Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 107, Issue 1
Displaying 1-14 of 14 articles from this issue
Special article
Monthly report: Comprehensive management of liver cirrhosis
Round-table discussion: Comprehensive management of liver cirrhosis
Original article
  • Kiyokazu SHIRAI, Akahito SAKO, Naoki ASAYAMA, Toshiko OGAMI, Ryo NAKAJ ...
    2010 Volume 107 Issue 1 Pages 48-60
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    New Japanese criteria for severity assessment in acute pancreatitis were introduced in October 2008. The new criteria are simpler than the previous ones, and are also expected to be more useful for the severity assessment. We retrospectively analyzed the clinical factors in our patients to predict prognosis, and evaluated the usefulness and limitations of the new criteria. There were fewes missing data in the new criteria compared with the previous criteria. The areas under the receiver operating characteristic (ROC) curves for mortality prediction were 0.870 for the new criteria and 0.884 for the previous criteria. However, there were more patients whose disease severity on admission were underestimated using the new criteria and who finally progressed to worse stages including death. This evidence strongly suggests the lower sensitivity of the new criteria in mortality prediction. Repeated assessment of severity after admission will be indispensable in the proper treatment of patients with acute pancreatitis.
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Case report
  • Motohiko KATO, Tsutomu NISHIDA, Shusaku TSUTSUI, Katsumi YAMAMOTO, Eii ...
    2010 Volume 107 Issue 1 Pages 61-69
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    A man in his seventies visited our hospital due to positive a fecal occult blood test. Colonoscopy showed a submucosal tumor in the rectum covered with reddish and irregular mucosa. Pathological examination of the biopsy specimen revealed well differentiated adenocarcinoma. The tumor was resected, and pathological examination showed carcinoid and adenocarcinoma components coexisting and mixed with each other. Because a previous colonoscopy had shown a submucosal tumor with a smooth surface, this case was diagnosed as a collision tumor of adenocarcinoma which developed on a carcinoid.
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  • Tomomi YAKABE, Kenji SUMI, Katsuhiko HIDAKA
    2010 Volume 107 Issue 1 Pages 70-76
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    Case 1) A 21-year-old Thai woman, and Case 2) a 22-year-old Indonesian woman, were each given a diagnosis of pulmonary tuberculosis. Immediately after starting medication, peritonitis symptoms appeared. Colonoscopies detected multiple rings and zonal ulcers. Abdominal tuberculosis was diagnosed, and anti-tubercular therapy was effective. Case 3) A 23-year-old man was given a diagnosis of pulmonary tuberculosis. The day after starting anti-tubercular therapy, he complained of abdominal pain that increased with muscular defense. He was given a diagnosis of perforation of the digestive tract, underwent emergency surgery, and recovered. Pathological examinations revealed granuloma with caseous necrosis and Mycobacterium tuberculosis. Physicians should be aware that tuberculosis can be a potential source of acute abdomen in young adults who do not take proper care of their health.
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  • Shogo KAIDA, Jiro NISHIDA, Hiroshi KISHIKAWA, Hitoshi ICHIKAWA, Tetsuo ...
    2010 Volume 107 Issue 1 Pages 77-83
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    A 64-year-old woman visited our outpatient clinic because of bloody stools and abdominal fullness. Digital rectal examination revealed a 6×4-cm oval mass. Abdominal CT scans demonstrated a concentric, multilayered structure in the rectum. Colonoscopy showed segments of the bowel were dark-purplish, and intussusception. Deeper insertion of the colonoscope through the lumen revealed a type 1 lesion. Under a diagnosis of sigmoid colon cancer with intrarectal intussusception, emergency surgery was performed. The resected specimen showed a type 1 advanced cancer and two early cancers at the base of the intussuscepted colon, all of which appear to have contributed to the intussusception.
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  • Eijiro HAYASHI, Hiroaki SHIBAHARA, Atsushi TSUJI, Mana KINOSHITA, Sato ...
    2010 Volume 107 Issue 1 Pages 84-92
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    A 95-year-old woman who presented with ischemic heart disease was admitted due to a sensation of chest compression. Endoscopy was performed due to anemia which showed an irregular ulcerative lesion in the duodenal bulb which a biopsy revealed to be high-grade neuroendocrine carcinoma. Distant metastasis was found and the patient died from the original disease 3 months after the first medical examination. The result of autopsy was neuroendocrine carcinoma of duodenum and invasion and metastases to multiple organs. We report a case of neuroendocrine carcinoma originating from the duodenum excluding the papilla which is extremely rare in Japan.
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  • Ryuji SUKEGAWA, Akinori MATSUMOTO, Satoshi SUZUKI, Motoya TOMINAGA, Ka ...
    2010 Volume 107 Issue 1 Pages 93-101
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    A 55-year-old woman was admitted because of a tumor located in the ventral region of S4 of the liver, just beneath the diaphragm. A CT scan revealed the round tumor to be delineated as a 33 mm in size, with an outer capsule. The tumor was visualized as concentric circles which presented high-, low-, and high- signal patterns on T2-weighted MRI. It also presented a triphasic pattern in which the border and the central part were not contrasted as a low signal pattern, while the middle part was contrasted as a high signal pattern by T1-weighted enhanced imaging with Gd-DTPA. Angiography revealed that the tumor did not originate from the liver but from the diaphragm, so it was surgically resected as a primary diaphragmatic tumor. We report a shwannoma which originated from the diaphragm, that showed characteristic imaging findings and required to be distinguished from a liver tumor.
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  • Noriyuki AKUTSU, Hideki WAKASUGI, Reina OHZEKI, Hirokazu OHASHI, Hidey ...
    2010 Volume 107 Issue 1 Pages 102-111
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    A 22-year-old man had been given a diagnosis of idiopathic portal hypertension in childhood. In June 2001, a hepatic nodule which gradually increased in size over the next 2 years, was detected in the left hepatic lobe. In February 2003, a left lateral segmentectomy was performed. Histological examination of the nodules suggested focal nodular hyperplasia (FNH)-like hyperplasia. Computerized tomography performed 2 years later showed other hepatic nodules, and a liver biopsy was performed. Histopathological examination conducted at this time also suggested FNH-like hyperplasia. Owing to the substantial enlargement of the nodules and frequent recurrence, it can be difficult to distinguish between benign and malignant lesions.
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  • Takahisa OGAWA, Jun HORAGUCHI, Yutaka NODA, Go KOBAYASHI, Kei ITO, Tak ...
    2010 Volume 107 Issue 1 Pages 112-119
    Published: 2010
    Released on J-STAGE: January 07, 2010
    JOURNAL FREE ACCESS
    A 75-year-old woman with jaundice was given a diagnosis of bile duct cancer using several imaging modalities. The proximal and middle bile ducts were evaluated as normal by multidetector-row CT and intraductal ultrasonography. However, peroral cholangioscopy (POCS) with narrow band imaging (NBI) clearly revealed the intraepithelial extent of the bile duct cancer from the distal bile duct to the hilar bile duct, which was confirmed by histological examination of the resected specimen. POCS combined with NBI is expected to be useful for determining the resection margin in bile duct cancer cases.
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