記述言語：日本語   出版者・発行元：梵天書房  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

肝炎対策が必要な診療科の特定を目的として、肝疾患診療連携拠点病院8施設における2016年から2020年のHBs抗原・HCV抗体件数・陽性率を調査し、肝臓内科以外(非専門科)の検査数上位3科の陽性率を解析した。非専門科での2020年のHBs抗原およびHCV抗体の陽性率は1.23%および2.12%で2016年より低下しており、HBs抗原検査数、HCV抗体検査数が多い診療科はいずれも眼科、産婦人科、整形外科の順であった。HBs抗原の陽性率が高い診療科は整形外科、消化管外科、眼科の順であり、HCV抗体の陽性率が高い診療科は消化管外科、整形外科、眼科の順であった。非専門科の肝炎ウイルス陽性率は低下しているものの、眼科・整形外科では検査数・陽性率とも上位であり、肝炎対策が急務である。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00263&link_issn=&doc_id=20231113140007&doc_link_id=10.2957%2Fkanzo.64.587&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.64.587&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: Treatment response to ursodeoxycholic acid may predict the prognosis of patients with primary biliary cholangitis (PBC). Recent studies have suggested the benefits of using machine learning (ML) to forecast complex medical predictions. We aimed to predict treatment response in patients with PBC using ML and pretreatment data. METHODS: We conducted a single-center retrospective study and collected data from 194 patients with PBC who were followed up for at least 12 months after treatment initiation. Patient data were analyzed with five ML models, namely random forest, extreme gradient boosting (XGB), decision tree, naïve Bayes, or logistic regression, to predict treatment response using the Paris II criteria. The established models were assessed using an out-of-sample validation. The area under the curve (AUC) was used to evaluate the efficacy of each algorithm. Overall survival and liver-related deaths were analyzed using Kaplan-Meier analysis. RESULTS: Compared to logistic regression (AUC = 0.595, P = 0.0219, 0.031 models), ML analyses showed significantly high AUC in the random forest (AUC = 0.84) and XGB (AUC = 0.83) models; however, the AUC was not significantly high for decision tree (AUC = 0.633) or naïve Bayes (AUC = 0.584) models. Kaplan-Meier analysis showed significantly improved prognoses in patients predicted to achieve the Paris II criteria by XGB (log-rank = 0.005 and 0.007). CONCLUSION: ML algorithms could improve treatment response prediction using pretreatment data, which could lead to better prognoses. In addition, the ML model using XGB could predict the prognosis of patients before treatment initiation.

DOI： 10.1002/jgh3.12915

PubMed

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掲載種別：研究論文（学術雑誌）  

DOI： 10.7326/aimcc.2022.0973

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Acute-on-chronic liver failure (ACLF), a disease with poor prognosis, is reportedly caused by cellular senescence due to mitochondrial dysfunction. In this study, we described and analyzed the underlying mechanism of a novel approach for ACLF using ABT263/navitoclax (Navi) that selectively eliminates senescent cells. METHODS: Irradiation-induced senescent hepatocytes were used for in vitro evaluation of the effects of Navi on ACLF (n = 6 for each group). Lipopolysaccharide- and carbon tetrachloride-induced ACLF mouse model was used for in vivo evaluation of the effects of Navi administration compared with the control using one-way or two-way analysis of variance, followed by Student's t-test or Kruskal-Wallis test. The effects on the senescence-associated secretory phenotype (n = 8 for each group) and mitochondrial functions, including adenosine triphosphate concentration and membrane potential (n = 8 for each group), were investigated using real-time polymerase chain reaction, immunohistochemistry, and enzyme analysis. RESULTS: Navi eliminated irradiation-induced senescent hepatocytes in vitro, leading to non-senescent hepatocyte proliferation. Navi eliminated senescent cells in the liver in vivo, resulting in downregulation of mRNA expression of senescence-associated secretory phenotype factors, a decrease of liver enzymes, and upregulated proliferation of non-senescent cells in the liver. Regarding mitochondrial functional assessment in the liver, adenosine triphosphate concentration and membrane potential were upregulated after Navi administration in vitro and in vivo. CONCLUSIONS: Navi may ameliorate ACLF damage by eliminating senescent cells in the liver, downregulating senescence-associated secretory phenotype factors, and upregulating mitochondrial functions. We believe that this novel approach using Navi will pave the way for ACLF treatment.

