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Koizumi K, Kimura K, Jinushi R, Sato R, Masuda S. Management of choledocholithiasis with an ultraslim cholangioscope in a patient with possible anaphylaxis to contrast medium. Endoscopy 2024; 56:E223-E224. [PMID: 38428922 PMCID: PMC10907123 DOI: 10.1055/a-2268-2470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryo Sato
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Sasaki A, Takeshima H, Yamashita S, Ichita C, Kawachi J, Naito W, Ohashi Y, Takeuchi C, Fukuda M, Furuichi Y, Yamamichi N, Ando T, Kobara H, Kotera T, Itoi T, Sumida C, Hamada A, Koizumi K, Ushijima T. Severe induction of aberrant DNA methylation by nodular gastritis in adults. J Gastroenterol 2024:10.1007/s00535-024-02094-y. [PMID: 38499886 DOI: 10.1007/s00535-024-02094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Nodular gastritis (NG) is characterized by marked antral lymphoid follicle formation, and is a strong risk factor for diffuse-type gastric cancer in adults. However, it is unknown whether aberrant DNA methylation, which is induced by atrophic gastritis (AG) and is a risk for gastric cancer, is induced by NG. Here, we analyzed methylation induction by NG. METHODS Gastric mucosal samples were obtained from non-cancerous antral tissues of 16 NG and 20 AG patients with gastric cancer and 5 NG and 6 AG patients without, all age- and gender-matched. Genome-wide methylation analysis and expression analysis were conducted by a BeadChip array and RNA-sequencing, respectively. RESULTS Clustering analysis of non-cancerous antral tissues of NG and AG patients with gastric cancer was conducted using methylation levels of 585 promoter CpG islands (CGIs) of methylation-resistant genes, and a large fraction of NG samples formed a cluster with strong methylation induction. Promoter CGIs of CDH1 and DAPK1 tumor-suppressor genes were more methylated in NG than in AG. Notably, methylation levels of these genes were also higher in the antrum of NG patients without cancer. Genes related to lymphoid follicle formation, such as CXCL13/CXCR5 and CXCL12/CXCR4, had higher expression in NG, and genes involved in DNA demethylation TET2 and IDH1, had only half the expression in NG. CONCLUSIONS Severe aberrant methylation, involving multiple tumor-suppressor genes, was induced in the gastric antrum and body of patients with NG, in accordance with their high gastric cancer risk.
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Affiliation(s)
- Akiko Sasaki
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hideyuki Takeshima
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
- Department of Epigenomics, Institute for Advanced Life Sciences, Hoshi University, Tokyo, Japan
| | - Satoshi Yamashita
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Wataru Naito
- Department of Diagnostic Pathology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yui Ohashi
- Department of Epigenomics, Institute for Advanced Life Sciences, Hoshi University, Tokyo, Japan
| | - Chihiro Takeuchi
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
- Department of Epigenomics, Institute for Advanced Life Sciences, Hoshi University, Tokyo, Japan
| | - Masahide Fukuda
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yumi Furuichi
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
- Department of Epigenomics, Institute for Advanced Life Sciences, Hoshi University, Tokyo, Japan
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nobutake Yamamichi
- Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Ando
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
| | - Tohru Kotera
- Department of Medical Examination, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Akinobu Hamada
- Division of Molecular Pharmacology, National Cancer Center Research Institute, Tokyo, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Toshikazu Ushijima
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan.
- Department of Epigenomics, Institute for Advanced Life Sciences, Hoshi University, Tokyo, Japan.
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Koizumi K, Kimura K, Jinushi R. Successful removal of a proximally migrated biliary fully covered self-expandable metal stent using a sphincterotome. Dig Endosc 2024; 36:374-375. [PMID: 38131247 DOI: 10.1111/den.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
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Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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Masuda S, Imamura Y, Jinushi R, Kubota J, Kimura K, Makazu M, Sato R, Kako M, Kobayashi M, Uojima H, Ichita C, Koizumi K. Antimicrobial therapy outcomes in acute cholangitis: Hilar multiple obstructions versus single hilar and common bile duct obstructions. JGH Open 2024; 8:e13047. [PMID: 38486876 PMCID: PMC10938463 DOI: 10.1002/jgh3.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
Background and Aim The appropriate duration of antimicrobial therapy for acute cholangitis (AC) arising from multiple hilar biliary obstructions as opposed to simple obstruction in the extrahepatic bile duct has not been established. This study assessed the efficacy of the duration of antimicrobial treatments in the Tokyo Guidelines 2018 for AC based on the cause and site of obstruction. Methods This single-center retrospective study involved patients with AC who underwent successful biliary drainage and completed a 7-day or shorter antimicrobial treatment. Patients were categorized into three groups: Group 1, bile duct stone or benign obstruction; Group 2, simple biliary obstruction due to malignancy; and Group 3, multiple hilar biliary obstruction due to malignancy. The primary outcome was clinical cure rate, and the secondary outcomes were 3-month recurrence rate and length of hospital stay. Results A total of 373 patients were selected. Patients in Group 3 were younger or had Charlson Comorbidity Index ≥4, and had fewer positive blood cultures. In Group 3, the clinical cure rate (87.1%) and 3-month recurrence rate (32.3%) were less favorable than those in the other groups. In Group 1, the clinical cure rate was significantly higher (98.1%, P = 0.02) with a much lower 3-month recurrence rate of only 3.4% (P < 0.001) than that in the other groups. The median hospital stay for all groups was 7 days. Conclusion This study suggests that the outcomes in Group 3 may be worse than those in Groups 1 or 2, regardless of the duration of the antibiotic treatment.
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Affiliation(s)
- Sakue Masuda
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, Department of MedicineKobe University Graduate School of MedicineKobeHyogoJapan
| | - Ryuhei Jinushi
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Jun Kubota
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Karen Kimura
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Makomo Makazu
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Ryo Sato
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Makoto Kako
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Masahiro Kobayashi
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Haruki Uojima
- Department of Gastroenterology, Internal MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Chikamasa Ichita
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Kazuya Koizumi
- Department of GastroenterologyMedicine Center, Shonan Kamakura General HospitalKamakuraKanagawaJapan
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Shionoya K, Koizumi K, Masuda S, Makazu M, Kubota J, Jinushi R, Kimura K. Difficulty in the diagnosis of pancreatic cancer based on the initial CT report: A retrospective study. Medicine (Baltimore) 2024; 103:e36224. [PMID: 38335424 PMCID: PMC10860937 DOI: 10.1097/md.0000000000036224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 02/12/2024] Open
Abstract
The role of computed tomography (CT) in the initial diagnosis of pancreatic cancer (PC) is well-known. CT reports made by radiologists are important as not all patients with PC are examined by specialists; however, some cases are not identified based on CT reports. Diagnosis via imaging of PC is sometimes difficult, and the diagnostic rate of PC and other pancreatic diseases can vary across radiologists. This study aimed to examine the diagnostic rate of PC in initial CT reports and the details of cases with diagnostic difficulties. This single-centered, retrospective study collected clinical data of 198 patients with histologically diagnosed PC between January 2018 and April 2022. Out of these contrast-enhanced CT was performed in 192 cases. PC was not reported as the main diagnosis in 18 patients (9.4%; 11 men and 7 women). Among these 18 cases, intrapancreatic mass lesions were detected in 3 (1.6%), indirect findings such as bile/pancreatic duct stenosis or dilation were detected in 5 (2.6%), and no PC-related findings were found in 10 (5.2%). The specialists suspected PC in 15 of these 18 cases based on initial CT reports. 17 cases were confirmed by endoscopic ultrasound-fine needle aspiration and one by biopsy after upper gastrointestinal endoscopy. To improve accuracy of its diagnosis, it is important that specialists provide feedback to diagnostic radiologists regarding the findings they did not report. Endoscopic ultrasound-fine needle aspiration should be performed by specialists when there is clinical information which indicates pancreatic disease of any kind.
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Affiliation(s)
- Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Masuda S, Jinushi R, Imamura Y, Kubota J, Kimura K, Shionoya K, Makazu M, Sato R, Kako M, Kobayashi M, Uojima H, Koizumi K. Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study. Endosc Int Open 2024; 12:E307-E316. [PMID: 38420157 PMCID: PMC10901644 DOI: 10.1055/a-2230-8229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims Although the number of resistant bacteria tends to increase with prolonged antimicrobial therapy, no studies have examined the relationship between the duration of antimicrobial therapy and increase in the number of resistant bacteria in acute cholangitis. We hypothesized that the short-term administration of antimicrobial agents in acute cholangitis would suppress bacterial resistance. Patients and methods This was a single-center, retrospective, observational study of patients with acute cholangitis admitted between January 2018 and June 2020 who met the following criteria: successful biliary drainage, positive blood or bile cultures, bacteria identified from cultures sensitive to antimicrobials, and subsequent cholangitis recurrence by January 2022. The patients were divided into two groups: those whose causative organisms at the time of recurrence became resistant to the antimicrobial agents used at the time of initial admission (resistant group) and those who remained susceptible (susceptible group). Multivariate analysis was used to examine risk factors associated with the development of resistant pathogens. Multivariate analysis investigated antibiotics used with the length of 3 days or shorter after endoscopic retrograde cholangiopancreatography (ERCP) and previously reported risk factors for the development of bacterial resistance. Results In total, 89 eligible patients were included in this study. There were no significant differences in patient background or ERCP findings between the groups. The use of antibiotics, completed within 3 days after ERCP, was associated with a lower risk of developing bacterial resistance (odds ratio, 0.17; 95% confidence interval, 0.04-0.65; P =0.01). Conclusions In acute cholangitis, the administration of antimicrobials within 3 days of ERCP may suppress the development of resistant bacteria.
