Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 110, Issue 7
Displaying 1-13 of 13 articles from this issue
Review article
Monthly report; Clinical Essence of Small Intestinal Diseases
Round-table discussion
Original article
  • Hirohito KAWAUCHI, Tomoyuki OHTA, Yu MATSUBARA, Koji YOSHIZAKI, Jun SA ...
    2013 Volume 110 Issue 7 Pages 1249-1257
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    Acute esophageal mucosal lesion (AEML) is a comprehensive disease that includes necrotizing esophagitis and acute erosive esophagitis, which result in upper gastrointestinal bleeding. However, little is known about AEML. We examined the clinicopathological features of 57 AEML cases. AEML presented as acute diffuse esophagitis showing an endoscopically erosive mucosa. The disease did not include corrosive injury, radiation-induced damage, infectious esophagitis, or acute exacerbation of chronic gastroesophageal reflux disease. AEML predominantly affected elderly men, and upper gastrointestinal bleeding was the frequent presenting symptom. Severe underlying diseases such as cranial nerve disease or pneumonia were observed in 98% of the patients. Esophageal sliding hernia and gastroduodenal ulcers were endoscopically observed in 67% and 63% of the patients, respectively. Deaths due to exacerbation of the underlying diseases accounted for 16%. Most cases rapidly improved with conservative management using a proton pump inhibitor or an H2 blocker. Therefore, AEML should be considered a disease having characteristics different from those of common gastroesophageal reflux disease.
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Case report
  • Takashi FUJISAWA, Yuko MATSUMOTO, Akihiko NISHIZAWA, Masafumi TAKATA
    2013 Volume 110 Issue 7 Pages 1258-1264
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    A 70's man was admitted to our hospital because of lumbago and paresthesia in the right lower extremity. He underwent surgical resection of gastric gastrointestinal stromal tumor (GIST), which was classified to the high-risk group according to the modified-Fletcher's classification, one and half years ago. CT, MRI, and PET-CT showed metastases to a part of the liver (S3-4), the 12th thoracic vertebra, and the sacral bone. Subsequently, radiotherapy for the bone metastasis and administration of imatinib mesylate were started. Four months after the initial admission, the liver and the bone metastatic lesions achieved PET-complete response (CR). This report shows that multimodality therapy with radiotherapy and imatinib mesylate was effective for liver and bone metastases after complete resection of gastric GIST.
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  • Osamu ARAI, Norikuni SHIBATA, Makoto KUBOKI, Hiroshi IKEDA, Kenji OMOT ...
    2013 Volume 110 Issue 7 Pages 1265-1271
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    A 34-year-old woman with underlying IgA nephropathy was admitted to our hospital with chief complaints of abdominal pain and pyrexia. Computed tomography showed increased mural thickness of the ileum and increased mesenteric fat density. Colonoscopic findings revealed a longitudinal ulcer in the terminal ileum and irregularly shaped ulcers and a longitudinal ulcer scar in the descending colon. Histopathological analysis of biopsy specimens from the ileum and descending colon showed non-caseating epithelioid cell granuloma. On the basis of these findings, the condition of the patient was diagnosed as ileocolonic Crohn's disease, and the patient received parenteral nutrition, followed by elemental diet. The patient was responsive to nutrition therapy, and the amount of uric protein decreased as her Crohn's disease activity index decreased. In conclusion, we assume that the Crohn's disease activity correlated with that of IgA nephropathy.
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  • Masahiro SAITO, Keisuke OIKAWA, Shiho UCHIYAMA, Yoshifumi INOMATA, Shu ...
    2013 Volume 110 Issue 7 Pages 1272-1280
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    We report an extremely rare case of undifferentiated pleomorphic sarcoma of the stomach. A 74-year-old woman was admitted for abdominal discomfort. A 13-cm gastric submucosal tumor and multiple liver and bone metastases were detected by computed tomography. The tumor had not been detected 8 months earlier. We performed EUS-FNAB for a suspected mesenchymal tumor, but the immunohistochemical test (c-kit, CD34, desmin, SMA, S-100) findings were negative. The tumor was confirmed as wild type for c-kit and PDGFRα. It grew rapidly and the patient died 2 months after admission. Pathological analysis of the EUS-FNAB specimens and autopsy revealed an undifferentiated pleomorphic sarcoma.
