Waguri N.,Niigata City General Hospital
Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology | Year: 2016
Portal hypertension induces collateral shunt formation between the portal and systemic circulation, decompressing the elevated portal pressure. Ectopic varices outside of the gastroesophageal region, such as jejunal varices, are rare conditions. This report describes the successful embolization of ruptured jejunal varices resulting from an extrahepatic portal obstruction. A 62-year-old man was admitted to our hospital with recurrent massive gastrointestinal bleeding. Fourteen months earlier, he had undergone a choledochojejunostomy and pancreatic cystojejunostomy for bile duct stenosis with an enlarged pancreatic pseudocyst due to severe chronic pancreatitis. Contrast-enhanced computed tomography showed jejunal intramural dilated vessels close to the choledochojejunal anastomosis, but extravasation was not observed. Due to the lack of a rapid definitive diagnosis, the patient required massive blood transfusions. Hemorrhagic scintigraphy using 99mTc-HSAD finally identified the site of the hemorrhage. Angiography and double-balloon endoscopy revealed the anastomotic jejunal varices to be the result of an extrahepatic portal obstruction. Laparotomic transcatheter variceal embolization with microcoils was successful in halting the refractory gastrointestinal bleeding. This surgery preserved hepatopetal portal venous flow by another route, and no complications were observed. At present, 4 years post-surgery, there has been no recurrence of gastrointestinal hemorrhage. The development of jejunal varices is often associated with postoperative adhesions. Some patients with a history of hepatico- or choledochojejunostomy may experience portal hypertension resulting from extrahepatic portal obstruction, leading to the formation of jejunal varices as hepatopetal portal collaterals. The choice of therapy in each patient should be based on the individual hemodynamics of the ectopic varices.
Watanabe T.,Niigata City General Hospital
Journal of Pediatric Biochemistry | Year: 2013
Kawasaki disease (KD) is an acute febrile vasculitis that predominantly affects children ≤ 5 years of age. The cause of KD remains unknown, but it is thought that the immune system is activated by an infectious trigger in a genetically susceptible host. Because KD is systemic vasculitis, multiple organ involvement can develop, including hyponatremia. Hyponatremia is common in patients with KD, occurring in 29%-70% of patients. Although hyponatremia is usually mild and asymptomatic in nearly all patients with KD, profound hyponatremia contributes to the development of central nervous system dysfunction in some patients. KD patients with hyponatremia have clinical and laboratory findings that are consistent with severe inflammation, including higher C-reactive protein levels and an increased incidence of coronary artery lesions. While the pathogenesis underlying the development of hyponatremia in KD is incompletely understood, several possible mechanisms have been proposed, including hypovolemic hyponatremia, the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ingestion of fluid that is hypo-osmolar relative to the fluid loss. Hypovolemic hyponatremia may be caused by gastrointestinal loss of fluid and sodium, and renal loss of fluid and sodium secondary to renal parenchymal injury and/or cytokine-induced renal tubular dysfunction. SIADH occurs in approximately 40% of KD patients with hyponatremia and may be a major cause of hyponatremia in KD. Although the pathogenesis underlying the development of SIADH in patients with KD is unclear, cerebral vasculitis or ADH secretion stimulated by cytokines, including interleukin (IL)-1β and IL-6, may contribute to the development of SIADH in patients with KD. © 2013-IOS Press and the authors. All rights reserved.
Miyajima M.,Niigata City General Hospital
Surgery today | Year: 2010
Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%-1.7% of all blunt abdominal trauma cases. Blunt gastric rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms of peritonitis in spite of presenting with persistent hypovolemic shock.
Kurabayashi T.,Niigata City General Hospital
Clinical calcium | Year: 2010
Calcium transfer from the mother to the infant during pregnancy and lactation plays an extremely important role in the bone health of the mother and neonate. Calcium aids in bone health through all ages but is especially crucial during pregnancy and lactation. Changes in the structure and metabolism of bone during pregnancy and the early stage of postpartum are evaluated by investigating bone mineral density (BMD), bone histomorphometry and bone markers of human or animal models. The bone resorption increased at the end of pregnancy and lactation, and the bone formation increases and the bone structure is almost recovered after cessation of lactating in postpartum. Puerperal BMD remained static over the subsequent 5-10 years. If the women have a low BMD at this stage of their reproductive life, it tends not to improve over this time. Perhaps identification of this at-risk group may lead to effective interventions to reduce fracture risk in later life.