DOI： 10.1111/hepr.13879

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aim: Symptoms of primary biliary cholangitis (PBC) frequently impair one's quality of life (QOL). Nonetheless, with improved treatment, the prognosis of PBC also improves. QOL plays an important role in patients with PBC. In this study, we aimed to reevaluate the transition of new symptom development in PBC and its predictive factors. Methods: This retrospective multicenter study enrolled 382 patients with PBC for symptom analysis. The impact of a newly developed symptom on PBC prognosis was investigated by Kaplan-Meier analysis with propensity score matching and logistic progression analysis. Results: The cumulative risk of developing a new symptom after 10 and 20 years of follow-up was 7.6 and 28.2%, and specifically that of pruritus, which was the most common symptom, was 6.7 and 23.3%, respectively. In Cox hazard risk analysis, serum Alb level (hazard ratio [HR], 1.097; 95% confidence interval [CI], 1.033-1.165; P = 0.002), the serum D-Bil level (HR, 6.262; 95% CI, 2.522-15.553, P < 0.001), and Paris II criteria (HR, 0.435; 95% CI, 0.183-1.036; P = 0.037) were significant independent predictors of a new symptom. Kaplan-Meier analysis showed that the overall survival and liver-related death were not significant between patients with and without a new symptom. Conclusion: The cumulative risk of new symptom development is roughly 30% 20 years after diagnosis and could be predicted by factors including serum albumin levels, serum D-Bil level, and Paris II criteria.

DOI： 10.1002/jgh3.12789

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Due to the developments in the treatment for hepatitis, it is possible to prevent the progression of liver fibrosis and improve patients' prognosis even if it has already led to liver cirrhosis (LC). Consequently, a two-step study was conducted. To begin with, a retrospective study was conducted to identify the potential predictors of non-malignancy-related mortality from LC. Then, we prospectively analyzed the validity of these parameters as well as their association with patients' quality of life. In the retrospective study, 89 cases were included, and the multivariate Cox regression analysis indicated that age (P = 0.012), model for end-stage liver disease (MELD) score (P = 0.012), and annual rate of change of the albumin-bilirubin (ALBI) score (P < 0.001) were significantly associated with LC prognosis. In the prospective study, 70 patients were included, and the patients were divided into cirrhosis progression and non-progression groups. The univariate logistic regression analysis indicated the serum procollagen type III N-terminal peptide level (P = 0.040) and MELD score (P = 0.010) were significantly associated with the annual rate of change of the ALBI score. Furthermore, the mean Chronic Liver Disease Questionnaire score worsened from 5.3 to 4.9 in the cirrhosis progression group (P = 0.034). In conclusion, a longitudinal increase in the ALBI score is closely associated with non-malignancy-related mortality and quality of life.

DOI： 10.1371/journal.pone.0263464

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記述言語：英語  

Acute upper gastrointestinal bleeding (UGIB) is a common disorder and a gastroenterological emergency. With the development of new techniques and devices, the survivability after gastrointestinal bleeding is improving. However, at the same time, we are facing the difficulty of severely complicated cases with various diseases. For example, while endoscopic examination with a normal diameter endoscope is essential for the diagnosis and treatment of UGIB, there are several cases in which it cannot be used. In these cases, transnasal endoscopy (TNE) may be a viable treatment option. This report reviews current hemostatic devices for endoscopic treatment and the safety and efficiency of using TNE in complicated cases. The latter will be demonstrated in a case report where TNE was employed in a patient with severe esophageal stenosis. This review summarizes the advances made in the devices used and will provide further ideas for the physician in terms of combining these devices and TNE.

DOI： 10.3390/medicines8090053

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

ABSTRACT: Gastrointestinal bleeding, hepatic encephalopathy (HE), and hepatocarcinogenesis are associated with the prognosis of patients with liver cirrhosis (LC). Proton pump inhibitors (PPIs) have been used to prevent bleeding, however the effects of PPIs on overall survival have not yet been elucidated. Therefore, this multicenter retrospective study aimed to assess the effect of PPI on the prognosis and HE occurrence of the patients with liver cirrhosis in Japan.A total of 456 patients diagnosed with LC at the 4 institutes during the study period (2010-2014) were assessed. PPI-treated and non-treated patients were compared using propensity score matching analysis. Primary and secondary endpoints of the study were set as the occurrence of HE and overall survival, respectively.A comparison of all cases showed a significantly poorer hepatic reserve function in the PPI-treated patients. The propensity-score matching analysis was performed and 120 PPI-treated patients were 1:1 matched with non-treated patients. The analysis revealed a higher incidence of HE in the PPI-treated than in the non-treated patients (P = .032; hazard ratio [HR], 2.162; 95% confidence interval [CI], 1.066-4.176), but the prognosis of PPI-treated patients was no worse than that of non-treated patients (P = .676; HR, 1.101; 95% CI, 0.702-1.726).This retrospective study showed that PPI administration for the patients with liver cirrhosis may partly be related to the increased incidence of HE but not worsen the patient prognosis.

