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Yoshioka W, Nakaji S, Tomonari AN, Takahashi H, Funato T, Inoue S. A new pancreatic guidewire-assisted biliary cannulation technique using double soft-tipped guidewire: wire bridge cannulation. VideoGIE 2024; 9:206-207. [PMID: 38618618 PMCID: PMC11009448 DOI: 10.1016/j.vgie.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Wataru Yoshioka
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
| | - So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
| | - Akiko Natalie Tomonari
- Department of Gastroenterology, ParkwayHealth Gleneagles Medical and Surgical Center, Shanghai, China
| | - Hirokazu Takahashi
- Department of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan
| | - Tomoyuki Funato
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
| | - Shin Inoue
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
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Nishiwaki T, Nakachi K, Inoue S, Ashikawa T, Funato T, Kawamitsu N, Yoshimura S, Nagumo H, Nakaji S, Homma K. Severe circumferential rectal ulcer associated with electric bidet toilet use. DEN Open 2024; 4:e347. [PMID: 38455240 PMCID: PMC10919415 DOI: 10.1002/deo2.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
A 66-year-old man presented to the gastroenterology department with anal pain. For >10 years, he had used an electric bidet toilet while defecating for >5 min at a time, because of constipation. Two weeks prior to his visit, he became aware of discomfort in his anal area and had used an enema 1 week previously. He had persistent diarrhea and began to use the electric bidet toilet at the highest water pressure for long periods. As a result, his anal pain worsened. A colonoscopy revealed circumferential inflammation and ulceration extending from the anal canal to the lower rectum. Approximately half of the Japanese population washes their anuses before and after defecation. Cleaning the anus after defecation using a bidet contributes to hand hygiene and local comfort, and may be effective against constipation. However, excessive bidet use may cause rectal disorders, such as rectal mucosal prolapse syndrome and solitary rectal ulcers. Herein, we report a rare case of a patient with advanced rectal ulceration caused by electric bidet toilet usage.
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Affiliation(s)
| | | | - Shin Inoue
- Department of GastroenterologyKameda Medical CenterChibaJapan
| | | | - Tomoyuki Funato
- Department of GastroenterologyKameda Medical CenterChibaJapan
| | | | | | - Hironobu Nagumo
- Department of GastroenterologyKameda Medical CenterChibaJapan
| | - So Nakaji
- Department of GastroenterologyKameda Medical CenterChibaJapan
| | - Koichi Homma
- Department of Diagnostic PathologyKameda Medical CenterChibaJapan
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Nishiwaki T, Tsutsumi Y, Nakaji S. A Mysterious Hepatic Mass. Gastroenterology 2024; 166:e6-e9. [PMID: 37329961 DOI: 10.1053/j.gastro.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Takuro Nishiwaki
- Department of Gastroenterology, Kameda Medical Center, Chiba, Japan.
| | - Yutaka Tsutsumi
- Department of Diagnostic Pathology, Tsutsumi Pathology Clinic, Aichi, Japan
| | - So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Chiba, Japan
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Nakaji S, Takahashi H, Yoshioka W, Shiratori T, Yoshimura S, Kawamitsu N, Tomonari A. Risk factors of early adverse events associated with endoscopic ultrasound-guided hepaticogastrostomy using self-expandable metal stent. Endosc Int Open 2024; 12:E164-E175. [PMID: 38292592 PMCID: PMC10827478 DOI: 10.1055/a-2240-1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Background and study aims This retrospective study aimed to investigate risk factors for early adverse events (AEs) associated with endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) using self-expandable metal stents (SEMS). Patients and methods The clinical success rate, technical success rate, and early AEs were assessed at two hospitals from 2010 to 2022. The analysis focused on risk factors associated with cholangitis, peritonitis, and SEMS migration. Results Technical success was achieved in all cases (94/94), and clinical success was 96.8% (91/94). Post-procedural acute cholangitis occurred in 12.8%of cases (12/94). However, no statistically significant risk factors were identified for cholangitis or biliary tract infection. Peritonitis occurred in only 2.1% of cases (2/94). Univariate analysis, using a 1.5 cm cut-off for the distance between the liver and gastrointestinal tract, revealed significant risk factors: braided-type SEMS, bile duct diameter (especially >4 mm), 6 mm diameter SEMS, and tract dilation ( P= 0.001, P= 0.020, P =0.023, and P =0.046, respectively). Adjusting the cut-offs to 2 cm underscored braided-type SEMS and tract dilation as risk factors ( P =0.002 and P =0.046, respectively). With 2.5-cm cut-offs, only braided-type SEMS remained significant ( P =0.018). Mortality within 14 and 30 days following EUS-HGS was 5.3% (5/94) and 16.0% (15/94), respectively. Conclusions EUS-HGS using SEMS demonstrated high technical and clinical success rates. Laser-cut SEMS may be superior in preventing early AEs.
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Affiliation(s)
- So Nakaji
- Gastroenterology, Kameda Medical Center, Kamogawa, Japan
- Department of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan
| | - Hirokazu Takahashi
- Department of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan
| | | | | | | | | | - Akiko Tomonari
- Department of Gastroenterology, ParkwayHealth China, Shanghai, China
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Saito K, Nagumo H, Ashikawa T, Funato T, Nakaji S, Matsui H. Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study. DEN Open 2023; 3:e153. [PMID: 35898839 PMCID: PMC9307723 DOI: 10.1002/deo2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022]
Abstract
Objectives In July 2017, supplementary guidelines on anticoagulants, including direct oral anticoagulants, were published in Japan. We investigated the changes in endoscopic submucosal dissection (ESD) of gastric mucosal lesions after the publication of the supplement, examined the risk factors, and developed a predictive model for post‐ESD bleeding. Methods We included 2272 gastric ESD cases from our hospital between May 2003 and June 2021 and classified them into two groups: 1789 cases before and 483 after the publication of the supplementary guidelines. A predictive model for post‐ESD bleeding was developed using the pre‐publication cohort data. Results The proportion of patients receiving warfarin decreased (5.0% vs. 1.4%) and those receiving direct oral anticoagulants increased (1.2% vs. 6.8%) after the publication of the supplementary guidelines. Post‐ESD bleeding occurred in 61 patients, but there was no significant difference in the bleeding rate between the groups (50 [2.8%] vs. 11 [2.3%] patients, respectively). Five risk factors (number of antithrombotic agents, dialysis, heparin replacement, resection specimen size, and procedure time) were identified for model development. The C‐statistic for the model and post‐publication cohorts were 0.83 and 0.72, respectively. In the model, each risk factor for postoperative bleeding was scored, and the risk was classified into three levels according to the total score. Bleeding rates at low, intermediate, and high risks were 1.6%, 10.3%, and 38.9%, respectively. Conclusion Despite changes in patient characteristics and clinical practice regarding ESD before and after the publication of the supplementary guidelines, we could still develop a simple and useful predictive model.
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Affiliation(s)
- Keita Saito
- Department of Gastroenterology Kameda General Hospital Japan
| | - Hironobu Nagumo
- Department of Gastroenterology Kameda General Hospital Japan
| | | | - Tomoyuki Funato
- Department of Gastroenterology Kameda General Hospital Japan
| | - So Nakaji
- Department of Gastroenterology Kameda General Hospital Japan
| | - Hiroki Matsui
- Department of Public Health Medicine, Graduate School of Medicine University of Tokyo Tokyo Japan
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Nakaji S, Takahashi H, Shiratori T, Yoshimura S, Kawamitsu N. Combination of a 19-gauge needle and 0.018-inch guidewire with a Y-connector during endoscopic ultrasound-guided hepaticogastrostomy. VideoGIE 2022; 7:284-286. [PMID: 36034065 PMCID: PMC9414937 DOI: 10.1016/j.vgie.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Saito K, Nagumo H, Iwasaki M, Nishiwaki T, Ozono D, Inoue S, Yoshimura S, Kishita H, Nakachi K, Harasawa H, Kawamitsu N, Yoshimura S, Shiratori T, Nakaji S, Ito H. A case of severe acute hemorrhagic duodenitis after administration of immune checkpoint inhibitor. DEN Open 2022; 2:e19. [PMID: 35310734 PMCID: PMC8828217 DOI: 10.1002/deo2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
Case: A 66‐year‐old man started carboplatin + etoposide + atezolizumab therapy for advanced small cell lung cancer. Seventeen days after the start of treatment, the patient presented with hematemesis and underwent emergency endoscopy, which revealed multiple erosions and ulcers in the duodenum. Some ulcers showed pulsating bleeding, which was stopped by clipping and cauterization using hemostats. Biopsy of the mucosal peri‐ulcer showed lymphocyte, eosinophil, and plasma cell infiltration. The patient was suggested to have acute hemorrhagic duodenitis, which was associated with immune checkpoint inhibitors (ICIs), and conservative treatment with blood transfusion and antacids was continued. However, 11 days after hemostasis, bleeding from a new ulcer was observed. Hemostasis was achieved by coagulation and clipping again, but the general condition of the patient deteriorated owing to the rapid progression of the primary disease, and he died 8 weeks after the start of treatment. Discussion: Although there have been several reports of colitis and other adverse events caused by ICIs, there have been very few reports of duodenitis. Endoscopic findings include diffuse erythema, erosions/ulcerations, and villous atrophy, and pathological findings include eosinophilic infiltration and increased levels of CD8‐positive T cells. However, there have been no reports of duodenal mucosal damage caused after administration of atezolizumab nor of severe cases of massive bleeding requiring endoscopic hemostasis and blood transfusion, as in this case.
