Pub Date : 2011-10-05DOI: 10.11405/NISSHOSHI.108.1726
慶一 橋口, 和文 山崎, 辰樹 市川, 史直 竹島, 一彦 中尾
A 66-year-old woman with a history of alcoholic liver cirrhosis and hepatocellular carcinoma was repeatedly hospitalized for the treatment of encephalopathy. Computed tomography demonstrated a portosystemic venous shunt which continued from portal branch P7 to the right renal vein. Since pharmacotherapy for encephalopathy was ineffective, balloon-occluded retrograde transvenous obliteration (B-RTO) was performed to block the portal-renal flow. Hyperammonemia and encephalopathy improved remarkably after the procedure. Intrahepatic portosystemic venous shunt draining into the right renal vein is a rare condition. To the best of our knowledge, management of this type of shunt by B-RTO has not been previously described. We report this case accompanied by a short review of the related literature.
{"title":"右腎静脈を排出路とする肝内門脈―大循環シャントによる肝性脳症に対しB-RTOが著効した1例","authors":"慶一 橋口, 和文 山崎, 辰樹 市川, 史直 竹島, 一彦 中尾","doi":"10.11405/NISSHOSHI.108.1726","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.1726","url":null,"abstract":"A 66-year-old woman with a history of alcoholic liver cirrhosis and hepatocellular carcinoma was repeatedly hospitalized for the treatment of encephalopathy. Computed tomography demonstrated a portosystemic venous shunt which continued from portal branch P7 to the right renal vein. Since pharmacotherapy for encephalopathy was ineffective, balloon-occluded retrograde transvenous obliteration (B-RTO) was performed to block the portal-renal flow. Hyperammonemia and encephalopathy improved remarkably after the procedure. Intrahepatic portosystemic venous shunt draining into the right renal vein is a rare condition. To the best of our knowledge, management of this type of shunt by B-RTO has not been previously described. We report this case accompanied by a short review of the related literature.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129561273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: We report a case of primary hepatic actinomycosis showing elevation of serum protein induced by vitamin K absence or antagonist II (PIVKA-II). A 68-year-old man visited an affiliated hospital with a complaint of high fever and body weight loss. Hematological examination revealed severe inflammatory reactions and liver dysfunction. Abdominal CT showed a heterogeneous low density area composed of cystic and solid part. We suspected the cystic part with band-like enhancement to be a hepatic abscess and performed percutaneous transhepatic abscess drainage. Although inflammatory reactions decreased after the drainage, the solid part did not shrink and blood chemistry revealed elevation of PIVKA-II. Since we could not rule out the possibility of hepatoma, right hepatectomy was performed. Histological examination revealed actinomycetes. Although primary hepatic actinomycosis is a rare disease, it must be kept in mind in the differential diagnosis of the liver tumor.
{"title":"PIVKA-II高値を示し, 悪性腫瘍との鑑別が困難だった原発性肝放線菌症の1例","authors":"剛文 森田, 孝宣 坂口, 泰 柴崎, 康介 大石, 淳司 鈴木, 和彦 福本, 圭介 稲葉, 聡 馬場, 康雄 竹原, 昌八 鈴木, 高 岡井, 弘之 今野","doi":"10.11405/NISSHOSHI.108.1735","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.1735","url":null,"abstract":": We report a case of primary hepatic actinomycosis showing elevation of serum protein induced by vitamin K absence or antagonist II (PIVKA-II). A 68-year-old man visited an affiliated hospital with a complaint of high fever and body weight loss. Hematological examination revealed severe inflammatory reactions and liver dysfunction. Abdominal CT showed a heterogeneous low density area composed of cystic and solid part. We suspected the cystic part with band-like enhancement to be a hepatic abscess and performed percutaneous transhepatic abscess drainage. Although inflammatory reactions decreased after the drainage, the solid part did not shrink and blood chemistry revealed elevation of PIVKA-II. Since we could not rule out the possibility of hepatoma, right hepatectomy was performed. Histological examination revealed actinomycetes. Although primary hepatic actinomycosis is a rare disease, it must be kept in mind in the differential diagnosis of the liver tumor.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114552405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: A woman in her 60's presented with a tumor of the pancreatic body. Pan-hysterectomy had been performed under a diagnosis of uterine leiomyoma 11 years previously. A sample obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed the histopathological proliferation of spindle-shaped bundles of atypical cells, and immunohistochemical staining demonstrated that these cells were positive for KIT. Therefore, distal pancreatectomy was performed under a diagnosis of pancreatic gastrointestinal stromal tumor (GIST). Immunohistochemical staining of surgical specimens demonstrated that the tumor cells were positive for desmin and negative for KIT and CD34. The low-grade leiomyosarcoma in pathological specimens of the uterine myoma obtained 11 years previously histologically resembled the pathological findings of the pancreatic specimens except for atypical nuclei and mitotic cells. Therefore, the final diagnosis was extremely rare metastatic leiomyosarcoma of the pancreas. Herein, we report metastasis of uterine leiomyosarcoma to the pancreas and discuss the usefulness and limitations of EUS-FNA.
