ALTA コウカ リョウホウゴ ニ ダイ4 ノ ジ ドウミャク カラ シュッケツ サイハツ オ クリカエシタ 1 レイ

A６９-year-old man was referred to our hospital for aluminum potassium sulfate and tannic acid （ALTA）sclerosing therapy for bleeding internal hemorrhoids. After two months from the first ALTA sclerosing therapy, he had recurrence with bleeding on defecation. The ALTA injection on the left anterior hemorrhoidal artery（one o’clock position）stopped bleeding. One o’clock position hemorrhoidal artery existed in ５８．６％ and called fourth hemorrhoidal artery. We first recognized pulsation of hemorrhoidal artery by the Doppler ultrasound probe and then we performed ALTA sclerosing therapy

カントン ジカク ノ ホゾンテキ チリョウゴ ニ コンジ シュジュツ トシテ ＡＬＴＡ オ シコウ シタ 1 レイ

Aluminum potassium sulfate and tannic acid（ALTA）are able to induce noninvasive sclerosis and involution of hemorrhoids through initiation of inflammatory reaction. A７７-year-old man was admitted to our hospital for an incarcerated hemorrhoid. We first performed the conservative treatment. After three weeks, we performed ALTA sclerosing therapy. Although he had necrosis at the injection site and an anoderm ulcer on the１st post-operative day, he had few of pain and fever. He was cured on the３２nd post-operative day. Although he had recurrence on the３０６th post-operative day, we performed re-ALTA sclerosing therapy. After that, he had no relapse and had good quality of life. For incarcerated hemorrhoids, the ALTA sclerosing therapy might be performed after some period of the conservative treatment

ステロイド チョウキ トウヨ カンジャ ニオケル シュウジュツキ ステロイド カバー

In patients receiving chronic corticosteroid therapy, the adrenocortical function has decreased because of suppression of the hypothalamic-pituitary-adrenal axis. Under such a condition, it is easy to fall into a serious acute adrenocortical insufficiency during surgical stress. Corticosteroid supplementation is done as prevention of adrenocortical insufficiency. It is changing from corticosteroid supplementation of high dose into that of low dose that based on extrapolation from what constitutes a normal cortisol response to stress in recent years. On the other hand, some authors reported that patients receiving therapeutic doses of corticosteroids who undergo a surgical procedure do not routinely require corticosteroid supplementation so long as they continue to receive their usual daily dose of corticosteroid. Therefore, furthermore investigation should be necessary

フクブ ショクドウ チョウフクショウ ニ タイシ フククウキョウカ テキシュツジュツ オ シコウ シタ １レイ

A 9-year-old boy was admitted to the hospital for close exploration of cystic tumor of the esophagus ventral detected in the abdominal contrast CT scan during the investigation of hematuria. Upper gastrointestinal fluoroscopic and endoscopic examination with ultrasonography showed a cystic tumor with the diameter of 2cm and smooth surface in the abdominal esophagus. Laparoscopic surgery was performed under the diagnosis of abdominal esophageal duplication cyst. At surgery, the soft and well-defined mass was present in the abdominal esophagus ventral and continuous with the esophagus wall. Histopathological study showed the cystic wall was lined with the pseudostratified ciliated epithelium and subepithelial muscle layer. These findings indicated abdominal esophageal duplication cyst. He was discharged on postoperative day 8 with good postoperative course. Abdominal esophageal duplication cyst is a rare disease. Laparoscopic surgery, which has not seen attempted before this case, seems to be a useful treatment of abdominal esophageal duplication cyst

Abrogation of Rbpj attenuates uveoretinitis

Experimental autoimmune uveoretinitis (EAU) is an organ-specific T cell-mediated disease induced by immunizing mice with interphotoreceptor retinoid binding protein (IRBP). Autoaggressive CD4+ T cells are the major pathogenic population for EAU. We investigated the contribution of Notch signaling in T cells to EAU pathogenesis because Notch signaling regulates various aspects of CD4+ T cell functions. Rbpj is required for Notch signaling, and Rbpj deficiency in T cells inhibited EAU disease severity. The amelioration of EAU in T cell-specific Rbpj-deficient mice correlated with low levels of IL-22 production from CD4+ T cells, although IRBP-specific CD4+ T cell proliferation and Th17 differentiation were unaffected. Administration of recombinant IL-22 during the late phase, but not the early phase, of EAU increased EAU clinical scores in T cell-specific Rbpj-deficient mice. Notch inhibition in mice immunized with IRBP with a γ-secretase inhibitor (GSI) suppressed EAU progression, even when GSI was administered as late as 13 days after IRBP immunization. Our data demonstrate that Rbpj/Notch-mediated IL-22 production in T cells has a key pathological role in the late phase of EAU, and suggest that Notch blockade might be a useful therapeutic approach for treating EAU