DOI： 10.1097/MD.0000000000026902

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Biochemical response to treatment in patients with primary biliary cholangitis (PBC) reflects prognosis. However, the best predictive criteria to detect biochemical response remain undetermined. In addition, because these criteria need > 6 months until definition, parameters that can estimate its results before initiating treatment are needed. METHODS: We conducted a single-center retrospective study on 196 patients with PBC, followed up for at least 12 months after initiating treatment. RESULTS: Kaplan-Meier analysis showed that Paris II (p = 0.002) and Rotterdam criteria (p = 0.001) could estimate the overall survival of PBC patients, whereas Paris II (p = 0.001), Rotterdam (p = 0.001), and Rochester criteria (p= 0.025) could estimate liver-related deaths. Cox hazard analysis revealed Paris II and Rotterdam criteria as significantly independent predictors of overall survival (hazard ratio (HR) 3.948, 95% CI 1.293-12.054, p = 0.016 and HR 6.040, 95% CI 1.969-18.527, p = 0.002, respectively) and liver-related deaths (HR 10.461, 95% CI 1.231-88.936, p = 0.032 and HR 10.824, 95% CI 1.252-93.572, p = 0.032, respectively). The results of Paris II criteria could be estimated by serum prothrombin time (Odds ratio (OR) 1.052, 95% CI 1.008-1.098, p = 0.021) and alanine transaminase level (OR 0.954, 95% CI 0.919-0.991, p = 0.014) whereas, those of Rotterdam criteria could be estimated by serum albumin level (OR 3.649, 95% CI 1.098-12.128, p = 0.035) at the time of diagnosis. CONCLUSIONS: This study highlights the best prediction criteria and pre-treatment parameters that facilitate the prognosis of PBC patients.

DOI： 10.1007/s12072-021-10163-0

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Society of Hepatology  

DOI： 10.2957/kanzo.62.96

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

令和元年度の肝疾患診療連携拠点病院17施設における肝炎医療コーディネーター(肝炎Co)配置と活動状況についてアンケート調査を行った。その結果、17施設における現職肝炎Co数は合計480名で、施設により8〜77名と大きな差があった。実働率は全体で78%であったが、施設により7.9〜100%と差があった。最も多い職種は看護師の50%で、次いで臨床検査技師の11%、薬剤師の8.0%、管理栄養士の8.0%、医師の3.5%であった。尚、看護師のうち29.3%は肝疾患担当部署に配属されていた。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Focal nodular hyperplasia (FNH) is the second most frequent benign liver tumor, and it is a fiber-rich stiff lesion. Typically, FNH can be diagnosed by imaging without biopsy. However, liver biopsy and diagnostic resection may be required to differentiate atypical FNH from other liver tumors, such as hepatocellular adenoma (HCA). Therefore, improved noninvasive diagnostic methods are needed. We experienced 2 cases where combination of magnetic resonance elastography (MRE) and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) helped diagnose FNH. A 36-year-old woman and 17-year-old boy with liver tumors measuring 40 mm in diameter each showed hypointense nodule centers, indicating a central scar, surrounded by hyperintense signals during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. To rule out HCA, we performed MRE and liver biopsy. On MRE, the mean stiffness of the mass was 11.6 kPa (mean stiffness of the background liver was 1.7 kPa) and 11.1 kPa (mean stiffness of the background liver was 2.4 kPa) in the first and second patients, respectively. Histological examination of both specimens showed CK7-positive bile-ductular proliferations, abundant fibrous tissue, and few Ki-67-positive cells. Based on these results, we diagnosed these tumors as FNH. Combination of Gd-EOB-DTPA-enhanced MRI and MRE can evaluate the character and stiffness of lesion and help in the diagnosis of FNH.

DOI： 10.1159/000516552

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Society of Hepatology  

A female patient in her 50s was diagnosed with hepatitis C virus infection, but she did not receive any treatment or was followed up. She was brought to the emergency room with complaints of abdominal pain and loss of consciousness, diagnosed as hemorrhagic shock due to a ruptured splenic artery aneurysm. Embolization of the splenic aneurysm was performed at our hospital, and the postoperative course was good. The patient was given direct-acting an-tiviral therapy, and a sustained viral response was achieved. Since there are still many untreated, unexamined, and unrecognized patients with hepatitis C in Japan, we report a literature review on splenic aneurysm in an attempt to identify patients with hepatitis.

