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Gastrointestinal polyposis with esophageal polyposis is useful for early diagnosis of Cowden's disease

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World Journal of Gastroenterology 2008年第37期14卷 5755-5759页

作者： Ken Umemura Sho Takagi Yasushi Ishigaki Masahiro Iwabuchi Shigeru Kuroki Yoshitaka Kinouchi Tooru Shimosegawa Division of Gastroenterology Tohoku University Graduate School of MedicineSendai 980-8574 Japan Division of Molecular Metabolism and Diabetes Tohoku University Graduate School of MedicineSendai 980-8574 Japan Department of Gastroenterology Sendai Medical CenterSendai 980-8574 Japan Department of Dermatology Kurihara Central HospitalKurihara 228-0014 Japan

Cowden's disease, one of the several hamartoma syndromes, is characterized by hyperplastic lesions and hamartomas distributed in the whole body. About thirty percent of patients with Cowden's disease have been reported to be complicated by malignant tumors. Based on the criteria of the International Cowden Consortium, this disease is mainly diagnosed as trichilemmoma of the face and oral mucosal papillomatosis. However, Cowden's disease patients themselves often do not recognize trichilemmoma of the face and oral mucosal papillomatosis. We report a case of Cowden's disease in a 33-year-old female patient who was diagnosed based on the characteristic findings at gastrointestinal endoscopy. Clinically, the patient was aware of having bloody stools. Multiple polyps found endoscopically in the esophagus, stomach, ileum, colon and rectum showed histopathologically hamartomatous changes and epithelial hyperplasia. Physical examination revealed oral papillomatosis and facial trichilemmomas. A germline mutation in exon 8 of the phosphatase and tensin homolog deleted on chromosome ten (PTEN) gene was found in this case. It was a point mutation of C to T at codon 1003 (CGA→TGA, arginine→stop codon). The characteristic findings on gastrointestinal endoscopy led us to a diagnosis of Cowden's disease. It has been reported that gastrointestinal polyposis with esophageal polyposis is found in about 85.7% of Japanese patients with Cowden's disease. The characteristic findings on gastrointestinal endoscopy can be a useful diagnostic clue to Cowden's disease.

关键词：胃肠息肉食管息肉早期诊断错构瘤

Criteria for the diagnosis and severity stratification of acute pancreatitis

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World Journal of Gastroenterology 2013年第35期19卷 5798-5805页

作者： Makoto Otsuki Kazunori Takeda Seiki Matsuno Yasuyuki Kihara Masaru Koizumi Masahiko Hirota Tetsuhide Ito Keisho Kataoka Motoji Kitagawa Kazuo Inui Yoshifumi Takeyama Kitasuma hospital University of Occupational and Environmental Health Japan School of Medicine Department of Surgery National Hospital Organization Sendai Medical Center Towada Shiritsu central hospital Department of Gastroenterology Kitakyushu Central Hospital kurihara central hospital Kumamoto Regional Medical Center Health Care Center Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu University Otsu Municipal hospital Department of Nutritional Science Nagoya University of Arts and Sciences Department of Internal Medicine Second Teaching HospitalFujita Health University School of Medicine Department of Surgery Kinki University School of Medicine

Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality *** further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as *** Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical *** can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity ***,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk ***,CE-CT scans are not necessarily required to evaluate the severity of acute *** was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity *** the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.

关键词： Severe acute pancreatitis Severity score Scoring system Prognostic factors Case-mortality

Recovery from Out-of-hospital Cardiopulmonary Arrest Due to Type A Acute Aortic Dissection: A Case Report

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Case Reports in Clinical Medicine 2016年第11期5卷 505-510页

作者： Yoko Sugawara Tomohiro kurihara Satoshi Ohtsubo Masanori Takamatsu Kenichiro Sasao Motojiro Takebe Shiho Irino Mirai Takahashi Takashi Hirotani Kazuhiko Sekine Department of Emergency and Critical Care Medicine Tokyo Saiseikai Central Hospital Tokyo Japan Department of Cardiovascular Surgery Tokyo Saiseikai Central Hospital Tokyo Japan

Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.

