Tomohiro Kudo

Takasaki General Medical Center, Takasaki, Gunma, Japan

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Publications (16)10.91 Total impact

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    ABSTRACT: A 39-year-old man with alcoholic cirrhosis was hospitalized because of hematemesis. In the previous 2 years, he had frequently experienced hemorrhage from esophageal varices. He had undergone endoscopic variceal ligation or endoscopic injection sclerotherapy each time. Emer-gency endoscopic examination at the time of presentation showed an arterial hemorrhagic esophageal ulcer in the lower esophagus. We attempted endoscopic hemostasis using a hemoclip, but were not successful. Abdominal angiography showed hemorrhage from a branch of the left gastric artery. Subsequently, we successfully achieved hemostasis with coils using transcatheter ar-terial embolization. Gastroenterological Endoscopy 1602.
    No preview · Article · Aug 2015 · Gastroenterological Endoscopy
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    ABSTRACT: A 38-year-old woman presented to our hospital with abdominal pain and vomiting. Abdominal computed tomography revealed intestinal obstruction caused by a tumorous lesion at the terminal ileum. Colonoscopy showed an elevated lesion like a submucosal tumor in the terminal ileum. Although the bioptic diagnosis was non-specific ileitis, she had two recurrences within two months after the first hospitalization. Laparoscopic ileocecal resection with lymph node dissection was performed as a diagnostic modality during the third hospitalization. Macroscopic findings showed that the serous surface of the terminal ileum coalesced fibrously, and the mucosal side bulged outward into the ileal lumen. On histopathological examination, all layers of the tumorous lesion showed a structure similar to the uterine stroma and glands infiltrate. Thus, ileal endometriosis was diagnosed. The glandular structure was also present in the appendix and a regional lymph node (#202) .
    No preview · Article · Jan 2015
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    ABSTRACT: A 76-year-old man had undergone high anterior resection for stage II rectal cancer. Colonoscopy was performed because the six-year post-surgery follow-up fecal occult blood test was positive. Stage II colon cancer was located 3cm from the anastomosis site toward the oral side. He was referred to our surgery department and underwent low anterior resection and double-barrel transverse colostomy. He did well, and colostomy closure was considered 4 months later. However, we endoscopically incised and dilated because of complete obstruction at the anastomotic site. With axis and direction of oral and anal sides of the transverse colon confirmed under fluoroscopic guidance, the obstructed area was incised with a needle-like knife and balloon dilated despite transverse colon perforation complication concerns. Because structures were not observed post-dilation and progress was satisfactory, colostomy closure was performed. Postoperative complete anastomotic obstruction is rare in recurrent colon cancer. We report a successful endoscopic incision of complete obstruction followed by colostomy closure case.
    No preview · Article · Jan 2015

