Daishu Toya

Endoscopic resection of large colorectal polyps using a clipping method

PURPOSE: In conventional endoscopic snare polypectomy, bleeding and perforation are the principal concerns. To prevent these complications, we employ an endoscopic clipping technique using the HX-3L clipping apparatus. METHODS: With this method, clips are used to clamp the base of a polyp. A snare is hung peripheral to the clips. The polyp is then resected by coagulating and cutting with an electric current. RESULTS: Neither bleeding nor perforation during or after polypectomy has occurred, nor have complications related to the use of clips developed. Gigantic polyps were not resected piecemeal, but rather were resecteden bloc facilitating a clear determination of cancer on the surface of the resected site. Endoscopic clipping permitted site marking for colonoscopic surveillance. CONCLUSION: We conclude that the clipping method has many advantages and is a useful technique in colonoscopic polypectomy.

K-ras mutations in duodenal aspirate without secretin stimulation for screening of pancreatic and biliary tract carcinoma.

K‐ras mutations at codon 12 (KRM) have been detected in over 80% of tissues and pure pancreatic juice (PPJ) samples from patients with pancreatic carcinoma (PCa) and are promising genetic tumor markers. Aspirating PPJ not only requires technical skill, but is also exhausting for patients. The authors attempted to evaluate whether the detection of KRM in the duodenal aspirate (DA) obtained immediately after endoscopic retrograde cholangiopancreatography (ERCP), an easier sample‐collecting method than collecting PPJ, could be useful for the diagnosis of PCa and biliary tract carcinoma (BTCa).

Subsegmental Transcatheter Arterial Embolization for Hepatocellular Carcinoma in the Caudate Lobe

PURPOSE To clarify the effectiveness of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in the caudate lobe of the liver. MATERIALS AND METHODS Thirteen patients with HCC in the caudate lobe underwent TAE. TAE was performed by injection of the mixture of anticancer drugs (mitomycin C and doxorubicin or epirubicin) and iodized oil, followed by gelatin sponge particles. Arterial anatomy of the caudate branch, local recurrence rate, and survival rate were evaluated. RESULTS From 31 TAEs for the caudate lobe, 22 subsegmental TAEs were successfully performed (71%). Local recurrence in the caudate lobe was seen in 10 patients (77%). Subsegmental TAE for the caudate lobe was repeated one to five times. Cumulative local recurrence rates were 33% and 75% within 3 and 6 months, respectively. Survival rates after first TAE for HCC in the caudate lobe were 89% and 74% for 1 and 3 years, respectively. CONCLUSION Local recurrence rate after subsegmental TAE for HCC in the caudate lobe was high. However, repeated subsegmental TAE possibly improves the prognosis of HCC in the caudate lobe.

The immunohistochemical evaluation of PSP/reg-protein in normal and diseased human pancreatic tissues

SummaryIn order to elucidate the characteristics ofreg-protein, which is identical to pancreatic stone protein (PSP/reg-protein), and the relationship between the generation and evolution of chronic pancreatitis and the expression of PSP/reg-protein in the pancreas, we investigated the expression of PSP/reg-protein in normal and diseased human pancreatic tissues by immunohistochemistry. The PSP/reg-protein was expressed in all cases with normal pancreas or chronic pancreatitis, and in 70.6% of cases with pancreatic cancer. This protein was present in the cytoplasm of acinar cells and, in some cases, in the intraluminal contents of ductules in nonmalignant tissues. From the view of distribution and cellular localization, PSP/reg-protein was expressed more broadly and densely in chronic pancreatitis with mild to moderate injury than in the normal pancreas. However, the protein was less expressed in severely damaged chronic pancreatitis tissue, such as calcifying pancreatitis, than in the normal pancreas. These findings suggest that mild to moderate injury to pancreatic tissue may stimulate the synthesis of PSP/reg-protein, whereas more severe injury tends to depress it.

Bowel preparation for the total colonoscopy by 2,000 ml of balanced lavage solution (Golytely) and sennoside

SummaryOne of disadvantages of the Golytely preparation is that examinees have to drink as much as 4,000 ml of Golytely. To overcome this disadvantage, we designed a modified preparation regimen in which examinees have to drink only 2,000 ml of Golytely by taking sennoside orally. Bowel preparation was carried out in 297 examinees by this modified method. Examinees ate their usual diet and took 36 mg of sennoside orally on the night before the examination. On the day of the examination, the examinees drank a total of 2,000 ml of Golytely. No severe complications were noted and 97% of the examinees were able to drink the dose of 2,000 ml. Subjects who had also experienced bowel preparation by the modified method of Brown were asked to compare the two regimens, and only 1% preferred Brown’s method while 73% preferred bowel preparation by our Golytely method. The result of bowel preparation by this method was excellent or good in 90 to 97% of the subjects at all sites in the colon and rectum. We conclude that bowel preparation for total colonoscopy using 2,000 ml of Golytely and sennoside is superior because it is highly acceptable to the examinees and provides excellent gut irrigation.

Serum Sialyl-Tn Antigen Levels in Patients with Digestive Cancers

Serum levels of sialyl-Tn antigen (STN) were measured using a one-step radioimmunoassay kit in 257 patients with digestive cancers, 121 patients with benign digestive diseases, and in 64 healthy controls. With 45 U/ml regarded as the cutoff value, the positive rates of serum STN in digestive cancers were as follows: pancreas 40.0%, stomach 28.1, colon and rectum 27.8, biliary tract 25.0, liver 7.1, and esophagus 0%. In benign digestive diseases, the positive rate of STN was low (4.1%). In gastric and colorectal cancers, simultaneous measurements of STN and carcinoembryonic antigen (CEA) revealed that the positive rates of STN, CEA, and STN and/or CEA were 28, 42, and 55%, respectively. There was no significant correlation between STN and CEA in these cancers. STN may be a useful serum marker for digestive cancers, especially gastric and colorectal cancers.

