61 results on '"Gunji N"'
Search Results
2. Cholesterol lowering effect of the methanol insoluble materials from the quinoa seed pericarp
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Konishi, Y., primary, Arai, N., additional, Umeda, J., additional, Gunji, N., additional, Saeki, S., additional, Takao, T., additional, Minoguchi, R., additional, and Kensho, G., additional
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- 2000
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3. Application of slurry nebulization to trace elemental analysis of some biological samples by inductively coupled plasma mass spectrometry
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Mochizuki, T., Sakashita, A., Iwata, H., Ishibashi, Y., and Gunji, N.
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- 1991
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4. Retrospective review of safety and efficacy of percutaneous gastrostomy placement without gastropexy in extremely sick patients
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Johnson, R., primary, Vaheesan, K., additional, Gunji, N., additional, Kwong, A., additional, Moreno, I., additional, and Gadani, S., additional
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- 2016
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5. 4:21 PMAbstract No. 406 - Retrospective review of safety and efficacy of percutaneous gastrostomy placement without gastropexy in extremely sick patients
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Johnson, R., Vaheesan, K., Gunji, N., Kwong, A., Moreno, I., and Gadani, S.
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- 2016
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6. In situ analysis of Ru carbonyl catalysts for carbonylation reactions by Fourier transform infrared spectrometry
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Kaihara, M., Mametsuka, H., Gunji, N., Nakamura, T., Ikariya, T., and Gohshi, Y.
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- 1996
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7. IMPLEMENTATION OF MPEG TRANSPORT DEMULTIPLEXER WITH A RISC-BASED MICROCONTROLLER
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Fujii, Y., primary, Nakase, J., additional, Matsuno, K., additional, and Gunji, N., additional
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8. IMPLEMENTATION OF MPEG TRANSPORT DEMULTIPLEXER WITH A RISC-BASED MICROCONTROLLER.
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Fujii, Y., Nakase, J., Matsuno, K., and Gunji, N.
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- 1996
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9. Long-term Risks of Recurrence After Hospital Discharge for Acute Lower Gastrointestinal Bleeding: A Large Nationwide Cohort Study.
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Sato Y, Aoki T, Sadashima E, Nakamoto Y, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Maehata T, Tateishi K, Kaise M, and Nagata N
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- Humans, Patient Discharge, Cohort Studies, Retrospective Studies, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage diagnosis, Acute Disease, Risk Factors, Hospitals, Thienopyridines, Recurrence, Hemostasis, Endoscopic, Diverticular Diseases
- Abstract
Background & Aims: Currently, large, nationwide, long-term follow-up data on acute lower gastrointestinal bleeding (ALGIB) are scarce. We investigated long-term risks of recurrence after hospital discharge for ALGIB using a large multicenter dataset., Methods: We retrospectively analyzed 5048 patients who were urgently hospitalized for ALGIB at 49 hospitals across Japan (CODE BLUE-J study). Risk factors for the long-term recurrence of ALGIB were analyzed by using competing risk analysis, treating death without rebleeding as a competing risk., Results: Rebleeding occurred in 1304 patients (25.8%) during a mean follow-up period of 31 months. The cumulative incidences of rebleeding at 1 and 5 years were 15.1% and 25.1%, respectively. The mortality risk was significantly higher in patients with out-of-hospital rebleeding episodes than in those without (hazard ratio, 1.42). Of the 30 factors, multivariate analysis showed that shock index ≥1 (subdistribution hazard ratio [SHR], 1.25), blood transfusion (SHR, 1.26), in-hospital rebleeding (SHR, 1.26), colonic diverticular bleeding (SHR, 2.38), and thienopyridine use (SHR, 1.24) were significantly associated with increased rebleeding risk. Multivariate analysis of colonic diverticular bleeding patients showed that blood transfusion (SHR, 1.20), in-hospital rebleeding (SHR, 1.30), and thienopyridine use (SHR, 1.32) were significantly associated with increased rebleeding risk, whereas endoscopic hemostasis (SHR, 0.83) significantly decreased the risk., Conclusions: These large, nationwide follow-up data highlighted the importance of endoscopic diagnosis and treatment during hospitalization and the assessment of the need for ongoing thienopyridine use to reduce the risk of out-of-hospital rebleeding. This information also aids in the identification of patients at high risk of rebleeding., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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10. Successful allogeneic hematopoietic stem cell transplantation for myelodysplastic neoplasms complicated with secondary pulmonary alveolar proteinosis and Behçet's disease harboring GATA2 mutation.
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Sato Y, Fukatsu M, Suzuki T, Sasajima T, Gunji N, Yoshida S, Asano N, Fukuchi K, Mori H, Takano M, Hayashi K, Takahashi H, Shirado-Harada K, Kimura S, Koyama D, Migita K, and Ikezoe T
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- Female, Humans, Germ-Line Mutation, GATA2 Transcription Factor genetics, Pulmonary Alveolar Proteinosis genetics, Pulmonary Alveolar Proteinosis therapy, Behcet Syndrome complications, Behcet Syndrome therapy, Neoplasms complications, Myelodysplastic Syndromes complications, Myelodysplastic Syndromes genetics, Myelodysplastic Syndromes therapy, Hematopoietic Stem Cell Transplantation adverse effects, Leukopenia
- Abstract
Myelodysplastic neoplasms (MDS) are defined by cytopenia and morphologic dysplasia originating from clonal hematopoiesis. They are also frequently complicated with diseases caused by immune dysfunction, such as Behçet's disease (BD) and secondary pulmonary alveolar proteinosis (sPAP). MDS with both BD and sPAP is extremely rare, and their prognosis is poor. In addition, haploinsufficiency of the hematopoietic transcription factor gene GATA2 is recognized as a cause of familial MDS and is frequently complicated by sPAP. Herein, we report a case of MDS combined with both BD and sPAP in association with GATA2 deficiency in a Japanese woman. Because she developed progressive leukopenia and macrocytic anemia during BD treatment at the age of 61, she underwent a bone-marrow examination and was diagnosed with MDS. She subsequently developed sPAP. At the age of 63, she underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Since allo-HSCT, she has maintained complete remission of MDS as well as the symptoms of BD and sPAP. Furthermore, we performed whole exome sequencing and identified the GATA2 Ala164Thr germline mutation. These findings suggest that patients with MDS, BD and sPAP should be considered for early allo-HSCT., (© 2023. Japanese Society of Hematology.)
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- 2023
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11. Early feeding reduces length of hospital stay in patients with acute lower gastrointestinal bleeding: A large multicentre cohort study.
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Kishino T, Aoki T, Sadashima E, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Kaise M, and Nagata N
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- Humans, Length of Stay, Acute Disease, Cohort Studies, Retrospective Studies, Multicenter Studies as Topic, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy, Colonoscopy methods
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Aim: No studies have compared the clinical outcomes of early and delayed feeding in patients with acute lower gastrointestinal bleeding (ALGIB). This study aimed to evaluate the benefits and risks of early feeding in a nationwide cohort of patients with ALGIB in whom haemostasis was achieved., Methods: We reviewed data for 5910 patients with ALGIB in whom haemostasis was achieved and feeding was resumed within 3 days after colonoscopy at 49 hospitals across Japan (CODE BLUE-J Study). Patients were divided into an early feeding group (≤1 day, n = 3324) and a delayed feeding group (2-3 days, n = 2586). Clinical outcomes were compared between the groups by propensity matching analysis of 1508 pairs., Results: There was no significant difference between the early and delayed feeding groups in the rebleeding rate within 7 days after colonoscopy (9.4% vs. 8.0%; p = 0.196) or in the rebleeding rate within 30 days (11.4% vs. 11.5%; p = 0.909). There was also no significant between-group difference in the need for interventional radiology or surgery or in mortality. However, the median length of hospital stay after colonoscopy was significantly shorter in the early feeding group (5 vs. 7 days; p < 0.001). These results were unchanged when subgroups of presumptive and definitive colonic diverticular bleeding were compared., Conclusion: The findings of this nationwide study suggest that early feeding after haemostasis can shorten the hospital stay in patients with ALGIB without increasing the risk of rebleeding., (© 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
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- 2023
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12. Characteristics of positive horizontal margins in patients who underwent colorectal endoscopic submucosal dissection.
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Kawashima K, Hikichi T, Onizawa M, Gunji N, Watahiki Y, Sakuma C, Mochimaru T, Murakami M, Suzuki O, Hashimoto Y, Kobayakawa M, and Ohira H
- Abstract
Objectives: Endoscopic submucosal dissection (ESD) enables en bloc resection of colorectal neoplasms, but occasionally results in positive horizontal margins (HMs). However, the site of the resected specimen that tends to be positive for HM has not been investigated. We aimed to clarify the characteristics associated with HMs in lesions resected en bloc with ESD., Methods: Patients with colorectal neoplasms who underwent en bloc resection with ESD were included in this study. The patients were divided into negative HMs (HM0) and positive or indeterminate HMs (HM1) groups. The characteristics associated with HM1 resection were investigated. In addition, the local recurrence rate during endoscopic follow-up for >6 months after ESD was observed., Results: In total, 201 lesions were analyzed in 189 patients (HM0, 189 lesions; HM1, 12 lesions). The HM1 group had a significantly larger median lesion diameter (25 vs. 55 mm; p < 0.001) and more lesions with >50% circumference than did the HM0 group ( p < 0.001). Furthermore, the prevalence of severe fibrosis was significantly higher in the HM1 group than in the HM0 group ( p < 0.001). Positive horizontal sites of the resected specimens were more frequent at the oral and anal sites than at the lateral sites. No local recurrences were observed in either group., Conclusions: The characteristics associated with HM1 depended on lesion size, particularly lesions with >50% circumference, and submucosal fibrosis., Competing Interests: Authors declare no conflicts of interest for this article., (© 2023 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
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- 2023
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13. Multicenter propensity score-matched analysis comparing short versus long cap-assisted colonoscopy for acute hematochezia.
