-
[show abstract]
[hide abstract]
ABSTRACT: Recently, the alteration of peripheral T cells has become a focus of attention in research on Crohn's disease (CD). To examine the characteristics of peripheral T cells in CD patients, we analyzed the expression of a memory T cell marker (CD45RO(Bright)CD3+) and the cytokine production by peripheral helper and cytotoxic T cells in patients with CD. With the use of monensin to prevent the secretion of cytokines under stimulation, we measured the count of intracellular cytokine-positive cells for production of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-2, IL-4, IL-6, IL-10, and granulocyte-macrophage colony stimulating factor (GM-CSF) in the peripheral T cell population using flow-cytometry. The counts of lymphocytes, T cells, and helper T cells in patients with CD were significantly lower than in normal volunteers. Although no difference in the counts of lymphocytes, total T cells, helper and cytotoxic T cells was observed, the counts of intracellular cytokine producing helper T cells in IFN-gamma, TNF-alpha or GM-CSF were significantly higher in active cases than in quiescent cases. These results suggest that stable CD patients are immunosuppressive, and activation of some kinds of T-cells, especially Th1-associated cytokine producing T-cells, correlate with disease progression. Th1-associated cytokine analysis of peripheral T cells may be one of the useful markers to evaluate the activeness of Crohn's disease.
Hiroshima journal of medical sciences 04/2005; 54(1):1-8.
-
[show abstract]
[hide abstract]
ABSTRACT: For easy screening of genetic instability in colorectal cancers, we tried BAT-26 and BAT-25 mononucleotide repeats using fluorescent analysis and evaluated their usefulness and problems compared with other markers: D5S346, D17S250, D2S123, and D2S391, D4S392 (located near BAT-26 and BAT-25 respectively). The high-frequency of MSI (MSI-H) tumours, defined as tumours having instability in more than two markers, were detected in 8/146 (5.5%). These MSI-H cases were younger ages at diagnosis, and showed significantly higher incidences of right side location, and poorly differentiated histology than other cases (p<0.05). Four cases (2.7%) showed a 1 bp size shift in BAT-26 and 2 of them showed loss of heterozygosity (LOH) at D2S391 near BAT-26 locus. Among 9 cases with a 1 bp size shift in BAT-25, 6 cases showed LOH at D4S392 near the BAT-25 locus (p=0.035). In all 4 cases, non-cancerous DNA had two analogous peaks of BAT-26, indicating the heterozygosity of BAT-26 in constitutional DNA. This phenomenon was also detected in the peaks of BAT-25 in some cases, in whose constitutional DNAs, 1 bp size shift was also detectable in three other markers. To elucidate the reasons for the alterations of the 1 bp size shift of peak of these markers, we examined by microsatellite analysis mixed samples of tumour DNA with complete loss of the one allele at the 1p loci and each constitutional DNA sample of neuroblastoma patients. One base shift of the peak signal of the microsatellite marker was clearly obtained in proportion to the ratio of cancerous DNA and constitutional DNA. Fluorescent-based analysis of BAT-26 or BAT-25 was easy and useful for detection of MSI-H in colorectal cancers without analyzing non-cancerous DNA. A 1 bp size shift in BAT-26 or BAT-25 was considered to be affected by LOH at these loci. Thus, it is important to distinguish MSI from LOH to evaluated MSI using these markers.
International Journal of Oncology 05/2003; 22(4):807-13. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to assess the long-term (greater than 2 years) results of seton drainage on anal fistulae in patients with Crohn's disease.
Between September 1990 and September 1999, 32 patients with Crohn's disease underwent seton drainage for complex anal fistulae. The median follow-up time in these patients was 62 months (range, 25-133 months). In 10 patients (31.3%), recurrent perineal abscesses occurred with inlying seton drainage, and these were drained by re-insertion of the seton. A Malecot catheter was also inserted in 8 patients with recurrence.
The overall success rate of long-term seton usage was 87.5%. The subsequent associated procedure was simple seton removal ( n = 9), secondary core-out fistulectomy ( n = 7), or lay-open fistulotomy ( n = 4). Eleven patients still had the seton in place. Recurrence developed in 3 patients (33%) who underwent simple seton removal and in 2 patients (18.2%) who underwent the secondary core-out procedure or fistulotomy. At the last follow-up examination, continence had not changed in 28 (87.5%) of the 32 patients. No change in continence was experienced by 10 of the 11 patients who underwent secondary fistulotomy or the secondary core-out procedure.
