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Rupture of small cystic pancreatic neuroendocrine tumor with many microtumors

World Journal of Gastroenterology 2017年第37期23卷 6911-6919页

作者： Ryota Sagami Hidefumi Nishikiori Shoichiro Ikuyama kazunari murakami Department of Gas--troenterology Oita San-ai Medical Center Department of Internal Medicine and Clinical Investigation Oita San-ai Medical Center Department of Gastroenterology Faculty of Medicine Oita University

Pancreatic neuroendocrine tumors(p NETs) are particularly rare. The various forms of PNETs, such as cystic degeneration, make differentiation from other similar pancreatic lesions difficult. We can detect small lesions by endoscopic ultrasound(EUS) and obtain preoperative pathological diagnosis by EUS-guided fine needle aspiration(FNA). We describe, here, an interesting case of p NET in a 42-year-old woman with no family history. Computed tomography and magnetic resonance imaging revealed an 18 mm × 17 mm cystic lesion with a nodule in the pancreatic tail. Two microtumors about 7 mm in diameter in the pancreatic body detected only by EUS, cystic rim and nodules all showed similar enhancement on contrast-harmonic EUS. Preoperative EUS-FNA of the microtumor was performed, diagnosing multiple p NETs. Macroscopic examination of the resected pancreatic body and tail showed that the cystic lesion had morphologically changed to a 13-mm main nodule, and 11 new microtumors(diameter 1-3 mm). Microscopically, all microtumors represented p NETs. From the findings of a broken peripheral rim on the main lesion with fibrosis, rupture of the cystic p NET was suspected. Postoperatively, pituitary adenoma and parathyroid adenoma were detected. The final diagnosis was multiple grade 1 p NETs with multiple endocrine neoplasia type 1. To the best of our knowledge, no case of spontaneous rupture of a cystic p NET has previously been reported in the English literature. Therefore, this case of very rare p NET with various morphological changes is reported.

关键词： Rupture Cystic pancreatic neuroendocrinetumor MEN1 NET Microtumor

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COVID-19 vaccination and liver disease

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World Journal of Gastroenterology 2022年第48期28卷 6791-6810页

作者： Sotaro Ozaka Takashi Kobayashi Kazuhiro Mizukami kazunari murakami Department of Gastroenterology Faculty of MedicineOita UniversityYufu 879-5593OitaJapan Department of Infectious Disease Control Faculty of MedicineOita UniversityYufu 879-5593OitaJapan

Various vaccines against severe acute respiratory syndrome coronavirus 2 have been developed in response to the coronavirus disease 2019(COVID-19)global pandemic,several of which are highly effective in preventing COVID-19 in the general *** with chronic liver diseases(CLDs),particularly those with liver cirrhosis,are considered to be at a high risk for severe COVID-19 and *** the increased rates of disease severity and mortality in patients with liver disease,there is an urgent need to understand the efficacy of vaccination in this ***,the data regarding efficacy and safety of COVID-19 vaccination in patients with CLDs is ***,several organ-specific or systemic immune-mediated side effects following COVID-19 vaccination,including liver injury similar to autoimmune hepatitis,have been recently *** the number of cases of vaccine-related liver injury is increasing,its frequency,clinical course,and mechanism remain ***,we review the current findings on COVID-19 vaccination and liver disease,focusing on:(1)The impact of COVID-19 in patients with CLD;(2)The efficacy,safety,and risk-benefit profiles of COVID-19 vaccines in patients with CLD;and(3)Liver injury following COVID-19 vaccination.

关键词： COVID-19 vaccine Liver disease Side effect Liver injury Immune-related hepatitis Autoimmune hepatitis

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Disease trends after Helicobacter pylori eradication based on Japanese nationwide claims and the health check-up database

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World Journal of Gastroenterology 2023年第4期29卷 692-705页

作者： Kazuhiro Mizukami Kentaro Sugano Tomomi Takeshima kazunari murakami Department of Gastroenterology Oita UniversityOita 8795593Japan Department of Medicine Jichi Medical UniversityTochigi 3290498Japan Milliman Inc. Tokyo 1020083Japan