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Kobayashi M, Akiyama S, Narasaka T, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Tsuchiya K, Kaise M, and Nagata N
- Abstract
Background and Aim: While short and long attachment caps are available for colonoscopy, it is unclear which type is more appropriate for stigmata of recent hemorrhage (SRH) identification in acute hematochezia. This study aimed to compare the performance of short versus long caps in acute hematochezia diagnoses and outcomes., Methods: We selected 6460 patients who underwent colonoscopy with attachment caps from 10 342 acute hematochezia cases in the CODE BLUE-J study. We performed propensity score matching (PSM) to balance baseline characteristics between short and long cap users. Then, the proportion of definitive or presumptive bleeding etiologies found on the initial colonoscopy and SRH identification rates were compared. We also evaluated rates of blood transfusions, interventional radiology, or surgery, as well as the rate of rebleeding and mortality within 30 days after the initial colonoscopy., Results: A total of 3098 patients with acute hematochezia (1549 short cap and 1549 long cap users) were selected for PSM. The rate of colonic diverticular bleeding (CDB) diagnosis was significantly higher in long cap users ( P = 0.006). While the two groups had similar rates of the other bleeding etiologies, the frequency of unknown etiologies was significantly lower in long cap users ( P < 0.001). The rate of SRH with active bleeding was significantly higher in long cap users ( P < 0.001). Other clinical outcomes did not differ significantly., Conclusion: Compared to that with short caps, long cap-assisted colonoscopy is superior for the diagnosis of acute hematochezia, especially CDB, and the identification of active bleeding., (© 2023 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
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- 2023
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14. Outcomes and recurrent bleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study.
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Yamauchi A, Ishii N, Yamada A, Kobayashi K, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Mori Y, Osawa K, Nakagami S, Kawai Y, Yoshikawa T, Kaise M, and Nagata N
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- Humans, Cohort Studies, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Ligation adverse effects, Multicenter Studies as Topic, Retrospective Studies, Diverticular Diseases complications, Diverticular Diseases therapy, Diverticulum, Colon complications, Diverticulum, Colon surgery, Hemostasis, Endoscopic adverse effects
- Abstract
Background and Aims: Ligation therapy, including endoscopic detachable snare ligation (EDSL) and endoscopic band ligation (EBL), has emerged as an endoscopic treatment for colonic diverticular bleeding (CDB); its comparative effectiveness and risk of recurrent bleeding remain unclear, however. Our goal was to compare the outcomes of EDSL and EBL in treating CDB and identify risk factors for recurrent bleeding after ligation therapy., Methods: We reviewed data of 518 patients with CDB who underwent EDSL (n = 77) or EBL (n = 441) in a multicenter cohort study named the Colonic Diverticular Bleeding Leaders Update Evidence From Multicenter Japanese Study (CODE BLUE-J Study). Outcomes were compared by using propensity score matching. Logistic and Cox regression analyses were performed for recurrent bleeding risk, and a competing risk analysis was used to treat death without recurrent bleeding as a competing risk., Results: No significant differences were found between the 2 groups in terms of initial hemostasis, 30-day recurrent bleeding, interventional radiology or surgery requirements, 30-day mortality, blood transfusion volume, length of hospital stay, and adverse events. Sigmoid colon involvement was an independent risk factor for 30-day recurrent bleeding (odds ratio, 1.87; 95% confidence interval, 1.02-3.40; P = .042). History of acute lower GI bleeding (ALGIB) was a significant long-term recurrent bleeding risk factor on Cox regression analysis. A performance status score of 3/4 and history of ALGIB were long-term recurrent bleeding factors on competing risk regression analysis., Conclusions: There were no significant differences in outcomes between EDSL and EBL for CDB. After ligation therapy, careful follow-up is required, especially in the treatment of sigmoid diverticular bleeding during admission. History of ALGIB and performance status at admission are important risk factors for long-term recurrent bleeding after discharge., (Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
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- 2023
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15. A balloon-assisted endoscopic submucosal dissection using long colonoscope and guidewire.
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Watahiki Y, Kawashima K, Hikichi T, Takagi T, Onizawa M, Gunji N, Watanabe C, Wada J, Oka Y, Hashimoto Y, and Ohira H
- Abstract
Balloon-assisted endoscopy enables stable endoscopic maneuverability. Balloon-assisted endoscopic submucosal dissection (BA-ESD) is useful in the treatment of proximal colorectal tumors where scope maneuverability is poor. Herein, we reported a case in which BA-ESD was successfully performed using a long colonoscope with a guidewire, although the lesion could not be reached using the balloon-assisted endoscopy technique with a therapeutic colonoscopy. A 50-year-old man underwent a colonoscopy that revealed a tumor in the ascending colon. BA-ESD was performed using a conventional therapeutic endoscope due to excessive intestinal elongation and poor endoscopic maneuverability. However, the transverse colon loop could not be reduced, and the total colonoscopy failed despite using balloon-assisted endoscopy. The scope was then changed from a conventional colonoscope to a long colonoscope, inserted into the terminal ileum, and the loop was reduced. After the guidewire was placed at the terminal ileum and the long colonoscope was removed, a therapeutic colonoscopy with an overtube was inserted into the ascending colon without reforming the colonic loop, allowing safe BA-ESD., Competing Interests: None., (© 2023 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
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- 2023
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16. Severe Enteritis after Cyclophosphamide Administration in a Patient with Microscopic Polyangiitis: A Case Report and Literature Review.
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Yoshida S, Temmoku J, Asano T, Iwasaki T, Matsumoto H, Fujita Y, Yashiro-Furuya M, Matsuoka N, Gunji N, Sato S, Watanabe H, Ohira H, and Migita K
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- Male, Humans, Middle Aged, Cyclophosphamide adverse effects, Administration, Intravenous, Infusions, Intravenous, Microscopic Polyangiitis drug therapy, Microscopic Polyangiitis diagnosis, Enteritis chemically induced, Enteritis drug therapy
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Severe enteritis is a rare side effect of cyclophosphamide (CPA) therapy, and only two cases have been reported to date. We herein report a 60-year-old man who developed severe enteritis after intravenous CPA administration for microscopic polyangiitis. He was successfully treated by discontinuation of CPA administration and long-term intensive supportive care. A diagnosis of CPA-associated enteritis was made based on the clinical course and imaging and pathological findings. This review of three cases of CPA-related enteritis, including our case, suggests that prompt CPA discontinuation and intensive systemic management are necessary when patients have gastrointestinal symptoms after CPA administration.
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- 2023
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17. Nationwide cohort study identifies clinical outcomes of angioectasia in patients with acute hematochezia.
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Kobayashi M, Akiyama S, Narasaka T, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Tsuchiya K, Kaise M, and Nagata N
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- Humans, Female, Cohort Studies, Retrospective Studies, Risk Factors, Dilatation, Pathologic, Recurrence, Neoplasm Recurrence, Local, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy
- Abstract
Background: While angioectasia is an important cause of acute hematochezia, relevant clinical features remain unclear. This study aims to reveal risk factors, clinical outcomes, and the effectiveness of therapeutic endoscopy for patients with acute hematochezia due to angioectasia., Methods: This retrospective cohort study was conducted at 49 Japanese hospitals between January 2010 and December 2019, enrolling patients hospitalized for acute hematochezia (CODE BLUE-J study). Baseline factors and clinical outcomes for angioectasia were analyzed., Results: Among 10,342 patients with acute hematochezia, 129 patients (1.2%) were diagnosed with angioectasia by colonoscopy. The following factors were significantly associated with angioectasia: chronic kidney disease, liver disease, female, body mass index < 25, and anticoagulant use. Patients with angioectasia were at a significant increased risk of blood transfusions compared to those without angioectasia (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.69-4.02). Among patients with angioectasia, 36 patients (28%) experienced rebleeding during 1-year follow-up. The 1-year cumulative rebleeding rates were 37.0% in the endoscopic clipping group, 14.3% in the coagulation group, and 32.8% in the conservative management group. Compared to conservative management, coagulation therapy significantly reduced rebleeding risk (P = 0.038), while clipping did not (P = 0.81). Multivariate analysis showed coagulation therapy was an independent factor for reducing rebleeding risk (hazard ratio [HR] 0.40; 95% CI 0.16-0.96)., Conclusions: Our data showed patients with angioectasia had a greater comorbidity burden and needed more blood transfusions in comparison with those without angioectasia. To reduce rebleeding risk, coagulation therapy can be superior for controlling hematochezia secondary to angioectasia., (© 2022. Japanese Society of Gastroenterology.)
