Trousseau's Syndrome Causing Refractory Deep Venous Thrombosis.

A 66-year-old man, who had been diagnosed with deep venous thrombosis (DVT), and who was treated with a vitamin K antagonist (VKA) and who had undergone the implantation of an inferior vena cava filter, was admitted due to an exacerbation of DVT. VKA was administered again; however, the patient's DVT worsened. Further examinations revealed colon cancer, which led to a diagnosis of Trousseau's syndrome. The regression of the thrombi was confirmed after the administration of heparin and the resection of the tumors. Trousseau's syndrome should always be kept in mind when patients present with refractory venous thrombosis. The administration of heparin, and cancer control are necessary for the effective treatment of thrombosis in such cases.

Hepatitis E virus subtype 3f strains isolated from Japanese hepatitis patients with no history of travel to endemic areas - The origin analyzed by molecular evolution.

Hepatitis E virus subtype 3f (HEV-3f) strains are usually isolated in Europe and Thailand. Recently, HEV-3f strains were detected from six acute hepatitis E patients in Japan, none of whom had a history of travel to endemic areas. We inferred the origin and transmission route of the six HEV-3f strains. A time-scaled phylogenetic tree of the six strains with reference strains was constructed using a Bayesian statistical inference framework. The time-scaled tree indicated that the six strains independently derived from similar European strains between 2008 and 2014. The pattern suggested recent inflow of multiple HEV-3f strains from Europe to Japan. Japan imports a substantial amount of pork from European countries every year. The emergence of acute hepatitis cases caused by HEV-3f strains in Japan, in patients with no history of travel abroad, might be influenced by the increased opportunities to consume pork products imported from European countries.

Changes in plasma ghrelin and leptin levels in patients with peptic ulcer and gastritis following eradication of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection and eradication therapy have been known to influence gastric ghrelin and leptin secretion, which may lead to weight gain. However, the exact relationship between plasma ghrelin/leptin levels and H. pylori infection has remained controversial. The aim of this study was to investigate plasma ghrelin and leptin levels in H. pylori-positive and -negative patients, to compare the two levels of the hormones before and after H. pylori eradication, and to examine the correlation between body mass index (BMI) and active ghrelin or leptin levels, as well as that between atrophic pattern and active ghrelin or leptin levels. METHODS: Seventy-two H. pylori-positive patients who underwent upper gastrointestinal endoscopy, 46 diagnosed as having peptic ulcer and 26 as atrophic gastritis, were enrolled. Control samples were obtained from 15 healthy H. pylori-negative volunteers. The extent of atrophic change of the gastric mucosa was assessed endoscopically. Body weight was measured and blood was collected before and 12 weeks after H. pylori eradication therapy. Blood samples were taken between 8 and 10 AM after an overnight fast. RESULTS: Plasma ghrelin levels were significantly lower in H. pylori-positive patients than in H. pylori-negative patients. In particular, plasma active ghrelin levels were significantly lower in patients with gastritis compared with patients with peptic ulcer. Plasma ghrelin levels decreased after H. pylori eradication in both peptic ulcer and gastritis patients, while plasma leptin levels increased only in peptic ulcer patients. Plasma leptin levels and BMI were positively correlated, and active ghrelin levels and atrophic pattern were weakly negatively correlated in peptic ulcer patients. CONCLUSION: H. pylori infection and eradication therapy may affect circulating ghrelin/leptin levels. This finding suggests a relationship between gastric mucosal injury induced by H. pylori infection and changes in plasma ghrelin and leptin levels.

Comparison of human gut microbiota in control subjects and patients with colorectal carcinoma in adenoma: Terminal restriction fragment length polymorphism and next-generation sequencing analyses.

