研究者詳細 - 辻　喜久

論文 - 辻　喜久

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International Association of Pancreatology Revised Guidelines on Acute Pancreatitis 2025: Supported and Endorsed by the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society

Andrea Párniczky, Alexandra Mikó, Aliye Uc, Anand Narayan Singh, Anshuman Elhence, Ashok Saluja, Atsushi Masamune, Barham K. Abu Dayyeh, Brian Davidson, Charles Mel Wilcox, Chris Forsmark, David Whitcomb, Deepak Gunjan, Dhiraj Yadav, Djuna Cahen, D. Nageshwar Reddy, Douglas Adler, Douglas Pleskow, En-Qiang Mao, Enrique de-Madaria, Enver Zerem, Federico Bolado, Fredrick Gorelick, Georgios Papachristou, Greg Cote, Guru Trikudanathan, Hana Alguel, Hjalmar Santvoort, James Buxbaum, Jens Werner, Ji Young Bang, John Neoptolemos, John Windsor, Julia Mayerle, Jun-Ho Choi, Kasper Overbeek, Kazuhiro Kikuta, Katsuya Kitamura, Luca Frulloni, Madhusudan K, Marc Besselink, Marco Bruno, Mark Lowe, Markus Lerch, Martin Freeman, Matthias Löhr, Morihisa Hirota, Mouen Khashab, Nicholas Zyromski, Nalini Guda, Namrata Singh, Niladri Baneerjee, Olaf J. Bakker, Panu Mentula, Peter Banks, Peush Sahni, Peter Hegyi, Peter Szatmary, Pramod Garg, Rajesh Gupta, Raju Sharma, Rakesh Kochhar, Robert Sutton, Rodrigo Cartin-Ceba, Rupjyoti Talukdar, Samagra Agarwal, Sohail Husain, Santhi Vege, Shuji Isaji, Shyam Varadarajulu, Shivanand Gamanagatti, Soumya Jagannath, Surinder Rana, Stefan Bouwense, Steve Pandol, Subodh Kumar, Sudipta Dhar Chowdhury, Sundeep Lakhtakia, Suresh Chari, Takao Itoi, Thilo Hackert, Thomas Bollen, Thomas Gress, Timothy Gardner, Vijay Singh, Vikas Dudeja, Vikesh Singh, Vinciane Rebours, Walter Park, Wei Huang, Wen-Hua He, Yi-No Kang, Yoshihisa Tsuji, Yoshifumi Takeyama

Pancreatology ( Elsevier BV ) 2025年07月 [査読有り]

DOI

Three Molecular Developmental Pathways of Remnant Pancreatic Cancer After Resection: A Nationwide Project Study of Japan Pancreas Society.

Shuji Suzuki, Yuko Omori, Yusuke Ono, Katsuya Hirose, Taito Itoh, Hidenori Karasaki, Mitsugi Shimoda, Yuichi Nagakawa, Ryota Higuchi, Itaru Endo, Toshiki Rikiyama, Michiaki Unno, Tsutomu Fujii, Yuki Sunagawa, Hidetoshi Eguchi, Hideki Sasanuma, Takahiro Akahori, Keiichi Okano, Masaji Tani, Satoshi Hirano, Yasuhiro Shimizu, Minoru Kitago, Shugo Mizuno, Tomohisa Yamamoto, Masayuki Furukawa, Masayuki Ohtsuka, Motokazu Sugimoto, Akira Matsushita, Kenichi Hakamada, Hisato Igarashi, Tamotsu Kuroki, Satoshi Tanno, Yoshihisa Tsuji, Atsushi Masamune, Kazuhiro Mizumoto, Yoshiki Hirooka, Hiroki Yamaue, Kazuichi Okazaki, Sohei Satoi, Yoshifumi Takeyama, Yusuke Mizukami, Toru Furukawa

Annals of surgery 281 ( 6 ) 1015 - 1025 2025年06月 [査読有り] [国際誌]

OBJECTIVE: To clarify the molecular mechanism of remnant pancreatic cancer (PC) development after primary PC resection. BACKGROUND: Molecular mechanisms of the development of remnant PCs after primary PC resection are largely unknown. METHODS: Forty-three patients undergoing remnant PC resection after primary PC resection between 2001 and 2017 at 26 institutes were retrospectively analyzed. Clinicopathologic features and molecular alterations detected by targeted amplicon sequencing of 36 PC-associated genes were evaluated. RESULTS: These patients showed significantly lower body mass indices and higher hemoglobin A1c values at remnant PC resection than at primary PC resection. A comparison of the molecular features between primary and remnant PCs indicated that remnant PCs were likely to develop through 3 different molecular pathways: successional, showing identical and accumulated alterations (n = 14); phylogenic, showing identical and distinct alterations (n = 26); and distinct, showing independent distinctive alterations (n = 3). The similarity of gene alterations was associated with time to the remnant PC development ( r = 0.384, P = 0.0173). Phylogenic pathways were significantly associated with the intraductal spread of carcinoma ( P = 0.007). Patient survival did not differ significantly depending on these molecular pathways. CONCLUSIONS: Molecular profiling uncovered 3 pathways for the development of remnant PCs, namely, successional, phylogenic, and distinct pathways. The vast majority of remnant PCs are likely to be molecularly associated with primary PCs either in the successional or phylogenic way. This information could impact the design of a strategy for monitoring and treating remnant PCs.

DOI PubMed

Participation-based clinical clerkships contribute to increased medical student confidence in community emergency care: a cohort study.

Hiroshi Mihara, Atsushi Jinno, Kenta Sato, Kazuhito Nomura, Takao Wakabayashi, Yoshihisa Tsuji

BMC medical education 25 ( 1 ) 734 - 734 2025年05月 [査読有り] [国際誌]

BACKGROUND: The Community-based assessment for Clinical and Emergency Practice (C-CEP) scale is a validated tool comprising 15 items across four components: "Attitude and Communication in Emergency Medicine," "Basic Clinical Skills," "Knowledge about Community Medicine," and "Knowledge in Evidence-Based Medicine." The C-CEP scale enables medical students' self-assessment of their confidence in clinical and emergency care. This study aimed to evaluate whether a two-week comprehensive general practice clerkship would improve C-CEP scores and to identify the specific training elements contributing to increased confidence in primary care, particularly in emergency responses. METHODS: After obtaining ethical approval and written informed consent, fifth-year medical students at Sapporo Medical University who participated in two-week off-campus clerkships at external healthcare facilities (hospitals) during the 2023 academic year were included. Pre- and post-clerkship C-CEP scores were collected. Changes in the baseline and average scores were analyzed across facilities accepting more than four trainees. Text mining was conducted on students' reflective portfolios from the facilities with significant findings to identify frequent and co-occurring words related to confidence-building activities. RESULTS: Out of 115 eligible participants, 97 students were included in the analysis (84.3% participation rate). The data from seven facilities accepting more than four trainees, representing 74 students in total, were analyzed. These facilities averaged 243 beds, were located 147 km from the medical school, and had an emergency admission rate of 84.6%. C-CEP scores showed significant improvement across all components post-clerkship (p < 0.05). Although pre-clerkship scores did not differ significantly across facilities, post-clerkship score increases varied. Multivariate analysis identified Facilities D and F as exhibiting significant differences in confidence improvement compared with the other facilities (R² = 0.20, p = 0.0379). Text mining highlighted that Facility F emphasized active learning activities such as "interviews," "examinations," and "conferences," whereas Facility D focused on passive activities such as "observation", which were associated with limited impact on trainee confidence. CONCLUSION: The C-CEP effectively measured confidence improvements in primary care and emergency responses among fifth-year medical students following their clinical clerkships. The C-CEP scale's ability to detect inter-facility differences highlights its potential to inform and refine clinical education programs, ensuring more targeted and effective training.

DOI PubMed

急性膵炎患者における長期入院の予測因子

上野真行, 羽田綾子, 辻喜久

胆膵の病態生理 41 ( 1 ) 65 - 69 2025年05月 [査読有り]

Diagnostic accuracy of endoscopic ultrasonographic shear wave elastography for assessing early chronic pancreatitis using the Japanese diagnostic criteria 2019.

Shuhei Shintani, Osamu Inatomi, Takuya Okamoto, Kosuke Hiroe, Takaaki Eguchi, Yuki Tomozawa, Akitoshi Inoue, Hidenori Kimura, Atsushi Nishida, Yoshihisa Tsuji, Yoshiyuki Watanabe, Akira Andoh

DEN open 5 ( 1 ) e387 2025年04月 [査読有り] [国際誌]

BACKGROUND AND AIM: Endoscopic ultrasound shear wave elastography (EUS-SWE) can facilitate an objective evaluation of pancreatic fibrosis. Although it is primarily applied in evaluating chronic pancreatitis, its efficacy in assessing early chronic pancreatitis (ECP) remains underinvestigated. This study evaluated the diagnostic accuracy of EUS-SWE for assessing ECP diagnosed using the Japanese diagnostic criteria 2019. METHODS: In total, 657 patients underwent EUS-SWE. Propensity score matching was used, and the participants were classified into the ECP and normal groups. ECP was diagnosed using the Japanese diagnostic criteria 2019. Pancreatic stiffness was assessed based on velocity (Vs) on EUS-SWE, and the optimal Vs cutoff value for ECP diagnosis was determined. A practical shear wave Vs value of ≥50% was considered significant. RESULTS: Each group included 22 patients. The ECP group had higher pancreatic stiffness than the normal group (2.31 ± 0.67 m/s vs. 1.59 ± 0.40 m/s, p < 0.001). The Vs cutoff value for the diagnostic accuracy of ECP, as determined using the receiver operating characteristic curve, was 2.24m/s, with an area under the curve of 0.82 (95% confidence interval: 0.69-0.94). A high Vs was strongly correlated with the number of EUS findings (rs = 0.626, p < 0.001). Multiple regression analysis revealed that a history of acute pancreatitis and ≥2 EUS findings were independent predictors of a high Vs. CONCLUSIONS: There is a strong correlation between EUS-SWE findings and the Japanese diagnostic criteria 2019 for ECP. Hence, EUS-SWE can be an objective and invaluable diagnostic tool for ECP diagnosis.

DOI PubMed

地方の中規模病院における内科医リカレント教育の試み

三原弘, 神野敦, 永幡研, 宮西秀二, 服部哲夫, 辻喜久

医学教育 ( 日本医学教育学会 ) 56 ( 1 ) 46 - 47 2025年02月 [査読有り]

DOI

IR情報の自動的な可視化への挑戦

篠崎淳, 高塚伸太朗, 三原弘, 山本武志, 鵜飼渉, 小山雅之, 小川宰司, 木村心南, 佐藤直, 深川周平, 横山和樹, 根木亨, 辻喜久

大学情報・機関調査研究集会論文集 ( 日本インスティテューショナル・リサーチ協会 ) 13 80 - 84 2024年11月 [査読有り]

札幌医科大学では、教学IRのみを行う目的で、2019年4月に統合IR部門が設置された。毎年の出版物として教学データを掲載する「データブック」の作成、および、「教員の業績評価」の実行が求められていた。本学においてデータを自動的に可視化するツールはなく、限られた予算内でこれらを達成するため、RとPythonを用いて０からシステム構築を行った。ここではその報告と課題を述べる。

DOI

Efficacy and safety of elobixibat in combination with or switched from conventional treatments of chronic constipation: A retrospective observational study.

Takaaki Eguchi, Osamu Inatomi, Shuhei Shintani, Kenji Momose, Tomoya Sako, Megumi Takagi, Daiki Fumihara, Kazuki Inoue, Norio Katayama, Toshiyuki Morisawa, Takumi Ota, Yoshihisa Tsuji

JGH open : an open access journal of gastroenterology and hepatology 8 ( 8 ) e70019 2024年08月 [査読有り] [国際誌]

BACKGROUND AND AIM: Elobixibat is a triple mode of action laxative that increases water secretion into the colon, promotes colonic motility, and reestablishes the defecation desire. This study aims to evaluate the effectivity and safety of elobixibat in chronic constipation (CC) patients refractory to conventional laxatives. METHODS: A single-center retrospective observational study was conducted in refractory CC patients diagnosed according to the Rome IV criteria and received elobixibat between April 2018 and June 2022 at Osaka Saiseikai Nakatsu Hospital. Data were collected for spontaneous bowel movement (SBM), Bristol stool form scale (BSFS) scores, abdominal symptoms, and adverse events. RESULTS: Eligible 311 patients were selected for the analysis. Two-week Elobixibat treatment significantly increased SBM (times/week) from 2.9 ± 1.9 to 4.3 ± 1.9 (P < 0.0001). The BSFS score improved significantly from 3.2 ± 1.7 to 4.4 ± 1.4 (P < 0.0001). The percentages of patients with hard stool were decrease and that with normal stools were increase. Improvements in abdominal symptoms (sensation of incomplete bowel evacuation, straining, abdominal pain and distention, and difficulty defecating) were also significant (P < 0.05). These constipation symptoms were improved irrespective of patient characteristics or previous laxatives. The 43.9% of previous laxatives were discontinued at the start of or after starting elobixibat treatment. A few adverse events were observed, elobixibat was well tolerated. CONCLUSION: Elobixibat was effective in patients who were refractory to other laxatives, irrespective of previous therapy or patient characteristics. Elobixibat may contribute to resolving polypharmacy with single mode of action laxatives.

DOI PubMed

在宅終末期ケアにおける訪問診療同行看護師の役割検討同行看護師および多職種、患者家族を対象としたインタビュー(会議録)

奥岡由美, 本田日奈子, 古山悦子, 神野敦, 市来智子, 日下勝博, 辻喜久, 辻喜久

Palliative Care Research ( (NPO)日本緩和医療学会 ) 19 ( Suppl. ) S.555 - S.555 2024年06月 [査読有り]

J-GLOBAL

Gut microbiota and metabolites in patients with COVID-19 are altered by the type of SARS-CoV-2 variant.

Yoshihiro Yokoyama, Tomoko Ichiki, Tsukasa Yamakawa, Yoshihisa Tsuji, Koji Kuronuma, Satoshi Takahashi, Eichi Narimatsu, Akio Katanuma, Hiroshi Nakase

Frontiers in microbiology 15 1358530 - 1358530 2024年 [査読有り] [国際誌]

INTRODUCTION: Patients with COVID-19 have dysbiosis of the intestinal microbiota with altered metabolites in the stool. However, it remains unclear whether the differences among SARS-CoV-2 variants lead to differences in intestinal microbiota and metabolites. Thus, we compared the microbiome and metabolome changes for each SARS-CoV-2 variant in patients with COVID-19. MATERIALS AND METHODS: We conducted a multicenter observational study of patients with COVID-19 and performed fecal microbiome, metabolome, and calprotectin analyses and compared the results among the different SARS-CoV-2 variants. RESULTS: Twenty-one patients with COVID-19 were enrolled and stratified according to the SARS-CoV-2 strain: six with the Alpha, 10 with the Delta, and five with the Omicron variant. Fecal microbiome analysis showed that α-diversity was reduced in the order of the Omicron, Delta, and Alpha variants (p = 0.07). Linear discriminant analysis revealed differences in the abundance of short-chain fatty acid-producing gut microbiota for each SARS-CoV-2 variant. Fecal metabolome analysis showed that the Omicron and Delta variants had markedly reduced propionic and lactic acid levels compared to the Alpha strain (p < 0.05). CONCLUSION: The intestinal microbiota of patients with COVID-19 varies depending on the SARS-CoV-2 variant. Dysbiosis of the intestinal microbiota due to differences in SARS-CoV-2 variants causes a decrease in intestinal short-chain fatty acids.

