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Crowned dens syndrome developed after an endoscopic retrograde cholangiopancreatography procedure

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World Journal of Gastroenterology 2016年第39期22卷 8849-8852页

作者： Hiroyasu Nakano Kazunari Nakahara Yosuke Michikawa Keigo Suetani Ryo Morita Nobuyuki Matsumoto fumio itoh Division of Gastroenterology and Hepatology Department of Internal Medicine St. Marianna University School of Medicine

We present a unique case of crowned dens syndrome(CDS) that developed after endoscopic retrograde cholangiopancreatography(ERCP) in a patient who presented with fever and neck pain. Administration of non-steroidal anti-inflammatory drugs was extremely effective for relieving fever and neck pain, and in the improvement of inflammatory markers. To the best of our knowledge, this is the first case report of CDS caused by an ERCP procedure. In a patient with fever and neck pain after an ERCP procedure, CDS should be considered in the differential diagnosis.

关键词： Acute cholangitis Pseudogout Endoscopic retrograde cholangiopancreatograhy Crowned dens syndrome

Correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis

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World Journal of Gastroenterology 2014年第45期20卷 17065-17074页

作者： Hideaki Takahashi Ryuta Shigefuku Yoshihito Yoshida Hiroki Ikeda Kotaro Matsunaga Nobuyuki Matsumoto Chiaki Okuse Shigeru Sase fumio itoh Michihiro Suzuki Division of Gastroenterology and Hepatology Department of Internal Medicine St.Marianna University School of Medicine Division of Gastroenterology Department of Internal Medicine Sapporo Shirakabadai Hospital Department of Molecular Biology Sapporo Medical University School of Medicine Anzai Medical Co. Ltd.

AIM: To elucidate the correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis (AL-LC).

关键词： Alcoholic liver cirrhosis Hepatic tissue blood flow Liver function Indocyanine green Xenon computed tomography

Thrombomodulin in the management of acute cholangitisinduced disseminated intravascular coagulation

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World Journal of Gastroenterology 2015年第2期21卷 533-540页

作者： Keigo Suetani Chiaki Okuse Kazunari Nakahara Yosuke Michikawa Yohei Noguchi Midori Suzuki Ryo Morita Nozomi Sato Masaki Kato fumio itoh Department of Gastroenterology and Hepatology St.Marianna UniversitySchool of MedicineKawasaki 216-8511Japan

AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.

关键词： Disseminated intravascular coagulation Acute chola

Acute hepatitis B of genotype H resulting in persistent infection

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World Journal of Gastroenterology 2014年第11期20卷 3044-3049页

作者： Norie Yamada Ryuta Shigefuku Ryuichi Sugiyama Minoru Kobayashi Hiroki Ikeda Hideaki Takahashi Chiaki Okuse Michihiro Suzuki fumio itoh Hiroshi Yotsuyanagi Kiyomi Yasuda Kyoji Moriya Kazuhiko Koike Takaji Wakita Takanobu Kato Department of Virology Ⅱ National Institute of Infectious DiseasesShinjyuku-KuTokyo 162-8640Japan Department of Internal Medicine Center for Liver DiseasesKiyokawa HospitalSuginamiTokyo 166-0004Japan Division of Gastroenterology and Hepatology Department of Internal MedicineSt. Marianna University School of MedicineKanagawa 216-8511Japan Department of Infectious Diseases Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Infection Control and Prevention Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

A 47-year-old man presented with general fatigue and dark *** laboratory data showed increased levels of hepatic *** patient was positive for hepatitis B virus(HBV)markers and negative for antihuman immunodeficiency *** HBV-DNA titer was set to 7.7 log copies/*** patient was diagnosed with acute hepatitis *** HBV infection route was *** serum levels of hepatic transaminases decreased to normal ranges without any treatment,but the HBVDNA status was maintained for at least 26 mo,indicating the presence of persistent *** isolated HBV from the acute-phase serum and determined the genome sequence.A phylogenetic analysis revealed that the isolated HBV was genotype *** this patient,the elevated peak level of HBV-DNA and the risk alleles at human genome single nucleotide polymorphisms s3077and rs9277535 in the human leukocyte antigen-DP locus were considered to be risk factors for chronic *** case suggests that there is a risk of persistent infection by HBV genotype H following acute hepatitis;further cases of HBV genotype H infection must be identified and ***,the complete determination of the HBV genotype may be essential during routine clinical care of acute hepatitis B outpatients.

