Takasuke Yoshida

Quantification of disease activity in patients with ulcerative colitis.

To develop an efficient index for evaluating ulcerative colitis, we quantitatively assessed disease activity by multiple regression analysis. Thirty-two consecutive cases with ulcerative colitis were studied. These cases were divided by degree of severity into three groups: mild, moderate, and severe; this tripartite grouping was used as a dependent variable. As independent variables, 11 predictors were selected from among physical findings and laboratory data. By multiple regression analysis with stepwise deletion, six factors indispensable to the disease activity were selected: temperature, pulse rate, erythrocyte sedimentation rate, red blood cell count, alpha 2-globulin, and number of bowel movements per day. Disease activity is predicted by using the following equation: Y = -12.168 + 0.333X1 + 0.022X2 + 0.018X3 - 0.337X4 + 0.056X5 + 0.033X6, where X1, X2, X3, X4, X5, and X6 denote temperature, pulse rate, erythrocyte sedimentation rate, red blood cell count, alpha 2-globulin, and number of bowel movements per day, respectively. By applying this equation to each case, the range of activity indices is expressed as follows: mild, less than 1.52; moderate, between 1.52 and 2.44; and severe, more than 2.44.

A case of spontaneous mesenteric hematoma and a review of 17 cases in Japan

SummaryA 47 year-old male was admitted to Miyazaki Medical college Hospital for further evaluation of an abdominal mass in the left upper quadrant. Abdominal ultrasound (US) and abdominal computed tomography (CT) showed two cystic masses in the mesenterium, which were suspected to be hematomas, but were not related to the pancreas, kidney or spleen. Superior mesenteric artery angiography and galluim (GA)-scintigraphy showed no definite findings. The patient underwent laparotomy on a suspicion of mesenteric hematoma. Two 4 × 3 × 3cm soft tumors were found in the small intestinal mesenterium. These masses were histopathologically hematomas and surrounded by thick collageneous granulation tissue. The patient had no recent history of abdominal trauma, taking drugs capable of producing bleeding tendency, and/or vascular disease. The case was diagnosed as spontaneous mesenteric hematoma.

Plasma GRP-like immunoreactivity in healthy and diseased subjects

SummaryGastrin releasing peptide(GRP)-like immunoreactivity in human plasma was measured using radioimmunoassay of neuromedin C (NMC) in 83 healthy and 58 diseased subjects. In the healthy group, the mean value of fasting GRP-like immunoreactivity was 2.1±1.4 (mean±SD) pmol/L. There was a slight positive correlation between the GRP-like immunoreactivity values and aging. Postprandial serial measurements demonstrated that GRP-like immunoreacitivity showed no response to a significant elevation of serum gastrin concentration. The group with chronic renal failure on hemodialysis gave the highest value, 7.1+2.1 pmol/L (p<0.01). There were no statistical differences between the healthy controls and groups with peptic ulcer, liver cirrhosis, diabetes mellitus or carcinomas, although some cancer patients had a marked increase in GRP-like immunoreactivity value.

Remarkable improvement of clinical status in a patient with multiple lymphomatous polyposis of the gastrointestinal tract after repetitive chemotherapy

SummaryThe effect of repeated courses of chemotherapy on gastrointestinal tumors seen in a 43 year-old male patient with multiple lymphomatous polyposis involving the entire gastrointestinal tract was presented. Numerous polypoid lesions from the stomach to the rectum were the characteristic finding in this case. The biopsied specimens from polyps either of the stomach or large intestine showed diffuse lymphocytic accumulation in the submucosa, which is consistent with multiple lymphomatous polyposis of the gastrointestinal tract. Remarkable regression of the large masses in the gastrointestinal tract was obtained by two courses of VEMP therapy, along with improvement of hypoalbuminemia and a positive CRP. Recurrence of gastrointestinal masses in the cecum and rectum was also eliminated by six courses of CHOP therapy, and a total of nine courses of CHOP therapy led to complete disappearance of masses in the gastrointestinal tract. The present case is different from the others in terms of the following viewpoints that first the ensuing large masses favorably responded to repetitive chemotherapy, secondly the histopathological findings remained benign despite the fact that large nodular masses had recurred in the cecum and rectum, and thirdly the pathological changes were still confined to the gastrointestinal tract without developing systemic malignant manifestations.