BACKGROUND Helicobacter pylori(***)infection is a risk factor for many diseases,including peptic ulcer disease and gastric *** *** eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic ***,both positive and negative impacts should be considered when assessing the effects of *** eradication *** To compare the incidence of these diseases before and after *** eradication and to comprehensively assess its *** This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and *** database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the *** statistics were used for the *** who received primary eradication therapy were defined as those prescribed medication for *** *** diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after *** incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and *** in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after *** We identified 5219731 patients who received primary eradication *** 65-69 years age group had the greatest number of patients in both *** was no significant increase in the incidence

关键词： Administrative claims Healthcare Allergy Eradication therapy Gastroesophageal reflux disease Helicobacter pylori Inflammatory bowel disease

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Latest insights into the effects of Helicobacter pylori infection on gastric carcinogenesis

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World Journal of Gastroenterology 2006年第17期12卷 2713-2720页

作者： kazunari murakami Masaaki Kodama Toshio Fujioka Department of Gastroenterology Oita University Faculty of Medicine OitaJapan

There appears to be the strong association between Helicobacter pylori （H pylori） and gastric cancer. We reviewed the latest evidences about the effects of H pylori infection on gastric carcinogenesis, classified into epidemiology, dynamics of gastric mucosal changes, DNA damages, virulence factors, host factors, and source of gastric malignancy. Through the considerable progress made in research into virulence factors resulting from differences between Hpylori strains, such as cagA positivity, as well as into host factors, such as gene polymorphisms, a diverse spectrum of H pyloriassociated diseases, including gastric cancer, is beginning to lend itself to elucidation. The impact of the novel hypothesis advanced by Houghton et al proposing bonemarrow derived stem cells （BMDC） as a potential source of gastric malignancy on evolving research remains to be seen with interest. Further progress in research into H pylori eradication as a viable prophylaxis of gastric cancer, as well as into the mechanisms of gastric carcinogenesis, is to be eagerly awaited for the current year and beyond.

关键词： Helicobacterpylori Gastric cancer Carcinogenesis CagA Intestinal metaplasia

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Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

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World Journal of Gastroenterology 2016年第40期22卷 9028-9034页

作者： Kazumi Togo Tetsuya Ueo Hirotoshi Yonemasu Hideho Honda Tetsuya Ishida Hiroshi Tanabe Kenshi Yao Akinori Iwashita kazunari murakami Departments of Gastroenterology Oita Red Cross Hospital Departments of Pathology Oita Red Cross Hospital Department of Pathology Fukuoka University Chikushi Hospital Department of Endoscopy Fukuoka University Chikushi Hospital Department of Gastroenterology Faculty of Medicine Oita University

Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.

关键词： Sporadic type Adenocarcinoma Magnifying endoscopy with narrow band imaging Adenocarcinoma without Helicobacter pylori infection Fundic gland polyp

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Monomorphic epitheliotropic intestinal T-cell lymphoma presenting as melena with long-term survival: A case report and review of literature

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World Journal of Gastroenterology 2021年第38期27卷 6501-6510页

作者： Sotaro Ozaka Kunimitsu Inoue Tomoya Okajima Takako Tasaki Shimpei Ariki Hideki Ono Takeaki Ando Tsutomu Daa kazunari murakami Department of Gastroenterology Faculty of MedicineOita UniversityOita 879-5593Japan Department of Gastroenterology Almeida Memorial HospitalOita 870-1195Japan Department of Hematology Almeida Memorial HospitalOita 870-1195Japan Department of Diagnostic Pathology Oita UniversityOita 879-5593Japan

BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare primary intestinal T-cell lymphoma,previously known as enteropathy-associated T-cell lymphoma type *** is an aggressive T-cell lymphoma with a poor prognosis and high mortality *** known major complications of MEITL are intestinal perforation and ***,we present a case of MEITL that was diagnosed following upper gastrointestinal bleeding from an ulcerative duodenal lesion,with recurrence-free survival for 5 *** SUMMARY A 68-year-old female was admitted to our hospital with melena and mild *** urgent esophagogastroduodenoscopy(EGD)revealed bleeding from an ulcerative lesion in the transverse part of the duodenum,for which hemostatic treatment was *** was diagnosed following repeated biopsies of the lesion,and cyclophosphamide,doxorubicin,vincristine,and prednisone(CHOP)chemotherapy was *** achieved complete remission after eight full cycles of CHOP *** the last follow-up examination,EGD revealed a scarred ulcer and 18Fluorodeoxyglucose(18FDG)positron emission tomography/computed tomography showed no abnormal FDG *** patient has been in complete remission for 68 mo after initial *** To rule out MEITL,it is important to carefully perform histological examination when bleeding from a duodenal ulcer is observed.