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Affiliation(s)
- Sakue Masuda
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuhei Jinushi
- Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University, Kobe, Japan
| | - Jun Kubota
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Karen Kimura
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kento Shionoya
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Makomo Makazu
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryo Sato
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Makoto Kako
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazuya Koizumi
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
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Koizumi K, Shionoya K, Masuda S, Kubota J, Kimura K. Unique double guidewire technique using a guidewire perforating the diverticulum for a difficult biliary cannulation. Endoscopy 2023; 55:E734-E735. [PMID: 37236249 PMCID: PMC10219756 DOI: 10.1055/a-2086-2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Masuda S, Tsukiyama T, Daigo R, Makazu M, Jinushi R, Koizumi K, Nishino T, Shionoya K, Kimura K, Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, Uojima H. Exploration of predictors associated with bleeding in computed tomography-guided core needle splenic biopsy: A retrospective study. Medicine (Baltimore) 2023; 102:e34951. [PMID: 37986279 PMCID: PMC10659597 DOI: 10.1097/md.0000000000034951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 11/22/2023] Open
Abstract
Splenic diseases may be caused by infections and can be either malignant, such as lymphoma and lung cancer, or benign, such as hemangioma. In some cases, diagnostic uncertainty of imaging persists, and image-guided splenic needle biopsy is a useful diagnostic tool to avoid the disadvantages of incorrect diagnosis, including performing unnecessary splenectomy or not giving the necessary treatment. Splenic biopsies can be divided into ultrasound-guided, computed tomography (CT)-guided fine-needle aspiration, or core needle biopsy (CNB). However, few studies have focused exclusively on complications associated with CT-guided CNB of the spleen. Therefore, we assessed bleeding, the most common complication of CT-guided CNB of the spleen, and evaluated factors associated with the bleeding. Using the biopsy database maintained at the institution, all patients who underwent CT-guided CNB of the spleen between May 2012 and September 2022 were identified retrospectively. The 18 identified patients were divided into post-biopsy bleeding and non-bleeding groups for analysis. In total, 17 patients (94.4%) could be diagnosed accurately with CT-guided CNB. Bleeding complications occurred in 7 cases of CT-guided CNB; of these, 2 patients with Common Terminology Criteria for Adverse Events grade 4 disease required transcatheter arterial embolization. The bleeding group was characterized by diffuse spleen tumors in all cases, with significantly more diffuse spleen tumors than the non-bleeding group. CT-guided CNB is a useful option for neoplastic lesions of the spleen that are difficult to diagnose using imaging alone. However, consideration should be given to post-biopsy bleeding in patients with diffuse splenic tumors.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryo Daigo
- Radiological Technologist, Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makomo Makazu
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takashi Nishino
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kento Shionoya
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Karen Kimura
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Chihiro Sumida
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jun Kubota
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Masahiro Kobayashi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makoto Kako
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Shionoya K, Kobayashi M, Kako M, Masuda S, Makazu M, Koizumi K. A Case of Drug-induced Liver Injury Considered Steroid-resistant and Histologically Diagnosed with Vanishing Bile Duct Syndrome. Intern Med 2023:2427-23. [PMID: 37952956 DOI: 10.2169/internalmedicine.2427-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) is characterized by bile duct degeneration and necrosis, which result in bile duct loss and bile stasis. A 70-year-old man had malaise after receiving celecoxib. Laboratory tests revealed elevated hepatobiliary enzymes. His condition worsened without response to medical treatment, and he was transferred to our hospital. A liver biopsy revealed severe bile duct injury and mild cholestasis. He was diagnosed with celecoxib-induced VBDS and underwent bilirubin adsorption therapy. However, his condition continued to deteriorate, and he died. An autopsy showed that liver regeneration was poor, and bile duct loss was exacerbated. The pathological autopsy findings were consistent with VBDS.
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Affiliation(s)
- Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Masahiro Kobayashi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
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Koizumi K, Kubota J, Masuda S. Endoscopic transpapillary gallbladder drainage using a tapered endoscopic sheath. Dig Endosc 2023; 35:e115-e116. [PMID: 37462058 DOI: 10.1111/den.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023]
Abstract
Watch a video of this article.
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Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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Shionoya K, Koizumi K, Tsuchiya T. Endoscopic gallbladder stenting using a 0.018-inch guidewire and a novel spiral dilator. Dig Endosc 2023; 35:e111-e112. [PMID: 37400081 DOI: 10.1111/den.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
Watch a video of this article.
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Affiliation(s)
- Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Shionoya K, Kako M, Masuda S, Makazu M, Koizumi K. Acute liver failure due to herpes simplex viral hepatitis diagnosed by skin lesions and blood tests: a case report. J Med Case Rep 2023; 17:338. [PMID: 37559160 PMCID: PMC10413703 DOI: 10.1186/s13256-023-04083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/16/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The incidence of acute liver failure from herpes simplex virus is rare. CASE PRESENTATION A 71-year-old Japanese man was diagnosed with acute liver failure and was transferred to our hospital. Steroid therapy, plasma exchange, and hemodiafiltration were started for liver failure, and antimicrobial therapy was initiated for pneumonia. Staphylococcus epidermidis was detected in blood culture. Skin rash appeared; a positive anti-herpes simplex virus result led to the diagnosis of acute liver failure from herpes simplex virus. Hence, acyclovir was started. After blood tests improved, treatments for acute liver failure were discontinued. Antimicrobial therapy was continued; however, he died. In this case, persistent bacteremia and drug-induced liver damage due to acyclovir may have contributed to his death. CONCLUSIONS Acute liver failure can lead to complications and death. Thus, careful observation is crucial, even if the patient has shown some improvements.
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Affiliation(s)
- Kento Shionoya
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan.
| | - Makoto Kako
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
| | - Sakue Masuda
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
| | - Makomo Makazu
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
| | - Kazuya Koizumi
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
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13
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Masuda S, Jinushi R, Koizumi K, Makazu M, Nishino T, Shionoya K, Kimura K, Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, Uojima H, Sugitani A. Endoscopic Papillary Balloon Dilation Can Be Safely Performed in Patients on Dual Antiplatelet Therapy: A Pilot Study. J Gastrointestin Liver Dis 2023; 32:216-221. [PMID: 37345612 DOI: 10.15403/jgld-4764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/22/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS Endoscopic papillary balloon dilation (EPBD), a low-risk procedure for bleeding, has been suggested as an alternative to endoscopic sphincterotomy for papillary dilatation in patients undergoing endoscopic stone removal who are at a higher risk of bleeding. Several guidelines recommend that combination of two antiplatelet agents should be reduced to single antiplatelet therapy when endoscopic sphincterotomy is performed. However, there is no evidence that EPBD affects the risk of bleeding in patients receiving a combination of two antiplatelet agents; thus, we aimed to explore this problem. METHODS We included 31 patients who underwent EPBD for common bile duct stones at our hospital from May 2014 to August 2022 and received either a combination of two antiplatelet agents or single antiplatelet therapy prior to the procedure. The group receiving a combination of two antiplatelet agents included patients who underwent EPBT without antiplatelet therapy withdrawal or with a shorter withdrawal period than those recommended by the guidelines. RESULTS In the group that received a combination of two antiplatelet agents, one of the two antiplatelet agents used was thienopyridine. No bleeding was observed after EPBD in this study. We did not find any significant between-group differences in hemoglobin levels and rate of post-endoscopic retrograde cholangiopancreatography pancreatitis. CONCLUSIONS In patients treated with a combination of two antiplatelet agents, EPBD could be safely performed without bleeding. Therefore, future prospective studies are warranted.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Ryuhei Jinushi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Makomo Makazu
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Takashi Nishino
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Kento Shionoya
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Karen Kimura
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Chihiro Sumida
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Jun Kubota
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Chikamasa Ichita
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Akiko Sasaki
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Masahiro Kobayashi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Makoto Kako
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Ayumu Sugitani
- Department of the Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan.
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14
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Jinushi R, Mizuide M, Tanisaka Y, Masuda S, Koizumi K, Sasaki A, Ishihara Y, Shionoya K, Sato R, Sugimoto K, Shin T, Shiomi R, Fujita A, Ryozawa S, Yamazaki T. Efficacy for diagnoses of scirrhous gastric cancer and safety of endoscopic ultrasound-guided fine-needle aspiration: A systematic review and meta-analysis. JGH Open 2023; 7:403-409. [PMID: 37359117 PMCID: PMC10290272 DOI: 10.1002/jgh3.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/23/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
Scirrhous gastric cancer (SGC) is diagnosed using endoscopy and/or biopsy; however, SGC diagnosis remains challenging owing to its special growth form and morphologic features. Hence, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), which is minimally invasive and has a high proportion of diagnostic tissue, may be an alternative investigative modality for patients with suspected SGC. This systematic review and meta-analysis aimed to identify and evaluate the evidence for the efficacy and safety of EUS-FNA in patients with suspected SGC. We conducted a systematic review using the PubMed (MEDLINE) and Ichushi-Web (NPO Japan Medical Abstracts Society) databases and included all entries in which SGC was evaluated using EUS-FNA in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the databases' inception to October 10, 2022. The primary outcome was the proportion of SGC diagnosed using EUS-FNA. In addition, we analyzed the proportion of adverse events associated with EUS-FNA. The electronic search identified 1890 studies; overall, four studies met the selection criteria and reported data on EUS-FNA performed on 114 patients with suspected SGC. The overall diagnostic yield of EUS-FNA for SGC was 82.6% (95% confidence interval, 74.6-90.6%) and the statistical heterogeneity was 0% (I 2 = 0%), indicating a low heterogeneity. Furthermore, the EUS-FNA diagnostic proportion for SGC lymph node metastasis was 75-100%, indicating a high diagnostic performance. The adverse event rate of EUS-FNA was 0%. EUS-FNA may be an alternative investigation mode for SGC patients with negative esophagogastroduodenoscopy-biopsy results.
