Hitoshi Yagisawa

Liver abscess as the initial manifestation of colonic Crohn's disease: Report of a case

Liver abscess is a rare complication of Crohns disease and in most of the reported cases, the diagnosis of Crohns disease preceded that of liver abscess. We report herein a case in which a liver abscess was the initial clinical manifestation of Crohns disease in a 36 year old man who presented with high fever and weakness. The diagnosis of liver abscess was established by abdominal ultrasonography, computed tomography and an arterial blood culture. The abscess was resolved with antibiotic therapy alone and during the drug therapy, a barium enema examination was performed which revealed a stricture at the transverse colon. Resection of the transverse colon was performed and macroscopic and microscopic examination of the resected specimen established the diagnosis of Crohns disease. The liver abscess was thus speculated to be secondary to the inflamed bowel. Although rare, Crohns disease should be included in the differential diagnosis of diseases causing liver abscess.

Clinical efficacy of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC).

PurposeTo evaluate the role of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC).MethodsCEUS and angiography were performed in ten cases of ruptured HCC. We evaluated whether this technique allowed us to determine the bleeding point by observing an extravasation of contrast media into the ascites.ResultsIn four of the ten cases, CEUS demonstrated an extravasation of Levovist into ascites. Angiography showed an extravasation of contrast medium in three of these four cases. In three of the remaining six cases, in which CEUS did not show the presence of contrast medium in ascites, angiography demonstrated an extravasation. In eight cases, it yielded cessation of bleeding. In two cases, embolization was not successful. The bleeding point was not determined by CEUS or angiography in one case.ConclusionCEUS allows us to differentiate active bleeding (presence of contrast medium in the ascites) from nonactive bleeding.

Portal gas in a patient with acute obstructive cholangitis: report of a case with emphasis on US findings.

Portal gas is relatively rare, and its relationship to ischemic bowel diseases has been emphasized. We report the case of a 70-year-old woman with acute obstructive cholangitis in whom portal gas was detected by ultrasonography (US) but not by computed tomography (CT). The former showed multiple echo spots moving in the portal vein. Doppler signals confirmed them to be bidirectional and spiky, which immediately led to the diagnosis of portal gas. Immediate appropriate antibiotic treatment and biliary drainage yielded the disappearance of the portal gas. We stress the usefulness of US and Doppler US for detecting and diagnosing portal gas. Our observation suggests that when portal gas is detected by US, the possibility of cholangitis should be included in the differential diagnosis.

Sonographic detection of an aneurysm of the gastroepiploic artery

Gastroepiploic artery aneurysm (GEAA) is very rare. 1 Furthermore, most GEAA cases are diagnosed after their rupture. We report a case of asymptomatic GEAA. The patient was a 61‐year‐old man. Sonography (US) revealed a 2‐cm anechoic mass in the epigastrium near the anterior abdominal wall. Color Doppler US and contrast‐enhanced US showed arterial flow within the mass leading to the diagnosisof visceral artery aneurysm. CT and angiography confirmed the diagnosis of right GEAA, and the aneurysm was treated successfully with embolization. Follow‐up US 6 months later confirmed the absence of blood flow within the lesion.

A dose-dependent controlled trial of human lymphoblastoid interferon α for genotype 1b chronic hepatitis C associated with high HCV-RNA levels

Abstract The efficacy of Interferon (IFN) therapy against hepatitis C is greatly affected by viral factors such as the level of viremia and the HCV genotype. The prognosis of those with high serum HCV-RNA levels in genotype 1b is poor. In the present report, we carried out a randomized controlled study of two IFN doses for patients with genotype 1b chronic hepatitis C whose serum HCV-RNA levels were at least 10 6 copies/ml as determined by multicyclic polymerase chain reaction (PCR) assay. These patients were randomly divided into two groups. Group A received 6 million units (MIU) of IFN 6 days per week for 8 weeks, followed by the same dose 3 days per week for 16 weeks (total IFN dose: 576 MIU). Group B received 6 MIU of IFN 6 days per week for 2 weeks, followed by the same dose 3 days per week for 22 weeks (total IFN dose: 480 MIU). The number of complete responders was four of 24 (16.6%) in group A and three of 20 (15.0%) in group B. There was no significant difference between the groups. On the basis of these findings, it appears that there is no advantage in lengthening the initial period of consecutive IFN administration to 8 weeks or in increasing the total dose by 100 MIU for those with genotype 1b hepatitis C and high virus levels.