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- 2023
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18. Weekend Effect on Clinical Outcomes of Acute Lower Gastrointestinal Bleeding: A Large Multicenter Cohort Study in Japan.
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Hayasaka J, Kikuchi D, Ishii N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Odagiri H, Hoteya S, Kaise M, and Nagata N
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- Humans, Japan epidemiology, Retrospective Studies, Hospital Mortality, Time Factors, Length of Stay, Acute Disease, Patient Admission, Gastrointestinal Hemorrhage therapy
- Abstract
Introduction: Weekend admissions showed increased mortality in several medical conditions. This study aimed to examine the weekend effect on acute lower gastrointestinal bleeding (ALGIB) and its mortality and other outcomes., Methods: This retrospective cohort study (CODE BLUE-J Study) was conducted at 49 Japanese hospitals between January 2010 and December 2019. In total, 8,120 outpatients with acute hematochezia were enrolled and divided into weekend admissions and weekday admissions groups. Multiple imputation (MI) was used to handle missing values, followed by propensity score matching (PSM) to compare outcomes. The primary outcome was mortality; the secondary outcomes were rebleeding, length of stay (LOS), blood transfusion, thromboembolism, endoscopic treatment, the need for interventional radiology, and the need for surgery. Colonoscopy and computed tomography (CT) management were also evaluated., Results: Before PSM, there was no significant difference in mortality (1.3% vs. 0.9%, p = 0.133) between weekend and weekday admissions. After PSM with MI, 1,976 cases were matched for each admission. Mortality was not significantly different for weekend admissions compared with weekday admissions (odds ratio [OR] 1.437, 95% confidence interval [CI] 0.785-2.630; p = 0.340). No significant difference was found with other secondary outcomes in weekend admissions except for blood transfusion (OR 1.239, 95% CI 1.084-1.417; p = 0.006). Weekend admission had a negative effect on early colonoscopy (OR 0.536, 95% CI 0.471-0.609; p < 0.001). Meanwhile, urgent CT remained significantly higher in weekend admissions (OR 1.466, 95% CI 1.295-1.660; p < 0.001)., Conclusion: Weekend admissions decrease early colonoscopy and increase urgent CT but do not affect mortality or other outcomes except transfusion., (© 2023 The Author(s). Published by S. Karger AG, Basel.)
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- 2023
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19. Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study.
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Shiratori Y, Ishii N, Aoki T, Kobayashi K, Yamauchi A, Yamada A, Omori J, Aoyama T, Tominaga N, Sato Y, Kishino T, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Yamamoto K, Yoshimoto T, Takasu A, Ikeya T, Omata F, Fukuda K, Kaise M, and Nagata N
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- Humans, Retrospective Studies, Acute Disease, Odds Ratio, Colonoscopy methods, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage therapy, Gastrointestinal Hemorrhage etiology
- Abstract
Background and Aims: We aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower GI bleeding., Methods: We identified 10,342 patients with acute hematochezia (CODE BLUE-J study) admitted to 49 hospitals in Japan. Of these, 6270 patients who underwent a colonoscopy within 120 hours were included in this study. The inverse probability of treatment weighting method was used to adjust for baseline characteristics among early (≤24 hours, n = 4133), elective (24-48 hours, n = 1137), and late (48-120 hours, n = 1000) colonoscopy. The average treatment effect was evaluated for outcomes. The primary outcome was 30-day rebleeding rate., Results: The early group had a significantly higher rate of stigmata of recent hemorrhage (SRH) identification and a shorter length of stay than the elective and late groups. However, the 30-day rebleeding rate was significantly higher in the early group than in the elective and late groups. Interventional radiology (IVR) or surgery requirement and 30-day mortality did not significantly differ among groups. The interaction with heterogeneity of effects was observed between early and late colonoscopy and shock index (shock index <1, odds ratio [OR], 2.097; shock index ≥1, OR, 1.095; P for interaction = .038) and performance status (0-2, OR, 2.481; ≥3, OR, .458; P for interaction = .022) for 30-day rebleeding. Early colonoscopy had a significantly lower IVR or surgery requirement in the shock index ≥1 cohort (OR, .267; 95% confidence interval, .099-.721) compared with late colonoscopy., Conclusions: Early colonoscopy increased the rate of SRH identification and shortened the length of stay but involved an increased risk of rebleeding and did not improve mortality and IVR or surgery requirement. Early colonoscopy particularly benefited patients with a shock index ≥1 or performance status ≥3 at presentation., (Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
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- 2023
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20. LONG-HOSP Score: A Novel Predictive Score for Length of Hospital Stay in Acute Lower Gastrointestinal Bleeding - A Multicenter Nationwide Study.
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Fujita M, Aoki T, Manabe N, Ito Y, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Ayaki M, Murao T, Suehiro M, Shiotani A, Hata J, Haruma K, Kaise M, and Nagata N
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- Humans, Length of Stay, Retrospective Studies, Colonoscopy, Quality of Life, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy
- Abstract
Introduction: Length of stay (LOS) in hospital affects cost, patient quality of life, and hospital management; however, existing gastrointestinal bleeding models applicable at hospital admission have not focused on LOS. We aimed to construct a predictive model for LOS in acute lower gastrointestinal bleeding (ALGIB)., Methods: We retrospectively analyzed the records of 8,547 patients emergently hospitalized for ALGIB at 49 hospitals (the CODE BLUE-J Study). A predictive model for prolonged hospital stay was developed using the baseline characteristics of 7,107 patients and externally validated in 1,440 patients. Furthermore, a multivariate analysis assessed the impact of additional variables during hospitalization on LOS., Results: Focusing on baseline characteristics, a predictive model for prolonged hospital stay was developed, the LONG-HOSP score, which consisted of low body mass index, laboratory data, old age, nondrinker status, nonsteroidal anti-inflammatory drug use, facility with ≥800 beds, heart rate, oral antithrombotic agent use, symptoms, systolic blood pressure, performance status, and past medical history. The score showed relatively high performance in predicting prolonged hospital stay and high hospitalization costs (area under the curve: 0.70 and 0.73 for derivation, respectively, and 0.66 and 0.71 for external validation, respectively). Next, we focused on in-hospital management. Diagnosis of colitis or colorectal cancer, rebleeding, and the need for blood transfusion, interventional radiology, and surgery prolonged LOS, regardless of the LONG-HOSP score. By contrast, early colonoscopy and endoscopic treatment shortened LOS., Conclusions: At hospital admission for ALGIB, our novel predictive model stratified patients by their risk of prolonged hospital stay. During hospitalization, early colonoscopy and endoscopic treatment shortened LOS., (© 2023 The Author(s). Published by S. Karger AG, Basel.)
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- 2023
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21. Endoscopic submucosal dissection with the combination of a scissor-type knife and novel traction method for colonic neoplasm involving a diverticulum.
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Kawashima K, Hikichi T, Gunji N, Onizawa M, and Ohira H
- Abstract
Video 1A 35-mm laterally spreading tumor partially infiltrated the interior portion of the diverticular orifice in the ascending colon. Glycerol and hyaluronate solution were injected into the submucosa to maintain adequate mucosal elevation. Mucosal incision and submucosal dissection were performed using a DualKnife and insulation-tipped knife from the anal side; however, safe submucosal dissection was challenging with these knives because of severe fibrosis and abundant blood vessels in the diverticulum. Therefore, to improve the visibility of the submucosa, a scissor-type knife and a multiloop traction device was used to facilitate the submucosal dissection. Finally, en bloc resection was achieved in 117 minutes without adverse events. A part of the diverticular defect after endoscopic submucosal dissection was clipped to prevent delayed perforation., (© 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)
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- 2022
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22. Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study.
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Gobinet-Suguro M, Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Uemura N, Itawa E, Sugimoto M, Fukuzawa M, Kawai T, Kaise M, and Itoi T
- Subjects
- Colon, Colonoscopy, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy, Humans, Recurrence, Retrospective Studies, Treatment Outcome, Diverticular Diseases etiology, Diverticular Diseases therapy, Diverticulum, Colon complications, Diverticulum, Colon therapy, Hemostasis, Endoscopic adverse effects
- Abstract
Background and Aims: Treatment strategies for colonic diverticular bleeding (CDB) based on stigmata of recent hemorrhage (SRH) remain unstandardized, and no large studies have evaluated their effectiveness. We sought to identify the best strategy among combinations of SRH identification and endoscopic treatment strategies., Methods: We retrospectively analyzed 5823 CDB patients who underwent colonoscopy at 49 hospitals throughout Japan (CODE-BLUE J-Study). Three strategies were compared: find SRH (definitive CDB) and treat endoscopically, find SRH (definitive CDB) and treat conservatively, and without finding SRH (presumptive CDB) treat conservatively. In conducting pairwise comparisons of outcomes in these groups, we used propensity score-matching analysis to balance baseline characteristics between the groups being compared., Results: Both early and late recurrent bleeding rates were significantly lower in patients with definitive CDB treated endoscopically than in those with presumptive CDB treated conservatively (<30 days, 19.6% vs 26.0% [P < .001]; <365 days, 33.7% vs 41.6% [P < .001], respectively). In patients with definitive CDB, the early recurrent bleeding rate was significantly lower in those treated endoscopically than in those treated conservatively (17.4% vs 26.7% [P = .038] for a single test of hypothesis; however, correction for multiple testing of data removed this significance). The late recurrent bleeding rate was also lower, but not significantly, in those treated endoscopically (32.0% vs 36.1%, P = .426). Definitive CDB treated endoscopically showed significantly lower early and late recurrent bleeding rates than when treated conservatively in cases of SRH with active bleeding, nonactive bleeding, and in the right-sided colon but not left-sided colon., Conclusions: Treating definitive CDB endoscopically was most effective in reducing recurrent bleeding over the short and long term, compared with not treating definitive CDB or presumptive CDB. Physicians should endeavor to find and treat SRH for suspected CDB., (Copyright © 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
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- 2022
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23. Colonic Endoscopic Submucosal Dissection for a Granular Cell Tumor with Insufficient Endoscopic Manipulation in the Hepatic Flexure.