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Affiliation(s)
- Keita Saito
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Hironobu Nagumo
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Miyuki Iwasaki
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Takuro Nishiwaki
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Daiki Ozono
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Shin Inoue
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Souhei Yoshimura
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Hideyuki Kishita
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | | | - Hisato Harasawa
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | | | | | | | - So Nakaji
- Department of Gastroenterology Kameda General Hospital Chiba Japan
| | - Hiroyuki Ito
- Department of Respiratory Medicine Kameda General Hospital Chiba Japan
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Shiratori T, Nakaji S, Yoshimura S, Kawamitsu N, Inoue S. Extracorporeal rendezvous technique combining endoscopic retrograde pancreatography with endoscopic ultrasound for main pancreatic duct disconnection arising from acute necrotizing pancreatitis: a case report. VideoGIE 2021; 6:472-474. [PMID: 34667914 PMCID: PMC8505271 DOI: 10.1016/j.vgie.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Video 1Extracorporeal rendezvous technique combining endoscopic retrograde pancreatography with EUS for main pancreatic duct disconnection arising from acute necrotizing pancreatitis: a case report.
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Affiliation(s)
| | - So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
| | | | - Natsuki Kawamitsu
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
| | - Shin Inoue
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
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Sakai Y, Sugiyama H, Kawaguchi Y, Kawashima Y, Hirata N, Nakaji S, Natsui M, Shioji K, Nakahara K, Tsuyuguchi T, Kato N. Uncovered versus covered metallic stents for the management of unresectable malignant distal biliary obstruction: a randomized multicenter trial. Scand J Gastroenterol 2021; 56:1229-1235. [PMID: 34375164 DOI: 10.1080/00365521.2021.1938207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The treatment result of the uncovered metallic stent (uncovered MS) and covered metallic stent (covered MS) for unresectable malignant distal biliary obstruction is controversial. This time, we conducted this study to compare the efficacies and complication rates of uncovered MS and covered MS in unresectable malignant distal biliary obstructions at a prospective randomized multicenter trial. MATERIALS AND METHODS From April 2014 to September 2018, patients with unresectable malignant distal biliary obstruction were randomly assigned to 2 groups: the uncovered MS group and the covered MS group. RESULTS 92 treatment results patients were discussed. 48 patients were assigned to the uncovered MS group and 44 cases were assigned to the covered MS group. Both groups showed a drainage effect. No significant difference was found in the drainage effect between the 2 groups. The number of stent occlusion was significantly greater (p = .0467) in uncovered MS (43.8%) comparing with those in covered MS (22.7%). As the cause of stent occlusion, tumor ingrowth was significantly greater (p < .001) in the uncovered MS group (35.4%) than in the covered MS group (2.3%). The median stent patency period was significantly longer (p = .0112) in the covered MS group (455 days) than that of the uncovered MS group (301 days). A significant difference in the median survival period was not found between the 2 groups. CONCLUSIONS Covered MS showed the possibility of extending the stent patency period by suppressing tumor ingrowth more than uncovered MS does. The UMIN Clinical Trial Registry number is UMIN000015093.
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Affiliation(s)
- Yuji Sakai
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiaki Kawaguchi
- Department of Gastroenterology, Tokai University Hospital, Iseahara, Japan
| | - Yohei Kawashima
- Department of Gastroenterology, Tokai University Hospital, Iseahara, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
| | - So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
| | - Masaaki Natsui
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibara, Japan
| | - Kazuhiko Shioji
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kazunari Nakahara
- Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Nakaji S, Okawa Y, Nakamura K, Itonaga M, Inase M, Sugiyama H, Suzuki R, Yamauchi K, Matsui H, Hirata N, Saito J, Ishii N, Tsuyuguchi T, Kato H, Kitano M, Kato N, Ohira H, Okada H, Torimura T, Maguchi H. Predictive model of bleeding following endoscopic sphincterotomy for the treatment of choledocholithiasis in hemodialysis patients: A retrospective multicenter study. JGH Open 2020; 4:915-922. [PMID: 33102764 PMCID: PMC7578281 DOI: 10.1002/jgh3.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/01/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Although hemodialysis (HD) is a strong risk factor for postendoscopic sphincterotomy (ES) bleeding, additional risk factors in HD patients remain unclear. There is no model for predicting post-ES bleeding risk in HD patients. Therefore, we conducted a retrospective multicenter study to reveal these risk factors and develop a predictive model of post-ES bleeding in HD patients. METHODS We retrospectively reviewed the medical records of HD patients who underwent ES at eight hospitals between January 2006 and December 2016, with post-ES bleeding as the main outcome measure. Univariate analyses were performed to extract possible risk factors for post-ES bleeding. Factors that were clinically important and statistically significant in our univariate analyses were then included in our logistic regression analysis for the development of a multivariate predictive model of post-ES bleeding. This predictive model was visualized using a predictive nomogram. RESULTS Post-ES bleeding occurred in 20 (16.3%) of 123 HD patients. Based on clinically important factors and the results of our univariate analyses, platelet count, prothrombin time (international normalized ratio), and HD duration were included in our predictive model of post-ES bleeding. Receiver operating characteristic analysis found that this model had an area under the curve of 0.715 (95% confidence interval, 0.609-0.822). We developed a predictive nomogram based on these results. CONCLUSIONS We demonstrated that post-ES bleeding is more common in HD patients than in the general population and succeeded in constructing a predictive model that can effectively identify HD patients at risk of post-ES bleeding.
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Affiliation(s)
- So Nakaji
- Department of GastroenterologyKameda Medical CenterChibaJapan
| | | | - Kenji Nakamura
- Department of GastroenterologySt. Luke's International HospitalTokyoJapan
| | - Masahiro Itonaga
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Masami Inase
- Department of GastroenterologyEbina General HospitalEbinaJapan
| | - Harutoshi Sugiyama
- Department of Gastroenterology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Rei Suzuki
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Kenji Yamauchi
- Department of Gastroenterology and HepatologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroki Matsui
- Clinical Research Support DivisionKameda Institute for Health Science, Kameda College of Health SciencesChibaJapan
| | - Nobuto Hirata
- Department of GastroenterologyKameda Medical CenterChibaJapan
| | - Junko Saito
- Department of GastroenterologyChikamori HospitalKochiJapan
| | - Naoki Ishii
- Division of GastroenterologyTokyo Shinagawa HospitalShinagawa CityJapan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Hironari Kato
- Department of Gastroenterology and HepatologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Masayuki Kitano
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Hiroyuki Okada
- Department of Gastroenterology and HepatologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Takuji Torimura
- Department of MedicineKurume University School of MedicineKurumeJapan
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Narita T, Hatakeyama S, Imai A, Tanaka T, Hamano I, Okamoto T, Yoneyama T, Yamamoto H, Yoneyama T, Hashimoto Y, Nakaji S, Suzuki T, Ohyama C. The impact of malnutrition on the risk of developing urolithiasis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Obase K, Matsumaru I, Nakaji S, Miura T, Eishi K. 41 Geometric change in valvular apparatus during tricuspid repair for severe tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
For repairing severe tricuspid regurgitation (TR) with leaflet tethering, our team employs spiral suspension procedure, in which papillary muscles (PMs) are approximated and suspended towards annulus by suture in addition to annuloplasty.
Purpose
To visualize subtricuspid apparatus and investigate its geometric change by the procedure, comparing with annuloplasty alone.
