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World Journal of Radiology 2014年第10期6卷 779-793页

作者： Atsushi Nambu Katsura Ozawa noriko kobayashi Masao Tago Department of Radiology Teikyo University Mizonokuchi Hospital Kawasaki City Kanagawa 213-8507 Japan Department of Internal Medicine Kofu Municipal Hospital Kofu City Yamanashi Prefecture 400-0832 Japan

This article reviews roles of imaging examinations in the management of community-acquired pneumonia(CAP), imaging diagnosis of specific CAP and discrimination between CAP and noninfectious diseases. Chest radiography is usually enough to confirm the diagnosis of CAP, whereas computed tomography is required to suggest specific pathogens and to discriminate from noninfectious diseases. Mycoplasma pneumoniae pneumonia, tuberculosis, Pneumocystis jirovecii pneumonia and some cases of viral pneumonia sometimes show specific imaging findings. Peribronchial nodules, especially tree-in-bud appearance, are fairly specific for infection. Evidences of organization, such as concavity of the opacities, traction bronchiectasis, visualization of air bronchograms over the entire length of the bronchi, or mild parenchymal distortion are suggestive of organizing pneumonia. We will introduce tips to effectively make use of imaging examinations in the management of CAP.

关键词： Community-acquired pneumonia Computed tomography Infection Pneumonia Lung disease

Difficulty in differentiating two cases of sigmoid stenosis by diverticulitis from cancer

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World Journal of Gastroenterology 2012年第27期18卷 3623-3626页

作者： noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi kobayashi Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of MedicineKagawa UniversityKagawa 761-0793Japan Department of Pharmacology Faculty of MedicineKagawa UniversityKagawa 761-0793Japan

The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging. The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%. However, few cases of stenosis due to diverticulitis have been reported. These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult. This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer. Case i was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy （CFS）. CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon. Barium enema revealed a marked, hourglass- shaped, 2-cm circumferential stenosis in the sigmoid colon. Fluorodeoxyglucose （FDG）-positron emission tomography computed tomography （CT） revealed an increased FDG uptake at the affected portion of the sigmoid colon. Sigmoid colon cancer was suspected,and laparoscopic sigmoidectomy was performed. Patho- logical examination demonstrated active inflammation with no evidence of malignancy. Case 2 was a 50-year- old man who presented to a nearby clinic with reduced stool output despite the urge to defecate. CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line. Contrast-enhanced abdomi- nal CT revealed multiple diverticula, wall thickening, and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery. A partial sig- moidectomy was performed. Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface, but a marked infiltration of inflammatory cells was observed.

关键词： Diverticulosis Colon cancer Colon stenosisPositron emission tomography-computed tomographyMagnetic resonance imaging

Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection

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World Journal of Gastroenterology 2012年第22期18卷 2872-2876页

作者： noriko Nishiyama Hirohito Mori Hideki Kobara Shintarou Fujihara Takako Nomura Mitsuyoshi kobayashi Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa Medical University

Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.

关键词： Duodenal hemangioma Endoscopic muco-sal resection Gastrointestinal bleeding Morphologicalchanges Capillary hemangioma

Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

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World Journal of Gastroenterology 2017年第39期23卷 7185-7190页

作者： Hirohito Mori Hideki Kobara Yu Guan Yasuhiro Goda Nobuya kobayashi noriko Nishiyama Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Departments of Pharmacology Kagawa University

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

关键词： Gastric submucosal tumors Gastrointestinal stromal tumor Reversible opening biopsy Endoscopic ultrasonography Large sample

Rectal perforations and fistulae secondary to a glycerin enema:Closure by over-the-scope-clip

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World Journal of Gastroenterology 2012年第24期18卷 3177-3180页

作者： Hirohito Mori Hideki Kobara Shintaro Fujihara noriko Nishiyama Mitsuyoshi kobayashi Tsutomu Masaki Kunihiko Izuishi Yasuyuki Suzuki Department of Gastroenterology and Neurology Kagawa Medical University School of MedicineKagawa 761-0793Japan Department of Gastroenterological Surgery Kagawa Medical University School of MedicineKagawa 761-0793Japan

Rectal perforations due to glycerin enemas(GE) typically occur when the patient is in a seated or lordotic standing *** the perforation occurs and peritonitis results,death is usually *** describe two cases of rectal perforation and fistula caused by a *** 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a *** case was further complicated by an abscess in the right rectal *** second patient was a 78-year-old woman who suffered from a rectovesical fistula after a *** both cases,we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip(OTSC) *** procedures resulted in dramatic improvement in both *** endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure,respectively,in elderly patients who are in poor general *** two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

关键词： Rectal perforation Glycerin enema Abscesslavage Fistula closure Over-the-scope-clip

Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第18期19卷 2752-2760页

作者： noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi kobayashi Makoto Oryu Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Department of Pharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers ***: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing fac

关键词： Over-the-scope clip Gastrointestinal bleed-ing Endoscopic submucosal dissection complications Gastrointestinal fistulae Gastrointestinal perforation

Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

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World Journal of Gastroenterology 2016年第13期22卷 3558-3563页

作者： Hirohito Mori Nobuya kobayashi Hideki Kobara noriko Nishiyama Shintaro Fujihara Taiga Chiyo Maki Ayaki Takashi Nagase Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Department of Gastroenterological Surgery Ehime Rosai Hospital

AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or ***: Two dogs(11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one ***: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.