{"title":"転移性膵平滑筋肉腫の1例―EUS-FNAの有用性と問題点―","authors":"健 小倉, 健次 山雄, 範 肱岡, 和生 原, 明 澤木, 伸匡 水野, 康正 丹羽, 正洋 田近, 宏紀 河合, 真也 近藤, 哲郎 佐伯, 麻奈 赤羽, 真 羽場, 輝子 友野, 怜 清水, 泰博 清水, 和貴 細田, 恭 谷田部","doi":"10.11405/NISSHOSHI.108.987","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.987","url":null,"abstract":": A woman in her 60's presented with a tumor of the pancreatic body. Pan-hysterectomy had been performed under a diagnosis of uterine leiomyoma 11 years previously. A sample obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed the histopathological proliferation of spindle-shaped bundles of atypical cells, and immunohistochemical staining demonstrated that these cells were positive for KIT. Therefore, distal pancreatectomy was performed under a diagnosis of pancreatic gastrointestinal stromal tumor (GIST). Immunohistochemical staining of surgical specimens demonstrated that the tumor cells were positive for desmin and negative for KIT and CD34. The low-grade leiomyosarcoma in pathological specimens of the uterine myoma obtained 11 years previously histologically resembled the pathological findings of the pancreatic specimens except for atypical nuclei and mitotic cells. Therefore, the final diagnosis was extremely rare metastatic leiomyosarcoma of the pancreas. Herein, we report metastasis of uterine leiomyosarcoma to the pancreas and discuss the usefulness and limitations of EUS-FNA.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124965457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-06-01DOI: 10.11405/NISSHOSHI.108.887
K. Yao, Y. Takaki, T. Nagahama, T. Matsui, A. Iwashita
{"title":"Optical equipment-based image enhanced endoscopy (IEE) の上部消化管領域における臨床応用","authors":"K. Yao, Y. Takaki, T. Nagahama, T. Matsui, A. Iwashita","doi":"10.11405/NISSHOSHI.108.887","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.887","url":null,"abstract":"","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130798280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-01DOI: 10.11405/NISSHOSHI.108.813
忠久 福井, 伊藤 由理子, 孝志 吉岡, 弘明 武田, 純男 河田
A 64-year-old male visited our hospital complaining of epigastric pain, and was diagnosed as esophageal cancer with multiple liver metastases. Histological examinations revealed squamous cell carcinoma. He had serious liver dysfunctions and his general conditions were severe, expressed as 3 of the performance status. He was treated using radiotherapy and chemotherapy with low-dose nedaplatin and 5-fluorouracil after the fully sufficient informed consent was taken. As for adverse events, Grade 2 of thrombocytopenia was only observed. Liver tumors responded to anticancer drug treatment immediately, and liver functions were almost normalized. The chemotherapy using low-dose nedaplatin and 5-FU combined with the radiotherapy was feasible and effective to patients with poor conditions.
{"title":"低用量ネダプラチン・5FU併用放射線治療が著効した，重度肝障害をともない全身状態不良の肝転移を有する食道癌の1例","authors":"忠久 福井, 伊藤 由理子, 孝志 吉岡, 弘明 武田, 純男 河田","doi":"10.11405/NISSHOSHI.108.813","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.813","url":null,"abstract":"A 64-year-old male visited our hospital complaining of epigastric pain, and was diagnosed as esophageal cancer with multiple liver metastases. Histological examinations revealed squamous cell carcinoma. He had serious liver dysfunctions and his general conditions were severe, expressed as 3 of the performance status. He was treated using radiotherapy and chemotherapy with low-dose nedaplatin and 5-fluorouracil after the fully sufficient informed consent was taken. As for adverse events, Grade 2 of thrombocytopenia was only observed. Liver tumors responded to anticancer drug treatment immediately, and liver functions were almost normalized. The chemotherapy using low-dose nedaplatin and 5-FU combined with the radiotherapy was feasible and effective to patients with poor conditions.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129286248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-04-05DOI: 10.11405/NISSHOSHI.108.619
隆志 中原, 宏美 菅, 春奈 中原, 泰正 浅本, 弘尚 小松, 宏則 徳毛, 邦夫 石田
: A 23-year-old man, complaining of chronic diarrhea, was given a diagnosis of Crohn's disease. He responded well to steroid therapy and infliximab administration. However, high fever appeared on the 28th day of hospitalization, and CT scan revealed multiple liver abscesses. Gram-positive branched rods were harvested by ultrasonography guided puncture examination. As Nocardia infection was suspected, sulfamethoxazole-trimethoprim was started immediately, and his clinical course improved dramatically. Afterwards, Nocardia farcinica was isolated from the culture of the liver abscess. This case is the first report of liver nocardiosis associated with Crohn's disease. Generally, Nocardia infection can be successfully treated by sulfamethoxazole-trimethoprim therapy. Liver nocardiosis is very rare but could be an important complication for patients with Crohn's disease.
