研究者詳細 - 辻　喜久

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年

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年 [査読有り] [国際誌]

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年11月 [査読有り] [国際誌]

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年08月 [査読有り] [国際誌]

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年06月 [査読有り] [国際誌]

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年 [査読有り] [国内誌]

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年12月 [査読有り] [国際誌]

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.

発症早期に動注療法を導入し、救命し得た重症急性膵炎の1例

辻喜久

倉敷中央病院年報 69巻 69 247 - 249 2007年 [査読有り]

重症急性膵炎に対するPerfusion CTの有効性と問題点

辻喜久, 山本博

日本腹部救急医学会雑誌 ( 日本腹部救急医学会 ) 27 ( 4 ) 587 - 593 2007年 [査読有り]

重症急性膵炎の重症化因子の1つに膵壊死があげられる。膵壊死の前段階としての“虚血”を診断できれば, 膵壊死予測が可能となるが, 現在のところ容易ではない。そこで急性脳虚血の予後予測に使用されているPerfusion CTを用いて, 膵血流速度, 膵血流量を算出, 虚血を診断し壊死予測が可能か検討した。後に膵壊死画診断された症例は, 有意に早期の膵血流が有意に低下し, Perfusion CTによる壊死予測の可能性が示された。Perfusion CTの有効性と, 問題点について報告し, また膵血流速度定量の重要性について文献的考察を加え検討する。

DOI CiNii J-GLOBAL

「急性膵炎の診療ガイドライン」によって診療行為がどう変わったか？「急性膵炎の診療ガイドライン」前後における市中病院の変化

辻喜久, 山本博

日本腹部救急医学会雑誌 ( 日本腹部救急医学会 ) 27 ( 3 ) 463 - 467 2007年 [査読有り]

目的・ガイドライン前後で当院での急性膵炎診療の変化を検討した。対象と方法・ガイドライン前群 (24ヵ月) と後群 (24ヵ月) にて, 患者数, 紹介数 (率), 厚労省スコア, 当院受診までの期間, 在院日数, 死亡数, 請求点数を比較した。結果・ガイドライン前群・80人, 後群 : 129人と受診者が増加した (P<0.05)。紹介例は増加 (P<0.05), 受診までの期間は短縮, 厚労省スコア, 在院日数, 請求点数は増加した (P<0.05)。死亡率は有意差は認めないものの17.6%から4.1%と改善した。考察・ガイドライン出版前後で早期紹介例は増加, 死亡率は減少した。早期に重症化が予測された場合, 基幹病院で速やかに治療導入を心がけることが重要であると考えられた。

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年09月 [査読有り] [国際誌]

当院における急性膵炎治療の現状と早期治療導入の重要性

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年

卵巣転移，腹膜播種で発症し，剖検にてはじめて診断が可能であった虫垂杯細胞カルチノイドの1例

山田敦, 山本博, 新井修, 清輔良江, 辻喜久, 中辻正人, 深津裕寿, 三好正嗣, 河野博行, 毛利裕一, 松枝和宏, 手銭高志, 島村淳之輔, 津嘉山朝達

日本消化器病学会雑誌 ( 一般財団法人日本消化器病学会 ) 102 ( 7 ) 905 - 11 2005年07月 [査読有り] [国内誌]

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

すい石症例に対する体外衝撃波結石破砕療法(ESWL)の有効性

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年

盲腸に限局したアメーバ性大腸炎の2例

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年

腸管出血性大腸菌O157感染による溶血性尿毒症症候群/血栓性血小板減少性紫斑病の1例

遠藤英樹, 辻喜久, 山本博

倉敷中央病院年報 67 2005年

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年01月 [査読有り] [国際誌]

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年

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年