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Kawashima K, Hikichi T, Onizawa M, Gunji N, Takeda Y, Mochimaru T, Ishizaki Y, Murakami M, Kobayashi R, Shioya Y, Suzuki O, Hashimoto Y, Kobayakawa M, and Ohira H
- Abstract
This report describes a granular cell tumor (GCT) with insufficient endoscopic manipulation in the hepatic flexure (HF) of the colon, which was treated by endoscopic submucosal dissection (ESD) using a splinting tube and the spring S-O clip traction method. A 44-year-old man presented with a 10 mm subepithelial tumor in the HF near the ascending colon on colonoscopy. The lesion had a smooth surface without erosion. The histology of biopsied specimen from the lesion was suspected as a GCT. Most GCTs are considered low-grade malignant, but ESD was chosen to treat the lesion due to the patient's insistence on endoscopic treatment. Because the lesion was located in the HF, it was assumed that the scope manipulation during ESD would be difficult. During ESD, a splinting tube was utilized to stabilize endoscopic manipulation and the spring S-O clip traction method to keep clear visualization of the submucosa, and the procedure was completed without adverse events. An 8 × 7 mm lesion with negative margins was removed by ESD. Hematoxylin and eosin staining showed atypical cells with round-to-oval nuclei and acidophilic vesicles, and immunohistochemical staining for S-100 protein was strongly positive with a Ki-67 labeling index of 5%. The lesion was pathologically confirmed as a GCT. This case showed the usefulness and safety of ESD for GCT with insufficient endoscopic manipulation in the HF., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2022 by S. Karger AG, Basel.)
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- 2022
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24. Trichuris trichiura Incidentally Detected by Colonoscopy and Identified by a Genetic Analysis.
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Ishizaki Y, Kawashima K, Gunji N, Onizawa M, Hikichi T, Hasegawa M, and Ohira H
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- Animals, Colon, Ascending, Colonoscopy, Humans, Zoonoses, Trichuriasis diagnosis, Trichuris genetics
- Abstract
Although trichuriasis, a zoonotic disease, has recently become rare in Japan due to improved environmental hygiene, we herein report a 79-year-old man in whom a worm was incidentally found in the ascending colon during colonoscopy for positive fecal occult blood and was endoscopically removed. A genetic analysis identified the worm as Trichuris trichiura possessing mixed sequences from non-human primate and human origins. Despite controversy regarding Trichuris trichiura infection originating from Japanese macaques, according to some studies, it originates primarily from humans. This report suggests the efficacy of a genetic analysis for identifying infection sources.
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- 2022
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25. Endoscopic direct clipping versus indirect clipping for colonic diverticular bleeding: A large multicenter cohort study.
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Kishino T, Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, and Kaise M
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- Age Factors, Aged, Blood Transfusion statistics & numerical data, Colonoscopy, Diverticulitis, Colonic epidemiology, Female, Gastrointestinal Hemorrhage epidemiology, Hemostasis, Endoscopic instrumentation, Humans, Japan epidemiology, Male, Multivariate Analysis, Odds Ratio, Propensity Score, Retrospective Studies, Secondary Prevention methods, Sex Factors, Treatment Outcome, Diverticulitis, Colonic therapy, Gastrointestinal Hemorrhage therapy, Hemostasis, Endoscopic methods
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Background: Direct and indirect clipping treatments are used worldwide to treat colonic diverticular bleeding (CDB), but their effectiveness has not been examined in multicenter studies with more than 100 cases., Objective: We sought to determine the short- and long-term effectiveness of direct versus indirect clipping for CDB in a nationwide cohort., Methods: We studied 1041 patients with CDB who underwent direct clipping (n = 360) or indirect clipping (n = 681) at 49 hospitals across Japan (CODE BLUE-J Study)., Results: Multivariate analysis adjusted for age, sex, and important confounding factors revealed that, compared with indirect clipping, direct clipping was independently associated with reduced risk of early rebleeding (<30 days; adjusted odds ratio [AOR] 0.592, p = 0.002), late rebleeding (<1 year; AOR 0.707, p = 0.018), and blood transfusion requirement (AOR 0.741, p = 0.047). No significant difference in initial hemostasis rates was observed between the two groups. Propensity-score matching to balance baseline characteristics also showed significant reductions in the early and late rebleeding rates with direct clipping. In subgroup analysis, direct clipping was associated with significantly lower rates of early and late rebleeding and blood transfusion need in cases of stigmata of recent hemorrhage with non-active bleeding on colonoscopy, right-sided diverticula, and early colonoscopy, but not with active bleeding on colonoscopy, left-sided diverticula, or elective colonoscopy., Conclusions: Our large nationwide study highlights the use of direct clipping for CDB treatment whenever possible. Differences in bleeding pattern and colonic location can also be considered when deciding which clipping options to use., (© 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
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- 2022
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26. Evaluation of the relationship between the spleen volume and the disease activity in ulcerative colitis and Crohn disease.
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Kawashima K, Onizawa M, Fujiwara T, Gunji N, Imamura H, Katakura K, and Ohira H
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- Adult, Body Weight, Female, Humans, Inflammatory Bowel Diseases, Male, Middle Aged, Pancreatic Cyst, Retrospective Studies, Colitis, Ulcerative diagnostic imaging, Crohn Disease diagnostic imaging, Spleen diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Abstract: Inflammatory bowel disease (IBD) is caused by the activation of an abnormal immune response in the intestinal mucosa; the spleen is involved in the main immune response. Ulcerative colitis (UC) and Crohn disease (CD) have different inflammatory mechanisms; this study aimed to quantitatively measure and compare the spleen volumes between patients with UC and CD and examine the relationship between spleen volume and disease activity in both.We retrospectively analyzed 44 patients with IBD aged 30-60 years (UC group, n = 24; CD group, n = 20). The control group comprised 19 patients with pancreatic cysts that did not affect the spleen volume. All patients underwent computed tomography (CT) between April 2014 and March 2019. Using the Image J software, spleen volumes in the UC, CD, and control groups were measured accurately from the CT images and adjusted for the body weight.No significant differences in the sex, age, or body weight were noted between the UC and CD groups and the control group. The spleen volumes, adjusted for the body weight, were 2.2 ± 1.0 cm3/kg, 2.0 ± 1.0 cm3/kg, and 3.6 ± 1.7 cm3/kg in the control, UC, and CD groups, respectively. The volumes differed significantly between the CD and control groups (P = .01), but not between the UC and control groups (P = .43). Furthermore, a significant strong correlation was found between the disease activity and the body weight-adjusted spleen volume in patients with CD (P < .01).The spleen volume, adjusted for the body weight, was significantly larger in patients with CD than in the controls and was also strongly correlated with the CD activity. These results suggest that the immune response in CD may affect the spleen volume., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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27. Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study.
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Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Fukuzawa M, Itoi T, Uemura N, Kawai T, and Kaise M
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Assessment, Colonoscopy, Gastrointestinal Hemorrhage etiology, Intestinal Diseases complications, Intestinal Diseases diagnosis
- Abstract
Introduction: The bleeding source of hematochezia is unknown without performing colonoscopy. We sought to identify whether colonoscopy is a risk-stratifying tool to identify etiology and predict outcomes and whether presenting symptoms can differentiate the etiologies in patients with hematochezia., Methods: This multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia., Results: Patients were mostly elderly population, and 29.5% had hemodynamic instability. Computed tomography was performed in 69.1% and colonoscopy in 87.7%. Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding. Thirty-day rebleeding rates were significantly higher with diverticulosis and small bowel bleeding than with other etiologies. In-hospital mortality was significantly higher with angioectasia, malignancy, rectal ulcer, and upper gastrointestinal bleeding. Colonoscopic treatment rates were significantly higher with diverticulosis, radiation colitis, angioectasia, rectal ulcer, and postendoscopy bleeding. More interventional radiology procedures were needed for diverticulosis and small bowel bleeding. Etiologies with favorable outcomes and low procedure rates were ischemic colitis and infectious colitis. Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis. The same was true in cases of hematochezia with diarrhea, fever, and hemodynamic instability., Discussion: This nationwide data set of acute hematochezia highlights the importance of colonoscopy in accurately detecting bleeding etiologies that stratify patients at high or low risk of adverse outcomes and those who will likely require more procedures. Predicting different bleeding etiologies based on initial presentation would be challenging., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)
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- 2021
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28. Outcomes in high and low volume hospitals in patients with acute hematochezia in a cohort study.
