Publications (45)184.39 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Humoral hypercalcemia due to a gastric carcinoma-secreting parathyroid hormone-related protein (PTHrP) is a rare disease associated with poor prognosis. A 61-year-old male with gastric cancer who had been receiving chemotherapy showed serum hypercalcemia and an elevated level of serum PTHrP with a suppressed intact parathyroid hormone level. Computed tomography revealed stable disease 4 weeks prior, and the laboratory examination revealed no adverse effects 2 weeks prior. The biopsy at the time of diagnosis was immunohistochemically positive for PTHrP later. Despite intensive care, the patient died of multiorgan failure on the 14th day after admission. In case of undifferentiated gastric cancer, the possibility of humoral hypercalcemia of malignancy caused by gastric cancer should be considered even when the patient is receiving chemotherapy.
- [Show abstract] [Hide abstract] ABSTRACT: An 85-year-old man presented to a nearby medical clinic following palpitation and tarry stools. On examination, anemia was detected. To further investigate the cause of these symptoms, he was referred to our hospital. Upper gastrointestinal endoscopy revealed elevated lesions throughout the stomach, and the mucous membrane was rough and hemorrhagic. Under magnifying endoscopy, the lesions demonstrated the absence of a mucosal microsurface pattern. However, a wide and meandering microvascular pattern could be seen along the faint margins of the lesions. Histopathological analysis of a tissue biopsy specimen indicated amyloidosis. AL amyloidosis was suspected at first; however, a specific staining procedure subsequently revealed that the patient had senile systemic amyloidosis (SSA) caused by transthyretin deposition.
- [Show abstract] [Hide abstract] ABSTRACT: Perforation, bleeding, and ileus are known complications of small intestinal lymphoma and can occur either at diagnosis or during the course of treatment. Surgery is an important component in the management of these gastrointestinalcompl ications. However, there is no consensus regarding the indications for and timing of surgery in smallintestinall ymphoma. We herein present our experience with a case of small intestinal lymphoma with ileus that required surgery during chemotherapy. A 69-year-old man developed abdominal pain. Computed tomography revealed lower right jaw lymphadenopathy, small intestinal wall thickening, and mesenteric lymphadenopathy. Malignant lymphoma(diffuse large B-cell type)was diagnosed on the basis of a lower jaw lymph node biopsy. The patient was initially administered chemotherapy. After the third cycle of chemotherapy, the patient developed smallintestinalobstruction detected upon abdominalcomputed tomography. Because a stricture persisted despite medicaltreatment, we performed partialresection of the smallintestine. The postoperative course was good, and the patient rapidly resumed chemotherapy. Currently, 6 months after the surgery, the patient is alive without any progression of the lymphoma. A multidisciplinary treatment strategy, including surgery, is desirable to achieve a safe but radicalcure for smallintestinall ymphoma.
- [Show abstract] [Hide abstract] ABSTRACT: A 48-year-old man with colorectal cancer and right inguinal lymph node metastasis had previously undergone radiotherapy and chemotherapy (uracil/tegafur/leucovorin) after a colostomy in another hospital before being referred to us. Esophagogastroduodenoscopy (EGD) revealed the presence of a gastric metastatic lesion. After three courses of treatment with a modified regimen of leucovorin plus 5-fluorouracil plus oxaliplatin-6 (mFOLFOX6), EGD revealed that the gastric lesion had disappeared; computed tomography revealed that the size of the primary tumor and inguinal lymph node metastasis were markedly reduced. Subsequently, he underwent rectal resection of the primary tumor and continued treatment with mFOLFOX6 in combination with bevacizumab. We reviewed 29 similar cases from the literature, and determined that surgical resection of the tumor and appropriate chemotherapy can lead to long-term survival for patients with gastric metastases from colorectal cancer. Furthermore, positive CK20 and CDX2 expression and negative CK7 expression were useful adjuncts in the immunohistochemical diagnosis of gastric metastases from colorectal adenocarcinoma.
