A 32-year-old woman visited our department because of repeated regurgitation of foodC and was diagnosed with rumination syndrome based on possession of symptoms typical for it. Although rumination syndrome is classified as a functional esophageal disorder according to the Rome II criteriaC it is not well known in JapanC and there have been no previous reports of it in an adult with normal intelligence. Since patients with rumination syndrome are often misdiagnosed and receive unnecessary treatmentC awareness of it by physicians is important.
A 63-year-old man visited our hospital complaining of brown urine. A physical examination showed jaundice of the skin and conjunctiva bulbar. Blood tests showed elevated serum levels of bilirubin and hepato-biliary enzymes. A type 2-like mass lesion was found near the papilla of Vater during the endoscopic retrograde cholangiopancreatography and was histologically proven to be a well-differentiated adenocarcinoma. A diagnosis of obstructive jaundice due to primary duodenal cancer arising near the papilla of Vater was made. After the jaundice was decreased by endoscopic biliary stenting, a pancreatoduodenectomy was performed. A histopathological examination of the resected specimen concerning the location and manner of invasion of cancer cells revealed that the cancer arose from the duodenal mucosa near the papilla of Vater.
The patient was a 58-year-old female. Though she had been in good healthC increased hepatobiliary enzymes were detected in a health examination. She visited our hospital for close examination. The serum IgG4 level was normal, but ERCP and MRCP showed band-like stricture and beaded appearance of the bile ducts. A diagnosis of primary sclerosing cholangitis (PSC) was made. Since hyperlipidemia was also observedC oral administration of bezafibrate (400mg/day) alone was performed as the initial treatment, and transaminase, ALP, and GGT rapidly decreased. These results suggested that the initial administration of bezafibrate alone is effective against PSC.
A 39-year-old woman was admitted to our hospital because of abdominal pain. She was diagnosed as intra-abdominal bleeding and an emergency laparotomy was performed. On laparotomy, massive bleeding in the abdominal cavity due to a ruptured aneurysm of the intrahepatic artery was found. We also verified small aneurysm of the common hepatic arteryC tinged with red, and was suspected systemic vasculitis. The postoperative course was uneventful, but the subsequent angiography revealed many other small aneurysm of hepatic, renal and lumbar aytery. Then it was diagnosed as polyarteritis nodosa. A case of polyarteritis nodosa presenting with intra-abdominal homorrhage like this case is rare, so we presented here together with a review of the literature.
A 69 years old man was admitted to our hospital for further examinations of the liver tumor October, 2003. No underlying liver disease was found. Two tumors in the liver, 2cm in diameter respectively, were detected by abdominal ultrasonography and MRI scan. Ultrasonogram-guided needle biopsy from the liver tumor showed diffuse infiltration of CD20 positive, small lymphocytes. A distinct single band demonstrating clonal JH gene rearrangement was detected by southern blot analysis using tissues by needle biopsy. Thus, the patient was diagnosed with primary hepatic MALT lymphoma in the normal liver. These tumors were treated with percutaneus radiofrequency ablation (RFA), followed by Rituximab administration. No relapse has been noted until September, 2005.
A 80-year old man was referred to our hospital because of an elevation of serum amylase level. Diffuse enlargement of the pancreas was detected by abdominal computed tomography, and also diffuse narrowing of the main pancreatic duct was revealed using endoscopic retrograde cholangiopancreatography. The serum level of IgG was elevated to 3450mg/dl. Besides, on the 10th hospital day, petechia developed and the platelet level decreased to 1.5×104/μl. The platelet-associated IgGC antiplatelet antibody and antinuclear antibody in serum were positive. The levels of serum complements were low. From all these findings the patient was diagnosed as autoimmune pancreatitis complicated with immune thrombocytopenia. The treatment with prednisolone was started, which was effective on each disease. The medication was suspended a year ago, and so far there is no data suggesting the recurrence of autoimmune pancreatitis or immune thrombocytopenia.