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Ishii N, Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Omata F, Shiratori Y, Imamura N, Yano T, and Kaise M
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Colonoscopy, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage therapy, Hospitals, High-Volume, Hospitals, Low-Volume
- Abstract
Outcomes of acute lower gastrointestinal bleeding have not been compared according to hospital capacity. We aimed to perform a propensity score-matched cohort study with path and mediation analyses for acute hematochezia patients. Hospitals were divided into high- versus low-volume hospitals for emergency medical services. Rebleeding and death within 30 days were compared. Computed tomography, early colonoscopy (colonoscopy performed within 24 h), and endoscopic therapies were included as mediators. A total of 2644 matched pairs were yielded. The rebleeding rate within 30 days was not significant between high- and low-volume hospitals (16% vs. 17%, P = 0.44). The mortality rate within 30 days was significantly higher in the high-volume cohort than in the low-volume cohort (1.7% vs. 0.8%, P = 0.003). Treatment at high-volume hospitals was not a significant factor for rebleeding (odds ratio [OR] = 0.91; 95% confidence interval [CI], 0.79-1.06; P = 0.23), but was significant for death within 30 days (OR = 2.03; 95% CI, 1.17-3.52; P = 0.012) on multivariate logistic regression after adjusting for patients' characteristics. Mediation effects were not observed, except for rebleeding within 30 days in high-volume hospitals through early colonoscopy. However, the direct effect of high-volume hospitals on rebleeding was not significant. High-volume hospitals did not improve the outcomes of acute hematochezia patients., (© 2021. The Author(s).)
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- 2021
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29. Correction to: Upregulation of complement C1q reflects mucosal regeneration in a mouse model of colitis.
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Gunji N, Katakura K, Abe K, Kawashima K, Fujiwara T, Onizawa M, Takahashi A, and Ohira H
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- 2021
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30. Upregulation of complement C1q reflects mucosal regeneration in a mouse model of colitis.
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Gunji N, Katakura K, Abe K, Kawashima K, Fujiwara T, Onizawa M, Takahashi A, and Ohira H
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- Animals, Colitis genetics, Colitis physiopathology, Disease Models, Animal, Female, Gene Expression Regulation, Inflammation, Macrophages immunology, Mice, Mice, Inbred C57BL, Up-Regulation, beta Catenin genetics, beta Catenin metabolism, Colitis metabolism, Complement C1q genetics, Intestinal Mucosa physiology, Macrophages metabolism, Regeneration, Wnt Signaling Pathway
- Abstract
Confirming mucosal healing is important in inflammatory bowel disease treatment. Complement C1q-mediated Wnt signaling activation has recently been suggested to mediate tissue repair and mucosal regeneration. We investigated the involvement of complement C1q and Wnt signaling in intestinal mucosal regeneration using a murine colitis model. The colitis model was established by providing C57BL/6J mice with 4% dextran sodium sulfate (DSS) for 1 week (inflammation phase) followed by regular water for 2 weeks (recovery phase). After 3 weeks, we investigated the relationship between C1q in serum and colonic tissue during the inflammation and recovery phases. We assessed Wnt signaling activity by evaluating β-catenin expression in mouse intestinal tissue. Serum C1q levels were elevated during the recovery phase. C1q-specific staining indicated high C1q expression in pathological intestinal tissue during the inflammation and recovery phases. C1q mRNA and protein expression was increased during both phases. Interestingly, C1q-expressing cells were consistent with macrophages (F4/80-positive cells). Moreover, the expression of β-catenin increased in the colonic tissues during the recovery phase of DSS-induced colitis but decreased during the inflammation phase of DSS-induced colitis. C1q expression may mediate Wnt signaling activity and intestinal epithelial regeneration.
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- 2021
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31. A case of Takayasu arteritis complicated by refractory ulcerative colitis successfully treated with tofacitinib.
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Sato S, Matsumoto H, Temmoku J, Fujita Y, Matsuoka N, Furuya M, Gunji N, Fujiwara T, Asano T, Onizawa M, Kobayashi H, Watanabe H, Ohira H, and Migita K
- Subjects
- Adolescent, Female, Humans, Treatment Outcome, Colitis, Ulcerative drug therapy, Colitis, Ulcerative etiology, Piperidines therapeutic use, Protein Kinase Inhibitors therapeutic use, Pyrimidines therapeutic use, Pyrroles therapeutic use, Takayasu Arteritis complications
- Published
- 2020
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32. Intestinal Behçet disease associated with myelodysplastic syndrome accompanying trisomy 8 successfully treated with abdominal surgery followed by hematopoietic stem cell transplantation: A case report.
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Asano T, Sato S, Furuya MY, Takahashi H, Shichishima-Nakamura A, Ohkawara H, Fujiwara T, Gunji N, Hashimoto C, Momma T, Saito M, Nakano H, Watanabe G, Temmoku J, Fujita Y, Matsuoka N, Kobayashi H, Watanabe H, Mouri M, Mashiyama F, Sakuma H, Ohira H, Mori M, Ikezoe T, and Migita K
- Subjects
- Adolescent, Behcet Syndrome diagnosis, Behcet Syndrome surgery, Chromosomes, Human, Pair 8, Female, Hematopoietic Stem Cell Transplantation methods, Humans, Myelodysplastic Syndromes diagnosis, Behcet Syndrome complications, Behcet Syndrome therapy, Myelodysplastic Syndromes complications, Trisomy pathology
- Abstract
Rationale: Intestinal Behçet disease (BD) with myelodysplastic syndrome (MDS) is a rare condition that is resistant to various immunosuppressive therapies. Several cases in which hematopoietic stem cell transplantation (HSCT) was effective for intestinal BD with MDS accompanying trisomy 8 have been reported., Patient Concerns: We report an 18-year-old female with a 7-year history of BD. Colonoscopy demonstrated a huge ulcer in the cecum. Chromosomal examination revealed a karyotype of trisomy 8 in 87% of cells. Bone marrow examination revealed dysplastic cells in multilineages., Diagnoses: A diagnosis of intestinal BD associated with MDS accompanying trisomy 8 was made., Interventions: The patient underwent ileocecal resection due to microperforations of ileocecal ulcers; she then underwent allogeneic peripheral blood stem cell transplantation (PBSCT) with her mother as a donor., Outcomes: After the PBSCT, the patient's symptoms due to BD (fever, oral aphthae, abdominal pain, and genital ulcers) completely disappeared, with no severe adverse events., Lessons: The present case demonstrates that HSCT including PBSCT might be an effective new therapeutic option for refractory intestinal BD with MDS when immunosuppressive therapy has achieved insufficient efficacy.
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- 2019
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33. Anisakiasis in the Small Intestine with Excessive Bleeding That Was Difficult to Diagnose Endoscopically.
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Kawashima K, Fujiwara T, Katakura K, Gunji N, Yokokawa A, Sakamoto A, Hikichi T, Kono K, and Ohira H
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- Abdominal Pain etiology, Anisakiasis pathology, Anisakiasis surgery, Gastrointestinal Hemorrhage etiology, Humans, Intestinal Obstruction etiology, Male, Middle Aged, Raw Foods, Seafood, Anisakiasis diagnosis, Endoscopy, Intestine, Small
- Abstract
Anisakiasis involves the stomach in most cases and occurs rarely in the small intestine. Anisakiasis in the small intestine is associated with abdominal pain and obstruction and is rarely associated with intestinal bleeding. Unlike in the stomach, anisakiasis in the small intestine is difficult to diagnose anatomically. The patient in this case study developed hypovolemic shock due to excessive bleeding and underwent emergency surgery. With the recent increase in the consumption of raw fish around the world, this report provides an important finding of bleeding in the small intestine due to an unknown cause.
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- 2019
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34. Delayed perforation after endoscopic submucosal dissection for mucosal colon cancer: A conservatively treated case.
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Kawashima K, Hikichi T, Fujiwara T, Gunji N, Nakamura J, Watanabe K, Katakura K, and Ohira H
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- Aged, Cecal Neoplasms diagnosis, Cecal Neoplasms surgery, Colonic Neoplasms diagnosis, Conservative Treatment, Humans, Intestinal Perforation diagnosis, Intestinal Perforation therapy, Male, Time Factors, Colonic Neoplasms surgery, Endoscopic Mucosal Resection adverse effects, Intestinal Perforation etiology
- Abstract
A 66-year-old man was diagnosed from colonoscopy as having a 40-mm elevated tumor in the cecum. With a preoperative diagnosis of intramucosal carcinoma, endoscopic submucosal dissection (ESD) was performed. The tumor was resected en bloc, yielding a specimen with a 66-mm diameter. No perforation was detected during the operation.Although neither abdominal pain nor fever was observed immediately after ESD, abdominal pain developed on the following day. Two days after ESD, the abdominal pain ceased. The patient was managed conservatively with fasting and intravenous antibiotic treatment. Four days after ESD, abdominal X-ray revealed marked gas retention. Computed tomography revealed pneumoperitoneum and a pelvic abscess, leading to a diagnosis of delayed perforation after colonic ESD and paralytic intestinal obstruction. A decompression tube was then inserted transnasally into the small intestine. Because a gradual decrease occurred in intestinal gas, the decompression tube was removed. Oral ingestion was resumed 13 days post-ESD.Delayed perforation after colonic ESD often requires emergency surgery. The present case was managed conservatively, despite paralytic intestinal obstruction. This approach is rarely employed for this condition and is therefore worth reporting.