- [Show abstract] [Hide abstract] ABSTRACT: We estimated 256 chronic hepatitis C (C-CH) patients with serotype 1 high viral load who received pegylaed interferon alfa-2b and ribavirin for 48 weeks. All patients were assessed for efficacy, tolerance and safety. Discontinuation of therapy for adverse events was 17.8% (45/256) for 48 weeks and 53 patients showed mild or moderate adverse events. The sustained virological response (SVR) rate was 44.5% (114/256). The SVR rate was significantly higher in patients less than 56 years old than more than 56 years old and was tend to be lower in the patients who reduced peylated interferon alfa-2b, ribavirin or both dosage than patients who received full dose. In logistic regression analysis, four independent factors were significantly associated with SVR; body mass index (= or >23.5), platelet counts (= or >16.4μ/l), adherence to pegylaed interferon alfa-2b (= or >80%) until 12 weeks and adherence to ribavirin (= or >80%) until 12 weeks. In conclusion, these results suggest that the combination therapy with pegylaed interferon alfa-2b and ribavirin may be safety and tolerance for C-CH patients with serogroup1 high viral load.
- [Show abstract] [Hide abstract] ABSTRACT: A 30-year-old woman with hepatitis for 5 months was admitted to our hospital. She had been given a diagnosis of liver dysfunction 2 years previously, and the hepatitis in this case was believed to be drug-induced. On admission, the patient was asymptomatic. Serologic tests for hepatitis A, B, and C were negative, and the laboratory results showed a WBC count of 7600/mm3 (lymphocytes, 85%), an AST level of 559 U/L, ALT level of 427 U/L, and EBV-DNA of 2.9x10(6) copies/microg DNA. Histopathological examination of the liver biopsy specimens revealed moderate lymphocyte infiltration in the sinusoids and positive Epstein-Barr-encoded RNA (EBER) -lymphocytes. Therefore, chronic active Epstein-Barr virus infection (CAEBV) was diagnosed. However, 9 months after the diagnosis she died of mycotic sepsis. We presume that the patient may have developed CAEBV at the prior diagnosis of liver dysfunction 2 years previously. Therefore, CAEBV associated with liver dysfunction should be considered during the differential diagnosis of patients showing persistent liver dysfunction.
- [Show abstract] [Hide abstract] ABSTRACT: We clarified how raffinose, one of the non-digestive oligosaccharides, reaches the large intestine. Seven healthy male volunteers were given a test meal containing 10.0 g raffinose. A double-lumen tube was placed in the terminal ileum, and the ileal contents were aspirated through the tube. The amounts of raffinose were orally administered and collected from the terminal ileum and were compared with each other. The result was that the mean+/-standard error percentage of the amount of ingested raffinose collected in the terminal ileum was 97.1+/-2.4%. Furthermore, the average times taken for 20%, 40%, 60% and 80% of raffinose to reach the terminal ileum were 2.0+/-0.6 h, 2.6+/-0.7 h, 3.6+/-0.7 h and 4.9+/-0.7 h, respectively. In conclusion, approximately 100% of ingested raffinose was recovered in the terminal ileum in the present study. This corresponds with the present generally accepted definition of a dietary fibre.
Article: The Oro-Ileal Transit of Cellulose[Show abstract] [Hide abstract] ABSTRACT: The effects of cellulose and the interindividual variations on the transit time in the small intestine remain unclear, but no previous study has to date taken these factors into sufficient consideration. We assessed the oro-ileal transit time and the recovery percentage of cellulose in the terminal ileum looking at interindividual variations. Seven healthy males received 100 mL of a dietary fiber-free basal diet with 5 g cellulose and 5 g of polyethylene glycol 4000. The ileal contents were aspirated every 30 min via an experimental tube placed in the terminal ileum to assess the oro-ileal transit time and the recovery percentage of cellulose. The mean percentage (with standard deviation) of the amounts of cellulose collected in the terminal ileum was 98.4%+/- 16.5% (ranging from 67.4% to 114.5%) with a coefficient variation of 16.8%. The average times (in hours) taken for 20%, 40%, 60%, and 80% of cellulose to reach the terminal ileum were 5.5 +/- 1.1, 6.7 +/- 0.7, 8.5 +/- 1.3, and 8.8 +/- 1.2, respectively, with large interindividual variations. In conclusion, the averaged recovery percentage of cellulose in the terminal ileum was approximately 100%, in accordance with the present generally accepted definition of dietary fiber. However, there were large interindividual variations in the oro-ileal transit time and the percentage of cellulose recovered.