Methods
11 patients who underwent spiral suspension and 10 patients who underwent annuloplasty alone were studied. Using 3D dataset derived from transesophgeal echocardiography with transgastric approach, the distances between the mid septal annulus (point C) and the anterior PM tip (point A) and posterior PM (point P) were calculated. Also, annular perimeter, leaflet surface area and tenting height were measured
Results
In all cases, PM tips could be visualized and identified for the measurements. By spiral suspension, the distance CA and tenting height were significantly reduced. On the other hand, by annuloplasty alone, CA and tenting height were likely to be increased but statistically not significant.
Conclusions
Spiral suspension ameliorated leaflet tethering with relocating PMs. Annuloplasty alone reduced leaflet surface area, which indicates increase of coaptation surface. Interestingly, PM tip- annulus distance and tenting height were possibly increased by annuloplasty. Further investigation is need in large number.
Result of measurements Annuloplasty alone Spiral suspension Pre-op Post-op Pre-op Post-op Annular perimeter, mm 120.9 ± 11.2 78.8 ± 5.1* 142.4 ± 18.2* 81.1 ± 6.4** Leaflet surface area, cm2 13.1 ± 3.1 5.6 ± 0.9* 19.3 ± 4.8* 5.8 ± 0.8** Tenting height, mm 2.8 ± 2.3 3.1 ± 1.2 7.0 ± 4.8* 2.9 ± 2.6** CA, mm 27.3 ± 3.9 29.1 ± 6.2 35.7 ± 6.9* 29.6 ± 5.2** CP, mm 33.1 ± 6.0 33.8 ± 9.4 38.5 ± 8.2 33.9 ± 6.1 *p < 0.05, vs Annuloplasty alone pre-op **p < 0.05, vs Spiral suspension pre-op
Abstract 41 Figure. Pre- and post-operative valve apparatus
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Affiliation(s)
- K Obase
- Nagasaki University Hospital, Cardiovascular Surgery, Nagasaki, Japan
| | - I Matsumaru
- Nagasaki University Hospital, Cardiovascular Surgery, Nagasaki, Japan
| | - S Nakaji
- Nagasaki University Hospital, Cardiovascular Surgery, Nagasaki, Japan
| | - T Miura
- Nagasaki University Hospital, Cardiovascular Surgery, Nagasaki, Japan
| | - K Eishi
- Nagasaki University Hospital, Cardiovascular Surgery, Nagasaki, Japan
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Nakaji S, Hirata N, Matsui H, Shiratori T, Kobayashi M, Yoshimura S, Kanda K, Kawamitsu N, Harasawa H. Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis. Endosc Int Open 2018; 6:E568-E574. [PMID: 29756014 PMCID: PMC5943695 DOI: 10.1055/a-0587-4470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Hemodialysis (HD) is considered one of the risk factors for post-endoscopic sphincterotomy (ES) bleeding. Therefore, we conducted a retrospective study to evaluate HD as a risk factor for post-ES bleeding in patients with choledocholithiasis. PATIENTS AND METHODS We used the post-ES bleeding rate as the main outcome measure. To evaluate the influence of HD on the risk of post-ES bleeding, logistic regression and propensity score analyses were conducted. In addition, univariate analysis-based comparisons of various clinical parameters (as secondary outcome measures) were performed between the patients in the HD and non-HD groups that experienced post-ES bleeding. RESULTS A total of 1518 patients were enrolled. In the multivariate analysis, a platelet count of < 50,000, anticoagulant therapy, bleeding during ES, and HD were found to be significantly associated with post-ES bleeding (odds ratio [OR]: 35.30, 95 % confidence interval [CI]: 3.81 - 328.00; OR: 4.39, 95 % CI: 1.53 - 12.60; OR: 4.28, 95 % CI: 2.30 - 7.97; and OR: 13.30, 95 % CI: 5.78 - 30.80, respectively). Propensity score matching created 28 matched pairs. Propensity score analysis showed that the risk difference between the groups was 0.214 (95 % CI: 0.022 - 0.407). In a comparison between the patients in the HD and non-HD groups that suffered post-ES bleeding, it was found that the post-ES bleeding was significantly more severe in the HD group (p = 0.033), and massive blood transfusions and long periods of hospitalization were more frequently required in the HD group (p = 0.008 and p < 0.001, respectively). CONCLUSION HD is an independent risk factor for post-ES bleeding and makes post-ES bleeding more serious.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan,Corresponding author So Nakaji Department of GastroenterologyKameda Medical Center929, Higashi-choKamogawa CityChiba296-8602Japan+81-4-7099-1131
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
| | - Hiroki Matsui
- Clinical Research Support Division, Kameda Institute for Health Science, Kameda College of Health Sciences, Kamogawa City, Japan
| | | | | | | | - Keisuke Kanda
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
| | - Natsuki Kawamitsu
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
| | - Hisato Harasawa
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan
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Katoh S, Kojima T, Morimoto S, Inoue K, Ida K, Nakaji S. Non-Machinery-Based System for Cell-Free, Concentrated Autogenous Ascitic Fluid Reinfusion. Int J Artif Organs 2018. [DOI: 10.1177/039139889501800708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A non-machinery-based system for the reinfusion of ascitic fluid was developed and assessed. In fundamental studies utilizing bovine serum, this procedure proved economical, quick and useful. The most suitable filter was PS-R (#405-2). Bovine serum with a protein concentration below 3.0 g/dl was treated using this system. Samples containing blood (prepared to 0.5% hematocrit) were also treated, but the treatment time required was double that of serum with the same protein concentration. In both cases the protein recovery ratios were about 90%. We conducted clinical studies on 62 occasions (machinery-based system; 31 times, non-machinery-based system; 31 times) on 19 cases of ascites refractory to treatment with various drugs including diuretics. Clarification of the differences between the non-machinery and the machinery-based system, indicated the former to be superior. This new procedure is easier because of its use of no machinery, and the high protein recovery ratio proved its usefulness.
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Affiliation(s)
- S. Katoh
- Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, Gifu
| | - T. Kojima
- Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, Gifu
| | - S. Morimoto
- Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, Gifu
| | - K. Inoue
- Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, Gifu
| | - K. Ida
- Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, Gifu
| | - S. Nakaji
- Medical Research and Development Department, Kuraray Co., Okayama - Japan
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15
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Sakai Y, Tsuyuguchi T, Hirata N, Nakaji S, Shimura K, Nishikawa T, Fujimoto T, Hamano T, Nishino T, Yokosuka O. Clinical utility of 0.025-inch guidewire VisiGlide2 TM in the endoscopic retrograde cholangiopancreatography-related procedures. World J Gastrointest Endosc 2017; 9:77-84. [PMID: 28250900 PMCID: PMC5311476 DOI: 10.4253/wjge.v9.i2.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the result of the use of 0.025-inch guidewire (GW) VisiGlide2TM as the first choice in the endoscopic retrograde cholangiopancreatography (ERCP)-related procedures without selecting the patient in a multicenter prospective study.
METHODS ERCP using 0.025-inch GW VisiGlide2TM as the first choice was conducted in patients who have needed ERCP, and its accomplishment rate of procedure, procedural time, incidence of accidental symptoms were compared with those of ERCP using 0.025-inch GW VisiGlideTM.
RESULTS The accomplishment rate of procedure was 97.5% (197/202), and procedural time was 23.930 ± 16.207 min. The accomplishment rate of procedure using 0.025-inch GW VisiGlideTM was 92.3% (183/195), and procedural time was 31.285 ± 19.122 min, thus the accomplishment rate of procedure was significantly improved and procedural time was significantly shortened (P < 0.05). Accidental symptoms by ERCP-related procedures were observed in 3.0% (6/202), and all were conservatively alleviated.
CONCLUSION When 0.025-inch GW VisiGlide2TM was used for ERCP-related procedure as the first choice, it showed high accomplishment rate of procedure and low incidence of accidental symptoms, suggesting it can be used as the universal GW. Clinical Trial Registry (UMIN0000016042).
