[Usefulness of ultrasonography for diagnosis and treatment in case of superior mesenteric artery (SMA) syndrome].

A 37-year-old man, who had been admitted to another facility because of integration dysfunction syndrome suffered from postprandial epigastric pain, vomiting and weight loss. He was referred to our hospital for further examinations and treatment. Ultrasound examination revealed gastric and duodenal dilatation, reduction of the distance between the superior mesenteric artery (SMA) and aorta and to-and-fro movement in his duodenum, suggesting SMA syndrome. Computed tomography and upper gastrointestinal tract examination also showed findings typical of SMA syndrome. We measured the SMA-aorta distance and the passage of duodenal contents in various body positions using ultrasound. He had to-and-fro movements in his duodenum in a supine, sitting, and left recumbent position. However, when examined in the right recumbent position, the SMA-aorta distance became longest, and intestinal juice flowed from the duodenum to the jejunum. He underwent postural therapy, maintaining a right recumbent position for 30 minutes after every meal, which improved his clinical symptoms.

[Large hepatocellular carcinoma successfully treated with transarterial chemoembolization using cisplatin].

A 83-year-old man was admitted to our hospital with a large hepatic tumor located in lateral segment. Alpha-fetoprotein was 7ng/ml, and protein induced by vitamin K deficiency and antagonist-II (PIVKA-II) was 50792mAU/ml. The tumor was diagnosed as hepatocellular carcinoma (HCC) by angiographically assisted CT. No ascites was detected and major serological findings were T-Bil 0.7mg/dl, Alb 4.2g/dl, and PT 129%. Because of advanced age and a history of heart disease, he was treated with transarterial chemoembolization using cisplatin (Lip-TACE). The total dose was 128mg of cisplatin and 15ml of lipiodol. No adverse effects appeared. After the third session of Lip-TACE, the levels of PIVKA-II became negative and continued within the normal range for 26 months. We confirmed a decrease of HCC with lipiodol accumulation by abdominal CT, and the response rate was PR. He has been well for 3 years since the first Lip-TACE procedure.

Magnifying colonoscopy used to predict disease relapse in patients with quiescent ulcerative colitis.

BACKGROUND: Many patients with quiescent ulcerative colitis (UC) experience relapse. However, clinical and conventional colonoscopic signs are inadequate for predicting relapse. This study's aim was to investigate the effectiveness of magnifying colonoscopy in predicting relapse in patients with quiescent UC and to evaluate the association of the findings of magnifying colonoscopy with the histological findings. METHODS: Magnifying colonoscopy was performed in 57 patients with clinical and endoscopic inactive UC. Patients were divided into 3 groups according to the findings of magnifying colonoscopy as MR (magnify-regular), MI (magnify-irregular), and MD (magnify-defect). Their subsequent clinical course was compared to assess the clinical usefulness of magnifying observation in predicting relapse. We also compared histological findings according to Riley's criteria to each finding of magnifying colonoscopy. RESULTS: Within 12 months, 1 of 18 patients (6.7%), 10 of 22 patients (45.5%), and 12 of 17 patients (70.6%) with findings of magnifying colonoscopy of MR, MI, and MD, respectively, experienced relapse. The MR group had a significantly low relapse rate compared with the MD and MI groups (P = 0.016, P = 0.002). When histological findings were compared with the findings of magnifying colonoscopy, the mean score of each variable, such as acute inflammatory cell infiltrate, chronic inflammatory cell infiltrate, and crypt architectural irregularities was significantly lower in the MR group than in the MD and MI groups. CONCLUSIONS: The findings of magnifying colonoscopy in patients with quiescent UC is useful for predicting relapse and is associated with histological grade of inflammation.