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Serum vitamin A, C, E and carotenoid levels and risk of malignant transformation among oral leukoplakia： a prospective study

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中国口腔颌面外科杂志 2008年第B5期6卷 121-122页

作者： Toru Nagao Saman Warnakulasuriya Hideo Fukano Koji Suzuki shuji hashimoto Kazuo Shimozato 不详 Department of Oral and Maxillofacial Surgery Okazaki City Hospital. Okazaki 444-8553 Japan Department of Oral Medicine WHO Collaborating Centre for Oral Cancer/Precancer King's College Dental Institute at Guy's King's & St. Thomas' Hospitals. London UK Department of Maxillofacial Surgery Aichi-Gakuin University School of Dentistry. Nagoya 464-8651 Japan Department of Public Health Fujita Health University School of Health Sciences Department of Hygiene Fujita Health University School of Medicine Toyoake 470-1192 Japan

Purpose: To evaluate any association between serum micronutrients levels and the risk of malignant transformation of oral leukoplakia。Methods: A prospective hospital based study on pathologically diagnosed oral leukoplakia (n=52) was undertaken during 1996 to 2004。Serum vitamin A (retinol), C, E (a -tocopherol) and carotenoid levels were measured at baseline by the HPLC method。Those who were lost to follow up (minimum 12 months) or did not complete blood analysis were excluded。Multivariate adjusted relative risks (RR) for malignant transformation of oral leukoplakia were calculated with the Cox proportional hazard model。Results: 39 patients with leukoplakias (median age 67, range 35-80) were evaluated。During follow-up (median 52 months:range 12-78 months), 7 carcinomas (2 invasive and 1 micro-invasive, 1 verrucous carcinoma and 3 ca in-situ) were detected。Median serum beta-carotene levels in the group with malignant changes was 20.7μg/dl compared with 44.9μg/dl in those that did not transform (P=0.001)。Having a higher serum beta-carotene level had a significantly inverse association with malignant transformation by the Cox proportional hazard model (RR= 0.08, 95%CI 0.01-0.99, P=-0.049)。Vitamin A, C and E were not significant。Conelusiom A high serum beta-carotene level was associated with reduced risk of malignant transformation of oral leukoplakia, and a result was consistent with previous epidemiological findings of dietary protection of beta-carotene for oral cancer。Further evidence for the preventive role of micronutrients for potentially malignant disorders of the oral cavity should be explored。

关键词：口腔黏膜白斑病治疗方法血清维生素A 类胡萝卜素

Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment

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World Journal of Gastroenterology 2019年第12期25卷 1457-1464页

作者： Hiroki Sato Manabu Takeuchi Satoru hashimoto Ken-ichi Mizuno Koichi Furukawa Akito Sato Junji Yokoyama shuji Terai Division of Gastroenterology Niigata University Medical and Dental Hospital Division of Gastroenterology Nagaoka Red Cross Hospital Division of Gastroenterology Niigata City General Hospital Division of Gastroenterology Nagaoka Chuo General Hospital

Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy(POEM). However,the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.

关键词： Diverticulum Esophagus Epiphrenic diverticulum Zenker's diverticulum Rokitansky diverticulum Iatrogenic disease Esophageal achalasia Peroral endoscopic myotomy Diverticulectomy

Proposed criteria to differentiate heterogeneous eosinophilic gastrointestinal disorders of the esophagus, including eosinophilic esophageal myositis

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World Journal of Gastroenterology 2017年第13期23卷 2414-2423页

作者： Hiroki Sato Nao Nakajima Kazuya Takahashi Go Hasegawa Ken-ichi Mizuno Satoru hashimoto Satoshi Ikarashi Kazunao Hayashi Yutaka Honda Junji Yokoyama Yuichi Sato shuji Terai Division of Gastroenterology and Hepatology Niigata University Medical and Dental Hospital Division of Gastroenterology and Hepatology Saiseikai Niigata Daini Hospital Division of Cellular and Molecular Pathology Department of Cellular FunctionNiigata University Graduate School of Medical and Dental Sciences

