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Clinical implications of accessory pancreatic duct

World Journal of Gastroenterology 2010年第36期16卷 4499-4503页

作者： Terumi Kamisawa kensuke takuma Taku Tabata Naoto Egawa Department of Internal Medicine Tokyo Metropolitan Komagome Hospital3-18-22 HonkomagomeBunkyo-kuTokyo 113-8677Japan

The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo,entering the duodenum at the minor duodenal papilla (MIP).With the growth,the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal *** of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde *** of the APD in 46 patients with acute pancreatitis was only 17%,which was significantly lower than in control cases (P < 0.01).The terminal shape of the APD was correlated with APD *** on the data about correlation between the terminal shape of the APD and its patency,the estimated APD patency in 167 patients with acute pancreatitis was 21%,which was signif icantly lower than in control cases (P < 0.01).A patent APD may function as a second drainage system for the main pancreatic duct to reduce the pressure in the main pancreatic duct and prevent acute *** f indings of 91 patients with pancreaticobiliary maljunction (PBM) were divided into a normal duct group (80 patients) and a dorsal pancreatic duct (DPD) dominant group (11 patients).While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma,n=42;bile duct carcinoma,n=6) were identified in PBM with a normal pancreatic duct system,only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05).Concentration of amylase in the bile of DPD dominance was signifi cantly lower than that of normal pancreatic duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L,P < 0.05).In PBM with DPD dominance,most pancreatic juice in the upper DPD is drained into the duodenum via the MIP,and reflux of pancreatic juice to the biliary tract might be reduced,resulting in less frequency of associated biliary carcinoma.

关键词： Accessory pancreatic duct Minor duodenal papilla Pancreas divisum Main pancreatic duct Acute pancreatitis Pancreaticobiliary maljunction

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Utility of pancreatography for diagnosing autoimmune pancreatitis

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World Journal of Gastroenterology 2011年第18期17卷 2332-2337页

作者： kensuke takuma Terumi Kamisawa Taku Tabata Yoshihiko Inaba Naoto Egawa Yoshinori Igarashi Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Department of Gastroenterology and Hepatology Omori Medical Center Toho University School of Medicine

AIM: To identify pancreatographic findings that facilitate differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) on endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). METHODS: ERCP findings of 48 AIP and 143 PC patients were compared. Diagnostic accuracies for AIP by ERCP and MRCP were compared in 30 AIP patients. RESULTS: The following ERCP findings suggested a diagnosis of AIP rather than PC. Obstruction of the main pancreatic duct (MPD) was more frequently detected in PC (P < 0.001). Skipped MPD lesions were detected only in AIP (P < 0.001). Side branch derivation from the narrowed MPD was more frequent in AIP (P < 0.001). The narrowed MPD was longer in AIP (P < 0.001), and a narrowed MPD longer than 3 cm was more frequent in AIP (P < 0.001). Maximal diameter of the upstream MPD was smaller in AIP (P < 0.001), and upstream dilatation of the MPD less than 5 mm was more frequent in AIP (P < 0.001). Stenosis of the lower bile duct was smooth in 87% of AIP and irregular in 65% of PC patients (P < 0.001). Stenosis of the intrahepatic or hilar bile duct was detected only in AIP (P = 0.001). On MRCP, diffuse narrowing of the MPD on ERCP was shown as a skipped non-visualized lesion in 50% and faint visualization in 19%, but segmental narrowing of the MPD was visualized faintly in only 14%. CONCLUSION: Several ERCP findings are useful for differentiating AIP from PC. Although MRCP cannot replace ERCP for the diagnostic evaluation of AIP, some MRCP findings support the diagnosis of AIP.

关键词： Autoimmune pancreatitis Pancreatic cancer Endoscopic retrograde cholangiopancreatography Magnetic resonance cholangiopancreatography

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Differences between diffuse and focal autoimmune pancreatitis

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World Journal of Gastroenterology 2012年第17期18卷 2099-2104页

作者： Taku Tabata Terumi Kamisawa kensuke takuma Seiichi Hara Sawako Kuruma Yoshihiko Inaba Department of Internal Medicine Tokyo Metropolitan Komagome Hospital3-18-22 HonkomagomeBunkyo-kuTokyo 113-8677Japan

