[show abstract][hide abstract] ABSTRACT: We report a rare case of pancreatic acinar cell carcinoma with widespread metastases in a 68-year-old woman who presented with subcutaneous nodules as the initial symptom. Computed tomography showed a pancreatic mass with hepatic tumors and enlarged lymph nodes besides ring-enhanced subcutaneous nodules. Magnetic resonance diffusionweighted imaging detected the presence of lesions in other organs. Histological analysis of a colonic polypoid lesion revealed carcinoma with endocrine and acinar differentiation compatible with pancreatic origin. Regrettably, she died of a cerebral infarction without any treatment, and autopsy findings confirmed our diagnosis.
[show abstract][hide abstract] ABSTRACT: A 24-year-old man presented with abdominal distension, diarrhea, and nausea. Blood tests showed eosinophilia (WBC 14400/microl, Eos 36%) and slight hypoproteinemia (TP 6.4 mg/dl, Alb 3.7 mg/dl). Ultrasonography and computed tomography revealed massive ascites (WBC 11500/microl, Eos 95%, protein 4.7 g/dl) and wall thickening of the small intestine. Endoscopic and histological examinations showed mucosal redness and edema with eosinophilic infiltration throughout the digestive tracts. Fecal alpha1- antitrypsin clearance was increased (44.6 ml/day). A diagnosis of eosinophilic gastroenteritis with ascites and protein-losing gastroenteropathy was made, and was classified as mixed type of both predominant subserosal and mucosal disease. Prednisolone therapy improved all the symptoms and findings. Measurements of serum levels of several cytokines and chemokines showed that interleukin-5 and soluble interleukin-2 receptor, but not eotaxin, were possible indicators of the disease activity. It should be kept in mind that eosinophilic gastroenteritis is one of the causes of ascites.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 11/2009; 106(11):1625-35.
[show abstract][hide abstract] ABSTRACT: A 48-year-old woman with iron deficiency anemia (Hb 8.1 g/dl) and Helicobacter pylori (H. pylori)-associated enlarged fold gastritis underwent successful H. pylori eradication. Hemoglobin, serum iron concentrations, and other indices of iron deficiency anemia reached almost normal levels 10 to 16 months after the first eradication treatment. Iron absorption tests and measurements of basal acid output were performed before and after eradication therapy. Iron absorption almost doubled within 3.5 months, whereas basal acid output was nothing but it increased after 15 months. Therefore, it was suggested that the increase in iron absorption was possibly involved in improvement of iron deficiency anemia after H. pylori eradication therapy. Furthermore, it was also suggested that mechanisms other than increase in acid secretion might be involved in increase in iron absorption.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 10/2009; 106(10):1508-15.
[show abstract][hide abstract] ABSTRACT: A 73-year-old woman was diagnosed as having tuberculosis of ileocecum by colonoscopy and started on medication. A month later, she admitted for ileus. Colonoscopy showed improvement of tuberculosis of ileocecum. An ileus tube was inserted on the same day, and ileus was improved once. But after removing the tube, she had ileus again. Computed tomography just after re-inserting an ileus tube with Amidotrizoic acid showed 3 stenoses of ileum. A partial resection of the small intestine was performed. Mycobacterium tuberculosis with PCR was positive. A postoperative course was uneventful and no recurrence has occurred up to now. During treatment of tuberculosis, ileus caused by intestinal tuberculosis may occur. It must be considered to examine the small intestine before beginning to treat tuberculosis of ileocecum or colon.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 03/2009; 106(2):208-15.
[show abstract][hide abstract] ABSTRACT: A 73-year-old woman without a history of allergic diseases visited our hospital complaining of sore throat and nocturnal cough. Blood tests showed marked eosinophilia (18000/mm(3);WBC 21900/mm(3), Eos 82.0%) with normal serum levels of C-reactive protein, non-specific and various allergen-specific IgE. Stool tests for protozoa or helminthic ova were negative. Chest X-ray films showed no pulmonary abnormalities. Endoscopic and histological examinations revealed reflux esophagitis (grade C according to the Los Angeles Classification System) with hiatal hernia with inflammatory infiltrates including eosinophils within the esophageal mucosa. A computed tomography showed the thickening of the esophageal wall. An administration of lansoprazole improved reflux esophagitis and also eosinophilia, and an alteration to famotidine caused heartburn with an increase in eosinophils. A re-alteration to omeprazole relieved the symptom and decreased eosinophils. It was shown that gastroesophageal reflux disease was one of the possible causes of eosinophilia.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 05/2007; 104(4):542-7.
[show abstract][hide abstract] ABSTRACT: A 63-year-old man visited our hospital complaining of brown urine. A physical examination showed jaundice of the skin and conjunctiva bulbar. Blood tests showed elevated serum levels of bilirubin and hepatobiliary enzymes. A type 2-like mass lesion was found near the papilla of Vater during the endoscopic retrograde cholangiopancreatography and was histologically proven to be a well-differentiated adenocarcinoma. A diagnosis of obstructive jaundice due to primary duodenal cancer arising near the papilla of Vater was made. After the jaundice was decreased by endoscopic biliary stenting, a pancreatoduodenectomy was performed. A histopathological examination of the resected specimen concerning the location and manner of invasion of cancer cells revealed that the cancer arose from the duodenal mucosa near the papilla of Vater.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 07/2006; 103(6):636-42.