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Uno S, Hase R, Kobayashi M, Shiratori T, Nakaji S, Hirata N, Hosokawa N. Short-course antimicrobial treatment for acute cholangitis with Gram-negative bacillary bacteremia. Int J Infect Dis 2017; 55:81-85. [DOI: 10.1016/j.ijid.2016.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 12/07/2022] Open
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Nakaji S, Hirata N, Mikata R, Kobayashi M, Shiratori T, Ogasawara S, Ooka Y, Tsuyuguchi T, Yamaguchi T, Yokosuka O. Clinical outcomes of endoscopic ultrasound-guided ethanol injection for hepatocellular carcinoma in the caudate lobe. Endosc Int Open 2016; 4:E1111-E1115. [PMID: 27747288 PMCID: PMC5063731 DOI: 10.1055/s-0042-116146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023] Open
Abstract
Background and study aims: Accurately puncturing hepatocellular carcinomas (HCC) that arise from the caudate lobe is generally considered to be technically difficult. We conducted a retrospective study to evaluate the feasibility and safety (the therapeutic outcomes and adverse events) of endoscopic ultrasound (EUS)-guided ethanol injection as a novel treatment for HCC in the caudate lobe. Patients and methods: Twelve patients with early-stage HCC of the caudate lobe that were treated with EUS-guided ethanol injection at two tertiary referral centers were reviewed retrospectively. To evaluate the therapeutic effect of the treatment, a local control curve and an overall survival curve were constructed using the Kaplan-Meier method. Results: The mean follow-up duration was 31.0 months. The 1-year local control rate was 80.2 %, and recurrent lesions developed in 2 cases (after 3 and 9 months, respectively). The overall survival rate was 91.7 %, 75.0 %, and 53.3 % at 1, 2, and 3 years, respectively. Concerning procedure-related adverse events (AEs), 2 patients suffered episodes of fever lasting a few days; however, no serious AEs occurred. Conclusions: EUS-guided ethanol injection could be a useful treatment for early-stage HCC in the caudate lobe because of its simplicity and reduced invasiveness.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center,Corresponding author So Nakaji 929, Higashi-cho, Kamogawa CityChiba, 296-8602Japan+81-4-7099-1131
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center
| | - Rintaro Mikata
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | | | | | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | - Toshio Tsuyuguchi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | | | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
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Nakaji S, Hirata N, Kobayashi M, Shiratori T, Sanagawa M. Endoscopic ultrasonography-guided ethanol injection as a treatment for ruptured hepatocellular carcinoma in the left hepatic lobe. Endoscopy 2016; 47 Suppl 1:E558-60. [PMID: 26610083 DOI: 10.1055/s-0034-1393394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Masayoshi Kobayashi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Masahiro Sanagawa
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Kawamura Y, Nakaji S, Hirata N. Abstract 525: Cases with Uncommon Anti-phospholipid Antibody Syndrome Developed Multifocal Vascular Disorders Such as Ischemic Enteritis, Portal Vein Thrombosis, Ischemic Heart Disease and Cerebral Infarction. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose:
We report cases with uncommon anti-phosholipid antibody syndrome developed ischemic enteritis, portal vein thrombosis, ischemic heart disease and cerebral infarction. The difficulty in diagnosing and treatment procedures for multifocal vascular disorders is discussed.
Patients and Methods:
Patient 1, 76-year-old man, with acute abdomen. Patient 2, 54-year-old man, with intractable esophageal varices. Clinical manifestation was superior mesenteric artery (SMA) thrombosis in the patient 1 and portal vein thrombosis in the patient 2. Serial CT scans were examined on 64 or 80 multidetector-row CT (Toshiba), with bolus injection of contrast media for CT angiography (CTA). Abdominal angiography with endovascular intervention and coronary angiography were performed on Allura Xper FD-20 and FD-10 (Philips).
Results:
Emergency CTA of patient 1 showed decreased contrast enhancement of SMA and SMV but enhancement of intestinal walls were well preserved. Although the patient’s symptom got better, follow-up CT revealed the growth of SMA thrombosis. The aspiration and the dissolution of SMA thrombosis were performed through the SMA catheter for five days resulted in complete recanalization.Then he felt chest oppression and 75% stenosis of RCA segment 4, followed by complete spastic occlusion on Acetylcholine loading on the coronary angiography, which recovered perfectly with intra-coronary nitroglycerin administration. He discharged our hospital with health, while he had cerebellar infarction with right cerebellar artery occlusion. On patient 2, to resolve portal hypertension, balloon-occluded retrograde transvenous obliteration was scheduled, however, due to numerous collaterals prevented the effective venous obliteration and splenic arterial embolization was selected alternatively.
Discussion and Conclusions:
The progressive SMA thrombosis with coronary disease and subsequent cerebellar occlusion seen in patient 1, and the portal vein thrombosis in patient 2 without chronic hepatitis nor cirrhosis were unusual. To discover underlining uncommon anti-phosholipid antibody syndrome is important to prevent serious vascular diseases in sequence.
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Affiliation(s)
| | - So Nakaji
- Gastroenterological Medicine, Kameda Med Cntr, Chiba, Japan
| | - Nobuto Hirata
- Gastroenterological Medicine, Kameda Med Cntr, Chiba, Japan
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Nakaji S, Hirata N, Shiratori T, Kobayashi M. Computed tomography enterography as a tool for identifying pancreaticojejunal anastomoses in patients who have undergone Whipple's resection. Endoscopy 2016; 47 Suppl 1 UCTN:E159-60. [PMID: 25926179 DOI: 10.1055/s-0034-1391421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa city, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa city, Chiba, Japan
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Kamogawa city, Chiba, Japan
| | - Masayoshi Kobayashi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa city, Chiba, Japan
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21
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Nakaji S, Hirata N. Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization. Endosc Ultrasound 2016; 5:390-392. [PMID: 28000631 PMCID: PMC5206828 DOI: 10.4103/2303-9027.190924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 71-year-old female was diagnosed with hepatocellular carcinoma (HCC). The tumor measured 65 mm in diameter and was located in the caudate lobe. Transarterial chemoembolization (TACE) was performed repeatedly; however, a follow-up dynamic computed tomography (CT) scan showed that the tumor remained viable. Thus, TACE was performed using drug-eluting beads that had been preloaded with epirubicin. Contrast-enhanced endoscopic ultrasonography (CE-EUS) was conducted for evaluating the treatment effects. First, we detected the internal part of the tumor. Then, a perflubutane suspension was injected intravenously. Next, CE-EUS was performed for the external ventral part of the tumor in the same manner. The perflubutane flowed into the tumor and spread into both its internal and external ventral regions. Thus, we considered that the tumor was still viable and planned to carry out TACE again. CE-EUS could be a useful tool for evaluating the treatment effects of TACE on HCC deep inside the liver.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Nakaji S, Hirata N, Shiratori T, Kobayashi M, Yamauchi K. Endoscopic ultrasound-guided pancreaticojejunostomy with a forward-viewing echoendoscope as a treatment for stenotic pancreaticojejunal anastomosis. Endoscopy 2015; 47 Suppl 1 UCTN:E41-2. [PMID: 25603522 DOI: 10.1055/s-0034-1391245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masayoshi Kobayashi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kenji Yamauchi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
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Matsuzaka M, Tanaka R, Okuse R, Suto S, Sasaki Y, Nakaji S. 1050 Geographical distributions of stomach and colorectal cancer mortality in Aomori prefecture. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Tanaka R, Matsuzaka M, Nakaji S. 1051 Association between distance from patients' residence to hospitals and stage at diagnosis among cancer patients in Aomori prefecture. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fujii H, Ishii E, Tochitani S, Nakaji S, Hirata N, Kusanagi H, Narita M. Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm. Dig Endosc 2015; 27:159-61. [PMID: 24684669 DOI: 10.1111/den.12261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/24/2014] [Indexed: 01/02/2023]
Abstract
In the expanded indications for endoscopic resection, Japanese guidelines for gastric cancer include differentiated cancers confined to the mucosa with an ulcer <30 mm. We describe a patient with lymph node metastasis after curative endoscopic submucosal dissection (ESD) for a tumor of this indication. The patient was a 70-year-old man with chronic hepatitis C. He underwent ESD for early gastric cancer in May 2010. Pathology revealed a moderately differentiated adenocarcinoma, 22 × 17 mm in size, that was confined to the mucosa with an ulcer. The horizontal and vertical margins were negative for the tumor. We diagnosed thiscase as curative resection of expanded indication and followed this patient with endoscopy, abdominal ultrasonography (AUS) or enhanced computed tomography (CT) approximately every 6 months. After 17 months, lymph node metastasis was detected with AUS and CT and diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy in August 2011. Distal gastrectomy with D2 dissection was carried out in December 2011. Although it is low, the possibility of recurrence should be borne in mind after endoscopic treatment of early gastric cancer, despite its inclusion in the expanded indications for endoscopic resection.