IgA1 & IgA2 distribution in the intestine

SummaryThe distribution of IgA1- and IgA2-containing cells was studied in 27 normal specimens taken from 3 parts of the intestine: the upper jejunum (8), the terminal ileum (5), and the large bowel (14). IgAl- and IgA2-containing cells were identified by an immunoperoxidase staining using mouse anti-IgA1 or IgA2 monoclonal antibody. The sum of IgA1-containing cells (IgA1 +) and IgA2-containing cells (IgA2 +) was greatest in the large bowel and least in the terminal ileum. IgA1 + were most frequent in the jejunum and least in the terminal ileum while IgA2 + were most frequent in the large bowel and least in the jejunum (p< 0.005). The ratio of IgA1 + /IgA2 + was 1.63 ± 0.41 in the jejunum which was significantly higher than 0.65 ±0.46 in the terminal ileum (p< 0.05) and 0.63 ±0.2 in the large bowel (p< 0.001). These results lead to the new recognition that there is a shift in preponderance of IgA subclasses in the intestine, namely IgA1 + cells predominate in the jejunum and IgA2 + cells predominate in the intestine distal to the terminal ileum.

Analysis of posterior echoes using reconstructed vertical ultrasound images

PurposeTo evaluate the role of vertical images reconstructed using 3-D data in the analysis of posterior echoes.MethodsReconstructed vertical images of US phantoms with the following artifacts were retrieved and analyzed: acoustic shadowing (clean and dirty); posterior echo enhancement (with/without lateral shadowing); and reverberation artifacts (clean and dirty).ResultsFor acoustic shadowing, a stone and posterior clean acoustic shadowing were imaged as an echogenic mass or an echogenic ring containing a central echo-free area. However, the stone and dirty acoustic shadowing were imaged as an echogenic mass or an echogenic mass consisting of many fine echo spots disseminated throughout the whole mass. For posterior echo enhancement, when lateral shadowing is present, the cyst and posterior echo enhancement are imaged as a round anechoic mass or a triple circle consisting of a thin anechoic outer rim, an echogenic ring, and an anechoic center. However, when lateral shadowing is absent, they are imaged as a round anechoic mass or a double circle consisting of an echogenic outer rim and an anechoic center. For clean reverberation artifacts and dirty reverberation artifacts, vertical images of clean reverberation artifacts consist of either a homogeneous echogenic area or an absent signal. However, vertical images of dirty reverberation artifacts consist of a homogeneous echogenic area and an area consisting of fine echo spots.ConclusionOur study suggests that reconstructed, previously unattainable, vertical plane images help us better understand the mode of posterior echoes.

Portal-systemic shunt through the right renal vein developing following portal tumor thrombus

Despite the semi-routine use of color Doppler sonography for evaluating portal circulation abnormalities, there is a relative paucity of information on portal-systemic (P-S) shunt through the right renal vein (P-SR shunt). We report such a case. The patient was a 60-year-old woman with hepatocellular carcinoma on liver cirrhosis. Serial sonography showed an aggravation in findings; an increase in the size of the tumor was followed by formation of a portal tumor thrombus, and then occurrence of a P-SR shunt. We present this case, with a comparison between the patients clinical course and the color Doppler results. To our knowledge, this is the first report to make such a comparison in a P-SR shunt case. We also briefly review the literature.

Isolated splenic granuloma: report of a case with an emphasis on ultrasound findings

There is a marked paucity of reports on contrast-enhanced ultrasonography (US) for focal splenic disease in the literature, and there are no previously reported contrast-enhanced US findings for splenic granuloma. We report the case of a 77-year-old cirrhotic woman with isolated splenic granulomas. We detail the diagnostic difficulty encountered in this case and briefly review the literature.

Inflammatory pseudotumor of the spleen: report of a case with emphasis on contrast-enhanced ultrasound findings.

Splenic inflammatory pseudotumor is a rare pathology, and the literature stresses the difficulty of preoperative diagnosis. There are no previous reports of contrast-enhanced ultrasound findings for this tumor in the literature. Our case appears to be the first to be examined using this technique. In our case, contrast-enhanced ultrasound showed the mass to be homogeneously and less enhanced than the surrounding parenchyma in all phases, and it included fine enhanced spots. We also briefly review the literature.