Takai K.,Niigata City General Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2013
We report five cases that presented with high fever, anasarca, hepatosplenomegaly and severe thrombocytopenia with reticulin fibrosis of the bone marrow. The constellation of symptoms is not compatible with any known disease, and we had difficulty in diagnosis and treatment. The age distribution was from 47 to 56 years, and two men and three women were affected. Two patients needed hemodialysis because of renal dysfunction and oliguria with massive pleural effusion. Laboratory examinations showed normal immunoglobulin levels and no monoclonal protein. None of them showed diagnostic autoantibodies for any autoimmune diseases. Histological examination of the liver in three patients and spleen in two showed non-specific findings. Lymphadenopathy was tiny and lymph node biopsy was carried out in only one case. Histologically, paracortical hyperplasia with vascular proliferation and atrophic germinal centers resembling hyaline-vascular-type Castleman's disease or POEMS syndrome were detected. Without a definitive diagnosis, treatment was started with cyclophosphamide, hydroxydaunorubicin, vincristine and prednisolone (CHOP) regimen in one patient, semi-pulse therapy with methyl-predonisolone in three and cyclosporin A in three. Two patients achieved complete remission, two were steroid-dependent and the remaining one died of multiple organ failure. These findings suggest that this disease may be a novel clinical entity belonging to systemic inflammatory disorder with a background of immunological abnormality or a unique variant of multicentric Castleman's disease. [J Clin Exp Hematop 53(1): 63-68, 2013].
Watanabe T.,Niigata City General Hospital
Pediatric Nephrology | Year: 2011
Although the etiology of Henoch-Schönlein purpura (HSP) remains unclear, influenza vaccinations have been implicated as possible triggers for HSP. We describe four patients with HSP following influenza vaccinations which developed during the pandemic of influenza A (H1N1) 2009 and review the literature concerning HSP associated with this vaccine. HSP in patients developed in October and November, 2009. Four patients exhibited purpura, three patients complained of arthralgias, and one patient had both abdominal pains and renal involvement. Reviewing the literature, 11 patients with HSP following influenza vaccinations have been reported. Eight patients were children and five patients had past histories of immunologically mediated diseases including HSP, drug eruptions, and food allergy. While a favorable outcome was noted in most patients, one patient developed end-stage renal failure and another patient exhibited chronic glomerulonephritis. Although the precise reason for clustering of our patients with HSP following influenza vaccination was unclear, increasing use of the recent influenza vaccine associated with the pandemic of influenza A (H1N1) 2009 might explain this phenomenon. Because the incidence of HSP caused by influenza vaccination was very low, influenza vaccination should not be limited for this reason. However, caution may be required with its use in children with immunologically mediated diseases such as HSP. © 2010 IPNA.
Kuwabara S.,Niigata City General Hospital |
Katayanagi N.,Niigata City General Hospital
Esophagus | Year: 2010
Background: Although the feasibility and advantages of video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer are well studied, its application is limited, possibly because it is technically complex. Methods: Ninety-eight patients who underwent VATS-E at our institutes were divided into three groups by the type of thoracoscope, TV monitor, and patient position used. For the first 18 patients, we used the left lateral position, a flexible thoracoscope, and a single TV monitor (method A); for the next 58 patients, the left lateral position, a 30° thoracoscope, and two TV monitors (method B); and for the last 22 patients, the prone position with 30° thoracoscope and single TV monitor (method C). We compared the area of operative field and clinical outcomes in these three approaches. Results: On the basis of subjective assessment, method C afforded a better operative field than methods A and B. No significant differences were noted between the three positions in operative time, duration of intubation, rate of occurrence of recurrent nerve palsy, and anastomotic leakage. However, blood loss, rate of respiratory tract complications, and length of postoperative hospital stay were decreased in the order of position. The total number of dissected lymph nodes increased in the order of position. Conclusions: VATS-E in prone position with a 30° thoracoscope and a single TV monitor appear to be superior to VATS-E in the left lateral position in terms of operative field, blood loss, respiratory tract complication, and number of lymph nodes dissected. Randomized control studies would help confirm these results. © Japan Esophageal Society and Springer 2010.
