Details of a Researcher - TSUJI Yoshihisa

急激な経過を辿った胆石性膵炎の一症例

久保敦司, 辻喜久, 辻喜久, 菊池理, 松枝和宏, 山本博

膵臓 24 ( 3 ) 2009

Simultaneous occurrence of inflammatory bowel disease and myelodysplastic syndrome due to chromosomal abnormalities in bone marrow cells.

Fumiyasu Nakamura, Tomohiro Watanabe, Kimiko Hori, Yoshiaki Ohara, Kouhei Yamashita, Yoshihisa Tsuji, Yoshihide Ueda, Sakae Mikami, Hiroshi Nakase, Tsutomu Chiba

Digestion 79 ( 4 ) 215 - 9 2009 [Refereed] [International journal]

BACKGROUND/AIMS: Although chromosomal abnormalities in bone marrow (BM) cells, such as trisomy 8, are risk factors for the development of inflammatory bowel diseases (IBD) as well as myelodysplastic syndrome (MDS), the mechanisms of how these cytogenetic abnormalities cause intestinal inflammation are poorly understood. METHODS AND RESULTS: A 55-year-old man with a 3-month history of watery diarrhea, fever and abdominal pain was admitted. Blood examinations revealed pancytopenia. Pathological analysis and endoscopic images of the entire colon led to the diagnosis of IBD of unclassified type. BM examination showed that the pancytopenia was due to MDS and that his BM cells had dual chromosomal abnormalities: 47, XY, +1, der(1;7)(q10;p10), +8. Immunological studies using peripheral blood monocytes from this patient revealed that the dual chromosomal abnormalities of BM cells led to the development of colitogenic monocytes producing a large amount of pro-inflammatory cytokines and showing resistance to apoptosis upon stimulation with microbial antigens. CONCLUSION: An abnormal karyotype of BM cells is not only responsible for the development of MDS, but also for IBD in this case.

IgG4-related autoimmune pancreatitis involving the colonic mucosa.

Kenji Ueno, Tomohiro Watanabe, Yukiko Kawata, Tomoyuki Gotoh, Yoshihisa Tsuji, Hiroshi Ida, Shinsuke Tada, Shujiro Yazumi, Tsutomu Chiba

European journal of gastroenterology & hepatology 20 ( 11 ) 1118 - 21 2008.11 [Refereed] [International journal]

We report a case of autoimmune pancreatitis involving the colonic mucosa. Although serum level of IgG4 was normal, computed tomography and endoscopic retrograde cholangiopancreatography showed diffuse enlargement of the pancreas and irregular narrowing of the pancreatic ducts, respectively. Colonoscopy revealed a polypoidal lesion in the ascending colon. A lymphoplasmacytic infiltration was seen both in the pancreas and in the polypoidal lesion of the colon. Furthermore, immunohistochemical analysis showed abundant IgG4-positive plasma cells in these lesions. This is the first case report of a simultaneous occurrence of autoimmune pancreatitis and a colonic polypoidal lesion, both of which are characterized with increased IgG4 responses.

Are prophylactic antibiotics really ineffective in reducing the risk of pancreatic necrosis?

Yoshihisa Tsuji, Tsutomu Chiba

The American journal of gastroenterology 103 ( 8 ) 2145 - 6 2008.08 [Refereed] [International journal]

Biliary complications in donors for living donor liver transplantation.

Seiji Shio, Shujiro Yazumi, Kohei Ogawa, Kazunori Hasegawa, Yoshihisa Tsuji, Masaya Kida, Junichi Yamauchi, Hiroshi Ida, Shinsuke Tada, Shinji Uemoto, Tsutomu Chiba

The American journal of gastroenterology 103 ( 6 ) 1393 - 8 2008.06 [Refereed] [International journal]

OBJECTIVES: With the increasing number of living donor liver transplantations, biliary complications in donors have emerged as a major postoperative problem. The aim of the present study was to characterize the features of the biliary complications that occur in donors. METHODS: The study subjects comprised 731 consecutive patients who donated liver grafts (434 right-lobe and 297 left-lobe grafts) for transplantation at Kyoto University Hospital from July 1999 to December 2006. Donors whose biliary complications could not be cured by conservative therapy were referred for endoscopic treatment. RESULTS: Postoperative biliary complications occurred in 55 (7.5%) donors. Initially, 48 of these 55 donors had biliary leakage and 7 had biliary stricture. Subsequently, 5 of 48 donors with leakage developed biliary stricture. The respective incidences of biliary leakage and overall biliary complications were significantly higher among donors of right-lobe grafts (9.9% and 11.1%) than among donors of left-lobe grafts (1.7% and 2.4%). Among 55 donors with biliary complications, 24 were cured by conservative therapy, and 1 was converted to surgical repair due to ileus. Endoscopic treatment was successful in 24 of 30 (80%) donors treated by endoscopic retrograde cholangiography, while the remaining 6 (20%) patients underwent surgery due to difficulties with cannulation (N = 2), excessive biliary leakage (N = 2), or complete biliary obstruction (N = 2). CONCLUSIONS: Donors of right-lobe grafts have a significantly higher incidence of biliary complications than donors of left-lobe grafts. When conservative therapy fails, endoscopic treatment is effective for these complications, and should be attempted as the first-line therapy before surgical repair.

