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Favorable response after radiation therapy for intraductal papillary mucinous neoplasms manifesting as acute recurrent pancreatitis:A case report

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World Journal of Clinical Cases 2022年第30期10卷 11116-11121页

作者： Ayaka Harigai kiyoshi kume Noriyoshi Takahashi So Omata Rei Umezawa Keiichi Jingu Atsushi Masamune Department of Radiation Oncology Tohoku University Graduate School of MedicineSendai 980-8574Japan Division of Gastroenterology Tohoku University Graduate School of MedicineSendai 980-8574Japan

BACKGROUND There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm(IPMN),who are surgically intolerant and require less invasive treatment options,which are *** the present study,we report a case of IPMN presenting with acute recurrent pancreatitis(ARP),in which radiation therapy effectively prevented further attacks of ARP and reduced tumor *** SUMMARY An 83-year-old man was referred to our hospital with an asymptomatic incidental pancreatic *** ultrasound imaging and magnetic resonance cholangiopancreatography revealed a multiloculated tumor in the head of the pancreas,with dilated pancreatic ducts and mural *** patient was diagnosed with mixed-type IPMN,and five years later,he developed *** endoscopic pancreatic ductal balloon dilatations failed to prevent further ARP *** was considered clinically inappropriate because of his old age and *** was referred to our department for radiation therapy targeted at those lesions causing intraductal hypertension and radiation was administered at a dose of 50 *** magnetic resonance imaging scan taken ten weeks after treatment revealed a decrease in tumor size and improvement of pancreatic duct *** months later,he remains symptom-free from *** This case highlights the important role of radiation therapy in mitigating the signs and symptoms of ARP in patients with inoperable IPMN.

关键词： Intraductal papillary mucinous neoplasm Acute recurrent pancreatitis Pancreas Radiation therapy Case report

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World Journal of Gastroenterology 2015年第33期21卷 9808-9816页

作者： Eriko Nakano Atsushi Kanno Atsushi Masamune Naoki Yoshida Seiji Hongo Shin Miura Tetsuya Takikawa Shin Hamada kiyoshi kume Kazuhiro Kikuta Morihisa Hirota Keisuke Nakayama Fumiyoshi Fujishima Tooru Shimosegawa Division of Gastroenterology Tohoku University Graduate School of Medicine Division of Nephrology Endocrinology and Vascular MedicineTohoku University Graduate School of Medicine Department of Pathology Tohoku University Graduate School of Medicine

A 50-year-old male was referred to our hospital for the evaluation of *** positron emission tomography revealed high fluorodeoxyglucose uptake in the pancreas,bilateral lacrimal glands,submandibular glands,parotid glands,bilateral pulmonary hilar lymph nodes,and *** data showed an elevation of hepatobiliary enzymes,renal dysfunction,and remarkably high immunoglobulin(Ig) G levels,without elevated serum *** computed tomography revealed swelling of the pancreatic head and bilateral *** retrograde cholangiopancreatography showed an irregular narrowing of the main pancreatic duct in the pancreatic head and stricture of the lower common bile *** examination by endoscopic ultrasonography-guided fine-needle aspiration revealed findings of lymphoplasmacytic sclerosing pancreatitis without IgG4-positive plasma *** laboratory values and the swelling of several organs were improved by the treatment with *** patient was diagnosed as having type 1 autoimmune pancreatitis(AIP) based on the International Consensus Diagnostic ***,we encountered a case of compatible type 1 AIP without elevated levels of serum IgG4 or IgG4-positive plasma *** case suggests that AIP phenotypes are not always associated with IgG4.

关键词： IgG4-related disease Steroid Intestinal nephritis

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Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy

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World Journal of Gastroenterology 2013年第31期19卷 5182-5186页

作者： Tetsuya Takikawa Atsushi Kanno Atsushi Masamune Shin Hamada Eriko Nakano Shin Miura Hiroyuki Ariga Jun Unno kiyoshi kume Kazuhiro Kikuta Morihisa Hirota Hiroshi Yoshida Yu Katayose Michiaki Unno Tooru Shimosegawa Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi 980-8574 Japan Division of Hepato-biliary-Pancreatic Surgery Tohoku University Graduate School of Medicine Miyagi 980-8574 Japan

The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen-Y hepaticojejunostomy for congenital biliary dilatation at the age of ***,she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving *** developed a pancreatic fistula and an intra-abdominal abscess after the *** complications were improved by percutaneous abscess drainage and antibiotic *** ever,upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the *** we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography,we tried an endoscopic ultrasonography(EUS) guided rendezvous technique for pancreatic duct *** transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle,the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic *** changed the echoendoscope to an oblique-viewing endoscope,then grasped the guidewire and withdrew it through the *** stenosis of the pancreaticojejunostomy was dilated up to 4 mm,and a pancreatic stent was put in *** the pancreatic stent was removed after three months,the patient remained *** duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.

关键词： Balloon dilatation Endoscopic ultrasoundguided fine needle aspiration Pancreaticobiliary maljunction Pancreaticoduodenectomy Pancreatitis Postoperative complication

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Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

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Advances in Computed Tomography 2013年第3期2卷 112-120页

作者： Yoshiki Noda Ryo Matsutera Yoshinori Yasuoka kiyoshi kume Hidenori Adachi Susumu Hattori Ryo Araki Motohiro Kosugi Yasuaki Kohama Tetsufumi Nakashima Tatsuya Sasaki Cardiovascular Division Osaka Minami Medical Center National Hospital Organization Osaka Japan

Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 - 1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 - 9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 - 9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 - 1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 - 25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.

关键词： Zero Coronary Artery Calcium Score Number of Noncalcified Coronary Plaque 64-Slice Multi-Detector Computed Tomography Japanese Patients

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