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World Journal of Gastroenterology 2006年第18期12卷 2955-2957页

作者： Terumi Kamisawa Pong Yui Chen hitoshi nakajima Naoto Egawa Department of Internal Medicine Tokyo Metropolitan Komagome HospitalTokyoJapan

Retroperitoneal fibrosis is an uncommon disorder characterized by the formation of a dense plaque of fibrous tissue in the retroperitoneum, and its etiology remains unknown. Autoimmune pancreatitis is a rare type of chronic pancreatitis characterized by fibrosis with abundant infiltration of IgG4-positive plasma cells and lymphocytes and obliterative phlebitis in the pancreas. We present a case of autoimmune pancreatitis that developed 10 mo after the occurrence of retroperitoneal fibrosis. Histological findings of the resected retroperitoneal mass were marked periureteral fibrosis with abundant infiltration of IgG4-positive plasma cells and lymphocytes and obliterative phlebitis. These findings suggest a common pathophysiological mechanism for retroperitoneal fibrosis and autoimmune pancreatitis in this case. Some cases of retroperitoneal fibrosis might be a retroperitoneal lesion of IgG4-related sderosing disease.

关键词： Autoimmune pancreatitis Retroperitoneal fibrosis IgG4

Usefulness of biopsying the major duodenal papilla to diagnose autoimmune pancreatitis:A prospective study using IgG4-immunostaining

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World Journal of Gastroenterology 2006年第13期12卷 2031-2033页

作者： Terumi Kamisawa Yuyang Tu hitoshi nakajima Naoto Egawa Kouji Tsuruta Atsutake Okamoto Department of Internal Medicine Tokyo Metropolitan Komagome Hospital 3-18-22 Honkomagome Bunkyo-ku Tokyo Japan Department of Surgery Tokyo Metropolitan Komagome Hospital 3-18-22 Honkomagome Bunkyo-ku Tokyo Japan

AIM： TO examine the histological and immunohistochemical findings of biopsy specimens taken from the major duodenal papilla of autoimmune pancreatitis （AIP） patients. METHODS： The major duodenal papilla in the resected pancreas of 3 patients with AIP and of 5 control patients [pancreatic carcinoma （n = 3） and chronic alcoholic pancreatitis （17 = 2）] was immunostained using anti-CD4-T cell, CD8-T cell and IgG4 antibodies. Forceps biopsy specimens taken from the major duodenal papilla of 2 patients with AIP and 5 control patients with suspected papillitis were prospectively taken during duodenoscopy and immunohistochemically examined. RESULTS： Moderate or severe Iymphoplasmacytic in- filtration including many CD4-positive or CD8-positive T lymphocytes and IgG4-positive plasma cells （≥10/HPF）, was observed in the major duodenal papilla of all 3 patients with AIR The same findings were also detected in the biopsy specimens taken from the major duodenal papilla of 2 patients with/kiP, but in controls, there were only a few （≤3/HPF） IgG4-positive plasma cells infiltrating the major duodenal papilla. CONCLUSIONS： An abundant infiltration of IgG4-positive plasma cells is specifically detected in the major duodenal papilla of patients with A/P. Although this is a preliminary study, IgG4-immunostaining of biopsy specimens taken from the major duodenal papilla may support the diagnosis of AIR

关键词： Autoimmune pancreatitis IgG4 Major duo-denal papilla

Malignancies associated with intraductal papillary mucinous neoplasm of the pancreas

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World Journal of Gastroenterology 2005年第36期11卷 5688-5690页

作者： Terumi Kamisawa Yuyang Tu Naoto Egawa hitoshi nakajima Kouji Tsuruta Atsutake Okamoto Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Tokyo Japan Department of Surgery Tokyo Metropolitan Komagome Hospital Tokyo Japan

AIM： As intraductal papillary mucinous neoplasm （IPMN） has a favorable prognosis, associated malignancies have potential significance in these patients. We examined the incidence and characteristics of pre-existing, coexisting and subsequent malignancies in patients with IPMN. METHODS： Seventy-nine cases of IPMN were diagnosed by detection of mucous in the pancreatic duct during endoscopic retrograde pancreatography. Histological diagnosis was confirmed in 30 cases （adenoma （n = 19） and adenocarcinoma （n = 11）. Other primary malignancies associated with IPMN, occurring in the prediagnostic or postdiagnostic period, were investigated. Postdiagnostic follow-up period was 3.3±0.5 years （range, 0.2-20 years）. RESULTS： Other 40 malignancies occurred in 28 patients （35%）. They were found before （n = 15）, at （n = 19） and after （n = 6） the diagnosis of IPMT. Major associated malignancies were gastric cancer （n = 12）, colonic cancer （n = 7）, esophageal cancer （n = 4）, pulmonary cancer （n = 4）, and independent pancreatic cancer （n = 3）. Pancreatic cancer was synchronous with IPMN in two patients and metachronous in one （3 years after diagnosis of IPMN）. Thirty-one lesions were treated surgically or endoscopically. Fourteen patients died of associated cancers. Development of other malignancies was related to age （71.9±8.2 v566.8±9.3, P〈0.05）, but not to gender or site of the tumor. CONCLUSION： IPMN is associated with a high incidence of other malignancies, particularly gastric and colonic cancers. Common genetic mechanisms between IPMN and other associated malignancies might be present. Clinicians should pay attention to the possibility of associated malignancies in preoperative screening and follow-up of patients with IPMN. 2005 The WJG Press and Elsevier Inc. All rights reserved