Small bowel anisakiasis with self-limiting clinical course.

Tomohiro Watanabe, Sakiko Ohta, Satoru Iwamoto, Yoshihisa Tsuji, Shuko Morita, Isao Doi, Yasunori Ueda, Tsutomu Chiba

Internal medicine (Tokyo, Japan) 47 ( 24 ) 2191 - 2 2008 [Refereed] [Domestic journal]

Perfusion computerized tomography can predict pancreatic necrosis in early stages of severe acute pancreatitis.

Yoshihisa Tsuji, Hiroshi Yamamoto, Shujiro Yazumi, Yuji Watanabe, Kazuhiro Matsueda, Hiroyuki Yamamoto, Tsutomu Chiba

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 5 ( 12 ) 1484 - 92 2007.12 [Refereed] [International journal]

BACKGROUND & AIMS: The mortality rate associated with severe acute pancreatitis (SAP) with necrosis remains high because early prediction of pancreatic necrosis is difficult. We evaluated whether perfusion computerized tomography (CT), which is used to identify early stage ischemia in the brain, could detect ischemic changes in the pancreas in the early stages of SAP and predict development of necrosis. PATIENTS AND METHODS: Thirty consecutive patients with a diagnosis of SAP according to the Atlanta criteria and whose score was greater than 6 were enrolled in this study. All patients were hospitalized within 3 days after onset of symptoms indicative of acute pancreatitis and underwent perfusion CT. Three weeks later, all patients underwent conventional contrast-enhanced CT to detect progression of their disease. RESULTS: Perfusion CT showed that 10 of the 30 patients had pancreatic ischemia at the time of diagnosis. Contrast-enhanced CT disclosed that pancreatic necrosis developed in 9 of these 10 patients, but not in the 20 patients who did not have pancreatic ischemia. The sensitivity and specificity of perfusion CT for predicting pancreatic necrosis was calculated to be 100% and 95.3%, respectively. CONCLUSIONS: Perfusion CT is a useful tool for early detection of ischemic changes in the pancreas that lead to pancreatic necrosis.

Effectiveness of Early Indication of Continual Regional Arterial Infusion for Severe Acute Pancreatitis

鳥橋孝一, 辻喜久, 山本博

倉敷中央病院年報 69 247 - 249 2007 [Refereed]

Perfusion Computed Tomography for the Diagnosis of Severe Acute Pancreatitis

Tsuji Yoshihisa, Yamamoto Hiroshi

Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) ( Japanese Society for Abdominal Emergency Medicine ) 27 ( 4 ) 587 - 593 2007 [Refereed]

Although the early detection of pancreatic ischemia in patients with severe acute pancreatitis remains difficult, we successfully visualized ischaemic areas of the pancreas body using perfusion computed tomography (CT). Perfusion CT is widely used for the early detection of brain ischaemia but has not been previously used to evaluate pancreatic blood flow. In our study, perfusion CT was successfully used to detect early ischaemia with the potential to progress to pancreatic necrosis in patients with acute pancreatitis, possibly predicting the prognosis. Here, we report the utility of perfusion CT and describe the clinical importance of evaluating pancreatic blood flow during the early stage of pancreatitis.

DOI CiNii J-GLOBAL

Changes in the Treatment of Severe Acute Pancreatitis in a Japanese Emergency Room After the Implementation of the JPN Guidelines

Tsuji Yoshihisa, Yamamoto Hiroshi

Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) ( Japanese Society for Abdominal Emergency Medicine ) 27 ( 3 ) 463 - 467 2007 [Refereed]

Background & Aims : In spite of treatment advances, the mortality rate for severe acute pancreatitis remains high. In July 2003, the JPN (define) guidelines were published in an attempt to reduce the mortality rate in Japan. These practical guidelines have been useful and popular in Japan. Here, we examined the changes in a Japanese emergency room after the adoption of the JPN guidelines. Patients & Methods : The clinical records of 209 consecutive patients with a diagnosis of acute pancreatitis who were treated at Kurashiki Central Hospital either 24 months before or after the publication of the JPN guidelines were retrospectively examined. The number of patients, the number of patients who were transported from another hospital, the period between disease onset and hospital admission, the severity, the length of the hospital stay, the mortality rate, and the cost of treatment were then compared between these two treatment periods. Results : Eighty patients with acute pancreatitis were treated at our hospital in the 24-month period before the JPN guidelines were published, whereas 129 patients were treated in a 24-month period after the guidelines were published (P<0.05). The number of patients transported from other hospitals, severity, length of hospital stay, and treatment cost all increased after the implementation of the JPN guidelines (P<0.05). On the other hand, the period between disease onset and hospital admission was shorted (P<0.05), and the mortality rate decreased from 17.6% to 4.1%. Conclusion : A large number of cases were transported to our hospital both before and after the implementation of the JPN guidelines, but the period between disease onset and hospital admission was shortened and the mortality rate decreased after guideline implementation. Early diagnosis, early transport, and the early recognition of indications for intensive care may have contributed to the reduction in the mortality rate for severe acute pancreatitis.