关键词： Monomorphic epitheliotropic intestinal T-cell lymphoma Enteropathyassociated T-cell lymphoma type II Gastrointestinal bleeding Intestinal lymphoma Duodenal ulcer Case report

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Expression of mutant type-p53 products in H pylori-associated chronic gastritis

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World Journal of Gastroenterology 2007年第10期13卷 1541-1546页

作者： Masaaki Kodama kazunari murakami Tadayoshi Okimoto Ryugo Sato Koichiro Watanabe Toshio Fujioka Department of Gastroenterology Faculty of MedicineOita UniversityHasama-machiOita879-5593Japan

AIM： To investigate the mutation of p53 immunohistochemically in non-tumorous gastric mucosa with H pylori infection before and aEer H pylori eradication therapy. METHODS： 53 subjects （36 male, 17 female, mean age ± SEM, 57.1 ± 12.1） undergoing endoscopic examination were included in this study. 42 of 53 patients were H pylori-positive, and 11 were H pylorinegative. All H pylori-positive patients had successful eradication therapy. Biopsy specimens were taken from five points of the stomach, as recommended by the updated Sydney system. Immunohistochemical studies were performed by using primary antibodies against p53 （DO-7 and PAb240）. RESULTS： p53 （DO-7 and PAb240） immunoreactivity was shown in the neck region of the gastric pits, however, quite a few cells were found to be immunopositive for p53 （PAb240）in the Hpylori-infected gastric mucosa. The proportion of patients immunopositive for p53 （PAb240） was significantly reduced 6 mo after eradication [28/42 （66.7%） to 6/42 （14.3%）] （P 〈 0.05）, while the biopsies taken from H pylori-negative patients showed no immunoreactivity for p53 （PAb240）. p53 （PAb240）-positive patients were divided into two groups by the number of positive cells detected： one with more than six positive cells per 10 gastric pits （group A, n = 12）, and the other with less than five positive cells per 10 gastric pits （group B, n = 30）. Atrophy scores in group A were significant higher than those in group B at the greater curvature of the antrum （group A： 2.00 ± 0.14 vs group B： 1.40 ± 0.15, P = 0.012）, the lesser curvature of the corpus （group A： 2.00 ± 0.21 vs group B： 1.07 ± 0.23, P = 0.017）, and the greater curvature of the corpus （group A： 1.20 ± 0.30 vs group B： 0.47 ±0.21, P = 0.031）. Group A showed significant higher intestinal metaplasia scores than group B only at the lesser curvature of the antrum （group A： 2.10 ± 0.41 vs group B： 1.12 ± 0.29, P = 0.035）. CONCLUSION： H pylori-associated chronic gastritis expressed the mutant-type p53, w

关键词： H pylori H pylori eradication Atrophic gastritis Mutant-type p53 Gastric cancer Updated Sydney system

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Helicobacter pylori-infected animal models are extremely suitable for the investigation of gastric carcinogenesis

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World Journal of Gastroenterology 2005年第45期11卷 7063-7071页

作者： Masaaki Kodama kazunari murakami Ryugo Sato Tadayoshi Okimoto Akira Nishizono Toshio Fujioka Department of Gastroenterology Department of Infectious Diseases (Microbiology)

Although various animal models have been developed to clarify gastric carcinogenesis, apparent mechanism of gastric cancer was not clarified in recent years. Since the recognition of the pathogenicity of Helocobacter pylori（H pylori）, several animal models with H pylori infection have been developed to confirm the association between Hpylori and gastric cancer. Nonhuman primate and rodent models were suitable for this study. Japanese monkey model revealed atrophic gastritis and p53 mutation after long-term infection of Hpylori. Mongolian gerbil model showed the development of gastric carcinoma with H pylori infection alone, as well as with combination of chemical carcinogens, such as N-methyl- N-nitrosourea and N-methyl-N-nitro-N＇-nitrosoguanidine. The histopathological changes of these animal models after H pylori inoculation are closely similar to those in human beings with Hpylori infection. Eradication therapy attenuated the development of gastric cancer in Hpylori- infected Mongolian gerbil. Although several features of animal models differ from those seen in human beings, these experimental models provide a starting point for further studies to clarify the mechanism of gastric carcinogenesis as a result of Hpylon infection and assist the planning of eradication therapy to prevent gastric carcinoma.