AIM To define clinical criteria to differentiate eosinophilic gastrointestinal disorder(Eo GD) in the esophagus. METHODS Our criteria were defined based on the analyses of the clinical presentation of eosinophilic esophagitis(Eo E), subepithelial eosinophilic esophagitis(s Eo E) and eosinophilic esophageal myositis(Eo EM), identified by endoscopy, manometry and serum immunoglobulin E levels(s-Ig E), in combination with histological and polymerase chain reaction analyses on esophageal tissue *** In five patients with Eo E, endoscopy revealed longitudinal furrows and white plaques in all, and fixed rings in two. In one patient with s Eo E and four with Eo EM, endoscopy showed luminal compression only. Using manometry, failed peristalsis was observed in patients with Eo E and s Eo E with some variation, while Eo EM was associated with hypercontractile or hypertensive peristalsis, with elevated s-Ig E. Histology revealed the following eosinophils per high-power field values. Eo E = 41.4 ± 7.9 in the epithelium and 2.3 ± 1.5 in the subepithelium; s Eo E = 3 in the epithelium and 35 in the subepithelium(conventional biopsy); Eo EM = none in the epithelium, 10.7 ± 11.7 in the subepithelium(conventional biopsy or endoscopic mucosal resection) and 46.8 ± 16.5 in the muscularis propria(peroral esophageal muscle biopsy). Presence of dilated epithelial intercellular space and downward papillae elongation were specific to Eo E. Eotaxin-3, IL-5 and IL-13 were overexpressed in Eo *** Based on clinical and histological data, we identified criteria, which differentiated between Eo E, s Eo E and Eo EM, and reflected a different pathogenesis between these esophageal Eo GDs.

关键词：嗜曙红的食道炎嗜曙红的食道的肌炎 Peroral 内视镜的肌切开术手提钻食管 Achalasia Peroral 食道的肌肉活体检视

幽门腺化生可能通过CDX2表达引起肠上皮化生甚至直接进展为胃癌

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Gastroenterology Report 2021年第4期9卷 370-373,I0003页

作者： Kazuyoshi Yagi Atsunori Tsuchiya Satoru hashimoto Taisuke Kato Osamu Onodera shuji Terai Department of Gastroenterology and Hepatology Uonuma Institute of Community MedicineNiigata University Medical and Dental HospitalNiigataJapan Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan Department of System Pathology for Neurological Disorders Brain Science BranchBrain Research InstituteNiigata UniversityNiigataJapan Department of Neurology Brain Research InstituteNiigata UniversityNiigataJapan

Introduction The majority of cases of gastric cancer are thought to develop due to chronic inflammation from Helicobacter pylori(***)infection leading to intestinal metaplasia,termed the intestinal metaplasia–dysplasia–cancer sequence[1].Chronic inflammation from *** infection causes mucin core protein 6-positive(MUC6t)pyloric-gland metaplasia;however,its origin is *** MUC6t pyloric-gland metaplasia is similar to spasmolytic polypeptide-expressing metaplasia in mouse studies[2–4].

关键词：肠上皮化生幽门腺 Helicobacter CDX2

MR Differentiation of Endometriomas Complicated with and without Malignancy: Comparison with Pathological Findings

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Open Journal of Medical Imaging 2014年第3期4卷 142-153页

作者： Mari Kohno Tsuyoshi Tajima Kazunori hashimoto Hideo Matsui Toshio Nishikawa shuji Sakai Department of Diagnostic Imaging and Nuclear Medicine Tokyo Women’s Medical University Tokyo Japan Department of Radiology National Center for Global Health and Medicine Tokyo Japan Department of Obstetrics and Gynecology Tokyo Women’s Medical University Tokyo Japan Department of Molecular Pathology School of Medicine Yokohama City University Yokohama Japan

Introduction: The purposes were to clarify the magnetic resonance imaging (MRI) findings of malignant ovarian lesions arising from endometriomas, and to compare the lesions’ histopathology and MRI characteristics. Materials and Methods: Between May 2004 and December 2012, 140 patients, all of whom were diagnosed as having an endometrioma by using MR imaging, underwent surgery. We compared the MR characteristics including size and signal intensity of the tumor and mural nodules, the thickness of the septum, and the thickness of the wall with the pathological diagnoses. The attached angles of the mural nodules to the cyst wall were also evaluated. Results: Among the 179 lesions, preoperative MR imaging diagnosed 153 benign and 26 malignant. Based on the pathological results, 169 were diagnosed as benign and 10 were diagnosed as malignant. Finally, preoperative MR imaging correctly diagnosed 152 benign (group 1) and nine malignant (group 2), misdiagnosed 17 benign as malignant (group 3) and misdiagnosed one malignant as benign (group 4). As for mural nodules, there was a significant difference between groups 1 and 2 in the mean maximum diameter of the mural nodules. An acute attached angle was shown in 1 of 7 in group 1, in 11 of 16 in group 2, and in 14 of 22 in group 3. We also compared benign group with malignant group on the final pathological findings. As for mural nodules, there was a significant difference between groups 1 + 3 and group 2 in the mean maximum diameter of the mural nodules. On dynamic study, there were 22 enhanced mural nodules (75.9%) on group 1 + 3. Conclusion: Most of endometriomas preoperatively diagnosed as benign were pathological benign lesions. Endometriomas that contain many enhanced mural nodules with papillary shape, larger size, showing hypointense on T1WI, hyperintense on T2WI and showing an acute attached angle may have malignant potential.