{"title":"インフリキシマブ治療中にノカルジア（放線菌）肝膿瘍を呈したクローン病の1例","authors":"隆志 中原, 宏美 菅, 春奈 中原, 泰正 浅本, 弘尚 小松, 宏則 徳毛, 邦夫 石田","doi":"10.11405/NISSHOSHI.108.619","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.619","url":null,"abstract":": A 23-year-old man, complaining of chronic diarrhea, was given a diagnosis of Crohn's disease. He responded well to steroid therapy and infliximab administration. However, high fever appeared on the 28th day of hospitalization, and CT scan revealed multiple liver abscesses. Gram-positive branched rods were harvested by ultrasonography guided puncture examination. As Nocardia infection was suspected, sulfamethoxazole-trimethoprim was started immediately, and his clinical course improved dramatically. Afterwards, Nocardia farcinica was isolated from the culture of the liver abscess. This case is the first report of liver nocardiosis associated with Crohn's disease. Generally, Nocardia infection can be successfully treated by sulfamethoxazole-trimethoprim therapy. Liver nocardiosis is very rare but could be an important complication for patients with Crohn's disease.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121743936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-11-05DOI: 10.11405/NISSHOSHI.107.1752
K. Momma, J. Fujiwara, Y. Tateishi, Misao Yoshida
{"title":"食道前癌病変の診断・取り扱い―内視鏡診断を中心に―","authors":"K. Momma, J. Fujiwara, Y. Tateishi, Misao Yoshida","doi":"10.11405/NISSHOSHI.107.1752","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.107.1752","url":null,"abstract":"","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130825138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract A 40-year-old man was admitted to our hospital because of epigastralgia and vomiting. His condition was diagnosed as acute pancreatitis with a pancreatic pseudocyst, obstructive jaundice, and duodenal stenosis. Because he had fever, abdominal pain, and elevated levels of C-reactive protein (CRP), endoscopic ultrasound-guided transmural cyst drainage (EUS-CD) was performed with a nasocystic tube on the 6th day. After the cyst was reduced and the patient recovered from the obstructive jaundice and duodenal stenosis, the nasal drainage tube was replaced with a plastic stent. Because a short extent of stenosis in the main pancreatic duct in the pancreatic head was found by endoscopic retrograde cholangiopancreatography (ERCP), a 5Fr pancreatic stent was placed to prevent pancreatitis. No recurrence of pancreatitis and the cyst occurred after removal of both stents 5 days later.
{"title":"閉塞性黄疸および十二指腸狭窄を合併した膵仮性嚢胞に対し超音波内視鏡ガイド下経消化管的嚢胞ドレナージ(EUS-CD)が奏効した1例","authors":"英明 本田, 博幸 宮谷, 敬恵 池谷, 健一 山中, 正俊 池田, 信也 牛丸, 徹 高松, 孝明 岩城, 規喜 鷺原, 行雄 吉田","doi":"10.11405/NISSHOSHI.107.1497","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.107.1497","url":null,"abstract":"Abstract A 40-year-old man was admitted to our hospital because of epigastralgia and vomiting. His condition was diagnosed as acute pancreatitis with a pancreatic pseudocyst, obstructive jaundice, and duodenal stenosis. Because he had fever, abdominal pain, and elevated levels of C-reactive protein (CRP), endoscopic ultrasound-guided transmural cyst drainage (EUS-CD) was performed with a nasocystic tube on the 6th day. After the cyst was reduced and the patient recovered from the obstructive jaundice and duodenal stenosis, the nasal drainage tube was replaced with a plastic stent. Because a short extent of stenosis in the main pancreatic duct in the pancreatic head was found by endoscopic retrograde cholangiopancreatography (ERCP), a 5Fr pancreatic stent was placed to prevent pancreatitis. No recurrence of pancreatitis and the cyst occurred after removal of both stents 5 days later.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131255694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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