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Akitaka Shibuya

Publications and source records attributed to Akitaka Shibuya.

14 recordsLinked to original sources
PubMed2006

Biliary tuberculosis causing cicatricial stenosis after oral anti-tuberculosis therapy.

A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction (PCR) testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage (EBD) tubes and percutaneous transhepatic biliary drainage (PTBD) tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of post-treatment cicatricial stenosis, although it is rare.

Administration, Oral↗
PubMed2005

Cellular and stromal characteristics in the scirrhous hepatocellular carcinoma: comparison with hepatocellular carcinomas and intrahepatic cholangiocarcinomas.

Scirrhous hepatocellular carcinoma (SHCC) is a rare variation of HCC, for which characteristics of tumor cells and the fibrotic stroma have not been clarified in detail. The present study was therefore carried out to elucidate cytological features of tumor and stromal cells and components of the stromal extracellular matrix in 15 SHCC patients undergoing hepatectomy without preoperative transarterial embolization. Diagnosis was on the basis of a scirrhous histological pattern exceeding 50% of the tumor area. Expression of cytoplasmic and extracellular matrix proteins was compared among SHCC, HCC and intrahepatic cholangiocarcinoma (ICC) cases with immunohistochemical staining. The lesions could be histologically divided into radiating and sinusoidal types. Common stromal components of SHCC and ICC were collagen types I and III. There was no expression of laminin-5 in the stroma of SHCC, but it was present in almost all ICC cases. Tenascin-C expression was significantly lower in the SHCC cases and its distribution differed between SHCC and ICC. Matrix metalloproteinase-7 (MMP-7) expression was significantly higher in SHCC compared with HCC. Almost all stromal cells were alpha-smooth muscle actin-positive both in SHCC and ICC, whereas glial fibrillary acid protein (GFAP)-positive stromal cells were significantly more increased in ICC than in SHCC. SHCC clearly differed from HCC with respect to collagen types I, III and MMP-7 expression, and from ICC with regard to stromal components including laminin-5, tenascin-C and GFAP(+) stromal cells.

Adenocarcinoma, Scirrhous↗
PubMed2004

Validity study of a new diagnostic scale for drug-induced liver injury in Japan-comparison with two previous scales.

There are no specific diagnostic markers for drug-induced liver injury (DILI), a disease that is unpredictable and occasionally fatal. A new diagnostic scale, the DDW-J scale, was recently proposed in Japan, by modifying the International Consensus Meeting (ICM) scale in the items concerning chronologic criteria, concomitant drug(s), and extrahepatic manifestations. In order to determine the validity of the DDW-J scale, we assessed 127 patients (81 patients with DILI and 46 control patients) received a total of 423 drugs. When patients were assessed as 'highly probable' or 'probable', the DDW-J scale had higher sensitivity and slightly lowers specificity than the ICM scale (93.8% versus 77.8% and 89.1% versus 100%). The DDW-J scale was able to accurately diagnose DILI in some cases that were overlooked using the ICM scale. While the weighted statistical test indicated a poor correlation between the ICM and the DDW-J scales, receiver operating characteristic curves revealed that these two were superior to the Maria and Victorino scale. Future work still must be done using statistical evidence to refine the weights of individual parameters. However, the results from our study indicate that the DDW-J scale is a powerful tool with potentially important clinical applications in the diagnosis of DILI.

Journal Article↗
PubMed2004

[5'-nucleotidase].

Explore the source record for details and available documents.

5'-Nucleotidase↗
PubMed2003

Profile and clinical significance of anti-nuclear envelope antibodies found in patients with primary biliary cirrhosis: a multicenter study.

Primary biliary cirrhosis (PBC) sera contain antibodies which recognize various nuclear envelope proteins of which antibody against gp210 has been proven to be diagnostic for disease. In contrast, the clinical significance of another nuclear envelope antibody, anti-p62 antibody has not been well investigated. In the present study, we have analyzed anti-nuclear envelope antibodies by indirect immunofluorescence and immunoblot using rat liver nuclear envelope proteins and wheat germ agglutinin-bound fraction. Test sera were obtained from 175 patients with PBC and from 120 controls. Anti-gp210, anti-lamina associated polypeptide 2, anti-lamin B receptor, and anti-p62 complex antibodies were detected with a frequency of 26% (46 of 175), 6% (11 of 175), 9% (16 of 175), and 13% (15 of 115), respectively. The confirmation of Scheuer's stage IV was made with a frequency of 27% (4 of 15) in PBC patients with anti-p62 complex antibody, in contrast to only 2% (2 of 100) in PBC patients without anti-p62 complex antibody. This difference was found to be statistically significant. The presence of anti-p62 complex antibody may be related with the progressive or advanced state of PBC.