Long-term seton drainage for complex anal fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function. A relatively good result was achieved by the secondary core-out procedure or fistulotomy at the time of seton removal.
Journal of Gastroenterology 02/2002; 37(11):912-5. · 4.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: The aim of this study was to determine the contribution of gastrointestinal motility to bowel function and the pathogenesis of pouchitis after ileal pouch-anal anastomosis. METHODS: Gastrointestinal transit time was assessed by a radiopaque marker technique in 32 patients with ulcerative colitis. RESULTS: Small intestinal transit time and pouch emptying time were 4.12 hours and 4.12.5 hours, respectively. There was no significant difference in pouch emptying time between patients with and without pouchitis. When only patients with acute pouchitis that responded to metronidazole were analyzed, there was a trend toward a prolonged pouch emptying time compared with those without pouchitis (P=0.095). Whole gut transit time was inversely correlated with 24-hour stool frequency in patients without pouchitis (r=–0.63,P<0.005). In the analysis of regional transit time, only small intestinal transit time was inversely correlated with 24-hour stool frequency (r=–0.472,P<0.05). Significant prolongation of small intestinal transit time was demonstrated in patients over a period of 41 months (the median time) after ileostomy closure compared with those whose pouches had been functioning for 6 to 41 months (5.41.7 hoursvs. 3.11.3 hours,P<0.005). CONCLUSIONS: There was an association between small intestinal motility and bowel frequency. Further investigation is necessary in the pathogenesis of acute pouchitis regarding the relationship between delayed pouch emptying and subsequent development of mucosal inflammation.
Diseases of the Colon & Rectum 11/2001; 44(12):1808-1813. · 3.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hepatic partial ischemic/reperfusion (I/R) injury, in which ischemic and nonischemic areas of the liver are likely to respond
to each other after reperfusion, often occurs following hepatobiliary surgical procedures. Kupffer cells (KCs) are considered
to play a major role in hepatic I/R injury. To study the activation of KCs in ischemic and nonischemic liver tissues following
hepatic I/R, we investigated the superoxide generation and proinflammatory cytokine production of KCs in both liver parts
in a rat model of partial hepatic I/R injury. KC superoxide generation in the ischemic and nonischemic lobes was upregulated
6 and 24 h after reperfusion, respectively, and then accelerated. The production of interleukin-1β (IL-1β) by KCs in the ischemic
lobes increased during the early and late phases, 6 h and 48–72 h after reperfusion, respectively. A late increase in IL-1β
production was also observed in the nonischemic lobes. Production of tumor necrosis factor-α (TNF-α) increased 6–24 h after
reperfusion in both lobes. Upregulation of IL-1β mRNA in the ischemic lobes preceded the upregulation of TNF-α mRNA in both
lobes. The hepatic partial I/R process results in activation of KCs in ischemic and nonischemic areas of the liver. The KCs
are activated during the early phase after reperfusion in the ischemic areas, followed by activation in both the ischemic
and nonischemic areas. This could be a cause of liver dysfunction after partial hepatic I/R during surgery.
Surgery Today 01/2001; 31(2):140-148. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Involvement of the gastroduodenum is extremely rare in Crohn's disease. For obstructing duodenal Crohn's disease, bypass
procedures have traditionally been selected. However, more recently, strictureplasty has become an acceptable surgical option.
We treated two Crohn's disease patients with short proximal duodenal stenosis, using Finney-type strictureplasty. Their postoperative
courses were uneventful and they have remained asymptomatic during follow-up periods of more than 5 years, and 4 months, respectively.
Owing to the good clinical results of our two patients, we consider strictureplasty to be indicated for short proximal duodenal
stenosis in Crohn's disease.
Journal of Gastroenterology 11/2000; 35(12):929-932. · 4.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a case of progression of primary biliary cirrhosis (PBC) after proctocolectomy for ulcerative colitis. A 43-year-old
woman underwent a total proctocolectomy after being diagnosed with ulcerative colitis. In the course of the preoperative investigation,
liver function test results were within the normal range. Four months after the proctocolectomy, the patient showed a high
level of alkaline phosphatase (2398 IU/l) and a positive anti-mitochondrial antibody titer (>1 : 160). There were no associated
symptoms. A liver biopsy demonstrated expansion of all portal areas by infiltrates of lymphocytes and histiocytes. These appearances
indicated chronic biliary disease and were compatible with PBC. The association of PBC and ulcerative colitis is rare. However,
a review of the recent literature suggests that PBC and ulcerative colitis may be associated; this combination should be kept
in mind.