DOI PubMed

Trauma-related thyroid storm in adolescents: A case report.

Atsushi Jinno, Naofumi Bunya, Junya Hagiwara, Kai Takao, Keigo Sawamoto, Akira Ishii, Takeshi Tsugawa, Eichi Narimatsu, Yoshihisa Tsuji

Acute medicine & surgery 11 ( 1 ) e70004 2024年 [査読有り] [国際誌]

BACKGROUND: Because of a scant report, it is little known that thyroid storms can occur after trauma, even in adolescence. Significantly, this increases the risk of delaying diagnosis resulting in life-threatening. CASE PRESENTATION: A 13-year-old girl was admitted to the emergency department after a traffic accident. Despite receiving comprehensive trauma care, the patient developed hyperthermia and tachycardia that did not respond to temperature management therapy. On the 10th day of her admission, she was diagnosed with a thyroid storm. Treatment for thyroid storm was initiated; thereby, her condition was totally improved. CONCLUSION: We experienced a case of an adolescent girl, who developed a thyroid storm during the treatment of trauma and could save her life. Clinicians should consider thyroid storm in post-traumatic hyperthermia and tachycardia patients, even in children.

DOI PubMed

便秘症治療難治抵抗例に対するエロビキシバット併用・切替え治療における治療有効な背景因子の検討

江口考明, 江口考明, 迫智也, 稲富理, 辻喜久

日本消化器病学会雑誌(Web) 121 2024年 [査読有り]

J-GLOBAL

IR情報の自動的な可視化への挑戦

篠崎淳, 高塚伸太朗, 三原弘, 山本武志, 鵜飼渉, 小山雅之, 小川宰司, 木村心南, 佐藤直, 深川周平, 横山和樹, 根木亨, 辻喜久

大学情報・機関調査研究集会論文集(Web) 13 2024年 [査読有り]

J-GLOBAL

在宅終末期ケアを担う訪問診療同行看護師の役割

奥岡由美, 本田日奈子, 古山悦子, 神野敦, 市来智子, 日下勝博, 辻喜久, 辻喜久

木村看護教育振興財団看護研究集録 ( 東京 : 木村看護教育振興財団 ) 31 ( 31 ) 1 - 24 2024年 [査読有り]

J-GLOBAL

急性膵炎患者における遺伝子組換えヒト可溶性トロンボモジュリン(rTM)投与の臨床的意義

江口考明, 江口考明, 辻喜久, 辻喜久, 稲富理

胆膵の病態生理 ( 金沢 : 日本胆膵病態・生理研究会 ) 40 ( 1 ) 7 - 11 2024年 [査読有り]

J-GLOBAL

化学療法開始後に脳梗塞を発症した膵癌患者の臨床的特徴

羽田綾子, 上野真行, 上野真行, 辻喜久

胆膵の病態生理 ( 金沢 : 日本胆膵病態・生理研究会 ) 40 ( 1 ) 107 - 112 2024年 [査読有り]

J-GLOBAL

都市と僻地の差異から学ぶ地域医療教育について

辻喜久

医学教育 ( (一社)日本医学教育学会 ) 54 ( 5 ) 467 - 473 2023年10月 [査読有り]

我々は,北海道南部の南檜山地域(2次医療圏)をリソースとした地域医療教育に取り組んでいる.南檜山地域は(1万4千km2,人口2万3,000人,高齢化率41.6%)と僻地である.一方,近年,"地域"に求められる医師像が多様化し,高度にデザインされた医師養成プログラムが必要となった.そこで,我々は,"差異"の概念に基づき地域医療教育のデザインを試みている."差異"は都市-地方間だけではなく,異なった文化間に常に生じうる.ここでは南檜山と札幌を遠隔診療/教育のシステムでつなぐことで"差異"が生じ,差異を経験した学修者において,より地域医療への理解が深まることを期待した.(著者抄録)

DOI J-GLOBAL

Sex-based differences in metabolic protection by the ANP genetic variant rs5068 in the general population.

Tomoko Ichiki, Valentina Cannone, Christopher G Scott, Seethalakshmi R Iyer, S Jeson Sangaralingham, Kent R Bailey, Jens P Goetze, Yoshihisa Tsuji, Richard J Rodeheffer, John C Burnett Jr

American journal of physiology. Heart and circulatory physiology 325 ( 3 ) H545-H552 2023年09月 [査読有り] [国際誌]

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are produced in the heart and secreted into the circulation. As hormones, both peptides activate the guanylyl cyclase receptor A (GC-A), playing a role in blood pressure (BP) regulation. A significant role for ANP and BNP includes favorable actions in metabolic homeostasis. Sex-based high prevalence of risk factors for cardiovascular disease in males compared with females is well established, but sex-based differences on cardiometabolic protection have not been investigated in relation to ANP (NPPA) and BNP (NPPB) gene variants. We included 1,146 subjects in the general population from Olmsted County, Minnesota. Subjects were genotyped for the ANP gene variant rs5068 and BNP gene variant rs198389. Cardiometabolic parameters and medical records were reviewed. In the presence of the minor allele of rs5068, diastolic BP, creatinine, body mass index (BMI), waist measurement, insulin, and prevalence of obesity and metabolic syndrome were lower, whereas HDL was higher in males with only trends observed in females. We observed no associations of the minor allele with echocardiographic parameters in either males or females. Regarding rs198389 genotype, the minor allele was not associated with any BP, metabolic, renal, or echocardiographic parameters in either sex. In the general community, the minor allele of the ANP gene variant rs5068 is associated with a favorable metabolic phenotype in males. No associations were observed with the BNP gene variant rs198389. These studies support a protective role of the ANP pathway on metabolic function and underscore the importance of sex in relationship to natriuretic peptide responses.NEW & NOTEWORTHY Males are characterized by lower ANP and BNP with greater prevalence of cardiometabolic disease. The ANP genetic variant rs5068 was associated with less metabolic dysfunction in males, whereas no metabolic profile was related to the BNP genetic variant rs198389 in the general population. ANP may play a more biological role in metabolic homeostasis compared with BNP in the general population with greater physiological metabolic actions in males compared with females.

DOI PubMed

超音波内視鏡下せん断波エラストグラフィによる慢性膵炎の定量的診断－膵の領域別計測とRosemont分類の対比－

新谷修平, 稲富理, 廣江光亮, 友澤裕樹, 井上明星, 木村英憲, 西田淳史, 辻喜久, 渡辺嘉之, 安藤朗

超音波医学 ( 公益社団法人日本超音波医学会 ) 50 ( 4 ) 485 - 492 2023年08月 [査読有り] [国内誌]

目的：超音波内視鏡（endoscopic ultrasound: EUS）は慢性膵炎（chronic pancreatitis: CP）の診断に広く用いられているが，Rosemont分類（Rosemont criteria: RC）による線維化の評価は概して主観的である．EUSを用いたせん断波エラストグラフィ（Shear wave elastography using EUS: EUS-SWE）は膵線維化の評価のための客観的アプローチであると提唱されている．しかし，どの膵領域を測定対象に選択するべきかは不明である．本研究の目的は膵の部位別にEUS-SWEを行い，CPの診断精度を比較することである．方法：EUS-SWEを受けたCPまたはCPを疑う50例の後ろ向き解析を実施した．RCに基づいて症例を2群（CP群と非CP群）に分類した．せん断波の速度（velocities of the shear wave: Vs）の測定によって膵硬度を評価し，Vsのカットオフ値を決定した．VsとRCとの相関および膵硬度に影響を及ぼすRC因子を評価した．結果：CP群では非CP群よりすべての領域でVsが有意に高値であった（P < 0.001）．VsによるCPの診断精度は膵体部で最も高かった［曲線下面積（area under the curve: AUC）：0.87］．すべての領域でRCの所見数とVsとの有意な相関が認められ，相関係数は膵体部で最も高かった（rs = 0.55）．多変量解析の結果から，蜂巣状分葉エコーがVsに関する独立因子であることが明らかになった（P = 0.02）．結論：膵体部はEUS-SWEによる膵硬度の評価に適した領域である．また，Vsの定量化はCPの診断に有用な客観的指標である．

DOI PubMed

Impact of S‐1 adjuvant chemotherapy longer than 6 months on survival in patients with resected pancreatic cancer: a nationwide survey by the Japan Pancreas Society based on real‐world data

Yoshito Tomimaru, Hidetoshi Eguchi, Yosuke Inoue, Yuichi Nagakawa, Akihiro Ohba, Hideki Takami, Michiaki Unno, Tomohisa Yamamoto, Shoji Kawakatsu, Tsuyoshi Hayashi, Ryota Higuchi, Hirohisa Kitagawa, Satoshi Hattori, Tsutomu Fujii, Yoshiki Hirooka, Hisato Igarashi, Masayuki Kitano, Tamotsu Kuroki, Atsushi Masamune, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Hiroki Yamaue, Sohei Satoi, Yoshifumi Takeyama

Cancer ( Wiley ) 129 ( 5 ) 728 - 739 2022年12月 [査読有り] [国際誌]

BACKGROUND: Based on the Japan Adjuvant Study Group of Pancreatic Cancer 01 study, the standard duration of adjuvant chemotherapy with S-1 (an oral 5-fluorouracil prodrug consisting of tegafur, gimeracil, and oteracil) in patients with resected pancreatic ductal adenocarcinoma (PDAC) was considered to be 6 months, but the impact of increasing its duration on postoperative survival was unknown. Here, the authors investigated this question by reviewing real-world data from a large cohort of patients with PDAC. METHODS: In total, 3949 patients who underwent surgery for PDAC during the study period followed by S-1 adjuvant chemotherapy in board-certified institutions were included. Based on the duration of S-1 chemotherapy, two subgroups were defined: a standard-duration group that included patients who were treated for 180 ± 30 days and a longer duration group that included patients who received treatment for >210 days. RESULTS: The median duration of S-1 chemotherapy was 167 days, with a mean ± standard deviation of 200 ± 193 days. After excluding patients who had a recurrence within 210 days after the initiation of adjuvant chemotherapy, postoperative recurrence-free survival (RFS) and overall survival (OS) in the standard-duration group (n = 1473) and the longer duration group (n = 975) were compared. RFS and OS did not differ significantly between the standard-duration and longer duration groups (5-year RFS: 37.8% vs. 36.2% respectively; p = .6186; 5-year OS: 52.8% vs. 53.4%, respectively; p = .5850). The insignificant difference was verified by multivariate analysis and propensity-score matching analysis. CONCLUSIONS: The current findings suggest that extending S-1 adjuvant chemotherapy beyond 6 months has no significant additional effect on survival in patients with PDAC. This could be useful in determining whether to extend S-1 chemotherapy in patients who have completed the standard 6-month treatment.

DOI PubMed

Self-assessment scale for the community-based and emergency practice.

Takao Wakabayashi, Yoshihisa Tsuji, Takeshi Yamamoto, Hitoshi Sohma, Wari Yamamoto

BMC medical education 22 ( 1 ) 799 - 799 2022年11月 [査読有り] [国際誌]

BACKGROUND: For current medical education, community-based primary care for the elderly is an essential topic. This study aimed to establish a scale of community-based assessment for clinical and emergency practice (C-CEP). METHODS: A self-assessment scale for C-CEP was developed according to four steps. Initially, we reviewed publications from the societies of the United States, British, and Japan regarding educational goals. In addition, we searched MEDLINE for educational goals regarding attitude, skills, and knowledge. Getting together, we established 23 items as the educational goals of the C-CEP. Second, we collected responses for these 23 items from 5th-grade medical students (n = 195). Third, we conducted an exploratory factor analysis (EFA) using their responses to determine the fundamental structure of the self-assessment scale. Finally, a confirmatory factor analysis (CFA) was performed to assess the fitness of the self-assessment scale developing the EFA, resulting in modification of the items. RESULTS: In EFA and CFA results, C-CEP Scale consisted of four factors with 15 items: "Attitude and communication in emergency care," Basic clinical skills," "Knowledge of community healthcare," and "Knowledge of evidence-based medicine perseverance." The model fit indices were acceptable (Goodness of Fix Index = 0.928, Adjusted Goodness of Fit Index = 0.900, Comparative Fit Index = 0.979, and Root Mean Square Error of Approximation = 0.045). The values of McDonald's omega as an estimate of scale reliability were more than 0.7 in all four factors. As for test-retest reliability, the intraclass correlation coefficients were ≥ 0.58 for all factors. All four factors of the C-CEP Scale correlated positively with the Medical Professionalism Evaluation Scale subscales. CONCLUSIONS: We developed a valid and reliable self-assessment scale to assess student competence.

DOI PubMed

Natriuretic Peptide-Based Novel Therapeutics: Long Journeys of Drug Developments Optimized for Disease States.

Tomoko Ichiki, Atsushi Jinno, Yoshihisa Tsuji

Biology 11 ( 6 ) 2022年06月 [査読有り] [国際誌]

The field of natriuretic peptides (NPs) as an endocrine hormone has been developing since 1979. There are three peptides in humans: atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), which bind to the guanylyl cyclase-A (GC-A) receptor (also called natriuretic peptide receptor-A (NPR-A)), and C-type natriuretic peptide (CNP), which binds to the GC-B receptor (also called the NPR-B) and then synthesizes intracellular cGMP. GC-A receptor stimulation has natriuretic, vasodilatory, cardiorenal protective and anti-renin-angiotensin-aldosterone system actions, and GC-B receptor stimulation can suppress myocardial fibrosis and can activate bone growth before epiphyseal plate closure. These physiological effects are useful as therapeutics for some disease states, such as heart failure, hypertension, and dwarfism. To optimize the therapeutics for each disease state, we must consider drug metabolism, delivery systems, and target receptor(s). We review the cardiac NP system; new designer NPs, such as modified/combined NPs and modified peptides that can bind to not only NP receptors but receptors for other systems; and oral drugs that enhance endogenous NP activity. Finally, we discuss prospective drug discoveries and the development of novel NP therapeutics.

