[Show abstract][Hide abstract] ABSTRACT: Infliximab is effective in the treatment of steroid-resistant Crohn disease. However, there is clinical concern about a possible correlation between an increased risk of anorectal cancer and infliximab treatment. We report a case of anorectal cancer in long-standing perianal Crohn disease. A 34-year-old patient with a long-standing perianal lesion of Crohn disease underwent 3 sessions of infliximab therapy. After therapy, the concentration of plasma CEA was 36.5ng/ml and rose to 91.4ng/ml. We suspected anorectal cancer, so abdominoperineal resection was performed. The histological findings indicated mucinous adenocarcinoma. Monitoring of patients with long-standing perianal Crohn disease is considered essential for early diagnosis of anal cancer after obtaining biopsy samples from perianal lesions. Additionally, when infliximab is started for perianal Crohn disease, thorough examination for perianal lesion should be performed.
No preview · Article · Jun 2010 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
[Show abstract][Hide abstract] ABSTRACT: A 21-year-old man undergoing appendectomy for acute appendicitis in 2002 was found to have inflammation of the terminal ileum and mesentery. Further fluoroscopy of the small intestine showed a nodular lesion at the terminal ileum, but no other abnormalities were seen. He was followed up without definitive diagnosis as an outpatient and admitted for acute abdomen presenting lower abdominal pain and high fever in 2005. Nil per os and antibiotics administration relieved symptoms, but a mesentery tumor was not ruled out in imaging modalities necessitating surgery. Cystic lesions at the terminal ileum and mesentery necessitated partial ileal resection. Pathologically, lymph ducts were dilated, yielding a definitive diagnosis of intestinal lymphangiectasia.
No preview · Article · May 2009 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: A 75-year old woman was admitted to our hospital with right upper quadrant pain, vomiting, and jaundice. Laboratory findings showed elevated total bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, and C-reactive protein levels. Abdominal ultrasonography (US) and drip infusion cholangiographic computed tomography (DIC-CT) showed not only cholecystocholedocholithiasis, but a gallbladder located left of the round ligament and close to the lateral segments of the liver. We performed laparoscopic cholecystectomy (LC) with choledocholithotomy for suspected cholecystocholedocholithiasis with a left-sided gallbladder. Routine ports were inserted in the American configuration for LC. The gallbladder was normogradely separated from the gallbladder fossa, and the fundus of the gallbladder was lifted ventrally and toward to the patient's right shoulder. These procedures provided the usual view for laparoscopic choledochotomy. The patient recovered uneventfully and was discharged on postoperative day 10. To our knowledge, this is the first report of laparoscopic common bile exploration in a patient with a left-sided gallbladder.
[Show abstract][Hide abstract] ABSTRACT: A 72-year-old man was given a diagnosis of Crohn's disease in 1976 at age 44, and partial resection of is ileum was performed. In November 1982, barium enema examination revealed on ileorectal fistula. As he had no complaint, conservative therapy was chosen. In August 2003, he had high fever and CT scan revealed presacral abscess. Ileocecal resection, partial resection of is small intestine and loop sigmoid colostomy were performed. In December 2004, the serum level of CEA was gradually elevated and he complained of anal mucus discharge. Endoscopic examination showed a fistula orifice in the rectum and biopsy of the fistula revealed mucinous adenocarcinoma. We performed abdominoperineal resection of the rectum with partial resection of the sacrum. We thought that careful observation helped the detection of such a rare case of carcinoma arising from a fistula tract.
No preview · Article · Nov 2007 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
[Show abstract][Hide abstract] ABSTRACT: Many complications are reported in ulcerative colitis, but fistula is uncommon and treatment is complicated. We report three cases of ulcerative colitis with anorectal fistulas, all in women in their thirties and forties. Fistulas developed 25, 9, and 12 years after the first attack. Case 1 and 2 had total colitis and case 3 left colitis, none of which were severe. All were treated surgically. Case 1 underwent total proctocolectomy and end ileostomy, case 2 total proctocolectomy and ileo-anal anastomosis, and case 3 transvaginal repair of the fistula and temporary loop ileostomy. In 1 to 3 years of follow-up, no fistula recurred. In conclusion, surgery was of benefit in cases of anorectal fistulas associated ulcerative colitis in remission. Surgerical procedure should be selected based on the disease in each case.
[Show abstract][Hide abstract] ABSTRACT: [corrected] 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) metabolizes glucocorticoids, thus enabling aldosterone to bind to the mineralocorticoid receptor. However, little is known about the regulatory mechanism of epithelial 11beta-HSD2 expression in the gut.
Sprague-Dawley rats were maintained on a sodium-depleted diet or subjected to continuous aldosterone infusion for 4 weeks. Plasma aldosterone and arginine-vasopressin (AVP) levels were measured by radioimmunoassay. Expression of 11beta-HSD2 in colonic epithelia was evaluated by Northern blotting and immunohistochemistry. T84 and Caco2 cells were stimulated with aldosterone, dexamethasone and AVP alone or in combination, and 11beta-HSD2 mRNA was measured by quantitative reverse transcription polymerase chain reaction (RT-PCR).
Sodium-depleted and aldosterone-infused rats showed an increase of plasma aldosterone and AVP. Both treatments resulted in induction of 11beta-HSD2 in the colonic epithelia at mRNA and protein levels. Positive immunoreactivity was detected in the cytoplasm of the surface epithelia in control rats. In contrast, epithelial cells in the crypt also showed immunoreactivity for 11beta-HSD2 in the proximal colon of dietary sodium-depleted and aldosterone-infused rats. Induction of 11beta-HSD2 mRNA was observed when T84 cells were stimulated with corticosteroids plus AVP.
Aldosterone has a pivotal role by increasing expression of 11beta-HSD2 in epithelial cells of the colon. AVP may act as a synergistic hormone in aldosterone-mediated 11beta-HSD2 induction.
No preview · Article · Aug 2005 · Scandinavian Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: A 25-year-old woman with typical itch-free red papulae from August 1999 was diagnosed with Degos disease. She took oral aspirin from then on, but reported abdominal discomfort in April 2001. We undertook laparotomy based on suspected diffuse peritonitis due to gastrointestinal perforation. Serobloody, purulent massive ascites had accumulated in the peritoneal cavity, and inflammation was observed along the entire small intestine. Despite marked dilation, no macroscopic perforation was seen in the small intestine. We conducted construction of a loop ileostomy for intestinal decompression, but she died of sepsis on postoperative day 91. Multiple inflammatory lesions were observed in the small intestine at autopsy, but no perforation was apparent macroscopically.
No preview · Article · Jan 2004 · Nippon Shokaki Geka Gakkai zasshi