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Serum fragmented cytokeratin 18 levels reflect the histologic activity score of nonalcoholic fatty liver disease more accurately than serum alanine aminotransferase levels. J Clin Gastroenterol 2010; 44:440-7. [PMID: 20104187 DOI: 10.1097/mcg.0b013e3181bdefe2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND GOALS Reliable noninvasive biomarkers to assess the histologic activity of nonalcoholic fatty liver disease (NAFLD) have not been established. As the frequency of Mallory bodies is known to be closely associated with the disease severity, we hypothesized that serum levels of Mallory body-related proteins were correlated with NAFLD histologic activity and evaluated this possibility. STUDY Serum levels of total and fragmented cytokeratin (CK) 18, heat shock protein (Hsp) 70, Hsp90alpha, ubiquitin+1, and p38alpha at the time of liver biopsy were measured in 118 NAFLD patients and their association with histologic findings and NAFLD histologic activity score (NAS) was investigated. RESULTS Serum levels of both forms of CK18 and Hsp90alpha were markedly higher in patients having nonalcoholic steatohepatitis (NASH) compared with non-NASH ones. Both forms of CK18 significantly correlated with degree of steatosis, lobular inflammation, and ballooning, and showed stronger positive correlations with NAS than serum aspartate and alanine aminotransferase (AST and ALT). Multiple regression analysis further revealed that fragmented CK18 and AST were effective predictors of NAS, with the former being the more definitive of the two (P<0.001 vs. 0.005). In 20 NAFLD patients who received a follow-up biopsy, changes in fragmented CK18 levels, but not AST or ALT levels, closely paralleled those in NAS. CONCLUSIONS These results establish the usefulness of fragmented CK18 measurement for assessing and monitoring the histologic activity of NAFLD.
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7252
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Sakamoto T, Saito Y, Matsuda T, Fukunaga S, Nakajima T, Fujii T. Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection. Surg Endosc 2010; 25:255-60. [PMID: 20559661 DOI: 10.1007/s00464-010-1169-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/11/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Piecemeal resection of colorectal neoplasms is associated with a higher risk of recurrent or residual tumors, but nearly all such cases can be cured by additional endoscopic resection (ER). Although the adoption of endoscopic submucosal dissection (ESD) for colorectal neoplasm is continuing, the safety of this treatment for recurrent or residual tumors has not been fully assessed. We evaluated salvage therapy for the treatment of recurrent or residual tumors, and propose an endoscopic treatment strategy for these tumors. METHODS This retrospective study was conducted for 60 consecutive patients who had with locally recurrent or residual tumor after ER between January 2004 and October 2005. Endoscopic treatment strategy, treatment results, complications and clinical outcomes were recorded. RESULTS Among 69 lesions in 60 patients, 67 were treated endoscopically, whereas 2 required surgical treatment. Of these 67, 87% (58/67) were resected by endoscopic mucosal resection (EMR) and 13% (9/67) by ESD. En bloc resection rate was 39% (23/58) in the EMR group and 56% (5/9) in the ESD group. One limitation of this study is that it was a single-center retrospective analysis. CONCLUSIONS ESD is safe and effective for the treatment of recurrent or residual colorectal tumors. However, because of its technical difficulty, the en bloc resection rate is lower than that for the treatment of nonrecurrent lesions.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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7253
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Tsuruta G, Tanaka N, Hongo M, Komatsu M, Horiuchi A, Hamamoto K, Iguchi C, Nakayama Y, Umemura T, Ichijo T, Matsumoto A, Yoshizawa K, Aoyama T, Tanaka E. Nonalcoholic fatty liver disease in Japanese junior high school students: its prevalence and relationship to lifestyle habits. J Gastroenterol 2010; 45:666-72. [PMID: 20084525 DOI: 10.1007/s00535-009-0198-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 12/12/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the increase in nonalcoholic fatty liver disease (NAFLD) in Japanese adults, its prevalence in adolescents remains unclear. This prompted us to evaluate the incidence and clinical characteristics of NAFLD among junior high school students. METHODS A population-based cross-sectional study was conducted among students in a single junior high school in Nagano prefecture. Serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (gammaGT) measurements and abdominal ultrasonography were performed in 249 