DOI PubMed

膵癌・膵炎患者における骨格筋量減少の臨床的意義

上野真行, 辻喜久, 宇座徳光, 妹尾浩

胆膵の病態生理 ( 日本胆膵病態・生理研究会 ) 38 ( 1 ) 1 - 6 2022年06月 [査読有り]

膵疾患患者は一般人口よりもサルコペニアの有病率が高い。外分泌機能障害や食事摂取量の低下がその一因と考えられる。膵癌領域ではサルコペニアが予後や術後合併症リスクと関連することが明らかになった。サルコペニアの定義と評価方法を概説した。膵癌と骨格筋量との関連を切除例と非切除例に分けて示した。急性膵炎は骨格筋量喪失の原因となる可能性があり、再発を繰り返して慢性膵炎に移行する例では骨格筋量の維持が重要である。

J-GLOBAL

Blue Foreign Body in the Esophagus.

Ryosuke Tomiyama, Tomoko Ichiki, Yoshihisa Tsuji

Gastroenterology 162 ( 7 ) e14-e15 2022年06月 [査読有り] [国際誌]

DOI PubMed

Two Types of Immune Checkpoint Inhibitor-related Pancreatitis.

Tomoko Ichiki, Yasuki Hori, Yoshihisa Tsuji

Internal medicine (Tokyo, Japan) 61 ( 10 ) 1477 - 1478 2022年05月 [査読有り] [国内誌]

DOI PubMed

Estimated tumor blood flow as a predictive imaging indicator of therapeutic response in pancreatic ductal adenocarcinoma: use of three-phase contrast-enhanced computed tomography.

Hiromitsu Maehira, Yoshihisa Tsuji, Hiroya Iida, Haruki Mori, Nobuhito Nitta, Takeru Maekawa, Sachiko Kaida, Toru Miyake, Masaji Tani

International journal of clinical oncology 27 ( 2 ) 373 - 382 2022年02月 [査読有り] [国内誌]

BACKGROUND: Preoperative chemotherapy or chemoradiotherapy is a common strategy for treating pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the association between the therapeutic response in PDAC and tumor blood circulation. METHODS: The medical records of patients who underwent chemotherapy or chemoradiotherapy prior to pancreatectomy for PDAC were reviewed. Of these, patient data that included three-phase contrast-enhanced computed tomography (CECT) findings before treatments were used in this study. We evaluated the estimated tumor blood flow (eTBF) using CECT. According to the therapeutic histopathological response defined by the Evans classification, patients were divided into poor (grade I/IIa) and good (grade IIb/III/IV) responder groups. The variables, including eTBF, were compared between the two groups. RESULTS: Thirty patients were enrolled in this study. Of these, 13 (43.3%) (grade IIB/III/IV: 8/4/1 patients) were categorized into the good responder group and 17 patients (56.7%) (grade I/IIA: 4/13 patients) were categorized into the poor responder group. eTBF was significantly higher in the good responder group (0.39 s-1 vs. 0.32 s-1, p = 0.007). An eTBF ≥ 0.36 s-1 was found to be an independent predictive factor for the destruction of over 50% of tumor cells (p = 0.036; odds ratio, 9.71; 95% confidence interval, 1.16-81.30). CONCLUSIONS: eTBF can be used to predict the therapeutic histopathological response in PDAC prior to treatment.

DOI PubMed

Larger Volume and Higher Fat Content of the Pancreatic Head Are Predictive Factors for Postendoscopic Retrograde Cholangiopancreatography Pancreatitis.

SHINTANI, Shuhei, INATOMI, Osamu, BAMBA, Shigeki, TAKEDA, Yoshiya, FUJIMOTO, Takehide, OTA, Shinichi, TSUJI, Yoshihisa, KUTSUMI, Hiromu, WATANABE, Yoshiyuki, ANDOH, Akira, 新谷, 修平, 稲富, 理, 馬場, 重樹, 竹田, 善哉, 藤本, 剛英, 大田, 信一, 辻, 喜久, 久津見, 弘, 渡邉, 嘉之, 安藤, 朗

Pancreas ( Lippincott Williams and Wilkins ) 51 ( 1 ) 28 - 34 2022年01月 [査読有り] [国際誌]

type:Journal Article Objectives:Acute pancreatitis is the most critical complication of endoscopic retrograde cholangiopancreatography (ERCP). In this study, we investigated the association between the volume/fat content of the pancreatic head and the incidence of post-ERCP pancreatitis (PEP). Methods:We retrospectively enrolled 157 patients who underwent ERCP. The volume and fat content of the pancreas were calculated by multislice computed tomographic imaging by using a volume analyzer. Multivariate analysis was performed to identify risk factors for PEP. Results:The mean volumes of the whole pancreas and pancreatic head were significantly larger, and the fat content of the pancreatic head was significantly higher in the PEP group (P < 0.01). There were no significant differences in the mean volume and fat content of the pancreatic body and tail in the PEP group. Multivariate analysis revealed that the pancreatic guidewire placement (odds ratio [OR], 12.4; P < 0.01), pancreatic head volume (OR, 5.3; P < 0.01), and the pancreatic head fat content (OR, 4.8; P < 0.01) were independent risk factors for PEP. Conclusions:The pancreatic head volume and fat content were independent predicting factors of PEP. Quantitative assessment of the pancreas may contribute to the prediction of PEP onset.

DOI PubMed

消化器内視鏡診療における医学教育の重要性

辻喜久

Gastroenterological Endoscopy ( (一社)日本消化器内視鏡学会 ) 64 ( 1 ) 7 - 18 2022年01月 [査読有り]

本邦における大学教育や医学教育の改革の重要性が注目されている.米国や英国といった諸外国での高等教育改革の細部を見ると,良い医師を育てよう,良い研究者を育てようという理念を見て取ることができる.こうした理念は教育の研究を推進させ,新しい用語や概念を生み出した.本邦では,第三者による各大学の教育の質評価が進んでいるが,これを表面的に乗り切るために用語や概念を形だけ新しくするものがいるとすれば大変残念である.これでは真の成長にはつながらない.そこで,本稿では,そういった改革に伴い欧米で発展した教育に関するいくつかの重要な用語の背景を整理し,今後,消化器内視鏡教育のデザインをされる諸先生方にその重要性を広く紹介することを目的とした.(著者抄録)

DOI CiNii

感染性walled-off necrosisの上腸間膜静脈内への穿破に対し、保存的治療で救命しえた1例

上西陽介, 上野真行, 辻喜久, 上山伸也, 小山貴, 池田有希, 戸川文子, 羽田綾子, 眞野俊史, 石田悦嗣, 山本博, 水野元夫

日本病院総合診療医学会雑誌 ( (一社)日本病院総合診療医学会 ) 18 ( 1 ) 20 - 27 2022年01月 [査読有り]

症例は67歳,男性。アルコール性慢性膵炎とwalled-off necrosis(WON)の既往があり,発熱と腹痛,尿量減少を主訴に近医を受診した。血液検査とCTで慢性膵炎の急性増悪と診断され入院した。当初は軽症であったが徐々に全身状態が悪化し,重症急性膵炎の基準を満たした為当院に搬入された。敗血症性ショック,播種性血管内凝固を伴い,特徴的なCT所見と持続性の菌血症をきたしていた事から,感染性WONが上腸間膜静脈に穿破したと考えた。循環動態が不安定で高度の凝固障害を伴い,ドレナージやネクロセクトミーは実施困難であった。感染性心内膜炎の治療指針に準じ,6週間の抗菌薬2剤併用療法と抗凝固療法を行い良好な転機が得られた。感染性WONの血管内穿破に対して侵襲的な治療が困難な際,これらの治療が有効な可能性が示された。総合診療医にとって,重症度評価の反復と円滑な病院連携の重要性を実感する一例であった。(著者抄録)

DOI

急性膵炎におけるDICとトロンボモジュリン製剤早期投与による有効性の検討

江口考明, 辻喜久, 岡田明彦

日本腹部救急医学会雑誌 42 ( 2 ) 2022年 [査読有り]

J-GLOBAL

Impaired tryptophan metabolism in the gastrointestinal tract of patients with critical coronavirus disease 2019.

Yoshihiro Yokoyama, Tomoko Ichiki, Tsukasa Yamakawa, Yoshihisa Tsuji, Koji Kuronuma, Satoshi Takahashi, Eichi Narimatsu, Hiroshi Nakase

Frontiers in medicine 9 941422 - 941422 2022年 [査読有り] [国際誌]

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is still causing a global pandemic. But the mechanism of COVID-19 severity is not well elucidated. MATERIALS AND METHODS: We conducted two single-center observational studies of patients with COVID-19. In the first study, the enrolled patients were distinguished based on critical vs. non-critical COVID-19. We collected blood samples from the patients at admission to measure markers related to inflammation and thrombosis and stool samples to analyze the fecal microbiome, metabolome, and calprotectin level. In the second study, we collected ileum and colon tissue samples from patients with critical COVID-19 who required colonoscopy due to severe gastrointestinal symptoms and analyzed mucosal gene expression. RESULTS: A total of 19 blood samples and 10 stool samples were collected. Interleukin (IL)-6 was the only serum inflammatory marker with significantly higher levels in the critical group than in the non-critical group. The fecal calprotectin level in the critical group was significantly higher than that in the non-critical group (P = 0.03), regardless of the presence of gastrointestinal symptoms. Stool metabolomic analysis showed that the level of indole-3-propionic acid, a ligand for aryl hydrocarbon receptor (AhR), was markedly decreased in the critical group compared to that in the non-critical group (P = 0.01). The expression of genes involved in tryptophan metabolism, including ACE2, AHR, CARD9, and IL22, was downregulated in the ileum of critical COVID-19 patients who required a colonoscopy. DISCUSSION: Critical COVID-19 patients have gastrointestinal inflammation potentially caused by impaired tryptophan metabolism in the small intestine due to decreased expression of genes involved in tryptophan metabolism.

DOI PubMed

消化器内視鏡診療における医学教育の重要性

辻喜久, 辻喜久

Gastroenterological Endoscopy (Web) 64 ( 1 ) 2022年 [査読有り]

J-GLOBAL

感染性walled-off necrosisの上腸間膜静脈内への穿破に対し,保存的治療で救命しえた1例

上西陽介, 上野真行, 上野真行, 辻喜久, 上山伸也, 小山貴, 池田有希, 戸川文子, 羽田綾子, 眞野俊史, 石田悦嗣, 山本博, 水野元夫

日本病院総合診療医学会雑誌(Web) 18 ( 1 ) 2022年 [査読有り]

J-GLOBAL

改定Atlanta分類と本邦ガイドラインを組み合わせた急性壊死性貯留の新診断基準の有用性検討

江口考明, 辻喜久, 児玉裕三

日本消化器病学会雑誌(Web) 119 2022年 [査読有り]

J-GLOBAL

急性膵炎に対するトロンボモジュリンアルファの早期投与による膵血流改善への有用性検討

江口考明, 辻喜久, 岡田明彦

日本外科感染症学会雑誌(Web) 19 ( 1 ) 2022年 [査読有り]

J-GLOBAL

Fatal Immune Checkpoint Inhibitor-related Pancreatitis.

Masayuki Ueno, Yoshihisa Tsuji, Toshihide Yokoyama, Takashi Koyama, Yosuke Uenishi, Etsuji Ishida, Motowo Mizuno

Internal medicine (Tokyo, Japan) 60 ( 24 ) 3905 - 3911 2021年12月 [査読有り] [国内誌]

We herein report a case of fatal pancreatitis induced by an immune checkpoint inhibitor. A 62-year-old man with cancer of unknown primary was treated with pembrolizumab. After 12 cycles, immune-related pneumonitis developed and was treated with prednisolone. Three months later, pancreatitis developed, which was successfully treated with hydration and protease inhibitors. Eight months later, another attack of pancreatitis occurred, which did not respond to therapy, including high-dose corticosteroids, and he eventually died. This is the first report describing fatal immune checkpoint inhibitor-related pancreatitis. Despite the rarity of this complication, attention should be paid to its potential severity and treatment.

DOI PubMed

Utility and safety of a new uneven double-lumen sphincterotome in cases of difficult biliary cannulation.

SHINTANI, Shuhei, INATOMI, Osamu, TAKEDA, Yoshiya, MATSUMOTO, Hiroshi, FUJIMOTO, Takehide, TSUJI, Yoshihisa, KUTSUMI, Hiromu, ANDOH, Akira, 新谷, 修平, 稲富, 理, 竹田, 善哉, 松本, 寛史, 藤本, 剛英, 辻, 喜久, 久津見, 弘, 安藤, 朗

BMC Gastroenterology ( BioMed Central Ltd ) 21 ( 1 ) 102 - 102 2021年12月 [査読有り] [国際誌]

type:Journal Article Background:We investigated the utility and safety of a new uneven double-lumen sphincterotome in biliary cannulation in comparison with the conventional pancreatic guidewire (PGW) method. Methods:We retrospectively evaluated 119 patients who required PGW placement because of difficult biliary cannulation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed using a conventional ERCP catheter or a new uneven double-lumen sphincterotome. The success rate of bile duct cannulation, the operation time of bile duct cannulation, and the incidence of post-ERCP pancreatitis (PEP) were evaluated. Results:Forty-four patients were treated with a new double-lumen sphincterotome (the new sphincterotome group) and 75 patients underwent conventional PGW placement (the conventional group). The success rate of bile duct cannulation was 39/44 (88.6%) in the new sphincterotome group and 63/75 (84.0%) in the conventional group (not significant). The total biliary cannulation time (from the reach to the papilla to the finish of biliary cannulation) was 16.0 (6.5-78) min in the new sphincterotome group and 26.0 (5-80) min in the conventional group (P < 0.01). The time from PGW placement to bile duct cannulation was 3.5 (0.3-57) min in the magictome group and 12.0 (1-65) min in the conventional group (P < 0.01). Hyperamylasemia was observed in 13/44 (29.5%) and 17/75 (22.7%), respectively (not significant). Five of 44 (11.3%) of the new sphincterotome group and 14/75 (18.7%) of the conventional group were diagnosed with PEP (not significant). Conclusion:A new double-lumen sphincterotome allows selective bile duct cannulation to be performed in a shorter time than the conventional PGW method. source:http://www.ncbi.nlm.nih.gov/pmc/articles/pmc7934518/

DOI PubMed CiNii

The clinical efficacy of azathioprine as maintenance treatment for autoimmune pancreatitis: a systematic review and meta-analysis.

