Koichi Shibasaki

A case of exacerbation of ulcerative colitis induced by combination therapy with PEG-interferon α-2b and ribavirin

A 55 year old man with chronic hepatitis C presented with diarrhoea and bloody stools in July 2003. Colonoscopic examination showed redness and oedematous mucosa in the rectum and ulcerative colitis was suspected. Biopsy of the lesion confirmed the diagnosis and treatment was initiated with mesalazine (5-ASA 2250 mg/day). However, he showed short term improvement and mesalazine was discontinued. He was treated with percutaneous radiofrequency ablation therapy (RFA)(Cool-tip) for adenomatous hyperplasia in S5 of the liver in December 2004. After providing consent to treatment with interferon (IFN), the patient underwent combination therapy with PEG-IFNα-2b (100 mg/week) and ribavirin (800 mg/day) for chronic hepatitis C. Liver biopsy and blood biochemistry revealed chronic active hepatitis C virus (HCV) F3/A2, genotype 1b, liver injury associated with HCV, aspartate aminotransferase (AST) 109 IU/l, alanine aminotransferase (ALT) 126 IU/l, and HCV RNA 3400.0 KIU/ml (by reverse transcription nested polymerase chain reaction, high range method). One …

Literature review in cases with exacerbation of ulcerative colitis induced by treatment with interferon and/or ribavirin

Ulcerative colitis (UC) is an immune disorder of the gastrointestinal tract which has been reported to be precipitated by interferon (IFN) therapy. We describe the results of a literature review of cases in which the development or exacerbation of UC was coincident with IFN and/or ribavirin (RIB) treatment for chronic hepatitis C. We summarized the studies on the effectiveness of IFN for UC or Crohns disease, which were primarily carried out in Europe and the USA.

Pelioid‐type hepatocellular carcinoma with numerous eosinophilic infiltrations in a patient with primary biliary cirrhosis

A 65‐year‐old woman with liver injury was referred to our hospital in 1992. She was diagnosed with primary biliary cirrhosis (PBC) of Scheuers histological classification stage IV. She was treated with 600 mg/day of ursodeoxycholic acid. A 1‐cm mass in S7 was detected in August 1995. The serum α‐fetoprotein (AFP) level increased to 1288 ng/mL in January 1996. Angiography showed a cotton wool‐like appearance in the delayed phase. Because the size of the tumor appeared to be increasing and the serum AFP levels increased with high levels of L3 fraction, a pelioid‐type hepatocellular carcinoma (HCC) was strongly suspected. Hepatic artery infusion with SMANCS and partial resection of S7 and S8 of the liver were performed in March 1996. The pathological diagnosis for theresected liver tumor was pelioid‐type HCC. The serum AFP level decreased to 50 ng/mL after the operation, but relapsed HCC was detected in S6 and S7. Angiography in September 1996 revealed multiple hypervascular lesions, and hepatic artery infusion with SMANCS was again performed; however, we were unable to suppress the progression of the relapsed HCC. The patient died due to an intra‐abdominal rupture of relapsed HCC and subsequent liver failure in December 1996. We report a rare case of pelioid‐type HCC with numerous eosinophilic infiltrations arising from PBC.

Immunohistochemical studies of organic anion transporters and urate transporter 1 expression in human salivary gland.

Background. Various substances including uric acid, organic acids and drugs are transported by organic anion transporters (OATs) in the kidney. In addition, a member of the OAT family, urate transporter 1 (URAT1), is involved in the reabsorption of uric acid from the renal tubule. Benzbromarone inhibits URAT1 to block uric acid reabsorption. Methods. Our group previously observed higher salivary uric acid levels than serum levels in patients taking benzbromarone, and reported the possible existence of URAT1-like uric acid excretion mechanism in the salivary gland. The purpose of this study was to elucidate the uric acid excretion mechanism in salivary gland tissues using rabbit anti-human OAT1-4 and URAT1 polyclonal antibodies with EnVision™ system. Results. In the salivary gland, OAT1 was expressed in ductal cells. OAT2 was found in both ductal cells and serous acinar cells and weak expression was also observed in several nuclei. OAT3 expression was observed in serous acinar cells and nuclei and OAT4 was expressed only in ductal cells. URAT1 expression was observed in the cytoplasm of ductal cells and strong punctuate staining was seen in part of the supra-nuclear cytoplasm. The number of cells expressing URAT1 was smaller compared with OATs. In the kidney, however, OAT1-4 and URAT1 were strongly expressed on proximal renal tubules. Conclusions. The present study confirmed the existence of OAT1-4 and URAT1 in the salivary gland. These results may support the previous speculation that benzbromarone inhibits URAT1 to block uric acid reabsorption in the salivary gland, resulting in higher salivary uric acid levels than serum levels.

