Yoshinori Sawa

Endoscopic Resection of Small Rectal Carcinoid Tumours Using an Aspiration Method with a Transparent Overcap

Rectal carcinoid tumours are often small and rarely metastatic. Endoscopic resection may, therefore, be the best treatment for small tumours. We diagnosed rectal carcinoid tumours in four women and three men (mean age 53 years; range, 43–63) between 1994 and 1999. Tumour depth was evaluated using a high-frequency ultrasonographic probe in five of the seven patients. All tumours were resected by endoscopic mucosal resection using an aspiration method with a transparent overcap. Histologically, all tumours were located within the submucosal layer. Tumour cells were found at the resected margin of the lateral side in one patient, and at the bottom of the margin in another. Both patients were followed up with frequent endoscopy, and no local recurrences have been detected at 1-year or 4-year follow-ups. Ultrasonographic examination before resection is useful to estimate tumour depth. Endoscopic resection by an aspiration method with a transparent overcap is safe and effective for the treatment of small rectal carcinoid tumours.

Decreased anti-Saccharomyces cerevisiae antibody titer by mesalazine in patients with Crohn's disease.

Saccharomyces cerevisiae may contribute to the pathophysiology of Crohn’s disease. We determined serum anti‐Saccharomyces cerevisiae antibody (ASCA) levels in patients with inflammatory bowel disease.

Prediction of Short-Term Outcome for Patients with Active Ulcerative Colitis

We report results of a retrospective chart review to evaluate factors predicting short-term outcome of patients with ulcerative colitis treated by corticosteroids. Between January 1992 and December 1997, we treated 71 patients with ulcerative colitis (44 with severe and 27 with moderately severe disease). Forty-nine patients were treated by conventional prednisolone therapy and 22 patients by steroid pulse therapy. There were no differences in clinical or endoscopic improvement between the two treatments. Clinical examination showed that 41 patients entered remission, 17 patients improved, and 13 patients did not respond. Endoscopically, 26 patients entered remission, 30 patients improved, and 15 patients did not respond. Extent of disease, type of disease (first attack, relapsing, or chronic active type), and endoscopic findings were factors useful in predicting short-term outcome of medical treatment.

Role of Granuloma in the Immunopathogenesis of Crohn’s Disease

Inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) are chronic long-lasting inflammatory diseases with yet unknown etiology. Recent advancement revealed that both diseases are associated with genetic predisposition and environmental factors such as luminal microorganisms and antigens. Crohn’s disease is associated with histopathologic features such as granuloma formation and longitudinal ulceration. In this article we describe the role of granuloma in the immunopathogenesis of Crohn’s disease. Granuloma of Crohn’s disease may play crucial roles as antigen-presenting cites to memory type T cells, which leads to activation and proliferation of T cells. Antigens presented at granuloma may be closely related to the disease.

Functional and phenotypical activation of leucocytes in inflamed human colonic mucosa

Infiltrating leucocytes are activated to generate reactive oxygen species or to produce several molecules in inflamed colonic mucosa. To clarify the phenotypical and functional properties of activating cells in colitic mucosa, 23 patients with ulcerative colitis and 13 controls were studied using a combined method for determining in situ nitroblue tetrazolium reducing activity and immunohisto‐chemical characterization. Antibodies 25F9 (anti‐macrophage), EG2 (anti‐eosinophil cationic protein), MAC387 (anti‐calprotectin, expressed by activated myeloid‐histiocytes lineage), and MAC‐1 (anti‐CD11b) were used. The proportion of EG2, calprotectin, and CD11b‐positive cells were significantly increased in inflamed mucosa. The proportion of EG2, calprotectin, and CD11b‐positive cells significantly correlated with the histological degree of inflammation. Proportion of EG2‐positive cells but not calprotectin nor CD11b‐positive cells was significantly correlated with nitroblue tetrazolium reducing activity. Aggregated cells reducing nitroblue tetrazolium seen in severely inflamed mucosa were found to be EG2 positive. Most of the calprotectin‐positive cells were 25F9 negative. In addition to activation of neutrophils and macrophages, eosinophil activation has been shown to be involved in inflamed colonic mucosa.

IgG subclasses of anti Saccharomyces cerevisiae antibody in inflammatory bowel disease

Elevation of serum anti Saccharomyces cerevisiae antibody (ASCA) has been reported in patients with Crohns disease. We analysed the subclasses of Immunoglobulin (Ig) G reaction in ASCA in sera from patients with inflammatory bowel disease, healthy controls, and patients with intestinal Behçets disease.

