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Clinically diagnosed late-onset fulminant Wilson's disease without cirrhosis: A case report

World Journal of Gastroenterology 2018年第2期24卷 290-296页

作者： Takahiro Amano Tokuhiro Matsubara Tsutomu Nishida Hiromi Shimakoshi Akiyoshi Shimoda Aya Sugimoto Kei Takahashi Kaori Mukai Masashi Yamamoto Shiro Hayashi sachiko nakajima Koji Fukui Masami Inada Department of Gastroenterology and Hepatology Toyonaka Municipal Hospital

A 64-year-old woman was referred to our hospital with jaundice of the bulbar conjunctiva and general fatigue. After admission, she developed hepatic encephalopathy and was diagnosed with fulminant hepatitis based on the American Association for the Study of Liver Disease(AASLD) position paper. Afterwards, additional laboratory findings revealed that serum ceruloplasmin levels were reduced, urinary copper levels were greatly elevated and Wilson's disease(WD)-specific routine tests were positive, but the Kayser-Fleischer ring was not clear. Based on the AASLD practice guidelines for the diagnosis and treatment of WD, the patient was ultimately diagnosed with fulminant WD. Then, administration of penicillamine and zinc acetate was initiated; however, the patient unfortunately died from acute pneumonia on the 28 th day of hospitalization. At autopsy, the liver did not show a bridging pattern of fibrosis suggestive of chronic liver injury. Here, we present the case of a patient with clinically diagnosed late-onset fulminant WD without cirrhosis, who had positive disease-specific routine tests.

关键词： Wilson’s disease Fulminant hepatitis Lateonset Liver cirrhosis Copper

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Impact of time from diagnosis to chemotherapy in advanced gastric cancer: A Propensity Score Matching Study to Balance Prognostic Factors

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World Journal of Gastrointestinal Oncology 2019年第1期11卷 28-38页

作者： Tsutomu Nishida Aya Sugimoto Ryo Tomita Yu Higaki Naoto Osugi Kei Takahashi Kaori Mukai Tokuhiro Matsubara Dai Nakamatsu Shiro Hayashi Masashi Yamamoto sachiko nakajima Koji Fukui Masami Inada Department of Gastroenterology Toyonaka Municipal Hospital

BACKGROUND It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer(A-GC).AIM To assess whether treatment delay affects the clinical outcomes of chemotherapy in *** This single-center retrospective study examined consecutive patients with A-GC between April 2012 and July 2018. In total, 110 patients with stage Ⅳ A-GC who underwent chemotherapy were enrolled. We defined the wait time(WT) as the interval between diagnosis and chemotherapy initiation. We evaluated the influence of WT on overall survival(OS).RESULTS The mean OS was 303 d. The median WT was 17 d. We divided the patients into early and elective WT groups, with a 2-wk cutoff point. There were 46 and 64 patients in the early and elective WT groups, respectively. Compared with the elective WT group, the early WT group had significantly lower albumin(Alb)levels and higher neutrophil/lymphocyte ratios and C-reactive protein(CRP)levels but not a lower performance status. The elective WT group underwent more combination chemotherapy than did the early WT group. OS was different between the two groups(230 d vs 340 d, respectively). Multivariate analysis revealed that higher CRP levels, lower Alb levels and monotherapy were significantly related to a poor prognosis. To minimize potential selection bias,patients in the elective WT group were 1:1 propensity score matched with patients in the early WT group; no significant difference in OS was found(303 d vs 311 d, respectively, log-rank P = 0.9832).CONCLUSION A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.

关键词： Advanced gastric cancer Waiting time Chemotherapy Prognosis Overall survival

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Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

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World Journal of Gastrointestinal Endoscopy 2016年第20期8卷 777-784页

作者： Shiro Hayashi Tsutomu Nishida Hiromi Shimakoshi Akiyoshi Shimoda Takahiro Amano Aya Sugimoto Kei Takahashi Kaori Mukai Tokuhiro Matsubara Masashi Yamamoto sachiko nakajima Koji Fukui Masami Inada Department of Gastroenterology and Hepatology Toyonaka Municipal Hospital

AIM To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography(ERCP) serum amylase levels and other factors for predicting postERCP *** This was a retrospective,single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December *** amylase levels were measured 2 h post-procedure,and patient- and procedure-related pancreatitis(PEP) risk factors wereanalyzed using a logistic *** A total of 1520 cases(average age 72 ± 12 years,60% male) were initially enrolled in this study,and 1403 cases(725 patients) were ultimately analyzed after the exclusion of 117 ***-five of these cases developed *** established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting *** analysis revealed that a cannulation time of more than 13 min [odds ratio(OR) 2.28,95%CI:1.132-4.651,P=0.0210] and 2 h amylase levels greater than the cutoff level(OR=24.1,95%CI:11.56-57.13,P<0.0001) were significant predictive factors for ***-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level(85%),and six of the remaining eight patients who developed PEP(75%) required longer cannulation *** 2 of the 1403 patients(0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation *** These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP.

关键词： Serum amylase levels Cannulation time Post-endoscopic retrograde cholangiopancreatography pancreatitis Predictor

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