Clinical evaluation of urinary 6-hydroxymethylpterin (6-HMP) in patients with cancer of the digestive organs

The purpose of this study is to clarify the clinical significance of urinary 6-HMP in patients with cancer of the digestive organs. High-performance liquid chromatography (HPLC) was used to determine 6-HMP in first morning urine. Conclusions were as follows:1.Cut off level of urinary 6-HMP was defined as 0.079 μg/ml, from 87 normal subjects.2.The daily profile of urinary 6-HMP in normal subjects was highest in morning and lowest at bedtime and daily changes were continuously under the cut off level.3.Sensitivity, specificity and accuracy of urinary 6-HMP were 64.2%, 77.6% and 70.5% respectively.4.In patients with malignant diseases, the overall positive rate was 64.2% and was clearly higher than benign diseases.5.The positive rate of urinary 6-HMP levels in malignant diseases was highest in pancreatic cancer (75.0%) and lowest in hepatocellular carcinoma (55.8%).6.Urinary 6-HMP elevated several days after operation and returned within normal range after 2–3 weeks.7.Urinary 6-HMP concentration correlated to the therapeutic effects of anticancer drugs, and increased again in tumor recurrence.

Complete response in a patient with colonic mantle cell lymphoma with multiple lymphomatous polyposis treated with combination chemotherapy using anti-CD20 antibody and cladribine

A 59-year-old woman suspected of having colonic malignant lymphoma was transferred to our hospital (Japan Labour Health and Welfare Organization Tsubame Rosai Hospital, Tsubame, Niigata, Japan) in October 2003. Systemic CT scan showed no swollen lymph nodes. Gallium scintiscan useful in localising lymphoma, showed no abnormal accumulation. Endoscopic findings of the oesophagogastroduodenal tract showed no tumour lesions. Colonoscopic examination was performed in November 2003, and clearly revealed multiple small elevations (fig 1A). Endoscopic mucosal resections were performed on lesions and the resected specimens suggested mantle cell lymphoma (MCL). A second colonoscopic examination performed in July 2004 revealed increased numbers of polyps, indicating a case of multiple lymphomatous polyposis (MLP). Biopsy was performed again to confirm the diagnosis of colonic MCL. Figure 1B–D shows the histopathological findings of both resected and biopsy specimens. Immunohistochemical examination of these specimens revealed positive immunoreactivity for CD20 and CD5 (fig 1E), and negative …

Successful treatment of mucosa-associated lymphoid tissue lymphoma in a patient with gastric and rectal lesions with metachronous and ectopic development

A 75-year-old female, who had an abnormal stomach x-ray finding, was admitted to the hospital for further examination and therapy. Upper GI endoscopy showed reddish and swollen folds on the greater curvature of the gastric body and a biopsy was of this lesion revealed malignant lymphoma (small cell type or mucosa-associated lymphoid tissue (MALT) lymphoma suspected). The patient was infected with Helicobacter pylori (H. pylori), however, in response to the patients wishes, a total gastrectomy, omentectomy and splenectomy were performed and the histological diagnosis was gastric MALT lymphoma. Two courses of CHOP therapy (cyclophosphamide (CPM) 750 mg/m2/day, day 1, adriamycin (ADM) 50 mg/m2/day, day 1, vincristine sulfate (VCR) 1.4 mg/m2/day, day 1, prednisolone 100 mg/body, day 1–5) were administered as adjuvant chemotherapy. A colonoscopic examination performed about 4.5 yr after the operation revealed rectal submucosal tumors and the biopsied specimens were diagnosed as malignant lymphoma. A transanal focal resection was performed and the histological diagnosis was metachronous and ectopic development of MALT lymphoma. The histological finding was similar to the gastric lesion. About 4 and 7 yr after the first development of rectal MALT lymphoma, MALT lymphomas developed repeatedly in the rectal lesion, however, these were resected repeatedly and no developmenthas occurred during the past two years. This report presents a very rare case of metachronous and ectopic MALT lymphoma development in the gastric and rectal lesions.

Detection and Analysis of Helicobacter pylori DNA in the Gastric Juice, Saliva, and Urine by Nested PCR

Abstract The aim of this study was to investigate the strain heterogeneity of Helicobacter pylori ( H. pylori ) in saliva, gastric juice, and urine by nested PCR and the direct sequence method, and to clarify the mode of transmission by examining whether H. pylori in the stomach and saliva are identical. Thirty-nine patients undergoing endoscopy were enrolled in this study. H. pylori DNA was assayed in 104 samples using two sets of primers, EHC-U/EHC-L and ET-5U/ET-5L. DNA sequencing was performed in 24 samples. H. pylori DNA was detected in 39 gastric juice samples (100%) and in 28 saliva samples (71.8%). The prevalence in urine samples was 50% (13/26). All samples except one were identical with over 97% identity to the DNA sequence of H. pylori type strain J99 (USA). Nested PCR was highly sensitive for detection of H. pylori DNA in saliva, DNA sequencing may be useful to clarify the mode of transmission.