Journal of Gastroenterology 10/2000; 35(11):870-872. · 4.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 29-year-old woman was hospitalized with a 1-month history of postprandial epigastric pain, nausea, and vomiting. An upper
gastrointestinal tract X-ray series showed a marked narrowing of the pyloric region. A histological examination of duodenal
mucosal biopsy samples showed granulomatous inflammation, and thus a diagnosis of intrinsic duodenal Crohn's disease was made.
A second upper gastrointestinal tract X-ray revealed a persistent gastric outlet obstruction. At laparotomy, the duodenal
wall was found to be thickened over a distance measuring 3.5cm in length from the pyloric ring. A longitudinal incision was
made over the entire length, up to 5.5cm beyond the pyloric ring on either side, while Finney-type anastomosis was also performed.
A postoperative upper gastrointestinal tract X-ray showed an improvement in the gastroduodenal passage. Enteral nutrition
therapy was provided postoperatively. Omeprazole was administered at a dose of 20mg/day for 2 months. The patient currently
remains on maintenance therapy with famotidine at 20mg/day and is clinically doing well.
Surgery Today 08/1997; 27(9):858-862. · 1.22 Impact Factor
-
Takashi Kodama,
Takahiro Santo,
Takashi Yokoyama,
Yoshio Takesue,
Eiso Hiyama, Yuji Imamura,
Yoshiaki Murakami,
Hiroaki Tsumura,
Kanae Shinbara,
Naokuni Tatsumoto,
Yuichirou Matsuura
[show abstract]
[hide abstract]
ABSTRACT: We examined the clinical features of 14 men (mean age 72 years) with postoperative enteritis caused by methicillin-resistantStaphylococcus aureus (MRSA). The patients had all undergone surgery for the treatment of digestive diseases and had received antibiotic prophylaxis
consisting of an extended-spectrum cephem. Diarrhea appeared a mean of 3.3 days postoperatively and lasted for 5 days on average.
In severe cases organ insufficiency was involved. Coagulase-positive staphylococci were the predominant organisms isolated
from watery diarrhea. In 13 of 14 patients, coagulase type II isolates producing enterotoxins A, C and toxic shock syndrome
toxin-1 (TSST-1) withenterotoxin A, C, andtst genes were isolated. These strains were sensitive to vancomycin and arbekacin; however, they were highly resistant to many
other antibiotics. We also investigated the effects of a glucocorticoid hormone and gamma globulin on production of tumor
necrosis factor-α (TNF-α) and interleukin-2 (IL-2) obtained from healthy volunteers. TNF-α and IL-2 production was enhanced
by TSST-1 and the supernatant of Iscove-modified dulbecco medium, in which coagulase type II isolates producing enterotoxins
A, C and TSST-1 with enterotoxin A, C were cultured for 24h. Both glucocorticoid hormone and gama globulin suppressed TNF-α
and IL-2 production, thus suggesting that these drugs may be effective in treating postoperative MRSA enteritis.
Surgery Today 08/1997; 27(9):816-825. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study was designed to determine the influence of ileal pouch capacity and anal sphincteric function on the clinical outcome
after ileal pouch-anal anastomosis. A total of 24 patients who had undergone ileal pouch-anal anastomosis (J pouch) for ulcerative
colitis were studied. The 24-hour stool frequency was found to be inversely correlated with the sensitivity threshold volume
(STV), maximal tolerance volume (MTV), and distensibility, but was independent of the maximal resting pressure and maximal
squeeze pressure. Patients experiencing nocturnal fecal incontinence had maximal resting pressures that were significantly
lower than those of nocturnally continent patients. Among the patients with fecal incontinence, those with frequent soiling
had lower resting pressures, STV, and distensibility than the patients with intermittent spotting. In addition, the STV in
patients needing nocturnal evacuation were lower than those of patients who did not evacuate after falling asleep. The conclusions
are as follows. Both stool frequency and the need for nocturnal pouch evacuation correlated directly with pouch volume. Anal
incontinence was more common in patients with low internal sphincteric function. In addition, frequent and gross nocturnal
incontinent patients demonstrate a worse function in both the anal sphincter and reservoir than those with intermittent spotting.