and 288 students in 2004 and 2007, respectively. In the latter survey, student lifestyle habits were also assessed, using questionnaires. RESULTS The prevalence of NAFLD was 4.4% and 4.5% in 2004 and 2007, respectively, which was lower than that of obesity (10.0% and 5.9%). Body mass index and ALT and gammaGT levels increased significantly with hepatic steatosis severity. Multivariate logistic regression analysis demonstrated that the presence of obesity and an ALT level of 30 U/L or more were independent predictors of NAFLD (odds ratio 16.9, P<0.001 and odds ratio 16.6, P=0.001, respectively). The ratios of students commuting to and from school by car and not doing sports outside of school were higher in NAFLD students compared with non-NAFLD ones. Such tendencies were observed independently of the presence of obesity. Additionally, one obese student with severe steatosis and liver dysfunction was diagnosed as having nonalcoholic steatohepatitis (NASH). CONCLUSIONS Approximately 4% of junior high school students had NAFLD that was primarily associated with obesity and reduced daily physical activity. Serum ALT measurement during school check-ups is recommended for the early detection of young adolescent NAFLD/NASH.
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Affiliation(s)
- Goro Tsuruta
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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7254
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Yoshida T, Kusumoto S, Inagaki A, Mori F, Ito A, Ri M, Ishida T, Komatsu H, Iida S, Sugauchi F, Tanaka Y, Mizokami M, Ueda R. Reactivation of hepatitis B virus in HBsAg-negative patients with multiple myeloma: two case reports. Int J Hematol 2010; 91:844-9. [PMID: 20473594 DOI: 10.1007/s12185-010-0592-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 04/21/2010] [Accepted: 04/25/2010] [Indexed: 12/31/2022]
Abstract
It was recently reported that hepatitis B virus (HBV) reactivation had occurred in HBsAg-negative lymphoma patients who received rituximab plus steroid combination chemotherapy. HBV reactivation in myeloma patients have not been reported extensively. We describe here two cases of HBV reactivation in HBsAg-negative myeloma patients receiving systemic chemotherapy: one from the medical records of 40 patients and another from 61 patients with prospective HBV-DNA monitoring. In the first case positive for anti-HBs, HBV reactivation was diagnosed when hepatitis developed during conventional chemotherapy such as MP and MCP regimen in a relapsed patient after autologous stem cell transplantation (APBSCT); in the second case positive for anti-HBc and anti-HBs, elevation of HBV-DNA was recognized by serial HBV-DNA monitoring performed prospectively following APBSCT. Interestingly, these two cases had the reduction of the titer of anti-HBs during the treatment, followed by HBV reactivation. These clinical data suggest that the HBV-DNA monitoring is necessary for not only HBsAg-positive but also HBsAg-negative myeloma patients with anti-HBc-positive and/or anti-HBs-positive following transplantation and after conventional chemotherapy in the salvage setting. Establishment of a standard strategy to prevent HBV reactivation is important for myeloma patients receiving systemic chemotherapy.
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Affiliation(s)
- Tatsuya Yoshida
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-chou, Mizuho-ku, Nagoya, 467-8601, Japan
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7255
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Chang KA, Kim TN, Lee SH. Autoimmune pancreatitis complicated by an infected pseudocyst. Clin J Gastroenterol 2010; 3:168-73. [PMID: 26190126 DOI: 10.1007/s12328-010-0152-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 03/26/2010] [Indexed: 12/24/2022]
Abstract
A 53-year-old man was admitted due to upper abdominal pain. He had been diagnosed with autoimmune pancreatitis (AIP) 4 years previously and had been taking steroids for maintenance therapy since that time. Abdominal computed tomography revealed multiple pseudocysts in the head of the pancreas and a dilated pancreatic duct with mottled calcifications around the pseudocyst. Despite the continuation of steroid therapy for 4 months, the size of the pseudocyst increased further and diffuse calcifications developed throughout the pancreas. He was readmitted due to severe abdominal pain and a high fever, and endoscopic drainage of the pancreatic pseudocyst was performed. Two months after the internal drainage, the pseudocyst disappeared and his symptoms subsided. There are few reports concerning AIP complicated by the formation of pseudocysts. We report this case to emphasize that AIP can be complicated by the development of pseudocysts with progression to chronic pancreatitis, accompanied by multiple calcifications.