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in Japan. The etiology of CRC has been linked to numerous factors including genetic mutation, diet, life style, inflammation, and recently, the gut microbiota. However, CRC-associated gut microbiota is still largely unexamined. This study used terminal restriction fragment length polymorphism (T-RFLP) and next-generation sequencing (NGS) to analyze and compare gut microbiota of Japanese control subjects and Japanese patients with carcinoma in adenoma. Stool samples were collected from 49 control subjects, 50 patients with colon adenoma, and 9 patients with colorectal cancer (3/9 with invasive cancer and 6/9 with carcinoma in adenoma) immediately before colonoscopy; DNA was extracted from each stool sample. Based on T-RFLP analysis, 12 subjects (six control and six carcinoma in adenoma subjects) were selected; their samples were used for NGS and species-level analysis. T-RFLP analysis showed no significant differences in bacterial population between control, adenoma and cancer groups. However, NGS revealed that i), control and carcinoma in adenoma subjects had different gut microbiota compositions, ii), one bacterial genus (Slackia) was significantly associated with the control group and four bacterial genera (Actinomyces, Atopobium, Fusobacterium, and Haemophilus) were significantly associated with the carcinoma-in-adenoma group, and iii), several bacterial species were significantly associated with each type (control: Eubacterium coprostanoligens; carcinoma in adenoma: Actinomyces odontolyticus, Bacteroides fragiles, Clostridium nexile, Fusobacterium varium, Haemophilus parainfluenzae, Prevotella stercorea, Streptococcus gordonii, and Veillonella dispar). Gut microbial properties differ between control subjects and carcinoma-in-adenoma patients in this Japanese population, suggesting that gut microbiota is related to CRC prevention and development.

[Physical diseases in alcoholism].

Rapid excessive alcohol drinking frequently causes disturbance of consciousness due to head trauma, brain edema, hypoglycemia, hyponatremia, hepatic coma and so on, provoked by acute alcohol intoxication. Rapid differential diagnosis and management are extremely important to save a life. On the other hands, the chronic users of alcohol so called alcoholism has many kinds of physical diseases such as liver diseases (i.e., fatty liver, alcoholic hepatitis, alcoholic liver cirrhosis and miscellaneous liver disease), diabetes mellitus, injury to happen in drunkenness, pancreas disease (i.e., acute and chronic pancreatitis and deterioration of chronic pancreatitis), gastrontestinal diseases (i.e., gastroduodenal ulcer), and so on. Enough attention should be paid to above mentioned diseases, otherwise they would turn worse more with continuation and increase in quantity of the alcohol. It should be born in its mind that the excessive drinking becomes the weapon threatening life.

Comparison of the gut microbiota composition between obese and non-obese individuals in a Japanese population, as analyzed by terminal restriction fragment length polymorphism and next-generation sequencing.

BACKGROUND: Obesity has become one of the most serious social problems in developed countries, including Japan. The relationship between the gut microbiota and obesity has recently attracted the attention of many researchers. Although the gut microbiota was long thought to contribute to obesity, the exact association remains largely unknown. We examined the human gut microbiota composition in a Japanese population in order to determine its relationship to obesity. METHODS: Stool samples from 23 non-obese subjects (body mass index [BMI] <20 kg/m(2)) and 33 obese subjects (BMI ≥25 kg/m(2)) were collected and DNA was extracted prior to colonoscopy. After terminal restriction fragment length polymorphism (T-RFLP) analysis, samples from 10 subjects (4 non-obese and 6 obese) were selected and subjected to next-generation sequencing for species-level analysis. RESULTS: T-RFLP analysis showed significantly reduced numbers of Bacteroidetes and a higher Firmicutes to Bacteroidetes ratio in obese subjects compared with non-obese subjects. Bacterial diversity was significantly greater in obese subjects compared with non-obese subjects. Next-generation sequencing revealed that obese and non-obese subjects had different gut microbiota compositions and that certain bacterial species were significantly associated with each group (obese: Blautia hydrogenotorophica, Coprococcus catus, Eubacterium ventriosum, Ruminococcus bromii, Ruminococcus obeum; non-obese: Bacteroides faecichinchillae, Bacteroides thetaiotaomicron, Blautia wexlerae, Clostridium bolteae, Flavonifractor plautii). CONCLUSION: Gut microbial properties differ between obese and non-obese subjects in Japan, suggesting that gut microbiota composition is related to obesity.

Surgical strategy for retrograde type A aortic dissection based on long-term outcomes.