DOI： 10.2957/kanzo.62.749

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Wisteria floribunda agglutinin (WFA) is a lectin that binds to the sugar chain of Mac-2 binding protein (M2BP), and WFA-positive M2BP (WFA+-M2BP) has been reported as a useful marker for assessing liver fibrosis in chronic liver disease. Tolvaptan (TLV), a selective vasopressin V2 receptor antagonist, is used for cirrhotic ascites in Japan, but good predictors of treatment efficacy remain to be established. Our aim was to investigate whether WFA+-M2BP monitoring before and after TLV administration can predict treatment efficacy in patients with cirrhotic ascites. Twenty patients (10 men), with a median age of 72 years, were enrolled. Cirrhosis was caused by hepatitis B virus (n = 3), hepatitis C virus (n = 4), alcohol (n = 8), and others (n = 5). Responders were defined as having a body weight loss of ≥ 1.5 kg/week after TLV administration. Serum WFA+-M2BP levels were measured at baseline and days 1, 3, and 7 after TLV treatment. Twelve patients (60%) were responders. Baseline WFA+-M2BP levels were correlated with serum albumin levels (r = -0.544, P = 0.013). The baseline furosemide dose was lower and platelet count was higher in responders than in non-responders (P < 0.05). The ratio of WFA+-M2BP levels on day 1 after TLV administration to baseline was lower in responders than in non-responders (P < 0.05). The decrease in the ratio discriminated responders from non-responders (AUC = 0.844, P < 0.05). In conclusion, monitoring serum WFA+-M2BP is helpful for predicting the efficacy of TLV treatment in patients with cirrhotic ascites.

DOI： 10.1620/tjem.252.287

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study investigated the efficacy and safety of radiotherapy as part of multidisciplinary therapy for advanced hepatocellular carcinoma (HCC). Clinical data of 49 HCC patients treated with radiotherapy were assessed retrospectively. The efficacy of radiotherapy was assessed by progression-free survival, disease control rate, and overall survival. Safety was assessed by symptoms and hematological assay, and changes in hepatic reserve function were determined by Child-Pugh score and albumin-bilirubin (ALBI) score. Forty patients underwent curative radiotherapy, and nine patients with portal vein tumor thrombus (PVTT) underwent palliative radiotherapy as part of multidisciplinary therapy. Local disease control for curative therapy was 80.0% and stereotactic body radiotherapy was 86.7% which was greater than that of conventional radiotherapy (60.0%). Patients with PVTT had a median observation period of 651 days and 75% three-year survival when treated with multitherapy, including radiotherapy for palliative intent, transcatheter arterial chemoembolization, and administration of molecular targeted agents. No adverse events higher than grade 3 and no changes in the Child-Pugh score and ALBI score were seen. Radiotherapy is safe and effective for HCC treatment and can be a part of multidisciplinary therapy.

DOI： 10.3390/cancers12102955

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Ulcerative colitis, a chronic and recurrent inflammatory disease, is localized to the colonic mucosa but can affect other organs and lead to various complications. Gastroduodenitis associated with ulcerative colitis has been reported. However, little is known about esophageal ulcers. We herein report two rare cases of esophageal ulcers associated with ulcerative colitis. Furthermore, the clinical and histological characteristics of 18 previously reported cases are summarized. This case series and literature review will encourage the accurate diagnosis and treatment of esophageal ulcers associated with ulcerative colitis.

DOI： 10.2169/internalmedicine.4437-20

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Gastroenterological Endoscopy Society  

A 75-year-old man with a complaint of black stool and anemia was referred to our hospital. Endoscopic examination revealed a non-pedunculated polyp at the posterior aspect of the bulb with a small area of erosion and blood spot on the top, and we performed endoscopic hemostasis. Five weeks later, endoscopic ultrasound (EUS)-fine needle aspiration (FNA) revealed Brunners gland hyperplasia and the tissue from EUS-FNA was non-neoplastic. Four days after EUS-FNA, the patient developed black stool again, and we performed endoscopic hemostasis again. Because the lesion repeatedly hemorrhaged and because endoscopic resection of a non-pedunculated polyp at the posterior aspect of the bulb would be difficult, he underwent open duodenal submucosal dissection. The tumor was 25×25×10 mm, and histological analysis showed acinar cells, ducts and smooth muscles, leading to the diagnosis of Brunners gland hamartoma (BGH). In the past, according to the location of the lesion, pancreaticoduodenectomy was a choice for treatment when endoscopic resection of a hemorrhaging BGH would be difficult. Therefore, EUS-FNA is useful for preoperative diagnosis.

