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Usefulness of bispectral monitoring of conscious sedation during endoscopic mucosal dissection

World Journal of Gastroenterology 2009年第5期15卷 595-598页

作者： Kazunori Hata Akira Andoh Kiyoyuki Hayafuji Atsuhiro Ogawa Tamio Nakahara Tomoyuki Tsujikawa Yoshihide Fujiyama Yasuharu Saito Department of Medicine Shiga University of Medical Science Seta-Tukinowa Otsu 520-2192 Japan Division of Endoscopy Shiga University of Medical Science Seta-Tukinowa Otsu 520-2192 Japan

AIM: To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction. METHODS: Three hundred sixty-six patients with an early-stage neoplasm of the digestive tract were enrolled. The BIS monitor (A-1050: Aspect medical systems/NIHON KOHDEN, Tokyo, Japan) was used. The appropriate sedative condition was set at 55 to 75 BIS levels (BIS value) during the endoscopic procedures. RESULTS: Among 366 cases, 13 were accompanied by adverse events during and/or after ESD. All episodes occurred in cases with BIS value between 56 and 65. Hypotension was observed in four cases, and bradycardia in six. Respiratory distress was observed in two cases with chronic pulmonary obstructive disease. All patients with adverse events were able to leave the hospital without extension of the hospitalization. CONCLUSION: BIS monitoring is useful to safely perform ESD. A BIS value of 70 to 75 is suitable for ESD.

关键词：内窥镜检查法镇静剂肿瘤化疗临床

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Hepatocellular carcinoma occurring in a Crohn’s disease patient

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World Journal of Gastroenterology 2010年第25期16卷 3215-3218页

作者： Mitsuaki Ishida Shigeyuki Naka Hisanori Shiomi Tomoyuki Tsujikawa Akira Andoh Tamio Nakahara Yasuharu Saito Yoshi-hide Fujiyama Mikiko Takikita-Suzuki Fumiyoshi Kojima Machiko Hotta Tohru Tani Yoshimasa Kurumi Hidetoshi Okabe Department of Clinical Lab-oratory Medicine and Division of Diagnostic Pathology Shiga University of Medical Science Otsu Shiga 520-2192 Japan Department of Surgery Shiga University of Medical Sci-ence Otsu Shiga 520-2192 Japan Department of Gastroenterology Shiga Uni-versity of Medical Science Otsu Shiga 520-2192 Japan Division of Endoscopy Shiga University of Medical Science Otsu Shiga 520-2192 Japan

We report a case of hepatocellular carcinoma (HCC) occurring in a patient with Crohn’s disease (CD) without chronic hepatitis or liver cirrhosis, and review the clinicopathological features of HCC in CD patients. A 37-year-old Japanese man with an 8-year history of CD and a medication history of azathioprine underwent resection of a liver tumor. The histopathology of the liver tumor was pseudoglandular type HCC. In the nonneoplastic liver, focal hepatocyte glycogenosis (FHG) was observed, however, there was no evidence of liver cirrhosis or primary sclerosing cholangitis. Only nine cases of HCC in CD patients have been reported previously in the English-language literature. Eight of 10cases (including the present case) had received azathioprine treatment, and four of these cases also showed FHG, which is considered a preneoplastic liver lesion, within the non-neoplastic liver. Although the precise mechanism of the development of HCC in CD patients is controversial, these results suggest that azathioprine therapy and FHG in the non-neoplastic liver contribute to the development of HCC. These findings also indicate that it is important to survey CD patients treated with prolonged azathioprine therapy for potential liver tumors.

关键词： Crohn’s disease Hepatocellular carcinoma Azathioprine Focal hepatocyte glycogenosis Hepato-carcinogenesis

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Hepatic reactive lymphoid hyperplasia in a patient with primary biliary cirrhosis

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World Journal of Hepatology 2010年第10期2卷 387-391页

作者： Mitsuaki Ishida Tamio Nakahara Yousuke Mochizuki Tomoyuki Tsujikawa Akira Andoh Yasuharu Saito Hiroshi Yamamoto Fumiyoshi Kojima Machiko Hotta Tohru Tani Yoshihide Fujiyama Hidetoshi Okabe Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology Shiga University of Medical Sci enceOtsuShiga 520-2192Japan Department of Gastroenterology Shiga University of Medical ScienceOtsuShiga 520-2192Japan Division of Endoscopy Shiga University of Medical ScienceOtsuShiga 520-2192Japan Department of Surgery Shiga University of Medical ScienceOtsuShiga 520-2192Japan

Reactive lymphoid hyperplasia(RLH) of the liver is an extremely rare lesion characterized by the proliferation of non-neoplastic lymphocytes forming follicles.Hepatic RLH is known to be associated with gastrointestinal carc inoma and autoimmune diseases including primary biliary cirrhosis(PBC).We report a case of hepatic RLH in a patient with PBC and gastric cancer.A 68 year old Japanese woman with a 10 year history of liver enzyme abnormality was admitted.Laboratory testing revealed that her anti-mitochondrial antibody was markedly elev ated.Five mo after the diagnosis of PBC,she was foun d to have gastric cancer.Abdominal computed tom og raphy disclosed a liver nodule in S8,suggesting metas tatic gastric carcinoma.Histopathologically,the resected liver lesion comprised of a nodular proliferation of small lym phocytes with lymphoid follicles.This is the first reported case of hepatic RLH in a patient with both PBC and gastric cancer.Pre-operative diagnosis of hepatic RLH by clinical imaging is extremely difficult.Therefore,a need le biopsy could be useful to make a diagnosis of hepat ic RLH,especially to differentiate from metastatic gastroin t estinal carcinoma.

关键词： Reactive lymphoid hyperplasia Pseudolymphoma Liver Primary biliary cirrhosis Gastric cancer

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