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The right hepatic artery syndrome

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World Journal of Gastroenterology 2005年第19期11卷 3008-3009页

作者： Kazumi Miyashita katsuya shiraki Takeshi Ito Hiroki Taoka Takeshi Nakano First Department of Internal Medicine Mie University School of Medicine TsuMie 514-8507Japan First Department of Surgery Mie University School of Medicine TsuMie 514-8507Japan

Various benign and malignant conditions could cause biliary obstruction. Compression of extrahepatic bile duct (EBD) by right hepatic artery was reported as a right hepatic artery syndrome but all cases were compressed EBD from stomach side. Our case compressed from dorsum was not yet reported, so it was thought to be a very rare case. We present here the first case of bile duct obstruction due to the compression of EBD from dorsum by right hepatic artery.

关键词： Right hepatic artery syndrome Obstructive jaundice Extrahepatic bile duct Right hepatic artery Endoscopic retrograde cholangiography Cholangioen-terostomy

Relative predictive factors for hepatocellular carcinoma after HBeAg seroconversion in HBV infection

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World Journal of Gastroenterology 2005年第43期11卷 6848-6852页

作者： Kazumoto Murata Kazushi Sugimoto katsuya shiraki Takeshi Nakano the First Department of Internal Medicine

AIM： To determine the predictive factors for hepatocellular carcinoma （HCC） development in patients after spontaneous or therapeutic HBeAg seroconversion. METHODS： In 48 patients who seroconverted to anti- HBe positive during follow-up, the background factors for HCC development were analyzed. RESULTS： HCC was developed in six patients during follow-up （average follow-up after HBeAg seroconversion： 10.9±5.4 years）. The incidence of HCC evaluated by Kaplan-Meier analysis was significantly higher in patients with abnormal aspartate aminotransferase （AST〉 40 IU/L） level, lower platelet counts （PLT〈10×10^4/IJL）, lower albumin level （Alb〈30 g/L）, positive HBV-DNA or older age at seroconversion （〉40 years）. However, lower platelet count was the only predictive factor for HCC development shown by multivariate proportional-hazard analysis. CONCLUSION： Active hepatitis or advanced hepatitis at HBeAg seroconversion or progressive hepatitis even after HBeAg seroconversion would be the risk factors for HCC development. These predictive factors should be taken into account in determining the frequency of biochemical study or imaging studies for HCC surveillance.

关键词： HBeAg seroconversion Hepatocellularcarcinoma Predictive factors

Portal hypertensive colopathy in patients with liver cirrhosis

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World Journal of Gastroenterology 2005年第20期11卷 3127-3130页

作者： Keiichi Ito katsuya shiraki Takahisa Sakai Hitoshi Yoshimura Takeshi Nakano First Department of Internal Medicine Mie University School of Medicine 2-174 Edobashi Tsu Mie 514-8507Japan

AIM: In patients with liver cirrhosis and portal hypertension, portal hypertensive colopathy is thought to be an important cause of lower gastrointestinal hemorrhage. In this study, we evaluated the prevalence of colonic mucosal changes in patients with liver cirrhosis and its clinical significance. METHODS: We evaluated the colonoscopic findings and liver function of 47 patients with liver cirrhosis over a 6-year period. The main cause of liver cirrhosis was post-viral hepatitis (68%) related to hepatitis B (6%) or C (62%) infection. All patients underwent upper gastrointestinal endoscopy to examine the presence of esophageal varices, cardiac varices, and congestive gastropathy, as well as a full colonoscopy to observe changes in colonic mucosa. Portal hypertensive colopathy was defined endoscopically in patients with vascular ectasia, redness, and blue vein. Vascular ectasia was classified into two types: type 1, solitary vascular ectasia; and type 2, diffuse vascular ectasia. RESULTS: Overall portal hypertensive colopathy was present in 31 patients (66%), including solitary vascular ectasia in 17 patients (36%), diffuse vascular ectasia in 20 patients (42%), redness in 10 patients (21%) and blue vein in 6 patients (12%). As the Child-Pugh class increased in severity, the prevalence of portal hypertensive colopathy rose. Child-Pugh class B and C were significantly associated with portal hypertensive colopathy. Portal hypertensive gastropathy, esophageal varices, ascites and hepatocellular carcinoma were not related to occurrence of portal hypertensive colopathy. Platelet count was significantly associated with portal hypertensive colopathy, but prothrombin time, serum albumin level, total bilirubin level and serum ALT level were not related to occurrence of portal hypertensive colopathy. CONCLUSION: As the Child-Pugh class worsens and platelet count decreases, the prevalence of portal hypertensive colopathy increases in patients with liver cirrhosis. A colonoscopi

关键词： Portal hypertensive colopathy Liver cirrhosis

Hemodynamics in the portal vein evaluated by pulse wave Doppler ultrasonography in patients with chronic hepatitis C treated with interferon

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World Journal of Gastroenterology 2005年第3期11卷 396-399页