Yoshiharu Masaki, Hiroshi Nakase, Yoshihisa Tsuji, Masanori Nojima, Kyoko Shimizu, Nobumasa Mizuno, Tsukasa Ikeura, Kazushige Uchida, Akio Ido, Yuzo Kodama, Hiroshi Seno, Kazuichi Okazaki, Seiji Nakamura, Atsushi Masamune

Journal of gastroenterology 56 ( 10 ) 869 - 880 2021年10月 [国内誌]

The effectiveness of azathioprine (AZA) in preventing relapse and maintaining autoimmune pancreatitis (AIP) remission has been reported; however, most of these studies are case series with no randomized control trials available in the literature. Therefore, this study performed a systematic review and meta-analysis of the existing literature on this subject to determine the clinical efficacy of AZA as maintenance therapy for AIP patients. A systematic search was performed to identify studies on the clinical efficacy of AZA as maintenance therapy in AIP patients. The crude multiple relapse rate was estimated to assess the ability of AZA to control relapses in AIP. Pooled estimates were obtained using a random-effects model with the DerSimonian-Laird method. We identified AIP patients who did not respond to initial steroid treatment, experienced steroid weaning failure, or those who relapsed during remission as refractory cases. After reviewing the studies, ten articles fulfilled the inclusion criteria and were selected for meta-analysis. Of all 4504 patients, 3534 patients were treated with steroids, and 346 patients were treated with AZA for relapsed AIP. In this meta-analysis, 14/73 (19.2%) patients receiving AZA for refractory AIP relapsed. Meanwhile, 14/47 (29.8%) patients without AZA experienced relapse. The integrated odds ratio for relapse risk in patients receiving AZA was estimated to be 0.52 (p = 0.15). This systematic review and meta-analysis demonstrated the efficacy of AZA in preventing relapse of AIP, which supports the use of AZA as a maintenance treatment in patients with AIP who relapse upon withdrawal of steroid therapy.

DOI PubMed

急性膵炎臨床におけるガイドラインの国際比較

辻喜久, 佐藤健太

膵臓 ( 一般社団法人日本膵臓学会 ) 36 ( 4 ) 226 - 232 2021年08月

近年，急性膵炎の治療に関するガイドラインが各国から発表されている．そこで本稿では，①最近10年以内（2010～2020年）に発行されたもの，②英語で書かれているもの，③国内外の医学会・学会が発行したもの，④GRADEシステムを採用しているもの，以上①～④にて収集された8つのガイドラインでの推奨度とエビデンス評価の相同に関して比較検討した．7つの主要項目に分けられた31の項目について，27の項目については概ね一致したが，4つの項目で不一致が認められた．しかし，詳細に記述を確認すると一概に不一致と言い切れない部分もあった．推奨が分かれる一つの原因は十分なエビデンスがないことであり，実際に項目内でもエビデンスの質の評価が大きく分かれていることが見て取れた．以上から，今後，新しい精度の高いエビデンスが蓄積されるにつれ，ある程度推奨度も統一されていくと考えられた．

DOI CiNii

Reducing the risk of developing walled-off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin.

Takaaki Eguchi, Yoshihisa Tsuji, Akihiko Okada, Dai Inoue, Hironobu Tokumasu, Kosuke Iwane, Yoshitaka Nakai, Toshihiro Kusaka, Yoshito Uenoyama, Koichi Fujita, Masataka Yokode, Yukimasa Yamashita, Yugo Sawai, Masanori Asada, Takao Mikami, Chiharu Kawanami, Yasushi Kudo, Shujiro Yazumi, Tsuyoshi Sanuki, Arata Sakai, Toshihiro Morita, Yojiro Sakuma, Norimitsu Uza, Yutaka Takada, Toshinao Itani, Katsutoshi Kuriyama, Kazuyoshi Matsumura, Kazuki Ikeda, Hitoshi Someda, Eiji Funatsu, Shinji Katsushima, Yuzo Kodama, Hiroshi Seno

Journal of hepato-biliary-pancreatic sciences 28 ( 9 ) 788 - 797 2021年06月 [国内誌]

BACKGROUND/PURPOSE: The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM). METHODS: In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled-off necrosis (WON), imaging costs for follow-up, and mortality were recorded. Finally, we investigated whether rTM could reduce the clinical impacts, adjusting the severity using propensity analysis with Inverse probability of treatment weighting. RESULTS: Patients with ANC developed WON with higher ratio than APFC (58/98 [59.2%] vs 20/135 [14.8%], OR = 8.3, P < .01]. Severity on admission and imaging costs for follow-up in ANC patients were significantly higher than those in APFC (P < .01). However, regarding mortality, there was no significant difference between patients with ANC and APFC (P = .41). Adjusting severity, it was revealed that rTM administration significantly reduced the risk of ANC developed WON (OR = 0.23, P = .01). CONCLUSIONS: While ANC had a higher clinical impact than that of APFC, we found that early administration of rTM may reduce the impact.

DOI PubMed

Diagnosing Biliary Strictures: Distinguishing IgG4-Related Sclerosing Cholangitis From Cholangiocarcinoma and Primary Sclerosing Cholangitis.

Yasuki Hori, Suresh T Chari, Yoshihisa Tsuji, Naoki Takahashi, Dai Inoue, Phil A Hart, Takeshi Uehara, Masayasu Horibe, Satoshi Yamamoto, Akira Satou, Lizhi Zhang, Kenji Notohara, Itaru Naitoh, Takahiro Nakazawa

Mayo Clinic proceedings. Innovations, quality & outcomes 5 ( 3 ) 535 - 541 2021年06月 [国際誌]

Biliary strictures caused by inflammation or fibrosis lead to jaundice and cholangitis which often make it difficult to distinguish malignant strictures. In cases when malignancy cannot be excluded, surgery is often performed. The concept of immunoglobulin G4 (IgG4)-related sclerosing cholangitis (SC) as a benign biliary stricture was recently proposed. The high prevalence of the disease in Asian countries has resulted in multiple diagnostic and treatment guidelines; however, there is need to formulate a standardized diagnostic strategy among various countries considering the utility, invasiveness, and cost-effectiveness. We evaluated accuracies of various diagnostic modalities for biliary strictures comparing pathology in the Delphi meetings which were held in Rochester, MN. The diagnostic utility for each modality was graded according to the experts, including gastroenterologists, endoscopists, radiologists, and pathologists from the United States and Japan. Diagnostic utility of 10 modalities, including serum IgG4 level, noninvasive imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography-related diagnostic procedures were advocated and the reasons were specified. Serum IgG4 level, noninvasive imaging, diagnostic endoscopic ultrasound and intraductal ultrasonography under endoscopic retrograde cholangiopancreatography were recognized as useful modalities for the diagnosis. The information in this article will aid in the diagnosis of biliary strictures particularly for distinguishing IgG4-SC from cholangiocarcinoma and/or primary SC.

DOI PubMed

一般内科における入院患者の入院日数の延長に関するリスクの検討

若林崇雄, 山本武志, 相馬仁, 辻喜久, 山本和利

日本病院総合診療医学会雑誌 ( 一般社団法人日本病院総合診療医学会 ) 17 ( 3 ) 274 - 281 2021年05月

【目的】一般内科における患者の入院日数の延長に関連する因子を検討する。【方法】2016 年 4 月 1 日から 2017 年 3 月 31 日まで 200 床規模のA病院総合診療科に即日入院した患者 289 名を対象とした。入院期間に影響を及ぼす要因として 12 項目の説明変数を選定し，比例Coxハザード分析を用いて入院日数の延長と関連する因子を検討した。【結果】在院日数の中央値は 10 日だった。入院前の住居と退院先の相違（ハザード比（HR）2.25，95％信頼区間（95％ CI）；1.35-3.75）であり，次いでBMI低値（HR 1.70，95％ CI；1.18-2.45），要介護（HR 1.56，95％ CI；1.07-2.27），ポリファーマシー（HR 1.48，95％ CI；1.08-2.04）が入院日数の延長と正の相関を示した。【結論】入院日数の延長と関連する因子が示唆された。今後は本検討を基に多施設前向き研究で妥当性を確保する必要がある。

DOI

Non-compliance to practice guidelines still exist in the early management of acute pancreatitis: Time for reappraisal?

Rupjyoti Talukdar, Yoshihisa Tsuji, Nitin Jagtap, R Pradeep, G V Rao, D Nageshwar Reddy

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2021年05月 [国際誌]

INTRODUCTION: Earlier national surveys on the management of acute pancreatitis (AP) had reported non-compliance to practice guidelines. In the past decade, several guidelines were revised based on new evidence. In this multicenter international survey, we aimed to evaluate the practice patterns of early management of AP and compliance to the revised treatment guidelines across different disciplines and practice environments. METHODS: A structured questionnaire was sent via email to a target population of 654 that constituted of medical and surgical gastroenterologists, physicians and general surgeons, paediatricians from academic and non-academic centres across 30 countries. Other than demographic variables, the questionnaire contained items pertaining to early management of AP, such as, assessment at admissions and within first 72 h s, details regarding analgesics, IV hydration, oral/enteral feeding and antibiotic use. RESULTS: The response rate was 46.2% and after exclusions, a total of 297 participant's responses were analysed. Majority of the participants were from Asia, followed by Europe and the Americas. 181 (60.9%) claimed to follow practice guidelines, out of which 59 (32.6%) followed more than one. On further probing, only 41.9% were actually compliant to feeding and 59.7% to antibiotic guidelines. Even though participants opted for aggressive hydration, early feeding and avoidance of prophylactic antibiotics, there were non-compliance and discrepancies in titration of fluid therapy, indications of feeding and antibiotic use. DISCUSSION: Discrepancies and non-compliance still appear to exist in the early management of AP due to lack of strong evidence. We discuss ways that could improve compliance to the existing guidelines until stronger evidence comes to the fore.

DOI PubMed

Dilemma of physician-mothers faced with an increased home burden and clinical duties in the hospital during the COVID-19 pandemic.

Sachiyo Nishida, Kanna Nagaishi, Masayo Motoya, Ayako Kumagai, Noriko Terada, Ai Kasuga, Narumi Kubota, Kotoe Iesato, Motonobu Kimizuka, Satsuki Miyajima, Masayuki Koyama, Hirofumi Ohnishi, Eichi Narimatsu, Naoya Masumori, Kazufumi Tsuchihashi, Taiji Tsukamoto, Yoshihisa Tsuji

PloS one 16 ( 6 ) e0253646 2021年 [国際誌]

PURPOSE: Since December 2019, coronavirus disease 2019 (COVID-19) has spread rapidly across the world. During the pandemic, physicians in our hospital have had to respond both to the issue of treating the patients and the increasing domestic burden associated with social disruption. The purpose of this study was to assess how much the burden on our doctors, especially female doctors, was increasing. MATERIAL AND METHODS: The Physicians' Career Support Committee in Sapporo Medical University conducted a questionnaire survey. The questionnaire inquired about a wide range of subjects with regard to working style and family life during the first and second waves of the COVID-19 pandemic, and was sent to all medical/dental physicians working in Sapporo Medical University. RESULTS: A total of 266 (42.7%) physicians in our hospital responded to our questionnaire and the data for 264 data were analyzed. The total numbers of males, females, and others, including those who did not want to specify, were 178 (67.4%), 82 (31.0%), and 4 (1.5%), respectively. Among them, 62 (23.5%) and 23 (8.7%) answered that their domestic burden was slightly or markedly increased. The increase in the domestic burden showed a significant difference between genders (p = 0.04). Even after correction for background differences using multivariate analysis, being female (p<0.001), having child dependents (p<0.001), and treating COVID-19 patients (p = 0.03) were significantly related to an increased domestic burden. Regarding family style, 58.1% of the physician-fathers were from two-income families (i.e., families with both parents in employment), and they answered that their partner mainly cared for the children. In contrast, 97.3% of physician-mothers were from two-income families, and 94.6% of the physician-mothers had to take care of children by themselves. CONCLUSION: Physician-mothers are caught in a dilemma between an increased home burden and clinical duties in the hospital, with a significantly higher ratio than physician-fathers during the pandemic. As we showed, female doctors could have not continued their careers and take responsible positions in the same way as male doctors. This is a social risk in the timing of a crisis, such as a pandemic.

DOI PubMed

急性膵炎臨床におけるガイドラインの国際比較

辻喜久, 佐藤健太

膵臓(Web) 36 ( 4 ) 2021年

J-GLOBAL

急性膵炎発症後3か月における心身の負担と社会復帰の現状

辻喜久, 石上敬介, 上野真行, 上野真行

膵臓(Web) 36 ( 3 ) 2021年

J-GLOBAL

一般内科における入院患者の入院日数の延長に関するリスクの検討

若林崇雄, 山本武志, 山本武志, 相馬仁, 辻喜久, 山本和利, 山本和利

日本病院総合診療医学会雑誌(Web) 17 ( 3 ) 2021年

J-GLOBAL

Optimal Treatment for Octogenarians With Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: A Multicenter Retrospective Study.

Sohei Satoi, Tomohisa Yamamoto, Kazushige Uchida, Tsutomu Fujii, Toshifumi Kin, Satoshi Hirano, Keiji Hanada, Takao Itoi, Yoshiaki Murakami, Hisato Igarashi, Hidetoshi Eguchi, Tamotsu Kuroki, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Yoshiki Hirooka, Atsushi Masamune, Toshio Shimokawa, Hiroki Yamaue, Kazuichi Okazaki

Pancreas 49 ( 6 ) 837 - 844 2020年07月 [国際誌]

OBJECTIVES: The objective of this study was to clarify the role of pancreatectomy for patients with resectable and borderline resectable pancreatic ductal adenocarcinoma aged 80 years or older using a nationwide audit by the Japan Pancreas Society. METHODS: Data were collected from 39 institutions from 2007 to 2014. The primary endpoint was overall survival, and secondary endpoints were surgical outcomes and predictive factors for prognosis. RESULTS: Data were obtained from 556 octogenarians who underwent pancreatectomy (n = 369, 66%), chemo(radio)therapy (n = 99, 18%), and palliative therapy (n = 88, 16%). Median survival times were 20.6, 18.6, and 8.8 months in each group, respectively. Even after propensity score matching, median survival time in the surgery group (22.8 months) was significantly higher than that in the chemotherapy group (18.5 months; hazard ratio, 0.64 [95% confidence interval, 0.44-0.93]; P = 0.020). Significant independent prognostic factors were body mass index, lymph node metastasis, and tumor diameter in the surgery group, and serum albumin level, American Society of Anesthesiologists classification, body mass index, modified Glasgow prognostic score, second-line chemotherapy, and tumor diameter in the chemotherapy group. CONCLUSIONS: Octogenarians with resectable/borderline resectable pancreatic ductal adenocarcinoma can be recommended for pancreatectomy according to mental and physical fitness for surgical procedures.

