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Biomedical subjects

E M Yoshida

Publications and source records attributed to E M Yoshida.

At least 73 records · Page 4Linked to original sources

Immune thrombocytopenic purpura in three patients with preexisting ulcerative colitis.

Ulcerative colitis (UC) is associated with extraintestinal diseases in numerous target tissues. Associated immune-mediated hematological diseases, however, are rarely described. We report three Caucasian adult patients with UC and immune thrombocytopenic purpura (ITP). Platelet-associated antibodies (IgG) were positive in two patients, and bone marrow examinations in two patients revealed normal to increased megakaryocyte numbers. ITP was treated with corticosteroids in all patients. Two patients eventually received intravenous immune gamma-globulin, and one patient required surgical splenectomy. Of particular interest, UC preceded the onset of ITP in all patients (by from 1 to 19 yr). This suggests that ITP in these patients is causally associated with UC, possibly secondary to immunostimulation from lumenal antigens and altered immunoregulation.

Adult↗

Markedly elevated serum CA 19-9 levels in a case of chronic pancreatitis.

Serum levels of carbohydrate antigen (CA) 19-9 exceeding 1000 U/mL are considered highly specific for pancreatic cancer and have not been reported in nonmalignant pancreatic disease. A young man with obstructive jaundice, a serum CA 19-9 level of 2350 U/mL and a mass in the head of the pancreas, seen on computed tomography, was found to have chronic pancreatitis without malignant disease. This case demonstrates that a markedly elevated serum level of CA 19-9 can occur in nonmalignant pancreatic disease and emphasizes the need for a histologic diagnosis of malignancy even if the clinical diagnosis of pancreatic cancer seems certain.

Adult↗

Hepatic artery interruption followed by portal vein thrombosis in an adult liver transplant.

Vascular complications following liver transplantation result in significant morbidity and mortality. We report a 28-year-old man who, because of a mycotic false aneurysm, underwent ligation of the hepatic artery 4.5 weeks post-transplantation and who, 4.5 months later, suffered a portal-mesenteric vein thrombosis. Adverse hepatic sequelae did not follow these events, demonstrating the capacity of the collateral circulation to perfuse the transplanted liver.

Adult↗

Pulmonary hypertension associated with primary biliary cirrhosis in the absence of portal hypertension: a case report.

Pulmonary hypertension is well described in association with portal hypertension of any cause including end stage primary biliary cirrhosis (PBC). The essential feature of this association is the presence of portosystemic shunting, including surgically created shunts. A patient with primary pulmonary hypertension and PBC without portal hypertension is reported. This suggests that primary pulmonary hypertension may be associated with PBC in the absence of portal hypertension. Decisions regarding appropriate organ transplantation may depend on whether pulmonary hypertension is primary or secondary to portal hypertension.

Adult↗

Perforation of the jejunum secondary to AIDS-related gastrointestinal Kaposi's sarcoma.

Intestinal perforation in human immunodeficiency virus-positive patients due solely to Kaposi's sarcoma (KS) has rarely been described. A homosexual man with acquired immunodeficiency syndrome-related KS who presented with an acute abdomen is presented. He was found to have a jejunal perforation through a small KS lesion. There were no infectious organisms identified at the site of perforation.

Abdomen, Acute↗

Hepatitis B infection and liver transplantation.

Patients with chronic hepatitis B virus (HBV) infection have historically incurred high rates of allograft reinfection from extrahepatic reservoirs of HBV, with worse long term outcome compared with that of transplant recipients without HBV infection. As a result, chronic HBV infection has been considered a contrandication for transplantation. Prophylaxis against HBV recurrence, in the form of passive immunization with high dose hepatitis B hyperimmunoglobulin and the antiviral agent lamivudine, has recently been demonstrated to decrease the risk of reinfection. With appropriate prophylaxis, liver transplantation can be a viable proposition for patients with HBV infection. Past experience and current status of HBV infection and transplantation are reviewed, with emphasis on the issues surrounding prophylaxis.

Antiviral Agents↗

Failure of ketoprofen and interferon combination therapy to improve interferon-resistant chronic hepatitis C.

Preliminary reports suggest that patients with interferon (IFN)-resistant chronic hepatitis C respond better to a combination of IFN-alpha and nonsteroidal anti-inflammatory drugs than to IFN alone. The efficacy of IFN combined with ketoprofen in the treatment of patients with IFN-resistant chronic hepatitis C was evaluated. Seventeen patients, nonresponsive after at least six months of treatment with IFN-alpha 2b and subsequently treated with the combination of IFN-alpha 2b plus ketoprofen for four months, were studied. Serum aminotransferases (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) and serum hepatitis C virus (HCV) RNA were analyzed before and throughout treatment. No patient normalized serum aminotransferases after combination therapy. There were no significant differences in mean serum ALT and AST levels before and after ketoprofen intervention. Serum HCV RNA became undetectable after treatment in only one patient, but was detectable again three months after treatment cessation. These results provide no convincing evidence that the combination of IFN-alpha 2b with ketoprofen improves the response to IFN in patients nonresponsive to IFN alone.

Adult↗