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Affiliation(s)
- Ryuhei Jinushi
- Graduate School of MedicineInternational University of Health and WelfareTokyoJapan
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
| | - Masafumi Mizuide
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yuki Tanisaka
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Sakue Masuda
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
| | - Yo Ishihara
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
| | - Kento Shionoya
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
| | - Ryo Sato
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Kei Sugimoto
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Takahiro Shin
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Rie Shiomi
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akashi Fujita
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Shomei Ryozawa
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Tsutomu Yamazaki
- Graduate School of MedicineInternational University of Health and WelfareTokyoJapan
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15
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Jinushi R, Koizumi K, Masuda S, Ryozawa S. Successful endoscopic hemostasis for waterfall-like gastroduodenal artery hemorrhage. Clin Case Rep 2023; 11:e7355. [PMID: 37251748 PMCID: PMC10220454 DOI: 10.1002/ccr3.7355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
Endoscopic hemostasis is the first step in cessation of gastrointestinal bleeding. Although IVR may sometimes be required for preventing rebleeding, prophylactic IVR was not considered necessary in this case because of complete endoscopic hemostasis.
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Affiliation(s)
- Ryuhei Jinushi
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Sakue Masuda
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Shomei Ryozawa
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
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16
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Masuda S, Tsukiyama T, Makazu M, Jinushi R, Koizumi K, Nishino T, Shionoya K, Kimura K, Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, Uojima H. A case of unsuccessful obliteration of percutaneous transhepatic gastric varices using the IMPEDE embolization plug. Clin Case Rep 2023; 11:e07323. [PMID: 37180327 PMCID: PMC10167619 DOI: 10.1002/ccr3.7323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/31/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Key Clinical Message Embolization with IMPEDE embolization plug cannot be confirmed on site. Therefore, we propose that the diameter of the device selected be up to 50% larger than the vein diameter to prevent embolization failure and recanalization. Abstract Balloon-occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration (PTO) are performed for treating sporadic gastric varices. IMPEDE embolization plug has been recently developed for these procedures; however, no studies have reported its use. This is the first report on its use in PTO of gastric varices.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology CenterShonan Kamakura General HospitalKamakuraJapan
| | - Makomo Makazu
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Ryuhei Jinushi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Takashi Nishino
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Kento Shionoya
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Karen Kimura
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Chihiro Sumida
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Jun Kubota
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Masahiro Kobayashi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Makoto Kako
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Haruki Uojima
- Department of Gastroenterology, Internal MedicineKitasato University School of MedicineSagamiharaJapan
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17
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Koizumi K, Masuda S, Jinushi R, Shionoya K. EUS-guided gallbladder drainage using a 22-gauge needle and 0.018-inch guidewire: A rescue technique in a challenging situation to puncture (with video). Endosc Ultrasound 2023; 12:342-344. [PMID: 37693109 PMCID: PMC10437205 DOI: 10.1097/eus.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/12/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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18
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Koizumi K, Masuda S, Shionoya K. Endoscopic transpapillary gallbladder drainage with "hooking technique" using a rotatable sphincterotome. Dig Endosc 2023; 35:e76-e77. [PMID: 37037667 DOI: 10.1111/den.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/19/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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19
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Masuda S, Koizumi K, Shionoya K, Jinushi R, Makazu M, Nishino T, Kimura K, Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, Haruki U. Comprehensive review on small common bile duct stones. World J Gastroenterol 2023; 29:1955-1968. [PMID: 37155530 PMCID: PMC10122794 DOI: 10.3748/wjg.v29.i13.1955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/22/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
Common bile duct stones are among the most common conditions encountered by endoscopists. Therefore, it is well researched; however, some items, such as indications for endoscopic papillary balloon dilatation (EPBD), safety of EPBD and endoscopic sphincterotomy in patients receiving dual antiplatelet therapy or direct oral anticoagulant, selection strategy for retrieval balloons and baskets, lack adequate evidence. Therefore, the guidelines have been updated with new research, while others remain unchanged due to weak evidence. In this review, we comprehensively summarize the standard methods in guidelines and new findings from recent studies on papillary dilation, stone retrieval devices, difficult-to-treat cases, troubleshooting during the procedure, and complicated cases of cholangitis, cholecystolithiasis, or distal biliary stricture.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kento Shionoya
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makomo Makazu
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Takashi Nishino
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Chihiro Sumida
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Jun Kubota
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Akiko Sasaki
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Masahiro Kobayashi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Uojima Haruki
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
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20
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Masuda S, Koizumi K, Shionoya K, Jinushi R, Makazu M, Nishino T, Kimura K, Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, Haruki U. Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor. World J Gastroenterol 2023; 29:1863-1874. [PMID: 37032729 PMCID: PMC10080698 DOI: 10.3748/wjg.v29.i12.1863] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030, a high mortality rate considering the number of cases. Surgery and chemotherapy are the main treatment options, but they are burdensome for patients. A clear histological diagnosis is needed to determine a treatment plan, and endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract seeding. With the development of personalized medicine and precision treatment, there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure, leading to the development of the fine-needle biopsy (FNB) needle. EUS-FNB is rapidly replacing EUS-guided fine-needle aspiration (FNA) as the procedure of choice for EUS-TA of pancreatic cancer. However, EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions, so it is important clinicians are familiar with both. Given these recent dev-elopments, we present an up-to-date review of the role of EUS-TA in pancreatic cancer. Particularly, technical aspects, such as needle caliber, negative pressure, and puncture methods, for obtaining an adequate specimen in EUS-TA are discussed.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kento Shionoya
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makomo Makazu
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Takashi Nishino
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Chihiro Sumida
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Jun Kubota
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Akiko Sasaki
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Masahiro Kobayashi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Uojima Haruki
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
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21
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Makazu M, Koizumi K, Masuda S, Jinushi R, Shionoya K, Tsukiyama T. Spontaneous retroperitoneal hematoma with duodenal obstruction with diagnostic use of endoscopic ultrasound: A case series and literature review. Clin J Gastroenterol 2023; 16:377-386. [PMID: 36959407 DOI: 10.1007/s12328-023-01780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/26/2023] [Indexed: 03/25/2023]
Abstract
Spontaneous retroperitoneal hematoma is rare and can cause duodenal obstruction. We report four cases of spontaneous retroperitoneal hematoma with duodenal obstruction, wherein endoscopic ultrasound was useful for diagnosis. The patients complained of vomiting with stable vital signs. Computed tomography, esophagogastroduodenoscopy, and endoscopic ultrasound findings were similar in all cases. Contrast-enhanced computed tomography revealed a low-density mass around the 2nd to 3rd part of the duodenum. Esophagogastroduodenoscopy showed an edematous, reddish, but non-neoplastic duodenal mucosa with stenosis of the lumen. Endoscopic ultrasound revealed a low-echoic mass around the duodenum and high-echoic floating matter suggesting debris and anechoic areas that indicated a liquid component. These findings suggested hematomas or abscesses. Although pseudoaneurysm of the pancreaticoduodenal artery was suspected in Case 3, we chose conservative treatment because the aneurysm was small. In Case 4, median arcuate ligament syndrome was suspected on angiography. No aneurysms or arteriovenous malformations were found; thus, endovascular embolization was not performed. The patients were treated conservatively and discharged within 3-5 weeks. English literature queries on spontaneous retroperitoneal hematoma with duodenal obstruction in MEDLINE revealed 21 cases in 18 studies. The clinical features of these patients and the present four cases have been discussed.
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Affiliation(s)
- Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Toshitaka Tsukiyama
- Interventional Radiology Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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22
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Jinushi R, Nishiguchi S, Masuda S, Sasaki A, Koizumi K, Ryozawa S. A case of post-COVID-19 myalgic encephalomyelitis/chronic fatigue syndrome characterized by post-exertional malaise and low serum acylcarnitine level. Clin Case Rep 2023; 11:e6930. [PMID: 36789311 PMCID: PMC9913186 DOI: 10.1002/ccr3.6930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
COVID-19 afflicts patients with acute symptoms and longer term sequelae. One of the sequelae is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is often difficult to diagnose, having no established tests. In this article, we synthesize information from literature reviews on patients with ME/CSF that developed after recovery from COVID-19.
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Affiliation(s)
- Ryuhei Jinushi
- Department of GastroenterologySaitama Medical University International Medical CenterHidakaJapan,Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan,Department of General Internal MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Sho Nishiguchi
- Department of General Internal MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Sakue Masuda
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Shomei Ryozawa
- Department of GastroenterologySaitama Medical University International Medical CenterHidakaJapan
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23
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Koizumi K, Masuda S, Makazu M, Hirose H, Jinushi R, Shionoya K, Suno Y. Endoscopic ultrasound-guided transduodenal drainage using forward-viewing echoendoscope for appendiceal abscess. Endoscopy 2023; 55:E384-E385. [PMID: 36720268 PMCID: PMC9889167 DOI: 10.1055/a-1996-0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Haruto Hirose
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yuma Suno
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Masuda S, Koizumi K, Makazu M. Troubleshooting of embedded M-Intraductal lasso in fistula of endoscopic ultrasonography-guided hepaticogastrostomy. Dig Endosc 2022; 34:e166-e167. [PMID: 36263657 DOI: 10.1111/den.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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Shionoya K, Sasaki A, Moriya H, Kimura K, Nishino T, Kubota J, Sumida C, Tasaki J, Ichita C, Makazu M, Masuda S, Koizumi K, Kawachi J, Tsukiyama T, Kako M. Clinical features and progress of ischemic gastritis with high fatalities: Seven case reports. World J Clin Cases 2022; 10:8686-8694. [PMID: 36157813 PMCID: PMC9453346 DOI: 10.12998/wjcc.v10.i24.8686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ischemic gastritis is a clinically rare and highly fatal disease that occurs when the hemodynamics of a patient with vascular risk is disrupted. Early diagnosis and treatment are possible only with upper endoscopy after symptom appearance. We report seven cases of ischemic gastritis and its clinical features, prognosis, and indicators that may help in early detection.
