Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 110, Issue 5
Displaying 1-19 of 19 articles from this issue
Review article
Monthly report; Innate immunity involved in the pathogenesis of gastrointestinal disease
Special contribution
Original article
  • Makoto NATSUME, Hitoshi SANO, Shigeki FUKUSADA, Kenta KACHI, Tadahisa ...
    2013 Volume 110 Issue 5 Pages 825-832
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    Diagnosis and treatment of biliary tract disease requires an intraductal radiocontrast agent. Although iodine-based contrast medium is commonly used, some patients show severe allergy to iodinated contrast agent. We have retrospectively reviewed the usefulness and safety of gadolinium as an alternative radiocontrast agent in 3 patients with allergy to iodine-based contrast medium in the diagnosis and treatment of biliary tract diseases. In case 1, percutaneous transhepatic biliary drainage and cholangiography were performed successfully and it was possible to visualize an intrahepatic bile duct stone. Percutaneous transhepatic cholangioscopic lithotomy was performed and the intrahepatic bile duct stone was removed. In case 2, endoscopic biliary lithotripsy was performed. In case 3, percutaneous transhepatic cholangiography and cholangioscopy provided a diagnosis of moderately differentiated carcinoma. He underwent pancreatoduodenectomy. Postoperative cholangiograms were also obtained successfully. Gadolinium contrast agent is an alternative to iodine-based cholangiography for the patients with allergy to iodine.
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Case report
  • Yasuyuki TAMAI, Kazuhiko KOBAYASHI, Yuji HARUKI, Takazumi YADA, Shinji ...
    2013 Volume 110 Issue 5 Pages 833-838
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    A 72-year-old Japanese woman was admitted because of vomiting and abdominal pain. An enhanced computed tomography scan showed a small intestinal obstruction due to ileal wall thickening and multiple liver metastases. Her serum alpha-fetoprotein (AFP) level was high at 1671.9ng/ml. An ileocecal resection was performed. The histological diagnosis was AFP-producing small intestinal cancer resembling the primitive gut epithelium of a fetus. The present case suggested that even intestinal cancer could produce AFP.
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  • Emiko TANIDA, Motoyoshi IZUMI, Tsuyoshi ABE, Izumi TSUCHIYA, Kanji OKU ...
    2013 Volume 110 Issue 5 Pages 839-845
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    A 48-year-old man was admitted to our hospital complaining of acute severe abdominal pain and constipation. He had received bone marrow transplantation for acute myelogenous leukemia 5 months previously and immunosuppressant treatment for chronic graft-versus-host disease. Abdominal X-ray and CT scan films revealed his large intestine widely dilated and filled with air, and colonic pseudo-obstruction was diagnosed. It was difficult to ascertain the cause of the symptoms until 6 days after onset of the abdominal pain when disseminated zoster eruption appeared over his whole body. It was disseminated varicella-zoster and complicated with colonic pseudo-obstruction. He was treated with acyclovir. It is important to suspect disseminated varicella-zoster and treat early immunocompromised patients complaining of severe acute abdominal pain and colonic pseudo-obstruction.
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  • Ayano MORI, Takahiro KOGAWA, Youhei ARIHARA, Masakazu ABE, Fumito TAMU ...
    2013 Volume 110 Issue 5 Pages 846-851
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    A 38-year-old man was given a diagnosis of as sigmoid colon cancer and underwent sigmoid colectomy. Post-operative pathological staging was stage IIIb. He then underwent adjuvant chemotherapy. One year and 4 months after the surgery, CT scans revealed multiple liver and lung metastases. He was given mFOLFOX6+bevacizumab, which was changed later to FOLFIRI+bevacizumab. After these chemotherapies, he was admitted to the hospital due to sudden abdominal pain and high grade fever. Obstructive jaundice was initially diagnosed, but detailed study of initial CT revealed intragastric wall abscess. After the drainage of the abscess, his conditions improved. We speculated that the abscess formation was caused by mucosal damage due to bevacizumab.
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  • Ayako TOMONO, Tomoyuki WAKAHARA, Kiyonori KANEMITSU, Akihiro TOYOKAWA, ...