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Affiliation(s)
- Kyung Ae Chang
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong, Nam-gu, Daegu, 705-717, Korea
| | - Tae Nyeun Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong, Nam-gu, Daegu, 705-717, Korea.
| | - Si Hyung Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong, Nam-gu, Daegu, 705-717, Korea
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7256
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Ulasi II, Ijoma CK, Onodugo OD. A community-based study of hypertension and cardio-metabolic syndrome in semi-urban and rural communities in Nigeria. BMC Health Serv Res 2010; 10:71. [PMID: 20302648 PMCID: PMC2858142 DOI: 10.1186/1472-6963-10-71] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of cardio-metabolic syndrome (CMS) is increasing worldwide. In people of African descent, there is higher prevalence of hypertension and complications than other races. Bearing in mind these facts, we looked at the CMS in the general population and the population with hypertension. Using the new International Diabetes Federation (IDF) definitions of CMS, we studied its prevalence in semi-urban and rural communities in South-east Nigeria in relation to hypertension. Method This is a cross sectional population based study involving 1458 adults aged from 25 to 64 years. Diagnosis of CMS was based on the new IDF criteria using the anthropometric measurements for Europids as there is none yet for blacks. Hypertension was defined according to the WHO/ISH criteria. Results The overall prevalence of CMS was 18.0% in the semi-urban community as against 10.0% in the rural community increasing to 34.7% and 24.7% respectively in the population with hypertension. The prevalence of co-morbidities - hyperglycaemia, abdominal obesity, and hypertriglceridaemia were 13.9%, 41.1% and 23.9% while in the hypertensive populations they were 21.2%, 55.0% and 31.3% in the general population in both communities combined. Except for low HDL cholesterol, every other co-morbidity was higher in hypertensive population than the general population. Conclusion The high prevalence of CMS in the semi-urban population especially for the population with hypertension underscores the double burden of disease in developing countries. The lesson is while infections and infestations are being tackled in these countries the non-communicable diseases should not be neglected.
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Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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7257
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Nagahara A, Hojo M, Asaoka D, Watanabe S. Maintenance therapy of gastroesophageal reflux disease. Clin J Gastroenterol 2010; 3:61-8. [PMID: 26189996 DOI: 10.1007/s12328-010-0139-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/08/2010] [Indexed: 12/20/2022]
Abstract
The aims of treatment of gastroesophageal reflux disease (GERD) are to cure mucosal breaks, control symptoms, and prevent complications (e.g. stricture, Barrett's esophagus, and esophageal adenocarcinoma). Proton pump inhibitors (PPIs) are known to be the best drugs to cure esophagitis; however, a highrecurrence rate of about 80% was described after the completion of initial therapy. Regretfully, not so many physicians perform maintenance therapy in clinical practice. Histamine H2 receptor antagonists have an insufficient effect in maintenance therapy compared with PPIs; therefore, they could be prescribed for mild reflux esophagitis. Several clinical trials have been conducted to investigate the efficacy of continuous PPI administration maintenance therapy for GERD. Among these trials, recent large-scale studies showed that esomeprazole was equal to or superior to other kinds of PPIs. On the other hand, on-demand PPI studies have been conducted, mainly in patients with nonerosive reflux disease or uninvestigated GERD;however, this strategy was less effective than continuous therapy in many studies. Because on-demand therapy is less expensive, it is worth confirming this strategy in further studies. Studies of maintenance therapy with investigations conducted for as long a period as 5 years have described that PPI maintenance therapy could be considered as effective, safe, and well tolerated.