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Affiliation(s)
- Hiroyuki Fujii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan
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26
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Sakai Y, Tsuyuguchi T, Kawaguchi Y, Hirata N, Nakaji S, Kitamura K, Mikami S, Fujimoto T, Ijima M, Kurihara E, Oana S, Nishino T, Tamura R, Sakamoto D, Nakamura M, Nishikawa T, Sugiyama H, Yoshida H, Mine T, Yokosuka O. Endoscopic papillary large balloon dilation for removal of bile duct stones. World J Gastroenterol 2014; 20:17148-17154. [PMID: 25493029 PMCID: PMC4258585 DOI: 10.3748/wjg.v20.i45.17148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/01/2014] [Accepted: 07/30/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation (EPLBD) for bile duct stones in a multicenter prospective study.
METHODS: Lithotomy by EPLBD was conducted in 124 patients with bile duct stones ≥ 13 mm in size or with three or more bile duct stones ≥ 10 mm. After endoscopic sphincterotomy, the papilla was dilated using balloons 12-20 mm in diameter fitting the bile duct diameter.
RESULTS: The success rate of first-time lithotomy was 86.3% (107/124) and the final lithotomy success rate was 100% (124/124). Lithotripsy was needed in 10 of the 124 (13.6%) patients. Adverse events due to the treatment procedure occurred in 6 (4.8%) patients, all of which were mild. Performing large balloon dilation after endoscopic sphincterotomy in patients with large stones or multiple stones in the bile duct is considered to ensure the safety of treatment and to reduce the need for lithotripsy.
CONCLUSION: It is suggested that treatment by EPLBD for large bile duct stones may be safe and useful.
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Nakaji S, Hirata N, Yamauchi K, Shiratori T, Kobayashi M, Fujii H, Ishii E. Endoscopic retrograde cholangiopancreatography using a cap-assisted highly flexible colonoscope in patients with Roux-en-Y anastomosis. Endoscopy 2014; 46:529-32. [PMID: 24770963 DOI: 10.1055/s-0034-1365516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In this retrospective study of 10 patients with Roux-en-Y anastomosis, endoscopic retrograde cholangiopancreatography (ERCP) using a cap-assisted thin highly flexible colonoscope was done for treatment of bile duct stones. In five patients, the papilla of Vater was successfully reached using the colonoscope alone. However, in the other five patients, combination with an overtube was needed to reach the papilla. In all cases, complete removal of bile duct stones was accomplished. Procedure-related adverse events occurred in two cases. In conclusion, use of a cap-assisted thin highly flexible colonoscope for ERCP was successful in patients with a Roux-en-Y anastomosis.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kenji Yamauchi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masayoshi Kobayashi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Eiji Ishii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
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Sakai Y, Tsuyuguchi T, Hirata N, Sugiyama H, Shimura K, Nakaji S, Shiratori T, Fujimoto T, Tsuchiya S, Mikami S, Yokosuka O. Long-term outcome of the WallFlex partially covered stent for unresectable malignant biliary obstruction: a multicenter single-arm prospective study. Hepatogastroenterology 2014; 60:1854-60. [PMID: 24088309 DOI: 10.5754/hge13480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Covered metallic stent was developed to prevent tumor ingrowth. However, procedural accidents due to its insertion often occur and migration after long-term insertion causes problems. The WallFlex partially covered stent (WF) with reduced axial force enables stenting along the bile duct. We examined the usefulness of WF placement in an unresectable malignant distal biliary obstruction. METHODOLOGY We examined procedural accidents, stent obstruction rate, and patency period caused by WF insertion. RESULTS Ninety-seven patients were analyzed; procedural accidents caused by WF insertion occurred in 8 patients (7.2%) composed of acute cholecystitis in 3 patients (3.2%), acute pancreatitis in 2 patients (2.1%), acute cholangitis in 1 patient (1%), and other in 1 patient (1%). The stent obstruction rate was 19.6% (19 patients), and obstruction cause includes sludge in 9 patients (9.3%), migration in 4 patients (4.1%), food impaction in 3 patients (3.1%), ingrowth in 1 patient (1%), overgrowth in 0 patients (0%), and unknown in 2 patients (2.1%). The mean stent patency period was 634.918 +/- 66.545 (7-946) days. CONCLUSIONS WF has less procedural accidents when inserted into unresectable malignant biliary obstruction patients with reduced migration rate after a long period and low obstruction rate.
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Kobayashi M, Hirata N, Nakaji S, Shiratori T, Fujii H, Ishii E. Gastrointestinal stromal tumor of the ampulla of Vater: A case report. World J Gastroenterol 2014; 20:4817-4821. [PMID: 24782637 PMCID: PMC4000521 DOI: 10.3748/wjg.v20.i16.4817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/09/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) usually develop in the stomach and small intestine and only rarely occur at the ampulla of Vater, with only 11 cases reported in the literature. We report a case of a GIST of the ampulla of Vater. A 36-year-old, previously healthy man presented with a loss of consciousness lasting a few minutes. A gastroduodenal endoscopy revealed a submucosal tumor with central ulceration at the ampulla of Vater. The enhanced computed tomography scan revealed a smooth-outlined hypervascular solid mass (24 mm × 30 mm) in the second part of the duodenum. Neither lymphadenopathy nor metastasis was observed. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed normal bile and pancreatic ducts. Biopsies were collected from the ulcerative lesion, and the tumor was diagnosed as a GIST. A submucosal tumor with central ulceration may be a characteristic form of GISTs of the ampulla of Vater, and biopsy studies are useful for the diagnosing such tumors. The patient underwent pancreatoduodenectomy, and the operative specimen revealed a 2.2-cm GIST with 1 mitosis per 50 high-power fields. The gold standard for treatment of GISTs is surgical resection without rupture of a capsule. If technically possible, local resection may be considered. However, when the location of the lesion presents challenges, a pancreatoduodenectomy should be performed for GIST of the ampulla of Vater.
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Nakaji S, Hirata N, Shiratori T, Kobayashi M, Fujii H, Ishii E, Matsue K, Hoshi K. A case of primary pancreatic lymphoblastic lymphoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2014; 7:180-4. [PMID: 26183638 DOI: 10.1007/s12328-014-0462-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/28/2014] [Indexed: 01/08/2023]
Abstract
Pancreatic involvement is an extremely rare manifestation of lymphoblastic lymphoma (LBL), and only a few cases have been reported. We report a case of LBL arising from the pancreas that was diagnosed using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The patient was a 57-year-old female who had suffered from abdominal pain for 2 weeks. A physical examination revealed an upper abdominal mass, but did not detect peripheral lymphadenopathy. Imaging studies including computed tomography (CT) and (18)F-fluorodeoxy glucose (FDG)-positron emission tomography-CT revealed an enlarged pancreatic body, which was positive for FDG uptake. EUS-FNA detected medium-sized proliferating atypical lymphocytes, and immunohistochemical staining demonstrated that these cells were positive for CD20, CD10, PAX5, and terminal deoxynucleotidyl transferase. A bone marrow examination was negative for lymphoma infiltration, and a diagnosis of LBL arising from the pancreas was made. The patient was successfully treated with a combination of chemotherapy and pancreatic irradiation.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan,
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Abstract
We present three cases of pseudoaneurysm caused by self-expandable metal stents that formed arteriobiliary fistulas and caused hemobilia. Diagnoses were made on the basis of dynamic computed tomography or angiography. One patient died because of bleeding and cholangitis, whereas the others were successfully treated by transarterial embolization.