关键词： Aortic Branch Artery Occlusion Cerebral Ischemia Malperfusion Prognosis Surgical Indication

Endoscopic papillary large balloon dilation for removal of bile duct stones

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World Journal of Gastroenterology 2014年第45期20卷 17148-17154页

作者： Yuji Sakai Toshio Tsuyuguchi Yoshiaki Kawaguchi Nobuto Hirata So Nakaji Katsuya Kitamura Shigeru Mikami Tatsuya Fujimoto Masashi Ijima Eishin kurihara Shuhei Oana Takayoshi Nishino Ryo Tamura Dai Sakamoto Masato Nakamura Takao Nishikawa Harutoshi Sugiyama Hitoshi Yoshida Tetsuya Mine Osamu Yokosuka Department of Gastroenterology and Nephrology Graduate School of Medicine Chiba University Department of Gastroenterology Tokai University Hospital Department of Gastroenterology Kameda Medical Center Division of Gastroenterology Department of Medicine Showa University School of Medicine Department of Internal Medicine Kikkoman General Hospital Department of Gastroenterology Kimitsu Central Hospital Department of Gastroenterology Isesaki Municipal Hospital Department of Gastroenterology Iwate Medical University Hospital Department of Gastroenterology Tokyo Women’s Medical University Yachiyo Medical Center

AIM:To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation(EPLBD)for bile duct stones in a multicenter prospective ***:Lithotomy by EPLBD was conducted in 124patients with bile duct stones≥13 mm in size or with three or more bile duct stones≥10 *** endoscopic sphincterotomy,the papilla was dilated using balloons 12-20 mm in diameter fitting the bile duct ***:The success rate of first-time lithotomy was 86.3%(107/124)and the final lithotomy success rate was 100%(124/124).Lithotripsy was needed in10 of the 124(13.6%)*** events due to the treatment procedure occurred in 6(4.8%)patients,all of which were *** large balloon dilation after endoscopic sphincterotomy in patients with large stones or multiple stones in the bile duct is considered to ensure the safety of treatment and to reduce the need for ***:It is suggested that treatment by EPLBD for large bile duct stones may be safe and useful.

关键词： Endoscopic retrograde cholangiopancrea-tography En

Are angiographic culprit lesions true?Disagreement between angiographic and optical coherence tomographic detection

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Journal of Geriatric Cardiology 2021年第10期18卷 844-846页

作者： Osamu kurihara Masamichi Takano Yusaku Shibata Nobuaki Kobayashi Yasushi Miyauchi Kuniya Asai Cardiovascular Center Nippon Medical School Chiba Hokusoh HospitalInzaiChibaJapan Division of Intensive Care Unit Nippon Medical School Chiba Hokusoh HospitalInzaiChibaJapan

Coronary angiography provides a two-dimensional silhouette of the vascular *** is the gold standard for the dia-gnosis of coronary artery disease and is essential during percutaneous coronary intervention(PCI).

关键词： coronary lesions Coronary

Clinical Characteristics of Japanese Type 2 Diabetic Patients Responsive to Sitagliptin

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Journal of Diabetes Mellitus 2014年第3期4卷 172-178页

作者： Kouichi Inukai Takumi Hirata Takashi Sumita Masaki Watanabe Yuichi Ikegami Daisuke Ito Susumu kurihara Nobuyuki Yasukawa Jiro Morimoto Nobuki Takata Kenta Kanazawa Tamotsu Neda Yoshikazu Sumitani Kiyoaki Inoue Yuichi Noguchi Toshio Hosaka Hitoshi Ishida Shigehiro Katayama Department of Internal Medicine Saitama Social Insurance Hospital Saitama Japan Division of Endocrinology and Diabetes Saitama Medical University Saitama Japan Foundation for Biomedical Research and Innovation Hyogo Japan Sakado central hospital Saitama Japan Third Department of Internal Medicine Division of Diabetes Endocrinology and Metabolism Kyorin University School of Medicine Tokyo Japan Watanabe Medical Clinic Hiroshima Japan