DOI PubMed

FileMakerによる情報共有システムの構築アンプロフェッショナル学生への対応

石井真理子, 辻喜久, 伊藤俊之

医学教育 ( (一社)日本医学教育学会 ) 51 ( Suppl. ) 217 - 217 2020年07月

膵疾患に対する栄養サポートの意義：サルコペニアとの関連を踏まえて

上野真行, 辻喜久, 平大地, 石田悦嗣, 守本洋一, 水野元夫

膵臓 ( 一般社団法人日本膵臓学会 ) 35 ( 2 ) 166 - 173 2020年04月

膵疾患患者では外分泌・内分泌機能が低下し，消化・吸収障害や糖尿病の合併率が高いため適切な栄養サポートが必要となることが少なくない．慢性膵炎に対する栄養療法に関しては多くのエビデンスがあり，個々の重症度や病期に応じたサポートが推奨されている．慢性膵炎患者に栄養サポートを行う上で骨格筋量や運動機能は重要な評価指標の1つである．骨格筋量が低下しサルコペニアを合併すると生活の質（QOL）が低下し，入院リスクや全死亡リスクが増加するので，正確な評価に基づき適切にサポートすることが重要である．急性膵炎の亜急性期～回復期や膵癌患者における栄養療法のエビデンスはまだ乏しいが，当院の研究ではいずれの疾患においても適切な栄養サポートが重要であることが示唆された．本稿では，慢性膵炎，急性膵炎，膵癌の各疾患における栄養療法の意義について，自施設の研究成果を紹介しつつ概説する．

DOI CiNii

社会構造の変遷と医師のプロフェッショナリズムの整理

辻喜久, 辻喜久

医学教育 ( 日本医学教育学会 ) 51 ( 1 ) 15 - 28 2020年

背景 : 本邦の医師プロフェッショナリズムは複数の意味で捉えられている可能性がある. 方法 : 西欧-本邦の医師プロフェッショナリズム形成史を比較した. 結果 : 西欧では産業革命と科学の進歩により知識と職業教育の専門化し "西欧近代的医師像" が生じ, ノスタルジック・プロフェッショナリズムと脱構築されたプロフェッショナリズムへと発展し本邦にも輸入された. 本邦では, " 伝統的自己犠牲的医師像" がノスタルジック・プロフェッショナリズムと結びつき, 脱構築されたプロフェッショナリズムと並立した. 考察 : 医師プロフェッショナリズムは本邦の伝統的価値観を背景に二義的に使用されている可能性が考えられた.

DOI CiNii J-GLOBAL

Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society.

Hiroyoshi Tsuchida, Tsutomu Fujii, Masamichi Mizuma, Sohei Satoi, Hisato Igarashi, Hidetoshi Eguchi, Tamotsu Kuroki, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Yoshiki Hirooka, Atsushi Masamune, Kazuhiro Mizumoto, Takao Itoi, Shinichi Egawa, Yuzo Kodama, Shin Hamada, Michiaki Unno, Hiroki Yamaue, Kazuichi Okazaki

Surgery 166 ( 6 ) 997 - 1003 2019年12月 [査読有り] [国際誌]

BACKGROUND: The importance of peritoneal washing cytology status both as a sign of irresectability and as a prognostic factor for pancreatic ductal adenocarcinoma remains controversial. The purpose of this nationwide, cancer registry-based study was to clarify the clinical implications of operative resection in patients who had positive cytology status. METHODS: Clinical data from 1,970 patients who underwent tumor resection were collected from the Pancreatic Cancer Registry in Japan. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. RESULTS: Among the 1,970 patients analyzed, positive cytology status was found in 106 patients and negative cytology status was found in 1,864 patients. The positive cytology status group had a greater frequency of pancreatic body and tail cancer and greater preoperative serum carbohydrate antigen 19-9 levels than the negative cytology status group (P < .001 each). The ratio of peritoneal recurrence tended to be greater in the positive cytology status group (14% vs 43%; P < .001). Overall median survival times were less in the positive cytology status group (17.5 months vs 29.4 months; P < .001). The 5-year survival rates were 13.7% and 31.1% in the positive cytology status and negative cytology status groups, respectively. Multivariate analysis of positive cytology status patients revealed that adjuvant chemotherapy was an independent prognostic factor. CONCLUSION: Positive cytology status was an adverse prognostic factor in patients who underwent resection for pancreatic ductal adenocarcinoma but did not preclude attempted curative resection. Curative resection followed by adjuvant chemotherapy may contribute to long-term prognosis in patients with positive cytology status.

DOI PubMed

消化器画像診断における時間軸画像の有用性—TIME AXIS IMAGING FOR DIAGNOSIS OF DIGESTIVE DISEASE—生涯教育セミナー記録平成30年度第26回日本外科学会生涯教育セミナー最新の診断技術 ; 中部地区

辻喜久

日本外科学会雑誌 = Journal of Japan Surgical Society / 日本外科学会編 ( 東京 : 日本外科学会 ) 120 ( 2 ) 261 - 263 2019年 [査読有り] [招待有り]

CiNii

消化器画像診断における時間軸画像の有用性

辻喜久

日本外科学会雑誌 120 ( 2 ) 2019年

J-GLOBAL

Chemokine CXCL16 mediates acinar cell necrosis in cerulein induced acute pancreatitis in mice.

Yojiro Sakuma, Yuzo Kodama, Takaaki Eguchi, Norimitsu Uza, Yoshihisa Tsuji, Masahiro Shiokawa, Takahisa Maruno, Katsutoshi Kuriyama, Yoshihiro Nishikawa, Yuki Yamauchi, Motoyuki Tsuda, Tatsuki Ueda, Tomoaki Matsumori, Toshihiro Morita, Teruko Tomono, Nobuyuki Kakiuchi, Atsushi Mima, Yuko Sogabe, Saiko Marui, Takeshi Kuwada, Akihiko Okada, Tomohiro Watanabe, Hiroshi Nakase, Tsutomu Chiba, Hiroshi Seno

Scientific reports 8 ( 1 ) 8829 - 8829 2018年06月 [査読有り] [国際誌]

Severe acute pancreatitis is a lethal inflammatory disease frequently accompanied by pancreatic necrosis. We aimed to identify a key regulator in the development of pancreatic necrosis. A cytokine/chemokine array using sera from patients with acute pancreatitis (AP) revealed that serum CXCL16 levels were elevated according to the severity of pancreatitis. In a mouse model of AP, Cxcl16 expression was induced in pancreatic acini in the late phase with the development of pancreatic necrosis. Cxcl16-/- mice revealed similar sensitivity as wild-type (WT) mice to the onset of pancreatitis, but better resisted development of acinar cell necrosis with attenuated neutrophil infiltration. A cytokine array and immunohistochemistry revealed lower expression of Ccl9, a neutrophil chemoattractant, in the pancreatic acini of Cxcl16-/- mice than WT mice. Ccl9 mRNA expression was induced by stimulation with Cxcl16 protein in pancreatic acinar cells in vitro, suggesting a Cxcl16/Ccl9 cascade. Neutralizing antibody against Cxcl16 ameliorated pancreatic injury in the mouse AP model with decreased Ccl9 expression and less neutrophil accumulation. In conclusion, Cxcl16 expressed in pancreatic acini contributes to the development of acinar cell necrosis through the induction of Ccl9 and subsequent neutrophil infiltration. CXCL16 could be a new therapeutic target in AP.

DOI PubMed CiNii

Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis.

Yoshihisa Tsuji, Naoki Takahashi, Hiroyoshi Isoda, Koji Koizumi, Sho Koyasu, Miho Sekimoto, Yuichi Imanaka, Shujiro Yazumi, Masanori Asada, Yoshihiro Nishikawa, Hiroshi Yamamoto, Osamu Kikuchi, Tsukasa Yoshida, Tetsuro Inokuma, Shinji Katsushima, Naoki Esaka, Akihiro Okano, Chiharu Kawanami, Nobuyuki Kakiuchi, Masahiro Shiokawa, Yuzo Kodama, Ichiro Moriyama, Takafumi Kajitani, Yoshikazu Kinoshita, Tsutomu Chiba

Journal of gastroenterology 52 ( 10 ) 1130 - 1139 2017年10月 [査読有り] [国内誌]

BACKGROUND: Perfusion CT can diagnose pancreatic necrosis in early stage of severe acute pancreatitis, accurately. However, no study to date has examined whether early diagnosis of pancreatic necrosis is useful in predicting persistent organ failure (POF). METHODS: We performed a multi-center prospective observational cohort study to investigate whether perfusion CT can predict the development of POF in the early stage of AP, based on early diagnosis of the development of pancreatic necrosis (PN). From 2009 to 2012, we examined patients showing potential early signs of severe AP (n = 78) on admission. Diagnoses for the development of PN were made prospectively by on-site physicians on the admission based on perfusion CT (diagnosis 1). Blinded retrospective reviews were performed by radiologists A and B, having 8 and 13 years of experience as radiologists (diagnosis 2 and 3), respectively. Positive diagnosis for the development of PN were assumed equivalent to positive predictions for the development of POF. We then calculated the area under the curve (AUC) of the receiver operating characteristic for POF predictions. RESULTS: Fourteen (17.9%) and 23 patients (29.5%) developed PN and POF, respectively. For diagnoses 1, 2, and 3, AUCs for POF predictions were 74, 68, and 73, respectively. CONCLUSIONS: Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .

DOI PubMed

Erratum to: Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis.

Journal of gastroenterology 52 ( 10 ) 1147 - 1148 2017年10月 [査読有り] [国内誌]

DOI PubMed

佐久間洋二朗, 児玉裕三, 宇座徳光, 辻喜久, 塩川雅広, 渡邉智裕, 仲瀬裕志, 千葉勉, 妹尾浩

膵臓 ( 日本膵臓学会 ) 32 ( 3 ) 339 - 339 2017年05月 [査読有り]

J-GLOBAL

膵臓Perfusion CTの撮影条件を最適化するためのデジタルファントムを用いたノイズと腫瘍径に関する検討

小泉幸司, 小泉幸司, 小澤聡, 松田晃, 東村享治, 辻喜久, 上野智弘, 富樫かおり, 杉本直三

電子情報通信学会技術研究報告 116 ( 393(MI2016 71-121) ) 2017年 [査読有り]

J-GLOBAL

Dual Energy CTを用いた膵石の成分分析の有用性

塚本純, 山崎辰洋, 日野真太郎, 石田悦嗣, 辻喜久

倉敷中央病院年報 79 2017年

J-GLOBAL

造影ダイナミックCTとフッ素18フルオロミソニダゾール陽電子放出断層撮像法を用いた、腫瘍間質の評価および腫瘍低酸素との関連性の評価

子安翔, 辻喜久, 原田浩, 中本裕士, 野橋智美, 木村寛之, 佐野紘平, 小泉幸司, 濱路政嗣, 富樫かおり

JSMI Report ( 日本分子イメージング学会 ) 10 ( 1 ) 63 - 66 2016年12月

J-GLOBAL

Pathogenicity of IgG in patients with IgG4-related disease.

Masahiro Shiokawa, Yuzo Kodama, Katsutoshi Kuriyama, Kenichi Yoshimura, Teruko Tomono, Toshihiro Morita, Nobuyuki Kakiuchi, Tomoaki Matsumori, Atsushi Mima, Yoshihiro Nishikawa, Tatsuki Ueda, Motoyuki Tsuda, Yuki Yamauchi, Ryuki Minami, Yojiro Sakuma, Yuji Ota, Takahisa Maruno, Akira Kurita, Yugo Sawai, Yoshihisa Tsuji, Norimitsu Uza, Kazuyoshi Matsumura, Tomohiro Watanabe, Kenji Notohara, Tatsuaki Tsuruyama, Hiroshi Seno, Tsutomu Chiba

Gut 65 ( 8 ) 1322 - 32 2016年08月 [査読有り] [国際誌]

OBJECTIVE: IgG4-related disease (IgG4-RD) is a systemic disease characterised by elevated serum IgG4 and IgG4-positive lymphoplasmacytic infiltration in the affected tissues. The pathogenic role of IgGs, including IgG4, in patients with IgG4-RD, however, is unknown. DESIGN: We examined the pathogenic activity of circulating IgGs in patients with IgG4-RD by injecting their IgGs into neonatal male Balb/c mice. Binding of patient IgGs to pancreatic tissue was also analysed in an ex vivo mouse organ culture model and in tissue samples from patients with autoimmune pancreatitis (AIP). RESULTS: Subcutaneous injection of patient IgG, but not control IgG, resulted in pancreatic and salivary gland injuries. Pancreatic injury was also induced by injecting patient IgG1 or IgG4, with more destructive changes induced by IgG1 than by IgG4. The potent pathogenic activity of patient IgG1 was significantly inhibited by simultaneous injection of patient IgG4. Binding of patient IgG, especially IgG1 and IgG4, to pancreatic tissue was confirmed in both the mouse model and AIP tissue samples. CONCLUSIONS: IgG1 and IgG4 from patients with IgG4-RD have pathogenic activities through binding affected tissues in neonatal mice.

DOI PubMed

ブータン王国における内視鏡診療の経験

二階堂光洋, 宮本心一, 児玉裕三, 宇座徳光, 辻喜久, 角田茂, 植村忠廣, 岡島英明, 前田紗江, 高橋陽子, 村本佳奈美, 石井鮎子, 西洋子, 樋口浩和, 武藤学, 松原和夫, 千葉勉

ヒマラヤ学誌 : Himalayan Study Monographs ( 京都大学ヒマラヤ研究会; 京都大学ブータン友好プログラム; 京都大学霊長類学・ワイルドライフサイエンス・リーディング大学院 ) 17 77 - 84 2016年03月

特集1: 京都大学ブータン友好プログラム特集 = Special Issue 1: Contribution from the Kyoto Bhutan Friendship Program京都大学医学部附属病院の国際支援事業によりブータン王国にて内視鏡診療に従事する機会を得た。ブータンでは消化器内視鏡検査は国内唯一の消化器内科医師と外科医師により行われており, 治療困難な症例は国外へ搬送されていた。内視鏡的逆行性膵胆管造影 (Endoscopic Retrograde Chorangiopancreatography: ERCP) 目的の国外搬送も絶えないため, ERCP 導入を中心とした内視鏡診療支援を行うこととなった。10週間の滞在中に約900件の内視鏡を施行した。大部分は上部消化管内視鏡検査であったが, ERCP に関しても, 現地の医師, 看護師を指導しながら, 23件を施行した。ブータンの内視鏡診療の現況に加え, ブータン人における消化器疾患の頻度及び ERCP 導入の実際について報告する。We provided medical care in the Kingdom of Bhutan from January to March in 2014 through the international medical support program of Kyoto University Hospital. Bhutan is a small, developing country with a population of about 700, 000 citizens located at the southern foot of the Himalayas. There are only 244 medical doctors in Bhutan (one-tenth of the number of doctors relative to population in Japan). Because of the shortage of doctors and the limited medical resources, patients with difficult-to-treat conditions are transferred to India or other countries. Gastrointestinal endoscopy is performed by the country's only gastroenterologist and six surgeons, mainly in Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) at Thimphu. Several years before, a Bhutanese surgeon had learned to perform endoscopic retrograde cholangiopancreatography (ERCP) in Thailand. However, ERCP cannot be established in Bhutanese routine clinical practice because of its technical difficulty. Although a duodenoscope and some devices for ERCP are available, at least one patient who needs ERCP is transferred to India every month. In this context, I was asked to reintroduce ERCP into JDWNRH. ERCP was performed in 23 cases involving 17 patients with the cooperation of Bhutanese doctors, nurses, and technicians. My experience leads me to believe that we can build a platform to continue ERCP in JDWNRH. During the 10 weeks, I also helped to perform about 900 endoscopies, mainly esophagogastroduodenoscopy, and I taught endoscopic techniques and diagnostic approaches to Bhutanese doctors. In this report, I describe the current status of endoscopy in Bhutan including the incidence of Bhutanese gastrointestinal disorders and the experience specifically related to introducing ERCP.