关键词： Acute hepatitis Chronic hepatitis Genotyping Hepatitis B virus Single nucleotide polymorphisms

Pancreatic involvement in chronic viral hepatitis

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World Journal of Gastroenterology 2005年第23期11卷 3508-3513页

作者： Yoshiki Katakura Hiroshi Yotsuyanagi Kiyoe Hashizume Chiaki Okuse Noriaki Okuse Kohji Nishikawa Michihiro Suzuki Shiro Iino fumio itoh Division of Gastroenterology and Hepatology

AIM: To elucidate the frequency and characteristics of pancreatic disorders in the course of chronic viral hepatitis. METHODS: We prospectively assessed the serum pancreatic enzyme levels and imaging findings in patients with chronic viral hepatitis and healthy control subjects. RESULTS: Serum amylase (t-Amy), salivary amylase (s-Amy), pancreatic amylase (p-Amy) and serum lipase levels were higher in hepatitis patients in comparison to control subjects. However, in asymptomatic viral carriers, only the serum t-Amy levels were higher than those of the controls. The levels of each enzyme rose with the progression of liver disease in patients with hepatitis B or C; whereas the levels of each enzyme within the same clinical stage of the disease did not differ between patients diagnosed with either hepatitis B or hepatitis C virus. Imaging findings demonstrated chronic pancreatitis in only 1 out of 202 patients (0.5%).CONCLUSION: Our data suggest that serum levels of pancreatic enzymes increase with the progression of liver disease in patients diagnosed with viral hepatitis. Pancreatic disease, asymptomatic in most cases, may represent an extrahepatic manifestation of chronic viral hepatitis.

关键词： Hepatitis C Hepatitis B Pancreatic disorder Amylase Lipase

Risk factors for retinopathy associated with interferonα-2b and ribavirin combination therapy in patients with chronic hepatitis C

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World Journal of Gastroenterology 2006年第23期12卷 3756-3759页

作者： Chiaki Okuse Hiroshi Yotsuyanagi Yoshihiko Nagase Yuhtaro Kobayashi Kiyomi Yasuda Kazuhiko Koike Shiro Iino Michihiro Suzuki fumio itoh Division of Gastroenterology and Hepatology Department of Internal Medicine St. Marianna University School of MedicineKawasakiKanagawa 216-8511Japan Department of Infectious Diseases Internal MedicineFaculty of MedicineUniversity of Tokyo7-3-1HongoBunkyoTokyo 113-8655Japan Division of Gastroenterology and Hepatology Department of Internal MedicineSt.Marianna University School of MedicineKawasakiKanagawa 216-8511Japan Center for Liver Diseases Kiyokawa HospitalMinamiasagayaSuginamiTokyo166-0004Japan Department of Infectious Diseases Internal MedicineFaculty of MedicineUniversity of Tokyo7-3-1KongoBunkyoTokyo 113-8655Japan Division of Gastroenterology and Hepatology Department of Internal MedicineSt.Marianna University School of MedicineKawasakiKanagawa216-8511Japan