DOI： 10.11280/gee.62.778

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This report highlights the easy peeling of the esophageal epithelium with Nikolsky phenomenon after swallowing the foreign body and the healing status of the esophagus only 3 days later in a patient of pemphigus vulgaris.

DOI： 10.1002/ccr3.2846

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本肝臓学会  

<p>平成21年に設立された新潟大学医歯学総合病院肝疾患相談センターは令和元年に10年目を迎え，236万人の新潟県民や医療従事者に対するウイルス性肝炎の情報の提供，啓発活動，助成制度のサポート等を新潟県健康対策課，厚生労働省健康局がん・疾病対策課肝炎対策室，国立国際医療センター肝炎情報センターとともに行ってきた．新潟県内の各種肝炎ウイルスの発生動向の報告，助成対象人数の把握や非受検者に対する啓発活動を各年度で行ってきた．C型肝炎については他県と同じく新規治療者数については減少段階にある．しかし，肝炎ウイルスは世界最大級の感染症であることにかわりなく，A型肝炎のエンデミック，B型肝炎ウイルスに対する耐性ウイルス発生や核酸アナログ製剤の長期利用による諸問題，E型肝炎の報告例の増加などについては今後も監視が必要である．また肝炎検査未受検者も多く，啓発活動を行う肝疾患相談センターの存在意義は今後も重要である．</p>

DOI： 10.2957/kanzo.61.245

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition in patients with hepatocellular carcinoma (HCC); to date, few cases have been reported. While hepatic dysfunction has been focused on the later stages of HCC, the management of symptoms in PTTM is important for supportive care of the cases. For the better understanding of PTTM in HCC, the information of our recent case and reported cases have been summarized. CASE SUMMARY: A patient with HCC exhibited acute and severe respiratory failure. Radiography and computed tomography of the chest revealed the multiple metastatic tumors and a frosted glass-like shadow with no evidence of infectious pneumonia. We diagnosed his condition as acute respiratory distress syndrome caused by the lung metastases and involvement of the pulmonary vessels by tumor thrombus. Administration of prednisolone to alleviate the diffuse alveolar damages including edematous changes of alveolar wall caused by the tumor cell infiltration and ischemia showed mild improvement in his symptoms and imaging findings. An autopsy showed the typical pattern of PTTM in the lung with multiple metastases. CONCLUSION: PTTM is caused by tumor thrombi in the arteries and thickening of the pulmonary arterial endothelium leading to the symptoms of dyspnea in terminal staged patients. Therefore, supportive management of symptoms is necessary in the cases with PTTM and hence we believe that the information presented here is of great significance for the diagnosis and management of symptoms of PTTM with HCC.

DOI： 10.3748/wjg.v25.i48.6949

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Carcinosarcoma is a biphasic malignant tumor comprising both carcinomatous and sarcomatous components; its occurrence in the duodenum is very rare. We herein report the case of a 96-year-old woman with duodenal carcinosarcoma showing rapid growth within the past year. The tumor was found to be bulging into the lumen and predominantly comprised sarcomatoid components with focal positive staining for cytokeratin. Therefore, the tumor was diagnosed as duodenal carcinosarcoma. The clinical information of the present case and our literature review of the 12 cases reported to date will help physicians diagnose and treat this rare tumor.

DOI： 10.2169/internalmedicine.2094-18

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer and Chemotherapy Publ. Inc.  

A secondary mesenteroaxial volvulus is a rare disease entity caused by various mechanisms and is known to be difficult to be repositioned by the endoscopic procedure. We had a chance to manage a case of left lobectomy-induced mesenteroaxial gastric volvulus. The case was an 80-year-old man and had been diagnosed with esophageal hiatal hernia. He had undergone left lobectomy to treat lung adenocarcinoma. Two months after the procedure, he complained of left abdominal and chest pain and hospitalized because of aggravation of esophageal hiatal hernia and appearance of ascites. His symptoms did not improve and CT scan showed the mesenteroaxial gastric volvulus in its short axis directioa Endoscopic repositioning was tried but turned out unsuccessful, surgical treatment consisting of hiatal hernia repair with gastropexy was performed. This case suggested that the secondary mesenteroaxial volvulus is difficult to be corrected by an endoscopic procedure. Appropriate decision making is essential for treating this condition.