DOI CiNii

Evaluation of Tumor-associated Stroma and Its Relationship with Tumor Hypoxia Using Dynamic Contrast-enhanced CT and (18)F Misonidazole PET in Murine Tumor Models.

Sho Koyasu, Yoshihisa Tsuji, Hiroshi Harada, Yuji Nakamoto, Tomomi Nobashi, Hiroyuki Kimura, Kohei Sano, Koji Koizumi, Masatsugu Hamaji, Kaori Togashi

Radiology 278 ( 3 ) 734 - 41 2016年03月 [査読有り] [国際誌]

PURPOSE: To determine the relationship between the fractional interstitial volume (Fis), as calculated at dynamic contrast material-enhanced (DCE) computed tomography (CT), and tumor-associated stroma and to analyze its spatial relationship with tumor hypoxia in several xenograft tumor models. MATERIALS AND METHODS: All animal experiments were approved by the animal research committee. Mice with three different xenograft tumors (U251, CFPAC-1, and BxPC-3; n = 6, n = 8, and n = 6, respectively) underwent DCE CT then hypoxia imaging with fluorine 18 ((18)F) fluoromisonidazole (FMISO) positron emission tomography (PET) within 24 hours. Immunohistochemical analysis was performed in harvested tumors to detect hypoxia markers and to quantify microvascular and stromal density. Two DCE CT parameters (amount of interstitial space associated with the amount of stroma [Fis] and flow velocity [Fv]) were identified and quantitatively validated by using immunohistochemistry. FMISO uptake within the tumor was also assessed in relation to DCE CT parameters. Imaging and immunohistochemical parameters were assessed by using the Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni correction, and Pearson correlation coefficient. RESULTS: Almost no α-smooth muscle actin-positive cells were found in the U251 xenograft, while abundant stroma was found in the entire BxPC-3 xenograft and in the periphery of the CFPAC-1 xenograft. Quantitative analysis showed a significant correlation (R = 0.83, P < .0001) between Fis and stromal density. FMISO uptake had a negative correlation with Fis (R = -0.58, P < .0001) and Fv (R = -0.53, P < .0001). CONCLUSION: DCE CT can be used to quantify parameters associated with tumor-associated stroma. Tumor hypoxia was Complementarily localized in tumor-associated stroma in these models.

DOI PubMed

Acute Pancreatitis-Progress and Challenges: A Report on an International Symposium.

Elham Afghani, Stephen J Pandol, Tooru Shimosegawa, Robert Sutton, Bechien U Wu, Santhi Swaroop Vege, Fred Gorelick, Morihisa Hirota, John Windsor, Simon K Lo, Martin L Freeman, Markus M Lerch, Yoshihisa Tsuji, Gil Y Melmed, Wahid Wassef, Julia Mayerle

Pancreas 44 ( 8 ) 1195 - 210 2015年11月 [査読有り] [国際誌]

An international symposium entitled "Acute pancreatitis: progress and challenges" was held on November 5, 2014 at the Hapuna Beach Hotel, Big Island, Hawaii, as part of the 45th Anniversary Meeting of the American Pancreatic Association and the Japanese Pancreas Society. The course was organized and directed by Drs. Stephen Pandol, Tooru Shimosegawa, Robert Sutton, Bechien Wu, and Santhi Swaroop Vege. The symposium objectives were to: (1) highlight current issues in management of acute pancreatitis, (2) discuss promising treatments, (3) consider development of quality indicators and improved measures of disease activity, and (4) present a framework for international collaboration for development of new therapies. This article represents a compilation and adaptation of brief summaries prepared by speakers at the symposium with the purpose of broadly disseminating information and initiatives.

DOI PubMed

Efficacy of recombinant human soluble thrombomodulin in preventing walled-off necrosis in severe acute pancreatitis patients

Takaaki Eguchi, Yoshihisa Tsuji, Hiroshi Yamashita, Takumi Fukuchi, Atsushi Kanamori, Kei Matsumoto, Takashi Hasegawa, Akio Koizumi, Ryuki Kitada, Masahiro Tsujimae, Taro Lwatsubo, Shintaro Koyama, Satoshi Ubukata, Mikio Fujita, Akihiko Okada

PANCREATOLOGY ( KARGER ) 15 ( 5 ) 485 - 490 2015年09月 [査読有り] [国際誌]

Objective: To investigate the efficacy of recombinant human soluble thrombomodulin (rTM) in preventing the development of walled-off necrosis (WON) in severe acute pancreatitis (SAP) patients. Methods: We retrospectively analyzed 54 SAP patients divided into two groups: SAP patients treated by rTM (rTM group, 24 patients) and not treated by rTM (control group, 30 patients). rTM was administered to patients with disseminated intravascular coagulation (DIC). Initially, on the admission day, we recorded patient severity and pancreatic necrosis/ischemia positive or negative. Then we investigated development of WON using 4 weeks later CT/MRI. Finally we compared the proportions of patients developing WON in the rTM group and the control group. Results: On the admission day, the condition of patients treated by rTM was significantly worse than patients in the control group; rTM group vs. control: 71.8 +/- 13.9 vs. 59.8 +/- 15.3 years for age, 10.7 +/- 3.5 vs. 8.0 +/- 4.4 for Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and 33 +/- 1.8 vs. 2.2 +/- 1.8 for sequential organ failure assessment (SOFA) score (p < 0.05). We found no significant differences on the admission day in rate of pancreatic necrosis/ischemia between patients treated by rTM and controls (58.3% vs. 63.3%, p = 0.71). Nevertheless, the proportion of patients developing WON was significantly lower among those administered rTM than in those not administered rTM {29.2% (7/24 patients) vs. 56.7% (17/30 patients), p < 0.05). Conclusion: Treatment of SAP patients treated by rTM may prevent progression from pancreatic necrosis/ischemia to WON. Copyright (C) 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. This is an open access article under the CC BY-NC-ND license.

DOI PubMed

Activation-Induced Cytidine Deaminase Contributes to Pancreatic Tumorigenesis by Inducing Tumor-Related Gene Mutations.

Yugo Sawai, Yuzo Kodama, Takahiro Shimizu, Yuji Ota, Takahisa Maruno, Yuji Eso, Akira Kurita, Masahiro Shiokawa, Yoshihisa Tsuji, Norimitsu Uza, Yuko Matsumoto, Toshihiko Masui, Shinji Uemoto, Hiroyuki Marusawa, Tsutomu Chiba

Cancer research 75 ( 16 ) 3292 - 301 2015年08月 [査読有り] [国際誌]

Pancreatic ductal adenocarcinoma (PDAC) develops via an accumulation of various gene mutations. The mechanism underlying the mutations in PDAC development, however, is not fully understood. Recent insight into the close association between the mutation pattern of various cancers and specific mutagens led us to investigate the possible involvement of activation-induced cytidine deaminase (AID), a DNA editing enzyme, in pancreatic tumorigenesis. Our immunohistochemical findings revealed AID protein expression in human acinar ductal metaplasia, pancreatic intraepithelial neoplasia, and PDAC. Both the amount and intensity of the AID protein expression increased with the progression from precancerous to cancerous lesions in human PDAC tissues. To further assess the significance of ectopic epithelial AID expression in pancreatic tumorigenesis, we analyzed the phenotype of AID transgenic (AID Tg) mice. Consistent with our hypothesis that AID is involved in the mechanism of the mutations underlying pancreatic tumorigenesis, we found precancerous lesions developing in the pancreas of AID Tg mice. Using deep sequencing, we also detected Kras and c-Myc mutations in our analysis of the whole pancreas of AID Tg mice. In addition, Sanger sequencing confirmed the presence of Kras, c-Myc, and Smad4 mutations, with the typical mutational footprint of AID in precancerous lesions in AID Tg mice separated by laser capture microdissection. Taken together, our findings suggest that AID contributes to the development of pancreatic precancerous lesions by inducing tumor-related gene mutations. Our new mouse model without intentional manipulation of specific tumor-related genes provides a powerful system for analyzing the mutations involved in PDAC.

DOI PubMed

Usefulness of Adalimumab for Treating a Case of Intestinal Behçet's Disease With Trisomy 8 Myelodysplastic Syndrome.

Masamichi Kimura, Yoshihisa Tsuji, Masako Iwai, Masahiro Inagaki, Ali Madian, Takuya Yoshino, Minoru Matsuura, Hiroshi Nakase

Intestinal research 13 ( 2 ) 166 - 9 2015年04月 [査読有り] [国際誌]

Behçet's disease (BD) is a systemic vasculitis, while myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematologic disorders characterized by ineffective hematopoiesis. Some studies suggest a relationship between MDS and BD, especially intestinal BD, and trisomy 8 seems to play an important role in both diseases. There are several reports on patients with BD comorbid with MDS involving trisomy 8 that frequently have intestinal lesions refractory to conventional medical therapies. Tumor necrosis factor (TNF)-α is strongly involved in the pathophysiology of several autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and BD. In addition, TNF-α plays an important role in the pathophysiology of MDS by inhibiting normal hematopoiesis and inducing the programmed cell death of normal total bone marrow cells and normal CD34+ cells. Recent clinical reports demonstrate the favorable effect of TNF-α antagonists in patients with refractory intestinal BD and in those with MDS. We present the case of a patient with intestinal BD and MDS involving trisomy 8 who was successfully treated with adalimumab.

DOI PubMed

Role of Early Prediction of Pancreatic Necrosis in Evaluating Severity of Acute Pancreatitis in the Early Stage

Yoshihisa Tsuji, Yuzo Kodama, Tsutomu Chiba

GASTROENTEROLOGY ( W B SAUNDERS CO-ELSEVIER INC ) 148 ( 4 ) S683 - S683 2015年04月

Evaluation of tumour hypoxia and cancer stroma using F-18-misonidazole PET and dynamic contrast enhanced CT in tumor-bearing mice models

S. Koyasu, Y. Nakamoto, H. Harada, Y. Tsuji, H. Kimura, K. Sano, T. Nobashi, K. Togashi

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING ( SPRINGER ) 41 S387 - S387 2014年10月 [査読有り]

Evaluation of intratumoral microenvironment with 18F-misonidazole PET and dynamic contrast enhanced CT in tumor-bearing mice models

Sho Koyasu, Yuji Nakamoto, Hiroshi Harada, Hiroyuki Kimura, Kohei Sano, Koji Koizumi, Yoshihisa Tsuji, Tomomi Nobashi, Kensuke Kurihara, Kaori Togashi

JOURNAL OF NUCLEAR MEDICINE ( SOC NUCLEAR MEDICINE INC ) 55 2014年05月 [査読有り]

Long-term efficacy of infliximab for refractory ulcerative colitis: results from a single center experience.

Satoshi Yamada, Takuya Yoshino, Minoru Matsuura, Naoki Minami, Takahiko Toyonaga, Yusuke Honzawa, Yoshihisa Tsuji, Hiroshi Nakase

BMC gastroenterology 14 80 - 80 2014年04月 [査読有り] [国際誌]

BACKGROUND: The long-term efficacy of infliximab (IFX) for patients with refractory ulcerative colitis (UC) is unclear. The aim of this study was to assess the long-term outcomes of IFX treatment in patients with refractory UC. METHODS: Thirty-three patients with refractory UC who received IFX treatment at Kyoto University Hospital between 2003 and 2013 were retrospectively evaluated. IFX intensification was defined as a dose escalation (up to 10 mg/kg) and/or shorter intervals between infusions (every 4-6 weeks). RESULTS: Of the 33 patients who received scheduled infusions of IFX, 24 (72.7%) achieved clinical remission within 8 weeks after initiating IFX treatment. Of these 24 responders, 17 (70.8%) experienced a relapse of UC and required IFX intensification, and 16 (66.7%) eventually maintained clinical remission with IFX treatment, including IFX intensification. Of the 33 patients, 6 (18.2%) underwent colectomy during IFX treatment. Multivariate regression analysis showed that a serum C-reactive protein (CRP) concentration <5 mg/L two weeks after starting IFX was a predictor of a positive clinical response to IFX induction therapy. No severe adverse events occurred in UC patients treated with IFX. CONCLUSION: IFX intensification was necessary for long-term maintenance of remission and to prevent colectomy in patients with refractory UC.

DOI PubMed

Subtraction color map of contrast-enhanced and unenhanced CT for the prediction of pancreatic necrosis in early stage of acute pancreatitis.

Yoshihisa Tsuji, Naoki Takahashi, Joel G Fletcher, David M Hough, Brendan P McMenomy, David M Lewis, Santhi S Vege, Suresh T Chari, Cynthia H McCollough, Katharine L Grant, Ernst Klotz

AJR. American journal of roentgenology 202 ( 4 ) W349-56 2014年04月 [査読有り] [国際誌]

OBJECTIVE: The objective of our study was to evaluate the accuracy of subtraction color-map images created from contrast-enhanced CT (CECT) and unenhanced CT for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. MATERIALS AND METHODS: Forty-eight patients underwent unenhanced CT and CECT within 72 hours from the onset of acute pancreatitis. Subtraction color-map images were created from unenhanced CT and CECT using a 3D nonrigid registration method. Three radiologists reviewed two image sets: CECT alone and subtraction color-map images in conjunction with CECT. Readers evaluated each image set for the presence of pancreatic necrosis. The reference standard for pancreatic necrosis was CT or MRI 1 week or more after the onset of acute pancreatitis. The performance of each image set for the prediction of pancreatic necrosis was calculated and compared using the McNemar test. RESULTS: Eleven of the 48 patients developed pancreatic necrosis. There were no technical failures creating the subtraction images. The sensitivity, specificity, and accuracy for predicting pancreatic necrosis with CECT were 64%, 97%, and 90%, respectively, for reader 1; 73%, 87%, and 83% for reader 2; and 73%, 87%, and 83% for reader 3. The sensitivity, specificity, and accuracy for predicting pancreatic necrosis with the subtraction color maps were 100%, 100%, and 100%, respectively, for reader 1; 100%, 95%, and 96% for reader 2; and 82%, 92%, and 90% for reader 3. Accuracy significantly improved with the addition of subtraction color maps compared with CECT alone for reader 1 (p = 0.03) and reader 2 (p = 0.02) but not for reader 3 (p = 0.37). CONCLUSION: A subtraction color map is accurate in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis.

DOI PubMed

Perfusion in the tissue surrounding pancreatic cancer and the patient's prognosis.

