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ABSTRACT: Type 1 autoimmune pancreatitis (AIP) is characterized by a high serum IgG4 concentration and is closely associated with the HLA-DRB1(*)04:05-DQB1(*)04:01 haplotype, for which family studies may disclose its immunogenetic significance. In the present study, we encountered two male siblings with type 1 AIP who exhibited diffuse pancreatic swelling with a capsule-like rim and diffuse pancreatic duct stricture. The younger brother also displayed characteristic IgG4-related sialadenitis and retroperitoneal fibrosis. Contrary to our expectations, the siblings showed only normal or slightly elevated values of serum IgG4 and no HLA DRB1(*)04:05-DQB1(*)04:01 haplotype, suggesting that type 1 autoimmune pancreatitis is associated with multiple immunogenetic factors.
Internal Medicine 01/2013; 52(8):895-9. · 0.94 Impact Factor
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Takashi Muraki,
Norikazu Arakura,
Ryou Kodama,
Suguru Yoneda,
Masafumi Maruyama,
Tetsuya Itou, Takayuki Watanabe,
Masahiro Maruyama,
Akihiro Matsumoto,
Shigeyuki Kawa,
Eiji Tanaka
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ABSTRACT: Background: Endoscopic retrograde cholangiopancreatography (ERCP) is subject to several complications that include a lengthy procedure time, technical difficulty, and active bowel movement induced by air insufflation. In ERCP carried out by non-expert endoscopists who are prone to excessive luminal insufflation, insufflation with carbon dioxide (CO(2) ) may provide better and safer outcomes. We aimed to assess the efficacy and safety of CO(2) insufflation during ERCP by non-expert endoscopists. Methods: This study included 208 consecutive patients who received ERCP, excluding those in poor general health or with obstructive lung disease. The first operator for each patient was a non-expert endoscopist having done 50 or fewer ERCP procedures. Primary outcomes were the changes in cardiopulmonary state during ERCP. Secondary outcomes were ERCP complications. We designed a single-center, randomized, prospective, double-blind, controlled trial with CO(2) and air insufflation during ERCP. Results: CO(2) insufflation did not affect overall procedure progression or results. A positive correlation was observed between procedure time and change in maximal systolic blood pressure from baseline among patients in the air insufflation group, but not in the CO(2) insufflation group (correlation coefficient 0.408 vs 0.114, change in the maximal systolic blood pressure from baseline +4.2 vs+1.2 mmHg/10 min). This was consistent with our findings in patients treated by the first operator alone. The occurrence rate of post-ERCP pancreatitis tended to be lower in the CO(2) group than the air group (4/102 [3.9%]vs 0/106 [0%], P = 0.056). Conclusions: CO(2) insufflation during ERCP by non-expert endoscopists is recommended from the standpoints of efficacy and safety.
Digestive Endoscopy 07/2012; · 1.19 Impact Factor
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ABSTRACT: A 34-year-old pregnant woman with Marfan’s syndrome in the 34th week of gestation was diagnosed with acute DeBakey type I
aortic dissection. Immediately after cesarean section, she underwent emergent operation of combined total aortic arch and
aortic root replacement using cardiopulmonary bypass, deep hypothermia and antegrade cerebral perfusion. Both maternal and
fetal outcomes were good and uneventful. Pregnancy increases the risk of aortic dissection especially for patients with Marfan’s
syndrome. Moreover it should be noted that cardiac surgery using cardiopulmonary bypass and deep hypothermia generally results
in fetal loss. If fetal maturity can be confirmed as in our case, cesarean section should be done before cardiovascular surgery.
We describe here a case of successful operation for mother and infant at the 34th week of gestation.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 53(4):220-222.
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ABSTRACT: IgG4-related disease is a new disease entity involving IgG4 in its clinical presentation and having 6 characteristic features: (1) systemic involvement; (2) solitary or multiple lesions showing diffuse or localized swelling, masses, nodules, and/or wall thickening on imaging; (3) high serum IgG4 concentration >135 mg/dL; (4) abundant infiltration of lymphoplasmacytes and IgG4-bearing plasma cells; (5) a positive response to corticosteroid therapy; and (6) complications of other IgG4-related diseases. To date, most IgG4-related diseases have been recognized as extrapancreatic lesions of autoimmune pancreatitis. This paper will discuss the utility of IgG4 as a biomarker of IgG4-related diseases, including in the diagnosis of autoimmune pancreatitis and its differentiation from pancreatic cancer, in the prediction of relapse, in the long-term follow-up of patients with autoimmune pancreatitis and normal or elevated IgG4 concentrations, and in patients with autoimmune pancreatitis and extrapancreatic lesions, as well as the role of IgG4 in the pathogenesis of IgG4-related disease.