Animals↗
PubMed2003

Severe chronic active Epstein-Barr virus infection associated with multiple necrotic lesions in the liver.

We report an atypical presentation of a chronic active Epstein-Barr virus (EBV) infection with multiple nodular coagulation necrosis in the liver, that appeared as hypodense areas on a CT scan. The patient, a 26-year-old man, was hospitalized following over 2 years of intermittent fever, weight loss and liver abnormalities after contracting infectious mononucleosis. We diagnosed his illness as a chronic active EBV infection (CAEBV) because of the high antibody titers against EBV and the histological evidence of organ disease with demonstration of EBV mRNA. A liver biopsy revealed EBV-infected T-cell infiltration with hemophagocytosis and marked hepatocytolytic necrosis. The patient developed multiple coagulation necrosis with well-defined borders surrounding T-cell aggregation in the liver 8 months later. He died of respiratory failure due to interstitial pneumonitis. The analysis of EBV-genome termini demonstrated a clonal proliferation of T-cells harboring EBV, but no T-cell antigen receptor (TCR) gene rearrangement was observed. We speculate that the pathogenesis of this disease was an atypical expression of organ damage as a result of an aberrant T-cell response to EBV infection.

Journal Article↗
PubMed2003

Assessment of 287 Japanese cases of drug induced liver injury by the diagnostic scale of the International Consensus Meeting.

Two hundred and eighty seven Japanese cases of drug induced liver injury were assessed by the diagnostic scale of the International Consensus Meeting (ICM). They were classified to the hepatocellular (55%), mixed (24%) and cholestatic (22%) type according to the type of liver injury. Five cases were diagnosed as 'unrelated', since the reaction occurred more than 15 days after stopping the drug. The remaining 282 cases were classified to 69 cases of 'highly probable', 170 cases of 'probable', 39 cases of 'possible', and four cases of 'unlikely'. The cases with positive drug-lymphocyte stimulation test (DLST) and with eosinophilia distributed to higher scores. Although the diagnostic scale of the ICM was found to be also useful for Japanese cases, the modification of the scale including the data of DLST and eosinophilia together with some other modifications were recommended in the view of the present status of Japan. Using the modified diagnostic scale, the 287 cases were classified to 173 cases of 'highly probable', 102 cases of "probable', 11 cases of 'possible', and one case of 'unlikely'. Although the modified diagnostic scale seems better than the original one, further assessment of the modified scale using many Japanese cases is needed for the further improvement of the scale.

Journal Article↗
PubMed2003

Nitric oxide involvement in depression during interferon-alpha therapy.

It has been postulated that interferon induces depression via a nitric oxide-related system. The purpose of this study was to test whether there was a difference in the effects of interferon-alpha (IFN-alpha) on nitric oxide production between patients with and without interferon-induced depression. The subjects had chronic hepatitis C and were being treated with IFN-alpha. We measured plasma nitrate, a marker of nitric oxide production in vivo, before, during, and after interferon therapy. Of 146 patients, 9 developed depression within the first 4 wk of interferon therapy, and 8 developed depression later. In the former group, a significant plasma nitrate increase was observed during therapy, followed by a decrease to baseline after discontinuation. This, however, was not the case with the latter group or those who had no psychiatric symptoms. These results suggest nitric oxide involvement in at least some forms of IFN-alpha-induced depression.

Adolescent↗
PubMed2002

Accurate prediction of fulminant hepatic failure in severe acute viral hepatitis: multicenter study.

