Akira Fujinaga

Three cases of acute or fulminant hepatitis E caused by ingestion of pork meat and entrails in Hokkaido, Japan: Zoonotic food-borne transmission of hepatitis E virus and public health concerns.

Aim:  In developed countries including Japan, the transmission route of indigenous hepatitis E virus (HEV) infection is obscure. Accordingly, public health implications of indigenous HEV infection have not been well addressed. The aim of this study was to clarify the route of transmission of a small outbreak of acute hepatitis E and assess the public health implications of indigenous zoonotic HEV transmission.

An Application of Endoscopic Color Doppler Ultrasonography (ECDUS) in the Diagnosis of Hemodynamics of Gastric Varices, and the Therapeutic Effect of Endoscopic Therapy

Abstract: We studied 14 patients using endoscopic color Doppler ultrasonography (ECDUS) to evaluate the hemodynamics of gastric varices, and evaluated the endoscopic therapeutic effects on gastric varices in 8 patients. Three patients had F3 type gastric varices and eleven had F2. The ECDUS was performed with a PENTAX FG‐32UA (7.5MHz, convex type) and a HITACHI EUB 565 was used as a display machine. The intramural blood flow in the gastric varices and inflows from the extra‐gastric wall were clearly observed with the ECDUS in all 14 patients. The extramural blood flow (gastro or spleno‐renal shunts) was detected in 9 of 14 patients. The velocity of the intramural flow in tumorous type varices (F3) was higher than in the nodular or flat elevated type (Fa). Next, we evaluated the therapeutic effects on gastric varices of the ECDUS. The successful disappearance of intramural blood flow was observed in 6 of 8 patients who had this endoscopic therapy. In two of the 8 patients, there was not enough therapeutic effect on the intramural blood flow. The extramural blood flow, however, did not change before or after endoscopic therapy with the ECDUS.

Heat‐Probe Coagulation Treatment of Recurrent Intramucosal Venous Dilatation of the Esophagus and Endoscopic Color Doppler Ultrasonographic Follow‐up

We treated 14 patients with high risk intramucosal venous dilatation (high risk IMVD) of esophageal varices using heat‐probe coagulation. Two of the 14 patients experienced bleeding from the high risk IMVD. We used an Olympus heat‐probe unit CD‐20Z to stop or prevent variceal bleeding. The 14 patients were treated one to four times (mean: 1.9 times) using a total of 450–2100 joules (mean: 1459 joules). The high risk IMVD disappeared with healing of the heat‐probe‐induced ulcers. No severe side effects were recorded. Two patients with bleeding from high risk IMVD were successfully treated by the heat‐probe technique. In addition, we studied the effects of endoscopic heat‐probe coagulation for esophageal varices via endoscopic color Doppler ultrasonography (ECDUS) in six patients. Our ECDUS study was conducted with a PENTAX FG‐32UA, 7.5MHz convex type, and a HITACHI EUB 565 display monitor. Following heat‐probe treatment, the esophageal walls thickened from 5.1 to 8 mm (mean: 6.3 mm) and a low echoic pattern was visualized by ECDUS. Esophageal intramural blood flow was not observed in any of the six patients. Paraesophageal veins and passageways remained patent in all six patients.

Clinical Features of Patients with Pancreas Divisum

Abstract: Between 1972 and 1992, 18, 128 ERCPs were performed. Pancreas divisum (PD) was diagnosed in 184 of these patients (1.02%). The clinical features of 108 cases were investigated (M53, F55, average age 54) who were encountered during the last 8 years.

The Usefulness of Endoscopic Color Doppler Ultrasonography (ECDUS) for Endoscopic Injection Sclerotherapy (EIS)

Abstract: We studied 12 patients using endoscopic injection sclerotherapy (EIS) guided by endoscopic color Doppler ultrasonography (ECDUS). The ECDUS was performed with a PENTAX FG‐32UA (7.5MH2, convex type) and a HlTACHl EUB 565 as a display machine.

Gastric Varices due to Splenic Vein Occlusion with Left Renal Cell Carcinoma

Abstract: A 57‐year‐old man was admitted to our hospital in March 1994 with general fatigue and weight loss. Left renal carcinoma was diagnosed by ultrasonography and computed tomography (CT). The left renal carcinoma was too advanced to allow curative resection. Postoperatively, interferon therapy was administered for treatment of the renal cancer at the department of urology. In November 1994, he was admitted to our department with hematemesis. Recurrent left renal carcinoma and splenic vein occlusion were seen on CT. Endoscopic findings showed cardiofornical varices. We diagnosed rupture of gastric varices due to splenic vein occlusion with left renal carcinoma. Endoscopic injection sclerotherapy (EIS) was performed. After EIS, bleeding from the gastric varices resolved completely.

An Evaluation of Endoscopic Color Doppler Ultrasonography in a Gastric Variceal Patient Who Underwent Balloon‐Occluded Retrograde Transvenous Obliteration

Abstract: A 64‐year‐old female was admitted to our hospital with enlarged solitary gastric varices. Cardiofornical varices were seen using an endoscopy. We performed balloon‐occluded retrograde transvenous obliteration (B‐RTO) for gastric varices using 5% ethanolamine oleate. We observed the gastric varices before and after B‐RTO using endoscopic color Doppler ultrasonography (ECDUS). Prior to B‐RTO, the intramural and extramural blood flow coming from gastric varices were detected. The intramural blood flow produced a to and fro color image on ECDUS. The blood flow velocity was 31.2 cm/sec. The amount of blood flow was 2.40 liter/min. Seven days after the B‐RTO, high echo lesions were observed in the gastric varices which indicated that the thrombosis and color flow image had also decreased. Twenty one days after B‐RTO, the color flow image of the gastric varices had nearly disappeared and had completely disappeared after 3 months. In this case, ECDUS was an extremely useful modality for viewing the therapeutic effects of B‐RTO.

Cytomegalovirus colitis in a patient undergoing postoperative adjuvant chemotherapy for lung adenocarcinoma with uracil-tegafur.

When we examine a patient with symptoms of acute enteritis in the course of chemotherapy with oral fluoropyrimidines such as uracil-tegafur (often referred to as UFT), we usually suspect 5-fluorouracil-induced enterocolitis. In case of persistent clinical symptoms despite discontinuation of chemotherapy, cytomegalovirus colitis should be considered in the differential diagnosis of chemotherapy-induced enterocolitis. We herein report the case of a patient who underwent surgery for lung adenocarcinoma followed by postoperative adjuvant chemotherapy with uracil-tegafur and was diagnosed as having cytomegalovirus colitis during the therapy. In the course of chemotherapy, cytomegalovirus colitis occasionally occurs even though the patient does not experience severe myelosuppression; thus, it is necessary that we recognize its potential occurrence.