Kazunori Hoshika

Characterization of cytokine expression in the rectal mucosa of ulcerative colitis: correlation with disease activity

OBJECTIVE:Mucosal inflammation in ulcerative colitis (UC) is presumed to be regulated by Th2-like cytokines. The aim of this study was to characterize local expression of various cytokines mRNA.METHODS:Total RNA was extracted from rectal biopsy specimens in 61 patients with UC, 18 inflammatory controls, and 16 noninflammatory controls. Reverse-transcription polymerase chain reaction (RT-PCR) was used to determine mRNA expression of interleukin (IL)-2, interferon (IFN)-γ, IL-4, IL-10, IL-13, and IL-15.RESULTS:Expression of IL-10 was more frequent in UC (75.4%) than in noninflammatory controls (37.5%, p < 0.01). IL-4 was more frequently positive in UC (41%) than in inflammatory controls (5.6%, p < 0.01) and in noninflammatory controls (6.3%, p < 0.01). Positive expressions of IL-4 (66.7%vs 20.6%, p < 0.01) and IL-13 (63.0%vs 29.4%, p < 0.01) were higher in active UC than in inactive UC. The positive rate of IL-2, interferon (IFN)-γ, and IL-15 expression showed no difference among the groups divided by clinical, endoscopic, and histological grade of inflammation.CONCLUSIONS:These findings suggest that in active UC, IL-4 is pivotal, in combination with other Th2-like cytokines. In contrast, Th1-like cytokines and IL-15 bear no definite relation to local inflammation of UC.

Endoscopic detection of ectopic multiple minute sebaceous glands in the esophagus. Report of a case and review of the literature.

SummaryThis case report describes a patient with a rare form of ectopic sebaceous glands. The patient was a 53-year-old woman complaining of prolapse of a polyp through the anus who was admitted for polypectomy of the rectal polyp. After polypectomy, esophagogastroduodenoscopy was performed to detect other lesions. Although she had no symptoms from an upper gastrointestinal series, such as dysphagia, heartburn, or epigastric pain, multiple yellow rounded elevated lesions arranged in rows, 0.5 mm in diameter and more than 100 in number were observed in the middle and lower esophagus. Histological examination of the biopsied specimens taken from the lesions endoscopically revealed a structure with the characteristics of a sebaceous gland including an excretory duct.

CASE REPORT: Does Metronidazole Cure Cap Polyposis by Its Antiinflammatory Actions Instead of by Its Antibiotic Action?: A Case Study

Cap polyposis (CP), which is histologically characterized by polyps consisting of elongated, tortuous and often distended crypts covered by a ‘cap’ of inflammatory granulation tissue, was first described by Williams et al. (1) in 1985. Some investigators have postulated that abnormal colonic motility leading to mucosal prolapse might cause this condition (2). A possible contribution of infections origin has also been suggested (3), but the precise mechanisms still remain unclear. Herein we describe a case of CP which was refractory to a broad spectrum antibiotic, but responded completely to metronidazole (MNZ).

Juvenile polyposis occurring in hereditary hemorrhagic telangiectasia

Various extraintestinal manifestations may occur in juvenile polyposis, but hereditary hemorrhagic telangiectasia has rarely been reported in this type of polyposis. The authors treated a 14-year-old girl with rectal bleeding and anemia who had multiple polyps of the colorectum. Large polyps were removed and histologically diagnosed as juvenile polyps. She was later diagnosed as having telangiectasia of the skin, and arteriovenous malformations in the lung and in the liver, all of which were compatible with the diagnosis of hereditary hemorrhagic telangiectasia. At age 32, she had multiple ulcers in the ileum and in the colon. The coexistence of juvenile polyposis and hereditary hemorrhagic telangiectasia may be a clue for the understanding of the histopathogenesis of juvenile polyposis.

Significance of modes of adherence in esophagealCandida albicans

Although esophageal candidiasis is the most common form ofCandida infection in the gastrointestinal tract, little attention has been directed toward determining the mechanism of its infection. We have already clarified the existence of four modes of adherence ofCandida albicans to the esophagus; attachment, subepithelial cell insertion, cavitation, and invasion. This study was undertaken to clarify the significance of each of these modes. Scanning electron microscopic observations were made of esophageal specimens from 8-week-old rabbits infected withCandida albicans IFO 1060. In this study, attachment and subepithelial cell insertion were found to be the most frequent modes of adherence. Cavitation occurred following subepithelial cell insertion, while invasion occurred following attachment and subepithelial cell insertion. These results suggest that attachment and subepithelial cell insertion play the most important role in the initial stage of adherence. The ratios of these modes for living yeast cells were similar to those for dead yeast cells and beads. This suggests thatCandida albicans can gain a foothold on the esophageal epithelium solely by physical contact, after which colonization occurs.

