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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：肝动脉综合症病理机制胆管栓塞胃部疾病

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 forhepatocellular carcinoma (HCC) development in patientsafter spontaneous or therapeutic HBeAg seroconversion.METHODS: In 48 patients who seroconverted to anti-HBe positive during follow-up, the background factors forHCC development were analyzed.RESULTS: HCC was developed in six patients duringfollow-up (average follow-up after HBeAg seroconversion:10.9±5.4 years). The incidence of HCC evaluated byKaplan-Meier analysis was significantly higher in patientswith abnormal aspartate aminotransferase (AST＞40 IU/L) level, lower platelet counts (PLT＜10×104/μL),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 肝细胞癌血清转化乙型肝炎

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 porlal 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 colonoscopic examination in patients with liver cirrhosis is

关键词：高血压手术入口肝硬化病理机制血小板

An anomaly in persistent right umbilical vein of portal vein diagnosed by ultrasonography

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World Journal of Gastroenterology 2005年第8期11卷 1179-1181页

作者： Shigeo Nakanishi Katsuya Shiraki Kouji Yamamoto Mutsumi Koyama takeshi nakano First Department of Internal Medicine Matsusaka Central General Hospital of Medicine

AIM: To detect the anomaly in the persistent right umbilical vein (PRUV) of portal vein (PV) with deviation of the ligamentum tere and left-sided gallbladder.METHODS: A total of 5783 candidates for routine analysis were evaluated for hepatic vascular abnormalities by ultrasonography.RESULTS: Ten candidates (0.17%) had a portal vein anomaly with a rightward-deviated ligamentum tere.The blood-flow velocity in the PRUV of the portal vein (17.7±3.0 cm/s) of the 10 cases was similar to that of the right anterior portal trunk (17.6±4.1 cm/s). However,the vessel diameter of the PRUV (ψ12.4±4.4 mm) was larger than the right anterior portal trunk (ψ6.1±0.9 mm).Therefore, flow volume in the anomalous portion (0.97±0.30 L/min) was more than that in the right anterior portal trunk (0.18±0.05 L/min).CONCLUSION: The anomaly plays an important role in intra-hepatic PV flow.

关键词：脐带血管超声检查肝门静脉胆囊韧带

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 1 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 bloocl 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：血流动力学血管入口脉搏多普勒超生诊断法慢性丙型肝炎干扰素 CHC

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 2nd 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 modalities. 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 34nodules (81.0%) using digital subtraction angiography (DSA), and in 42 nodules (100%) using US CO2angiography.Following transcatheter arterial embolization, 1.5Harmonic 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 arterial embolization on HCC.

关键词： 1.5谐波成像超声检查肝细胞癌临床表现

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 (F0-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： HA HCV IFN AUC ROC PⅢP RIA AIM

Primary biliary cirrhosis after aortoiliac reconstruction surgery using a Y-graft: A case report

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World Journal of Gastroenterology 2005年第39期11卷 6219-6220页

作者： Tomoko Inoue Katsuya Shiraki Hiroyuki Fuke Yutaka Yamanaka Kazumi Miyashita Keiichi Ito Masahiro Suzuki Kazushi Sugimoto Kazumoto Murata takeshi nakano First Department of Internal Medicine Mie University School of Medicine 2-174 EdobashiTsuMie 514-8507Japan

Primary biliary cirrhosis (PBC) is an autoimmune disease characterized by anti-mitochondrial antibodies and destruction of intra-hepatic bile ducts. Though little is known about the etiology of PBC, some reports suggest that xenobiotics and viral infections may induce PBC. We describe a case of PBC after the aortoiliac reconstruction surgery using a Y-graft.

关键词：原发性胆硬化腹主动脉骼动脉 Y-移植手术病例报告

Basket pattern blood flow signals discovered in a case of splenic hamartoma by power Doppler ultrasonography

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World Journal of Gastroenterology 2005年第33期11卷 5235-5238页

作者： Shigeo Nakanishi Katsuya Shiraki Kouji Yamamoto takeshi nakano Mutsumi Koyama Takatsugu Yano Takayuki Sanda Hisao Tamaki Tadanori Hirano Kazuo Fukudome Akinori Ishihara First Department of Internal Medicine Mie University School of Medicine Tsu Mie 514-8507 Japan Department of Internal Medicine Matsusaka General Hospital Matsusaka Mie 102 Japan First Department of Internal Medicine Mie University School of Medicine TsuMie 514-8507Japan Department of Internal Medicine Matsusaka General Hospital Matsusaka Mie 102 Japan Department of Surgery Matsusaka General Hospital Matsusaka Mie 102 Japan Tadanori Hirano Department of Radiology Matsusaka General Hospital Matsusaka Mie 102 Japan First Department of Internal Medicine Mie University School of Medicine Tsu Mie 514-8507 Japan Department of Pathology Matsusaka General Hospital Matsusaka Mie 102 Japan

We present the gray-scale ultrasonography (GSUS), power Doppler ultrasonography (PDUS), abdominal computed tomography (CT), and magnetic resonance imaging (MRI) findings for a case of splenic hamartoma in a 27-year-old man, showing a ψ 50 mm homogeneous, iso- and hypo-echoic splenic mass with evidence of a small plural cystic lesion.This splenic hamartoma showed increased vascularity on power Doppler sonograms. PDUS showed multiple circular blood flow signals inside the mass (i.e. a basket pattern),which was consistent with the small plural cystic lesion shown by GSUS. Spectral analysis also confirmed arterial and venous flow. CT scans showed that the mass had lowdensity relative to the normal spleen and MRI showed that the mass was isodense, relative to the normal spleen.Therefore, CT and MRI are not useful for the diagnosis of splenic hamartoma. Ultrasonography can be used to diagnose splenic hamartoma without administration of a contrast material and therefore is an indispensable method for the diagnosis of splenic hamartoma.

关键词：血液流动信号脾脏错构瘤多普勒超声波检查 CT检查 MRI检查