BACKGROUND: The optimal management of a retrograde type A aortic dissection (RAAD) is controversial, and few reports have discussed the long-term outcomes of surgical strategies. To determine the most appropriate strategy, we studied the early and late outcomes of RAAD cases. METHODS: From 1998 to 2014, 44 patients with RAAD (mean age of 63 ± 11 years) underwent surgical repair. Ascending aortic replacement (AAR) was performed in 21 patients and ascending and total arch replacement (TAR) was performed in 23 patients. Eight of the patients who received TAR underwent complete resection of the primary tear in the distal arch or descending aorta (TAR-R[+]), whereas the remaining 15 patients received elephant trunk implantation as an alternative procedure for tear resection (TAR-R[-]). The early and late outcomes (mean follow-up, 86.5 months) were evaluated. RESULTS: Hospital mortality occurred in 4 of the 44 (9.1%) patients, with no mortalities among the patients undergoing TAR-R[-]. There was a tendency toward a higher incidence of late aorta-related events in the AAR group, with a significantly higher patency rate of the false lumen in the proximal site of the residual aorta compared with the TAR group (p = 0.009). Furthermore, the 5-year rate of freedom from aortic growth greater than 50 mm was significantly lower after AAR than after TAR (p = 0.04). A multivariate analysis indicated that the initial ascending aortic diameter (odds ratio [OR], 1.5; p = 0.02) and AAR (OR, 29.1; p = 0.01) were independent predictors of late aortic expansion. CONCLUSIONS: The surgical outcomes were acceptable in both the AAR and TAR groups. The long-term outcomes potentially support the aggressive adoption of TAR in relatively younger patients with significant ascending aortic enlargement at presentation.

B-mode ultrasound with algorithm based on statistical analysis of signals: evaluation of liver fibrosis in patients with chronic hepatitis C.

OBJECTIVE: The purpose of this study was to evaluate the degree of liver fibrosis in patients with chronic hepatitis C by use of a method in which the homogeneity of the tissue texture of the liver on B-mode ultrasound images is analyzed on the basis of results of a statistical chi-square test of the echo amplitudes. The method includes an algorithm for removing small structures, such as cross sections of the thin vessels, in the background texture to minimize differences in analysis results between users. SUBJECTS AND METHODS: Analysis was performed on images of 148 patients with histologically proven chronic hepatitis C without cirrhosis. The peak value of the C(m)(2) (modified chi-square distribution) histogram was calculated from B-mode ultrasound images, and the resulting value was compared with the histologic fibrosis grade. RESULTS: The peak C(m)(2) histogram value for grade F3 fibrosis was higher than that for grades F0 and F1 (p < 0.0001) and F2 (p = 0.0003). The value for grade F2 was higher than that for grades F0 and F1 (p = 0.0027). The values gradually increased with an increase in liver fibrosis grade, although no difference was found between grades F0 and F1. CONCLUSION: The grades of liver fibrosis in patients with chronic hepatitis C are well discriminated with the B-mode ultrasound-based analysis algorithm without discrimination between grades F0 and F1. Findings on conventional ultrasound images may reflect progression of liver fibrosis even in the absence of cirrhosis.

Transcatheter arterial embolization and extrabeam radiation therapy for subcutaneous seeding of hepatocellular carcinoma by percutaneous ethanol injection.

A 74-year-old man with a hepatocellular carcinoma received percutaneous ethanol injection twice following the needle biopsy of the tumor. Two years and 6 months after percutaneous ethanol injection, a subcutaneous tumor, which appeared to be a needle tract seeding by percutaneous ethanol injection, was recognized in the right lower anterior chest wall. A curative surgical resection was impossible because of the patient's decreased coagulopathy and severe liver dysfunction. The disseminated tumor was treated with extrabeam radiotherapy (20 fractions; total dose of 50 grays) followed by transcatheter arterial embolization by means of superselective catherization. The size of the subcutaneous tumor was decreased to about 15 mm in diameter. Contrast medium enhanced computed tomography demonstrated no enhancement in the tumor. The patient is currently doing well without further recurrence of hepatocellular carcinoma and without enlargement of the subcutaneous tumor after extrabeam radiation therapy and transcatheter arterial embolization.

Hepatic angiosarcoma mimicking cavernous hemangioma on angiography.

A 60-year-old woman was admitted to our department for evaluation of a hepatic mass. The mass was diagnosed as a hemangioma of the liver by abdominal angiography because of typical cotton wool appearance and stretched arterial vessels and no peripheral staining. However, one month later, the mass was surgically removed because of extravasation. Histological findings of a specimen of the mass revealed that it entirely contained abundant necrotic tissue, and a small residual part after transcatheter arterial embolization was consistent with hemangioma. However, she complained of hemoptysis and thigh pain after several weeks. Computed tomography revealed multiple lung masses and a mass of right musculus gluteus medius. Reexamined histological findings of the liver tumor showed hemangiosarcoma. We should pay attention to the fact that it is sometimes difficult to differentiate cavernous hemangioma from angiosarcoma by angiography.