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- 2018
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35. Stool filling of an intestinal duplication cyst at the ileocecal valve triggers colonic intussusception: a case report.
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Kimura S, Iida H, Gunji N, Gohongi T, and Ogata T
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Background: Intestinal duplication, a congenital malformation, is considered a rare condition, particularly in adults. Although it affects young children, a minority of patients remains asymptomatic until adulthood. Here, we describe a case of an intestinal duplication cyst that caused intussusception by a unique mechanism., Case Presentation: A 19-year-old man was admitted to our hospital for intermittent abdominal pain. Computed tomography revealed colonic intussusception induced by a nodular mass in the ileocecal region. Urgent ileocecal resection was performed because of the risk of colonic ischemia. The resected material comprised a stool-filled noncommunicating cyst that protruded into the enteric lumen at the ileocecal valve. Histological analyses revealed that the inner wall of the cyst was lined with colonic mucosa and that the muscle layer of the cyst was shared with that of the original enteric wall; furthermore, the cyst had a vestige of an opening site in the wall. We concluded that the cyst was an intestinal duplication that poured stool into its lumen through the tiny orifice, thereby triggering intussusception., Conclusions: The present case suggests that stool-pouring can cause intussusception into the space of an intestinal duplication lesion.
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- 2018
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36. Evaluation of Brain Activity Using Near-infrared Spectroscopy in Inflammatory Bowel Disease Patients.
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Fujiwara T, Kono S, Katakura K, Abe K, Takahashi A, Gunji N, Yokokawa A, Kawashima K, Suzuki R, Wada A, Miura I, Yabe H, and Ohira H
- Subjects
- Adolescent, Adult, Aged, Brain-Derived Neurotrophic Factor blood, Case-Control Studies, Colitis, Ulcerative blood, Colitis, Ulcerative diagnostic imaging, Crohn Disease blood, Crohn Disease diagnostic imaging, Depression blood, Female, Humans, Male, Middle Aged, Risk Factors, Young Adult, Brain diagnostic imaging, Colitis, Ulcerative psychology, Crohn Disease psychology, Depression diagnostic imaging, Spectroscopy, Near-Infrared methods
- Abstract
Depression is implicated as a risk factor for the recurrence of inflammatory bowel disease (IBD). Near-infrared spectroscopy (NIRS) and brain-derived neurotrophic factor (BDNF) are useful tools for evaluation of brain activity and a depressive state, respectively. The aim of this study was to clarify the association between brain activity or depressive symptoms and IBD using NIRS and BDNF. This study included 36 ulcerative colitis (UC) patients, 32 Crohn's disease (CD) patients, and 17 healthy controls (HC). Center for Epidemiologic Studies Depression Scale (CES-D) scores were determined, NIRS was performed, and serum BDNF levels were measured in all subjects. NIRS showed that the mean oxygenated hemoglobin concentration was significantly lower in the frontal lobe in the UC group than in the HC group (HC 167 ± 106 vs. UC 83.1 ± 85.3, p < 0.05). No significant difference was seen between the HC and CD groups. There were also no significant differences in CED-D scores and BDNF levels among the groups. Changes in the NIRS values of the UC group may indicate decreased brain activity and a fundamental difference between UC and CD, which are often lumped together as two types of IBD.
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- 2018
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37. A case of gastric lipoma resected by endoscopic submucosa dissection with difficulty in preoperative diagnosis.
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Ichinose M, Hikichi T, Kanno Y, Gunji N, Fujita M, Kuroda M, Terashima K, Sato Y, Kawana S, Hashimoto Y, Ohira H, and Miyata M
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- Aged, Humans, Lipoma diagnosis, Male, Stomach Neoplasms diagnosis, Endoscopic Mucosal Resection methods, Lipoma surgery, Stomach Neoplasms surgery
- Abstract
A 66-year-old man was referred to our hospital with an increasing subepithelial lesion in the gastric antrum. Using esophagogastroduodenoscopy, a tumor with a steep, 20-mm-high rise protruding in the lumen was observed. The mucosal surface of the tumor was reddish, with ulcers forming at the base. Moreover, the tumor was mobile and soft. A biopsy specimen was taken from the ulcer, but tumor tissue was not collected from the submucosa. Endoscopic ultrasonography (EUS) showed a high echoic mass in the submucosa. However, because the mucosal surface of the ulceration was red, the mesenchymal tumor with internal bleeding was inferred to be lipoma. Additionally, because the tumor was small, flexible, and soft, collecting tumor tissue under EUS-guided fine-needle aspiration was inferred as difficult. We were unable to make a final diagnosis because the lesion showed a small tumor with atypical macroscopic morphology. Therefore, endoscopic submucosa dissection (ESD) was chosen for the diagnostic treatment. Sodium hyaluronate sufficient for separation from the muscular layer was injected into the submucosa. Then submucosal dissection was performed just above the muscle layer. Results demonstrate the possibility of removing the tumor reliably without perforation. Pathological evaluation of the ESD specimen indicated a diagnosis of gastric lipoma.
- Published
- 2017
- Full Text
- View/download PDF
38. Imiquimod-induced CCR9 Ameliorates murine TNBS Colitis.
- Author
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Suzuki R, Katakura K, Fujiwara T, Gunji N, Watanabe H, and Ohira H
- Subjects
- Aminoquinolines therapeutic use, Animals, Cell Differentiation drug effects, Cells, Cultured, Colitis chemically induced, Female, Imiquimod, Membrane Glycoproteins physiology, Mice, Mice, Inbred BALB C, T-Lymphocytes, Regulatory drug effects, Toll-Like Receptor 7 physiology, Trinitrobenzenesulfonic Acid, Aminoquinolines pharmacology, Colitis drug therapy, Receptors, CCR physiology
- Abstract
Aims: To investigate whether Imiquimod (IMQ) as TLR7 ligand protects mice from colonic inflammation and the mechanisms underlying in such immunoregulatory conditions. METHODS: Murine colitis was induced to Balb/c mice by administration of trinitrobenzene sulfonic acid (TNBS) with or without daily intraperitoneal administration of IMQ. Colitis was evaluated by body weight decreases and by histological score. Also colonic mRNA expression was measured by RT-PCR. To confirm the induction of Regulatory T cells (Tregs) by type-1 IFN from pDCs, we generated mouse bone marrow-derived pDCs and co-cultured these with CD4
+ T cells isolated from mouse spleen with or without IMQ stimulation. Cytokine production in the culture supernatant was measured by ELISA and the number of Tregs were analyzed by flow cytometry. Spleen and mesenteric lymph nodes (MLN) from IMQ-treated mice were collected, and mRNA expressions of cytokine were measured by RT-PCR and cytokine productions were measured by ELISA. Tregs and chemokine expressions were analyzed in colon of TNBS-induced colitis mouse by immunohistochemistry. RESULTS: Administration of IMQ significantly suppressed colonic inflammation of TNBS-induced colitis. In the colons of IMQ-treated mice, mRNA expression of TNF-α was decreased, and strong expressions of IL-6, IFN-β and TGF-β were detected. IL-10 and TGF-β productions were increased in the supernatant of co-cultured cells stimulated with IMQ, although we were unable to detect Treg differentiaton in IMQ-stimulated co-cultured cells. In MLN of IMQ-treated mice, strong expressions of TLR7, IFN-β, TGF-β and Foxp3 mRNA were detected. IL-10 production from MLN cells was also increased in the IMQ-treated group. Finally, Tregs in the inflamed colon and CCR9 in MLN of IMQ-treated mice were detected. CONCLUSION: These results suggest that IMQ protects mice from TNBS colitis through induction of CCR9, which regulates accumulation of Tregs in the inflamed colon.- Published
- 2016
- Full Text
- View/download PDF
39. Paralytic Ileus due to Superior Mesenteric Venous Thrombosis after Transarterial Injection for Hepatocellular Carcinoma.
- Author
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Nakajima Y, Takahashi A, Kanno Y, Gunji N, Imaizumi H, Hayashi M, Okai K, Abe K, Watanabe H, and Ohira H
- Subjects
- Abdominal Pain diagnostic imaging, Aged, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular pathology, Humans, Intestinal Pseudo-Obstruction drug therapy, Liver Neoplasms complications, Liver Neoplasms pathology, Male, Mesenteric Ischemia diagnostic imaging, Radiography, Thrombophlebitis drug therapy, Treatment Outcome, Venous Thrombosis etiology, Anticoagulants administration & dosage, Carcinoma, Hepatocellular drug therapy, Embolization, Therapeutic adverse effects, Intestinal Pseudo-Obstruction diagnosis, Liver Neoplasms drug therapy, Mesenteric Veins pathology, Portal Vein pathology, Venous Thrombosis drug therapy, Warfarin administration & dosage
- Abstract
A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.