    2013 Volume 110 Issue 5 Pages 852-860
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    A 78-year-old man was admitted for workup for a liver tumor. Both serum AFP and PIVKA-II levels were high (2260ng/ml and 806mAU/ml, respectively). Contrast-enhanced CT scan and MRI using Gd-EOB-DTPA demonstrated a liver tumor in segment 6 resembling the imaging patterns of hepatocellular carcinoma (HCC), while the upper gastrointestinal endoscopy revealed a type 2 gastric cancer in the gastric antrum. Although the liver metastasis of the gastric cancer was undeniable, we performed partial resection of segment 6 of the liver and distal gastrectomy under a preoperative diagnosis of double cancer. Histopathologically, gastric tumor consisted of two components, such as well differentiated adenocarcinoma and hepatoid adenocarcinoma. The histology of the liver tumor was similar to that of the hepatoid component in the stomach lesion. Immunohistochemical staining revealed both the gastric and the liver tumors to be positive for AFP and PIVKA-II, yielding a definite diagnosis of AFP and PIVKA-II producing gastric cancer with liver metastasis. Because many cases of this disease have liver metastases at presentation with confusing images with HCC, the diagnosis of liver tumors should be carefully differentiated in the gastric cancer patients with liver tumors, high serum AFP and PIVKA-II levels.
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  • Hiroyoshi SENDO, Hitoshi HARADA, Hiroshi HASEGAWA, Takashi YASUDA, Tad ...
    2013 Volume 110 Issue 5 Pages 861-868
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    The perivascular epithelioid cell family of tumors (PEComas) includes common lesions such as angiomyolipomas, lymphangioleiomyomas, and clear cell "sugar" tumors of the lung. Less frequently, PEComas arise in various other locations throughout the body, including the soft tissue, bone, and the visceral organs. We report the case of a 64-year-old man who underwent total cystectomy because of a primary malignant PEComa of the bladder in August 2010. The patient was treated with the mammalian target of rapamycin inhibitor for lung and bone metastasis from April 2011 and showed stable disease. Computed tomography showed a growing mass in the neck of the gallbladder 5 months later, which was suspected to be gallbladder cancer. Cholecystectomy and lymphadenectomy was performed in February 2012, and histopathological examination indicated gallbladder metastasis from the primary malignant PEComa of the bladder. This is, to our knowledge, the first report of malignant PEComa metastasis to the gallbladder.
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  • Mitsuru OKUNO, Seiji ADACHI, Noriaki NAKAMURA, Osamu YAMAUCHI, Koshiro ...
    2013 Volume 110 Issue 5 Pages 869-874
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    A man visited to our hospital because of high grade fever. Computed tomography revealed multilocular space occupying lesion which were suspected liver abscess. Upper gastrointestinal endoscopy showed an advanced gastric cancer with an ulcer on antrum. Antibiotics decreased the level of CRP, concurrently with the reduction of liver space occupying lesion. While he underwent distal gastrectomy, pathological examination demonstrated the existence of bacterial foci and microabscesses on the surface of the gastric cancer. We speculate in this case that liver abscesses were formed by the infection of resident bacteria through portal vein.
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  • Takuya ISHIKAWA, Jun-ichi HARUTA, Takeo YAMAGUCHI, Masao DOISAKI, Tsuy ...
    2013 Volume 110 Issue 5 Pages 875-882
    Published: 2013
    Released on J-STAGE: May 07, 2013
    JOURNAL FREE ACCESS
    A 45-year-old woman visited our hospital due to upper left quadrant pain and melena. Colonoscopy revealed longitudinal ulcers in the transverse colon. The endoscopic findings and pathological examination of a biopsy specimen led to diagnosis of Crohn disease, and mesalazine was administered. Although the colorectal lesions showed improvement with mesalazine, a blood test revealed elevation of biliary enzymes. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing of the main pancreatic duct and smooth stricture of the distal bile duct. Steroid therapy improved the pancreatic lesion, which was diagnosed as type 2 autoimmune pancreatitis.
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