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Affiliation(s)
- Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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7258
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Ito T, Nakamura T, Fujimori N, Ono T, Yasuda M, Niina Y, Uchida M, Igarashi H, Takayanagi R. [Chronic pancreatitis. 4. Therapy]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2010; 99:56-61. [PMID: 20373581 DOI: 10.2169/naika.99.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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7259
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Clinicopathological properties of the superficial spreading type early gastric cancer. J Gastrointest Surg 2010; 14:52-7. [PMID: 19821002 DOI: 10.1007/s11605-009-1059-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 09/22/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION We investigated differences in characteristics between the superficial spreading type early gastric cancer (EGC) characterized by a wide and superficial extension and the common type EGC. PATIENTS AND METHODS Between 1982 and 2008, we retrospectively reviewed clinical reports of patients with the EGC treated at Kochi Medical School. RESULTS Sixty-one patients (9.6%) out of 646 patients had the superficial spreading type EGC. The occurrences of diffuse type histology and lymph node metastasis were significantly greater in the superficial spreading type than in the common type. The incidence of EGC confined to the mucosa was significantly greater in the lymph node-positive superficial spreading type than in the lymph node-positive common type. CONCLUSIONS In patients with the superficial spreading type EGC, lymph node metastasis was more prominent regardless of the degree of tumor invasion. Therefore, appropriate extensive lymph node dissection and wide surgical resection are required for the curative resection of the superficial spreading type EGC.
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7260
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Fujimori N, Nakamura T, Oono T, Igarashi H, Takahata S, Nakamura M, Tanaka M, Hayashi A, Aishima S, Ishigami K, Ogoshi K, Ito T, Takayanagi R. Adenocarcinoma involving the whole pancreas with multiple pancreatic masses. Intern Med 2010; 49:1527-32. [PMID: 20686284 DOI: 10.2169/internalmedicine.49.3347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man was referred to our hospital for further investigation of pancreatic masses. Imaging studies revealed hypovascular masses in the pancreatic head and body. Total pancreatectomy was performed under the diagnosis of double primary pancreatic carcinomas. Macroscopic examination revealed 3 nodules: one each in the pancreatic head, body, and tail. Microscopically, all 3 lesions showed similar carcinoma cells, which communicated with each other via the intraductal component, indicating a single large tumor. Incidentally, we also identified an adenocarcinoma of the common bile duct (CBD). The final diagnosis was synchronous double cancer involving the whole pancreas and the CBD.
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Affiliation(s)
- Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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7261
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Mizokami M, Tanaka E, Chayama K, Tanaka Y, Kurosaki M, Izumi N, Arase Y, Kumada H, Imazeki F, Yokosuka O, Kudo M. JSH Consensus Kobe 2009: Diagnosis and Treatment of Hepatitis B. KANZO 2010; 51:243-260. [DOI: 10.2957/kanzo.51.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
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7262
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Kopelman Y, Siersema PD, Nir Y, Szold A, Bapaye A, Segol O, Willenz EP, Lelcuk S, Geller A, Kopelman D. Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model. Gastrointest Endosc 2009; 70:1146-57. [PMID: 19647245 DOI: 10.1016/j.gie.2009.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 05/01/2009] [Indexed: 01/12/2023]
Abstract
BACKGROUND Performing a full-thickness intestinal wall resection of a sessile polyp located on the mesenteric side with a compression clip may lead to compression of mesenteric vessels. The application of such a clip may therefore cause a compromised blood supply in the particular bowel segment, leading to perforation. OBJECTIVE To evaluate the performance of a newly developed, nitinol compression clip, called the NiTi clamp, for full-thickness resection of the bowel wall, while the clip is deliberately deployed endoluminally on the mesenteric side. DESIGN Prospective animal study. Multinational, multidisciplinary; gastroenterology and general surgery, research cooperation. SETTING Animal research laboratory. INTERVENTION Six pigs were operated upon and endoscopically evaluated and then killed after 3 weeks. Linear compression closure clips based on nitinol springs were used. Three longitudinal enterotomies were performed: in the cecum, spiral colon, and proximal rectum. Four clips were deployed in each animal. MAIN OUTCOME MEASUREMENTS A total of 23 clips were deployed. The average expulsion day was 9 days. RESULTS All but 3 clips were normally expelled. One pig developed bowel ischemia due to intussusception. In endoscopic procedures, no signs of significant segmental mucosal ischemia were found. The macroscopic appearance of the compression closure lines was thin and delicate, but epithelialization was significantly delayed at 5 sites. LIMITATION Differences between porcine and human colorectal anatomy. CONCLUSION Full-thickness clamping of the bowel with the NiTi clamp, including the local mesenteric vasculature, does not significantly impair local healing of the clamp site and gives hope to further development of novel full-thickness endoscopic resection technologies.