  • No preview · Article · Mar 2014
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    ABSTRACT: A 35-year-old female has attended a near hospital with non-B non-C type liver cirrhosis for two years. She was already pointed out stenosis of an inferior vena cava and the right and middle hepatic veins by contrast enhanced CT performed five months before hospitalization. In January 2012, she visited the hospital with chief complaints of fever, nausea and abdominal fullness. Contrast enhanced CT showed a left hepatic vein was remarkably occupied by a fresh thrombus. She was diagnosed as Budd-Chiari syndrome and transmitted to our hospital. Although she received the thrombolytic therapy by danaparoid sodium and Antithrombin III products, there was no curative effect Her edema, pleural effusion and ascites progressed gradually, and she died of hepatic and respiratory failure on the twenty sixth hospital days Although the right and middle hepatic vein lesions showed the liver cirrhosis accompanying an old hepatic vein thrombi, the left hepatic lobe showed congestion liver by the fresh left hepatic vein thrombus. Therefore, it seemed that the occlusion of the right and middle hepatic veins developed first, and hepatic failure advanced rapidly by the occlusion of the left hepatic vein with the fresh thrombus. We experienced the interesting precious case in which the disease progression of Budd-Chiari syndrome has been confirmed by imaging and autopsy. We speculated liver transplantation was necessary to save her.
    No preview · Article · Jan 2014 · Kanzo
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    ABSTRACT: MK615, a compound extracted from the Japanese apricot "Prunus mume" has been reported to have in vitro anti-tumor activities against several cancer cell lines, including hepatocellular carcinoma (HCC). However, the clinical effects and feasibility of administering MK615 for patients with HCC were unknown. We experienced a case with advanced HCC for which MK615 was effective against both lymph node and pulmonary metastases. A 60-year-old female underwent surgical resection of a 9 cm HCC in the right lobe. The pathological diagnosis was moderately differentiated HCC with vascular invasion. The HCC recurred in the liver 8 mo after the surgery. Radiofrequency ablation and transarterial infusion chemotherapy were performed, but the recurrence was not controlled. One year after the intrahepatic recurrence, pulmonary and lymph metastasis appeared. Sorafenib was administered, but was not effective. Then, MK615 was administered as a final alternative therapy after informed consent was obtained from the patient. Three months later, her alpha-fetoprotein level decrease and both the lymph node and pulmonary metastases decreased in size. The patient has survived for more than 17 mo after the MK615 administration, and was in good condition. Although further investigations are necessary to clarify its safety and efficacy in humans, MK615 may be useful for the treatment of HCC, without serious adverse effects.
    No preview · Article · Oct 2013 · World Journal of Hepatology
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    ABSTRACT: Sixty year-old male positive for both HCV-RNA and HBsAg was treated by triple therapy of peginterferon alpha2b, ribavirin and telaprevir. Eight weeks after the beginning of the therapy, the patient developed drug induced hypersensitivity syndrome (DIHS) with general erythema multiforme and 64 times anti-HHV6 antibody elevation. Sixty milligram of prednisolone was administered with gradual dose reduction and the skin lesion was improved. HBV-DNA and transaminase elevated one week after the steroid induction and entecavir improved them. DIHS itself and the aggravation of hepatitis B by corticosteroid should be kept in mind in cases with dual infection of HBV and HCV treated by antivirals including telaprevir.
    No preview · Article · Oct 2013 · Hepato-gastroenterology
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    ABSTRACT: A 73-year-old man was admitted to a hospital with a complaint of epigastralgia and for evaluation of liver dysfunction. After hospitalization, he experienced disturbance of consciousness with septic shock, and was then transferred to our hospital. Computed tomography revealed dilatation of the intrahepatic bile duct and tumor of the middle bile duct. We diagnosed acute obstructive suppurative cholangitis. As a result, endoscopic nasobiliary drainage was performed, and the patient recovered. Based on pathological examinations of the bile duct biopsy specimen, the tumor was diagnosed as a carcinosarcoma. Consequently, the patient underwent pylorus-preserving pancreatoduodenectomy. However, 4 months after surgery, the patient died due to widespread metastasis of the carcinosarcoma. Preoperative diagnosis of carcinosarcoma of the bile duct is extremely rare. Our study suggests the efficacy of bile duct biopsy in such cases.
    No preview · Article · Feb 2013 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
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    ABSTRACT: A woman in her seventies was admitted because of general fatigue and liver dysfunction (ALT 2565 IU/l). She was diabetic and, 2 months ago, began eating kikuimo (Jerusalem artichoke) containing inulin, which is thought to decrease blood sugar level. Although tests showed no evidence of acute infection of HAV, HBV, HCV, EBV and CMV, a drug-induced lymphocyte stimulation test using kikuimo extract was positive. She was first diagnosed with drug-induced liver injury according to the Japanese diagnostic criteria for the disease. After a non-eventful recovery, her serum was found to be positive for hepatitis E-antibody and RNA (genotype 3), indicating recent, autochthonous infection of HEV. The patient might have been misdiagnosed with drug-induced liver injury unless the serum test for HEV had been performed. We believe that HEV screening is mandatory for accurate diagnosis of hepatitis E and drug-induced liver injury.