关键词： MR Imaging Endometrioma Malignancy Mural Nodule Subtraction Image

Management of gastric and duodenal neuroendocrine tumors

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World Journal of Gastroenterology 2016年第30期22卷 6817-6828页

作者： Yuichi Sato Satoru hashimoto Ken-ichi Mizuno Manabu Takeuchi shuji Terai Department of Gastroenterology Niigata University Graduate School of Medical and Dental Sciences Division of Endoscopy Niigata University Medical and Dental Hospital

Gastrointestinal neuroendocrine tumors(GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs(G-NETs) and duodenal NETs(D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three distinct subgroups: type?Ⅰ, Ⅱ, and Ⅲ. Type?Ⅰ?G-NETs, which are the most common subtype(70%-80% of all G-NETs), are associated with chronic atrophic gastritis, including autoimmune gastritis and Helicobacter pylori associated atrophic gastritis. Type Ⅱ G-NETs(5%-6%) are associated with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome(MEN1-ZES). Both type?Ⅰ?and Ⅱ G-NETs are related to hypergastrinemia, are small in size, occur in multiple numbers, and are generally benign. In contrast, type Ⅲ G-NETs(10%-15%) are not associated with hypergastrinemia, are large-sized single tumors, and are usually malignant. Therefore, surgical resection and chemotherapy are generally necessary for type Ⅲ G-NETs, while endoscopic resection and followup, which are acceptable for the treatment of most type?Ⅰ?and Ⅱ G-NETs, are only acceptable for small and well differentiated type Ⅲ G-NETs. D-NETs include gastrinomas(50%-60%), somatostatin-producing tumors(15%), nonfunctional serotonin-containing tumors(20%), poorly differentiated neuroendocrine carcinomas(< 3%), and gangliocytic paragangliomas(< 2%). Most D-NETs are located in the first or second part of the duodenum, with 20% occurring in the periampullary region. Therapy for D-NETs is based on tumor size, location, histological grade, stage, and tumor type. While endoscopic resection may be considered for small nonfunctional D-NETs(G1) located in the higher papilla region, surgical resection is necessary for most other D-NETs. However, there is no consensus regarding the ideal treatment of D-NETs.

关键词： Gastric neuroendocrine tumors Duodenal neuroendocrine tumors Classification Endoscopic treatment End

Vonoprazan 20 mg vs lansoprazole 30 mg for endoscopic submucosal dissection-induced gastric ulcers

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World Journal of Gastrointestinal Endoscopy 2016年第19期8卷 716-722页

作者： Kazuya Takahashi Yuichi Sato Junji Kohisa Jun Watanabe Hiroki Sato Kenichi Mizuno Satoru hashimoto shuji Terai Department of Endoscopy Niigata University Medical and Dental Hospital Division of Gastroenterology and Hepatology Sado General Hospital Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata University Division of Gastroenterology and Hepatology Nagaoka Red Cross Hospital

AIM To compare the healing effects of vonoprazan and lansoprazole on gastric ulcers induced by endoscopic submucosal dissection(ESD).METHODS Data were obtained from a total of 26 *** patients were randomized to the vonoprazan group and 12 were randomized to the lansoprazole *** were administered either 20 mg vonoprazan or 30 mg lansoprazole per day after *** images just after ESD,on day 8,and on day 28 were used for the evaluation of the shrinking rate of ESD *** shrinking rates and the incidence of delayed bleeding were compared between the 2 *** The shrinking rates of ESD ulcers on day 8 [vonoprazangroup: 61.8%(range: 24.0%-91.1%),lansoprazole group: 71.3%(range: 25.2%-88.6%)] and on day 28 [vonoprazan group: 95.3%(range: 76.2%-100%),lansoprazole group: 97.2%(range: 81.1%-99.8%)] were not statistically different between the 2 *** day 28,most of the ulcers in both groups healed to more than 90%,whereas 3 of 14(21.4%) in the vonoprazan group and 1 of 12(8.3%) in the lansoprazole group had delayed ulcer healing,which was not statistically different(P = 0.356).The frequency of delayed bleeding was 0 in the both *** together,there were no significant differences between the two drug *** Our study indicates that vonoprazan is potent for the management of ESD ulcers although lansoprazole is also sufficient and cost-effective.