Japanese type 2 diabetic patients were treated with sitagliptin to evaluate the efficacy of this agent, and also to investigate the clinical characteristics of those who responded to sitagliptin. In total, 1001 diabetic patients, inadequately controlled (HbA1c ≥ 6.5%) with oral hypoglycemic agents (OHA) other than DPP-4 inhibitors or with diet and exercise only, were enrolled. We added 50mg of sitagliptin to the therapeutic regimens of 410 patients including 68 OHA naive patients, while the other 591 patients were switched from a single OHA to 50 mg of sitagliptin. After 6 months, glycemic control was significantly improved due to both reduced insulin resistance, as demonstrated by a significant HOMA-R reduction, and recovery of pancreatic β cell function, as assessed by HOMA-β and the proinsulin/insulin (PI/I) ratio. In the bivariable analysis, a good response, defined as an HbA1c reduction during the 6 months of at least 0.9%, was associated with high HbA1c and PI/I at baseline and combination treatments with sulfonylurea, biguanide and α-glucosidase inhibitors, but not with obesity. On the other hand, in the multivariable regression analysis, only high baseline HbA1c and combination treatment with anα-glucosidase inhibitor were significantly associated with a good response to sitagliptin. In patients with type 2 diabetes, the addition of sitagliptin or switching from another OHA to this agent achieved an HbA1c reduction without overloading β cells. In particular, we suggest that a good response to sitagliptin can be expected when this agent is combined with an α-glucosidase inhibitor (UMIN No. #000014157).

关键词： Sitagliptin Type 2 Diabetes DPP-4 Inhibitors

Vulnerable atherosclerotic plaque features:findings from coronary imaging

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Journal of Geriatric Cardiology 2021年第7期18卷 577-584页

作者： Osamu kurihara Masamichi Takano Yasushi Miyauchi Kyoichi Mizuno Wataru Shimizu Cardiovascular Center Chiba Hokusoh HospitalNippon Medical SchoolChibaJapan Mitsukoshi Health and Welfare Foundation TokyoJapan Division of Cardiology Nippon Medical SchoolTokyoJapan

Pathological studies have suggested that features of vulnerable atherosclerotic plaques likely to progress and lead to acute cardiovascular events have specific *** the progress of intravascular coronary imaging technology,some large prospective studies have detected features of vulnerable atherosclerotic plaques using these imaging ***,the rate of cardiovascular events,such as acute coronary syndrome,has been found to be considerably reduced in the limited follow-up period available in the statin ***,not all disrupted plaques lead to thrombus formation with clinical *** sub-occlusive or occlusive thrombus formation does not occur,a thrombus on a disrupted plaque will organize without any symptoms,forming a"healed plaque".Although vulnerable plaque detection using intracoronary imaging is focused on"thin-cap fibroatheroma"leading to plaque rupture,superficial plaque erosion is increasingly recognized;however,the underlying mechanism of thrombus formation on eroded plaques is not well *** of intravascular imaging,optical coherence tomography(OCT)has the highest image resolution and has enabled detailed characterization of the plaque in ***,we reviewed the status and limitations of intravascular imaging in terms of detecting vulnerable plaque through mainly OCT *** suggested that vulnerable plaque should be reconsidered in terms of eroded plaque and healed plaque and that both plaque and circulating blood should be assessed in greater detail accordingly.

关键词： coronary acute superficial

Retrospective Analysis of S-1 plus Bevacizumab as Maintenance Therapy after Induction of S-1 and Oxaliplatin (SOX) plus Bevacizumab as First-Line Chemotherapy in Patients with Metastatic Colorectal Cancer

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Journal of Cancer Therapy 2020年第2期11卷 35-43页

作者： Yasutake Uchima Naoki Aomatsu Gen Tsujio Takehiko Iwauchi Shinji Matsutani Hiroto Tanaka Hironari Miyamoto Takuma Okada Shigeaki kurihara Toshiki Hirakawa Keiichiro Hirata Junya Morimoto Shigehito Yamagata Kazuhiro Takeuchi Department of Surgery Fuchu HospitalOsakaJapan