Yoshihiro Nishikawa, Yoshihisa Tsuji, Hiroyoshi Isoda, Yuzo Kodama, Tsutomu Chiba

BioMed research international 2014 648021 - 648021 2014年 [査読有り] [国際誌]

OBJECTIVE: The objective was to investigate the relationship between prognosis in case of pancreatic cancer and perfusion in tissue surrounding pancreatic cancer using perfusion CT. METHODS: We enrolled 17 patients diagnosed with inoperable pancreatic adenocarcinoma. All patients were examined by perfusion CT and then underwent chemotherapy using gemcitabine. The time density curve (TDC) of each CT pixel was analyzed to calculate area under the curve (AUC) and blood flow (BF) using a mathematical algorithm based on the single-compartment model. To measure the AUC and BF of tumor (AUCT and BFT) and peritumoral tissue (AUCPTT and BFPTT), regions of interest were manually placed on the cancer and in pancreatic tissue within 10 mm of proximal pancreatic parenchyma. Survival days from the date of perfusion CT were recorded. Correlation between AUC or BF and survival days was assessed. RESULTS: We found a significant correlation between AUCPTT or BFPTT and survival days (P = 0.04 or 0.0005). Higher AUCPTT or BFPTT values were associated with shorter survival. We found no significant correlation between AUCT or BFT and survival. CONCLUSIONS: Our results suggest that assessments of perfusion in pancreatic tissue within 10 mm of proximal pancreatic parenchyma may be useful in predicting prognosis.

DOI PubMed

急性膵炎におけるInnate Immunity

渡邉智裕, 辻喜久, 千葉勉

膵臓 ( 一般社団法人日本膵臓学会 ) 29 ( 1 ) 45 - 50 2014年 [査読有り] [招待有り]

膵臓腺房細胞におけるTrypsinogenを中心とする膵酵素の過剰な活性化とそれに引き続く膵組織の自己消化が急性膵炎の発症に中心的な役割を果たすと考えられてきた．しかしながら，Trypsinogenの発現が極めて低い状況下においても，急性膵炎が誘導されることが報告され，急性膵炎の発症にはTrypsinogenの活性化に加えて，様々な免疫反応が関与することが示唆されている．膵炎発症モデルマウスを用いた最近の研究により，急性膵炎の発症には自然免疫反応が関与することが示唆されている．急性膵炎の発症に伴い，膵組織へ移行する腸内細菌や膵組織の壊死に伴って放出される内因性自己抗原が自然免疫活性化分子として機能し，宿主の自然免疫反応受容体を活性化し，急性膵炎の病態形成に重要な役割を果たすことが明らかになっている．

DOI CiNii J-GLOBAL

重症急性膵炎に対するPerfusion CTのアルゴリズム毎の有用性に関する検討

吉田司, 三谷洋介, 熊谷健, 松枝和宏, 山本博, 辻喜久, 渡邊祐司

倉敷中央病院年報 76 2014年

J-GLOBAL

膵perfusion CTの現状と今後

辻喜久

Japanese Journal of Diagnostic Imaging 32 ( 1 ) 2014年 [査読有り]

J-GLOBAL

Pancreatic Blood Flow Measurements in the Pig Pancreatitis Model Using Perfusion CT with Deconvolution Method

Yoshihisa Tsuji, Kazutaka Yamada, Miori Kisimoto, Shujiro Yazumi, Hiroyoshi Isoda, Tsutomu Chiba

ABDOMINAL IMAGING: COMPUTATIONAL AND CLINICAL APPLICATIONS ( SPRINGER-VERLAG BERLIN ) 8676 94 - 102 2014年 [査読有り]

Introduction: We compared pancreatic blood flow (PBF) measured by perfusion CT with deconvolution method and Laser Doppler Flow (LDF) to determine whether uncollected contrast material from the pancreas affects measurement of perfusion CT, using porcine pancreatitis model (n = 7). Materials and Methods: The pancreas was divided into head and tail. We arranged that PBF of tail was circulated by single input/output vessel. Ischemic pancreatitis was induced to tail, shutting off input/output vessel for 30 min. PBF was measured both by perfusion CT with deconvolution method and LDF, during the overall course. We calculated uncollected ratio of contrast material, assuming area-under-curve differences between the input and output vessels correspond to uncollected. Results: tail PBF measured by perfusion CT with deconvolution was significantly correlated with LDF, despite of pancreatitis (P < 0.05). The uncollected ratio was 19 %. Discussion: Although the uncollected ratio was not few, result of perfusion CT was significantly related with LDF.

DOI

Risk of cancer in patients with autoimmune pancreatitis.

Masahiro Shiokawa, Yuzo Kodama, Kenichi Yoshimura, Chiharu Kawanami, Jun Mimura, Yukitaka Yamashita, Masanori Asada, Masataka Kikuyama, Yoshihiro Okabe, Tetsuro Inokuma, Masaya Ohana, Hiroyuki Kokuryu, Kazuo Takeda, Yoshihisa Tsuji, Ryuki Minami, Yojiro Sakuma, Katsutoshi Kuriyama, Yuji Ota, Wataru Tanabe, Takahisa Maruno, Akira Kurita, Yugo Sawai, Norimitsu Uza, Tomohiro Watanabe, Hironori Haga, Tsutomu Chiba

The American journal of gastroenterology 108 ( 4 ) 610 - 7 2013年04月 [査読有り] [国際誌]

OBJECTIVES: Although simultaneous occurrences of autoimmune pancreatitis (AIP) and cancer are occasionally observed, it remains largely unknown whether cancer and AIP occur independently or these disorders are interrelated. The aim of this study was to examine the relationship between AIP and cancer. METHODS: We conducted a multicenter, retrospective cohort study. One hundred and eight patients who met the Asian diagnostic criteria for AIP were included in the study. We calculated the proportion, standardized incidence ratio (SIR), relative risk, and time course of cancer development in patients with AIP. We also analyzed the clinicopathological characteristics of AIP patients with cancer in comparison with those without cancer. RESULTS: Of the 108 AIP patients, 18 cancers were found in 15 patients (13.9%) during the median follow-up period of 3.3 years. The SIR of cancer was 2.7 (95% confidence interval (CI) 1.4-3.9), which was stratified into the first year (6.1 (95% CI 2.3-9.9)) and subsequent years (1.5 (95% CI 0.3-2.8)) after AIP diagnosis. Relative risk of cancer among AIP patients at the time of AIP diagnosis was 4.9 (95% CI 1.7-14.9). In six of eight patients whose cancer lesions could be assessed before corticosteroid therapy for AIP, abundant IgG4-positive plasma cell infiltration was observed in the cancer stroma. These six patients experienced no AIP relapse after successful cancer treatment. CONCLUSIONS: Patients with AIP are at high risk of having various cancers. The highest risk for cancer in the first year after AIP diagnosis and absence of AIP relapse after successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.

DOI PubMed

Technique and clinical applications of hepatic perfusion ct with dual-input algorithms

Sho Koyasu, Yoshihisa Tsuji

Computed Tomography: New Research ( Nova Science Publishers, Inc. ) 65 - 73 2013年03月

Perfusion computed tomography (CT) is a new technology used to evaluate tissue hemodynamics. More specifically, Perfusion CT is a technique used to obtain a time density curve (TDC) of targeted tissue from an image dataset of dynamic contrasted enhanced CT to measure several perfusion parameters in normal and pathologic tissue in patients with liver disease (e.g., malignant and inflammatory disease). Since liver perfusion involves two input vessels, the hepatic artery and portal vein, we must measure hepatic arterial and portal perfusion separately to truly evaluate hepatic perfusion. Actually, advanced perfusion algorithms that measure hepatic perfusion require both TDCs for administered contrast material in the hepatic artery and portal vein. This chapter reviews the techniques and clinical applications of hepatic perfusion CT based on dual-input algorithms. © 2013 Nova Science Publishers, Inc. All rights reserved.

Relationship between pancreatic perfusion parameters and clinical complications of severe acute pancreatitis.

Tsubasa Watanabe, Yoshihisa Tsuji, Naoki Takahashi, Tsukasa Yoshida, Masashi Tamaoki, Osamu Kikuchi, Yuji Watanabe, Yuzo Kodama, Hiroyoshi Isoda, Hiroshi Yamamoto, Tsutomu Chiba

Pancreas 42 ( 1 ) 180 - 2 2013年01月 [査読有り] [国際誌]

DOI PubMed

原発性硬化性胆管炎として長期経過観察されたIgG4関連硬化性胆管炎の3例

南竜城, 栗田亮, 栗山勝利, 佐久間洋二朗, 大田悠司, 田邊渉, 丸野貴久, 塩川雅広, 澤井勇悟, 辻喜久, 宇座徳光, 児玉裕三

胆道 27 ( 3 ) 2013年

J-GLOBAL

Sensing of commensal organisms by the intracellular sensor NOD1 mediates experimental pancreatitis.

Yoshihisa Tsuji, Tomohiro Watanabe, Masatoshi Kudo, Hidenori Arai, Warren Strober, Tsutomu Chiba

Immunity 37 ( 2 ) 326 - 38 2012年08月 [査読有り] [国際誌]

The intracellular sensor NOD1 has important host-defense functions relating to a variety of pathogens. Here, we showed that this molecule also participates in the induction of a noninfectious pancreatitis via its response to commensal organisms. Pancreatitis induced by high-dose cerulein (a cholecystokinin receptor agonist) administration depends on NOD1 stimulation by gut microflora. To analyze this NOD1 activity, we induced pancreatitis by simultaneous administration of a low dose of cerulein (that does not itself induce pancreatitis) and FK156, an activator of NOD1 that mimics the effect of gut bacteria that have breached the mucosal barrier. The pancreatitis was dependent on acinar cell production of the chemokine MCP-1 and the intrapancreatic influx of CCR2(+) inflammatory cells. Moreover, MCP-1 production involved activation of the transcription factors NF-κB and STAT3, each requiring complementary NOD1 and cerulein signaling. These studies indicate that gut commensals enable noninfectious pancreatic inflammation via NOD1 signaling in pancreatic acinar cells.

DOI PubMed

Hepatic arterial perfusion increases in the early stage of severe acute pancreatitis patients: evaluation by perfusion computed tomography.

Sho Koyasu, Hiroyoshi Isoda, Yoshihisa Tsuji, Hiroshi Yamamoto, Kazuhiro Matsueda, Yuji Watanabe, Tsutomu Chiba, Kaori Togashi

European journal of radiology 81 ( 1 ) 43 - 6 2012年01月 [査読有り] [国際誌]

PURPOSE: Although hepatic perfusion abnormalities have been reported in patients with acute pancreatitis, hepatic perfusion with severe acute pancreatitis (SAP) has not been quantitatively evaluated in humans. Therefore, we investigated hepatic perfusion in patients with SAP using perfusion CT. MATERIALS AND METHODS: Hepatic perfusion CT was performed in 67 patients with SAP within 3 days after symptom onset. The patients were diagnosed as having SAP according to the Atlanta criteria. Fifteen cases were established as a control group. Perfusion CT was obtained for 54s beginning with a bolus injection of 40 ml of contrast agent (600-630 mgI/kg) at a flow rate of 4 ml/s. Perfusion data were analyzed by the dual-input maximum slope method to obtain hepatic arterial perfusion (HAP) and hepatic portal perfusion (HPP). Finally, we compared HAP and HPP in SAP patients with those in the control group, respectively. RESULTS: Average HAP was significantly higher in SAP patients than in the control group (75.1 ± 38.0 vs. 38.2 ± 9.0 ml/min/100ml; p<0.001). There was no significant difference in average HPP between SAP patients and the control group (206.7 ± 54.9 vs. 204.4 ± 38.5 ml/min/100ml; p=0.92). CONCLUSION: Using quantitative analysis on perfusion CT, we first demonstrated an increase of HAP in the right hepatic lobe in SAP patients.

DOI PubMed

膵血流解析による自己免疫性膵炎と膵癌の鑑別

廣田衛久, 滝川哲也, 林晋太郎, 三浦晋, 千葉勉, 正宗淳, 下瀬川徹, 津田雅視, 辻喜久, 菅野敦, 菊田和宏, 粂潔, 濱田晋, 海野純, 有賀宏之

膵臓 ( 日本膵臓学会 ) 27 ( 4 ) 601 - 607 2012年

自己免疫性膵炎（AIP）は膵癌（PC）との鑑別が臨床上の問題である．本研究では，Perfusion CTによる膵血流解析が両者の鑑別に有用であるかを検討した．AIP 12症例（全例type 1）とPC 22症例にPerfusion CTを施行し，single-compartment kinetic model法を用いて画像解析を行い，3つのパラメータを用いて両者を比較した．F_V値はAIPで平均81.3/分に対しPCでは平均19.3/分と有意に低値（p=0.0005），V_D値はAIPが28.8に対しPCでは93.6と有意に高値（p=0.0084），R²値はAIPが0.659に対しPCでは0.250と有意に低値（p<0.0001）であった．また，カラーマップ画像も鑑別に有用であった．本研究は，AIPとPCの鑑別におけるPerfusion CTの有用性を示す最初の報告である．

DOI CiNii J-GLOBAL

Perfusion computed tomography findings of autoimmune pancreatitis.

Morihisa Hirota, Masashi Tsuda, Yoshihisa Tsuji, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Jun Unno, Hiromichi Ito, Hiroyuki Ariga, Tsutomu Chiba, Atsushi Masamune, Kennichi Satoh, Tooru Shimosegawa

Pancreas 40 ( 8 ) 1295 - 301 2011年11月 [査読有り] [国際誌]

OBJECTIVES: The aim of this study was to clarify the pancreatic blood perfusion in patients with autoimmune pancreatitis (AIP) and the changes after steroid treatment. METHODS: Perfusion computed tomography was performed in 11 patients with AIP and 12 control subjects. Pancreatic volumetric blood flow (F(V)), volume of distribution (V(D)), and blood transit time τ were determined from a single-compartment kinetic model. Nine patients with AIP were reexamined by perfusion computed tomography after corticosteroid administration. RESULTS: The pancreatic F(V) values of the 11 patients with AIP (82.7/min) were significantly lower than those of control subjects (163.5/min, P = 0.0006). On the other hand, the pancreatic V(D) and τ values were not significantly different between AIP and normal. After steroid treatment, the F(V) values of 9 reexamined patients with AIP (76.2/min) were significantly elevated (109.8/min, P = 0.0391). However, the changes of the values after the treatment differed in degree among individuals. The values of 4 patients were dramatically elevated to greater than 100/min, whereas those of 4 other patients did not improve well. The value of the remaining patient whose initial F(V) value was normal (168.09/min) did not change after the treatment. CONCLUSIONS: Pancreatic volumetric perfusion was attenuated in AIP patients. The perfusion was improved after the steroid treatment.

DOI PubMed

Relationship between serum angiopoietin-2 level and perfusion CT parameters in severe acute pancreatitis.

