(7):492-494. · 4.16 Impact Factor
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ABSTRACT: Background: An imaging modality that can be used to identity small stones after a biliary lithotripsy is required. Intraductal ultrasonography was evaluated by using percutaneous transhepatic cholangioscopy as the gold standard.Methods: Lithotripsy, under percutaneous transhepatic cholangioscopy guidance, was performed in 20 patients. A thin-caliber ultrasonic probe (2.0 mm in diameter and 20 MHz frequency) was inserted into the bile duct through the percutaneous tract after lithotripsy, and residual stones were identified. This was followed by percutaneous transhepatic cholangioscopy.Results: In the extrahepatic bile ducts, intraductal ultrasonography provided images of all the stones demonstrated on cholangioscopy (n = 11). The sensitivity was superior to that of cholangiography (P < 0.005). However, in the intrahepatic bile ducts, intraductal ultrasonography only visualized the stones located in the cannulated lobe. Extrahepatic stones smaller than 5.0 mm in diameter or in a common hepatic duct larger than 15.0 mm in diameter were missed by cholangiography, but were visualized by the use of intraductal ultrasonography (P < 0.05).Conclusions: Intraductal ultrasonography is equivalent to cholangioscopy in the extrahepatic bile ducts. Cholangiography and intraductal ultrasonography should be used in combination to image intrahepatic and extrahepatic stones.
Journal of Gastroenterology and Hepatology 12/2000; 16(1):100 - 103. · 2.87 Impact Factor
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ABSTRACT: Percutaneous recanalization of the bile duct is essential for placing biliary stents and carrying out other interventions.
This prospective study was performed to establish safe approaches for percutaneous recanalization of the bile duct when it
had previously resulted in failure. Between July 1995 and July 1999, percutaneous recanalization of the bile duct was attempted
in 58 patients with a malignant biliary stenosis. When recanalization failed, an endoscopic naso-biliary drainage (ENBD) catheter
was placed across the stenosis. The procedure was again attempted along the ENBD catheter. In the period of the study, four
patients underwent successful recanalization after ENBD, although attempts prior to ENBD had been unsuccessful. As a result,
the success rate of recanalization in the period was 100% (58/58). When recanalization fails, the use of an ENBD catheter
may provide access to the biliary tree, and the biliary stenosis can be recanalized safely.
Journal of Gastroenterology 07/2000; 35(8):622-626. · 4.16 Impact Factor
