We investigated the safety, clinical efficacy, and significance of tacrolimus trough levels in 20 outpatients with active ulcerative colitis. Adverse effects were observed in 16 (80%) patients, and most events were reversible and showed improvement or complete recovery. Three patients required hospitalization because of disease aggravation. The rate of efficacious tacrolimus trough levels was 60% within 1 week and 95% within 2 weeks. At 12 weeks, the clinical remission rate was 25% and the improvement rate was 55%. The clinical remission rate was significantly higher in patients with the relapse-remission type than in those with the chronic inflammation type. These results indicate that the use of tacrolimus in outpatients with ulcerative colitis is safe and that efficacious trough levels can be rapidly achieved in these patients.
An 82-year-old woman with a history of bronchiectasis for 20 years was admitted to our hospital with anorexia and diarrhea. Sigmoidoscopy showed multiple mucosal erythematous areas and erosions. Histologic examination with Congo red stain revealed massive amyloid deposition around the submucosal vessels as well as in the parenchyma of the mucosa and submucosa. With immunohistochemistry, the diagnosis of secondary/reactive AA amyloidosis was confirmed. Esophagogastroduodenoscopy demonstrated diffuse dark brown mucosa, establishing the diagnosis of acute necrotizing esophagitis. Ischemia associated with amyloid deposition of the vessels in the esophagus was considered to be a possible etiology of acute necrotizing esophagitis. Additionally, gastric outlet obstruction and gastroesophageal reflux associated with gastroduodenal erosions caused by amyloid deposition were supposed to be another factor. Amyloid deposition in the esophageal mucosa may cause a reduction in mucosal defense that is responsible for the pathogenesis. We report the first case of acute necrotizing esophagitis associated with amyloidosis.
A man in his 70s underwent chemoradiotherapy for squamous cell carcinoma of the esophagus in 2009. A follow-up gastroendoscopy performed 3 years later revealed a reddish depressed lesion in the greater curvature of the middle stomach body. On the basis of histological and immunohistochemical findings and clinical features, including endoscopic findings, a diagnosis of lymphomatoid gastropathy was made. Follow-up studies revealed a decrease in the size of the lesion and the development of chronic gastritis. Although lymphomatoid gastropathy is rare, recognition of this disease is important because misdiagnosis as lymphoma may lead to unnecessary radical therapeutic procedures.
An 80-year-old man presented with abdominal fullness and vomiting. Laboratory data revealed severe anemia, an inflammatory response, and elevated white blood cell counts. Abdominal computed tomography indicated ileus caused by a jejunal tumor measuring 8cm in diameter. Although small-bowel endoscopy enabled visualization of the tumor, adequate biopsy specimens could not be obtained for accurate diagnosis. The patient's condition rapidly deteriorated, because of which surgical treatment could not be initiated. The patient died approximately 3 weeks after admission. High serum granulocyte colony-stimulating factor (G-CSF) levels were detected at autopsy. Immunohistochemical staining of the autopsy specimen indicated positive G-CSF levels in the jejunal tumor. On the basis of these findings, a final diagnosis of undifferentiated carcinoma of the jejunum producing G-CSF was made.
We report the case of a 64-year-old man who underwent resection on two occasions for recurrent renal cell carcinoma. He first underwent right nephrectomy for renal cell carcinoma, and 10 years later, he underwent pylorus-preserving pancreaticoduodenectomy for pancreatic metastasis. Microscopic extracapsular invasion without lymph node metastasis was observed at that time. Twelve years after the first surgery, he was diagnosed with stomach metastasis. Clinically, metastases to other organs was not observed, and endoscopic ultrasonography revealed no changes in the submucosal layer; endoscopic submucosal dissection was subsequently performed. Pathologically, the tumor was found to be localized in the mucosal layer. There has been no occurrence of metastases for 2 years and 6 months since the last surgery.
Nocardia infection is a fatal complication in compromised hosts and is often associated with a poor prognosis. Here we report the case of a 42-year-old man with acute liver injury treated with steroids who developed pulmonary nocardiosis. Pulmonary computed tomography was performed followed by bronchoscopy, which confirmed the diagnosis of pulmonary nocardiosis. This facilitated expedient and successful treatment of the pulmonary infection. Computed tomography is a useful tool for screening respiratory tract infection in immunocompromised patients, such as those with acute liver injury.
A 54-year-old man exhibited a pancreatic mass on abdominal ultrasonography. Diagnostic imaging with endoscopic ultrasonography, computed tomography, and magnetic resonance imaging revealed that the mass comprised various internal structures and was not connected to the pancreatic duct. Over a period of 4 years and 2 months, the mass increased from 22mm to 32mm in diameter. Laparoscopic enucleation was performed, and a histopathological diagnosis of a lymphoepithelial cyst (LEC) of the pancreas was obtained. LEC is rare and seldom reported in the literature. Although it is considered to be benign, most case reports indicate that they tend to increase in size. This indicates that LEC should be carefully monitored if surgery is not performed after diagnosis.
A 56-year-old woman was admitted to our hospital with fever and systemic malaise. Abdominal computed tomography revealed an enhanced tumor of the pancreatic head, measuring 9cm in maximal diameter and containing a low-density area. Subtotal stomach-preserving pancreatoduodenectomy was performed. Hemorrhage and necrosis were evident within the tumor, and osteoclastic polynuclear giant cells were also identified. A diagnosis of giant cell anaplastic ductal carcinoma of the pancreas was made. The patient has been free from recurrence for 6 months since surgery.