AIM:To investigate differences in clinical features between diffuse-and focal-type autoimmune pancreatitis(AIP).METHODS:Based on radiological findings by computed tomography and/or magnetic resonance imaging,we divided 67 AIP patients into diffuse type(D type) and focal type(F type).We further divided F type into head type(H type) and body and/or tail type(B/T type) according to the location of ***,we classified the 67 AIP patients into three groups:D type,H type and B/T *** compared the three types of AIP in terms of clinical,laboratory,radiological,functional and histological findings and clinical ***:There were 34 patients with D-type,19 with H-type and 14 with B/T-type *** obstructive jaundice was frequently detected in D-typepatients(88%) and H-type patients(68%),no B/T-type patients showed jaundice as an initial symptom(P < 0.001).There were no differences in frequency of abdominal pain,but acute pancreatitis was associated more frequently in B/T-type patients(36%) than in D-type patients(3%)(P = 0.017).Serum immunoglobulin G(IgG)4 levels were significantly higher in D-type patients(median 309 mg/dL) than in B/T-type patients(133.5 mg/dL)(P = 0.042).Serum amylase levels in B/T-type patients(median:114 IU/L) were significantly greater than in H-type patients(72 IU/L)(P = 0.049).Lymphoplasmacytic sclerosing pancreatitis(LPSP) was histologically confirmed in 6 D-type,7 H-type and 4 B/T-type patients;idiopathic duct-centric pancreatitis was observed in no *** fibrosis and abundant infiltration of CD20-positive B lymphocytes with few IgG4-positive plasma cells were detected in 2 B/T-type *** therapy was effective in all 50 patients(31 D type,13 H type and 6 B/T type).Although AIP relapsed during tapering or after stopping steroids in 3 D-type and 3 H-type patients,no patients relapsed in B/T *** follow-up,radiological features of 6 B/T-type patients were not changed and 1 B/T-type patient impr

关键词： Autoimmune pancreatitis Immunoglobulin G 4 Lymphoplasmacytic sclerosing pancreatitis

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Sclerosing cholangitis associated with autoimmune pancreatitis differs from primary sclerosing cholangitis

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World Journal of Gastroenterology 2009年第19期15卷 2357-2360页

作者： Terumi Kamisawa kensuke takuma Hajime Anjiki Naoto Egawa Masanao Kurata Goro Honda Kouji Tsuruta Department of Internal Medicine Tokyo Metropolitan Komagome Hospital3-18-22 HonkomagomeBunkyo-kuTokyo 113-8677Japan Department of Surgery Tokyo Metropolitan Komagome Hospital3-18-22 HonkomagomeBunkyo-kuTokyo 113-8677Japan

AIM:To clarify the characteristic features of biliary le-sions in patients with autoimmune pancreatitis(AIP) and compare them with those of primary sclerosing cholangitis(PSC) .METHODS:The clinicopathological characteristics of 34 patients with sclerosing cholangitis(SC) associated with AIP were compared with those of 4 patients with ***:SC with AIP occurred predominantly in el-derly *** jaundice was the most frequent initial symptom in SC with *** SC patients with AIP had elevated serum IgG4 levels,and sclerosing diseases were more frequent in these *** pa-tients with AIP responded well to steroid ***-mental stenosis of the lower bile duct was observed only in SC patients with AIP,but a beaded and pruned-tree appearance was detected only in PSC *** infi ltration of IgG4-positive plasma cells was de-tected in the bile duct wall and the periportal area,as well as in the pancreas,of SC patients with ***:SC with AIP is distinctly different from *** two diseases can be discriminated based on cholangiopancreatographic findings and serum IgG4 levels.

关键词： Autoimmune pancreatitis IgG4 Primarysclerosing cholangitis Sclerosing cholangitis

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Strategy to differentiate autoimmune pancreatitis from pancreas cancer

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World Journal of Gastroenterology 2012年第10期18卷 1015-1020页

作者： kensuke takuma Terumi Kamisawa Rajesh Gopalakrishna Seiichi Hara Taku Tabata Yoshihiko Inaba Naoto Egawa Yoshinori Igarashi Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Department of Gastroenterology and Hepatology Omori Medical Center Toho University School of Medicine