BACKGROUND: We have attempted to predict the development of fulminant hepatic failure at the stage of severe acute hepatitis before the onset of coma. This prediction is valuable because it may be used to block the development of fulminant hepatic failure with appropriate medical treatment. METHODS: To establish a discrimination formula, we retrospectively compared 13 clinical and laboratory variables in 36 patients with acute viral hepatitis and prothrombin levels of 40% or less of the control value who later developed fulminant hepatic failure with these variables in 12 patients who recovered spontaneously. A prospective study of 58 patients who developed fulminant hepatic failure and 18 who spontaneously recovered confirmed the validity of this formula. RESULTS: In the retrospective study,we established the following discrimination equation: Z = -0.89 + 1.74 x (causal viruses, 1 point for type A or type B in acute hepatitis B virus [HBV] infection, 2 points for others) + 0.056 x (total bilirubin, mg/dl)-0.014 x (cholinesterase, U/ml). A positive Z value indicates that fulminant hepatic failure will develop. In the prospective study, the specificity, sensitivity, predictive accuracy, and positive and negative predictive values were 0.833, 0.983, 0.947, 0.950, and 0.938, respectively. CONCLUSIONS: The present study indicated that fulminant hepatic failure can be predicted, by a simple discrimination equation, at the stage of severe acute hepatitis.

Adolescent↗
PubMed2002

High serum glyceraldehyde-3-phosphate dehydrogenase levels in patients with liver cirrhosis.

We have developed a mouse monoclonal antibody against glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and established a form of semi-quantitative latex particle aggregation as a first-screening technique for determining serum levels of GAPDH. Focusing on chronic liver diseases, we measured serum GAPDH in 213 patients to clarify its clinical significance. Serum GAPDH levels were similar in healthy control subjects, patients who were hepatitis B or C virus carriers, or with chronic hepatitis. However, the levels were significantly increased in patients with cirrhosis (P<0.001). Logistic regression analysis indicated that the presence of hepatocellular carcinoma and a high gamma-globulin level were closely associated with high GAPDH levels (P=0.006 and 0.011, respectively). Elevated serum GAPDH was also confirmed in a patient with cirrhosis associated with hepatocellular carcinoma using Western blotting analysis. The mechanism(s) of serum GAPDH elevation remains unclear, but one possible source is increased leakage of the GAPDH molecule into the serum from damaged cirrhotic hepatocytes underlying hepatocarcinogenesis or chronic inflammation.

Journal Article↗
PubMed2002

Hepatocellular carcinoma and survival in patients with primary biliary cirrhosis.

The incidence of hepatocellular carcinoma (HCC) in patients with primary biliary cirrhosis (PBC) is not well known. The aims of this study are to determine HCC incidence and survival, and to identify risk factors associated with these outcomes in patients with PBC. We collected information on 396 patients with PBC at enrollment and followed-up from 6 to 271 months. They were all negative for hepatitis B and C virus markers. HCC was detected by scanning with ultrasonography, computed tomography, or both every 4 to 6 months. Life expectancy (LE) was approximated with the declining exponential approximation of LE. A total of 14 patients developed HCC. The cumulative appearance rate of HCC in patients with advanced-stage PBC (Scheuer's stage III or IV) was significantly higher than that for patients with early-stage (stage I or II) (12.3% and 7.7% by the tenth year, respectively. P =.021). Proportional hazards analysis showed 3 factors are independently associated with the development of HCC: age at the time of diagnosis, male gender, and history of blood transfusion. Age, male gender, and advanced-stage PBC were associated with survival, but HCC development was not. The disease-specific annual mortality rate was estimated to be 0.008 for women and 0.028 for men with advanced-stage PBC. In conclusion, HCC develops in old patients with advanced-stage PBC, but HCC does not affect the patients' survival.

Adult↗
PubMed2002

Hepatitis A virus infection associated with hemophagocytic syndrome: report of two cases.

Virus-associated hemophagocytic syndrome (VAHS) is reported to be a rare complication in hepatitis A virus infections. We encountered two patients with hepatitis A virus-associated hemophagocytic syndrome (HAV-AHS). Although hemophagocytosis associated with other types of virus infections is fatal, the present patients with HAV-AHS recovered well without any treatment. Thrombocytopenia is an initial important finding of VAHS which is not rare in patients with acute hepatitis A. If bone marrow aspiration is performed more frequently, more HAV-AHS will be diagnosed. Further investigations are necessary to clarify the clinical features of HAV-AHS in more patients.

Adult↗