DOI CiNii J-GLOBAL

Usefulness of perfusion computed tomography for early detection of pancreatic ischemia in severe acute pancreatitis.

Yoshihisa Tsuji, Yuji Watanabe, Kazuhiro Matsueda, Hiroyuki Yamamoto, Etsuji Ishida, Hiroshi Yamamoto

Journal of gastroenterology and hepatology 21 ( 9 ) 1506 - 8 2006.09 [Refereed] [International journal]

Trial to Improve the Prognosis of Severe Acute Pancreatitis by Early Induction Intensive Care

辻喜久, 山本直樹, 畑貴子, 酒井章裕, 青山育雄, 光藤大地, 合原彩, 新井修, 清輔良江, 中辻正人, 片山幸子, 大西秀樹, 中西崇, 石田悦嗣, 三好正嗣, 毛利裕一, 金吉俊彦, 池田弘, 下村宏之, 松枝和宏, 山本博

倉敷中央病院年報 68 2006

[A case of goblet cell carcinoid of the appendix presented as a metastatic ovarian tumor and peritoneal dissemination, and diagnosed by autopsy].

Atsushi Yamada, Hiroshi Yamamoto, Osamu Arai, Yoshie Kiyosuke, Yoshihisa Tsuji, Masato Nakatsuji, Hirotoshi Fukatsu, Masatsugu Miyoshi, Hiroyuki Kono, Hirokazu Mouri, Kazuhiro Matsueda, Takashi Tezen, Junnosuke Shimamura, Choutatsu Tsukayam

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology ( The Japanese Society of Gastroenterology ) 102 ( 7 ) 905 - 11 2005.07 [Refereed] [Domestic journal]

症例は55歳女性．卵巣癌，腹膜播種と診断し両側付属器切除術を施行した．手術標本の病理所見から転移性卵巣癌を疑ったが原発巣は不明であった．化学療法を行ったが術後6カ月目に死亡した．剖検にて虫垂杯細胞カルチノイドと診断した．虫垂杯細胞カルチノイドはカルチノイド類似像と腺癌類似像の両方を有するまれな腫瘍である．卵巣転移，腹膜播種により発症し，予後不良であった1例を経験したので文献的考察を加えて報告する．

DOI DOI2 PubMed CiNii

Effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) for Patients with Pancreatic Duct Stones

三好正嗣, 清野哲司, 山本博, 毛利裕一, 新井修, 清輔良江, 辻喜久, 中辻正人, 山田敦

倉敷中央病院年報 67 2005

Two Cases of Amoebic Colitis Restricted to the Cecum

清輔良江, 山本博, 新井修, 辻喜久, 中辻正人, 山田敦, 深津裕寿, 河野博行, 三好正嗣

倉敷中央病院年報 67 2005

A Case of Hemolytic Uremic Syndrome/Thrombotic Thrombocytopenic Purpura Associated with Enterohemorrhagic Escherichia coli O157

遠藤英樹, 辻喜久, 山本博

倉敷中央病院年報 67 2005

Heidenhain variant of Creutzfeldt-Jakob disease: diffusion-weighted MRI and PET characteristics.

Yoshihisa Tsuji, Hiroshi Kanamori, Gaku Murakami, Masayuki Yokode, Takahiro Mezaki, Katsumi Doh-ura, Ken Taniguchi, Kozo Matsubayashi, Hidenao Fukuyama, Toru Kita, Makoto Tanaka

Journal of neuroimaging : official journal of the American Society of Neuroimaging 14 ( 1 ) 63 - 6 2004.01 [Refereed] [International journal]

Creutzfeldt-Jakob disease (CJD) is characterized by rapidly progressive dementia with a variety of neurological disorders and a fatal outcome. The authors present a case with visual disturbance as a leading symptom and rapid deterioration in global cognitive functions. The cerebrospinal fluid was positive for 14-3-3 protein, and diffusion-weighted magnetic resonance imaging (MRI) showed marked hyperintensity in the parieto-occipital cortices, where hypometabolism was clearly detected on positron emission tomography (PET). Pattern-reversal visual evoked potentials showed prolonged P100 latencies and increased N/5/P100 amplitudes. All these findings supported a diagnosis of the Heidenhain variant of CJD, whereas a long clinical course, a lack of myoclonus, and an absence of periodic synchronous discharges on electroencephalography were atypical. Diffusion-weighted MRI and PE1 in combination with visual evoked potential recording and 14-3-3 protein detection may be useful for the early diagnosis of CJD.

自己免疫関連性すい炎の4症例

若林肇, 新井修, 清輔良江, 辻喜久, 中辻正人, 山田敦, 深津裕寿, 三好正嗣, 河野博行

日本消化器病学会雑誌 101 2004

Hypothyroidismのoverlapにより病態が複雑化した慢性肝疾患の2例

中辻正人, 池田弘, 新井修, 清輔良江, 辻喜久, 若林肇, 金吉俊彦, 清野哲司, 島村淳之輔

岡山済生会総合病院雑誌 35 2003