- Published
- 2016
- Full Text
- View/download PDF
40. Postsurgical radiation therapy for gastric carcinosarcoma with c-kit expression: a case report.
- Author
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Gohongi T, Iida H, Gunji N, Orii K, and Ogata T
- Subjects
- Aged, Antigens, CD34 analysis, Biopsy, Carcinosarcoma chemistry, Carcinosarcoma secondary, Fatal Outcome, Gastroscopy, Humans, Immunohistochemistry, Lung Neoplasms secondary, Lymphatic Metastasis, Radiation Dosage, Radiotherapy, Adjuvant, Stomach Neoplasms chemistry, Stomach Neoplasms pathology, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Biomarkers, Tumor analysis, Carcinosarcoma therapy, Gastrectomy, Proto-Oncogene Proteins c-kit analysis, Stomach Neoplasms therapy
- Abstract
Gastric carcinosarcomas are rare morphologically biphasic tumors, consisting of carcinoma and sarcoma components, with a poor clinical course. Here we report the case of a 70-year-old man with advanced Borrmann type III carcinosarcoma arising from the upper body of the stomach with extensive lymph node metastasis who underwent a total, but palliative, gastrectomy. Histology showed the tumor consisted of a biphasic structure of tubular adenocarcinoma and spindle cell sarcoma. Immunohistochemistry revealed sarcoma cells expressing c-kit (CD117) and CD34, which are criteria for gastrointestinal stromal tumors. Nine months after the surgical operation, tumor metastases had extended to the hepatohilar, retroperitoneal and mediastinal lymph nodes. Radiation therapy of 50 Gy markedly decreased the size of each of these nodes and reduced the risk of respiratory complications and jaundice. However, the patient died of respiratory failure due to bronchopneumonia with multiple lung metastases 22 mo after resection. Autopsy revealed severe necrosis in most of the lymph nodes with tumor metastases. Radiation therapy combined with gastrectomy should be considered to improve survival in patients with gastric carcinosarcomas that express c-kit.
- Published
- 2015
- Full Text
- View/download PDF
41. Concurrent primary sclerosing cholangitis and eosinophilic colitis.
- Author
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Gunji N, Katakura K, Takahashi A, Fujiwara T, Suzuki R, Watanabe H, and Ohira H
- Subjects
- Abdominal Pain etiology, Adult, Anti-Inflammatory Agents therapeutic use, Biopsy, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis, Sclerosing diagnosis, Colitis diagnosis, Diagnosis, Differential, Diarrhea etiology, Eosinophilia diagnosis, Hepatitis, Autoimmune diagnosis, Hepatitis, Autoimmune drug therapy, Humans, Liver pathology, Male, Prednisolone therapeutic use, Cholangitis, Sclerosing complications, Colitis complications, Eosinophilia complications
- Abstract
A 39-year-old man presented with diarrhea and abdominal pain. At 26 years of age, he was found to have eosinophilia and abnormal liver function parameters, for which prednisolone therapy was started. He subsequently underwent a liver biopsy and endoscopic retrograde cholangiopancreatography, and received a diagnosis of primary sclerosing cholangitis (PSC). On presentation to our hospital, he was further diagnosed with eosinophilic colitis based on aggravation of diarrhea and severe eosinophilic infiltration in the colonic mucosa. We herein report a rare case of concurrent PSC and eosinophilic colitis.
- Published
- 2014
- Full Text
- View/download PDF
42. [Usefulness of ursodeoxycholic acid in a case of hepatic sarciodosis].
- Author
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Saito A, Takano M, Kaise S, Utsumi Y, Gunji N, Ishihata R, Irisawa A, and Ohira H
- Subjects
- Adult, Humans, Male, Cholagogues and Choleretics therapeutic use, Liver Diseases drug therapy, Sarcoidosis drug therapy, Ursodeoxycholic Acid therapeutic use
- Abstract
A 38-year-old man was admitted to our hospital with a diagnosis of pulmonary sarcoidosis accompanied with elevated biliary enzyme levels. Various imaging modalities, and percutaneous liver biopsy confirmed the diagnosis of hepatic sarcoidosis. Abnormalities of biliary enzymes improved after the administration of ursodeoxycholic acid (UDCA). In this case, the mechanism of pharmacologic action was considered to be the glucocorticoid-like effect of UDCA. UDCA might be a therapeutic option for hepatic sarcoidosis without general symptoms.
- Published
- 2010
43. [Xanthogranulomatous cholecystitis associated with a suspicious colonic fistula and its spontaneous resolution].
- Author
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Saito A, Takano M, Gunji N, Watanabe K, Ishihata R, Utsumi Y, Igari H, Irisawa A, and Ohira H
- Subjects
- Aged, 80 and over, Biliary Fistula diagnosis, Biliary Fistula pathology, Cholecystitis diagnosis, Cholecystitis pathology, Colonic Diseases diagnosis, Colonic Diseases pathology, Diagnostic Imaging, Female, Gallbladder Diseases diagnosis, Gallbladder Diseases pathology, Humans, Intestinal Fistula diagnosis, Intestinal Fistula pathology, Xanthomatosis diagnosis, Xanthomatosis pathology, Biliary Fistula etiology, Cholecystitis complications, Colonic Diseases etiology, Gallbladder Diseases etiology, Intestinal Fistula etiology, Remission, Spontaneous, Xanthomatosis complications
- Abstract
Fistula between the gallbladder and colon is a rare condition. Even more infrequent is spontaneous resolution of the fistula. We encountered a case of cholecystocolic fistula associated with xanthogranulomatous cholecystitis (XGC) that was diagnosed definitively using CT, MRI, and colonoscopy. An 82-year-old woman with no remarkable medical history presented with fever and right hypochondralgia that had continued for 8 days. Abdominal ultrasound showed a hyperechoic area as air in the lumen of the gallbladder with a hypertrophic wall. Contrast-enhanced CT, with the peripheral layer enhanced homogeneously by contrast medium, indicated air in the gallbladder with a thickened wall. Furthermore, MRI and colonoscopy revealed a fistula between the gallbladder and transverse colon strongly suggested. Those findings suggested cholecystocolic fistula associated with XGC. The patient was treated initially by administration of antibiotics, while fasting. Unfortunately, surgical specimens did not show the fistula, thus it was decided that the existence of cholecystocolic fistula with spontaneous resolution were highly suspected by the clinical course and imaging in this patient.
- Published
- 2009
44. [Concurrent low-dose cisplatin/5-FU chemotherapy and radiation for the recurrent gastric carcinoma--case reports].
- Author
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Gohongi T, Iida H, Nakai R, Gunji N, and Orii K
- Subjects
- Adenocarcinoma drug therapy, Adenocarcinoma radiotherapy, Aged, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Cisplatin administration & dosage, Combined Modality Therapy, Drug Administration Schedule, Fluorouracil administration & dosage, Gastrectomy, Humans, Lymphatic Metastasis, Male, Radiotherapy Dosage, Splenectomy, Stomach Neoplasms surgery, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymph Nodes pathology, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local radiotherapy, Stomach Neoplasms drug therapy, Stomach Neoplasms radiotherapy
- Abstract
We report two postoperative cases of recurrent gastric carcinoma successfully treated with concurrent low-dose cisplatin/5-FU chemotherapy and radiation therapy. Case 1: A 74-year-old man underwent total gastrectomy and splenectomy for advanced gastric carcinoma followed by a local recurrence at the anastomotic site 6 months after surgery. Case 2: A 75-year-old man underwent total gastrectomy and splenectomy for advanced gastric carcinoma followed by multiple lymph node swelling along the abdominal aorta one year after surgery. We employed concurrent radiation therapy and low-dose CDDP/5-FU therapy for the recurrent gastric carcinoma tumor which consisted of 5-FU (125-250 mg/body/day, as a 24-h intravenous injection for 4 weeks) and low-dose cisplatin (10 mg/body on day 1, 8, 15, 22). X-ray radiation was delivered to the target tumor in a daily fraction of 1.8 Gy, 6 days/week, with a total dose of 50.4 Gy. PR and CR were obtained after the therapy. Grade 3 leucopenia was observed in Case 1,which was successfully treated with G-CSF injection. The concurrent low-dose cisplatin/5-FU chemotherapy and radiation therapy could be an effective treatment modality for the recurrent tumors of gastric carcinoma after surgery.
- Published
- 2006
45. Concurrent proton beam radiotherapy and systemic chemotherapy for the metastatic liver tumor of gastric carcinoma: a case report.