Autoimmune pancreatitis (AIP) is a newly described entity of pancreatitis in which the pathogenesis appears to involve autoimmune mechanisms. Based on histological and immunohistochemical examinations of various organs of AIP patients, AIP appears to be a pancreatic lesion reflecting a systemic "IgG4-related sclerosing disease". Clinically, AIP patients and patients with pancreatic cancer share many features, such as preponderance of elderly males, frequent initial symptom of painless jaundice, development of new-onset diabetes mellitus, and elevated levels of serum tumor markers. It is of uppermost importance not to misdiagnose AIP as pancreatic cancer. Since there is currently no diagnostic serological marker for AIP, and approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological, and histopathological features. Findings suggesting AIP rather than pancreatic cancer include:fluctuating obstructive jaundice; elevated serum IgG4 levels; diffuse enlargement of the pancreas; delayed en- hancement of the enlarged pancreas and presence of a capsule-like rim on dynamic computed tomography; low apparent diffusion coefficient values on diffusion-weighted magnetic resonance image; irregular narrowing of the main pancreatic duct on endoscopic retrograde cholangiopancreatography; less upstream dilatation of the main pancreatic duct on magnetic resonance cholangiopancreatography, presence of other organ involvement such as bilateral salivary gland swelling, retroperitoneal fibrosis and hilar or intrahepatic sclerosing cholangitis; negative work-up for malignancy including endoscopic ultrasound-guided fine needle aspiration; and steroid responsiveness. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection.

关键词： Autoimmune pancreatitis Pancreatic cancer Endoscopic retrograde cholangiopancreatography Magnetic resonance cholangiopancreatography

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Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

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World Journal of Gastroenterology 2012年第26期18卷 3409-3414页

作者： kensuke takuma Terumi Kamisawa Taku Tabata Seiichi Hara Sawako Kuruma Yoshihiko Inaba Masanao Kurata Goro Honda Koji Tsuruta Shin-ichiro Horiguchi Yoshinori Igarashi Department of Internal Medicine Tokyo Metropolitan Komagome HospitalTokyo 113-8677Japan Department of Surgery Tokyo Metropolitan Komagome HospitalTokyo 113-8677Japan Departments of Pathology Tokyo Metropolitan Komagome HospitalTokyo 113-8677Japan Department of Gastroenterology and Hepatology Omori Medical CenterToho University School of MedicineTokyo 143-8541Japan

AIM:To clarify the strategy for early diagnosis of pancreaticobiliary maljunction(PBM) without biliary dilatation and to pathologically examine gallbladder before cancer ***:The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography(ERCP).Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having *** these,patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary *** process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively *** analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was ***:Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain(n = 16) or jaundice(n = 12).Radical surgery for gallbladder cancer was only possible in 11 patients(31%) and only 4 patients(11%) survived for 5 *** patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography(MRCP).The median age of these 8 patients was younger by a decade than PBM patients with gallbladder *** 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not *** thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls,and hyperplastic changes,hypertrophic muscular layer,subserosal fibrosis,and adenomyomatosis were detected in 7(88%),5(63%),7(88%) and 5(63%) patients,***-67 labeling index was high and K-ras mutation was detected in 3 of 6 ***:To detect PBM without biliar

关键词： Pancreaticobiliary maljunction Pancreato-biliary reflux Ultrasound Gallbladder cancer Endo-scopic ultrasonography

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Endoscopic diagnosis of pancreaticobiliary maljunction

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World Journal of Gastrointestinal Endoscopy 2011年第1期3卷 1-5页

作者： Terumi Kamisawa kensuke takuma Fumihide Itokawa Takao Itoi Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Department of Gastroenterology Tokyo Medical University

Pancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. As the action of the sphincter of Oddi does not functionally affect the junction in PBM patients, continuous pancreatobiliary reflux occurs, resulting in a high incidence of biliary cancer. PBM can be divided into PBM with biliary dilatation (congenital choledochal cyst) and PBM without biliary dilatation (maximal diameter of the bile duct ≤ 10 mm). The treatment of choice for PBM is prophylactic surgery before malignant changes can take place. Endoscopic retrograde cholangiopancreatography (ERC P) is the most effective examination method for close obs ervation of the pattern of the junction site. When the communication between the pancreatic and bile ducts is maintained, despite contraction of the sphi ncter on ERCP, PBM is diagnosed. In these pat ients, levels of pancreatic enzymes in the bile are gene rally elevated, due to continuous pancreatobiliary reflux via a long common channel. Magnetic resonance cholangiopancreatography and 3D-computed tomography can diagnose PBM, based on findings of an anomalous union between the common bile duct and the pancreatic duct, in addition to a long common channel. Endoscopic ultrasonography and intraductal ultra sonography can demonstrate the junction outside the duodenal wall, and are useful for the diagnosis of asso ciated biliary cancer. Gallbladder wall thickness on ultra so nography can be a screening test for PBM.