CASE SUMMARY Of the seven patients, six had vascular risk and five died within 2 wk of diagnosis. Their symptoms included hematemesis and hypotension. Although surgery is a choice for radical treatment, not all patients were tolerant. For such patients, conservative treatment was selected, but all of them died. In contrast, patients who underwent repeat endoscopy showed improved mucosal findings, suggesting that this improvement may not affect prognosis. Some ischemic changes such as wall thickening, mural emphysema, and fluid retention in the stomach were observed before diagnosis through endoscopy and computed tomography (CT). The CT scan can be effective for early detection, and improvement in circulatory failure and aggressive treatment may save the lives of patients with this disease.
CONCLUSION The characteristic CT findings enable early detection of ischemic gastritis. Early diagnosis increases the chance of survival if early therapeutic intervention and improvement of circulatory dynamics can be achieved in this highly fatal disease.
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Affiliation(s)
- Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Hidekazu Moriya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Toshitaka Tsukiyama
- Department of Radiology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
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Koizumi K, Masuda S, Shionoya K, Makazu M. Endoscopic ultrasound-guided hepaticojejunostomy using forward-viewing echoendoscope for transected aberrant right posterior hepatic duct in Roux-en-Y hepaticojejunostomy. Endoscopy 2022; 54:E933-E934. [PMID: 35835153 PMCID: PMC9736790 DOI: 10.1055/a-1881-4068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Ichita C, Sasaki A, Kawachi J, Sumida C, Nishino T, Masuda S, Koizumi K. Esophageal stent removal by stent cutting using the endoscopic submucosal dissection technique. Endoscopy 2022; 54:E935-E936. [PMID: 35835151 PMCID: PMC9736841 DOI: 10.1055/a-1882-4724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Shionoya K, Koizumi K, Masuda S, Suno Y, Kawachi J, Kimura K, Makazu M, Kubota J, Nishino T, Sumida C, Tasaki J, Ichita C, Sasaki A, Hadano H, Kako M. Liver cyst with biliary communication treated with endoscopic ultrasound-guided drainage: A case report. Medicine (Baltimore) 2022; 101:e29007. [PMID: 35356909 PMCID: PMC10684242 DOI: 10.1097/md.0000000000029007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Simple liver cysts are common, and usually benign and asymptomatic, requiring little to no treatment. Liver cysts with biliary communication, however, are rare and require effective treatment to avoid recurrence. PATIENT CONCERNS A 70-year-old woman with breast cancer visited our hospital for treatment. Physical examination revealed abdominal distension and bilateral lower leg edema. DIAGNOSIS Abdominal contrast-enhanced computed tomography revealed a giant liver cyst, inducing inferior vena cava compression that was causing her edema. INTERVENTIONS Percutaneous transhepatic cyst drainage was performed. Since the bilirubin level in the drained fluid was high, the patient was diagnosed with a liver cyst with biliary communication. After the procedure, her symptoms improved and the cyst decreased in size. However, the drainage volume did not decrease after approximately 2 weeks. Sclerotherapy with minocycline was ineffective. Thus, endoscopic retrograde cholangiopancreatography was performed, and an endoscopic nasobiliary drainage tube was inserted. The percutaneous drainage tube was clamped, and the cyst showed increase in size. Therefore, endoscopic ultrasound-guided cyst drainage, which is less invasive than surgery, was performed. OUTCOMES The cyst tended to decrease in size even after the percutaneous drainage tube had been removed. At 3years follow-up, the cyst has almost disappeared. LESSONS Endoscopic ultrasound-guided drainage can treat liver cyst with biliary communication.
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Affiliation(s)
| | - Kazuya Koizumi
- Correspondence: Kazuya Koizumi, Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-shi, Kanagawa 247-8533, Japan (e-mail: ).
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Masuda S, Tsukiyama T, Minagawa Y, Koizumi K, Kako M, Kinbara T, Haruki U. Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature. World J Clin Cases 2022; 10:2591-2603. [PMID: 35434047 PMCID: PMC8968590 DOI: 10.12998/wjcc.v10.i8.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiotherapy for hepatocellular carcinoma (HCC) is considered to have limited efficacy because of treatment intensity considering that the irradiated area includes the liver, which is highly radiosensitive. In this report, we present two cases in which tumor control by surgical resection, radiofrequency ablation, transcatheter arterial chemoembolization (TACE), and lenvatinib administration was difficult, but stereotactic body radiotherapy (SBRT) using the Synchrony system by Radixact™ and Gold Anchor® (GA) was effective.
CASE SUMMARY A 60-year-old man had a single 10-cm HCC in the right lobe. Viable lesions remained after TACE, and levels of alpha-fetoprotein and protein induced by vitamin K antagonists II (PIVKA-II) decreased and quickly re-elevated. We performed SBRT with GA. Three weeks after implantation, localized radiotherapy (SBRT; 40 Gy/5 fractions) was performed using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared, and the PIVKA-II levels decreased. A 77-year-old man had a single 12-cm HCC in the right lobe. The patient experienced recurrence after hepatectomy. Further recurrence occurred after TACE, and we performed SBRT with GA. Because of the proximity of the HCC to the gastrointestinal tract, localized radiotherapy (SBRT; 39 Gy/13 fractions) to the HCC was performed 3 wk after implantation using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared on computed tomography, and the PIVKA-Ⅱ levels decreased.
CONCLUSION SBRT using the Synchrony system and GA can deliver a large dose accurately and safely, and could have a high therapeutic effect.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Yumiko Minagawa
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Takeshi Kinbara
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Uojima Haruki
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
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Masuda S, Koizumi K, Nishino T, Tazawa T, Kimura K, Tasaki J, Ichita C, Sasaki A, Kako M, Uojima H, Sugitani A. Direct oral anticoagulants increase bleeding risk after endoscopic sphincterotomy: a retrospective study. BMC Gastroenterol 2021; 21:401. [PMID: 34689751 PMCID: PMC8543952 DOI: 10.1186/s12876-021-01980-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Bleeding can be a serious adverse event of endoscopic sphincterotomy (EST). However, the risk of EST bleeding between direct oral anticoagulant (DOAC) users and those who received no antithrombotic agents has not been clarified. This study analyzed the risk factors for bleeding after EST in patients on DOAC and evaluated the Japan Gastroenterological Endoscopy Society (JGES) guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Methods We retrospectively analyzed 524 patients treated with EST who received DOAC or no antithrombotic drug from May 2016 to August 2019. We investigated the risk factors for bleeding. DOAC was typically discontinued for ≤ 1-day based on the JGES guideline. Although DOAC therapy recommenced the next morning after EST in principle, the duration of DOAC cessation and heparin replacement were determined by the attending physician based on each patient’s status. Results The number of patients on DOAC (DOAC group) and those not on antithrombotic drug (no-drug group) was 42 (8.0%) and 482 (92.0%), respectively. DOAC was discontinued for ≤ 1-day in 17 (40.0%) patients and for > 1-day in 25 (60.0%). Of the 524 patients, 21 (4.0%) had EST bleeding. The bleeding rate was higher in the DOAC group (14.0%) (p = 0.004). Multivariate analysis showed that bleeding occurred more frequently in patients on DOAC (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.37–11.4, p = 0.011), patients with low platelet counts (< 100,000/µl) (OR 6.74, 95% CI 2.1–21.6, p = 0.001), and elderly patients (> 80 years old) (OR 3.36, 95%CI 1.17–9.65, p = 0.024). Conclusions DOAC treatment, low platelet count, and old age (> 80 years old) are risk factors for EST bleeding. Although the bleeding incidence increased in patients on DOAC who received antithrombotic therapy according to the JGES guidelines, successful hemostasis was achieved with endoscopy in all cases, and no thrombotic events occurred after cessation of DOAC. Thus, the JGES guidelines are acceptable.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Takashi Nishino
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Tomohiko Tazawa
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Junichi Tasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0375, Japan
| | - Ayumu Sugitani
- Department of the Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, 065-0033, Japan
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Masuda S, Koizumi K, Uojima H, Kimura K, Nishino T, Tasaki J, Ichita C, Sasaki A. Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis. Cureus 2021; 13:e18449. [PMID: 34650837 PMCID: PMC8487445 DOI: 10.7759/cureus.18449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Considering that pathogens resistant to initial antibiotic therapies for cholangitis can affect mortality rates, appropriate initial empiric antibiotic therapy is important. However, evidence regarding the influence of pathogens resistant to initial antibiotics in patients with cholangitis who have undergone early endoscopic retrograde cholangiopancreatography (ERCP) is limited, and the conditions in several cases can improve with early ERCP even when pathogens resistant to initial antibiotics are detected on time. Therefore, this study aimed to assess the influence of pathogens resistant to initial antibiotics on the course of cholangitis in patients undergoing early ERCP. Materials and methods Patients (n=266) with positive blood or bile culture results treated with early ERCP were divided into those with cultures that were resistant to the initial antibiotics (antibiotic-resistant group; n=66; 24.8%) and those with cultures that were sensitive to the initial antibiotics (antibiotic-sensitive group; n=200; 75.2%). The duration of hospitalization, in-hospital mortality rates due to cholangitis, rates of increased disease severity, and complications during hospitalization were studied. Results Enterococcus, Enterobacter, Citrobacter, and Pseudomonas species showed high resistance to several antibiotics. No significant between-group differences were found in the duration of hospitalization, in-hospital mortality rates due to cholangitis, and rates of increased disease severity. However, the rate of post-ERCP cholecystitis was significantly higher in the antibiotic-resistant group than in the antibiotic-sensitive group (p=0.0245). Conclusions Even if the initial antibiotics were ineffective, the rate of fatal outcomes did not increase among patients with cholangitis who had undergone early ERCP. However, when initial antibiotics were ineffective, the frequency of post-ERCP cholecystitis increased even after early bile duct decompression.