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

肺葉切除後に胃間膜軸性捻転を来し、内視鏡的整復が困難であった1例を報告する。症例は80歳代、男性。以前より滑脱型の食道裂孔ヘルニアを指摘されていた。左肺腺癌に対して左肺上葉切除を施行された2ヵ月後に左胸腹痛を自覚し、造影CTで食道裂孔ヘルニアの悪化と周囲に腹水出現を認めたため入院した。保存的治療で症状は改善したが、食事再開に伴い再度症状が悪化した。造影CTでは胃が短軸性に捻転している所見を認めた。内視鏡的整復を試みたが困難であり、外科的にヘルニア修復および胃壁固定術を施行し、以後、再発なく軽快している。特発性胃軸捻転症は内視鏡的整復成功例が散見されるが、二次性胃軸捻転症では癒着などのため困難なことが多い。本症例も肺葉切除後の二次性胃軸捻転症として、内視鏡的整復術を施行するも困難であった。(著者抄録)

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

62歳男性。門脈閉塞をともなう慢性膵炎と膵仮性嚢胞による閉塞性黄疸のため、胆管空腸吻合、嚢胞空腸吻合術が施行されていた。反復する大量下血にて入院した。出血シンチグラフィーが出血部位同定に有用で、血管造影とダブルバルーン小腸内視鏡で胆管空腸吻合部空腸静脈瘤と確定診断した。開腹下空腸静脈瘤塞栓術を施行し、出血は消失した。求肝性門脈血流は肝胃間膜経由の別側副路から保たれ、合併症もなく有効な治療となった。(著者抄録)

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記述言語：日本語  

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.

PubMed

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担当区分：筆頭著者   記述言語：英語  

A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.

DOI： 10.5946/ce.2015.48.6.563

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer and Chemotherapy Publ. Inc.  

We aimed to elucidate the incidence and outcomes of delayed perforation after endoscopic submucosal dissection (ESD). A total of 1,611 resections was done by ESD at our hospital and delayed perforation occurred in 6 patients (0.37%). Five patients were elderly and had pre-existing disease. Two patients had antithrombotic medicine. No relation was found with operative time. These delayed perforations were thought to be due to over coagulation (n = 4) and bile reflux for residual stomach (n = 1). Three patients underwent emergency surgery and the size of perforation was over 10 mm in all. When delayed perforation is large in size or occurs in remnant stomach, we should consider immediate surgical treatment.

Scopus

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

当施設で治療した早期胃癌に対するendoscopic submucosal dissection(ESD)1,611例中6例(0.37%)の遅発性穿孔について原因と治療経過を検討した。基礎疾患をもった高齢の男性に多く、2例で抗血栓薬を内服していた。局在はすべて体中部であり、術時間に一定の傾向は認めなかった。過凝固が原因と考えられた症例が4例、残胃内への胆汁の逆流が原因と考えられた症例が1例であった。手術を要した3例は穿孔径が10mm以上で、手術時期が遅れた残胃の1例では術後長期の経過をたどった。穿孔径が大きい場合や残胃症例に対しては迅速な手術を考慮するべきである。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

症例は65歳の女性。2003年に近医のCTで肝S2に20mm大の血管腫を指摘され、フォローされていた。2009年にS2背側の別部位に嚢胞様腫瘤を指摘され、2011年に53mmに増大したため当科を紹介受診。その時点でフォローされていた血管腫は画像上消失していた。増大傾向の腫瘤は単純CTで低吸収、内部は辺縁主体に不均一な造影効果を認めた。MRI T1強調in phaseで高信号、opposed phaseで低信号で脂肪に富む腫瘤であり、高分化脂肪肉腫と、脂肪成分を主体とする血管筋脂肪腫を鑑別に挙げた。明らかな増大傾向で5cmを超えることを根拠に、左葉外側区域切除術を施行、病理学的に脂肪成分優位の血管筋脂肪腫と確定診断した。増殖能の高い腫瘍と推測されたが、Ki67陽性細胞は低頻度で、増大の主体は成熟脂肪組織であった。発生初期からの増大する経過を追えた報告はほとんどなく、貴重な症例と考え報告する。(著者抄録)

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 65-year-old female patient was referred to our institute for enlarged liver tumor in segment 2. Computed tomography demonstrated a 53-mm low-density tumor with faint heterogeneous enhancement. The tumor appeared as a high-intensity lesion on T1-and T2-weighted images of magnetic resonance imaging (MRI). A fat suppressed T1-weighted image (opposed phase) showed the tumor as a low-intensity lesion. The differential diagnoses were well-differentiated liposarcoma and hepatic angiomyolipoma. Hepatic lateral segmentectomy was performed, and histological examination of a surgically obtained specimen revealed hepatic angiomyol- ipoma. The tumor was enlarged, but its main component was a mature adipose tissue and the proliferative potential of the tumor was low. The course of the tumor size increase would provide valuable information. © 2013 The Japan Society of Hepatology.