关键词： Pancreaticobiliary maljunction Pancreatobiliary reflux Congenital choledochal cyst Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Magnetic resonance cholangiopancreatography

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Droplet morphology analysis of drop-on-demand inkjet printing

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China Foundry 2024年第1期21卷 20-28页

作者： Hu-xiang Xia Takechi kensuke Tajima Shin Kawamura Yoshiumi Qing-yan Xu Key Laboratory for Advanced Materials Processing Technology(MOE) School of Materials Science and EngineeringTsinghua UniversityBeijing 100084China Toyota Central R&D Labs. Inc.41-1 Yokomichi NagakuteAichi 480-1192Japan Frontier Research Center Toyota Motor Corporation1 Toyota-ChoToyotaAichi 471-8572Japan

As an accurate 2D/3D fabrication tool,inkjet printing technology has great potential in preparation of micro electronic *** morphology of droplets produced by the inkjet printer has a great impact on the accuracy of *** this study,the drop-on-demand(DoD)inkjet simulation model was established,and the accuracy of the simulation model was verified by corresponding *** simulation result shows that the velocity of the droplet front and tail,as well as the time to disconnect from the nozzle is mainly affected by density(ρ),viscosity(μ)and surface tension(σ)of *** the liquid filament is about to disconnect from the nozzle,the filament length and filament front velocity are found to have a linear correlation withσ/ρμand ln(ρ/(μσ1/2)).

关键词： microdevice fabrication inkjet printing droplet morphology modeling and simulation

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打倒帕金森病

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商业周刊（中文版） 2024年第2期 90-97页

作者： Robert Langreth kensuke Koike(插图) 融汐(译) 不详

加州大学伯克利分校(University of California at Berkeley)的细胞生物学家兰迪·谢克曼(Randy Schekman)获得了2013年诺贝尔医学奖,原因是他对酵母细胞如何将蛋白质输送到需要的地方的深人研究。他的部分研究成功帮助实现了生物技术... 详细信息

加州大学伯克利分校(University of California at Berkeley)的细胞生物学家兰迪·谢克曼(Randy Schekman)获得了2013年诺贝尔医学奖,原因是他对酵母细胞如何将蛋白质输送到需要的地方的深人研究。他的部分研究成功帮助实现了生物技术的突破,包括生产胰岛素和肝炎疫苗的新方法。尽管谢克曼有着卓越的才华,还能接触到其他的优秀科学家和医生。

关键词：肝炎疫苗诺贝尔医学奖兰迪帕金森病谢克胰岛素酵母细胞

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Development of natural treatment system consisting of black soil and Kentucky bluegrass for the post-treatment of anaerobically digested strong wastewater

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Journal of Environmental Sciences 2016年第3期28卷 44-50页

作者： Xiaochen Chen kensuke Fukushi Department of Urban Engineering The University of Tokyo Integrated Research System for Sustainability Science The University of Tokyo

To develop a sound post-treatment process for anaerobically-digested strong wastewater,a novel natural treatment system comprising two units is put *** first unit,a trickling filter,provides for further reduction of biochemical oxygen demand and adjustable *** subsequent soil–plant unit aims at removing and recovering the nutrients nitrogen（N）,phosphorus（P）and potassium（K）.As a lab-scale feasibility study,a soil column test was conducted,in which black soil and valuable Kentucky bluegrass were integrated to treat artificial nutrient-enriched *** a long-term operation,the nitrification function was well established in the top layers,despite the need for an improved denitrification process prior to discharge.P and K were retained by the soil through distinct *** they either partially or totally remained in plant-available forms in the soil,indirect nutrient reuse could be *** for Kentucky bluegrass,it displayed better growth status when receiving wastewater,with direct recovery of 8%,6% and 14% of input N,P and K,***,the indispensable role of Kentucky bluegrass for better treatment performance was proved,as it enhanced the cell-specific nitrification potential of the soil nitrifying microorganisms inhabiting the *** further upgrade,the proposed system is expected to become a new solution for strong wastewater pollution.

关键词： Natural treatment system Black soil Kentucky bluegrass Strong wastewater Soil column test

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