Kurume, Japan
Kurume, Japan

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Shigeto K.,Kurume University | Kawaguchi T.,Kurume University | Niizeki T.,Kurume University | Kunitake Y.,Kurume University | And 7 more authors.
Oncology Letters | Year: 2016

Peritoneovenous shunt is normally used for the treatment of refractory ascites. However, its efficacy in treating tolvaptan-resistant refractory ascites has not been reported thus far. In addition, the impact of peritoneovenous shunt on the prognosis of cirrhotic patients remains controversial. In the present report, a case of tolvaptan-resistant refractory ascites associated with liver cirrhosis and portal vein thrombosis is described. The male patient was diagnosed with hepatitis C virus-related liver cirrhosis at the age of 51 years. At the age of 56 years, the patient developed portal vein thrombosis, resulting in the development of refractory ascites. Since the ascites was resistant to treatment with a low-sodium diet and diuretics such as tolvaptan, a peritoneovenous shunt was implanted upon obtaining consent. The shunt immediately increased the urine volume, and the ascites was markedly decreased. The patient's body weight decreased from 62.7 to 57.1 kg in 2 days, and his ascites symptom inventory-7 score decreased from 23 to 0 points in 31 days. Although the patient succumbed to sepsis on day 486 following the shunt implant, his activities of daily living were preserved until 8 days prior to mortality. Thus, the present case supports the efficacy of peritoneovenous shunt for the treatment of tolvaptan-resistant refractory ascites associated with liver cirrhosis and portal vein thrombosis. Furthermore, the present case suggests that peritoneovenous shunt may prolong the survival of cirrhotic patents with refractory ascites. © 2016, Spandidos Publications. All rights reserved.


Nomura Y.,Kurume University | Naito Y.,Kurume University | Naito Y.,Naito Hospital | Eriguchi N.,Naito Hospital | And 11 more authors.
Pathology Research and Practice | Year: 2011

IgG4-related disease has been recognized as a systemic syndrome characterized by mass-forming lesions with lymphoplasmacytic infiltration and sclerosis. This disease has been identified in various sites, including the pancreas, retroperitoneum, lung, head, and neck. Herein we report a case of IgG4-related sclerosing mesenteritis. An 82-year-old woman was admitted to our hospital due to persistent abdominal pain. Abdominal computed tomography demonstrated a solitary mass with a maximal diameter of 11.7. cm in mesentrium of the small intestine. On her laboratory examination, only C-reactive protein level was elevated. Although the pre-operative diagnosis was indefinite, she underwent ileocecectomy. Grossly, an elastic soft mass with foci of hemorrhage was seen in the mesentrium. Microscopically, the lesion was composed of fibroblastic or myofibroblastic spindle cells with abundant stromal fibrosis and inflammatory infiltrate, such as lymphocytes and plasma cells accompanied by lymphoid follicles with a germinal center. Obstructive phlebitis was observed. Immunohistochemically, numerous IgG4-positive plasma cells were observed, and the IgG4/IgG ratio was 75.9%. The serum level of IgG4 examined at post-operation was high. These findings suggested that this lesion was consistent with IgG4-related sclerosing mesenteritis. © 2011 Elsevier GmbH.


Fukui T.,Showa University | Oono K.,Showa University | Hara N.,Showa University | Yamamoto T.,Showa University | And 3 more authors.
Endocrine Journal | Year: 2013

Type 2 diabetes (T2D) is characterized by a steady worsening of β-cell dysfunction as the disease progresses. The objective of this study was to estimate the decline of insulin secretion in Japanese type 2 diabetic patients (T2D-patients) by glucagon injection over an observation period of more than 10 years. Thirty-three T2D-patients were followed for 10.4±1.4 years. Fasting C-peptide immunoreactivity (FCPR), the 6 min value of CPR after glucagon injection (6MCPR), and the increment of CPR (ΔCPR) were measured at baseline and follow-up. FCPR, 6MCPR, ΔCPR were significantly lower at follow-up than at baseline (p<0.05, p<0.005, and p<0.0005, respectively). The annual change of ΔCPR was significantly (p<0.05) greater than the annual change of FCPR (-0.062±0.076 ng/mL/year and-0.025±0.067 ng/mL/year, respectively). In contrast, CPR-index (an index of β-cell function) and SUIT-index (secretory units of islets in transplantation) calculated based on fasting blood samples were unaltered. The annual changes of FCPR, 6MCPR, and ΔCPR were negatively correlated with the FCPR, 6MCPR, and ΔCPR values at baseline, respectively. Duration of diabetes, BMI, diabetic retinopathy, and secondary sulfonylurea failure at baseline were not correlated with the annual changes of FCPR, 6MCPR, and ΔCPR. In conclusion, our longitudinal observations suggest that β-cell function progressively declines in Japanese T2D-patients. The annual declines of ΔCPR were more prominent than the annual declines of FCPR. ΔCPR after glucagon injection may be more useful for estimating individual longitudinal insulin secretion than fasting blood samples. © The Japan Endocrine Society.


