: Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving both upper and lower motor neurons and the pathogenesis of this disorder is still unknown. To date, few reports have suggested that motor neuron diseases may have a paraneoplastic origin. However, it is still under discussion whether ALS occurring in cancer patients is paraneoplastic. A 60-year-old man with rectal cancer (Stage IV) having multiple lung, liver and para-aortic lymph node metastases underwent anterior resection of the rectum as palliative surgery. He was referred to our hospital for adjuvant chemotherapy. Lung and lymph node metastases decreased after 2 courses of chemotherapy using CPT-11 and 5-FU/LV but liver metastases were enlarged, following up increase in CEA. Thereafter, he suffered from muscle weakness in hands, arms, and legs and results of neurophysiologic studies were compatible with primary lateral sclerosis (ALS). For second line chemotherapy, he was treated with low-dose CDDP/5-FU over 6 courses. As a result, the size the of metastatic lesions markedly reduced and CEA was decreased to the normal level. Although significant tumor reduction was observed, his neurological symptoms rapidly progressed. He died of aspiration pneumonia 8 months after onset of the disease. Autopsy revealed that his neuropathological findings were compatible with ALS, and it was thought to be the primary cause of death in the because of absence of cancer progression. In this case the neurological syndrome was not affected by cancer therapy. Thus our case does not support the hypothesis that ALS in associated with cancer and the relationship between both disorders remains uncertain.
{"title":"経過中に筋萎縮性側索硬化症(ALS)を発症した進行大腸癌の1剖検例","authors":"康史 佐藤, 哲治 高山, 二階堂 ともみ, 優子 和田, 保 佐川, 阿部 清一郎, 勉 佐藤, 諭 井山, 和幸 村瀬, 啓伸 荒木, 康裕 佐藤, 淳二 加藤, 新津 洋司郎, 英樹 千葉","doi":"10.11405/NISSHOSHI.104.1365","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.1365","url":null,"abstract":": Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving both upper and lower motor neurons and the pathogenesis of this disorder is still unknown. To date, few reports have suggested that motor neuron diseases may have a paraneoplastic origin. However, it is still under discussion whether ALS occurring in cancer patients is paraneoplastic. A 60-year-old man with rectal cancer (Stage IV) having multiple lung, liver and para-aortic lymph node metastases underwent anterior resection of the rectum as palliative surgery. He was referred to our hospital for adjuvant chemotherapy. Lung and lymph node metastases decreased after 2 courses of chemotherapy using CPT-11 and 5-FU/LV but liver metastases were enlarged, following up increase in CEA. Thereafter, he suffered from muscle weakness in hands, arms, and legs and results of neurophysiologic studies were compatible with primary lateral sclerosis (ALS). For second line chemotherapy, he was treated with low-dose CDDP/5-FU over 6 courses. As a result, the size the of metastatic lesions markedly reduced and CEA was decreased to the normal level. Although significant tumor reduction was observed, his neurological symptoms rapidly progressed. He died of aspiration pneumonia 8 months after onset of the disease. Autopsy revealed that his neuropathological findings were compatible with ALS, and it was thought to be the primary cause of death in the because of absence of cancer progression. In this case the neurological syndrome was not affected by cancer therapy. Thus our case does not support the hypothesis that ALS in associated with cancer and the relationship between both disorders remains uncertain.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126236899","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 : 2007-09-05DOI: 10.11405/NISSHOSHI.104.1344
英彦 松川, 伸之 白神, 敏光 継, 美穂 足立, 正治 宮澤, 一男 柏崎, 紀文 日比
: Conventional colonoscopy and barium enema are the main examinations for colonic lesions, but each of them has different limitations according to the condition of the patient. It has been reported that preparations for these examinations also caused complications, such as colonic perforation leading to fatality. To avoid these complications, colonic enema with water-soluble contrast medium (Gatrografin) has been performed as a screening method for those suspected to have obstructive colonic diseases, or those in whom it was difficult to be form colonoscopy and barium enema because of their poor condition. There are few reports about water-soluble contrast enema (WSCE). We retrospectively examined 121 cases of WSCE performed from January 2004 to December 2005 and assessed the acceptability of examination and its ability to detect colonic lesions. We divided our patients into five groups according to the reason for performing WSCE. In all cases, we were able to perform WSCE without complications and assess colonic lesions. In 58 cases, we compared the results of WSCE with those of barium enema or colonoscopy, or both In 8 cases we missed small colonic polyps and erosions, but we missed only one large polyp 3 cm in diameter, which we detected retrospectively. In conclusion, WSCE is safe and useful for the diagnosis of colonic disease, and may be one of the choices of colonic examination especially for those who are suspected to have obstructive colonic diseases or hemorrhagic lesions as well as for those in whom it is difficult to perform barium enema or colonoscopy.