关键词： Laparoscopic and endoscopic cooperative surgery Endoscopic cholecystectomy Single port Safer and complete resection Feasibility

Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids

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World Journal of Gastroenterology 2017年第27期23卷 5034-5040页

作者： Kenichi Yoshikawa Reimi Kawashima Yuki Hirose Keiko Shibata Takafumi Akasu noriko Hagiwara Takeharu Yokota Nami Imai Akira Iwaku Go kobayashi Hirohiko kobayashi Akiyoshi Kinoshita Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Masayuki Saruta Division of Gastroenterology and Hepatology Internal Medicinethe Jikei University Daisan Hospital Division of Gastroenterology and Hepatology Internal Medicinethe Jikei University School of Medicine

We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid(ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury,and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa,from the rectum to the anus,and this is the first description of a case that developed a severe liver disorder after this treatment; hence,an analysis of future cases as they accumulate is desirable.

关键词： Aluminum potassium sulfate and tannic acid injection Aluminum potassium sulfate and tannic acid therapy Rectal submucosal injection Drug-induced lymphocyte stimulation test Drug-induced liver injury

Role of Cathepsin G in the Degradation of Glyceraldehyde-3-Phosphate Dehydrogenase Triggered by 4-Hydroxy-2-Nonenal in U937 Cells

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CellBio 2014年第2期3卷 35-42页

作者： Satoshi Ohta noriko Suzuki Shigeki kobayashi Toshiyuki Chikuma Department of Analytical Chemistry of Medicines Showa Pharmaceutical University Tokyo Japan

Degradation of oxidized or oxidatively modified proteins is an essential part of the cellular antioxidant defense system. 4-Hydroxy-2-nonenal (HNE), a major reactive aldehyde formed by lipid peroxidation, causes many types of cellular damage. HNE-modified proteins are degraded by the ubiquitin-proteasome pathway or the lysosomal pathway. However, our previous studies using U937 cells showed that HNE-modified glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is degraded by cathepsin G. In the present study, we examined whether GAPDH in U937 cells treated with HNE in culture is degraded similarly to that incubated with HNE and U937 cell extract. Treatment with HNE for 10 min in culture decreased GAPDH activity in a concentration dependent manner, but did not affect GAPDH degradation. The proteasome activities were not affected by HNE, but culturing with HNE decreased cathepsin G activity and protein level in a concentration dependent manner. These results suggest that HNE-induced oxidative stress leads to decreased cathepsin G activity and results in the loss of GAPDH degradation. Taken together, our findings indicate that cathepsin G has an important role in the degradation of oxidatively modified GAPDH in U937 cells.

关键词： 4-Hydroxy-2-Nonenal Glyceraldehyde-3-Phosphate Dehydrogenase Cathepsin G U937 Oxidative Stress Proteasome

Endoscopic submucosal dissection in a patient with esophageal adenoid cystic carcinoma

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World Journal of Gastroenterology 2017年第45期23卷 8097-8103页

作者： Kenichi Yoshikawa Akiyoshi Kinoshita Yuki Hirose Keiko Shibata Takafumi Akasu noriko Hagiwara Takeharu Yokota Nami Imai Akira Iwaku Go kobayashi Hirohiko kobayashi Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Haruka Kaneyama Keiichi Ikeda Masayuki Saruta Division of Gastroenterology and Hepatology Internal MedicineJikei University Daisan Hospital Department of Endoscopy Jikei University Daisan Hospital Division of Gastroenterology and Hepatology Internal MedicineJikei University School of Medicine

We report the first use of endoscopic submucosal dissection(ESD) for the treatment of a patient with adenoid cystic carcinoma of the esophagus(EACC). An 82-year-old woman visited our hospital for evaluation of an esophageal submucosal tumor. Endoscopic examination showed a submucosal tumor in the middle third of the esophagus. The lesion partially stained with Lugol's solution,and narrow band imaging with magnification showed intrapapillary capillary loops with mild dilatation and a divergence of caliber in the center of the lesion. Endoscopic ultrasound imaging revealed a solid 8 mm × 4.2 mm tumor,primarily involving the second and third layers of the esophagus. A preoperative biopsy was non-diagnostic. ESD was performed to resect the lesion,an 8 mm submucosal tumor. Immunohistologically,tumor cells differentiating into ductal epithelium and myoepithelium were observed,and the tissue type was adenoid cystic carcinoma. There was no evidence of esophageal wall,vertical stump or horizontal margin invasion with p T1 b-SM2 staining(1800 μm from the muscularis mucosa). Further studies are needed to assess the use of ESD for the treatment of patients with EACC.

关键词： Adenoid cystic carcinoma of esophagus Endoscope Ultrasound Esophageal Tumor Endoscopic submucosal dissection