关键词： Intraductal papillary mucinous neoplasms Pancreas Gastric cancer Colonic cancer

Sclerosing cholecystitis associated with autoimmune pancreatitis

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World Journal of Gastroenterology 2006年第23期12卷 3736-3739页

作者： Terumi Kamisawa Yuyang Tu hitoshi nakajima Naoto Egawa Kouji Tsuruta Atsutake Okamoto Shinichirou Horiguchi hitoshi nakajima NaotoEgawa Department of Internal Medicine Tokyo MetropolitanKomagome Hospital 3-18-22 Honkomagome Bunkyo-ku TokyoJapan Department of Surgery Tokyo Metropolitan Komagome Hospital 3-18-22 HonkomagomeBunkyo-ku Tokyo Japan Department of Pathology TokyoMetropolitan Komagome Hospital 3-18-22 HonkomagomeBunkyo-ku Tokyo Japan

AIM： TO evaluate the histopathological and radiological findings of the gallbladder in patients with autoimmune pancreatitis （AIP）. METHODS： The radiological findings of the gallbladder of 19 AIP patients were retrospectively reviewed. Resected gallbladders of 8 AIP patients were examined histologically and were immunostained with anti- IgG4 antibody. Controls consisted of gallbladders resected for symptomatic gallstones （n = 10） and those removed during pancreatoduodenectomy for pancreatic carcinoma （n = 10）, as well as extrahepatic bile ducts and pancreases removed by pancreatoduodenectomy for pancreatic carcinoma （n = 10）. RESULTS： Thickening of the gallbladder wall was detected by ultrasound and/or computed tomography in 10 patients with AIP （3 severe and 7 moderate）; in these patients severe stenosis of the extrahepatic bile duct was also noted. Histologically, thickening of the gallbladder was detected in 6 of 8 （75%） patients with AIP; 4 cases had transmural lymphoplasmacytic infiltration with fibrosis, and 2 cases had mucosal-based lymphoplasmacytic infiltration. Considerable transmural thickening of the extrahepatic bile duct wall with dense fibrosis and diffuse ly,mphoplasmacytic infiltration was detected in 7 patients. Immunohistochemically, severeor moderate infiltration of IgG4-positive plasma cells was detected in the gallbladder, bile duct, and pancreas of all 8 patients, but was not detected in controls. CONCLUSION： Gallbladder wall thickening with fibrosis and abundant infiltration of IgG4-positive plasma cells is frequently detected in patients with AIP. We propose the use of a new term, sclerosing cholecystitis, for these cases that are induced by the same mechanism as sclerosing pancreatitis or sclerosing cholangitis in AIP.

关键词： Autoimmune pancreatitis Sclerosing cholecystitis IgG4

MRCP and MRI findings in 9 patients with autoimmune pancreatitis

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World Journal of Gastroenterology 2006年第18期12卷 2919-2922页

作者： Terumi Kamisawa Pong-Yui Chen Yuyang Tu hitoshi nakajima Naoto Egawa Kouji Tsuruta Atsutake Okamoto Noriko Kamata Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Bukyo-ku Tokyo Japan Department of Surgery Tokyo Metropolitan Komagome Hospital Bunkyo-ku Tokyo Japan Department of Radiology Tokyo Metropolitan Komagome Hospital Bunkyo-ku Tokyo Japan

