A questionnaire survey including hepatic function test values was performed to elucidate the medical treatment of hepatic diseases by gastroenterologists and general internists. Serum ALT level was considered to be an index of destruction of hepatic cells in 94 and 80% of gastroenterologists and general internists, respectively. Serum γ-GTP values were used as an index of bile stasis and destruction of the bile duct cells by 93% and 70% of the gastroenterologists, respectively and in 61% and 49% of the internists, respectively. In addition, for hepatitis C, gastroenterologists considered the mean serum ALT values (standard values for drug therapy introduction) as ≥62IU/L, while general internists considered it as ≥79IU/L. In the case of fatty liver, the mean serum ALT values considered by gastroenterologists and general internists were ≥93IU/L and ≥90IU/L, respectively. These survey results suggest that there is a need for research-based clarification of hepatic function test values regulating therapy and unification of guidelines for standard values in medical treatment.
To clarify the clinical features of acute acalculous cholecystitis (AAC), we reviewed 113 cases of AAC experienced from January, 2000 to December, 2007 in regard to patient background, etiology, imaging diagnosis, treatment, and outcomes. Functional bile stasis caused AAC in 34 of 113 cases (30.1%), and 28 of those developed in a nosocomial manner (82.4%). On the contrary, mechanical bile stasis caused 37 cases (32.7%), and all but one case developed in a community-acquired manner. mechanical bile stasis included 9 cases of biliary tract neoplasm (5, cystic duct cancer; 3, gallbladder cancer; 1, papillary adenoma). Since considerable cases of AAC were caused by biliary tract neoplasm, we have to pay attention to their existences.
A 54-year-old man had been admitted to Nara city hospital because of hematemesis and dyspnea caused by physical exertion, and was given a diagnosis of esophago-cardial varices and portal venous thrombosis. He was transferred to our hospital for further examinations and treatments. Ultrasonography (US) and computed tomography (CT) revealed the progression of portal venous thrombosis. Danaparoid sodium was administered to treat the portal vein thrombus. 5 days later, the patient was found to have hematemesis resulting from a cardial varices rupture. After endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) was performed, danaparoid sodium was administered for 2 weeks. After the treatment, portal vein thrombus had almost disappeared. Due to an increased risk of bleeding, cases of esophago-cardial varices with portal venous thrombosis must be treated with care. This is the first report of upper gastrointestinal bleeding due to danaparoid sodium. Danaparoid sodium must be carefully administered when patients have portal venous thrombosis with delicate varices.
A 59-year-old woman was admitted because of vomiting, CT examinations it was determined that the cause of vomiting was duodenal stenosis due to hematoma after rupture of the inferior pancreaticoduodenal artery aneurysm. In addition, it was believed that the aneurysm had been caused by obstruction of the celiac artery. The aneurysm of the inferior pancreaticoduodenal artery was detected by angiography, and embolization was performed using coils. The embolization was successful. Since then the duodenal stenosis improved and the vomiting symptoms disappeared. We reviewed 28cases of duodenal stenosis due to rupture of the pancreaticoduodenal artery aneurysm in the Japanese literature.
A 29-year-old woman was referred to our hospital for the intensive examination of leg edema and hypoproteinemia. CT scan of showed multiple thin-walled cysts in both lungs, suggesting lymphangioleiomyomatosis. CT scan of the abdomen, lymphoscintigraphy showed enlarged abdominal lymph nodes. Protein loss from the gastrointestinal tract was documented by measurement of the clearance of alpha-1 antitrypsin from the plasma using a 72h stool collection and 99mTc human serum albumin scintigraphy. We thought that secondary lymphangiectasia with lymphangioleiomyomatosis caused protein-losing gastroenteropathy. Dietary therapy resulted in symptomatic improvement.
A 82-year-old asymptomatic HBV carrier man was admitted with liver dysfunction in May 2007. With anti-HBe antibody and high viral load, he had fulminant hepatic failure without proximate cause. He was treated with entecavir and corticosteroids, but died about one month later. Autopsy specimen of liver revealed submassive hepatic necrosis with faint regeneration. HBV obtained was segregated into genotype Bj, and mutation was detected at nt1896 in a precore region.
A 50-year-old man with chronic HCV infection had been received the injections of 12MU of Consensus-Interferon (C-IFN) three times a week in a previous hospital. Six months later, C-IFN therapy was terminated because of fever and massive ascites. Diuretics and antibiotics had not been effective against these symptoms. In the meantime, skin symptoms of purpura and giant ulcers in the extremities developed, and he was transferred to our hospital. Because skin biopsy revealed vasculitis and serum MPO-ANCA was positive, the diagnosis of ANCA associated vasculitis was made. Methylpredonizoron pulse therapy improved skin symptoms and massive ascites, and the skin ulcers eventually disappeared. ANCA is suggested to be responsible for this rare complication.
A 77-year-old woman underwent abdominal ultrasonic diagnosis in a screening test for diabetes mellitus. A 65×45mm tumor with low echo level was revealed and located from the uncinate process of the pancreas to the body. Contrast-enhanced computed tomography demonstrated the pancreas had a low density area in the arterial phase and a comparable area in the equilibrium phase, compared with the parenchyma of the normal pancreas. Gallium-scintigraphy showed strong accumulation, consistent with the tumor. Mucosa-associated lymphoid tissue (MALT) lymphoma was diagnosed by endosonography-guided fine-needle aspiration biopsy (EUS-FNAB). Complete remission was achieved after radiation therapy.