Teruji Sugita

IgG4-related stomach muscle lesion with a renal pseudotumor and multiple renal rim-like lesions: A rare manifestation of IgG4-related disease

Abstract We describe a 74-year-old man with immunoglobulin G4-related disease (IgG4-RD) presenting with gastric cancer, stomach and kidney lesions. For 15 years, the patient had been treated under a diagnosis of sclerosing cholangitis, which was revealed to be IgG4-RD only when the cancer was found. Histology revealed the gastric cancer and IgG4-related lesion in the muscularis propria to be separate. This case suggests that the stomach muscle can also be a site of involvement of IgG4-RD.

Role of ultrasonography in treatment selection.

In spite of difficulties impacting objectivity and reproducibility due to its dependence on the technical and diagnostic ability of each examiner, ultrasonography (US) in general can evaluate very well soft tissue lesions, especially small lesions of 1 cm or less in size. US can reliably delineate the nature of several lesions, and can detect dilated mammary ducts and lymph nodes. On the other hand, US may miss ductal spread or lymph node metastasis of breast cancer, especially if the lesions are too minute to be detected by the instrument. US should be used together with X-ray or MR mammography to prevent false negative cases. US is useful for evaluating the local nature and characteristics of cancerous lesions such as size, invasiveness, histological type, intraductal spread etc, and can evaluate regional lymph node and liver metastasis for pre-treatment staging. In addition, US-guided techniques are essential for preoperative pathological diagnosis by FNAC or CNB and for marking the marginal line for partial mastectomy. US should be more actively used to monitor intra-mammary recurrence after breast conserving surgery.

Meloxicam as an adjuvant to peginterferon-α-2a and ribavirin treatment for genotype 1 chronic hepatitis C: A randomized trial

In this multicenter, randomized trial, we evaluated the effectiveness of meloxicam – a non‐steroidal anti‐inflammatory drug – as an adjuvant for enhancing antiviral efficacy and preventing neutropenia during the treatment of patients with genotype 1 chronic hepatitis C using peginterferon and ribavirin.

Can CEA predict malignancy of cystic tumor of the appendix? report of a case

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A Case of Choledochoduodenal Fisutula Developed by Duodenal Ulcer.

十二指腸潰瘍に合併する胆道十二指腸瘻は比較的まれである, 我々は十二指腸潰瘍に合併した総胆管十二指腸瘻の1例を経験したので報告する. 症例は25歳の男性. 心窩部痛と嘔吐を主訴に当院に入院した. 腹部超音波検査で胆嚢内と肝内胆管にガス像を認めた. 上部消化管造影では十二指腸球部の拡張と狭窄を認めたが瘻孔は認めなかった. 経皮経肝胆管造影で十二指腸狭窄部の口側の総胆管十二指腸瘻と診断した. 手術は潰瘍空置幽門側胃切除・Billroth II法再建 (Finsterer-Bancroft手術) を行い十二指腸断端の減圧のため肝管空腸吻合を付加した. 術後経過は良好である. 近年抗潰瘍薬の進歩により胆道十二指腸瘻が内科的治療で治癒したとの報告も多く見られるようになったが, 本症例では十二指腸狭窄があり, 胆管十二指腸瘻がその口側に開口していたため胆道再建を含む手術が必要であった.