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Affiliation(s)
- Yasuko Nezu
- Department of Gastroenterology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Eiji Ishii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
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Arai T, Akao N, Seki T, Kumagai T, Ishikawa H, Ohta N, Hirata N, Nakaji S, Yamauchi K, Hirai M, Shiratori T, Kobayashi M, Fujii H, Ishii E, Naito M, Saitoh SI, Yamaguchi T, Shibata N, Shimo M, Tokiwa T. Molecular genotyping of anisakis larvae in Middle Eastern Japan and endoscopic evidence for preferential penetration of normal over atrophic mucosa. PLoS One 2014; 9:e89188. [PMID: 24586583 PMCID: PMC3938461 DOI: 10.1371/journal.pone.0089188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/16/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Anisakiasis is a parasitic disease caused primarily by Anisakis spp. larvae in Asia and in Western countries. The aim of this study was to investigate the genotype of Anisakis larvae endoscopically removed from Middle Eastern Japanese patients and to determine whether mucosal atrophy affects the risk of penetration in gastric anisakiasis. METHODS In this study, 57 larvae collected from 44 patients with anisakiasis (42 gastric and 2 colonic anisakiasis) were analyzed retrospectively. Genotyping was confirmed by restriction fragment length polymorphism (RFLP) analysis of ITS regions and by sequencing the mitochondrial small subunit (SSU) region. In the cases of gastric anisakiasis, correlation analyses were conducted between the frequency of larval penetration in normal/atrophic area and the manifestation of clinical symptoms. RESULTS Nearly all larvae were A. simplex seusu stricto (s.s.) (99%), and one larva displayed a hybrid genotype. The A. simplex larvae penetrated normal mucosa more frequently than atrophic area (p = 0.005). Finally, patients with normal mucosa infection were more likely to exhibit clinical symptoms than those with atrophic mucosa infection (odds ratio, 6.96; 95% confidence interval, 1.52-31.8). CONCLUSIONS In Japan, A. simplex s.s. is the main etiological agent of human anisakiasis and tends to penetrate normal gastric mucosa. Careful endoscopic examination of normal gastric mucosa, particularly in the greater curvature of the stomach will improve the detection of Anisakis larvae.
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Affiliation(s)
- Toshio Arai
- Department of Environmental Parasitology, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
- Department of Gastroenterology, Toukatsu Hospital, Nagareyama-shi, Chiba, Japan
| | - Nobuaki Akao
- Department of Environmental Parasitology, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
- * E-mail:
| | - Takenori Seki
- Department of Environmental Parasitology, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Takashi Kumagai
- Department of Environmental Parasitology, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hirofumi Ishikawa
- Department of Environmental Parasitology, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Nobuo Ohta
- Department of Environmental Parasitology, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kenji Yamauchi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Mitsuru Hirai
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masayoshi Kobayashi
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Eiji Ishii
- Department of Gastroenterology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Mikio Naito
- Department of Endoscopy, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Shin-ichi Saitoh
- Department of Endoscopy, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshikazu Yamaguchi
- Department of Gastroenterology, Toukatsu Hospital, Nagareyama-shi, Chiba, Japan
| | - Nobumitsu Shibata
- Department of Pathology, Toukatsu Hospital, Nagareyama-shi, Chiba, Japan
| | - Masamune Shimo
- Department of Pathology, Toukatsu Hospital, Nagareyama-shi, Chiba, Japan
| | - Toshihiro Tokiwa
- Laboratory of Veterinary Pathology, Azabu University, Sagamihara, Kanagawa, Japan
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Sudo K, Ishihara T, Hirata N, Ozawa F, Ohshima T, Azemoto R, Shimura K, Nihei T, Nishino T, Nakagawa A, Nakamura K, Hara T, Tada M, Mikata R, Tawada K, Yokosuka O, Nakaji S, Yamaguchi T. Randomized controlled study of gemcitabine plus S-1 combination chemotherapy versus gemcitabine for unresectable pancreatic cancer. Cancer Chemother Pharmacol 2014; 73:389-96. [PMID: 24322377 DOI: 10.1007/s00280-013-2368-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/02/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to evaluate efficacy and safety of gemcitabine plus S-1 (GS) combination chemotherapy in patients with unresectable pancreatic cancer. METHODS Patients were randomly assigned to receive GS (oral S-1 60 mg/m(2) daily on days 1-15 every 3 weeks and gemcitabine 1,000 mg/m(2) on days 8 and 15) or gemcitabine (1,000 mg/m(2) on days 1, 8, and 15 every 4 weeks). The primary endpoint was progression-free survival (PFS). RESULTS One hundred and one patients were randomly assigned. PFS was significantly longer in the GS arm with an estimated hazard ratio (HR) of 0.65 (95 % CI 0.43-0.98; P = 0.039; median 5.3 vs 3.8 months). Objective response rate (ORR) was also better in the GS arm (21.6 vs 6 %, P = 0.048). Median survival was 8.6 months for GS and 8.6 months for GEM (HR 0.93; 95 % CI 0.61-1.41; P = 0.714). Grade 3-4 neutropenia (44 vs 19.6 %, P = 0.011) and thrombocytopenia (26 vs 8.7 %, P = 0.051) were more frequent in the GS arm. CONCLUSIONS GS therapy improved PFS and ORR with acceptable toxicity profile in patients with unresectable pancreatic cancer.
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Affiliation(s)
- Kentaro Sudo
- Department of Gastroenterology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan,
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Sakai Y, Tsuyuguchi T, Hirata N, Nakaji S, Shimura K, Fujimoto T, Tsuchiya S, Nishino T, Nishikawa T, Sugiyama H, Yokosuka O. Can endoscopic sphincterotomy be performed safely in elderly patients aged 80 years or older with pancreatic and biliary diseases? Hepatogastroenterology 2014; 60:1251-6. [PMID: 23340278 DOI: 10.5754/hge121248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS The purpose of this study was to investigate whether endoscopic sphincterotomy (EST) can be usefully and safely performed in elderly patients aged 80 years or older. METHODOLOGY The eligible patients with pancreatic and biliary diseases who required EST were divided into two groups depending on their age: under 80 (group A) and 80 or older (group B). Patient characteristics, EST success rate and incidence of the related complications were evaluated. RESULTS Of the 720 patients who required EST, 522 patients were in group A and 198 in group B. Group B incidences of patient characteristics at baseline disease and anticoagulant/antiplatelet therapy were significantly higher than in group A (p<0.05). The EST success rates were 97.1% (507/522) in group A and 96.5% (191/198) in group B. The incidences of the related complications were 8.8% (46/522) in group A and 4% (8/198) in group B, respectively, again without significant difference. CONCLUSIONS The EST success rate and the incidence of related complications were comparable between patients in groups A and B, indicating that EST can be safely performed even in the elderly aged 80 years or older.
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Nakaji S, Hirata N, Fujii H, Iwaki K, Shiratori T, Kobayashi M, Wakasugi S, Ishii E, Takeyama H, Hoshi K. A case of focal autoimmune pancreatitis (AIP) mimicking an intraductal papillary mucinous neoplasm (IPMN). Clin J Gastroenterol 2013; 6:329-33. [PMID: 26181739 DOI: 10.1007/s12328-013-0392-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/17/2013] [Indexed: 12/27/2022]
Abstract
The present case involved a 76-year-old man with a cystic mass in the head of his pancreas. The cystic lesion, which measured 17.7 × 9.8 mm, was first detected by ultrasonography (US) at the age of 72 years. Follow-up endoscopic ultrasonography (EUS) performed at 4 years after the lesion had first been detected revealed a mural nodule measuring 14.0 × 8.4 mm in the cyst. Endoscopic retrograde pancreatography (ERP) imaging revealed that the main pancreatic duct was in communication with the cyst and that there was no irregular narrowing of the main pancreatic duct. On the basis of these results, the patient was diagnosed with an intraductal papillary mucinous neoplasm (IPMN), and stomach-preserving pancreaticoduodenectomy was performed. A histopathological examination revealed that the interior of the cystic part of the lesion was lined by a pancreatic ductal epithelium. A pathological examination of the nodular lesion detected storiform fibrosis, severe lymphoplasmacytic infiltration, and hyperplasia in the pancreatic duct epithelium together with a small amount of mucus. On immunohistological staining, the infiltrating lymphoplasmacytes were found to be positive for IgG4. Accordingly, the patient was diagnosed with focal autoimmune pancreatitis (AIP). In conclusion, we reported a case of focal AIP mimicking IPMN. This case showed neither enlargement of the pancreas nor irregular narrowing of the main pancreatic duct.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Kosuke Iwaki
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Masayoshi Kobayashi
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Satoshi Wakasugi
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Eiji Ishii
- Department of Gastroenterology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Hiroyuki Takeyama
- Department of Anatomic Pathology, Kameda Medical Center, Kamogawa, Japan
| | - Kazuei Hoshi
- Department of Anatomic Pathology, Kameda Medical Center, Kamogawa, Japan
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Nakaji S, Hirata N, Yoshimura S, Shiratori T, Kobayashi M, Ishii E, Matsue K. A case of primary pancreatic Burkitt's lymphoma diagnosed by EUS-guided FNA. Gastrointest Endosc 2013; 77:958-9; discussion 959. [PMID: 23522023 DOI: 10.1016/j.gie.2013.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 01/29/2013] [Indexed: 02/08/2023]
Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Nakaji S, Hirata N, Iwaki K, Shiratori T, Kobayashi M, Inase M. Endoscopic ultrasound (EUS)-guided ethanol injection for hepatocellular carcinoma difficult to treat with percutaneous local treatment. Endoscopy 2013; 44 Suppl 2 UCTN:E380. [PMID: 23139031 DOI: 10.1055/s-0032-1309918] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S Nakaji
- Department of Gastroenterology, Kameda Medical Center, Chiba, Japan.