Cross-reactivity of yeast antigens in human colon and peripheral leukocytes

Elevation of the serum anti‐Saccharomyces cerevisiae antibody (ASCA) level has been reported in patients with Crohns disease. This study investigated the antigenic distribution of S. cerevisiae in human colon and peripheral leukocytes. ASCA was isolated from sera from patients with Crohns disease using immuno‐affinity chromatography and then biotinylated and assayed immunohistologically and immunocytologically to determine the distribution of antigens recognized by ASCA in human colon and peripheral leukocytes. Immunoblot analysis of yeast extract and human peripheral leukocytes was performed. Immunohistological study using biotinylated ASCA revealed the presence of yeast‐like particles in the granulation tissue of inflamed colonic mucosa. Biotinylated ASCA also stained lymphocytes and polymorphonuclear cells infiltrating inflamed intestine. Monocytes in epithelioid granulomas of colon with Crohns disease were also stained. Polymorphonuclear leukocytes in peripheral blood were also stained with biotinylated ASCA. The antigens reactive to ASCA among heat‐extracted, non‐heat‐extracted yeast antigens, and human leukocyte extract differed. The findings of cross‐reactivity of polymorphonuclear leukocytes with S. cerevisiae antigen and the presence of S. cerevisiae antigen in Crohns disease granulomas suggest the possibility of involvement of S. cerevisiae in the pathogenesis of Crohns disease. Copyright

ENDOSCOPIC PLACEMENT OF METALLIC STENT FOR COLONIC STRICTURE RESULTING FROM CARCINOMA LOCATED AT THE SPLENIC FLEXURE

A 67‐year‐old woman was admitted to Ikuwakai Memorial Hospital with sub‐ileus symptoms. Radiographic and endoscopic examination revealed that the patient had a colonic cancer approximately 15 cm in length from the descending colon to the distal transverse colon with severe stricture. The histopathological finding was mucinous adenocarcinoma. Abdominal computed tomography showed multiple liver metastases and intraperitoneal lymph‐node swelling. A per‐rectal decompression tube was inserted temporarily, and surgical colostomy was initially proposed. However, the patient rejected surgery, and stent therapy was considered as an alternative therapy. An ultraflex esophageal expandable metallic stent was installed. At day 4, tumor projection through the expandable metal‐stent mesh was observed and additional balloon dilatation was carried out under colonoscopic assistance. At day 7, ileus symptoms disappeared and the patient had been able to maintain oral feeding for 3 months until she died as a result of cachexia by systemic metastasis of colonic cancer.

Crohn’s disease complicated by adult-onset Still’s disease

A 31-year-old man with Crohn’s disease developed arthritis, spiking fever, and skin rash indistinguishable from that of adult-onset Still’s disease. He was admitted to our hospital because of a periumbilical intestinal skin fistula. Crohn’s disease had been diagnosed in 1991, and had required intestinal resection twice, and schizophrenia had been diagnosed in 1993. He developed polyarthritis and spiking fever, accompanied by a macular skin rash on both forearms. Marked hepatosplenomegaly and bilateral pleural effusion were detected on computed tomography examination. These findings are indistinguishable from those of adult-onset Still’s disease. Because his mental status had deteriorated following high-dose prednisolone on a previous admission, he was treated with an immunosuppressive agent on this occasion, with the treatment being successful. This is the first report of adult-onset Still’s disease complicating Crohn’s disease. In patients with Crohn’s disease, polyarthritis and skin rash can easily be misdiagnosed as enteropathic arthritis with erythema nodosum associated with the Crohn’s disease. Although adult-onset Still’s disease may not be fatal, early diagnosis is important because it can, in rare cases, result in life-threatening complications.

Successful treatment with topical mesalazine for a patient with intractable crohn’s colitis

A 32‐year‐old woman was admitted to our hospital for intractable Crohn’s disease. Crohn’s colitis was diagnosed at another hospital in August 1999. She had been successfully treated with oral mesalazine and an elemental diet. In March 2000, she had been admitted to the previous hospital for her third flare up of symptoms. She responded to oral mesalazine administration and total parenteral nutrition, but bowel symptoms were exacerbated and C‐reactive protein level was elevated after a polymeric diet was started. Prednisolone 30 mg/day was started in addition to total parenteral nutrition, but hematochezia and elevated serum C‐reactive protein level persisted, and she was referred to our hospital. She had about four bowel movements per day with fresh bleeding at the time of admission. Total parenteral nutrition and oral mesalazine were continued. The dose of oral prednisolone was increased from 15 mg/day to 40 mg/day. However, the frequency of bowel movements did not decrease and C‐reactive protein level continued to exceed 1.5 mg/day. Mesalazine enemas were begun on 23 January 2001, and were effective in improving hematochezia and serum C‐reactive protein. Both radiologic and endoscopic examinations revealed remarkable improvement.