关键词： Lansoprazole 胃的癌症内视镜的 submucosal 解剖钾竞争的酸 blocker 质子泵禁止者 Vonoprazan

Endoscopic ultrasound-guided fine-needle aspiration for diagnosing a rare extraluminal duodenal gastrointestinal tumor

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World Journal of Gastrointestinal Endoscopy 2017年第12期9卷 583-589页

作者： Kazunao Hayashi Kenya Kamimura Kazunori Hosaka Satoshi Ikarashi Junji Kohisa Kazuya Takahashi Kentaro Tominaga Kenichi Mizuno Satoru hashimoto Junji Yokoyama Satoshi Yamagiwa Kazuyasu Takizawa Toshifumi Wakai Hajime Umezu shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University Division of Digestive and General Surgery Graduate School of Medical and Dental Sciences Niigata University Department of Pathology Niigata University Medical and Dental Hospital

Duodenal gastrointestinal stromal tumors(GISTs) are extremely rare disease entities, and the extraluminal type is difficult to diagnose. These tumors have been misdiagnosed as pancreatic tumors; hence, pancreaticoduodenectomy has been performed, although partial duodenectomy can be performed if accurately diagnosed. Developing a diagnostic methodology including endoscopic ultrasonography(EUS) and fine-needle aspiration(FNA) has allowed us to diagnose the tumor directly through the duodenum. Here, we present a case of a 50-year-old woman with a 27-mm diameter tumor in the pancreatic uncus on computed tomography scan. EUS showed a well-defined hypoechoic mass in the pancreatic uncus that connected to the duodenal proper muscular layer and was followed by endoscopic ultrasoundguided fine-needle aspiration(EUS-FNA). Histological examination showed spindle-shaped tumor cells positively stained for c-kit. Based on these findings, the tumor was finally diagnosed as a duodenal GIST of the extraluminal type, and the patient underwent successful mass resection with partial resection of the duodenum. This case suggests that EUS and EUS-FNA are effective for diagnosing the extraluminal type of duodenal GISTs, which is difficult to differentiate from pancreatic head tumor, and for performing the correct surgical procedure.

关键词： Gastrointestinal stromal tumor Duodenum Extraluminal type Pancreatic head tumor Endoscopic ultrasonography Endoscopic ultrasound-guided fineneedle aspiration Partial resection

Serum type Ⅳ collagen level is predictive for esophageal varices in patients with severe alcoholic disease

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World Journal of Gastroenterology 2008年第13期14卷 2044-2048页

作者： Satoshi Mamori Yasuyuki Searashi Masato Matsushima Kenichi hashimoto Shinichiro Uetake Hiroshi Matsudaira shuji Ito Hisato Nakajima Hisao Tajiri Division of Gastroenterology and Hepatology Department ofInternal Medicine the Jikei University School of Medicine Tokyo105-8461 Japan Division of Clinical Research anddevelopment the Jikei University School of Medicine Tokyo105-8461 Japan Tokyo Medical Center of Alcohol RelatedDisabilities Tokyo 175-0091 Japan

AIM: To determine factors predictive for esophageal varices in severe alcoholic disease (SAD). METHODS: Abdominal ultrasonography (US) was performed on 444 patients suffering from alcoholism. Forty-four patients found to have splenomegaly and/ or withering of the right liver lobe were defined as those with SAD. SAD patients were examined by upper gastrointestinal (UGI) endoscopy for the presence of esophageal varices. The existence of esophageal varices was then related to clinical variables. RESULTS: Twenty-five patients (56.8%) had esophageal varices. A univariate analysis revealed a significant difference in age and type Ⅳ collagen levels between patients with and without esophageal varices. A logistic regression analysis identified type Ⅳ collagen as the only independent variable predictive for esophageal varices (P = 0.017). The area under the curve (AUC) for type Ⅳ collagen as determined by the receiver operating characteristic (ROC) for predicting esophageal varices was 0.78. CONCLUSION: This study suggests that the level of type Ⅳ collagen has a high diagnostic accuracy for the detection of esophageal varices in SAD.

关键词：胶原蛋白食管静脉曲张酒精中毒腹部超声波检查法