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Affiliation(s)
- Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Haruki Uojima
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, JPN
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Sasaki A, Ichita C, Sumida C, Kimura K, Nishino T, Tasaki J, Masuda S, Kawachi J, Kudo M, Teshima S, Koizumi K, Kako M. Advanced Colon Cancer after Curative Resection of Intramucosal Adenocarcinoma with Endoscopic Submucosal Dissection. Case Rep Gastroenterol 2021; 15:603-609. [PMID: 34616263 PMCID: PMC8454252 DOI: 10.1159/000516314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022] Open
Abstract
Endoscopic resection, particularly endoscopic submucosal dissection (ESD), for colorectal cancers enables a precise pathological diagnosis and safe R0 resection. The recurrence rate after ESD is generally extremely low, with annual surveillance colonoscopy recommended. However, surveillance may not be considered for super-elderly patients owing to their condition. This is a case report of an 85-year-old man in whom curative resection was achieved for an intramucosal adenocarcinoma with ESD. The patient presented with a hypoechoic mass located in his lower right abdomen, diagnosed via surveillance abdominal ultrasound. He had undergone curative ESD for intramucosal cecal cancer 2 years prior. Colonoscopy revealed a type 2 epithelial tumor at the proximal aspect of the ESD scar. Ileocolic resection with lymph node dissection was performed. An epithelial tumor and well-differentiated adenocarcinoma but not a submucosal tumor was detected in the mucosal layer. The lesion was diagnosed not as a local recurrence after ESD but as a newly emerged original advanced cancer. After ESD for colorectal cancer, a newly developed advanced cancer may occur at the site of the ESD scar in a shorter term than usual. Surveillance colonoscopy after ESD is necessary even for super-elderly patients.
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Affiliation(s)
- Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Madoka Kudo
- Department of Diagnostic Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Teshima
- Department of Diagnostic Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Tanaka K, Sasaki A, Egashira H, Teshima S, Kimura K, Nishino T, Tazawa T, Tasaki J, Ichita C, Masuda S, Koizumi K, Kako M. A Targeted Biopsy during Menstruation for the Definitive Diagnosis of Rectovaginal Endometriosis: A Report of Two Cases. Intern Med 2021; 60:999-1004. [PMID: 33116009 PMCID: PMC8079915 DOI: 10.2169/internalmedicine.5430-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the definitive diagnosis of rectovaginal endometriosis in two cases. Case 1 involved a 46-year-old woman with abdominal pain and hematochezia. The diagnosis after the first and second examinations using lower gastrointestinal (GI) endoscopy was unclear. Differential diagnoses included mucosa-associated lymphoid tissue and colorectal cancer. The third lower GI endoscopy with a targeted biopsy, performed during menstruation, confirmed rectovaginal endometriosis. Case 2 involved a 38-year-old woman with hematochezia. Lower GI endoscopy during menstruation revealed rectovaginal endometriosis. When rectovaginal or bowel endometriosis is suspected, lower GI endoscopy and a targeted biopsy during menstruation can prevent unnecessary surgery.
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Affiliation(s)
- Kosuke Tanaka
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Hideto Egashira
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | | | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Tomohiko Tazawa
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
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Ichita C, Sasaki A, Sumida C, Kimura K, Nishino T, Tasaki J, Masuda S, Koizumi K, Kawachi J, Kako M. Clinical and endoscopic features of aorto-duodenal fistula resulting in its definitive diagnosis: an observational study. BMC Gastroenterol 2021; 21:45. [PMID: 33526013 PMCID: PMC7851914 DOI: 10.1186/s12876-021-01616-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated with high mortality. The present study aimed to examine the clinical and the endoscopic characteristics of ADF in eight patients who presented to our hospital. We also sought to clarify the diagnostic approach towards the disease. Methods The present study examined the clinical and the endoscopic/computed tomography (CT) characteristics of ADF in eight patients who were definitively diagnosed with this condition in a 12-year period at our hospital. Results The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients’ mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful. Conclusions In patients who have undergone intervention to manage an aortic pathology and have episodes of upper gastrointestinal bleeding, ADF cannot be definitively diagnosed with only one investigation. In addition, when performing upper GI endoscopy in cases where an ADF is suspected, tip attachment, converting to a long endoscope, and using marking clips can be helpful.
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Affiliation(s)
- Chikamasa Ichita
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Masuda S, Koizumi K, Moriya H, Nishino T, Uojima H, Tazawa T, Kimura K, Tasaki J, Ichita C, Sasaki A, Kako M, Hidaka S, Kudo M. Secondary Minimal Change Disease Due to Pancreatic Cancer Improved by Chemotherapy. Intern Med 2021; 60:251-257. [PMID: 32963158 PMCID: PMC7872799 DOI: 10.2169/internalmedicine.5499-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We herein describe an 82-year-old patient who presented with proteinuria and systemic edema. He was diagnosed with minimal change disease (MCD) and was found to have stage III pancreatic cancer. He could not undergo surgical resection due to invasion to the celiac artery and he was thus treated with chemotherapy. After a month of chemotherapy, his proteinuria improved to a normal level. After two months of chemotherapy, computed tomography indicated a partial response to the therapy. MCD can occur as paraneoplastic syndrome in patients with malignant disease, and chemotherapy can be effective for MCD associated with paraneoplastic syndrome.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Hidekazu Moriya
- Department of Nephrology, Shonan Kamakura General Hospital, Japan
| | - Takashi Nishino
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Tomohiko Tazawa
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Karen Kimura
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Junichi Tasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Makoto Kako
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Sumi Hidaka
- Department of Nephrology, Shonan Kamakura General Hospital, Japan
| | - Madoka Kudo
- Department of Pathology, Shonan Kamakura General Hospital, Japan
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Endo S, Kumamoto K, Enomoto T, Koizumi K, Kato H, Saida Y. Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study "The CODOMO study". Int J Colorectal Dis 2021; 36:987-998. [PMID: 33247313 PMCID: PMC8026453 DOI: 10.1007/s00384-020-03806-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Advances in endoscopic technology have led to the reevaluation of self-expandable metallic stent (SEMS) placement as a bridge-to-surgery (BTS) in patients with obstructive colorectal cancer. In Japan, after inclusion of SEMS placement as a BTS in the medical insurance coverage in 2012, this procedure has been increasingly performed. However, a transanal decompression tube (TADT) placement has been used as a BTS. We aimed to retrospectively evaluate the optimal strategy for obstructive left-sided colorectal cancer (OLCRC) by comparing SEMS and TADT placement with emergency surgery. METHODS We included 301 patients with stage II and III OLCRC from 27 institutions. The study patients were divided into Surgery group (emergency surgery, n = 103), SEMS group (BTS by SEMS, n = 113), and TADT group (BTS by TADT, n = 85). We compared the survival and perioperative outcomes of patients in the Surgery group as a standard treatment with those in the SEMS and TADT groups. RESULTS The 3-year relapse-free survival rate in patients in the Surgery group was 74.8%, while that in patients in the SEMS group and TADT group were 69.0% (p = 0.39) and 55.3% (p = 0.006), respectively. The technical success rate was not statistically different, but the clinical success rate was significantly higher in the SEMS group than in the TADT group (p = 0.0040). With regard to postoperative complications after curative surgery, the SEMS group had significantly lower of complications (≥ grade 2) than the Surgery group (p = 0.022). CONCLUSION Patients who underwent SEMS placement for OLCRC had similar oncological outcomes to patients who underwent emergency surgery.
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Affiliation(s)
- Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizu-Wakamatsu City, Fukushima, 969-3492, Japan.
| | - K Kumamoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizu-Wakamatsu City, Fukushima, 969-3492, Japan
| | - T Enomoto
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - K Koizumi
- Department of Gastroenterology, Tokyo Metropolitan Cancer Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - H Kato
- Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Y Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
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Okada T, Mizukami Y, Ono Y, Sato H, Hayashi A, Kawabata H, Koizumi K, Masuda S, Teshima S, Takahashi K, Katanuma A, Omori Y, Iwano H, Yamada M, Yokochi T, Asahara S, Kawakubo K, Kuwatani M, Sakamoto N, Enomoto K, Goto T, Sasajima J, Fujiya M, Ueda J, Matsumoto S, Taniue K, Sugitani A, Karasaki H, Okumura T. Digital PCR-based plasma cell-free DNA mutation analysis for early-stage pancreatic tumor diagnosis and surveillance. J Gastroenterol 2020; 55:1183-1193. [PMID: 32939577 DOI: 10.1007/s00535-020-01724-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cell-free DNA (cfDNA) shed from tumors into the circulation offers a tool for cancer detection. Here, we evaluated the feasibility of cfDNA measurement and utility of digital PCR (dPCR)-based assays, which reduce subsampling error, for diagnosing pancreatic ductal adenocarcinoma (PDA) and surveillance of intraductal papillary mucinous neoplasm (IPMN). METHODS We collected plasma from seven institutions for cfDNA measurements. Hot-spot mutations in KRAS and GNAS in the cfDNA from patients with PDA (n = 96), undergoing surveillance for IPMN (n = 112), and normal controls (n = 76) were evaluated using pre-amplification dPCR. RESULTS Upon Qubit measurement and copy number assessment of hemoglobin-subunit (HBB) and mitochondrially encoded NADH:ubiquinone oxidoreductase core subunit 1 (MT-ND1) in plasma cfDNA, HBB offered the best resolution between patients with PDA relative to healthy subjects [area under the curve (AUC) 0.862], whereas MT-ND1 revealed significant differences between IPMN and controls (AUC 0.851). DPCR utilizing pre-amplification cfDNA afforded accurate tumor-derived mutant KRAS detection in plasma in resectable PDA (AUC 0.861-0.876) and improved post-resection recurrence prediction [hazard ratio (HR) 3.179, 95% confidence interval (CI) 1.025-9.859] over that for the marker CA19-9 (HR 1.464; 95% CI 0.674-3.181). Capturing KRAS and GNAS could also provide genetic evidence in patients with IPMN-associated PDA and undergoing pancreatic surveillance. CONCLUSIONS Plasma cfDNA quantification by distinct measurements is useful to predict tumor burden. Through appropriate methods, dPCR-mediated mutation detection in patients with localized PDA and IPMN likely to progress to invasive carcinoma is feasible and complements conventional biomarkers.