- [Show abstract] [Hide abstract] ABSTRACT: Helicobacter pylori infection has been reported to cause enhanced reactive oxygen species in the gastric mucosa. We examined the relationship between H. pylori infection and neutrophil function of peripheral blood. The subjects were 904 volunteers who participated in the Iwaki Health Promotion Project in 2005. 158 subjects who were infected with H. pylori in 2005 also participated in this project in 2006 and were categorized into two groups: the eradication group, in which H. pylori was successfully eradicated during the 12 month period, and the non-eradication group, in which eradication was unsuccessful or the subjects did not receive eradication therapy. The laboratory assays performed were: a titre of H. pylori antibody; neutrophil counts; and oxidative burst activity (OBA) of neutrophils. Logistic regression analysis was executed, with H. pylori infection as the dependent variable and other items as the independent variables. OBA showed an inverse association with H. pylori infection in 2005. Additionally, when comparing the eradication and non-eradication groups, the change rates of OBA between 2005 and 2006 did not show any significant difference. It was concluded that H. pylori infection does not lower OBA, but those individuals in whom OBA was lower were more prone to H. pylori infection.
- [Show abstract] [Hide abstract] ABSTRACT: We investigated the effects of cellulose supplementation on fecal consistency and fecal weight. About 26 women were classified into two groups-normal defecation and constipation groups. All subjects ate the following meals during the experiment: ordinary meals (first week), experimental meals (second week), and experimental meals mixed with 4 g (third week) and 8 g (fourth week) cellulose. The experimental meal contained 16.7 g fiber. Fecal weights, fecal water content, fecal consistency, and defecation frequency were measured during the experimental period. As a result, in the normal defecation group, the mean fecal weight was 222.9 g day(-1) in the first week, and thereafter decreased. Although 20/24 g of fiber intake in the third/fourth week increased the fecal weight to over 150 g, the fecal consistency was still lower than the optimal consistency of around 300 g cm(-2). However, these changes were not observed in the constipated group.
- [Show abstract] [Hide abstract] ABSTRACT: Gastric cancer in Japan, previously the top killer cancer, has recently shown decreased incidence and mortality rates. Epidemiological studies have demonstrated that environmental factors are closely associated with stomach oncogenesis, as evident from the geographical differences seen throughout Japan in both incidence and mortality. Moreover, Japanese immigrant populations gradually exhibit the lower incidence and mortality rates of gastric cancer in their chosen country. Likewise, younger generations in Japan have lower mortality rates than older generations at the same age, which may be accounted by the dramatic lifestyle changes in Japan after World War II. In addition to exploring and learning from the impact of these environmental factors, deliberate strategies to further lower the incidence and mortality rates of gastric cancer must include aggressive eradication programs for Helicobacter pylori and dietary education in both school curricula and for the general adult population to lower the intake of causative agents such as salt and increase the intake of beneficial agents such as fruits, vegetables and seaweeds. The dietary education should be coupled with better motivation for the general population to undergo regular screening with improved techniques. In the future, changes in these environmental factors and progresses in the diagnosis of and therapeutic strategies for gastric cancer will lead to further decrease in the incidence and mortality rates of this disease in Japan.
- [Show abstract] [Hide abstract] ABSTRACT: Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.
- [Show abstract] [Hide abstract] ABSTRACT: Dietary fiber by definition is resistant to digestion and absorption in the human small intestine, and it should naturally reach the large intestine. To date, there have been several reports that have examined in vivo how much dietary fiber actually reaches the terminal ileum in human subjects using glucose, with large differences in results. We compared the amount of pectin in the human terminal ileum with that of orally administered pectin. Seven healthy male volunteers ages 20 to 27 y were given a test meal containing 4.05 g of pectin. A double-lumen tube was placed in the terminal ileum by using the endoscopic retrograde bowel insertion method, and the ileal contents were aspirated through the tube. Amounts of pectin orally administered and collected from the terminal ileum were estimated as galacturonic acid concentrations (Englyst's method) and were compared with each other. The mean +/- standard deviation amount of pectin collected in the terminal ileum was 3.58 +/- 0.43 g, or 88.4 +/- 10.5% of pectin administered. Further, there were large individual differences in recovery, ranging from 76.8% to 105.1%. Approximately 90% of ingested pectin was recovered in the terminal ileum in this study. Ten percent may have been degraded by bacteria within the digestive tract, especially the terminal ileum.