- Author
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Gohongi T, Tokuuye K, Iida H, Nakai R, Gunji N, Akine Y, and Orii K
- Subjects
- Adenocarcinoma secondary, Aged, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Cisplatin administration & dosage, Combined Modality Therapy, Drug Administration Schedule, Female, Fluorouracil administration & dosage, Gastrectomy, Humans, Liver Neoplasms secondary, Lymph Node Excision, Lymphatic Metastasis, Radiotherapy Dosage, Stomach Neoplasms surgery, Adenocarcinoma drug therapy, Adenocarcinoma radiotherapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Liver Neoplasms drug therapy, Liver Neoplasms radiotherapy, Stomach Neoplasms pathology
- Abstract
We report a case of a woman with a metastatic liver tumor from gastric carcinoma, who has been successfully treated with concurrent proton beam therapy and systemic chemotherapy. A 76-year-old woman underwent distal gastrectomy with regional lymph node dissection for advanced gastric carcinoma on January 17, 2002. She received five courses of sequential chemotherapy with methotrexate-5-fluorouracil after the surgical resection. A metastatic liver tumor was detected in the caudate lobe of the liver by computed tomography at 6 months after the surgical resection. We employed concurrent proton beam therapy and systemic chemotherapy which consisted of 5-fluorouracil (250 mg/body per day, as a 24-h intravenous injection for 4 weeks) and low dose cisplatin (10 mg/body on days 1-5 every week for 4 weeks). Proton beam therapy targeting the metastatic liver tumor was performed in a daily fraction of 3 Gy, 5 days per week, with a total dose of 66 Gy over 30 days. The tumor disappeared 3 months after the treatment and no recurrence has been observed for 2 years after termination of the treatment. Throughout the entire course of treatment, the patient received injections of granulocyte stimulating factor subcutaneously for grade 3 leukopenia. She never complained of abdominal symptoms, such as epigastralgia, nausea or diarrhea. Liver failure related to proton irradiation has not been observed. This concurrent proton beam radiotherapy with systemic chemotherapy could be an effective treatment modality for metastatic liver tumor from gastric carcinoma.
- Published
- 2005
- Full Text
- View/download PDF
46. Pancreatic carcinoid: transcatheter arterial chemoembolization of liver metastases.
- Author
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Gunji N, Miyamoto H, Orii K, Kawamoto T, and Fukao K
- Subjects
- Angiography, Carcinoid Tumor diagnostic imaging, Carcinoid Tumor pathology, Carcinoid Tumor therapy, Female, Follow-Up Studies, Hepatectomy, Humans, Liver blood supply, Liver pathology, Liver Neoplasms diagnostic imaging, Liver Neoplasms pathology, Liver Neoplasms therapy, Middle Aged, Neoplasm Recurrence, Local diagnostic imaging, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Palliative Care, Pancreas pathology, Pancreatectomy, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms pathology, Splenectomy, Tomography, X-Ray Computed, Antibiotics, Antineoplastic administration & dosage, Carcinoid Tumor secondary, Chemoembolization, Therapeutic, Doxorubicin administration & dosage, Liver Neoplasms secondary, Pancreatic Neoplasms therapy
- Abstract
Carcinoid tumors are a common disease in the gastrointestinal tract, but are extremely rare in pancreas. To our knowledge, only 33 carcinoid tumors of pancreas have been reported in the English literature. Complete surgical resection of pancreatic carcinoid contributes to prolonged survival. But distant metastases, including liver metastasis, prevent long-term survival. We report here one resected case of pancreatic carcinoid tumor with liver metastases. Postoperatively, multiple liver metastases had arisen in the bilateral lobe of the liver and were treated with transcatheter arterial chemoembolization. In this case, transcatheter chemoembolization was effective for palliation for postoperative liver metastases.
- Published
- 2003
47. Endoscopic management of upper gastrointestinal bleeding from a duodenal diverticulum.
- Author
-
Gunji N and Miyamoto H
- Subjects
- Aged, Follow-Up Studies, Humans, Male, Treatment Outcome, Diverticulum surgery, Duodenal Diseases surgery, Duodenoscopes, Gastrointestinal Hemorrhage surgery, Hemostasis, Surgical instrumentation
- Abstract
Hemorrhage from duodenal diverticulum is a rare cause of upper gastrointestinal hemorrhage. The side-viewing endoscope was used for almost all cases of diagnosis and endoscopic hemostasis. However, a forward-viewing endoscope is used in emergent endoscopic study for upper gastrointestinal hemorrhage. We report a case in which the endoscopic hemostasis of bleeding duodenal diverticulum was performed during emergent forward-viewing endoscopic study.
- Published
- 2003
48. E-cadherin expression in the primary tumors and metastatic lymph nodes of poorly differentiated types of rectal cancer.
- Author
-
Kanazawa N, Oda T, Gunji N, Nozue M, Kawamoto T, Todoroki T, and Fukao K
- Subjects
- Cell Differentiation, Humans, Immunohistochemistry, Lymphatic Metastasis, Adenocarcinoma chemistry, Cadherins analysis, Carcinoma, Signet Ring Cell chemistry, Lymph Nodes chemistry, Neoplasm Proteins analysis, Rectal Neoplasms chemistry
- Abstract
Purpose: Dysfunction of E-cadherin, a cell-cell adhesion molecule, correlates with the grade of dedifferentiation and/or invasiveness of rectal cancer. However, the relationship between E-cadherin expression in the primary tumor and the potential for metastasis has never been reported., Methods: E-cadherin expression in 43 primary rectal cancer, including 10 poorly differentiated type, and their associated metastatic lymph nodes (LN mets.) were immunohistochemically evaluated., Results: Heterogeneous immunostaining, suggestive of damage to the E-cadherin-mediated cell-cell adhesion system, was seen in 13 of the 28 LN mets positive primary lesions, but in 0 of the 15 LN mets negative primaries. Furthermore, the incidence of heterogeneous immunostaining differed significantly between poorly differentiated and differentiated cancers, being seen in 8 of 10 cases and 5 of 33 cases, respectively (P = 0.0003 by Fisher's exact test). Interestingly, most of the LN mets. foci (25 of 28 cases) showed homogeneous staining regardless of the E-cadherin staining pattern of the primary lesion., Conclusion: Heterogeneous immunostaining of E-cadherin in poorly differentiated rectal cancer was associated with lymph node metastasis. Its staining pattern in metastatic lymph nodes were, however, generally homogenous.
- Published
- 2002
- Full Text
- View/download PDF
49. Reevaluation of spiral CT cholangiography: basic considerations and reliability for detecting choledocholithiasis in 80 patients.
- Author
-
Takahashi M, Saida Y, Itai Y, Gunji N, Orii K, and Watanabe Y
- Subjects
- Adult, Aged, Aged, 80 and over, Alkaline Phosphatase blood, Bile, Bile Duct Diseases diagnostic imaging, Bilirubin blood, Contrast Media adverse effects, Female, Gallstones blood, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Pancreatic Diseases diagnostic imaging, Predictive Value of Tests, Radiographic Image Enhancement, Sensitivity and Specificity, Statistics, Nonparametric, Cholangiography methods, Gallstones diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Purpose: The purpose of this work was to reevaluate the characteristics and diagnostic accuracy of spiral CT cholangiography (CTC) for detecting biliary calculi., Method: Spiral CTC was performed in 133 patients with suspected biliary or pancreatic diseases. All source images were reviewed by two radiologists who were unaware of final diagnoses. Attenuation values of bile were correlated with biochemical data and visualization of anatomic detail. The statistical measures in detecting the presence of choledocholithiasis were calculated in 80 patients with confirmed diagnoses., Results: Statistically significant correlations were found between the degree of biliary enhancement and both serum bilirubin and alkaline phosphatase levels. Of the 80 patients, 18 (23%) had choledocholithiasis and 62 did not. Observers diagnosed them with a sensitivity of 89% and a specificity of 98%. A mild adverse reaction to contrast material was observed in three (2.3%) patients., Conclusion: Spiral CTC is a reliable, noninvasive, and accessible technique for detecting choledocholithiasis.
- Published
- 2000
- Full Text
- View/download PDF
50. Pancreatic carcinoma: correlation between E-cadherin and alpha-catenin expression status and liver metastasis.
- Author
-
Gunji N, Oda T, Todoroki T, Kanazawa N, Kawamoto T, Yuzawa K, Scarpa A, and Fukao K
- Subjects
- Adult, Aged, Cadherins physiology, Cell Adhesion physiology, Cell Communication physiology, Cell Division physiology, Cytoskeletal Proteins physiology, Female, Humans, Immunohistochemistry, Male, Middle Aged, Neoplasm Proteins physiology, Phenotype, alpha Catenin, Cadherins biosynthesis, Cytoskeletal Proteins biosynthesis, Liver Neoplasms metabolism, Liver Neoplasms secondary, Neoplasm Proteins biosynthesis, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms pathology
- Abstract
Background: Dysfunction of the E-cadherin/catenin-mediated cell-cell adhesion system has been associated with invasiveness and poor differentiation of human carcinomas. However, its importance in the genesis of liver metastasis has not been examined sufficiently., Methods: A series of 26 primary pancreatic carcinomas and the concomitant liver metastases from 15 of them, obtained at autopsy, were analyzed for E-cadherin and alpha-catenin protein expression by immunohistochemistry., Results: Both E-cadherin and alpha-catenin expression were preserved in 15 (58%) and reduced in 11 (32%) of the 26 primary pancreatic carcinomas. In the former 15 primaries, carcinoma cells were attached to each other tightly, whereas the latter 11 primaries showed isolated or loosely connected attachments. The metastatic ratio was higher in tumors exhibiting tight adhesion than in those with loose adhesion: 73% and 36%, respectively (P = 0.059). E-cadherin and alpha-catenin expression patterns in liver metastases basically followed those in the corresponding primaries (P < 0.01)., Conclusions: Reduced E-cadherin and alpha-catenin expression in primary pancreatic carcinoma has no significant predictive value regarding the presence of liver metastasis. Rather, there is a greater tendency for liver metastasis in cases in which the integrity of the E-cadherin/catenin-mediated cell-cell adhesion system is intact.
- Published
- 1998
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