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Affiliation(s)
- Tetsuhiro Okada
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hiroki Sato
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Akihiro Hayashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hidemasa Kawabata
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kazuya Koizumi
- Center for Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sakue Masuda
- Center for Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Yuko Omori
- Department of Pathology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Hirotoshi Iwano
- Department of Gastroenterology and Endoscopic Unit, Shibetsu City Hospital, Shibetsu, Japan
| | - Masataka Yamada
- Department of Gastroenterology and Endoscopic Unit, Shibetsu City Hospital, Shibetsu, Japan
| | - Tomoki Yokochi
- Department of Clinical Research, Chiba Tokushukai Hospital, Funabashi, Japan
| | - Shingo Asahara
- Department of Clinical Research, Chiba Tokushukai Hospital, Funabashi, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Katsuro Enomoto
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Takuma Goto
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Junpei Sasajima
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Jun Ueda
- Center for Advanced Research and Education, Asahikawa Medical University, Asahikawa, Japan
| | - Seiji Matsumoto
- Center for Advanced Research and Education, Asahikawa Medical University, Asahikawa, Japan
| | - Kenzui Taniue
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Ayumu Sugitani
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hidenori Karasaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
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Sato H, Sasajima J, Okada T, Hayashi A, Kawabata H, Goto T, Koizumi K, Tamamura N, Tanabe H, Fujiya M, Chiba SI, Tanino M, Ono Y, Mizukami Y, Okumura T. Resection for pancreatic cancer metastases contributes to survival: A case report with sequential tumor genotype profiling during the long-term postoperative course. Medicine (Baltimore) 2020; 99:e20564. [PMID: 32569179 PMCID: PMC7310851 DOI: 10.1097/md.0000000000020564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Surgical management is not a standard treatment option for metastatic recurrence of pancreatic adenocarcinoma. However, the surgical management of a solitary metastasis is useful in selected cases. PATIENT CONCERNS A 42-year-old woman was referred to our hospital on account of epigastric pain associated with a mass in the pancreatic body. The patient had a family history of branch duct-type intraductal papillary mucinous neoplasm of the pancreas. DIAGNOSIS The patient was diagnosed with pancreatic ductal adenocarcinoma (PDA) complicated with pancreatitis due to pancreatic duct involvement. INTERVENTIONS The patient underwent distal pancreatectomy, and pathological examination revealed a tubular adenocarcinoma. Solitary liver and lung metastatic tumors were found 6 and 43 months after the initial presentation, respectively, and sequential metastasectomies were performed. OUTCOMES The patient survived until 8 years after her initial presentation. The genetic profiles of the resected specimens, primary PDA, and recurrent tumors in the liver and lung possessed identical KRAS mutations at codon 12, whereas there were no mutations in the main tumor suppressor genes, such as TP53, CDKN2A, and SMAD4. Multiplex polymerase chain reaction-based microsatellite instability assay demonstrated microsatellite stability. CONCLUSION In our case, the patient with pancreatic adenocarcinoma survived for over 8 years following the resection of the primary tumor and resections of metachronous metastatic tumors. The outcome of PDA may be associated with the genetic profile that regulates its biological behavior. Operative management of solitary metastatic tumors may be a therapeutic options for selected patients with pancreatic cancer.
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Affiliation(s)
| | | | | | | | | | | | - Kazuya Koizumi
- Department of Medicine
- Present address: Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | | | | | | | - Mishie Tanino
- Department of Surgical Pathology, Asahikawa Medical University, Asahikawa
| | - Yusuke Ono
- Department of Medicine
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo
| | - Yusuke Mizukami
- Department of Medicine
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo
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Masuda S, Koizumi K, Uojima H, Tazawa T, Kimura K, Nishino T, Tasaki J, Ichita C, Sasaki A, Egashira H, Kako M. Pancreatic pseudocyst-portal vein fistula: a case treated with EUS-guided cyst-drainage and a review of the literature. Clin J Gastroenterol 2020; 13:597-606. [PMID: 32215857 DOI: 10.1007/s12328-020-01105-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
Pancreatic pseudocyst and portal vein thrombosis are common conditions resulting from acute and chronic pancreatitis. However, pancreatic pseudocyst-portal vein fistula (PPVF) is a rare and life-threatening complication. In PPVF patients, drainage or operative therapy is necessary under certain conditions, including communication between the pseudocyst and pancreatic duct, pancreatic duct stricture, pancreatic duct stone, and infection that is difficult to control with antibiotics. We describe the case of a 78-year-old woman who presented with an infected pancreatic pseudocyst invading the portal venous system with obstruction due to thromboembolization. Conservative therapy with antibiotics was insufficient. We, therefore, performed endoscopic ultrasound-guided cyst-drainage (EUS-CD). During EUS-CD, PPVF and pseudocyst-pancreatic duct fistula were confirmed by contrast medium injection. Despite the presence of the pseudocyst-pancreatic duct fistula, the pancreatic duct was not visualized in the pancreatic head, suggesting stricture in the main pancreatic duct. We, therefore, performed endoscopic retrograde pancreatography, which revealed pancreatic stone in the main pancreatic duct. Then, we added a 7-Fr pancreatic stent. She was discharged after 89 days of hospitalization. We reviewed the literature on the management of PPVF formation, and EUS-CD is considered to be a good treatment option for PPVF patients without portal vein patency.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Kazuya Koizumi
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa, 252-0375, Japan
| | - Tomohiko Tazawa
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Takashi Nishino
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Junichi Tasaki
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Akiko Sasaki
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hideto Egashira
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Koizumi K, Masuda S, Tazawa T, Kako M, Teshima S. Endoscopic ultrasonography-guided drainage for spontaneous rupture of a pancreatic pseudocyst into the peritoneal cavity in a patient with autoimmune pancreatitis. Clin J Gastroenterol 2020; 13:591-596. [PMID: 32078121 DOI: 10.1007/s12328-020-01104-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/04/2020] [Indexed: 12/29/2022]
Abstract
A 75-year-old man was referred to our hospital due to a huge pancreatic cyst. Computed tomography revealed a monocular cyst 15 cm in size without a solid mass lesion nearby. He was diagnosed with pancreatic pseudocyst. Endoscopic ultrasound (EUS)-guided drainage was planned for the next day due to abdominal distension; however, the pseudocyst ruptured into the peritoneal cavity before treatment could be applied. To prevent the progression of peritonitis, EUS-guided drainage of the pseudocyst was performed. A nasocystic tube and plastic stent were placed into the ruptured cyst via the gastric wall through the same puncture tract. After the treatment, the cyst rapidly decreased in size, and the peritonitis improved without surgery. The patient's serum IgG4 level was found to be elevated to 820 mg/dL. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct stricture without obstruction. No communication between the main pancreatic duct and the pseudocyst was found. An EUS-guided fine-needle aspiration biopsy of the hypoechoic site was performed, revealing IgG4-positive plasma cell infiltration. He was finally diagnosed with AIP associated with the rupture of a pseudocyst. Oral corticosteroid (30 mg/day) treatment was started and gradually tapered. There has been no recurrence in the 28 months since the initiation of treatment.
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Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Tomohiko Tazawa
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Masuda S, Koizumi K, Uojima H, Tazawa T, Tasaki J, Ichita C, Nishino T, Kimura K, Sasaki A, Egashira H, Kako M. Ischemic pancreatitis with infected walled-off necrosis with a colonic fistula after cardiopulmonary bypass successfully treated by endoscopic ultrasound-guided drainage. Clin J Gastroenterol 2019; 13:127-133. [PMID: 31327132 DOI: 10.1007/s12328-019-01019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
A 72-year-old man who had been on continuous ambulatory peritoneal dialysis treatment for 10 years underwent cardiopulmonary bypass for aortic valve replacement due to aortic valve stenosis. After surgery, he experienced pancreatitis, and rupture of a splenic artery aneurysm. He went into cardiopulmonary arrest but was successfully treated by transcatheter arterial embolization (TAE) with cardiopulmonary resuscitation. At three weeks after TAE, CT showed heterogeneous enhancement and the accumulation of pancreatic fluid in the pancreatic tail. At 4 months after TAE, he had sepsis and CT showed greater fluid collection with emphysema in comparison to 3 months previously. We diagnosed infected walled-off necrosis (WON). Conservative therapy with antibiotics was not sufficiently effective; thus, we performed endoscopic ultrasound-guided drainage (EUS-D). Contrast imaging revealed WON with colonic fistula. The WON remarkably decreased in size on CT after EUS-D. We experienced a rare case of ischemic acute pancreatitis (AP) caused by cardiopulmonary bypass complicated with infected WON with a colonic fistula. Ischemic AP more frequently shows a severe course with a fatal outcome in comparison to AP of other causes. However, in our case, ischemic AP with infected WON was successfully treated by EUS-D despite the presence of a WON with a colonic fistula.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Haruki Uojima
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.,Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0375, Japan
| | - Tomohiko Tazawa
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Junichi Tasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Takashi Nishino
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hideto Egashira
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Masuda N, Yamashita T, Saji S, Araki K, Ito Y, Takano T, Takahashi M, Tsurutani J, Koizumi K, Kitada M, Kojima Y, Sagara Y, Tada H, Iwasa T, Kadoya T, Iwatani T, Hasegawa H, Morita S, Ohno S. Abstract OT2-07-05: A phase III trial to compare eribulin mesylate + trastuzumab (H) + pertuzumab (P) with paclitaxel or docetaxel + HP for HER2-positive advanced or metastatic breast cancer (JBCRG-M06/ EMERALD). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-07-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Docetaxel + Trastuzumab (H) + Pertuzumab (P) provided progression-free survival (PFS) and overall survival (OS) benefits in HER2-positive advanced or metastatic breast cancer (AMBC) in the CLEOPATRA study as a first-line therapy. However, long-term administration of docetaxel at a dose of 75 mg/m2 every 3 weeks in AMBC patients (pts) is difficult due to the toxicities. Eribulin mesylate (E) is a well-tolerated microtubule inhibitor, and we have reported the efficacy and safety of EHP regimen as first- and second-line therapy for AMBC in a multicenter, phase II study (JBCRG-M03/UMIN000012232). In this M06 study, we address the clinical question as to which is the better chemotherapy partner for HP as first line regimen, in terms of efficacy, toxicity and QOL.