ESOPHAGEAL CANDIDA INFECTION AND ADHERENCE MECHANISMS IN THE NONIMMUNOCOMPROMISED RABBIT

Candida infection of the esophagus has been reported not only in immunocompromised hosts but also in healthy individuals. However, its mechanisms of action in healthy individuals have not been clarified. Our previous study suggested that physical contact was an important factor for the adherence ofCandida albicans. The aim of the present study was to test our hypothesis and clarify the adherence mechanisms. Suspensions ofCandida albicans cells were given to rabbits in drinking water without the use of immunosuppressive drugs and/or antibiotics, and the esophagus was examined. Candidial lesions were observed in 14 of 15 rabbits given the suspensions held in water with and without 30% sucrose for 13 days. The number ofCandida albicans cells adhering to the esophagus per square millimeter by subepithelial cell insertion was significantly larger than that adhering by attachment. These results indicate that adherence ofCandida albicans to the esophagus occurs by sustained physical contact alone under a nonimmunosuppressive state, and that subepithelial cell insertion results in greater attachment on adherence. Our findings provide a clue that may help clarify the mechanism ofCandida infection in healthy individuals.

The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal Diphyllobothrium latum infection: report of a case.

The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal diphyllobothrium latum infection: report of a case

Helicobacter-independent, chemotherapy-resistant, radiosensitive gastric MALT lymphoma with massive deposits of amyloidlike substance.

Gastric lymphoma is a heterogeneous group of various clinicopathologic conditions. Mucosa-associated lymphoid tissue (MALT) lymphoma, which was first described by Isaacson and Wright (1) in 1983, has become a distinct entity in gastric lymphoma. For a long time, the treatment for gastric lymphoma has been surgical resection regardless of the clinicopathologic features (2). As for gastric MALT lymphoma, a causal relationship with Helicobacter pylori(Hp) infection has been indicated (3, 4), and antibiotic therapy to eradicate Hp has become the treatment of choice (5, 6). However, some gastric MALT lymphomas do not respond to Hp eradication. It remains controversial what the approach should be when Hp eradication proves ineffective. Recently, it has been reported that radiation therapy, which has been used frequently as an adjuvant therapy to other treatments, might become a primary therapy for gastric MALT lymphoma (7). Because radiation has more adverse effects than Hp eradication, the indications for radiation therapy should be carefully determined. We used radiation therapy for a patient with a gastric MALT lymphoma that had not responded to Hp eradication therapy, and which had further resisted single-agent chemotherapy and combined chemotherapy. Herein, we describe the

A case of systemic malignant lymphoma with intestinal involvement of lymphomatous polyposis type

Multiple lymphomatous polyposis is a rare type of intestinal lymphoma characterized by non-Hodgkins lymphoma of follicular mantle cell origin and extremely poor prognosis. We report a case of systemic lymphoma with the intestinal involvement of multiple lymphomatous polyposis. Although radiographic and endoscopic features of the case were compatible with multiple lymphomatous polyposis, histologic evidence suggested the diagnosis of diffuse large cell lymphoma rather than mantle cell lymphoma. Our case seems to be unique in its histologic findings and also in its prognosis, because the patient has been alive for more than 50 months after diagnosis.

A case of Cronkhite Canada syndrome with improved hypoproteinemia by gastroileocolectomy.

胃・小腸・結腸切除術により,低蛋白血症,全身症状の改善したCronkhite-Canada症候群の1例を報告した.症例は52才女性で昭和53年12月,貧血と胃ポリポーシスのため精査入院.皮膚色素沈着,爪甲萎縮,十二指腸・回盲部・結腸のポリポーシスを発見されて一旦退院するも,昭和54年3月泥状便,下肢の浮腫あり,再入院.低蛋白血症がすすみ, 7月には両側胸水・腹水が貯留した.その時血中蛋白は3.2g/dl, K値2.8mEq/l,血中ガストリン504pg/ml, 131I-PVPテストは4.5%.胃・大腸X線では増悪を示した.名種対症療法には抵抗を示し,蛋白製剤の補充でのみ軽快した.合併症も輸血後肝炎,左大腿静脈血栓症などをみた.昭和55年に入り症状は悪化しやむを得ず4月半胃切除術,小腸・右半結腸除術を行なつたところ,高ガストリン血症は正常化し, 1カ月後より全く蛋白製剤を投与せずに血中蛋白も6.7g/dlと上昇維持できて退院した.肝障害を残したが3年後の現在,下痢はなく爪甲,皮膚色素沈着も殆ど正常に復し,検査データも正常化した.ただし残胃,十二指腸,大腸に軽度多発性ポリープの所見を残している. Cronkhite-Canada症候群の病態を蛋白喪失性胃腸症と把握し,極力内科的治療を試みるべきであるが,奏効しない場合は漏出面積の縮小を目的に胃切除術,結腸切除術が望ましいと思われた.文献的にはステロイド薬の投与が奏効しており蛋白製剤と共に一度は試みるべきであると思われた.胃腸切除の奏効例は少なく,まだ積極的には勧められない.