Natural resistance of W/Wv mice to ethanol-induced gastric lesions and its abrogation by bone marrow grafting: Possible role of mast cells and LTC4

SummaryThe extent of ethanol-induced acute gastric lesions, gastric leukotriene C4 (LTC4) levels, and the number of gastric mucosal mast cells were examined in mast cell-deficient W/Wv mice, normal litter-mate +/+ mice, and bone marrow-reconstituted W/Wv mice. After administration of ethanol, +/+ mice developed gastric lesions and elevation of gastric LTC4 levels in a dose dependent manner. In mast cell-deficient W/Wv mice, the extent of gastric lesions was far less than that of +/+ mice and the level of gastric LTC4 was not significantly altered. This difference was not due to anemia because blood-transfused non-anemic W/Wv mice were still resistant to ethanol-induced gastric lesions. When W/Wv mice were reconstituted with +/+ bone marrow cells, their natural resistance against ethanol-induced gastric lesions was abrogated. The extent of gastric lesions of bone marrow-reconstituted W/Wv mice paralleled with the increase in number of gastric mucosal mast cells and also with the level of gastric LTC4. Furthermore, ethanol-induced gastric lesions in bone marrow-reconstituted W/Wv mice was inhibited by pretreatment with 5-lipoxygenase inhibitor, AA-861, in a dose dependent manner. These results suggest that LTC4 may, even if it is not a prerequisite factor for ethanol induced acute gastric lesions, act as the amplitier in the sequential events of the pathogenesis.

Gastrointestinal Manifestations in Systemic Amyloidosis

Amyloid deposition in the gastrointestinal (GI) tract is quite common in systemic amyloidosis (AL) as is cardiac and renal involvement. However, amyloid deposition per se does not always produce symptoms or signs in clinical settings.

The possible role of LTC4 in the pathogenesis of ethanol-induced gastric lesions in mice and their prevention by 5-lipoxygenase inhibitor AA-861, and leukotriene receptor antagonist FPL-55712

SummaryThe extent of acute gastric lesions produced by intragastric administration of ethanol in mice paralleled gastric leukotriene (LT) C4 levels. Furthermore, an inverse dose-response relationship was observed between the extent of gastric lesions and the number of mast cells in the gastric mucosa. When mice were pretreted with the 5-lipoxygenase inhibitor, A A-861, both the extent of ethanol-induced gastric lesions and the level of gastric LTC4 decreased dose-dependently. In contrast, when mice were pretreated with the LTC4 receptor antagonist, FPL-55712, the extent of ethanol-ionduced gastric lesions was depressed without significant reduction of gastric LTC4 level. These results indicate that both production of LTC4 and also subsequent binding of LTC4 to the receptors is important for the pathogenesis of gastric lesions and suggest that mast cell-derived LTC4 plays a major role in the development of ethanol-induced gastric lesions.

A case of short bowel syndrome in which remarkable amelioration of mental deterioration was achieved by administration of trace elements

SummaryA patient with short bowel syndrome manifesting psychiatric deterioration was demonstrated. Four years after extensive small bowel resection the patient developed various psychological manifestations. Laboratory data did not indicate the specific causes but showed extensive hyponutritional state. After 2 weeks therapy by total parenteral nutrition (TPN), laboratory data returned to normal, but her psychiatric condition remained almost unchanged. When trace elements (copper, cobalt, magnganese and zinc) were added to TPN, her psychiatric impairment rapidly improved. Although the mechanism involved in this situation may be multifactorial, the trace elements were primarily responsible for recovering from abnormal psychiatric condition.