Methods: JBCRG-M06 is a multicenter open-label randomized phase III study for HER2-positive AMBC pts who have received no prior chemotherapy except for the HER2- Antibody-Drug Conjugate (ADC). Pts will be randomized 1:1 to E (1.4mg/m2 on day 1 and 8) + H (8 mg/kg loading dose followed by 6 mg/kg) +P (840 mg loading dose followed by 420 mg) q3wks or standard taxanes (docetaxel 75mg/m2 on day1 or paclitaxel 80mg/m2 on day 1, 8 and 15) + HP q3wks. Stratification factors for randomization are; presence of visceral metastases, number of prior taxanes on perioperative adjuvant treatment, and treatment with prior anti-HER2-ADC. Primary endpoint is PFS and secondary endpoints include overall response rate, duration of response, OS, patient-reported outcomes (PRO) relating to QOL and peripheral neuropathy, new-metastases free survival, and safety. Translational research to search for biomarker for individual precision therapy will be performed. Main eligibility criteria are as follows: pts with HER2-positive AMBC, female aged 20-70 years old, ECOG PS of 0-1, LVEF ≥ 50% at baseline and adequate organ function. Pts who had progressive MBC within 6 months after the end of primary adjuvant systemic chemotherapy are excluded. The sample size was calculated by type1 error (2-sided) of 0.05 and 80% power to estimate the noninferiority margin 1.33 with an expected median PFS of 14.2 months. The target number of pts is 480 recruited over the duration of 3-years. The first patient in was achieved on August 2017. (ClinicalTrials.gov Identifier:NCT03264547).
Citation Format: Masuda N, Yamashita T, Saji S, Araki K, Ito Y, Takano T, Takahashi M, Tsurutani J, Koizumi K, Kitada M, Kojima Y, Sagara Y, Tada H, Iwasa T, Kadoya T, Iwatani T, Hasegawa H, Morita S, Ohno S. A phase III trial to compare eribulin mesylate + trastuzumab (H) + pertuzumab (P) with paclitaxel or docetaxel + HP for HER2-positive advanced or metastatic breast cancer (JBCRG-M06/ EMERALD) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-07-05.
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Affiliation(s)
- N Masuda
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - T Yamashita
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - S Saji
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - K Araki
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Y Ito
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - T Takano
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - M Takahashi
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - J Tsurutani
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - K Koizumi
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - M Kitada
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Y Kojima
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Y Sagara
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - H Tada
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - T Iwasa
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - T Kadoya
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - T Iwatani
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - H Hasegawa
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - S Morita
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - S Ohno
- NHO Osaka National Hospital, Osaka, Japan; Kanagawa Cancer Center, Yokohama, Japan; Fukushima Medical University Hospital, Fukushima, Japan; Hyogo College of Medicine, Nishinomiya, Japan; The Cancer Institute Hospital of JFCR, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan; NHO Hokkaido Cancer Center, Sapporo, Japan; Kindai University Hospital, Osaka-Sayama, Japan; Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Asahikawa Medical University Hospital, Asahikawa, Japan; St. Marianna University School of Medicine Hospital, Kawasaki, Japan; Sagara Hospital, Kagoshima, Japan; Tohoku University Hospital, Sendai, Japan; Hiroshima University Hospital, Hiroshima, Japan; Eisai Co., Ltd., Tokyo, Japan; Graduate School of Medicine Kyoto University, Kyoto, Japan
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Koizumi K, Hosiai M, Katsumata N, Toda T, Kise H, Hasebe Y, Kono Y, Sunaga Y, Yoshizawa M, Watanabe A, Moriguchi T, Matsuda K, Sugita K. P3794Plasma exchange regulates CD14+CD16+ activated monocytes and CD4+CD25+FOXP3+ regulatory T cells in Kawasaki disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Koizumi
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - M Hosiai
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - N Katsumata
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - T Toda
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - H Kise
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - Y Hasebe
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - Y Kono
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - Y Sunaga
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - M Yoshizawa
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - A Watanabe
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
| | - T Moriguchi
- Faculty of Medicine, University of Yamanashi, Department of Emergency and Critical Care Medicine, Chuo, Yamanashi, Japan
| | - K Matsuda
- Faculty of Medicine, University of Yamanashi, Department of Emergency and Critical Care Medicine, Chuo, Yamanashi, Japan
| | - K Sugita
- Faculty of Medicine, University of Yamanashi, Department of Pediatrics, Chuo, Yamanashi, Japan
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Kono K, Okada Y, Onimaru H, Yokota S, Arima Y, Fukushi I, Koizumi K, Hasebe Y, Yoshizawa M, Kise H, Hoshiai M, Sugita K, Toda T. P1859Functional and anatomical connectivity from the dorsomedial hypothalamus to the ventral medullary cardiovascular regions: possible neural substrate mediating stress-induced sympathoexcitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Kono
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - Y Okada
- National Hospital Organization Murayama Medical Center, Clinical Research Center, Tokyo, Japan
| | - H Onimaru
- Showa University, Department of Physiology, Tokyo, Japan
| | - S Yokota
- Shimane University School of Medicine, Department of Anatomy and Morphological Neuroscience, Shimane, Japan
| | - Y Arima
- Shimane University School of Medicine, Department of Anatomy and Morphological Neuroscience, Shimane, Japan
| | - I Fukushi
- National Hospital Organization Murayama Medical Center, Clinical Research Center, Tokyo, Japan
| | - K Koizumi
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - Y Hasebe
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - M Yoshizawa
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - H Kise
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - M Hoshiai
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - K Sugita
- University of Yamanashi, Pediatrics, Yamanashi, Japan
| | - T Toda
- University of Yamanashi, Pediatrics, Yamanashi, Japan
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Hasebe Y, Yokota S, Takeda K, Sugama S, Kono Y, Koizumi K, Fukushi I, Hoshiai M, Kakinuma Y, Pokorski M, Horiuchi J, Sugita K, Okada Y. P4780Activation of astrocytes is requred for the persistence of post-stress blood pressure elevation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Hasebe
- University of Yamanashi, Department of Pediatrics, Graduate School of Medicine, Yamanashi, Japan
| | - S Yokota
- Shimane University, Anatomy and Morphological Neuroscience, Izumo, Japan
| | - K Takeda
- Fujita Health University, Faculty of Rehabilitation, School of Health Sciences, Mie, Japan
| | - S Sugama
- Nippon Medical School, Department of Physiology, Tokyo, Japan
| | - Y Kono
- University of Yamanashi, Department of Pediatrics, Graduate School of Medicine, Yamanashi, Japan
| | - K Koizumi
- University of Yamanashi, Department of Pediatrics, Graduate School of Medicine, Yamanashi, Japan
| | - I Fukushi
- National Hospital Organization Murayama Medical Center, Clinical Research Center, Musashimurayama, Tokyo, Japan
| | - M Hoshiai
- University of Yamanashi, Department of Pediatrics, Graduate School of Medicine, Yamanashi, Japan
| | - Y Kakinuma
- Nippon Medical School, Department of Physiology, Tokyo, Japan
| | - M Pokorski
- Opole Medical School, Faculty of Physiotherapy, Opole, Poland
| | - J Horiuchi
- Toyo University, Department of Biomedical Engineering, Graduate School of Science & Engineering, Saitama, Japan
| | - K Sugita
- University of Yamanashi, Department of Pediatrics, Graduate School of Medicine, Yamanashi, Japan
| | - Y Okada
- National Hospital Organization Murayama Medical Center, Clinical Research Center, Musashimurayama, Tokyo, Japan
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Sakai Y, Iwai T, Shimura K, Gon K, Koizumi K, Ijima M, Chiba K, Nakatani S, Sugiyama H, Tsuyuguchi T, Kamisawa T, Maetani I, Kida M. Safety and efficacy of metallic stent for unresectable distal malignant biliary obstruction in elderly patients. World J Gastroenterol 2018; 24:69-75. [PMID: 29358883 PMCID: PMC5757127 DOI: 10.3748/wjg.v24.i1.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/02/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.
METHODS Of 272 patients with unresectable distal malignant biliary obstruction, 184 patients under the age of 80 were classified into Group A, and 88 subjects aged 80 years or more were classified into Group B. The safety of metallic stent insertion, metal stent patency period, and the obstruction rate were examined in each group.
RESULTS In Group B, patients had a significantly worse performance status, high blood pressure, heart disease, cerebrovascular disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher (P < 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779 (1-965) d; 252.000 ± 35.998 (1-618) d in Group A and 269.000 ± 47.885 (1-965) d in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 82 of the 272 (30.15%) patients; in 53/184 (28.80%) patients in Group A and in 29/88 (32.95%) of those in Group B, showing no significant difference between the two groups. Procedural accidents due to metal stent insertion occurred in 24/272 (8.8%) patients; in 17/184 (9.2%) of patients in Group A and in 7/88 (8.0%) of those in Group B, with no significant difference between the two groups, either.
CONCLUSION These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.