DOI： 10.2957/kanzo.54.112

Scopus

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

肝性脳症に対しバルーン下逆行性経静脈的塞栓術(B-RTO)を施行した14例(男9例、女5例、平均64.5歳)の成績を報告した。門脈大循環シャントの部位は胃腎7例、脾腎5例、mesocaval 3例、奇静脈1例、傍臍静脈1例であった。10例でB-RTO施行による門脈圧上昇緩和目的で部分脾動脈塞栓術を施行した。シャント血管の完全な塞栓が得られなかったのは2例で、1例は翌日バルーン破損を認め、他の1例は排血路が多彩でコイル塞栓が中心であった。残り12例は完全な塞栓が得られ、血中アンモニア値正常化と脳症症状改善が認められた。術後合併症は症候性胸腹水4例、特発性細菌性腹膜炎或いは敗血症2例、門脈血栓症1例、麻痺性イレウス1例が認められた。術後2ヵ月以上経過した13例において、血中アンモニア値は正常値維持4例、時折軽度上昇5例、再上昇し高値持続2例、低下なし2例であった。顕性脳症は3例に認め、うち2例は肝病変進展によるものであった。

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記述言語：英語  

PURPOSE: To evaluate the efficacy and safety of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE) for gastric varices and/or hepatic encephalopathy. MATERIALS AND METHODS: B-RTO was performed in 19 consecutive patients with gastric varices and/or hepatic encephalopathy, of whom 10 received simultaneous combined B-RTO and PSE (group 1) and nine received B-RTO monotherapy (group 2). To evaluate the safety of these techniques, we analyzed 20 patients who received PSE monotherapy during the same period as a control group (group 3). Outcomes were retrospectively assessed. RESULTS: No significant differences were observed in baseline characteristics among the three groups except for significantly lower platelet counts and larger spleen volumes in group 3. In all cases in groups 1 and 2, gastric varices disappeared and hepatic encephalopathy improved after treatment. Procedure times were not significantly different between groups 1 and 2 (P = .7435). In group 1, the volume of sclerosing agent required for B-RTO was significantly lower (P = .0355) and exacerbation of esophageal varices was significantly less frequent (P = .0146) than in group 2. Few serious complications occurred in patients who received combined therapy. CONCLUSIONS: This study indicates that concomitant PSE may help diminish the increase in portal venous pressure after B-RTO for portosystemic shunts, and may allow a reduction in the volume of hazardous sclerosing agent used. It is worth evaluating the efficacy of simultaneous B-RTO and PSE in a prospective study.

DOI： 10.1016/j.jvir.2012.01.065

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

大量の肝性腹水が腹腔内圧の上昇をもたらし、腹部コンパートメント症候群を発症している状況を腹水前後の膀胱内圧測定、腎静脈流速測定を中心に検討した。対象症例は穿刺前後の膀胱内圧測定、腎静脈の流速測定等が可能であった腹水合併肝硬変8例。穿刺前後の膀胱内圧、尿潜血反応、腎機能、腎静脈流速等を経時的に観察した。末期肝硬変患者が肝腎症候群へ移行する過程で腹水による腹腔内圧の上昇が腎うっ血を併発させ、レニン-アンギオテンシン-アルドステロン系の亢進に関係する可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

大量の肝性腹水が腹腔内圧の上昇をもたらし、腹部コンパートメント症候群を発症している状況を腹水前後の膀胱内圧測定、腎静脈流速測定を中心に検討した。対象症例は穿刺前後の膀胱内圧測定、腎静脈の流速測定等が可能であった腹水合併肝硬変8例。穿刺前後の膀胱内圧、尿潜血反応、腎機能、腎静脈流速等を経時的に観察した。末期肝硬変患者が肝腎症候群へ移行する過程で腹水による腹腔内圧の上昇が腎うっ血を併発させ、レニン-アンギオテンシン-アルドステロン系の亢進に関係する可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：英語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

