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Kanayama Y.,Ashiya Municipal Hospital | Hirota S.,Hyogo College of Medicine
Journal of Japanese Society of Gastroenterology | Year: 2010

A 54-year-old woman suffered acute hepatitis after she acquired cystitis. Laboratory results on admission showed : AST 925, ALT 1171, ALP 623, γ-GTP127IU/l, T-Bil 5.0mg/dl, antinuclear antibodies negative, smooth muscle antibodies 80, antimitochondrial antibodies (AMA) 80, antimitochondrial M2 antibody (AMA-M2) 117 index, IgG 2210mg/dl. She also had HLA-DR4 and HLA-DR8. Histological study of a liver biopsy specimen suggested that she had autoimmune hepatitis rather than primary biliary cirrhosis. When prednisolone was administered, her liver function immediately improved and AMA and AMA-M2 levels fell to 20 and 52 respectively. However when cystitis recurred 4 months later, her liver function worsened. Laboratory findings showed AST 174, ALT 183IU/l. Upon increasing the dosage of prednisolone, her liver function improved again. After the recurrence of hepatitis, AMA and AMA-M2 levels increased to 320 and 149 respectively. We speculate that the urinary tract infection triggered an autoimmune response and her genetic predisposition also played a crucial role in the process.

Kurabayashi A.,Kochi Medical School | Kakinuma Y.,Kochi Medical School | Morita T.,Ashiya Municipal Hospital | Inoue K.,Kochi Medical School | And 2 more authors.
PLoS ONE | Year: 2013

Our conditional VHL knockout (VHL-KO) mice, having VHL gene deletion induced by tamoxifen, developed severe hypoglycemia associated with disproportionately increased storage of PAS-positive substances in the liver and resulted in the death of these mice. This hypoglycemic state was neither due to impaired insulin secretion nor insulin receptor hypersensitivity. By focusing on insulin-like growth factor I (IGF-I), which has a similar effect on glucose metabolism as the insulin receptor, we demonstrated that IGF-I receptor (IGF-IR) protein expression in the liver was upregulated in VHL-KO mice compared to that in the mice without VHL deletion, as was the expression of glucose transporter (GLUT) 1. The interaction of the receptor for activated C kinase (RACK) 1, which predominantly binds to VHL, was enhanced in VHL-KO livers with IGF-IR, because VHL deletion increased free RACK1 and facilitated the IGF-IR-RACKI interaction. An IGF-IR antagonist retarded hypoglycemic progression and sustained an euglycemic state. These IGF-IR antagonist effects on restoring blood glucose levels also attenuated PAS-positive substance storage in the liver. Because the effect of IGF-I on HIF-1α protein synthesis is mediated by IGF-IR, our results indicated that VHL inactivation accelerated hepatic glucose storage through the upregulation of IGF-IR and GLUT1 and that IGF-IR was a key regulator in VHL-deficient hepatocytes. © 2013 Kurabayashi et al.

Takahi Y.,Osaka Central Hospital | Uesaka Y.,Osaka Central Hospital | Kiuchi H.,Osaka Central Hospital | Yamaguchi A.,Aqua Medical Clinic | And 3 more authors.
Japanese Journal of Urology | Year: 2012

(Objectives): Female urological diseases, including pelvic organ prolapse and urinary incontinence, are common in elderly people, but public knowledge about these diseases is limited. We analyzed information tools that patients with female urological disease utilized to acquire information about their diseases. (Materials and methods): This study included 3,480 patients who presented to our female urological clinic between January 2005 and December 2008. We conducted a questionnaire survey on what information tools were used for information gathering. (Results): The newspaper was the leading information tool (39.9%), followed by referral from another clinic (17.8%), internet (15.7%), TV (14.8%), recommendation by family or friends (5.5%), books or magazines (3.2%), and informative sessions for the public (0.6%). The temporal trend in the rate of information tool use over the 4 years showed that internet use increased significantly every year (p trend = 0.041) and was the most utilized tool in 2008, along with referral from other clinics. The rate of newspaper or TV use depended on their volumes of the female urological diseases. Additionally, no change over the study period was observed for the rate of internet utilization for patients in their 40s or under; however, it increased in patients in their 50s or over, and patients in their 50s and 60s utilized the internet as often as patients in their 40s or under in 2008. (Conclusions): The newspaper was the most utilized information tool for patients with female urological diseases. However, internet use for gathering disease information is increasing, and the internet may be the most important information tool in the near future. © 2012 Japanese Urological Association.

Nishida T.,Osaka University | Tsujii M.,Osaka University | Tanimura H.,Osaka Kaisei Hospital | Tsutsui S.,Itami City Hospital | And 19 more authors.
World Journal of Gastroenterology | Year: 2014

Aim: To evaluate the efficacy and safety of esomeprazole-based triple therapy compared with lansoprazole therapy as first-line eradication therapy for patients with Helicobacter pylori (H. pylori) in usual post-marketing use in Japan, where the clarithromycin (CAM) resistance rate is 30%. Methods: For this multicenter, randomized, open-label, non-inferiority trial, we recruited patients (≥ 20 years of age) with H. pylori infection from 20 hospitals in Japan. We randomly allocated patients to esomeprazole therapy (esomeprazole 20 mg, CAM 400 mg, amoxicillin (AC) 750 mg for the first 7 d, with all drugs given twice daily) or lansoprazole therapy (lansoprazole 30 mg, CAM 400 mg, AC 750 mg for the first 7 d, with all drugs given twice daily) using a minimization method with age, sex, and institution as adjustment factors. Our primary outcome was the eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. H. pylori eradication was confirmed by a urea breath test from 4 to 8 wk after cessation of therapy. Results: ITT analysis revealed the eradication rates of 69.4% (95%CI: 61.2%-76.6%) for esomeprazole therapy and 73.9% (95%CI: 65.9%-80.6%) for lansoprazole therapy (P = 0.4982). PP analysis showed eradication rate of 76.9% (95%CI: 68.6%-83.5%) for esomeprazole therapy and 79.8% (95%CI: 71.9%-86.0%) for lansoprazole therapy (P = 0.6423). There were no differences in adverse effects between the two therapies. Conclusion: Esomeprazole showed non-inferiority and safety in a 7 day-triple therapy for eradication of H. pylori compared with lansoprazole. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

Ikeda-Miyagawa Y.,Hyogo College of Medicine | Kihara T.,Ashiya Municipal Hospital | Matsuda R.,Ashiya Municipal Hospital
Japanese Journal of Anesthesiology | Year: 2014

We experienced a case of negative pressure pulmonary edema (NPPE) after administration of sugammadex under general anesthesia with LMA Supreme®. Sugammadex was administered to a 76-year-old female patient following spontaneous ventilation. Immediately after the administration of sugammadex, laryngospasm occurred, and the patient's oxygen saturation dropped to 70%. About five minutes after the appearance of laryngospasm, she started to breathe spontaneously. However, a chest x-ray at this time showed pulmonary edema. We suspected that sugammadex administration had triggered the laryngospasm, causing postoperative NPPE. When selecting a LMA under general anesthesia for airway management we have to keep in mind the possibility of NPPE followed by laryngospasm.

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