- [Show abstract] [Hide abstract] ABSTRACT: Ulcerative colitis (UC) is an idiopathic, non-specific inflammatory disorder involving primarily the mucosa and submucosa of the colon, especially the rectum. It usually produces a bloody diarrhea and various degrees of systemic involvement. These definitions of idiopathic proctocolitis were established by Council for International Organization of Medical Science (CIOMS) in 1973. In Japan, the first criteria for diagnosis of UC were established by the Research Committee of UC (the Japanese Ministry of Health and Welfare) in 1974, based on the definitions by CIOMS. Since then, some minor revisions have been made. The newest criteria for diagnosis of UC were published in 1998. The diagnosis of UC is made on the basis of a combination of clinical, endoscopic, radiologic, and histologic findings.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the effects of mild to moderate hepatic impairment on the pharmacokinetics and pharmacodynamics of landiolol hydrochloride, a new ultra-short-acting beta1-adrenergic antagonist. Six patients with hepatic impairment and six healthy volunteers were enrolled in the open-label, parallel-group study. Landiolol hydrochloride was given intravenously with a 1-minute loading infusion of 0.06 mg/kg/min, followed by a 60-minute infusion of 0.02 mg/kg/min using an automated infusion pump. Venous blood was drawn just before (predose) and 1, 2, 5, 15, 30 and 61 minutes after beginning the continuous intravenous infusion (during infusion); 2, 5, 10 and 30 minutes and 1, 4 and 8 hours after the end of the infusion (after infusion); and 24 hours after beginning the infusion (next day). Urine samples were collected up to 24 hours after beginning the infusion. Before subjects were discharged, an indocyanine green elimination test, clinical laboratory testing, physical examination and recording of ECGs and vital signs were performed. The geometric mean maximum plasma concentration and area under the concentration-time curve values for the patients with hepatic impairment were 42% and 44% higher, respectively, than those observed for the healthy volunteers, indicating that hepatic impairment affected the disposition of landiolol hydrochloride. There were no significant changes in the elimination half-life of the drug. There were no clinically significant differences between the two groups in terms of reductions in heart rate or blood pressure. The pharmacokinetic and pharmacodynamic characteristics of this ultra-short-acting beta1-blocker were maintained even in the patients with hepatic impairment. Although we did not observe any drug-related adverse events in these patients, hypotension or bradycardia should be considered, necessitating continuous monitoring of both heart rate and BP in patients with hepatic impairment who receive landiolol hydrochloride.
- [Show abstract] [Hide abstract] ABSTRACT: Background: It is well recognized that the season of the year exerts an influence on some diseases and causes of death such as coronary heart diseases, stroke, infectious diseases and so on. Methods: We evaluated the influence of seasonal changes on diseases and causes of death in Japan using the Japan Vital Statistics from 1970 to 1999 and recorded weather data (mean temperature), by a Fourier decomposition in a log linear regression model.Results: Major influences of seasonal change with the highest rates in winter were seen on the following: the overall causes of death; infectious and parasitic diseases including tuberculosis; respiratory disease, including pneumonia and influenza; heart and cerebrovascular diseases; diabetes; and digestive diseases and accidents. Two peaks were seen in suicides, a large peak in April and a small peak in autumn. Cancer and homicides were little or not at all influenced by seasonality. There was no major difference in changes between the years studied, except for respiratory disease and tuberculosis, which showed a clear reduction in the seasonality effect from 1970 to 1999. Conclusions: To reduce the overall mortality rate and to prolong life expectancy in Japan, measures must be taken to reduce those mortality rates associated with seasonal differences, especially those causes of death which show a strong correlation with seasonal change: respiratory, heart, cerebrovascular, diabetes and infectious diseases.