AIM： To evaluate magnetic resonance cholangiopancreatography （HRCP） findings in conjunction with magnetic resonance （MR） images in autoimmune pancreatitis （AIP） patients. METHODS： Nine patients with AIP underwent HRI, HRCP, endoscopic retrograde cholangiopancreatography （ERCP）, computed tomography, and ultrasonography. The HRCP and MR images taken before and after steroid therapy were reviewed and compared with other imaging modalities. The HRCP findings of the AIP cases were compared to those of 10 cases with carcinoma of the head of the pancreas.RESULTS： On MRCP, the narrowed portion of the main pancreatic duct noted on ERCP was not visualized, while the non-involved segments of the main pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder than that seen in cases of pancreatic carcinoma. Stenosis or obstruction of the lower bile duct was detected in 8 patients. MR images showed enlargement of the pancreas with decreased signal intensity on T1- weighted MR images, increased signal intensity on T2- weighted MR images, and, in 3 patients, a hypointense capsule-like rim. After steroid therapy, the previously not visualized portion of the main pancreatic duct was seen, along with improvement of the bile duct stenosis. Pancreatic enlargement decreased, and the abnormal signal intensity on both T1- and T2-weighted MR images became isointense.CONCLUSION： MRCP cannot differentiate irregular narrowing of the main pancreatic duct seen with AIP from stenosis of the main pancreatic duct seen with pancreatic carcinoma. However, MRCP findings in conjunction with MR imaging of pancreatic enlargement that shows abnormal signal intensity on T1- and T2- weighted MR images are useful in supporting a diagnosis of AIP.

关键词： Autoimmune pancreatitis Magnetic resonance cholangiopancreatography Magnetic resonance

Pancreatic cancer with a high serum IgG4 concentration

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World Journal of Gastroenterology 2006年第38期12卷 6225-6228页

作者： Terumi Kamisawa Pong Yui Chen Yuyang Tu hitoshi nakajima Naoto Egawa Kouji Tsuruta Atsutake Okamoto Tsunekazu Hishima Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Bukyo-ku Tokyo Japan Department of Surgery Tokyo Metropolitan Komagome Hospital Bunkyo-ku Tokyo Japan Department of Pathology Tokyo Metropolitan Komagome Hospital Bunkyo-ku Tokyo Japan

Differentiation between autoimmune pancreatitis and pancreatic cancer is sometimes difficult. It has been reported that serum IgG4 concentrations are significantly elevated and particularly high (>135 mg/dL) in autoimmune pancreatitis. Measurement of serum IgG4 has become a useful tool for differentiating between autoimmune pancreatitis and pancreatic cancer. However, we present a 74-year-old female with a markedly elevated serum IgG4 (433 mg/dL) who underwent pancreaticoduodenectomy for pancreatic cancer. Elevated serum IgG4 levels continued after the resection. On histology, adenocarcinoma of the pancreas accompanied with moderate lymphoplasmacytic infiltration infiltrated the lower bile duct and duodenum, but there were no findings of autoimmune pancreatitis. Although a small metastasis was detected in one parapancreatic lymph node, regional lymph nodes were swollen. Abundant IgG4-positive plasma cells infiltrated the cancerous areas of the pancreas, but only a few IgG4-positive plasma cells were detected in the noncancerous areas. Pancreatic cancer cells were not immunoreactive for IgG4. An abundant infiltration of IgG4-positive plasma cells was detected in the swollen regional lymph nodes and in the duodenal mucosa. We believe that the serum IgG4 level was elevated in this patient with pancreatic cancer as the result of an IgG4-related systemic disease that had no clinical manifestations other than lymphadenopathy.

关键词： IgG4 Pancreatic cancer Autoimmune pancreatitis

Increased tumor necrosis factor receptor 1 expression in human colorectal adenomas

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World Journal of Gastroenterology 2012年第38期18卷 5360-5368页

作者： Kunihiro Hosono Eiji Yamada Hiroki Endo Hirokazu Takahashi Masahiko Inamori Yoshitaka Hippo hitoshi Nakagama Atsushi nakajima Division of Gas-troenterology Yokohama City University School of Medicine Yokohama 2360004 Japan Division of Cancer Development System National Cancer Center Research Institute Tokyo 1040045 Japan

AIM: To determine the expression statuses of tumor necrosis factor (TNF)-α, its receptors (TNF-R) and downstream effector molecules in human colorectal adenomas. METHODS: We measured the serum concentrations of TNF-α and its receptors in 62 colorectal adenoma patients and 34 healthy controls. The protein expression of TNF-α, TNF-R1, TNF-R2 and downstream signals of the TNF receptors, such as c-Jun N-terminal kinase (JNK), nuclear factor-κ B and caspase-3, were also investigated in human colorectal adenomas and in normal colorectal mucosal tissues by immunohistochemistry. Immunofluorescence confocal microscopy was used to investigate the consistency of expression of TNF-R1 and phospho-JNK (p-JNK). RESULTS: The serum levels of soluble TNF-R1 (sTNF-R1) in adenoma patients were significantly higher than in the control group (3.67 ± 0.86 ng/mL vs 1.57 ± 0.72 ng/mL, P < 0.001). Receiver operating characteristic analysis revealed the high diagnostic sensitivity of TNF-R1 measurements (AUC was 0.928) for the diagnosis of adenoma, and the best cut-off level of TNF-R1 was 2.08 ng/mL, with a sensitivity of 93.4% and a specificity of 82.4%. There were no significant differences in the serum levels of TNF-α or sTNF-R2 between the two groups. Immunohistochemistry showed high levels of TNF-R1 and p-JNK expression in the epithelial cells of adenomas. Furthermore, a high incidence of co-localization of TNF-R1 and p-JNK was identified in adenoma tissue. CONCLUSION: TNF-R1 may be a promising biomarker of colorectal adenoma, and it may also play an important role in the very early stages of colorectal carcinogenesis.

