A 37-year-old man, who had been admitted to another facility because of integration dysfunction syndrome suffered from postprandial epigastric pain, vomiting and weight loss. He was referred to our hospital for further examinations and treatment. Ultrasound examination revealed gastric and duodenal dilatation, reduction of the distance between the superior mesenteric artery (SMA) and aorta and to-and-fro movement in his duodenum, suggesting SMA syndrome. Computed tomography and upper gastrointestinal tract examination also showed findings typical of SMA syndrome. We measured the SMA-aorta distance and the passage of duodenal contents in various body positions using ultrasound. He had to-and-fro movements in his duodenum in a supine, sitting, and left recumbent position. However, when examined in the right recumbent position, the SMA-aorta distance became longest, and intestinal juice flowed from the duodenum to the jejunum. He underwent postural therapy, maintaing a right recumbent position for 30 minutes after every meal, which improved his clinical symptoms.
A 42-year-old Japanese woman, who resided in Indonesia suffered from watery diarrhea. As soon as she returned to Japan, she had a medical examination at our hospital. Oocysts of Cyclospora cayetanensis were isolated from her stool on the 14th day. Treatment with 1.6g/day sulfamethoxazole/trimethoprim combination for 1 week was effective. Cyclosporiasis is a of newly-emerging infection and causes group infection or traveler's diarrhea. Cyclosporiasis should be suspected in patients with diarrhea who have returned from the endemic areas to Japan.
A 63-year-old woman was admitted to our hospital with complaints of abdominal distention and bilateral cervical masses. Her serum AFP was 11700ng/dl. AFP was confirmed immunohistochemically by biopsy of a sigmoid colon tumor, yielding a diagnosis of AFP-producing carcinoma of the sigmoid colon, accompanied by multiple liver metastases, and systemic multiple lymph node metastases. Due to her poor general condition with mitral regurgitation, the patient began S-1 treatment. The patient's general condition rapidly worsened after 1 course of S-1 had no effect. She died on the 59th hospital day and a pathological autopsy was performed. We examined 67 cases of AFP-producing colon cancer in Japan, including our own, and report the findings with references.
In October 2007, a woman in her early 30s presented, complaining of worm discharge in her stool. We identified it as Diphyllobothrium nihonkaiense, and identified it by virtual enterography and virtual enteroscopy. It was treated by 1500mg/day praziquantel orally. We think these methods, of pathology as well as capsule enteroscopy and enteroscopy, are useful for the searching of the small intestinal lesions. We hope these examinations will become more widespread with reference to these cases.
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 559U/L, ALT level of 427U/L, and EBV-DNA of 2.9×106copies/μg 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.
A 72-year-old woman received combination therapy with peginterferon α and ribavirin for treatment of chronic hepatitis C. Approximately 40 weeks after starting treatment, she developed an eruption in the left inner canthus and sarcoidosis was diagnosed after biopsy of the eruption. Combination therapy was discontinued, and further detailed examinations revealed bilateral hilar lymphadenopathy, uveitis, and complete atrioventricular block. A permanent cardiac pacemaker was implanted, and her sarcoidosis improved upon administration of corticosteroids.
A 65-year-old woman was admitted with upper abdominal pain and pyrexia. She was given a diagnosis of acute pancreatitis and treated with intravenous infusion. After recovering, abdominal enhanced-CT showed a low density area in the head of the pancreas, measuring 2cm in maximum dimension. Endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) revealed acinar cell carcinoma (ACC). She underwent curative subtotal stomach-preserving pancreaticoduodenectomy. The definitive diagnosis, based on the histopathological examinations including immunohistochemical staining, was ACC. ACC of the pancreas is extremely rare, occurring in approximately 1% of all cases of pancreatic neoplasm. We report a rare case diagnosed as ACC by EUS-FNA prior to surgical treatment.
A 62-year-old man was admitted to receive extracorporeal shock wave lithotripsy (ESWL) for a right renal pelvic calculus. During the operation, the patient complained of right upper quadrant pain. Later in the day, laboratory data showed elevated serum amylase levels, and abdominal CT revealed an enlarged pancreas. These findings led to a diagnosis of acute pancreatitis. The following day, urine output had decreased, and pleural and ascitic fluid had accumulated. For these reasons, the patient was transferred to our hospital to receive combination therapy, including arterial infusion therapy with protease inhibitors, antibiotics and continuous hemodiafiltration. The condition of the patient improved, and he was discharged on day 30. Acute pancreatitis should be considered as an early complication after ESWL for urinary tract calculus.