Pancreatic arteriovenous malformation presenting as interesting findings on endoscopic retrograde pancreatography

Pancreatic arteriovenous malformation is a very rare disease. The case we have encountered is the second in Japan and the 10th in the world. A vascular lesion was seen in the pancreatic body; however, findings suggestive of vascular lesions in other regions such as those seen in Osler-WeberRendu disease were not observed. This case was interesting in that marked acinal filling was localized in the region of the arteriovenous malformation as demonstrated by endoscopic retrograde pancreatography. Some mechanism attendant upon arteriovenous malformation may have caused the contrast medium to be extravasated easily. With the progress of angiography in recent years, attention has been paid to arteriovenous malformation as a cause of gastrointestinal hemorrhage. However , reports on pancreatic arteriovenous malformation are few (1-7). We encountered a case of pancreatic arteriovenous malformation and interesting findings were obtained by endoscopic retrograde pancreatography.

Pericardial fat volume is an independent risk factor for the severity of coronary artery disease in patients with preserved ejection fraction

OBJECTIVES The aim of this study was to assess the relationship between the pericardial fat volume (PFV) and the characteristics of coronary plaques in patients with ischemic heart disease (IHD). BACKGROUND It has been suggested that pericardial adipose tissue promotes plaque development in coronary artery disease (CAD). METHODS We analyzed the cardiac computed tomography scans in consecutive patients suspected of CAD. PFV was quantified using validated software and indexed to body surface area, and the severity of coronary stenosis was evaluated in the patients who underwent coronary angiography. A total of 105 subjects (mean age, 68±10 years) with IHD were categorized into tertiles of body surface area-indexed PFV values (PFVi, cm3/m2): low-tertile, PFVi < 81.2 cm3/m2; mid-tertile, 81.2 cm3/m2 ≤ PFVi ≤ 114 cm3/m2; high-tertile, PFVi > 114 cm3/m2. Their body mass index (BMI), waist circumference, Gensini score (GS), and coronary plaque component were evaluated. RESULTS The GS was significantly different between the high-tertile and the low-tertile groups, indicating a stepwise decrease in GS from high-tertile to mid-tertile and to low-tertile. PFVi had a significant positive correlation with BMI (p=0.0001) and GS (p<0.0001). However, no significant association was found between GS and BMI. On the multivariate analysis, high PFVi remained an independent predictor for the coronary artery disease severity (p<0.001), while BMI and waist circumference were not independent predictors. CONCLUSIONS Obese patients were found to have more PFVi, and the characteristics of their coronary lesions were more severe. Pericardial adipose tissue as unique ectopic fat might be more highly associated with IHD progression.

Serum tumor markers in patients with hepatocellular carcinoma: Diagnosis of α-fetoprotein -low or -negative patients

SummaryThe presence of specific gamma-glutamyl transpeptidase isoenzyme (γ-GTPI) and variant alkaline phosphatase (VAALP) were concurrently determined, and levels of basic fetoprotein (BFP) and carcinoembryonic antigen (CEA) in addition to α-fetoprotein (AFP) were measured in 144 hepatocellular carcinoma (HCC) patients in order to evaluate the diagnostic value of these tumor markers with respect to AFP-low or -negative patients and the tumor stage.Serum AFP levels below 400 ng/ml, commonly seen in sera of hepatobiliary diseases other than HCC, were noted in 42% of the patients. The diagnostic usefulness was increased by combination assay of these markers except for CEA. A definitive diagnosis of HCC could be made in 78% of the patients by a combination of γ-GTPI, VAALP and AFP. Moreover, a diagnosis of malignancy could be made in 87% of cases by the inclusion of BFP. The prevalence of BFP and CEA increased in proportion to the tumor stage, whereas that of AFP and γ-GTPI were independent of stage and were high even in patients in comparatively early stages. Furthermore, secreting type markers such as AFP and γ-GTPI were relatively useful for diagnosis of HCC when the lesions were still small.

PURIFICATION OF γ-GLUTAMYLTRANSPEPTIDASE (γ-GTP) FROM HUMAN HEPATOCELLULAR CARCINOMA (HCC), AND COMPARISON OF γ-GTP WITH THE ENZYME FROM HUMAN KIDNEY a

In order to elucidate the characteristics of novel gamma-GTP, which was reported in our previous publications to be specific to sera of HCC, gamma-GTP was purified from HCC tissues, and its physicochemical and immunologic properties were compared with those of the normal adult kidney enzyme. The enzyme from HCC tissue and from normal kidney were found to be similar or identical with respect to the Km value for substrate, optimal pH, thermostability, effect of various amino acids as acceptors, behavior to cations or ethylendiaminetetraacetate, and immunologic properties. However, the HCC tissue enzyme was distinguishable from the normal kidney enzyme with respect to molecular weight, electrophoretic mobility before and after neuraminidase treatment, Con-A-affinity, sensitivity to neuraminidase, and isoelectrophoretic point. These results support the conceivability that novel gamma-GTP in the sera of HCC patients is largely due to structural differences in the carbohydrate moieties.