AIM： To elucidate the frequency and risk factors for retinopathy in patients with chronic hepatitis C who are treated by interferon-ribavirin combination therapy. METHODS： We prospectively analyzed 73 patients with histologically confirmed chronic hepatitis C, who underwent combination therapy for 24 wk. Optic fundi were examined before, and 2, 4, 12 and 24 wk alter the start of combination therapy. RESULTS： Fourteen patients （19%） developed retinopathy, which was initially diagnosed by the appearance of a cotton wool spot in 12 patients. Retinal hemorrhage was observed in 5 patients. No patient complained of visual disturbance. Retinopathy disappeared in 9 patients （64%） despite the continuation of combination therapy. However, retinopathy persisted in 5 patients with retinal hemorrhage. A comparison of the clinical background between the groups with and without retinopathy showed no significant differences in age, gender, viral genotype, RNA level, white blood cell count, platelet count, prothrombin time, complications by diabetes mellitus or hypertension, or pretreatment arteriosclerotic changes in the optic fundi. However, multiple logistic regression analysis revealed that complication by hypertension was observed with a high frequency in the group with retinopathy （P = 0.004, OR = 245.918, 95% CI = 5.6-10786.2）.CONCLUSION： Retinopathy associated with combination therapy of interferon α-2b and ribavirin tends to develop in patients with hypertension.

关键词： Retinopathy Ribavirin Chronic hepatitis C Interferon

An updated review of gastric cancer in the next-generation sequencing era:Insights from bench to bedside and vice versa

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World Journal of Gastroenterology 2014年第14期20卷 3927-3937页

作者： Hiroyuki Yamamoto Yoshiyuki Watanabe Tadateru Maehata Ryo Morita Yoshihito Yoshida Ritsuko Oikawa Shinya Ishigooka Shun-ichiro Ozawa Yasumasa Matsuo Kosuke Hosoya Masaki Yamashita Hiroaki Taniguchi Katsuhiko Nosho Hiromu Suzuki Hiroshi Yasuda Yasuhisa Shinomura fumio itoh Division of Gastroenterology and Hepatology Department of Internal MedicineSt. Marianna University School of Medicine Division of Cancer Cell Research Institute of Medical ScienceUniversity of Tokyo Department of Gastroenterology Rheumatology and Clinical ImmunologySapporo Medical University School of Medicine Department of Molecular Biology Sapporo Medical University School of Medicine

Gastric cancer(GC)is one of the most common malignancies and remains the second leading cause of cancer-related death *** is an increasing understanding of the roles that genetic and epigenetic alterations play in *** studies using nextgeneration sequencing(NGS)have revealed a number of potential cancer-driving genes in ***-exome sequencing of GC has identified recurrent somatic mutations in the chromatin remodeling gene ARID1A and alterations in the cell adhesion gene FAT4,a member of the cadherin gene *** in chromatin remodeling genes(ARID1A,MLL3 and MLL)have been found in 47%of ***-genome sequencing and whole-transcriptome sequencing analyses have also discovered novel alterations in *** studies of cancer epigenetics have revealed widespread alterations in genes involved in the epigenetic machinery,such as DNA methylation,histone modifications,nucleosome positioning,noncoding RNAs and *** advances in molecular research on GC have resulted in the introduction of new diagnostic and therapeutic strategies into clinical *** antihuman epidermal growth receptor 2(HER2)antibody trastuzumab has led to an era of personalized therapy in *** addition,ramucirumab,a monoclonal antibody targeting vascular endothelial growth factor receptor(VEGFR)-2,is the first biological treatment that showed survival benefits as a single-agent therapy in patients with advanced GC who progressed after firstline *** NGS to systematically identify gene alterations in GC is a promising approach with remarkable potential for investigating the pathogenesis of GC and identifying novel therapeutic targets,as well as useful *** this review,we will summarize the recent advances in the understanding of the molecular pathogenesis of GC,focusing on the potential use of these genetic and epigenetic alterations as diagnostic biomarkers and novel therapeutic targets.