International Journal of Rheumatology 01/2012; 2012:198314.
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2012; 109(6):897-904.
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Masahiro Maruyama,
Norikazu Arakura,
Yayoi Ozaki, Takayuki Watanabe,
Tetsuya Ito,
Suguru Yoneda,
Masafumi Maruyama,
Takashi Muraki,
Hideaki Hamano,
Akihiro Matsumoto,
Shigeyuki Kawa
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ABSTRACT: Autoimmune pancreatitis (AIP) has the potential to progress to a chronic state that forms pancreatic stones. The aim of this study was to clarify the risk factors underlying pancreatic stone formation in AIP.
Sixty-nine patients with AIP who had been followed for at least 3 years were enrolled for evaluation of clinical and laboratory factors as well as computed tomography and endoscopic retrograde cholangiopancreatography findings.
During the course of this study, increased or de novo stone formation was seen in 28 patients, who were defined as the stone-forming group. No stones were observed in 32 patients, who were defined as the non-stone-forming group. Nine patients who had stones at diagnosis but showed no change during the course of this study were excluded from our cohort. Univariate analysis revealed no significant differences in clinical or laboratory factors associated with AIP-specific inflammation between the two groups. However, pancreatic head swelling (P = 0.006) and narrowing of both Wirsung's and Santorini's ducts in the pancreatic head region (P = 0.010) were significantly more frequent in the stone-forming group. Furthermore, multivariate analysis identified Wirsung and Santorini duct narrowing at diagnosis as a significant independent risk factor for pancreatic stone formation (OR 4.4, P = 0.019).
A primary risk factor for pancreatic stone formation in AIP was narrowing of both Wirsung's and Santorini's ducts, which most presumably led to pancreatic juice stasis and stone development.
Journal of Gastroenterology 12/2011; 47(5):553-60. · 4.16 Impact Factor
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Hiroshi Koyama,
Asumi Iesato,
Yuko Fukushima,
Toshihiro Okada, Takayuki Watanabe,
Michihiko Harada,
Tokiko Ito,
Kazuma Maeno,
Yasuhiro Mochizuki,
Kenichi Ito,
Jun Amano
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ABSTRACT: Aromatase inhibitors (AI) have largely replaced tamoxifen as the first-line of treatment for postmenopausal women with advanced or metastatic hormone-receptor-positive breast cancer. However, there is no established strategy for treating AI refractory cases. In this study, we investigated the efficacy of high-dose Toremifene therapy (HD-TOR). From January 2001 through April 2010, nineteen patients received 120 mg of TOR daily. The overall response rate was 36.8% (CR; 1, PR; 6), and the clinical benefit was 47.4%. The clinical benefit rate to each of the metastatic organs were: lung, 42.9%; bone, 13%; liver, 25%; and lymph node, 40%. A higher clinical benefit rate was observed in lung or lymph node metastases. The clinical benefit rate of HD-TOR as first to third-line therapy was 50%, which was more effective than that of fourth-line therapy. Our data suggests that HD-TOR may be one of the effective treatment strategies for patients with AI refractory advanced or metastatic hormone receptor-positive breast cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2011; 38(7):1123-6.
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Ken-Ichi Ito,
Toru Hanamura,
Koichi Murayama,
Toshihiro Okada, Takayuki Watanabe,
Michihiko Harada,
Tokiko Ito,
Hiroshi Koyama,
Toshiharu Kanai,
Kazuma Maeno,
Yasuhiro Mochizuki,
Jun Amano
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ABSTRACT: The aim of the present study was to investigate the role of a multimodality treatment for anaplastic thyroid carcinoma (ATC).
Clinical data of 40 consecutive patients treated between 1985 and 2009 were retrospectively analyzed.