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Affiliation(s)
- Yael Kopelman
- Gastroenterology Institute, Israel Institute of Technology, Haifa, Israel.
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7263
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Matsubayashi H, Tomita H, Sugiura T, Sasaki K, Inui T, Takizawa K, Yamaguchi Y, Ono H. Autoimmune pancreatitis without a response to steroid therapy: a case which met criteria after withdrawal of steroid. Intern Med 2009; 48:2087-91. [PMID: 20009397 DOI: 10.2169/internalmedicine.48.2568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Autoimmune pancreatitis (AIP) sometimes forms a pancreatic mass lesion, which is often difficult to distinguish from pancreatobiliary malignancy, however it generally responds to steroid therapy. A 70-year-old man was referred to our institute with the suspected diagnosis of pancreatic cancer due to a mass lesion detected at the pancreatic head. Various images demonstrated an ill-defined mass at the enlarged pancreatic head with focal narrowing of the main pancreatic duct. Serum antinuclear antibody (ANA) was negative (x40 dilution) on the onset. Forceps biopsy from the narrowed pancreaticobiliary duct and fine-needle aspiration biopsy under endoscopic ultrasonography (EUS-FNAB) ruled out pancreatobiliary malignancy. Steroid therapy was started at 40 mg per day but was not effective according to subsequent image analyses. Repeated EUS-FNA from the pancreatic mass was performed but was again negative for carcinoma. Seven months later, under steroid-off condition, still no response was recognized in the clinical image but the titer of serum ANA was increased to be positive (x80), satisfying the criteria of AIP in Japan (2006). Although very rare, this is a case meeting Japanese criteria of AIP after withdrawal of steroid without response to steroid in the clinical images, suggesting the necessity of careful follow-up.
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7264
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van der Eb AJ, van Kesteren LW, van Bruggen EF. Structural properties of adenovirus DNA's. Exp Ther Med 1969; 15:2739-2748. [PMID: 29456677 PMCID: PMC5795490 DOI: 10.3892/etm.2018.5743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/16/2017] [Indexed: 12/21/2022] Open
Abstract
The current study presents the case of a 9-year-old Chinese boy who presented with eosinophilia and elevated serum levels of immunoglobulin G4 (IgG4). A bone marrow puncture identified an elevated eosinophil rate of 23% (normal range, <5%), which indicated eosinophilia. However, gene analysis, fluorescent in situ hybridization and other examinations, including bone marrow aspiration, blood routine, auto-antibody tests and parasitic and allergens screening, contradicted a diagnosis of secondary or clonal eosinophilia. Furthermore, the patient exhibited multiple lymph node swelling and a lymph biopsy strongly indicted a pathological diagnosis of IgG4-related disease (IgG4-RD). His peripheral blood flow cytometry confirmed an elevated count of plasmablasts, which is specific to IgG4-RD. The patient responded well to therapy with prednisone and remained healthy in all follow-ups. By taking all these factors into consideration, the boy was diagnosed with IgG4-RD. It is difficult to distinguish IgG4-RD from hypereosinophilic syndrome and the potential association between the two remains unclear. However, the present case study serves as a reminder that IgG4-RD may occur in children and medical professionals should not neglect this possibility.
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