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Nakaji S, Hirata N, Shiratori T, Kobayashi M, Inase M. Endoscopic lithotripsy with peroral direct cholangioscopy using a conventional endoscope. World J Gastrointest Endosc 2013; 5:132-4. [PMID: 23515588 PMCID: PMC3600550 DOI: 10.4253/wjge.v5.i3.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 09/06/2012] [Accepted: 12/22/2012] [Indexed: 02/05/2023] Open
Abstract
Recently, peroral direct cholangioscopy (PDCS) using an ultra-slim endoscope has come into the spotlight. However, the working channel is too small to use various devices for lithotripsy. We report a case of endoscopic lithotripsy with PDCS using a conventional endoscope as a cholangioscope. Computed tomography scan on an 80-year-old female who was admitted with acute cholangitis showed two large stones in the bile duct. Endoscopic retrograde cholangiopancreatography was attempted first. However, mechanical lithotripsy failed because the stone was too large for the basket catheter. Finally, electric hydraulic lithotripsy with PDCS using a conventional endoscope was performed allowed the stones to be cleared completely. In conclusion, PDCS using a conventional endoscope can be an alternative solution for endoscopic lithotripsy for patients with large stones in the dilated bile duct.
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Affiliation(s)
- So Nakaji
- So Nakaji, Nobuto Hirata, Toshiyasu Shiratori, Masayoshi Kobayashi, Masami Inase, Department of Gastroenterology, Kameda Medical Center, Kamogawa city, Chiba 296-8602, Japan
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Abstract
Granular cell tumor (GCT) of the biliary system is rare. It is reported that it occurs more commonly in young black women. We report here our seldom experience of a Japanese case in whom icterus was found as a first symptom just after a caesarean operation. A 36-year-old Japanese woman developed icterus after delivery by the Caesarean operation. A surgical operation was performed without can deny that there was a tumor-related change in a bile duct as a result of examination for various images. As a result of pathological evaluation, GCT was diagnosed. By the preoperative organization biomicroscopy result, it was not able to be attachd a right diagnosis. It was thought that this tumor, although rare, should be considered as one of the causes of biliary stenosis in the younger population.
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Toda M, Morimoto K, Nakamura S, Umeda T, Nakaji S, Sugawara K. The unique correlation between anti-mutagenicity of human saliva and change in body weight. Environ Health Prev Med 2012; 6:82-7. [PMID: 21432241 DOI: 10.1007/bf02897950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2000] [Accepted: 01/06/2001] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to investigate the effect of weight reduction on the anti-mutagenicity of human saliva. Subjects were 16 male college judo players. The anti-mutagenicity of the saliva was measured using the umu test. There was an inhibiting effect of the saliva on the mutagenicity of AF-2. However, a modifying effect of the saliva on Trp-P-1 was not observed. On the day before a competition and 7 days after the competition, the inhibiting capacity of the saliva for the mutagenicity of AF-2 decreased and increased in two non-weight reduction and two weight reduction groups, respectively.However, on the day before the competition, the changed body weights (r=-0.77, p<0.01) and BMI (r=-0.77, p<0.01) were significantly correlated with that of the inhibiting capacity of the saliva for the mutagenicity of AF-2. In addition, the BMI at 20 days before the competition was not significantly but markedly correlated with it (r=0.50, p=0.057). At 7 days after the competition, however, these correlations were not found.These findings suggest a unique correlation between the anti-mutagenicity of human saliva and body weight or BMI.
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Affiliation(s)
- M Toda
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, 565-0871, Suita, Osaka, Japan
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Kurakake S, Umeda T, Nakaji S, Sugawara K, Saito K, Yamamoto Y. Changes in physical characteristics, hematological parameters and nutrients and food intake during weight reduction in judoists. Environ Health Prev Med 2012; 3:152-7. [PMID: 21432495 DOI: 10.1007/bf02931706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/1997] [Accepted: 07/08/1998] [Indexed: 10/21/2022] Open
Abstract
We studied changes in physical characteristics: body composition; muscle and physical strength; hematological parameters; and nutrients and food intake in 22 male college judoists who were losing weight purposefully. Nutritional parameters in blood, such as triglycerides, decreased immediately before matches and rebounded after matches. Free fatty acid increased before matches and returned to previous levels 10 days after matches. IgM and complements decreased before matches and did not return to previous levels even 10 days after matches. These changes were noted in the marked weight reduction group (weight lost / body weight before weight reduction, weight reduction rate≥6%). In contrast, creatine kinase increased before matches in the slight and moderate weight reduction groups (weight reduction rate< 3%, 3≤and<6%, respectively). The marked weight reduction group showed no changes in creatine kinase, however, indicating inadequate exercise due to excessive weight reduction. Muscle strength (grip) and nutrients and food intake decreased significantly before matches. These changes were noted in the marked weight reduction group. These findings suggested that a weight reduction rate of 6% or more adversely affected the performance and health of the judoist.
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Affiliation(s)
- S Kurakake
- Department of Health and Physical Education, Oita Medical University, Oita
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Shiraishi M, Suzuki K, Abe T, Kikuchi T, Satoh H, Nakaji S, Sugawara K. Diurnal variation in neutrophil function. Environ Health Prev Med 2012; 1:65-70. [PMID: 21432424 DOI: 10.1007/bf02931192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/1995] [Accepted: 01/16/1996] [Indexed: 11/25/2022] Open
Abstract
Neutrophil functions, including chemotaxis, reactive oxygen species (ROS)-producing capacity of neutrophils, and serum opsonic activity were investigated in 9 young healthy male volunteers. Venous blood of these volunteers was obtained under standardized conditions at 4-h intervals over a 24-h span. Neutrophil chemotaxis was evaluated by a modified Boyden technique, ROS-producing capacity of neutrophils and serum opsonic activity were measured by a simultaneous multiple measurement system based on luminol-dependent chemiluminescence and indicated by peak height and peak time. ROS-producing capacity of neutrophils and serum opsonic activity were activated in the daytime, and decreased from night to morning. There were negative correlations between the peak time of the luminol-dependent chemiluminescent response, neutrophil number (p<0.01) and segmented neutrophil number (p>0.01). On the other hand, no significant correlations were noted between serum opsonic activity and IgG, IgA, IgM, C3 or C4. In contrast, the peaks of neutrophil chemotaxis were at the wake-up time (6:00a.m.) and in the evening (6:00p.m.). This study indicates that diurnal variation of neutrophil function exists.
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Affiliation(s)
- M Shiraishi
- Department of Hygiene, Hirosaki University School of Medicine, 5 Zaifu-cho, 036, Hirosaki, Japan
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Inoue R, Ishibashi Y, Tsuda E, Yamamoto Y, Matsuzaka M, Takahashi I, Danjo K, Umeda T, Nakaji S, Toh S. Knee osteoarthritis, knee joint pain and aging in relation to increasing serum hyaluronan level in the Japanese population. Osteoarthritis Cartilage 2011; 19:51-7. [PMID: 21044694 DOI: 10.1016/j.joca.2010.10.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 10/19/2010] [Accepted: 10/26/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate relationship between serum hyaluronan (HA) level and the presence and severity of radiographic knee osteoarthritis (OA) as well as degree of knee pain in Japanese population. DESIGN A total of 616 volunteers participated in this study. Based on the Kellgren-Lawrence (K-L) grade, participants were radiographically classified into three groups: Normal (K-L grade 0 or 1), Moderate (grade 2) and Severe (grade 3 or 4). The degree of knee pain was quantified by visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) Pain. Serum HA levels were compared among the Normal, Moderate and Severe groups, and the relationship between serum HA level and the severity of knee OA was analyzed after age, sex and body mass index (BMI) were adjusted. In addition, the correlation between serum HA level and the degree of knee pain was analyzed in each group. RESULTS Regarding relationship between serum HA level and the severity of radiographic knee OA, serum HA levels of the Moderate and Severe groups were significantly higher than in the Normal group (P<0.001). Furthermore, serum HA level correlated with the severity of radiographic knee OA (r=0.289, P<0.001) after adjusting for age, sex and BMI. Serum HA level correlated with VAS of knee pain and/or KOOS Pain in the Normal and Moderate groups. CONCLUSION Serum HA level has the potential to be useful for the diagnosis of the presence and severity of knee OA.