- [Show abstract] [Hide abstract] ABSTRACT: Only a few reports have compared the fermentation of pectin and cellulose using the hydrogen-breath test, and no studies have examined the relation between the hydrogen breathing pattern and colonic microflora. Using breath-hydrogen measurements, we investigated whether different dietary fibers (DFs) were fermented differently and whether there were individual differences after ingestion of the same DF; we also examined the relation between individual fecal microflora and the fermentation of DF. Results of hydrogen tests in 14 men were compared after they had ingested 20 g of pectin, 20 g of cellulose, or 6 g of lactulose (a DF-like substance). We examined the relation between the breath hydrogen results and the subjects' fecal microflora. We defined significant fermentation (i.e., positive cases) as a continuous rise in hydrogen in the expiratory air of >19 ppm. The subjects were divided into 3 groups according to their hydrogen breath test pattern, i.e., positive for lactulose and pectin (Group LP, n = 4); positive for lactulose alone (Group L, n = 7); and negative for pectin, cellulose, and lactulose (Group N, n = 3). Individual differences were noted in subjects from Group LP and Group L. The detection frequency of lecithinase-negative clostridia was higher in Group LP than in the other groups (P < 0.05), and the detection frequency and the number of lecithinase-positive clostridia were higher in Groups LP and L than in Group N (P < 0.05). These findings suggest that the Clostridium species are associated with hydrogen production. The hydrogen breath test results of DFs depend on both the type of DF and the individual colonic microflora. The amount and constitution of colonic microflora might be predicted by the hydrogen-breath test using different DFs.
- [Show abstract] [Hide abstract] ABSTRACT: We examined the defecatory conditions in a population of Japanese subjects and analyzed the measured parameters as a means for self-evaluation of defecation. Subjects (n=1195) were residents of northern Japan and were all aged over 40 years. The state of defecation and fecal characteristics were assessed with regard to nine parameters including "self-reported bowel habit" and "bowel movement frequency." Logistic regression analysis was carried out to analyze the association between the complaint of constipation and other eight parameters. A higher tendency for constipation was noted in women than in men. The highest value of the odds ratio was "bowel movement frequency"; especially the value "once per three days or more" was noted in both genders (odds ratio: 13.38 and 42.46 in men and women, respectively). In addition, "stool appearance", "length of time for bowel movement", "straining after bowel movement", "alternating diarrhea/constipation/disorder" and "travel-related changes in bowel movements" were significantly related with the complaint of constipation ("self-reported bowel habits") in both genders. In conclusion, the study elucidated that personal and subjective evaluation of bowel habits in normal subjects consisted of various factors under the heading of "bowel movement frequency".
- [Show abstract] [Hide abstract] ABSTRACT: In the past few decades, the number of bed-ridden elderly patients has been increasing. This group of patients is frequently fed with a liquid formula diet. The aim of this study was to evaluate the usefulness of a liquid formula diet containing dietary fiber (DF) for elderly bed-ridden patients. Eighteen elderly, bed-ridden patients were given L-3 Fiber, a DF-containing liquid formula diet (DF-LFD), for 4 weeks, while a number of parameters were monitored, including serum levels of total cholesterol, triglyceride, total protein, creatinine, uric acid, glucose, sodium, potassium, and calcium, urine protein/sugar, and defecation frequency. Total protein, albumin and total cholesterol significantly increased following the administration of the DF-LFD, associated with an average increase in body weight of 1.94 kg (5.0%). Defecation frequency significantly increased one week after DF-LFD administration was started, but this effect was transient. Although a few patients complained of nausea, vomiting or abdominal pain, no severe side effects were seen. In conclusion, DF-LFD supplementation appears to be beneficial for elderly bed-ridden patients, and can increase nutritional-related parameters, such as body weight, total protein, albumin and total cholesterol, without severe side effects.
Khirosaki, Aomori, Japan
- • Department of Gastroenterology and Hematology
- • School of Medicine
Northwestern UniversityEvanston, Illinois, United States