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  • Osamu KINOSHITA, Kazuma OKAMOTO, Hirotaka KONISHI, Shuhei KOMATSU, Sat ...
    2013 Volume 110 Issue 7 Pages 1281-1287
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    A 56-year-old man underwent distal pancreatectomy in July 1997, and chemotherapy was administered as adjuvant therapy. The histopathological diagnosis was a neuroendocrine tumor of the pancreas, NET G2 (Ki-67 labeling index: 3%), T2N0M0 stage IB, according to the TNM classification. In July 2011, follow-up endoscopic examination showed a submucosal tumor covered with almost normal gastric mucosa in the posterior wall of the upper stomach. Endoscopic ultrasound showed a heterogeneous-echoic submucosal tumor present at both the submucosal layer and the proper muscle layer. Abdominal enhanced CT revealed a 3-cm-diameter enhanced mass in the posterior wall of the upper stomach. We performed local resection of the gastric posterior wall. The histopathological diagnosis was a metastatic gastric tumor secondary to a pancreatic endocrine tumor, NET G2 (Ki-67 labeling index: 10%). In this paper, we report a rare case of metastatic gastric cancer secondary to a pancreatic neuroendocrine tumor 15 years after the first operation, together with a review of the literature.
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  • Toshifumi DOI, Naoki WAKABAYASHI, Naoto IWAI, Yukihiro MORITA, Kiyoshi ...
    2013 Volume 110 Issue 7 Pages 1288-1295
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    A 35-year-old man was hospitalized for severe acute pancreatitis. On the 24th hospital day, CT scan showed a pancreatic pseudocyst in the head of the pancreas. Conservative medical treatment for 1 month was not effective, and CT scan revealed a fistulous communication of the pseudocyst to the common bile duct and duodenum. After the formation of a fistulous communication, we detected common bile duct stones composed of fatty acid calcium and we removed them endoscopically. The pseudocyst gradually decreased in size and disappeared 4 months later. Follow-up CT scan showed no sign of recurrence.
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  • Yutaka TSUTSUMI, Yasuyuki KUNIEDA, Jun YAMAUCHI, Souichi NAKAGAWA, Aki ...
    2013 Volume 110 Issue 7 Pages 1296-1303
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    Hemorrhage through the pancreatic duct into the duodenum, the so-called "hemosuccus pancreaticus", is a rare cause of gastrointestinal bleeding. A 75-year-old man, who was treated with anticoagulation agents for an old myocardial infarction, was admitted to our hospital for sudden tarry stools and abdominal pain. His hemoglobin level slightly dropped to 12.6g/dL. His liver function tests results and the serum amylase level were elevated. A second upper gastrointestinal endoscopy revealed continuous bleeding from the ampulla of Vater. A rupture of an aneurysm of the splenic artery to the pancreatic duct was suggested by abdominal computed tomographic scan, abdominal magnetic resonance imaging, celiac arteriography, and endoscopic ultrasonography. The conservative treatment of stopping the bleeding with anticoagulation agents was successful.
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  • Hirotada NISHIE, Fumihiro OKUMURA, Shigeki FUKUSADA, Tadahisa INOUE, K ...
    2013 Volume 110 Issue 7 Pages 1304-1312
    Published: 2013
    Released on J-STAGE: July 05, 2013
    JOURNAL FREE ACCESS
    We report a rare case of intraductal papillary mucinous carcinoma (IPMC) with acute obstructive suppurative pancreatic ductitis (AOSPD), liver abscess, and pancreatobiliary fistula formation. A man in his sixties was admitted to our hospital with a chief complain of high grade fever and anorexia. CT and MRI revealed a multilocular cystic lesion in the pancreatic head, fistula formation between the common bile duct and this cystic lesion, and multiple liver abscess. We performed endoscopic nasopancreatic drainage for the AOSPD, endoscopic biliary drainage for the biliary flow obstruction, and percutaneous transhepatic drainage for the liver abscess. Klebsiella pneumoniae was detected in the culture of pancreatic juice and liver abscess, but not in the bile and blood culture. These culture studies revealed that the liver abscess was caused by AOSPD. The patient underwent pancreaticoduodenectomy for the IPMC. The pathological diagnosis was IPMC.
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