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Affiliation(s)
- Yuji Sakai
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Tomohisa Iwai
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
| | - Kenji Shimura
- Department of Gastroenterology, Asahi Central Hospital, Chiba 289-2511, Japan
| | - Katsushige Gon
- Iruru Maetani, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Masashi Ijima
- Department of Gastroenterology, Subaru Health Insurance Society Ota Memorial Hospital, Gunma 373-8585, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo 113-8677, Japan
| | - Seigo Nakatani
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo 113-8677, Japan
| | | | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
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Uojima H, Hidaka H, Nakayama T, Sung JH, Ichita C, Tokoro S, Masuda S, Sasaki A, Koizumi K, Egashira H, Kako M. Efficacy of combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites patients: A randomized study. World J Gastroenterol 2017; 23:8062-8072. [PMID: 29259382 PMCID: PMC5725301 DOI: 10.3748/wjg.v23.i45.8062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/25/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To assess the effects of a combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites patients.
METHODS A two-center, randomized, open-label, prospective study was conducted. Japanese patients who met the criteria were randomized to trial group and the combination diuretic group (received 7.5 mg of tolvaptan) or the conventional diuretic group (received 40 mg of furosemide) for 7 d in addition to the natriuretic drug which was used prior to enrolment in this study. The primary endpoint was the change in body weight from the baseline. Vital signs, fluid intake, and laboratory and urinary data were assessed to determine the pharmacological effects after administration of aquaretic and natriuretic drugs.
RESULTS A total of 56 patients were randomized to receive either tolvaptan (n = 28) or furosemide (n = 28). In the combination and conventional diuretic groups, the average decrease in body weight from the baseline was 3.21 ± 3.17 kg (P < 0.0001) and 1.75 ± 2.36 kg (P = 0.0006), respectively, when measured on the final dosing day. Following 1 wk of treatment, a significantly greater reduction in body weight was observed in the combination diuretic group compared to that in the conventional diuretic group (P = 0.0412).
CONCLUSION Compared to a conventional diuretic therapy with only a natriuretic drug, a combination diuretic therapy with natriuretic and aquaretic drugs is more effective for patients with cirrhotic ascites.
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Affiliation(s)
- Haruki Uojima
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
| | - Hisashi Hidaka
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
| | - Tsuyoshi Nakayama
- Department of Gastroenterology, Shonan Atsugi Hospital, Kanagawa 243-8551, Japan
| | - Ji Hyun Sung
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Shinnosuke Tokoro
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Sakue Masuda
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Akiko Sasaki
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Hideto Egashira
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
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Ono Y, Sugitani A, Karasaki H, Ogata M, Nozaki R, Sasajima J, Yokochi T, Asahara S, Koizumi K, Ando K, Hironaka K, Daito T, Mizukami Y. An improved digital polymerase chain reaction protocol to capture low-copy KRAS mutations in plasma cell-free DNA by resolving 'subsampling' issues. Mol Oncol 2017; 11:1448-1458. [PMID: 28691390 PMCID: PMC5623814 DOI: 10.1002/1878-0261.12110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022] Open
Abstract
Genetic alterations responsible for the initiation of cancer may serve as immediate biomarkers for early diagnosis. Plasma levels of cell‐free DNA (cfDNA) in patients with cancer are higher than those in healthy individuals; however, the major technical challenge for the widespread implementation of cfDNA genotyping as a diagnostic tool is the insufficient sensitivity and specificity of detecting early‐stage tumors that shed low amounts of cfDNA. To establish a protocol for ultrasensitive droplet digital polymerase chain reaction (ddPCR) for quantification of low‐frequency alleles within a limited cfDNA pool, two‐step multiplex ddPCR targeting eight clinically relevant mutant KRAS variants was examined. Plasma samples from patients with colorectal (n = 10) and pancreatic cancer (n = 9) were evaluated, and cfDNA from healthy volunteers (n = 50) was utilized to calculate reference intervals. Limited cfDNA yields in patients with resectable colorectal and pancreatic cancers did not meet the requirement for efficient capture and quantification of rate mutant alleles by ddPCR. Eight preamplification cycles followed by a second‐run ddPCR were sufficient to obtain approximately 5000–10 000 amplified copies per ng of cfDNA, resolving the subsampling issue. Furthermore, the signal‐to‐noise ratio for rare mutant alleles against the extensive background presented by the wild‐type allele was significantly enhanced. The cutoff limit of reference intervals for mutant KRAS was determined to be ~ 0.09% based on samples from healthy individuals. The modification introduced in the ddPCR protocol facilitated the quantification of low‐copy alleles carrying driver mutations, such as oncogenic KRAS, in localized and early‐stage cancers using small blood volumes, thus offering a minimally invasive modality for timely diagnosis.
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Affiliation(s)
- Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Ayumu Sugitani
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Hidenori Karasaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Munehiko Ogata
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Reo Nozaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Junpei Sasajima
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan.,Department of Medicine, Asahikawa Medical University, Japan
| | - Tomoki Yokochi
- Department of Clinical Research, Chiba Tokushukai Hospital, Japan
| | - Shingo Asahara
- Department of Clinical Research, Chiba Tokushukai Hospital, Japan
| | - Kazuya Koizumi
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kiyohiro Ando
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | | | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan.,Department of Medicine, Asahikawa Medical University, Japan
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Miyata Y, Kashiwagi H, Koizumi K, Kawachi J, Kudo M, Teshima S, Isogai N, Miyake K, Shimoyama R, Fukai R, Ogino H. Fatal liver gas gangrene after biliary surgery. Int J Surg Case Rep 2017; 39:5-8. [PMID: 28783522 PMCID: PMC5545817 DOI: 10.1016/j.ijscr.2017.07.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/07/2017] [Accepted: 07/23/2017] [Indexed: 02/06/2023] Open
Abstract
Liver gas gangrene is a rare condition with a highly mortality rate. Development of liver gas gangrene is associated with host conditions such as malignancy and immunosuppression. We report a case of liver gas gangrene after biliary surgery which is one of the risks of the liver parenchymal infection.
Introduction Liver gas gangrene is a rare condition with a highly mortality rate. It is mostly associated with host factors, such as malignancy and immunosuppression. Presentation of case A 57-year-old female was admitted to our hospital with abnormalities of her serum hepato-biliary enzymes. She had a history of hypertension, diabetes mellitus, cerebral infarction, and chronic renal failure. She was diagnosed with bile duct cancer of the liver hilum and a left hepatectomy was carried out, with extrahepatic bile duct resection. Initially her post-operative state was uneventful. However, she suddenly developed melena with anemia on post-operative day (POD) 18. A Computed tomography (CT) examination on POD 19 revealed a massive build up of gas and portal gas formation in the anterior segment of the liver. Although we immediately provided the drainage and a probe laparotomy, she died on POD 20 due to shock with disseminated intravascular coagulation. Discussion Liver gas gangrene is rare and has a high mortality rate. This case seems to have arisen from an immunosuppressive state after major surgery with biliary reconstruction for bile duct cancer and subsequent gastrointestinal bleeding, leading to gas gangrene of the liver.
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Affiliation(s)
- Yui Miyata
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan.
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Madoka Kudo
- Department of Pathology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Ryota Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
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50
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Noguchi T, Ebina K, Hirao M, Morimoto T, Koizumi K, Kitaguchi K, Matsuoka H, Iwahashi T, Yoshikawa H. Oxygen ultra-fine bubbles water administration prevents bone loss of glucocorticoid-induced osteoporosis in mice by suppressing osteoclast differentiation. Osteoporos Int 2017; 28:1063-1075. [PMID: 27896363 DOI: 10.1007/s00198-016-3830-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED Oxygen ultra-fine bubbles (OUB) saline injection prevents bone loss of glucocorti\coid-induced osteoporosis in mice, and OUB inhibit osteoclastogenesis via RANK-TRAF6-c-Fos-NFATc1 signaling and RANK-p38 MAPK signaling in vitro. INTRODUCTION Ultra-fine bubbles (<200 nm in diameter) have several unique properties, and they are tested in various medical fields. The purpose of this study was to investigate the effects of oxygen ultra-fine bubbles (OUB) on glucocorticoid-induced osteoporosis (GIO) model mice. METHODS Prednisolone (PSL, 5 mg) was subcutaneously inserted in 6-month-old male C57BL/6J mice, and 200 μl of saline, OUB-diluted saline, or nitrogen ultra-fine bubbles (NUB)-diluted saline was intraperitoneally injected three times per week for 8 weeks the day after operations. Mice were divided into four groups; (1) control, sham-operation + saline; (2) GIO, PSL + saline; (3) GIO + OUB, PSL + OUB saline; (4) GIO + NUB, PSL + NUB saline. The effects of OUB on osteoblasts and osteoclasts were examined by serially diluted OUB medium in vitro. RESULTS Bone mass was significantly decreased in GIO [bone volume/total volume (%): control vs. GIO 12.6 vs. 7.9; p < 0.01] while significantly preserved in GIO + OUB (GIO vs. GIO + OUB 7.9 vs. 12.9; p < 0.05). In addition, tartrate-resistant acid phosphatase (TRAP)-positive cells in the distal femur [mean osteoclasts number/bone surface (mm-1)] was significantly increased in GIO (control vs. GIO 6.8 vs. 11.6; p < 0.01) while suppressed in GIO + OUB (GIO vs. GIO + OUB 11.6 vs. 7.5; p < 0.01). NUB did not affect these parameters. In vitro experiments revealed that OUB significantly inhibited osteoclastogenesis by inhibiting RANK-TRAF6-c-Fos-NFATc1 signaling, RANK-p38 MAPK signaling, and TRAP/Cathepsin K/DC-STAMP mRNA expression in a concentration-dependent manner. OUB did not affect osteoblastogenesis in vitro. CONCLUSIONS OUB prevent bone loss in GIO mice by inhibiting osteoclastogenesis.
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Affiliation(s)
- T Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Ebina
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - M Hirao
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - T Morimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Koizumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Kitaguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - H Matsuoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - T Iwahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - H Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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