{"title":"水溶性造影剤(ガストログラフィン®）を用いた前処置なしの注腸造影検査の有用性","authors":"英彦 松川, 伸之 白神, 敏光 継, 美穂 足立, 正治 宮澤, 一男 柏崎, 紀文 日比","doi":"10.11405/NISSHOSHI.104.1344","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.1344","url":null,"abstract":": Conventional colonoscopy and barium enema are the main examinations for colonic lesions, but each of them has different limitations according to the condition of the patient. It has been reported that preparations for these examinations also caused complications, such as colonic perforation leading to fatality. To avoid these complications, colonic enema with water-soluble contrast medium (Gatrografin) has been performed as a screening method for those suspected to have obstructive colonic diseases, or those in whom it was difficult to be form colonoscopy and barium enema because of their poor condition. There are few reports about water-soluble contrast enema (WSCE). We retrospectively examined 121 cases of WSCE performed from January 2004 to December 2005 and assessed the acceptability of examination and its ability to detect colonic lesions. We divided our patients into five groups according to the reason for performing WSCE. In all cases, we were able to perform WSCE without complications and assess colonic lesions. In 58 cases, we compared the results of WSCE with those of barium enema or colonoscopy, or both In 8 cases we missed small colonic polyps and erosions, but we missed only one large polyp 3 cm in diameter, which we detected retrospectively. In conclusion, WSCE is safe and useful for the diagnosis of colonic disease, and may be one of the choices of colonic examination especially for those who are suspected to have obstructive colonic diseases or hemorrhagic lesions as well as for those in whom it is difficult to perform barium enema or colonoscopy.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115123509","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 : 2007-09-05DOI: 10.11405/NISSHOSHI.104.1329
T. Furukawa
{"title":"膵上皮内腫瘍性病変(PanIN）と膵管内乳頭粘液性腫瘍(IPMN）の病理-膵発癌との関連-","authors":"T. Furukawa","doi":"10.11405/NISSHOSHI.104.1329","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.1329","url":null,"abstract":"","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125945424","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}
: This study was undertaken to clarify the importance of nutritional status in patients with acute cholecystitis, and also evaluate whether they benefited from enteral nutrition supplementation, including medium-chain triglycerides (MCT), during the convalescent stage. Patients with acute cholecystitis admitted to our hospital between April 1994 and March 2002 were classified into a poor nutrition group (n=40; total serum protein 5.0 g/dl). Patients with poor nutrition were significantly more elderly than those with fair nutrition, and had significantly higher serum C-reactive protein (CRP) concentrations. The two groups did not differ significantly with respect to other laboratory data, gender distribution, or medical treatment. We supplemented ordinary meals with enteral nutrition including MCT in 16 patients during the convalescent stage (MCT group). We compared their length of hospital stay and days required to recovery to pre-admission functional status for activities of daily living (ADL) with the same intervals in 16 patients without supplementation (non-MCT group) selected to match for age, gender, and fair or poor nutritional status from among 111 patients. Hospitalizations were significantly longer in the poor nutrition group (43.0+/-2.2 days) than in the fair nutrition group (27.0+/-8.2 days). Significantly more days were required to recover ADL status in the poor nutrition group (12.0+/-7.2 days) than in the fair group (9.4+/-5.2 days). Hospitalizations were significantly shorter in the MCT group (20.1+/-15 days) than in the non-MCT group (35.4+/-12.8 days). Significantly fewer days were required to recover ADL status in the MCT group (10.9+/-7 days) than in the non-MCT group (13.1+/-6.8 days). Administration of enteral nutrition including MCT during convalescence from acute cholecystitis thus appears to promote functional recovery shorten hospital stay.
