Hitoshi Fujino

Onset of diabetes with high titer anti-GAD antibody after IFN therapy for chronic hepatitis

A case of hyperglycemia induced by the injection of interferon-alpha was experienced in our hospital. This patient showed a sustained high titer of anti-GAD antibody after the onset of diabetes, suggesting that the involvement of immunological disturbance by IFN induces the onset of the disease. However, the susceptibility and the response of the immune system differs from patient to patient, and only limited destruction of beta-cells in the islet of Langerhans and normalization of glucose tolerance by CSII was induced in this patient.

A case of chronic pancreatitis complicated by massive pericardial and right pleural effusion

SummaryA 42-year-old man was admitted complaining of dyspnea. Chest X-ray showed an increase in cardiac size, and echocardiography revealed a large volume of pericardial effusion. Pancreatic enzyme levels were elevated in both serum and pericardial effusion. Computed tomography and endoscopic retrograde pancreatography demonstrated a fistula connecting a pancreatic pseudocyst with the pericardium and the right pleural cavity. Massive pericardial and right pleural effusion is an extremely rare complication of chronic pancreatitis. In this case, computed tomography and endoscopic retrograde pancreatography were useful for diagnosing the fistula.

A case report of primary fibrosarcoma of the liver

SummaryA 75-year-old woman was admitted to our hospital complaining of right hypochondrial pain. Echo sonography and computed tomography demonstrated a large tumor with irregular internal density in the right lobe of the liver. Angiography revealed a moderately hypervascular tumor. She was treated with transcatheter arterial embolization. Three weeks later, the tumor ruptured. She died of accompanying acute myocardial infarction seven months after the onset of the illness. Autopsy revealed primary fibrosarcoma of the liver. The tumor appearance varied from firm whitish to soft myxomatous. A part of the tumor showed hemorrhagic necrosis. There was no intrahepatic metastasis. The tumor tissue was composed of spindle shaped cells and immunohistochemically stained with vimentin.

A case of gallbladder cancer manifesting chylous ascites and chylothorax

SummaryA case of gallbladder cancer manifesting both chylous ascites and chylothorax was reported. A 66-year-old man was hospitalized with milky ascites. The patient was diagnosed as having gallbladder cancer based on findings of endoscopic retrograde cholangiopancreatography (ERCP) and celiac angiography. The diagnosis of chylous ascites was confirmed by the presence of microscopically visible free fat and the biochemical analysis of the fluid. The patient also gradually developed chylous thoracic effusion. Autopsy revealed lymphogenous metastasis in multiple retroperitoneal and mediastinal nodes. Chylothorax and chyloperitoneum are relatively rare. Only five cases have been reported in Japan that manifested both conditions.