Background: The SOFT study was a phase III trial designed to validate the non-inferiority of S-1 and oxaliplatin (SOX) plus bevacizumab to mFOLFOX6 plus bevacizumab in terms of PFS in patients with metastatic colorectal cancer (mCRC) who had not previously received chemotherapy. In this study, we retrospectively reviewed cases in which S-1 plus bevacizumab as maintenance therapy after induction of S-1 and Oxaliplatin (SOX) plus bevacizumab as first-line chemotherapy in patients with metastatic colorectal cancer was applied in order to evaluate its efficacy and safety in clinical practice. Material and method: Among the 40 patients with mCRC at the Fuchu hospital who received SOX plus bevacizumab as a first line treatment between August 2013 and December 2018. The eligible patients had histologically confirmed mCRC. On day 1 of each 3-week period during the study, patients in the SOX plus bevacizumab received a 7.5 mg/kg intravenous infusion of bevacizumab, followed by an intravenous infusion of 130 mg/m2 oxaliplatin. S-1 (40 - 60 mg) was administered orally two times per day from after dinner on day 1 to after breakfast on day 15, followed by a 7-day rest. Results: The median PFS was 15.0 months and median OS was 36.0 months. The response rate (RR: complete pus partial response) was 85.0%, and the disease control rate (DCR: RR plus stable disease) was 92.5%. The most common adverse events with SOX plus bevacizumab were hypertension (50%), neurosensory toxicity (50%), anorexia (32.5%), fatigue (45%), pigmentation (39%), Neutrophil count decreased (30%), and platelet count decreased (40%). The most common grade 3/4 adverse events were neurosensory toxicity (5%) and fatigue (9%). Conclusion: This study revealed that the survival benefit of S-1 and oxaliplatin (SOX) plus bevacizumab in Japanese patients with mCRC was like that observed in previous clinical trials. Therefore, S-1 and oxaliplatin (SOX) plus bevacizumab can be considered as routine first-line treatment opt

关键词： S-1 Oxaliplatin Bevacizumab Colorectal Cancer

Huge Sacrococcygeal Teratoma in an Adult Female: A Case Report

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Journal of Cancer Therapy 2019年第3期10卷 197-202页

作者： Yasutake Uchima Naoki Aomatsu Takuma Okada Hironari Miyamoto Gen Tsujio Shigeaki kurihara Toshiki Hirakawa Takehiko Iwauchi Junya Morimoto Kazuhiro Takeuchi Department of Surgery Fuchu Hospital Izumi Osaka Japan

Background: Teratomas are a type of germ cell tumor, which are mostly benign, and dominative in adult females. Sacococcygeal teratomas are usually found in newborns or children, and can be detected prenatally;they are exceedingly rare in adults. We reported a case of a sacrococcygeal teratoma in adult female. Case presentation: A 26-year-old female was diagnosed with a presacral tumor 6 years ago. Pelvic computed tomography (CT) demonstrated a presacral heterogeneous tumor, containing multi-located cystic area and enhanced solid component with calcification. Magnetic resonance imaging (MRI) showed a presacral non-enhanced cystic lesion with solid component, 128 mm × 104 mm × 102 mm, which was suspected of having invaded the rectal wall, fifth sacral vertebra (S5), and coccyx. She underwent abdomino-sacral total excision of tumor with coccygectomy. Histopathological examination revealed a tumor with intricate admixture of ectodermal (epidermis, sebaceous glands and squamous), mesenchymal (cartilage, adipose tissue, blood vessels, nerves and skeletal muscle) and endodermal components (respiratory epithelium and intestinal epithelium) respectively. After 24 months of follow-up the patient was both clinically and radiologically disease free. Conclusions: Early complete excision was the preferred definitive modality of treatment for sacrococcygeal teratoma, and multi-staged excision and reconstruction resulted in successful and safe treatment in our case.

关键词： Sacrococcygeal Teratoma Adult Surgical Treatment