Tsubasa Watanabe, Yoshihisa Tsuji, Yuzo Kodama, Hiroyoshi Isoda, Hiroshi Yamamoto, Tsutomu Chiba

The American journal of gastroenterology 106 ( 10 ) 1859 - 61 2011年10月 [査読有り] [国際誌]

DOI PubMed

【膵疾患画像診断における最近の進歩】重症急性膵炎発症早期における"可逆性-非可逆性膵虚血"の診断

辻喜久, 渡邉翼, 塩川雅広, 栗田亮, 澤井勇悟, 上野憲司, 塩せいじ, 宇座徳光, 児玉裕三, 小泉幸司, 磯田裕義, 渡邊祐司, 山本博, 千葉勉

膵臓 ( 日本膵臓学会 ) 26 ( 1 ) 59 - 65 2011年02月 [査読有り]

[背景と目的]脳虚血性疾患では、虚血領域は2種類に分けられ、壊死に至る不可逆性の領域と、虚血であるものの治療によって壊死することなく治癒する可逆性虚血領域である。今回、重症急性膵炎にPerfusion CTを用いれば、可逆性虚血領域が診断できるか検討した。[方法]発症3日以内に、Perfusion CTを撮像した71人の重症急性膵炎患者を対象とした。全ての膵実質を、頭部、体部、尾部に分け、膵血流速度(FV)、膵血流量(VD)をPerfusion CT(Single compartment kinetic model)にて測定した。3週間後に造影CTを行い、頭部、体部、尾部がそれぞれ壊死したか診断した。[結果]発症早期に、FV、VDどちらも低下している場合、高率に壊死した。発症早期に、FV、VD片方だけ低下している場合、壊死する場合もあれば、回復する場合もあった。発症早期に、FV、VDどちらも低下していなければ壊死しなかった。[考察]発症早期にFV、VDどちらも低下した実質は高率に壊死し、このような実質は不可逆性膵虚血/早期壊死であると考えられた。単一のParameterのみ低下した実質は、必ずしも壊死しない場合があり、こうした実質は可逆性膵虚血である場合があると考えられた。以上から、複数のPerfusion Parameterを用いることで、可逆性-非可逆性膵虚血を診断しうる可能性があると考えられたが、こうしたPerfusion CTの所見と病理との比較や、用語の定義など、今後の課題であると考えられた。(著者抄録)

DOI CiNii J-GLOBAL

Measurement of canine pancreatic perfusion using dynamic computed tomography: influence of input-output vessels on deconvolution and maximum slope methods.

Miori Kishimoto, Yoshihisa Tsuji, Nana Katabami, Junichiro Shimizu, Ki-Ja Lee, Toshiroh Iwasaki, Yoh-Ichi Miyake, Shujiro Yazumi, Tsutomu Chiba, Kazutaka Yamada

European journal of radiology 77 ( 1 ) 175 - 81 2011年01月 [査読有り] [国際誌]

OBJECTIVE: We investigated whether the prerequisite of the maximum slope and deconvolution methods are satisfied in pancreatic perfusion CT and whether the measured parameters between these algorithms are correlated. METHODS: We examined nine beagles injected with iohexol (200 mgI kg(-1)) at 5.0 ml s(-1). The abdominal aorta and splenic and celiac arteries were selected as the input arteries and the splenic vein, the output veins. For the maximum slope method, we determined the arterial contrast volume of each artery by measuring the area under the curve (AUC) and compared the peak enhancement time in the pancreas with the contrast appearance time in the splenic vein. For the deconvolution method, the artery-to-vein collection rate of contrast medium was calculated. We calculated the pancreatic tissue blood flow (TBF), tissue blood volume (TBV), and mean transit time (MTT) using both algorithms and investigated their correlation based on vessel selection. RESULTS: The artery AUC significantly decreased as it neared the pancreas (P<0.01). In all cases, the peak time of the pancreas (11.5±1.6) was shorter than the appearance time (14.1±1.6) in the splenic vein. The splenic artery-vein combination exhibited the highest collection rate (91.1%) and was the only combination that was significantly correlated between TBF, TBV, and MTT in both algorithms. CONCLUSION: Selection of a vessel nearest to the pancreas is considered as a more appropriate prerequisite. Therefore, vessel selection is important in comparison of the semi-quantitative parameters obtained by different algorithms.

DOI PubMed

重症急性膵炎とnon-occlusive mesenteric ischemia

辻喜久, 辻喜久, 山本博, 能登原憲司, 児玉祐三, 千葉勉

日本腹部救急医学会雑誌 ( 日本腹部救急医学会 ) 31 ( 7 ) 1029 - 1037 2011年 [査読有り]

重症急性膵炎に非閉塞性腸間膜虚血症（non occlusive mesenteric ischemia：NOMI）を併発すると，予後不良である。また，重症急性膵炎におけるNOMI併発の機序など，いまだ不明な部分も多い。近年，重症急性膵炎患者における血管攣縮関連因子（angiopoietin-2, エンドセリン-1，VEGFなど）や凝固関連因子（ADAMTS13など）の異常が報告されており，NOMIとの関連が推測される。一方，NOMIの病理像については，不明な点が多い。われわれの経験では，虚血に由来した腸管のダメージが腸管の各所に不連続に偏在しており，NOMIの病理像の特徴の一つと考えられた。また，NOMIの診断方法は，血管撮影検査がgolden standardであるが，簡便な検査とはいいがたい。一方，われわれの肝perfusion CT検査を用いた研究では，肝血流障害がNOMIに併発することが明らかになり，肝血流を指標としてNOMIを診断できる可能性があると考えられた。最後に，こうした重症急性膵炎におけるNOMI発症の機序や病理像，診断方法の理解から，現在のわれわれの治療方針について報告する。

DOI CiNii J-GLOBAL

Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis.

Yoshihisa Tsuji, Kyoko Hamaguchi, Yuji Watanabe, Akira Okumura, Hiroyoshi Isoda, Naoki Yamamoto, Osamu Kikuchi, Hiroyuki Yamamoto, Kazuhiro Matsueda, Kenji Ueno, Shinsuke Tada, Kaori Togashi, Hiroshi Yamamoto, Tsutomu Chiba

Journal of gastroenterology 45 ( 11 ) 1155 - 62 2010年11月 [査読有り] [国内誌]

BACKGROUND: We performed perfusion computed tomography (P-CT) and angiography of the pancreas in patients with severe acute pancreatitis (SAP) and compared the usefulness of these two methods in predicting the development of pancreatic necrosis. METHODS: We compared P-CT and angiography results taken within 3 days after symptom onset in 21 SAP patients. We divided the pancreas into three areas, the head, body, and tail, and examined each area for perfusion defects (via P-CT) and arterial vasospasms (by angiography). Three weeks later, all patients underwent contrast-enhanced CT to determine whether pancreatic necrosis had developed. RESULTS: Of the 21 SAP patients, 16 exhibited perfusion defects, while 17 proved positive for vasospasms in at least one area. Fourteen patients developed pancreatic necrosis. Of the 63 pancreatic areas from the 21 SAP patients, perfusion defects appeared in 25 areas (39.7%), 24 of which showed vasospasms (96.0%). Angiography showed 33 areas with vasospasms (52.4%), of which 24 showed perfusion defects (72.7%). Of the 25 areas with perfusion defects, 21 developed pancreatic necrosis (84.0%). Of the 33 areas with vasospasms, 21 developed necrosis (63.6%). Pancreatic necrosis developed only in the areas positive both for perfusion defects and for vasospasms. No areas without perfusion defect or vasospasms developed pancreatic necrosis. P-CT predicted the development of pancreatic necrosis with significantly higher accuracy than angiography. CONCLUSION: While both P-CT and angiography are useful in predicting the development of pancreatic necrosis in patients with SAP, P-CT appears to be more accurate for this purpose.

DOI PubMed CiNii

NOD1 contributes to mouse host defense against Helicobacter pylori via induction of type I IFN and activation of the ISGF3 signaling pathway.

Tomohiro Watanabe, Naoki Asano, Stefan Fichtner-Feigl, Peter L Gorelick, Yoshihisa Tsuji, Yuko Matsumoto, Tsutomu Chiba, Ivan J Fuss, Atsushi Kitani, Warren Strober

The Journal of clinical investigation 120 ( 5 ) 1645 - 62 2010年05月 [査読有り] [国際誌]

Nucleotide-binding oligomerization domain 1 (NOD1) is an intracellular epithelial cell protein known to play a role in host defense at mucosal surfaces. Here we show that a ligand specific for NOD1, a peptide derived from peptidoglycan, initiates an unexpected signaling pathway in human epithelial cell lines that results in the production of type I IFN. Detailed analysis revealed the components of the signaling pathway. NOD1 binding to its ligand triggered activation of the serine-threonine kinase RICK, which was then able to bind TNF receptor-associated factor 3 (TRAF3). This in turn led to activation of TANK-binding kinase 1 (TBK1) and IkappaB kinase epsilon (IKKepsilon) and the subsequent activation of IFN regulatory factor 7 (IRF7). IRF7 induced IFN-beta production, which led to activation of a heterotrimeric transcription factor complex known as IFN-stimulated gene factor 3 (ISGF3) and the subsequent production of CXCL10 and additional type I IFN. In vivo studies showed that mice lacking the receptor for IFN-beta or subjected to gene silencing of the ISGF3 component Stat1 exhibited decreased CXCL10 responses and increased susceptibility to Helicobacter pylori infection, phenotypes observed in NOD1-deficient mice. These studies thus establish that NOD1 can activate the ISGF3 signaling pathway that is usually associated with protection against viral infection to provide mice with robust type I IFN-mediated protection from H. pylori and possibly other mucosal infections.

DOI PubMed

The radiological exposure of pancreatic perfusion computed tomography.

Yoshihisa Tsuji, Koji Koizumi, Hiroyoshi Isoda, Kenji Ueno, Shinsuke Tada, Tsutomu Chiba, Ryuichirou Doi

Pancreas 39 ( 4 ) 541; author reply 541-3 2010年05月 [査読有り] [国際誌]

DOI PubMed

重症急性膵炎に合併したNOMIの病理所見と治療選択についての考察

辻喜久, 辻喜久, 能登原憲司, 山本博, 千葉勉

日本消化器病学会雑誌 107 2010年

J-GLOBAL

Perfusion CTによる自己免疫性膵炎と膵癌の鑑別

廣田衛久, 辻喜久, 下瀬川徹

日本消化器病学会雑誌 107 2010年

J-GLOBAL

重症急性膵炎発症早期における“Ischemia penumbra”について

辻喜久, 山本博, 千葉勉

日本消化器病学会雑誌 107 2010年

J-GLOBAL

膵蔵Perfusion-CTにおける装置間の違い-自作ファントムにおける検討-

梶谷尊郁, 辻喜久, 山本浩之, 森山一郎, 矢田伸広, 氏平武樹, 奥井彰二, 小松明夫

日本放射線技術学会雑誌 66 ( 9 ) 2010年

J-GLOBAL

急性膵炎の重症化に関わる自然免疫担当分子の同定とその分子機序の解明

辻喜久, 渡邉智裕, 千葉勉

日本消化器病学会雑誌 107 2010年

J-GLOBAL

Spontaneous rupture of liver plasmacytoma mimicking hepatocellular carcinoma.

Kosuke Ueda, Hiroyuki Matsui, Tomohiro Watanabe, Junya Seki, Tatsuo Ichinohe, Yoshihisa Tsuji, Kayoko Matsumura, Yugo Sawai, Hiroshi Ida, Yoshihide Ueda, Tsutomu Chiba

Internal medicine (Tokyo, Japan) 49 ( 7 ) 653 - 7 2010年 [査読有り] [国内誌]

Extramedullary plasmacytoma of the liver is rare. Here, we report a case presenting with rupture of extramedullary plasmacytoma of the liver. She had a past history of multiple myeloma with IgA lambda type. Her serum was positive for hepatitis C virus infection and exhibited elevated levels of serum protein induced by vitamin K absence or antagonist-II. She was initially diagnosed as rupture of hepatocellular carcinoma (HCC) and then treated with transarterial chemoembolization (TACE) since bloody ascites and formation of hematoma were seen around hyper-vascular liver tumors on computed tomography. However, the clinical course of this case after TACE was atypical for HCC rupture, as shown by the development of a huge intra-abdominal abscess extending from the liver tumor. Immuno-histochemical analysis of the tumor biopsy specimen revealed massive infiltration of plasma cells expressing IgA and lambda chain. To our knowledge, this is the first case of rupture of extramedullary liver plasmacytoma.

PubMed

Colonic polyposis associated with autoimmune pancreatitis.

Hiroyuki Matsui, Tomohiro Watanabe, Kenji Ueno, Satoru Ueno, Yoshihisa Tsuji, Kayoko Matsumura, Masato Nakatsuji, Yoshihide Ueda, Tsutomu Chiba

Pancreas 38 ( 7 ) 840 - 2 2009年10月 [査読有り] [国際誌]

DOI PubMed

Massive jejunal bleeding due to Heyde syndrome successfully treated with double balloon endoscopy.

Sakiko Ohta, Tomohiro Watanabe, Shuko Morita, Satoru Ueno, Yoshihisa Tsuji, Hiroshi Nakase, Tsutomu Chiba

Clinical journal of gastroenterology 2 ( 3 ) 187 - 189 2009年06月 [査読有り] [国内誌]

There is a well-documented relationship between aortic valve stenosis and recurrent gastrointestinal bleeding from angiodysplasia in elderly patients, called Heyde syndrome. We report a case of Heyde syndrome with massive jejunal bleeding. Capsule endoscopy showed bleeding from jejunal angiodysplasia. Spurting bleeding from jejunal angiodysplasia was identified and treated by double balloon endoscopy. No gastrointestinal bleeding was seen after the endoscopic treatment and aortic valve replacement was performed. This case suggests that capsule endoscopy and double balloon endoscopy were very useful for the diagnosis and treatment of small intestinal bleeding due to Heyde syndrome.

DOI PubMed

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.

DOI PubMed

重症急性膵炎症例における腹部臓器血流障害

辻喜久, 山本博, 千葉勉

日本消化器病学会雑誌 106 2009年

J-GLOBAL

ヒストン脱アセチル化阻害剤による胆道癌細胞株におけるRUNX3発現回復およびTGF-β経路の活性化

塩せいじ, 依田広, 多田真輔, 長谷川和範, 辻喜久, 上野憲司, 八隅秀二郎, 千葉勉

日本消化器病学会雑誌 106 2009年

J-GLOBAL

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

J-GLOBAL

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.

DOI PubMed

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]

DOI PubMed

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.

DOI PubMed

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]

PubMed

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.

PubMed

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]

J-GLOBAL

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]

PubMed

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

J-GLOBAL

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

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

J-GLOBAL

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

J-GLOBAL

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

J-GLOBAL

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.

PubMed

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

J-GLOBAL

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

J-GLOBAL

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