作者： Shigeo Nakanishi katsuya shiraki Kouji Yamamoto Mutsumi Koyama Noboru Kimura Takeshi Nakano First Department of Internal Medicine Toshiba Corporation

AIM: To employ pulse wave Doppler ultrasonography to evaluate the changes in portal blood flow velocity in patients with chronic hepatitis C (CHC) receiving interferon (IFN) treatment. METHODS: The subjects in this study were 14 patients (13 men and l woman) with CHC who received IFN treatment. Portal blood flow velocity was measured in the vessels at the porta hepatis at four time points: before IFN administration (pre-IFN), 2 wk after the start of administration (wk 2), 24 wk after the start of administration (wk 24, i.e., the end of IFN administration), and 24 wk after the end of administration (wk 48). RESULTS: The patients with CHC in whom IFN treatment resulted in complete elimination or effective elimination of viruses showed a significant increase in portal blood flow velocity at the end of IFN treatment compared with that before IFN treatment. In contrast, when IFN was ineffective, no significant increase in portal blood flow velocity was observed at wk 24 or 48 compared with the pre-IFN value. In addition, the patients with CHC in whom IFN was ineffective showed significantly lower portal blood flow velocity values than control subjects at all measurement time points. CONCLUSION: Pulse wave Doppler ultrasonography is a noninvasive and easily performed method for evaluating the effects of IFN treatment in patients with CHC. This technique is useful for measuring portal blood flow velocity before and 24 wk after IFN administration in order to evaluate the changes over time, thus assessing the effectiveness of IFN treatment.

关键词： Chronic Hepatitis C Interferon Pulsed-wave Doppler ultrasonography Portal Vein Hemodynamics

Familial occurrence of congenital bile duct dilatation

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World Journal of Gastroenterology 2008年第6期14卷 941-943页

作者： Junji Iwasaki Yoshifumi Ogura Shunichi Nakagawa Kenji Kato Akinobu Kondo katsuya shiraki Department of Surgery Matsusaka City Hospital 1550 Tono-machi Matsusaka Mie 515-8544 Japan First Department of Internal Medicine Mie University School of Medicine 2-174 Edobashi Tsu Mie 514-8507 Japan

Congenital bile duct dilatation (CBD) that developed in a parent and son is presented. Familial occurrence of CBD is rare, with only a few male cases having been reported. Since the initial report of CBD occurring in siblings in 1981, a total of 20 cases (10 pairs) have been published as of 2007. Clinical and genetic features of CBD are discussed.

关键词： Congenital bile duct dilatation Familial occurrence Choledochal cyst Choledochocele Anomalous pancreaticobiliary duct junction

Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses

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World Journal of Gastroenterology 2005年第33期11卷 5248-5250页

作者： Msahiro Suzuki Kazuo Nabeshima Mitsukazu Miyazaki Hitoshi Yoshimura Shinsei Tagawa katsuya shiraki Internal Medicine Mie Prefectual Shima Hospital Japan First Department of Internal Medicine University School of Medicine Tsu 514-8507 Japan

We report on a case of Churg-Strauss syndrome (CSS)with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone,after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission.

关键词： Churg-Strauss syndrome Cholecystitis Liverabscesses

Aspartate aminotransferase-immunoglobulin complexes in patients with chronic liver disease

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World Journal of Gastroenterology 2005年第10期11卷 1529-1531页

作者： Masahiko Tameda katsuya shiraki Kinue Ooi Koujirou Takase Yoshitane Kosaka Tsutomu Nobori Yukihiko Tameda Department of Clinical Laboratory Medicine The First Department of Internal Medicine

AIM: To determine the complex of AST and immunoglobulin and to investigate its clinical significance in patients with liver ***: The complex of AST and immunoglobulin was determined by encounter immunoelectrophoresis and its clinical significance was investigated in 128 patients with liver ***: AST was bound to immunoglobulin of antiimmunoglobulin A (IgA) class, but any binding to antiimmunoglobulin G and anti-immunoglobulin M classes was not observed. Although the incidence of ASTimmunoglobulin complex was 41.8% in chronic hepatitis (CH), the incidences in liver cirrhosis and hepatocellular carcinoma were 62.2 and 90.0%, respectively. In alcoholic liver disease with high level of serum IgA, the incidence of the complex was 66.7%, which was higher than that in CH. The ratio of binding to lambda-chain of IgA was higher than that to kappa-chain of IgA. The serum level of IgA and the ratio of AST/alanine aminotransferase (ALT) were significantly higher in patients with AST-IgA complex than in those without ***: These results suggest that AST-IgA complex in patients with progressive liver diseases and alcoholic liver injury can lead to elevation of the ratio of AST/ALT.

