Fumihiko Kinekawa

Relationship between esophageal dysfunction and neuropathy in diabetic patients.

OBJECTIVE:Few studies have compared esophageal dysfunction with diabetic neuropathy, and their relationship is not yet clear. The aim of this study was to investigate the relationship between esophageal function and diabetic neuropathy.METHODS:A total of 59 patients with type 2 diabetes were studied. Long-term ambulatory esophageal pH and motility monitoring were performed. The motor nerve conduction velocity (MCV) and coefficient of variation of R-R intervals (CVRR) were also examined.RESULTS:The 59 patients were classified into four groups: group 1 consisted of patients with both diabetic autonomic neuropathy (DAN) and diabetic motor neuropathy (DMN), group 2 had DMN alone, group 3 had DAN alone, and group 4 had neither DAN nor DMN. In pH monitoring, differences were observed among the four groups in DeMeester score, total number of acid reflux episodes, and % time pH < 4 (p < 0.05). A correlation was observed between % time pH < 4 and MCV; however, no correlation with CVRR was observed. In motility monitoring, differences were observed among the four groups in amplitude of peristaltic waves (p < 0.001), rising velocity of peristaltic waves (p < 0.01), and percentage of effective peristalsis (p < 0.01). A correlation was observed between esophageal motility and MCV; however, no correlation with CVRR was observed.CONCLUSIONS:Esophageal motility disorder and abnormal acid reflux were related to DMN in diabetic patients. A significant correlation was found between esophageal dysfunction and MCV. However, no significant correlation was found between esophageal dysfunction and CVRR.

Efficacy of zinc administration in patients with hepatitis C virus-related chronic liver disease.

Objective. Zinc supplementation has been shown to contribute to inhibition of liver fibrosis and improvement in hepatic encephalopathy. However, little is known about the anti-inflammatory effect of zinc on hepatitis C virus (HCV)-related chronic liver disease (CLD). We therefore examined the effects of zinc administration on inflammatory activity and fibrosis in the liver of patients with HCV-related CLD. Material and methods. Polaprezinc, a complex of zinc and l-carnosine, was administrated at 225 mg/day for 6 months to 14 patients with HCV-related CLD, in addition to their ongoing prescriptions. Peripheral blood cell counts, liver-related biochemical parameters, serological markers for liver fibrosis, HCV-RNA loads, and serum levels of zinc and ferritin were evaluated before and after zinc administration. Results. Serum zinc concentrations were positively correlated with hepatic reserve before zinc supplementation. A significant increase in serum zinc level was observed after zinc supplementation (64±15 versus 78±26 mg/dl, p=0.0156). Treatment with polaprezinc significantly decreased serum aminotransferase levels (aspartate aminotransferase (AST): 92±33 versus 63±23 IU/l, p=0.0004; alanine aminotransferase (ALT): 106±43 versus 65±32 IU/l, p=0.0002), whereas alkaline phosphatase levels were significantly increased (305±117 versus 337±118 U/l, p=0.0020). Serum ferritin levels were significantly decreased by treatment with polaprezinc (158±141 versus 101±80 ng/ml, p=0.0117). The reduction rate of ALT levels by polaprezinc was positively correlated with that of ferritin (r2=0.536, p=0.0389). There was a tendency toward a decrease in serum type IV collagen 7S levels after treatment with polaprezinc. However, administration of polaprezinc did not affect peripheral blood cell counts, other liver function tests, or HCV-RNA loads. Conclusions. These findings suggest that polaprezinc exerts an anti-inflammatory effect on the liver in patients with HCV-related CLD by reducing iron overload.

Esophageal function worsens with long duration of diabetes

BackgroundThe aim of this study was to assess the relationship between the duration of diabetes and esophageal dysfunction.MethodsWe examined 66 patients with type 2 diabetes. Duration of diabetes was determined by asking patients and from their medical records. The patients were divided into three groups according to the duration of their diabetes: group A, 1–4 years, n = 26; group B, 5–9 years, n = 20; and group C, 10+ years, n = 20. Ambulatory esophageal 24-h pH and motility were monitored, and gastroesophageal reflux and esophageal motility disorders were estimated in detail.ResultsWhen the duration of diabetes was long, the percentage of time with pH < 4 tended to increase. The amplitude of esophageal peristaltic waves and the frequency of effective peristalsis were reduced when the duration of diabetes was long. A significant correlation was observed between the duration of diabetes and the frequency of effective peristalsis. The number of esophageal peristaltic waves per minute and the percentage of multipeaked peristaltic waves increased significantly in group B, and decreased when the duration of diabetes became longer.ConclusionsGastroesophageal reflux and esophageal motility disorders worsened with long duration of diabetes. These esophageal dysfunctions should be considered in patients with long-standing diabetes.

Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction

BackgroundIn endoscopic biliary stenting against malignant biliary obstruction, stent blockage remains as an important problem. Stent blockage occurs as a result of bacterial adherence to the inner wall of the stent. We evaluated the stent placement above the intact sphincter of Oddi to retain the function of the sphincter of Oddi as a bacteriological barrier.MethodsSixteen patients with malignant biliary obstruction were assessed as the patients with the stent above the intact sphincter of Oddi. Sixteen patients with malignant biliary obstruction were assessed as the patients with the conventional stent placement across the sphincter of Oddi. Tannenbaum 10-Fr. stents were used in both the groups.ResultsThe median patency periods of the stent were 255 days (25th to 75th percentiles, 212–454 days; range, 39–454 days) for the group of the stents placed above the sphincter of Oddi and 82 days (25th to 75th percentiles, 48–131 days; range, 22–196 days) for the group of the stents placed across the sphincter of Oddi, respectively, with significant difference (P = 0.0001). The occlusion rates of stents placed above and across the sphincter of Oddi were 37.5% and 93.8%, respectively, with significant difference (P = 0.0008). The dislocation rates of the stent were 0% and 6.3%, respectively (not significant).ConclusionsPlacement of the stent above the intact sphincter of Oddi was associated with longer stent patency and lower occlusion rate.

Is the questionnaire for the assessment of gastroesophageal reflux useful for diabetic patients

Objective. It has been suggested that the questionnaire reported by Carlsson et al. has high sensitivity in diagnosing gastroesophageal reflux disease (GERD) and is considered to be one of the most useful diagnostic tools for GERD. The aim of the present study was to evaluate the ability of the questionnaire to identify gastroesophageal reflux (GER) diagnosed by 24-h pH monitoring in diabetic patients. Material and methods. Fifty-three patients with type 2 diabetes were enrolled in the present study. GER was monitored by means of an antimony electrode. Patients completed the questionnaires immediately before undergoing pH monitoring. Results. Diabetic patients were found to have few symptoms, and the average score on the questionnaire was extremely low. No significant difference in scores on the questionnaire was observed between patients with and those without GER. Conclusions. The questionnaire was shown not to be useful for diagnosing GER as a complication in diabetic patients. We, therefore, should not diagnose GER as a complication in diabetes mellitus on the basis of the questionnaire.

Paraneoplastic necrotizing myelopathy in a patient with advanced esophageal cancer : An autopsied case report

We report the first autopsied case of paraneoplastic necrotizing myelopathy associated with esophageal cancer in the literature. The patient had acute flaccid paraplegia and urinary retention, and had a good recovery of strength of both legs in response to corticosteroids. MRI showed a characteristic lesion with post-gadolinium enhancement of the cervical to mid-thoracic spinal cord at the onset, which has never been reported. Taken together, these results suggest that there is an underlying autoimmune mechanism in paraneoplastic necrotizing myelopathy.

Fulminant hepatic failure caused by malignant melanoma of unknown primary origin

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Influence of percutaneous local therapy for hepatocellular carcinoma on gastric function

AIM To investigate the influence of percutaneous local therapy on gastric myoelectrical activity in patients with hepatocellular carcinomas. METHODS Forty-four patients with hepatocellular carcinoma (HCC) [27 males and 17 females, ranging in age from 49 to 81 years old (69.7 ± 8.01 years)] who were admitted for percutaneous local therapy were enrolled in this study. We examined clinical abdominal symptoms using the Gastrointestinal Symptom Rating Scale (GSRS) before and 3 d after percutaneous local therapy. We also measured cutaneous fasting and postprandial electrogastrography (EGG) recordings before and 3 d after percutaneous local therapy. RESULTS We found that the percentage of normogastria in the fasting period was lower in the Child B group than in the Child A group (66.8% ± 8.6% vs 84.0% ± 3.8%). After percutaneous local therapy for HCC, the percentages of normogastria in the fasting period were significantly decreased (81.6% ± 3.5% vs 75.2% ± 4.5%). None of the postprandial EGG parameters changed significantly after percutaneous local therapy for HCC. Percutaneous local therapy for HCC reduced the power ratio (PR). In particular, the PR of tachygastria was significantly decreased after therapy (P < 0.01). However, no significant differences were found in the postprandial EGG parameters. Likewise, no significant differences were found in the calculated GSRS scores obtained from the questionnaire before and after therapy. CONCLUSION Gastric slow-wave dysrhythmias were induced by percutaneous local therapy in HCC patients, even though the GSRS scores obtained from the questionnaire did not change significantly.