Surgery Today 04/1997; 27(5):392-397. · 1.22 Impact Factor
-
Takashi Kodama,
Takashi Yokoyama,
Yoshio Takesue,
Mitsuaki Okita,
Atsushi Nakamitsu,
Eiso Hiyama, Yuji Imamura,
Takahiro Santo,
Yoshiaki Murakami,
Hiroaki Tsumura,
Kanae Shinbara,
Katsunari Miyamoto,
Naokuni Tatsumoto,
Yuichirou Matsuura
[show abstract]
[hide abstract]
ABSTRACT: The severity and predicted outcome of postoperative Pseudomonas aeruginosa (P. aeruginosa) infections (PPAI) was evaluated using a severity scoring system based on a simplification and modification of the APACHE II system. A total of 86 patients in whom P. aeruginosa was isolated from various sources were examined. PPAI developed in 50 patients, resulting in an overall mortality rate of 24%. An increased severity score (SS) correlated with an increased risk of developing PPAI. Thus, PPAI developed in 33% of the patients with an SS of 0–1, in 66.7% of those with an SS of 2–3, and in 100% of those with an SS of 6 or higher. Moreover, the mortality rate of the patients with an initial score of 6 or higher was 50%. The mean (SD) initial severity score was 5.42.9 for survivors and 2.92.6 for nonsurvivors (P
Surgery Today 01/1995; 25(8):672-678. · 1.22 Impact Factor
-
Yoshiaki Murakami,
Takashi Yokoyama,
Takashi Kodama,
Yoshio Takesue,
Mitsuaki Okita,
Atsushi Nakamitsu, Yuji Imamura,
Takahiro Santo,
Hiroaki Tsumura,
Katsunari Miyamoto,
Yuichiro Matsuura
[show abstract]
[hide abstract]
ABSTRACT: Nuclear DNA content in eight surgically resected mucin-producing pancreatic tumors (MPPT) consisting of two mucinous intraductal adenocarcinomas (MIDAC), two mucinous intraductal adenomas (MIDA), one mucinous cystadenocarcinoma (MCAC), and three mucinous cystadenomas (MCA) were measured by flow cytometry using paraffin-embedded tissue samples. The technique of Shutte was used for the preparation of paraffin-embedded tissue into single dissociated nuclei, while the method of Vindelov was used for staining the isolated nuclei with propidium iodine. Clinicopathologically, the four patients with MIDAC or MIDA were all male and had cystic lesions with a dilated pancreatic duct at the head of the pancreas, while the four patients with MCAC or MCA were all females and had cystic tumors at either the body or tail of the pancreas. All eight patients with MPPT had no metastasis to the regional lymph nodes and were all still alive without recurrence. In an analysis of nuclear DNA content, seven of eight patients had DNA diploid tumors while one patient with a MIDAC perforating the duodenum and choledochus had a DNA aneuploid tumor. Thus, these findings suggest that DNA diploid patterns in MPPT might be associated with a favorable prognosis in MPPT although some patients whose MPPT invaded the surrounding organs might have DNA aneuploid tumors.
Surgery Today 01/1993; 23(6):491-495. · 1.22 Impact Factor
-
Yoshiaki Murakami,
Takashi Kodama,
Yoshio Takesue,
Mitsuaki Okita,
Atsushi Nakamitsu, Yuji Imamura,
Hitoshi Sewake,
Hiroaki Tsumura,
Katsunari Miyamoto,
Yuichiro Matsuura,
Takashi Yokoyama
[show abstract]
[hide abstract]
ABSTRACT: A rare case of anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the biliary tract (AAPBDS without DBT) associated with mucosal dysplasia of the biliary duct is described herein. A 53 year old male with a long history of diarrhea and right upper abdominal pain was diagnosed as having AAPBDS without DBT by endoscopic retrograde cholangiopancreatography and other examinations. Excision of the gallbladder and biliary duct with a Roux-en-Y hepatico-jejunostomy was performed and subsequent pathological examination of the surgical specimens showed mucosal hyperplasia of the gall-bladder and mucosal dysplasia of the biliary duct. Considering the dysplastic changes of the biliary duct as seen in our case, and the high incidence of AAPBDS without DBT developing into carcinoma of the biliary duct, being 12.2 per cent, we suggest that pancreaticobiliary ductal diversion with excision of the gall-bladder and biliary duct should also be performed for AAPBDS without DBT. However, further pathological investigations concerning the excised biliary duct in AAPBDS without DBT will be need to be carried out.
Surgery Today 04/1992; 22(3):276-279. · 1.22 Impact Factor
