Objective and Methods : A long-term effect of ipragliflozin on adipose tissue mass reduction in Japanese patients with obese type 2 diabetes (T2D) was investigated. Ipragliflozin was administered (50mg/day) once daily for 12 months. At 0, 3, 6 and 12 months, visceral and subcutaneous adipose tissue area was determined by two different bioelectrical impedance methods, and blood samples for HbA1c, renal function, lipids and liver function obtained, and body weight and blood pressure recorded. The primary endpoint was decrease in body fat mass. Secondary endpoints included changes in body weight and the laboratory data. Results : Seventeen of 20 participants (mean body mass index (BMI) 35.1±1.1 kg/m2) completed this prospective observational study. Visceral fat area (cm2, mean±SD) at 0, 3, 6 and 12 months was 166.0±49.7, 149.7±46.1, 149.7±42.4 and 148.5±40.2, respectively : the value at 3 months was significantly lower than baseline (P＝0.027). Subcutaneous fat at the corresponding time points was 359.3±110.5, 316.6±87.1, 326.8±87.2 and 325.9±90.4, respectively : the values at each post treatment period was significantly less than the baseline (P＝0.003, 0.018 and 0.036 for the three points, respectively). Body weight was significantly reduced by 12 months (P＝0.045). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (γ-GTP) levels decreased significantly. There were no significant correlations between serum hepatobiliary enzyme levels and Δbody weight or Δvisceral fat, but Δγ-GTP was correlated with Δsubcutaneous fat (Spearman's P＝0.004). Conclusion : During the 1 year interval, ipragliflozin significantly reduced subcutaneous adipose tissue and serum AST, ALT, and γ-GTP levels.
We describe two primary biliary cholangitis (PBC) cases with hepatocellular carcinoma (HCC) in a non-cirrhotic stage. Case 1 : A 61-year-old woman was diagnosed as having PBC by anti-mitochondrial antibody (AMA) positivity. She was complicated with HCC at the age of 80, as confirmed by imaging studies along with elevation of tumor markers. Transcatheter arterial chemoembolization (TACE) therapy did not prevent a recurrence and she died at 82 years of age. A liver specimen at autopsy revealed Nakanuma stage 3 PBC with HCC dissemination. Case 2 : A 61-year-old woman was diagnosed at Nakanuma stage 3. She was complicated with HCC for 10 years in a non-cirrhotic stage but cured by TACE therapy. Clinicians should bear in mind that patients with an advanced but non-cirrhotic stage of PBC may become complicated with HCC. Further studies are needed to clarify the risk factors of HCC development in non-cirrhotic PBC.
Endometriosis is a benign disease in which endometrial tissue exists outside the endometrium and the myometrium, and it occurs in all parts. We report two cases of abdominal wall endometriosis. Case 1 : A 37-year-old woman complained of a subcutaneous mass with pain associated with her menstrual cycle. She had a solid mass on the right side of the scar 8 years after undergoing a cesarean section. The biopsy from the mass indicated a diagnosis of endometriosis, and she underwent a complete resection of the tumor. Case 2 : A 42-year-old woman presented with persistent lower abdominal pain. She had had a cesarean section 12 years earlier. Computed tomography showed a 12mm mass in the context of the scar associated with tenderness. Wide surgical excision was performed and the pathological diagnosis was endometriosis.
Although endometriosis is a common disease in reproductive women, some reports about abdominal wall endometriosis have been published. Most abdominal wall endometriosis is associated with obstetrics and gynecological surgeries, especially a cesarean section. Many patients complain of a painful subcutaneous mass at the surgical scar. We should consider endometriosis for the differential diagnosis of an abdominal wall mass on a surgical scar and resect totally without residual tumor.