关键词： Alcoholic liver disease Aspartate aminot-ransferase AST/ALT Chronic hepatitis Chronic liver disease Hepatocellular carcinoma Immunoglobulin Liver cirrhosis

1.5 Harmonic Imaging Sonography with microbubble contrast agent improves characterization of hepatocellular carcinoma

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World Journal of Gastroenterology 2005年第36期11卷 5607-5613页

作者： Kouji Yamamoto katsuya shiraki Shigeo Nakanishi Hiroyuki Fuke Takeshi Nakano Akira Hashimoto Atsuya Shimizu Toshinobu Hamataki First Department of Internal Medicine Mie University School of Medicine Tsu Mie 514-8507 Japan Department of Internal Medicine Saiseikai Matsusaka General Hospital Matsusaka Mie 515-8557 Japan Sales Engineering Department Toshiba Medical Systems Corporation Nagoya Aichi 450-0003 Japan

AIM： TO investigate the usefulness of 1.5 Harmonic Imaging Sonography with the use of the contrast agent Levovist for the diagnosis of hepatocellular carcinoma （HCC） and for the evaluation of therapeutic response. METHODS： Phantom experiments were performed to compare the contrast effects of 2^rd harmonic imaging and 1.5 Harmonic Imaging Sonography. 1.5 Harmonic Imaging Sonography was employed to examine 36 patients with HCC （42 nodules） before and after the treatment and to compare against the findings obtained using other diagnostic imaging modaUties. RESULTS： In 1.5 Harmonic Imaging Sonography, the tumor vessels of HCCs were clearly identified during the early phase, and late-phase images clearly demonstrated the differences in contrast enhancement between the tumor and surrounding hepatic parenchyma. Blood flow within the tumor was detected in 36 nodules （85.7%） during the early phase and in all 42 nodules （100%） during the late phase using 1.5 Harmonic Imaging Sonography, in 38 nodules （90.5%） using contrast-enhanced CT, in 34 nodules （81.0%） using digital subtraction angiography （DSA）, and in 42 nodules （100%） using US CO2angiography. Following transcatheter arterial embolization, 1.5 Harmonic Imaging Sonography detected blood flow and contrast enhancement within the tumors that were judged to contain viable tissue in 20 of 42 nodules （47.6%）. However, 6 of these 20 cases were not judged in contrastenhanced CT. 1.5 Harmonic Imaging Sonography was compared with the US CO2 angiography findings as the gold standard, and the sensitivity and specificity of these images for discerning viable and nonviable HCC after transcatheter arterial embolization were 100% and 100%,respectively. CONCLUSION： 1.5 Harmonic Imaging Sonography permits the vascular structures of HCCs to be identified and blood flow within the tumor to be clearly demonstrated. Furthermore, 1.5 Harmonic Imaging Sonography is potentially useful for evaluating the therapeutic effects of transcatheter arte

关键词： 1.5 Harmonic imaging sonography Hepatocellular carcinoma Microbubble

Noninvasive estimation of liver fibrosis and response to interferon therapy by a serum fibrogenesis marker, YKL-40, in patients with HCV-associated liver disease

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World Journal of Gastroenterology 2005年第4期11卷 476-481页

作者： Yukiko Saitou katsuya shiraki Yutaka Yamanaka Yumi Yamaguchi Tomoyuki Kawakita Norihiko Yamamoto Kazushi Sugimoto Kazumoto Murata Takeshi Nakano First Department of Internal Medicine Mie University School of Medicine TsuMie 514-8507Japan

AIM: To evaluate the clinical utility of serum fibrosis markers, including YKL-40, in patients with HCV-associated liver disease. METHODS: A total of 109 patients with HCV-associated liver disease were enrolled. We measured serum type IV collagen, amino-terminal peptide of type III procollagen (PIIIP), hyaluronic acid (HA), YKL-40 levels and biochemical. Parameters by RIA or ELISA. Eighty-eight patients underwent liver biopsy, and 67 of 109 patients received interferon (IFN) therapy. We also investigated the relationship between the concentrations of serum fibrosis markers and histological fibrosis scores (METAVIR), and evaluated the changes of the levels of fibrosis markers before and after the IFN therapy. RESULTS: The increase in serum levels of all markers, particularly HA, was correlated with the progression of liver fibrosis (for type IV collagen, F= 9.076, P<0.0001; for PIIIP, F= 9.636, P<0.0001; for HA, F=13.128, P<0.0001; and for YKL-40, F= 8.016, P<0.0001). YKL-40 had strong correlation with HA (r= 0.536, P<0.0001). Based on the receiver operating curve (ROC), the ability of serum HA exceeded the abilities of other serum markers to determine fibrosis score 4 from fibrosis score 0-3 (AUC = 0.854). While YKL-40 was superior to other fibrosis markers for predicting severe fibrosis (F2-F4) from mild fibrosis (FO-F1) (YKL-40, AUC = 0.809; HA, AUC = 0.805). After IFN therapy, only YKL-40 values significantly decreased not only in the responder group, but also in the nonresponder group (P = 0.03). CONCLUSION: YKL-40 may be a useful non-invasive serum marker to estimate the degree of liver fibrosis and to evaluate the efficacy of IFN therapies in patients with HCV-associated liver disease.

关键词： HCV Liver fibrosis YKL-40 Interferon