症例は50代の女性.30代でC型肝炎ウイルスへの感染を指摘されていたが治療に至らず,継続的な受診も行っていなかった.腹痛と意識消失を主訴に救急搬送され,脾動脈瘤破裂による出血性ショックと診断された.当院で脾動脈瘤塞栓術を施行し,術後経過は良好であった.外来にて直接作用型抗ウイルス薬を導入し,ウイルス学的著効を達成した.CT検査の普及により,脾動脈瘤の偶然の発見も増加していると報告されていて,今後本例のように肝臓以外の疾患での受診を契機に,ウイルス性肝炎や肝硬変の診断から治療に至る症例もある.C型肝炎の未治療者や未受検者,非認識受検者は国内に未だ数多く存在しており,脾動脈瘤に関する文献的考察と,新潟県で実施している肝炎患者の拾い上げの試みについても併せて記載し報告する.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00263&link_issn=&doc_id=20211111030008&doc_link_id=1390852945233297152&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390852945233297152&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：英語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：英語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-甲信越支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肥満学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：医学書院  

＜Point＞非アルコール性脂肪肝炎(NASH)は,メタボリックシンドロームの肝臓における表現型であり,進行性の病態をとる.老化は,加齢性変化,テロメア長の変化,サーチュイン蛋白,細胞老化などを介してNASHの病態に関与しており,肝臓の脂肪化,炎症,線維化,発癌に重要な役割をもっている.老化がNASHの病態を進展させるメカニズムを明らかにすることで,新たな診断法や治療法を開発できる可能性がある.(著者抄録)

CiNii Article

CiNii Books

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟市民病院  

第一世代直接抗ウイルス薬であるtelaprevir(TVR)を擁するTVR/peg-interferon(PEG)/ribavirin(RBV)3剤併用療法の治療成績を報告する。対象は2012年2月から2013年6月までに3剤併用療法(TVR 12週、PEG/RBV 24週)を導入された、genotype 1b・高ウイルス量のC型慢性肝疾患の連続16例。治療開始後4週(RVR)、12週(EVR)、治療終了時(ETR)、治療終了後24週(SVR24)のHCV-RNA陰性化率は81.3%、100%、93.8%、87.5%と高率で、ALT改善効果も良好であった。副作用は皮膚障害が75%と高率にみられたが、減量・休薬、抗アレルギー薬、ステロイド外用・内服など、皮膚科医と連携し治療した。十分な副作用対策を行うことで、高率なウイルス学的治癒が得られており、有効性の高い治療法であると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟市民病院  

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記述言語：日本語   出版者・発行元：新潟市民病院  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：新潟市民病院  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：NATURE PUBLISHING GROUP  

Web of Science

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記述言語：日本語   出版者・発行元：新潟市民病院  

【背景】プロテアーゼ阻害薬の登場によりインターフェロン(IFN)単独治療では難治性とされるgenotype 1b、高ウイルス量症例のウイルス学的治癒も高い確率で狙える時代になってきた。しかし、その強い副作用などから恩恵を受けられない症例も少なくない。PEG-IFNα2a少量長期投与を行いウイルス学的治癒となった症例を報告する。【症例】50歳代の女性。初回治療の天然型IFNα 24週治療では再燃し、2次治療としてのIFNα2b/RBV 24週治療では無効であった。3次治療としてのPEG-IFNα2b/RBV 72週治療では終了後1ヵ月で早期再燃した。その後HCV-RNA量の増加に遅れてALTの上昇がみられた。ALT正常化、肝発癌抑制目的に、4次治療としてPEG-IFNα2a 90μgの週1回長期投与の方針とした。28週でHCV-RNA陰性化したため、さらに100週治療を継続した。その後ウイルス学的治癒を確認し、現在経過観察中である。【考察】PEG-IFN治療の登場前から2年以上の長期IFN治療の高いSVR率が報告されている。我々もそれに倣い、以前も2年半にわたる天然型IFNα少量長期投与でSVRに至ったC型肝硬変症例を経験し、報告してきた。IFN少量長期療法でもHCV-RNA陰性化が得られれば、その後長期の治療継続に期待してもよいと思われた。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟市民病院  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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開催年月日： 2020年12月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

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開催年月日： 2020年11月

会議種別：口頭発表（一般）  

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開催年月日： 2019年6月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

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開催年月日： 2018年11月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2018年6月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2018年5月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2018年5月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2017年11月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2016年5月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2014年5月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：新潟日報メディアシップ   国名：日本国  

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開催年月日： 2013年11月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：山梨県立図書館   国名：日本国  

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開催年月日： 2012年5月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：信州大学医学部付属病院 外来棟４階大会議室   国名：日本国  

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