{"title":"急性胆嚢炎における経腸栄養剤(中鎖脂肪酸トリグリセライド含有）の臨床的効果","authors":"幸伸 野村, 和郎 乾, 純治 芳野, 貴夫 若林, 一武 奥嶋, 隆 小林, 広尚 三好, 雄太 中村","doi":"10.11405/NISSHOSHI.104.1352","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.1352","url":null,"abstract":": This study was undertaken to clarify the importance of nutritional status in patients with acute cholecystitis, and also evaluate whether they benefited from enteral nutrition supplementation, including medium-chain triglycerides (MCT), during the convalescent stage. Patients with acute cholecystitis admitted to our hospital between April 1994 and March 2002 were classified into a poor nutrition group (n=40; total serum protein 5.0 g/dl). Patients with poor nutrition were significantly more elderly than those with fair nutrition, and had significantly higher serum C-reactive protein (CRP) concentrations. The two groups did not differ significantly with respect to other laboratory data, gender distribution, or medical treatment. We supplemented ordinary meals with enteral nutrition including MCT in 16 patients during the convalescent stage (MCT group). We compared their length of hospital stay and days required to recovery to pre-admission functional status for activities of daily living (ADL) with the same intervals in 16 patients without supplementation (non-MCT group) selected to match for age, gender, and fair or poor nutritional status from among 111 patients. Hospitalizations were significantly longer in the poor nutrition group (43.0+/-2.2 days) than in the fair nutrition group (27.0+/-8.2 days). Significantly more days were required to recover ADL status in the poor nutrition group (12.0+/-7.2 days) than in the fair group (9.4+/-5.2 days). Hospitalizations were significantly shorter in the MCT group (20.1+/-15 days) than in the non-MCT group (35.4+/-12.8 days). Significantly fewer days were required to recover ADL status in the MCT group (10.9+/-7 days) than in the non-MCT group (13.1+/-6.8 days). Administration of enteral nutrition including MCT during convalescence from acute cholecystitis thus appears to promote functional recovery shorten hospital stay.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129228906","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 57 year-old woman was admitted to our hospital because of large hepatocellular carcinoma (HCC). Laboratory data showed hypercholesterolemia, thrombocytosis and hypoglycemia. Based on several examinations and the clinical course, we diagnosed HCC with paraneoplastic syndrome. It is rare that 3 paraneoplastic phenomena occur in a patient with HCC. In particular, paraneoplastic thrombocytosis is very rare in paraneoplastic syndrome associated with HCC.
{"title":"高コレステロール血症, 血小板増多症, 低血糖を合併した肝細胞癌の1例","authors":"E. Inomata, Tetsuro Sohda, Hidetoshi Nakane, Daisuke Morihara, Osamu Hirose, Yuji Kitamura, Kaoru Iwata, Makoto Irie, Yasuaki Takeyama, Hiroshi Watanabe, S. Sakisaka","doi":"10.11405/NISSHOSHI.104.1231","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.1231","url":null,"abstract":"A 57 year-old woman was admitted to our hospital because of large hepatocellular carcinoma (HCC). Laboratory data showed hypercholesterolemia, thrombocytosis and hypoglycemia. Based on several examinations and the clinical course, we diagnosed HCC with paraneoplastic syndrome. It is rare that 3 paraneoplastic phenomena occur in a patient with HCC. In particular, paraneoplastic thrombocytosis is very rare in paraneoplastic syndrome associated with HCC.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"21 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120918869","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 : 2007-04-01DOI: 10.11405/NISSHOSHI.104.555
T. Eguchi, S. Koike, K. Maeno, T. Nakamura, T. Iwasa, K. Nakazawa, K. Furuta
: We report a case of nonocclusive mesenteric ischemia (NOMI) which occurred in a patient with torsion of gallbladder. A 91-year-old woman was admitted to the hospital and was diagnosed of acute cholecystitis. The next day, she went into shock. Then, we diagnosed her illness as torsion of gallbladder by computed tomography and ultrasonography, and performed an emergency operation. After cholecystectomy, it was recognized that the wide range of the small intestine had become necrotic sporadically. We diagnosed it as NOMI, and performed the wide resection of the small intestine followed by making double stomas. There is no previous report of NOMI associated with torsion of gallbladder. We guess the cause of NOMI in this case would be dehydration because of gallbladder torsion. NOMI has high mortality. Early diagnosis and early treatment are of great importance in NOMI.