    No preview · Article · Apr 2012 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
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    ABSTRACT: To evaluate the value of ABC (D) stratification [combination of serum pepsinogen and Helicobacter pylori (H. pylori) antibody] of patients with gastric cancer. Ninety-five consecutive patients with gastric cancer were enrolled into the study. The serum pepsinogen I (PG I)/pepsinogen II (PG II) and H. pylori antibody levels were measured. Patients were classified into five groups of ABC (D) stratification according to their serological status. Endoscopic findings of atrophic gastritis and histological differentiation were also analyzed in relation to the ABC (D) stratification. The mean patient age was (67.9 ± 8.9) years. Three patients (3.2%) were classified into group A, 7 patients (7.4%) into group A', 27 patients (28.4%) into group B, 54 patients (56.8%) into group C, and 4 patients (4.2%) into group D, respectively. There were only three cases in group A when the patients taking acid proton pump inhibitors and those who had undergone eradication therapy for H. pylori (group A') were excluded. These three cases had mucosal atrophy in the grey zone according to the diagnostic manual of ABC (D) stratification. Histologically, the mean age of the patients with well differentiated adenocarcinoma was significantly higher than that of the patients with poorly differentiated adenocarcinoma (P < 0.05). There were no differences in the pattern of atrophy in the endoscopies between the well differentiated and poorly differentiated groups. ABC (D) stratification is a good method for screening patients with gastric cancers. Endoscopy is needed for grey zone cases to check the extent of mucosal atrophy.
    Full-text · Article · Nov 2011 · World Journal of Gastroenterology
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    ABSTRACT: To examine the efficacy of glycyrrhizin preparation (GL-p) in the treatment of a rat model of ulcerative colitis (UC). Experimental colitis was induced by oral administration of dextran sodium sulfate. Rats with colitis were intrarectally administered GL-p or saline. The extent of colitis was evaluated based on body weight gain, colon wet weight, and macroscopic damage score. The expression levels of pro-inflammatory cytokines and chemokines in the inflamed mucosa were measured by cytokine antibody array analysis. The effect of GL-p on myeloperoxidase (MPO) activity in the inflamed mucosa and purified enzyme was assayed. GL-p treatment significantly ameliorated the extent of colitis compared to sham treatment with saline. Cytokine antibody array analysis showed that GL-p treatment significantly decreased the expression levels of pro-inflammatory cytokines and chemokines, including interleukin (IL)-1β, IL-6, tumor necrosis factor-α, cytokine-induced neutrophil chemoattractant-2, and monocyte chemoattractant protein-1 in the inflamed mucosa. Furthermore, GL-p inhibited the oxidative activity of mucosal and purified MPO. GL-p enema has a therapeutic effect on experimental colitis in rats and may be useful in the treatment of UC.
    Full-text · Article · May 2011 · World Journal of Gastroenterology
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    ABSTRACT: We investigated the therapeutic effect of polaprezinc (PZ), N-(3-aminopropionyl)-L-histidinato zinc, in rats with experimentally-induced colitis by focusing on calcineurin (CN) inhibition. CN plays a crucial role in T-cell activation and cytokine gene expression and is targeted by immunosuppressants such as cyclosporine and FK506. Colitis was induced into male Wistar rats by trinitrobenzene sulfonic acid and was treated with intrarectally administered PZ. The inflammation was assessed by the macroscopic damage score, colon wet weight, and proinflammatory mediator expression by RT-PCR analysis. Protein expression of calcineurin and the activation of its substrate, the nuclear factor of activated T cells (NFAT) transcription factor, were also studied. Calcineurin inhibition by PZ was investigated in in vitro experiments using colonic mucosa, purified calcineurin enzyme, and Jurkat T cells. CN was activated in the colitic mucosa; PZ treatment inhibited CN activation, the expression of proinflammatory cytokines in the mucosa, and thereby ameliorated the experimental colitis in rats. In in vitro experiments, PZ inhibited CN activity, NFAT activation, interleukin-2 expression, and the growth of Jurkat T cells. In the effective concentrations, PZ did not affect cell viability. Our results suggest that PZ can be used as an immunosuppressive agent for the treatment of colitis through its inhibitory effect on CN activity.
    No preview · Article · Feb 2011 · Life sciences
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    ABSTRACT: A 19-year old man was admitted for treatment of a right psoas abscess. He was first diagnosed as Crohn's disease with ileocolitis and fistula, which caused the abscess. Following the drainage of the abscess and conservative treatment including administration of antibiotics, total parenteral nutrition and medication, his symptoms were temporarily improved. After recurrence, additional therapy with infliximab successfully induced remission. He has remained free from abdominal symptoms and recurrence of the abscess. It seems that conservative treatment including infliximab administration is useful for induction as well as maintenance of remission and avoiding surgical treatment.
    No preview · Article · Oct 2009 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology

  • No preview · Article · Mar 2008 · Nihon Naika Gakkai Zasshi
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    ABSTRACT: Arterial stiffness assessed by pulse wave velocity (PWV) reflects early stage arteriosclerosis. The influence of hyperinsulinemia on peripheral vascular disease (PVD) is still unknown. We determined the influences of hyperinsulinemia on PVD assessed by PWV in moderately hyperglycemic patients. Thirty-six moderately hyperglycemic, outcoming patients were recruited in this study. All subjects were divided into two groups by fasting immunoreactive insulin (F-IRI) concentrations; group A; F-IRI> or =5 microU/ml, group B; F-IRI<5 microU/ml. Both hbPWV (from heart to brachial artery) and baPWV (brachial to artery to ankle) were evaluated by using Form PWV/ABI, in addition to ankle-brachial pressure index (ABPI). In group A, both hbPWV and baPWV showed significantly higher values than in group B. ABPIs were not different between two groups. Although age, FPG, plasma HbA1c, serum total-cholesterol, HDL-cholesterol concentrations, and systolic and diastolic blood pressure were at same levels in group A as group B, body mass index, HOMA-R, serum triglyceride concentrations were significantly higher in group A, indicating the existence of insulin resistance in group A. Hyperinsulinemia may be involved in the development of PVD in moderately hyperglycemic patients.
    No preview · Article · Oct 2003 · Diabetes Research and Clinical Practice
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    ABSTRACT: Background & Aims: Prokinetics have been used in combination with polyethylene glycol electrolyte lavage solution (PEG-ELS) to reduce the volume of lavage solution and to ensure the preparation. However, prokinetics sometimes accompany troublesome side effects including fatal ones. The aim of this study is to elucidate the usefulness of mosapride citrate, which has fewer side effects, for colonoscopy lavage preparation. Methods: Eighty-two patients were randomly assigned to receive 2,000 ml of PEG-ELS with sennoside (control group) or 1,500 ml of PEG-ELS with sennoside and mosapride citrate (mosapride group). Colonoscopists blinded to group assignment scored the adequacy of colon cleansing. Time to lavage solution ingestion, time and number of motions to the appearance of clear excretion, and side effects were recorded. Results and Conclusions: The mosapride group had a favorable trend in the overall colon cleansing and a significant superiority in the residual foam over the control group. Side effects had a tendency to be less frequent in the mosapride group. Time to lavage solution ingestion was significantly reduced in the mosapride group. Mosapride citrate coadministered with sennoside and 1500 ml of PEG-ELS is applicable to bowel preparation with favorable colon cleansing and good patient acceptability.
    No preview · Article · Jan 2002 · The Kitakanto Medical Journal

Publication Stats

49 Citations
10.91 Total Impact Points

Institutions

  • 2012-2013
    • Takasaki General Medical Center
      Takasaki, Gunma, Japan
  • 2002-2011
    • Gunma University
      • Department of Medicine and Molecular Science
      Maebashi, Gunma, Japan