Hiroshi Toyoshima

Significant Increase in Prostaglandin E-Main Urinary Metabolite by Laxative Administration: Comparison with Ulcerative Colitis

Objective: To assess the production of prostaglandin E2, an important chemical mediator in diarrhea induced by laxative administration, a prostaglandin E-main urinary metabolite (7α-hydroxy-5,11-diketotetranor-prosta-1,16-dioic acid, PGE-MUM) was measured in healthy volunteers and compared with the values of patients with ulcerative colitis. Methods: PGE-MUM was determined by a simplified immunoassay of bicyclic PGE-MUM and analyzed for the influence of laxative administration and active/remission phases of ulcerative colitis. Results: Administration of laxatives induced a significant increase in PGE-MUM in healthy volunteers. A significant elevation was also found in the active as compared with the remission phase of ulcerative colitis. The PGE-MUM levels were significantly correlated with our modified Talstad scores, clinical disease activity indices in ulcerative colitis. It was confirmed by time course studies of individual patients that changes in PGE-MUM correlated well with colitis activity. Conclusion: Laxative administration induces production of prostaglandin E2 as one of the chemical mediators, although its production grade is relatively low as compared with ulcerative colitis in the active phase.

Composite carcinoid-adenocarcinoma tumor of the stomach: Report of a case

We describe herein the case of an extremely unusual composite carcinoid-adenocarcinoma tumor of the stomach, most of which was found to be carcinoid. The carcinoid tumor component exhibited argyrophilic granules, immunohistochemical localization of chromogranin, and serotonin immunoreaction. Conversely, none of the adenocarcinoma component reacted with argyrophilia, chromogranin, or serotonin. DNA flow cytometric analysis revealed a near-diploid pattern in the carcinoid element and an aneuploid pattern in the adenocarcinoma element. The transitional zone and continuity between the two tumor components were observed. These findings suggest that the tumor originated from the endocrine system, although part of it showed nonendocrine differentiation. The patient died approximately 6 months after the onset of symptoms and an autopsy could not be performed.

Portosystemic Shunt Following Gastrectomy. A Report of Two Cases.

消化性潰瘍に対する胃切除術後21年と31年を経て, 門脈大循環短絡のため高アンモニア血症と脳波異常を伴う高度意識障害を呈した2例を経験した.58歳と65歳の男性で, 2例とも神経学的に異常を認めず, ICGを除く肝機能は正常で, 経動脈性門脈造影で胃冠状静脈と左腎静脈の間に太い短絡を認めた.解除術中に測定した門脈圧はおのおの140mmと103mm salineで正常範囲内にあり, 肝の組織検査で肝硬変を認めなかった.2例とも短絡解除術直後から血中アンモニア値は正常となり, 高度の意識障害は著明に改善した.短絡解除術前みられた肝萎縮, 肝動脈末梢のcorkscrew像が消失し, ICG停滞率も改善した.著者らは, 門脈大循環短絡は胃切除術後の胃冠状動脈の局所的内圧上昇が原因ではないかと推定している.内外の文献を検索した限りこのような症候群はみられないので, 胃切除術後の非常に稀な合併症として報告する.