Hiyoshi T.,Red Cross | Shiozaki M.,Shiozaki Clinic | Inoue M.,Sasazuka Inoue Clinic | Takahashi T.,Shinjuku Minamiguchi Ekimae Clinic | And 5 more authors.
Therapeutic Research | Year: 2013

Purpose : To assess the efficacy and safety of fixed-dosed mitiglinide/voglibose in terms of glycemic and lipid parameters, in patients with type 2 diabetes mellitus who switch their therapy from glinides or α-GIs. Methods : Fourteen outpatients with type 2 diabetes mellitus, who had inadequate glycemic control with diet and exercise therapy, and antidiabetic medication with a glinide or α-GI alone, were eligible for this study. After switching from their prior glinide or α-GI monotherapy to fixed-dosed mitiglinide/voglibose combination therapy for 16 weeks, we evaluated the effects of the combination on fasting glycemic and lipid parameters in the observation period (0 week), and at 4, 8, 12, 16 weeks after administering the combination. In addition, we conducted meal load tests using a test meal in 8 non-hemodialysis patients and evaluated postprandial glycemic and lipid parameters at 30 and 60 minutes after this loading in the observation period (0 week) and at 16 weeks after administering the combination. Results : Four of 14 subjects were hemodialysis patients who started the combination therapy from once a day. Based on this patient background, we evaluated efficacy of the combination by dividing them into 10 non-dialysis patients and 4 dialysis patients with type 2 diabetes mellitus. In 10 non-dialysis patients, 8 patients switched from a prior α -GI, and 2 patients from a prior glinide. After switching to the combination therapy from the prior drugs, HbA1c and GA significantly decreased (p<0.05) in a parallel fashion after 4 weeks. The mean HbA1c and GA values were 8.38±0.48% and 23.16±1.69% respectively in the observation period, then 6.87±0.19% and 18.09±0.92% after 16 weeks. The differences from the observation period were -1.49±0.53% and -4.61±1.70% respectively. 1,5-AG significantly increased (p<0.05) after 4 weeks, and was inversely correlated with HbA1c and GA. The mean 1,5-AG value was 7.41±1.68μg/mL in the observation period, and 14.26±2.51μg/mL after 16 weeks, which was a difference from the observation period of +6.40±2.56μg/mL. In the subgroup of patients with an HbA1c of more than 7.4% and with less than 10μ/mL of 1,5-AG in the observation period, both glycemic parameters clearly improved after treatment with the combination, demonstrating its clinical usefulness. In addition, with test meal loads, the combination significantly increased (p<0.05) early insulin secretion and improved postprandial hyperglycemia at 30 and 60 minutes post-load in the patients with prior use of an α-GI. Furthermore, in 3 hemodialysis patients, the combination also improved GA and HbA1c. Conclusions : A fixed-dosed mitiglinide/voglibose combination significantly improved the glycemic parameters of HbA1c, GA and 1,5-AG by reducing postprandial glycemic excursions in patients with type 2 diabetes mellitus who had switched therapy from glinides or α-GIs.


Naito Y.,Kurume University | Okabe Y.,Kurume University | Kawahara A.,Kurume University | Taira T.,Kurume University | And 9 more authors.
Diagnostic Cytopathology | Year: 2012

Primary pancreatic lymphoma (PPL) is a rare disease with <1% of extranodal non-Hodgkin's lymphoma arising in the pancreas. This report provides immunocytochemical information on PPL that would be valuable for making differential diagnoses between PPL, pancreatic neuroendocine tumor, acinar cell carcinoma, and pancreatic ductal cancer. A 68-year-old woman had a chief complaint of abdominal pain. Fine needle aspiration cytology (FNAC) was performed. The FNAC smear showed moderate cellularity, with a small to moderate number of irregular cells and lymphocytes. No epithelial tumor clusters or abundant mucoid background were seen. The cells were scattered with pleomorphism and showed irregular nuclear shapes with finely granular chromatin, an increased nuclei-cytoplasm ratio, and prominent nucleoli. Cytologically, PPL was suspected with Papanicolaou staining but definite diagnosis was not made. Therefore, the specimen was destained, immunocytochemically examined for leukocyte common antigen (LCA), and PPL was suspected again. Numerous tumor cells were found in the surgical sample and tumor cells were positive for CD20 and negative for CD45RO. Based on these findings, the tumor was diagnosed as PPL, B-cell type. The preoperative FNAC smear that was examined for LCA was then reexamined for CD20, CEA, and Synaptophysin. As a result, the tumor cells were positive for LCA and CD20, whereas they were negative for CEA and Synaptophysin. Taking these findings together with the cytopathologic findings, this specimen was reconfirmed as PPL. Immunocytochemical examination for LCA and CD20 is useful in the identification of malignant pancreatic lymphoma, B-cell type. Copyright © 2010 Wiley Periodicals, Inc.


PubMed | Kurume University and Naito Hospital
Type: Journal Article | Journal: Oncology letters | Year: 2016

Peritoneovenous shunt is normally used for the treatment of refractory ascites. However, its efficacy in treating tolvaptan-resistant refractory ascites has not been reported thus far. In addition, the impact of peritoneovenous shunt on the prognosis of cirrhotic patients remains controversial. In the present report, a case of tolvaptan-resistant refractory ascites associated with liver cirrhosis and portal vein thrombosis is described. The male patient was diagnosed with hepatitis C virus-related liver cirrhosis at the age of 51 years. At the age of 56 years, the patient developed portal vein thrombosis, resulting in the development of refractory ascites. Since the ascites was resistant to treatment with a low-sodium diet and diuretics such as tolvaptan, a peritoneovenous shunt was implanted upon obtaining consent. The shunt immediately increased the urine volume, and the ascites was markedly decreased. The patients body weight decreased from 62.7 to 57.1 kg in 2 days, and his ascites symptom inventory-7 score decreased from 23 to 0 points in 31 days. Although the patient succumbed to sepsis on day 486 following the shunt implant, his activities of daily living were preserved until 8 days prior to mortality. Thus, the present case supports the efficacy of peritoneovenous shunt for the treatment of tolvaptan-resistant refractory ascites associated with liver cirrhosis and portal vein thrombosis. Furthermore, the present case suggests that peritoneovenous shunt may prolong the survival of cirrhotic patents with refractory ascites.

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