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Affiliation(s)
- R Inoue
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
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Nakaji S, Hirata N, Kobayashi M, Saito J, Shiratori T, Tomonari A, Inase M, Tochitani S, Iwata M, Fukatsu K, Fujii H, Kataoka J, Tamaki N, Ohmori J, Ishii E, Ito H, Wakasugi S. [Case of von Hippel-Lindau disease diagnosed by detection of multiple pancreatic endocrine tumors and renal tumor 13 years after bilateral adrenalectomy]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:1978-1987. [PMID: 21139368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
von Hippel-Lindau (VHL) syndrome is an inherited neoplastic syndrome caused by abnormity of the VHL gene found on the short arm of the chromosome 3. We reported a case of VHL disease diagnosed by the detection of multiple pancreatic endocrine tumors and renal tumor 13 years after bilateral adrenalectomy. A 40-year-old man presented with multiple pancreas tumors (maximum size 42 mm in diameter) detected by screening abdominal ultrasonography. A 23 mm renal tumor was detected by contrast computed tomography scan at that time. His past history included left retinal angioma (age 15) and bilateral adrenal pheochromocytoma (age 27). VHL was diagnosed by genetic testing. Endoscopic ultrasound-guided fine-needle aspiration biopsy of the pancreas tumor was performed, and tumor was diagnosed as an endocrine tumor. After diagnosis, distal pancreatectomy (body-tail) was performed. This was a didactic case indicating that we should suspect VHL syndrome based on past history and family history and follow such cases up strictly.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Japan.
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Abstract
OBJECTIVES To clarify the effect of lipid profiles on postmenopausal bone loss using a longitudinal method and to determine whether cytokines are involved in bone loss. METHODS The subjects were Japanese residents participating in the Iwaki Health Promotion Projects. Women with one or more of the following factors were excluded: a history of surgical menopause, current or past users of bisphosphonates or current user of other drugs known to influence bone and lipid metabolism, and current medication for diabetes or hypertension. Consequently, 99 postmenopausal women (61.2 ± 7.7 years old) and 85 premenopausal women (41.2 ± 8.6 years old) were selected for this study. The osteo-sono-assessment index (OSI) of the left calcaneal bone was obtained twice at 1-year intervals and the annual percentage change in OSI was calculated. Serum total cholesterol, high and low density lipoprotein cholesterol, triglycerides, homocysteine and cytokines such as adipocytokines, interleukins and tumor necrosis factor-α were measured. Postmenopausal women were grouped into three groups according to their basal cholesterol level, and the relationship between basal cholesterol level and annual change in OSI was studied. RESULTS The annual percentage change in OSI in postmenopausal women with a serum total cholesterol level ≥240 mg/dl was significantly higher compared to those with a normal total cholesterol level, suggesting that hypercholesterolemia accelerates postmenopausal bone loss. No significant differences were seen in any of the cytokines that presumably cause bone resorption. CONCLUSION These results showed that hypercholesterolemia has an inverse effect on bone loss independent of cytokines presumed to mediate bone loss.
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Affiliation(s)
- A Tarakida
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, Japan
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Shinke K, Ando K, Koyama T, Takai T, Nakaji S, Ogino T. Properties of various carbon nanomaterial surfaces in bilirubin adsorption. Colloids Surf B Biointerfaces 2010; 77:18-21. [DOI: 10.1016/j.colsurfb.2009.12.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 12/23/2009] [Accepted: 12/24/2009] [Indexed: 02/05/2023]
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Saito J, Hirata N, Furuzono M, Nakaji S, Inase M, Nagano H, Iwata M, Tochitani S, Fukatsu K, Fujii H, Ishii E, Kataoka J, Mikata R, Masuya Y, Ito H, Ohmori J, Wakasugi S, Ebara M, Hoshi K. [A case of duodenal gangliocytic paraganglioma with lymph node metastasis]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:639-648. [PMID: 20379099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 28-year-old man complained of tarry stool. A series of examinations showed a submucosal tumor with bleeding at the papilla of Vater and a swollen # 17b lymph node, both of which indicated a hypervascular tumor. The pathological findings of the enucleated tumor specimens revealed gangliocytic paraganglioma with metastasis to the # 17b lymph node. Additional pancreaticoduodenectomy revealed another # 17b lymph node metastasis 7-mm in diameter. Although the majority of gangliocytic paragangliomas are benign, 7% of reported cases have lymph node metastases, as shown in the present case. These findings are important in treating patients with gangliocytic paraganglioma.
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Affiliation(s)
- Junko Saito
- Department of Gastroenterology, Kameda Medical Center, Japan
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Abstract
The effects of cellulose and the interindividual variations on the transit time in the small intestine remain unclear, but no previous study has to date taken these factors into sufficient consideration. We assessed the oro-ileal transit time and the recovery percentage of cellulose in the terminal ileum looking at interindividual variations. Seven healthy males received 100 mL of a dietary fiber-free basal diet with 5 g cellulose and 5 g of polyethylene glycol 4000. The ileal contents were aspirated every 30 min via an experimental tube placed in the terminal ileum to assess the oro-ileal transit time and the recovery percentage of cellulose. The mean percentage (with standard deviation) of the amounts of cellulose collected in the terminal ileum was 98.4%+/- 16.5% (ranging from 67.4% to 114.5%) with a coefficient variation of 16.8%. The average times (in hours) taken for 20%, 40%, 60%, and 80% of cellulose to reach the terminal ileum were 5.5 +/- 1.1, 6.7 +/- 0.7, 8.5 +/- 1.3, and 8.8 +/- 1.2, respectively, with large interindividual variations. In conclusion, the averaged recovery percentage of cellulose in the terminal ileum was approximately 100%, in accordance with the present generally accepted definition of dietary fiber. However, there were large interindividual variations in the oro-ileal transit time and the percentage of cellulose recovered.
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Affiliation(s)
- T Oyama
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Yamamoto Y, Nakaji S, Umeda T, Matsuzaka M, Takahashi I, Tanabe M, Danjo K, Kojima A, Oyama T. Effects of long-term training on neutrophil function in male university judoists. Br J Sports Med 2008; 42:255-9. [PMID: 18390768 DOI: 10.1136/bjsm.2007.032011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To clarify the effects of high-intensity and high-frequency long-term/chronic training on neutrophil function and serum levels of myogenic enzymes in male university judoists. METHODS The subjects were 24 male judoists who had stopped judo training for 6 months and then restarted their training. The following parameters were examined before and after a 2 h unified exercise loading (UEL) at the beginning of the restarted quotidian training (pre-training) and at 2 months, 4 months and 6 months thereafter: myogenic enzymes, neutrophil and leucocyte counts, and neutrophil phagocytic activity (PA) and oxidative burst activity as a measure of reactive oxygen species (ROS) production capability. RESULTS Myogenic enzymes that were measured after UEL at all four points significantly increased except for creatine kinase at the 2-month point (p<0.01 in each) and neutrophil counts significantly increased after UEL at the pre-training, 2-month and 4-month points (p<0.01 in each), but these changes became smaller from the 2-month point. PA significantly decreased after UEL at the pre-training and 2-month points (p<0.01 in each), but no change was seen at the 4-month and 6-month points. On the other hand, no change in ROS production per cell after UEL was seen at the pre-training point, but it significantly increased after UEL at the 2-month, 4-month and 6-month points (p<0.01 in each). CONCLUSION The changing rate of the levels of UEL-mediated myogenic enzymes, neutrophil mobilisation and neutrophil function was seen to decrease at the 2-month, 4-month and 6-month assessments, compared with the pre-training point: these may comprise at least some of the long-term training effects.
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Hasan KN, Shoji M, Sugimoto K, Tsutaya S, Matsuda E, Kudo R, Nakaji S, Suda T, Yasujima M. Association of novel promoter single nucleotide polymorphisms in vasopressin V1a receptor gene with essential hypertension in nonobese Japanese. J Hum Hypertens 2007; 21:825-7. [PMID: 17653244 DOI: 10.1038/sj.jhh.1002227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the association between four novel single nucleotide polymorphisms (SNPs) in the promoter region of V1aR gene and essential hypertension in 620 Japanese subjects (365 hypertensives and 255 healthy). A significant association was found between one of the genotypes and alleles at SNP -6951 and hypertension in a subsample of nonobese individuals. This association demonstrated an independent risk for nonobese hypertension.
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