Watanabe T.,Niigata City General Hospital
European Journal of Pediatrics | Year: 2013
Renal complications of influenza A virus infections are uncommon but can contribute to a deterioration in the patient's condition, which include acute kidney injury (AKI) in critically ill patients, rhabdomyolysis, hemolytic uremic syndrome (HUS), acute glomerulonephritis (AGN), disseminated intravascular coagulation (DIC), Goodpasture's syndrome, and acute tubulointerstitial nephritis (TIN). The clinical characteristics of AKI in critically ill patients with pandemic influenza A(H1N1) 2009 virus (A(H1N1)pdm09) infection are similar to uninfected patients. Underlying conditions associated with AKI include older age, diabetes mellitus, obesity, pregnancy, history of asthma, and chronic kidney disease. Histologic examination of the kidneys from patients with A(H1N1)pdm09 infection who died include acute tubular necrosis (ATN), myoglobin pigment, and DIC. A(H1N1)pdm09 is present in the kidneys of some patients. The clinical characteristics of patients with rhabdomyolysis associated with influenza A include younger age and the frequent occurrence of muscle symptoms. AKI occurs in approximately one third of patients with rhabdomyolysis due to influenza A. HUS is associated with A(H1N1)pdm09 as follows: Streptococcus pneumoniae-associated HUS following A(H1N1)pdm09 infection, HUS triggered by A(H1N1)pdm09 in patients with genetic complement dysregulation, and HUS associated with A(H1N1)pdm09 without known underlying disorder. AGN, Goodpasture's syndrome, and acute TIN are extremely rare complications of influenza A virus infection. Although the pathogenesis underlying renal injuries due to influenza A virus has not been delineated, some hypotheses have been advanced, including ATN due to renal hypoperfusion or rhabdomyolysis, glomerular microthrombosis due to DIC, direct viral injury to the kidney, and an altered immune system with systemic mononuclear cell activation following influenza A virus infections. © 2012 Springer-Verlag Berlin Heidelberg.
Takai K.,Niigata City General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2010
We report three patients who presented with high fever, anasarca, hepatosplenomegaly, lymphadenopathy and severe thrombocytopenia accompanied by reticulin fibrosis of the bone marrow. This constellation of symptoms is not compatible with any known disease entity, and we had difficulty in diagnosis and treatment. A 47-year-old woman was suspected of having splenic lymphoma and received one course of CHOP regimen followed by continued steroid therapy. Her condition was improved but repeatedly became exacerbated with tapering of steroid. A 56-year-old man was treated with steroid pulse therapy and splenectomy without improvement. Histology of the liver and spleen did not show any specific findings. Immunosuppressive therapy with cyclosporin A was successful. Another 49-year-old man showed histological findings of paracortical hyperplasia with vascular proliferation and atrophic germinal centers on inguinal lymph node biopsy. These findings were similar to those of the hyaline-vascular type of Castleman disease or POEMS syndrome, but non-specific. Although he received steroid pulse therapy, he died of multiple organ failure. Autopsy demonstrated cytomegalovirus infection and hemophagocytic histiocytosis without malignant lymphoma. We suggest that this constellation represents a new clinical entity belonging to systemic inflammatory disorders with a background of immunological abnormality, requiring prompt and vigorous immunosuppressive therapy.
Sakuma I.,Niigata City General Hospital
Chūdoku kenkyū : Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology | Year: 2010
We report two cases of methanol poisoning and evaluate the kinetics of methanol, ethanol, and formate. The first case was a 48-year-old man (case 1). His initial methanol level was 56.4 mg/dL and serum ethanol level was 2.4 mg/dL. Serum formate was not detected, and ethanol administration was initiated. However, methanol was eliminated slowly, and serum formate increased. His methanol and formate levels decreased rapidly following hemodialysis. He was discharged without any sequelae. The second case was a 35-year-old man (case 2). His serum methanol level was 400 mg/dL, and serum ethanol was not detected. His serum formate level was 13.4 mg/dL, and ethanol and activated folate were administered. He underwent hemodialysis immediately after diagnosis. Methanol and formate decreased rapidly, and he was discharged without any sequelae. Methanol and formate are eliminated slowly if ethanol is administered alone. We suggest that hemodialysis should be considered immediately after ethanol administration.