The median survival time (MST) stratified by clinical stage was 6.0 months for stage IVB and 4.2 months for stage IVC. When the stage IVB patients were classified into 2 groups (IVB-a and IVB-b) in accord with the extent of involvement of the tumor, the MST of the patients with IVB-a (9.6 months) was significantly longer than that of patients with IVB-b (4.0 months) (p < .05). The MST of the patients treated with surgery followed by radiation and chemotherapy (13.7 months) tended to be longer compared with the patients treated with 2 or fewer modalities.
The patients with a less-invasive primary tumor may gain a survival benefit from aggressive multimodality therapeutic approaches.
Head & Neck 04/2011; 34(2):230-7. · 2.40 Impact Factor
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ABSTRACT: A man in his 80's was admitted complaining of epigastralgia, and acute pancreatitis was diagnosed. Abdominal CT and MRI showed enlargement of the pancreatic head encircling the descending part of the duodenum and a duodenal diverticulum. Endoscopic retrograde cholangio-pancreatography (ERCP) revealed annular pancreas and high confluence of pancreaticobiliary ducts. Annular pancreas had been reported to have associated with a broad spectrum of pancreatic anomalies, few cases of annular pancreas coexisting with high confluence of pancreaticobiliary ducts, or pancreaticobiliary maljunction have been reported. Combination of both anomalies was interesting from the view point of embryology. We report a rare case of annular pancreas with high confluence of pancreaticobiliary ducts.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2011; 108(9):1589-95.
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The Breast Journal 06/2009; 15(4):435-7. · 1.64 Impact Factor
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ABSTRACT: Breast-conserving surgery (BCS) has been carried out as desirable choice for patients with early-stage breast cancer. However, many patients obliged to abandon BCS because of tumours accompanied by extended intraductal components or multiple tumours. The purpose of this study was to develop a novel endoscopic-assisted technique for skin-sparing mastectomy (SSM) combined with sentinel node biopsy (SNB), followed by immediate breast reconstruction with mammary prosthesis. Between April 2000 and November 2006, 33 patients diagnosed with primary breast cancer underwent endoscopic-assisted SSM. Immediate reconstruction with the mammary prosthesis was carried out in 30 of 33 patients. On postoperative histopathological diagnosis, 21 tumours were diagnosed as ductal carcinoma in situ or lobular carcinoma in situ. Twelve tumours were diagnosed as invasive carcinoma. Eight of 12 invasive carcinomas were accompanied by a wide spreading intraductal component. Two patients were diagnosed as having multicentric carcinomas, which made the standard breast-conserving treatment difficult. After a mean follow-up period of 51.2 months (range 16-86 months), neither locoregional recurrence nor distant metastasis has been detected. Thus, combining SSM and SNB with immediate reconstruction with the mammary prosthesis may offer the selected patients with early-stage breast cancer favourable aesthetic results without incurring additional oncological risks. The procedure could be an alternative treatment option for patients with widely spreading intraductal component or multiple tumours.
ANZ Journal of Surgery 11/2008; 78(10):894-8. · 1.25 Impact Factor
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ABSTRACT: A 34-year-old pregnant woman with Marfan's syndrome in the 34th week of gestation was diagnosed with acute DeBakey type I aortic dissection. Immediately after cesarean section, she underwent emergent operation of combined total aortic arch and aortic root replacement using cardiopulmonary bypass, deep hypothermia and antegrade cerebral perfusion. Both maternal and fetal outcomes were good and uneventful. Pregnancy increases the risk of aortic dissection especially for patients with Marfan's syndrome. Moreover it should be noted that cardiac surgery using cardiopulmonary bypass and deep hypothermia generally results in fetal loss. If fetal maturity can be confirmed as in our case, cesarean section should be done before cardiovascular surgery. We describe here a case of successful operation for mother and infant at the 34th week of gestation.
The Japanese Journal of Thoracic and Cardiovascular Surgery 05/2005; 53(4):220-2.
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ABSTRACT: We report a case of a successfully repaired aberrant right subclavian artery aneurysm combined with bicuspid aortic valve using a multibranched vascular prosthesis. Approaching solely through a median sternotomy under cardiopulmonary bypass, hypothermic circulatory arrest, and selective cerebral perfusion, we performed a successful single-stage correction by aortic valve replacement, resection of aneurysm, and reconstruction of the right subclavian artery.
The Annals of Thoracic Surgery 07/2004; 77(6):2196-7. · 3.74 Impact Factor