关键词： Tumor necrosis factor-α Tumor necrosis factor receptor 1 c-Jun N-terminal kinase Colorectal adenoma Biomarker

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World Journal of Gastroenterology 2006年第11期12卷 1805-1809页

作者： Yoshimi nakajima hitoshi Takagi Naondo Sohara Ken Sato Satoru Kakizaki Kenichi Nomoto Hideki Suzuki Taketoshi Suehiro Tatsuo Shimura Takayuki Asao Hiroyuki Kuwano Masatomo Mori Ken Nishikura Department of Medicine and Molecular Science Gunma University Graduate School of Medicine MaebashiGunma 371-8511Japan Department of Surgery Gunma University Graduate School of Medicine MaebashiGunma 371-8511Japan Division of Molecular and Functional Pathology Department of Cellular Function Niigata University Graduate School of Medicine and Dental SciencesNiigataNiigata 951-8510Japan

A 42-year-old woman was admitted to our hospital because of multiple liver tumors detected by ultrasonography. Colonoscopy revealed submucosal tumor in the rectum, which was considered the primary lesion. Endoscopic mucosal resection followed by histopathological examination revealed that the tumor was carcinoid. The resected margin of the tumor was positive for malignant cells. Two courses to transcatheter arterial chemotherapy for liver metastasis were ineffective. Accordingly, the rectal tumor and metastatic lymph nodes were surgically resected. One month after the operation, she received liver transplantation （left lateral segment and caudate lobe） from her son. No recurrent lesion has been observed at two years after the liver transplantation. Liver transplantation should be considered as a treatment option even in advanced case of carcinoid metastasis to the liver. We also discuss the literature on liver transplantation for metastatic carcinoid tumor.

关键词： Carcinoid Liver metastasis Living related liver transplantation

Oral esomeprazole vs injectable omeprazole for the prevention of hemorrhage after endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2017年第10期9卷 514-520页

作者： Takashi Uchiyama Takuma Higurashi hitoshi Kuriyama Yoshinobu Kondo Yasuo Hata Atsushi nakajima Department of Gastroenterology and Hepatology Yokohama City University School of Medicine Department of Gastroenterology Chigasaki Municipal Hospital Department of Endocrinology and Metabolism Chigasaki Municipal Hospital

AIM To evaluate the effectiveness of oral esomeprazole(EPZ) vs injectable omeprazole(OPZ) therapy to prevent hemorrhage after endoscopic submucosal dissection(ESD).METHODS A case-control study was conducted using a quasirandomized analysis with propensity score matching. A total of 258 patients were enrolled in this study. Patients were treated with either oral EPZ or injectable OPZ. The endpoint was the incidence of hemorrhage after *** Data of 71 subjects treated with oral EPZ and 172 subjects treated with injectable OPZ were analyzed. Analysis of 65 matched samples revealed no difference in the incidence of hemorrhage after ESD between the oral EPZ and injectable OPZ groups(OR = 0.89, 95%CI:0.35-2.27, P ≥ 0.99).CONCLUSION We conclude that oral EPZ therapy is a useful alternative to injectable PPI therapy for the prevention of hemorrhage after ESD.

关键词： Endoscopic submucosal dissection Proton pump inhibitors Hemorrhage

Repair Effect of Hot Work Tool Steel by Laser-Melting Process

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Journal of Materials Science & Technology 2003年第Z1期19卷 91-93页

作者： Yahong SUN Satoshi HANAKI hitoshi UCHIDA Hisakichi SUNADA Nobuhiro TSUJII Graduate School of Engineering Himeji Institute of Technology 2167ShoshaHimeji 671-2201Japan Technical Research Laboratories Sanyo Special Steel Co.LTD.3007NakajimaShikama-kuHimeji 672-8677Japan

Both wear and crack due to heat checking in hot work tool steel are major failure *** is desirable to find amethod to lengthen the tool life while reducing manufacturing *** paper suggests a method to improve toollife for hot work tool steel(SKD6)with crack by laser-melting *** method has been evaluated using theimpact and fatigue test *** is demonstrated that a repair of the crack by a laser-melting process is effectivefor life extension of the damaged tool.

关键词： Hot work tool steel Laser-melting process Impact test Fatigue test Fractography