{"title":"胆嚢捻転症に併発した非閉塞性腸管虚血(NOMI）の1例","authors":"T. Eguchi, S. Koike, K. Maeno, T. Nakamura, T. Iwasa, K. Nakazawa, K. Furuta","doi":"10.11405/NISSHOSHI.104.555","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.555","url":null,"abstract":": We report a case of nonocclusive mesenteric ischemia (NOMI) which occurred in a patient with torsion of gallbladder. A 91-year-old woman was admitted to the hospital and was diagnosed of acute cholecystitis. The next day, she went into shock. Then, we diagnosed her illness as torsion of gallbladder by computed tomography and ultrasonography, and performed an emergency operation. After cholecystectomy, it was recognized that the wide range of the small intestine had become necrotic sporadically. We diagnosed it as NOMI, and performed the wide resection of the small intestine followed by making double stomas. There is no previous report of NOMI associated with torsion of gallbladder. We guess the cause of NOMI in this case would be dehydration because of gallbladder torsion. NOMI has high mortality. Early diagnosis and early treatment are of great importance in NOMI.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"24 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128797692","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 : 2007-03-05DOI: 10.11405/NISSHOSHI.104.339
弘之 須藤, 義幸 伊藤, 幸直 山崎, 卓次 加藤
Helicobacter pylori (H pylori) is a common bacterium that is present in millions of people worldwide. In the United States, more than 50% of people older than 60 years are affected. Helicobacter pylori is found in the mucous lining of the stomach. It is known to be responsible for 60% to 80% of gastric ulcers (those occurring in the stomach) and 70% to 90% of duodenal ulcers (those occurring in the first part of the small intestine). The recognition of an association between this bacterium and peptic ulcer disease (occurring in the stomach or duodenum) by Dr Barry J. Marshall and Dr John R. Warren, both from Australia, was made in 1983, and they were awarded the Nobel prize in physiology (how the body works internally) and medicine in 2005. It is now understood that peptic ulcer disease is not caused by stress or by eating foods high in acid. It is often caused by the H pylori bacterium. Although the infection typically is acquired in childhood, it may continue without any problem throughout a person’s lifetime. Only 15% to 20% of those who carry this bacterium ever develop symptoms related to an ulcer. Treatment is recommended only for people who have an ulcer as a consequence of the bacterium’s presence. Treatment is important because people who have ulcers tend to have recurrent problems, and eliminating the H pylori infection prevents relapses. Patients infected with H pylori are more likely than others to develop certain types of cancer of the stomach, so testing and treatment for H pylori infection is recommended in patients with a family history of gastric cancer. This issue of JAMA includes a Commentary about a new treatment option for H pylori.
幽门螺杆菌(幽门螺杆菌)是一种常见的细菌，存在于全球数百万人体内。在美国，超过50%的60岁以上的老年人受到影响。幽门螺杆菌存在于胃粘膜中。已知60%至80%的胃溃疡(发生在胃里的溃疡)和70%至90%的十二指肠溃疡(发生在小肠的前半部分)是由它引起的。1983年，澳大利亚的巴里·j·马歇尔(Barry J. Marshall)博士和约翰·r·沃伦(John R. Warren)博士发现了这种细菌与消化性溃疡(发生在胃或十二指肠)之间的联系，并于2005年获得了诺贝尔生理学(人体内部如何运作)和医学奖。现在了解到消化性溃疡疾病不是由压力或食用高酸食物引起的。它通常由幽门螺杆菌引起。虽然这种感染通常是在儿童时期获得的，但它也可能在一个人的一生中毫无问题地持续下去。只有15%到20%的携带这种细菌的人会出现与溃疡有关的症状。建议只对因细菌存在而导致溃疡的人进行治疗。治疗很重要，因为患有溃疡的人往往有复发的问题，消除幽门螺杆菌感染可以防止复发。感染幽门螺杆菌的患者比其他人更容易患上某些类型的胃癌，因此建议有胃癌家族史的患者进行幽门螺杆菌感染的检测和治疗。本期《美国医学会杂志》包括一篇关于幽门螺杆菌新治疗方案的评论。
{"title":"Helicobacter pylori 除菌後の体重増加","authors":"弘之 須藤, 義幸 伊藤, 幸直 山崎, 卓次 加藤","doi":"10.11405/NISSHOSHI.104.339","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.104.339","url":null,"abstract":"Helicobacter pylori (H pylori) is a common bacterium that is present in millions of people worldwide. In the United States, more than 50% of people older than 60 years are affected. Helicobacter pylori is found in the mucous lining of the stomach. It is known to be responsible for 60% to 80% of gastric ulcers (those occurring in the stomach) and 70% to 90% of duodenal ulcers (those occurring in the first part of the small intestine). The recognition of an association between this bacterium and peptic ulcer disease (occurring in the stomach or duodenum) by Dr Barry J. Marshall and Dr John R. Warren, both from Australia, was made in 1983, and they were awarded the Nobel prize in physiology (how the body works internally) and medicine in 2005. It is now understood that peptic ulcer disease is not caused by stress or by eating foods high in acid. It is often caused by the H pylori bacterium. Although the infection typically is acquired in childhood, it may continue without any problem throughout a person’s lifetime. Only 15% to 20% of those who carry this bacterium ever develop symptoms related to an ulcer. Treatment is recommended only for people who have an ulcer as a consequence of the bacterium’s presence. Treatment is important because people who have ulcers tend to have recurrent problems, and eliminating the H pylori infection prevents relapses. Patients infected with H pylori are more likely than others to develop certain types of cancer of the stomach, so testing and treatment for H pylori infection is recommended in patients with a family history of gastric cancer. This issue of JAMA includes a Commentary about a new treatment option for H pylori.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"5 12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130473600","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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