Osamu Yoneyama

The Relationship Between Iron Deficiency in Patients with Helicobacter Pylori‐Infected Nodular Gastritis and the Serum Prohepcidin Level

Helicobacter pylori (H. pylori) is recognized as a causative agent for unexplained iron‐deficiency anemia (IDA). We evaluated many background factors influencing an iron‐deficiency state in adult patients with various H. pylori‐infected upper gastrointestinal tract diseases.

Simultaneous Combined Balloon-occluded Retrograde Transvenous Obliteration and Partial Splenic Embolization for Portosystemic Shunts

PURPOSE To evaluate the efficacy and safety of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE) for gastric varices and/or hepatic encephalopathy. MATERIALS AND METHODS B-RTO was performed in 19 consecutive patients with gastric varices and/or hepatic encephalopathy, of whom 10 received simultaneous combined B-RTO and PSE (group 1) and nine received B-RTO monotherapy (group 2). To evaluate the safety of these techniques, we analyzed 20 patients who received PSE monotherapy during the same period as a control group (group 3). Outcomes were retrospectively assessed. RESULTS No significant differences were observed in baseline characteristics among the three groups except for significantly lower platelet counts and larger spleen volumes in group 3. In all cases in groups 1 and 2, gastric varices disappeared and hepatic encephalopathy improved after treatment. Procedure times were not significantly different between groups 1 and 2 (P = .7435). In group 1, the volume of sclerosing agent required for B-RTO was significantly lower (P = .0355) and exacerbation of esophageal varices was significantly less frequent (P = .0146) than in group 2. Few serious complications occurred in patients who received combined therapy. CONCLUSIONS This study indicates that concomitant PSE may help diminish the increase in portal venous pressure after B-RTO for portosystemic shunts, and may allow a reduction in the volume of hazardous sclerosing agent used. It is worth evaluating the efficacy of simultaneous B-RTO and PSE in a prospective study.

Simultaneous combined balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices.

Background We previously reported the techniques and usefulness of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE), based on the hypothesis that concomitant PSE can diminish the increase in portal venous pressure after B-RTO. Objective After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for gastric fundal varices (GVs). Methods We performed B-RTO in 36 consecutive patients treated for GVs from 2005 to 2013. Twenty-three patients underwent simultaneous combined B-RTO and PSE (Group 1) and 13 underwent B-RTO monotherapy (Group 2). The outcomes were retrospectively evaluated. Results There were no significant differences in baseline characteristics between the two groups except that the splenic volumes were larger in Group 1 than 2. B-RTO was technically successful in 21 of 23 patients (91.3%) in Group 1 and in 12 of 13 patients (92.3%) in Group 2. In all patients with ruptured GVs (six in Group 1 and five in Group 2), complete hemostasis was obtained by B-RTO. Exacerbation of esophageal varices was significantly less frequent in Group 1 than 2 (p = 0.0017). Conclusion Concomitant PSE with B-RTO may contribute to prevention of the exacerbation of esophageal varices after B-RTO.

Opposing effects of soluble TNF receptor p55 on the biological action of TNF in a colonic epithelial cell line

Background and Aim: In ulcerative colitis (UC), the levels of extracellular soluble TNF receptors (sTNFRs), known TNF antagonists, increase in the serum and in mucosal lesions. We examined the effect of sTNFRs on TNF-induced ICAM-I expression and IL-8 production in a colonic epithelial cell line to ascertain the role of sTNFRs in DC. Methods: Recombinant TNF (10ng/ml) and recombinant sTNFR (1-I,OOOng/ml) were simultaneously added to confluent HT-29 cells. After 24 hours of incubation, the cell surface expression of ICAM-I was analyzed by flow cytometry, and IL-8 production in the medium and concentrations ofTNF in the serum and colonic mucosa of DC patients were measured by enzyme linked immuno solvent assay (ELISA), and concentration of sTNFR in the serum and colonic mucosa was measured by enzyme linked immunological binding assay. Results: When the sTNFRp55/TNF concentration ratio was greater than or equal to 10, sTNFRs significantly suppressed TNF-induced ICAM-I expression and IL-8 production by HT-29 cells. On the other hand, when the sTNFRp55/TNF concentration ratio was between 1/10 and I, sTNFRs significantly increased TNF-induced ICAM·I expression and IL·8 production in HT-29 cells. The sTNFR concentration was significantly higher in the serum and colonic mucosa of patients with active DC than in controls or patients with inactive DC, but the sTNFRp55/TNF concentration ratio in mucosa did not exceed I in any patients with active DC. Conclusions: The results of the present study showed that relatively low concentrations of sTNFRs enhanced the physiological activity of TNF in a colonic epithelial cell line. The sTNFR concentration in DC patients did not exceed this relatively low concentration range, suggesting that the increase in sTNFRs in the mucosa of DC patients works synergistically with TNF to enhance inflammation. Thus, large quantities of sTNFRp55 are necessary to suppress TNF activity, caution should be exercised when administering sTNFRp55 in a clinical setting.