关键词： Helicobacter pylori Gastric carcinoma Animal model Japanese monkey Mongolian gerbil

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Aspirin-induced small bowel injuries and the preventive effect of rebamipide

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World Journal of Gastroenterology 2011年第46期17卷 5117-5122页

作者： Kazuhiro Mizukami kazunari murakami Takashi Abe Kunimitsu Inoue Masahiro Uchida Tadayoshi Okimoto Masaaki Kodama Toshio Fujioka Department of General Medicine and Gastroenterology Faculty of MedicineOita University

AIM:To evaluate the influence of taking low-dose aspirin for 4 wk on small intestinal complications and to examine the preventive effect of ***:This study was conducted as a single-center,randomized,double-blind,cross-over,placebo-controlled *** healthy male subjects were *** subject underwent video capsule endos-copy after 1 and 4 wk of taking aspirin and omepra-zole,along with either rebamipide or placebo *** primary endpoint was to evaluate small bowel damage in healthy subjects before and after taking low-dose aspirin for 4 ***:The number of subjects with mucosal breaks(defined as multiple erosions and/or ulcers)were 1 at 1 wk and 1 at 4 wk on the jejunum,and 6 at 1 wk(P = 0.0061)and 7 at 4 wk on the ileum(P =0.0019).Rebamipide significantly prevented mucosal breaks on the ileum compared with the placebo group(P = 0.0173 at 1 wk and P = 0.0266 at 4 wk).CONCLUSION:Longer-term,low-dose aspirin adminis-tration induced damage in the small *** prevented this damage,and may be a candidate drug for treating aspirin-induced small bowel complications.

关键词： Healthy subjects Low-dose aspirin Smallbowel injury Capsule endoscopy Rebamipide

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Influence of proton pump inhibitor treatment on Helicobacter pylori stool antigen test

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World Journal of Gastroenterology 2012年第1期18卷 44-48页

作者： Masaaki Kodama kazunari murakami Tadayoshi Okimoto Yoshihiro Fukuda Tadashi Shimoyama Masumi Okuda Chieko Kato Intetsu Kobayashi Toshio Fujioka Department of Gastroenterology Faculty of Medicine Oita University Faculty of Medicine Hasama Division Health Science Center Oita University General Medicine and Community Health Science Hyogo College of Medicine Department of Gastroenterology Hirosaki University Graduate School of Medicine Toyama City Medical Association Health Management Center Department of Microbiology Toho University

AIM: To investigate the effects of proton pump inhibitor (PPI) treatment on stool antigen test using the TestMate pylori enzyme immunoassay. METHODS: This study assessed 28 patients [16 men and 12 women; mean age (63.1 ± 5.9) years; range, 25-84 years] who underwent stool antigen test and urea breath test (UBT) before and after PPI administration. RESULTS: Using the UBT as the standard, the sensitivity, specif icity and agreement of the stool antigen test in all 28 patients were 95.2%, 71.4%, and 89.3%, respectively, before PPI administration, and 88.9%, 90.9%, and 89.3%, respectively, after PPI treatment. Mean UBT values were 23.98% ± 5.33% before and 16.19% ± 4.75% after PPI treatment and, in 15 patients treated for ≥ 4 wk, were signif icantly lower after than before 4 wk of PPI treatment (12.58% ± 4.49% vs 24.53% ± 8.53%, P = 0.048). The mean optical density (A450/630) ratios on the stool antigen test were 1.16 ± 0.20 before and 1.17 ± 0.24 after PPI treatment (P = 0.989), and were 1.02 ± 0.26 and 0.69 ± 0.28, respectively, in the group treated for > 4 wk (P = 0.099).

关键词： Helicobacter pylori Stool antigen test Urea breath test Proton pump inhibitor

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