We examined the compliance with, and efficacy of, the clinical guideline for the diagnosis of hepatocellular carcinoma (HCC). We classified 74 patients with HCC into 3 categories;23 surveillance cases, 18 non-surveillance cases, and 33 incidental cases. Patients from affiliated hospitals included more non-surveillance and incidental cases than in university hospital-treated cases. HCC was diagnosed at an earlier stage in the surveillance group than the incidental group, and the surveillance group had a better outcome than the incidental group. There was no significant difference in HCC stage or outcome between surveillance and non-surveillance groups. The guidelines appeared to be useful for early diagnosis of HCC except for the fact that some in the surveillance group were diagnosed at an advanced stage and around 30% of the incidental group had some risk factors of HCC. Those conducting surveillance must improve their skills for early diagnosis of HCC and both doctors and patients must increase compliance with the guidelines.
Scoring systems for the diagnosis of fibrosis in non-alcoholic fatty liver disease (NAFLD) have been devised all over the world. However, the usefulness of these scoring systems for Japanese populations has not been established. We examined the diagnostic ability of several scoring systems for the diagnosis of advanced fibrosis in NAFLD patients. A total of 52 patients with NAFLD who had undergone liver biopsy were included in this study. The area under the receiver operating characteristic (AUROC) of the scoring system for the advanced fibrosis was greatest for NAFLD fibrosis score (NFS) (0.913). At a cutoff point of -0.876 modified from the original low cutoff point (-1.455), the sensitivity, specificity, and positive and negative predictive values for advanced fibrosis were 100%, 82.5%, 63.2%, and 100%, respectively. Based on these results, we conclude that low cutoff point of NFS should be modified to -0.876 for a Japanese population with a lower BMI than Western populations.
A health check up in a 31-year-old man revealed free air under the diaphragm by a chest X-ray. The CT showed marked cystic emphysema along the small intestinal wall, as well as thickening and stenosis of the pyloric wall of stomach. Therefore, we suspected pneumatosis cystoides intestinalis (PCI) with stenosis of the pylorus. Since no perforation of the intestinal tract was diagnosed, it was preserved. Upper G.I. endoscopy showed H2 stage gastric ulcer in the posterior wall of the antrum. Eventually, a diagnosis of PCI with gastric ulcer and stenosis of the pylorus was, which we preserved. We report this rare case here.
A 64-year-old woman was introduced to our hospital with liver tumors. Our examination revealed that she had advanced colon carcinoma with multiple liver metastasis. Without symptoms from the primary cancer, she underwent chemotherapy of avastin FOLFOX. After 2 courses of chemotherapy, she suffered ileus and underwent operation. The resected specimen showed marked tumor necrosis and fibrosis, but few tumor cells remained in the primary lesion. We think this was a rare case of suffered ileus because of marked response of chemotherapy in primary colon carcinoma.
A 63-year-old woman with Behçet disease presented with epigastric pain due to refractory gastric ulcers. Examinations indicated that these ulcers were caused by gastrointestinal Behçet disease. Steroid therapy proved ineffective, so we gave 5mg/kg of infliximab. However, since the patient responded poorly to the treatment the infliximab was discontinued and a total gastrectomy was performed. After surgery, a marginal ulcer developed and infliximab was again administered. Although this brought about improvement in the conditions of the marginal ulcer, infusion-related hypersensitivities in the patient caused polyarthralgia. We therefore discontinued the infliximab treatment and began 40mg of adalimumab every other week. After 3 months of the new treatment, the patient's marginal ulcer completely healed and her epigastric pain disappeared. This case suggests that adalimumab may be as useful as infliximab for treating refractory gastrointestinal Behçet disease.
A 40-year-old man presented to our department with left lower abdominal pain. Laboratory test showed slight leukocytosis and moderately elevated C-reactive protein (CRP). Computed tomography (CT) of the abdomen showed a typical fat density lesion adjacent to the sigmoid colon. The diagnosis of primary epiploic appendagitis of the sigmoid colon was established, and the patient was managed conservatively. Primary epiploic appendagitis is a self-limiting illness, and diagnosed by characteristic radiographic findings. Inaccurate diagnosis can lead to unnecessary treatments including surgical intervention. When we encounter a case of acute abdomen, we should consider the possibility of this disease to make accurate diagnosis and give proper treatment.
A 75-year-old man was admitted because of watery diarrhea, hematochezia and right lower abdominal pain. Many deep undermining colonic ulcers were found by colonoscopy, and we detected trophozoite amoeba pathologically. Metronidazole was administered orally from 3 days after admission. However, since CT demonstrated a huge abscess in the abdominal cavity, we performed percutaneous drainage from 17 days after admission. On day 157, the patient was discharged, because the colonic ulcers had almost healed, and trophozoite amoebas were not recognized pathologically.
A woman in her 50s was admitted with obstructive jaundice due to a pancreatic mass. She had a history of a right breast phyllodes tumor treated with mastectomy 3 years previously. Diagnostic imaging (endoscopic ultrasonography (EUS), CT, and MRI) demonstrated a well-demarcated mass in the pancreatic head. EUS-FNA showed spindle shaped tumor cells. The pancreaticoduodenectomy specimen showed a malignant spindle cell tumor consistent with a metastatic malignant phyllodes tumor. In addition, immunohistochemical staining demonstrated that the staining pattern of pancreatic tumor was similar to that of the breast phyllodes tumor. Pancreatic metastases from breast phyllodes tumors have rarely been reported in the literature.