Hepatic screlosed hemangioma which was misdiagnosed as metastasis of gastric cancer : report of a case

A screlosed hemangioma of the liver is rare among hepatic tumors. A 75 years old male was referred to our hospital for gastric cancer and a hepatic tumor. The histological finding of gastric cancer was revealed to be well differentiated adenocarcinoma. The liver tumor was 1.1×1.0 cm in size and located in segment 8 of the liver. Computed tomography (CT) showed it to be a tumor with ring enhancement. Magnetic resonance imaging (MRI) showed the tumor to have a low signal on T1-weighted and slightly high signal on T2-weighted images. Level of hemoglobin was 7.8 g/dl. It was thought to be persistent bleeding from gastric cancer. With diagnosis of liver metastasis from gastric cancer, chemotherapy is recommended. However, to control the bleeding from gastric cancer, we performed distal gastrectomy and wedge resection of liver (S8). The histological examination of the liver tumor revealed to be a hepatic sclerosed hemangioma with hyalinized tissue and collagen fibers. We report herein a case of the rare tumor which was misdiagnosed as a liver metastasis of gastric cancer

脂肪由来幹細胞の栄養因子を介した肝傷害に対しての保護効果

Background In this study we investigated whether adipose-derived stem cells (ADSCs) had any beneficial protective effects on liver injury and regeneration in vivo. Moreover, we examined whether ADSCs protect hepatocytes by trophic molecules. Materials and Methods We transplanted ADSCs into mice after 70% hepatectomy (Hx) and ischemia-reperfusion (I/R), and observed liver injury and regeneration after reperfusion. We co-cultured hepatocytes with ADSCs using a Transwell System for seven days and evaluated the viabilities of hepatocytes and the cytokine levels in the culture medium. Bevacizumab was used in order to confirm the effect of VEGF on hepatocytes. Results ADSCs improved serum liver function at six hours after reperfusion in a non-lethal model and stimulated liver regeneration at 24 hours after reperfusion in a lethal model. VEGF levels in the culture medium increased by co-culture ADSCs with hepatocytes. ADSCs improved the viabilities of hepatocytes. The inhibited production of VEGF by bevacizumab did not affect the viability of hepatocytes. Conclusions ADSCs were able to ameliorate liver injury and stimulate liver regeneration in subsequent Hx and I/R injured model mice. Furthermore, hepatocytes were protected by the trophic molecules of the ADSCs. However, such protective effects might be provided by mechanisms other than VEGF signaling

Clinical role of Foxp3+regulatory T cell in Living donor related liver transplantation for prediction of life-threatening complications

Purposes : It is no doubt that regulatory T cells (Foxp3+CD4+CD25+T cells : Treg) play important roles in transplant immunity.We investigated the significance of Treg expression in acute stage of living donorrelated liver transplantation (LDLT) for the possibility of the sensitive marker for immunological state and homeostatic stress after liver transplantation. Methods : Peripheral blood was drawn from 5 recipients of LDLT preoperatively and on post operative 1, 4, 7, and 14 days. The peripheral blood mononuclear cells (PBMCs) were stained with CD4, CD25, Foxp3, and were analyzed with FACScan. This data was compared with clinical output of LDLT. Result : The populations of Treg were significantly decreased in all patients on day 1 after LDLT and significantly increased in patients who had early postoperative complications compared with patients who had no complications. Conclusions : The population of Treg in peripheral blood may reflect the surgical stress such as life-threatening complications after LDLT

Atypically large well-differentiated hepatocellular carcinoma with extensive fatty metamorphosis : Report of a Case

A large well-differentiated hepatocellular carcinoma (HCC) with fatty change is rare, and to date only a few cases have been reported. Herein, we present a 68-year-old man who developed a well-differentiated HCC with extensive fatty metamorphosis. The patient was referred to our institute because of a rapidly growing tumor in the left lobe of the liver. Ultrasonography showed a hyperechoic lesion with a peripheral hypoechoic area. Dynamic contrast-enhanced computed tomography (CT) scan in all three phases revealed the tumor which showed diffuse low attenuation with internal irregular enhancement. He underwent left lateral segmentectomy at the liver. Histological diagnosis confirmed well-differentiated HCC and the surrounding non-cancerous area was diagnosed as non-alcoholic steatohepatitis. The patient is still alive without recurrence after 17 months of follow-up