关键词： Next-generation sequencing Microsatellite instability MicroRNA Epigenetic field defect Gastric washes Insulin-like growth factor 1 receptor

Transcriptional silencing of Dickkopf gene family by CpG island hypermethylation in human gastrointestinal cancer

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World Journal of Gastroenterology 2008年第17期14卷 2702-2714页

作者： Tadateru Maehata Hiroaki Taniguchi Hiroyuki Yamamoto Katsuhiko Nosho Yasushi Adachi Nobuki Miyamoto Chie Miyamoto Noriyuki Akutsu Satoshi Yamaoka fumio itoh Department of Gastroenterology and Hepatology St. Marianna University School of Medicine First Department of Internal Medicine Sapporo Medical University

AIM： To clarify alterations of Dickkopfs （Dkks） and Kremen2 （Krm2） in gastrointestinal cancer. METHODS： We investigated the expression profiles and epigenetic alterations of Dkks and Krm2 genes in gastrointestinal cancer using RT-PCR, tissue microarray analysis, and methylation specific PCR （MSP）. Cancer cells were treated with the demethylating agent and/or histone deacetylase inhibitor. WST-8 assays and/n y/tro invasion assays after treatment with specific siRNA for those genes were performed. RESULTS： Dkks and Krm2 expression levels were reduced in a certain subset of the gastrointestinal cancer cell lines and cancer tissues. This was correlated with promoter hypermethylation. There were significant correlations between Dkks over-expression levels and beta-catenin over-expression in colorectal cancer. In colorectal cancers with beta-catenin over-expression, Dkk-1 expression levels were significantly lower in those with lymph node metastases than in those without. Down-regulation of Dkks expression by siRNA resulted in a significant increase in cancer cell growth and invasiveness in vitro.CONCLUSION： Down-regulation of the Dkks associated to promoter hypermethylation appears to be frequently involved in gastrointestinal tumorigenesis.

关键词： Dickkopf genes Kremen2 gene Methylation Wnt signaling Gastrointestinal cancer

Fatal liver failure caused by reactivation of lamivudine-resistant hepatitis B virus:A case report

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World Journal of Gastroenterology 2007年第6期13卷 964-969页

作者： Yuka Suzuki Hiroshi Yotsuyanagi Chiaki Okuse Yoshihiko Nagase Hideaki Takahashi Kyoji Moriya Michihiro Suzuki Kazuhiko Koike Shiro Iino fumio itoh Division of Gastroenterology and Hepatology Department of Internal Medicine St. Marianna University School of Medicine 2-16-1 Sugao Miyamae-ku Kawasaki 216-8511 Japan Division of Infectious Diseases Department of Internal Medicine University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 Japan Center for Liver Diseases Seizankai Kiyokawa Hospital 2-31-12 Asagayaminami Suginami Tokyo 166-0004 Japan

We present a case of fetal liver failure caused by the activation of larnivudine-resistant hepatitis B virus （HBV） nine months after lamivudine treatment. A 57-year old man visited our hospital for the treatment of decornpensated chronic hepatitis B. Lamivudine was started in December 2001. Subsequently, serum HBV was negative for HBV DNA with seroconversion from HBeAg to anti-HBe and improvement of liver function. However, HBV DNA and HBeAg were again detected in September 2002. He was complicated by breakthrough hepatitis and admitted to our hospital in November for severely impaired liver function. Vidarabine treatment was started and serum HBV DNA and alanine aminotransferase （ALT） decreased transiently. However, after the start of m-interferon treatment, HBV DNA level increased and liver function deteriorated. He died 1 mo after admission. An analysis of amino acid sequences in the polymerase region revealed that rtM204I/V with rtLSOI/V occurred at the time of viral breakthrough. After the start of antiviral treatment, rtL180M was detected in addition to rtM204I/V and rtLSOI/V, and became predominant in the terminal stage of the disease. HBV clone with a high replication capacity may be produced by antiviral treatment leading to the worsening of liver function. Antiviral therapy for patients with breakthrough hepatitis in advanced liver disease should be carefully performed.

关键词： Hepatitis B virus Lamivudine Polymerase Interferon Tyrosine-methionine-aspartate-aspartate