PubMed Health⌕ Search

Biomedical subjects

Masami Yoshiike

Publications and source records attributed to Masami Yoshiike.

6 recordsLinked to original sources
PubMed2005

Treating patients with autoimmune pancreatitis: results from a long-term follow-up study.

BACKGROUND: Steroid therapy is currently common treatment for autoimmune pancreatitis (AIP); however, indications of steroid therapy have yet to be established, and the clinical course after steroid therapy is unknown. METHODS: A total of 23 patients with AIP were subdivided into 4 groups according to the initial treatments undertaken. They were treated with pancreatoduodenectomy on suspicion of pancreatic tumor in 6 patients, choledochoduodenostomy with pancreatic biopsy in 4 patients, supportive therapy in 3 patients, and steroid therapy in 10 patients. Clinical course of AIP in each group was examined. RESULTS: Prognosis of the AIP patients is almost good except for the 2 patients who progressed to pancreatic insufficiency after resection. Two patients without jaundice improved spontaneously. Steroid therapy was effective in all patients treated, but pancreatic atrophy developed in 5 of these patients. Steroid therapy improved insulin secretion and glycemic control in 4 of 7 diabetes mellitus (DM) patients. CONCLUSION: To avoid futile surgery, in relatively elderly male patients with obstructive jaundice suggestive of pancreatic carcinoma, preoperative clinical suspicion of AIP is mandatory. Indications of steroid therapy for AIP are thought to be obstructive jaundice due to stenosis of the bile duct, other associated systemic autoimmune, and DM coincidental with AIP.

Adult↗
PubMed2005

Pancreatic tumor associated with pancreas divisum.

BACKGROUND: Although there has been considerable controversy regarding pancreas divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions. METHODS: A retrospective investigation was undertaken of pancreatic tumors associated with pancreas divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal papillary mucinous tumor of the pancreas and 32 cases of pancreas divisum. RESULTS: Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal papillary mucinous tumor (n = 1). All tumors developed from the dorsal pancreas of pancreas divisum. Periductal and interlobular fibrosis detected in the non-carcinomatous pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with pancreas divisum preceded carcinoma. CONCLUSIONS: Pancreatic tumors were detected in 12.5% of cases of pancreas divisum. In pancreas divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the minor duodenal papilla might be a factor promoting oncogenesis.

Adenocarcinoma↗
PubMed2004

Chronic pancreatitis in the elderly in Japan.

BACKGROUND/AIM: Although the elderly comprise an increasingly large segment of the population, little has been written about chronic pancreatitis in this age group in Japan. In this study, we analyzed the clinical features of elderly Japanese patients with chronic pancreatitis and compared them with those of late-onset chronic pancreatitis patients in Western countries. METHODS: Subjects were 182 patients (162 males and 20 females) with chronic pancreatitis. They were divided into two groups: early-onset group (onset <65 years of age, n = 119) and late-onset group (onset > or =65 years of age, n = 63). Clinical findings and follow-up data were examined for each group. RESULTS: Alcohol abuse was the most common etiological factor in early-onset pancreatitis patients. In the late-onset group, the frequencies of idiopathic and autoimmune pancreatitis increased. Furthermore, the age at onset of autoimmune pancreatitis was >60 years in 94% of the cases. The late-onset group was more likely to have painless disease, and calcification of the pancreas and steatorrhea were rare in this group. Major causes of death were malignancy and malnutrition in each group. CONCLUSIONS: Early- and late-onset chronic pancreatitis showed different clinical features. Clinicians should consider autoimmune pancreatitis in the differential diagnosis in elderly patients with obstructive jaundice.

Age Factors↗
PubMedDate not supplied

Classification of choledochocele.

BACKGROUND/AIMS: Choledochocele is a rare abnormality of cystic or diverticular dilatation of the terminal intramural portion of the common bile duct. Because its anatomic form does not fit the criteria for pancreaticobiliary maljunction, reflux of bile or pancreatic juice has not been discussed in relation to choledochocele. Considering the flow of bile and pancreatic juice, the authors developed a new classification of choledochocele, and investigated associated pancreaticobiliary diseases. METHODOLOGY: We reviewed 82 cases of choledochocele, and classified them into three groups on cholangiopancreatographic findings; Type A (n=27): cystic dilatation of the common channel, Type B (n=31): cystic dilatation of the intramural bile duct forming the common channel, Type C (n=24): cystic dilatation of the intramural bile duct opening into the duodenum separately from the pancreatic duct. RESULTS: Biliary carcinoma was associated with 2 cases of Type A and 1 case of Type B choledochocele. Acute pancreatitis occurred in 10 Type A and 6 Type B choledochoceles. Biliary pancreatic reflux was reported in 4 cases of Type A and 1 case of Type B. Marked elevation of amylase in the bile was reported in 5 Type A and 5 Type B choledochoceles. CONCLUSIONS: In choledochoceles forming a common channel (Type A and B), two-way regurgitation may occur, and induce acute pancreatitis and biliary carcinoma. This classification of choledochocele is useful for analysis of pathophysiology and determination of therapeutic strategy.

Adolescent↗
PubMedDate not supplied

Chronic pancreatitis progressing from segmental lesions.

BACKGROUND/AIMS: Chronic pancreatitis is histologically and functionally a progressive disease. To examine the natural history of chronic pancreatitis, we evaluated serial pancreatography in cases of chronic pancreatitis, focusing on the progression of diffuse-type chronic pancreatitis from the segmental type. METHODOLOGY: We reviewed 57 patients with chronic pancreatitis who had undergone endoscopic retrograde pancreatography on more than 2 occasions at intervals of at least 1 year. Cases of chronic pancreatitis were categorized as diffuse (n=37) and segmental (n=20) on the findings of initial endoscopic retrograde pancreatography. RESULTS: Twenty-three cases of diffuse-type chronic pancreatitis showed progression of pancreatic duct abnormalities. Segmental abnormalities of the main pancreatic duct at the body or tail of the pancreas spread to the head of the pancreas in 8 cases. Etiologies of these cases of chronic pancreatitis were alcoholic, in which patients continued drinking after initial endoscopic retrograde pancreatography. In 2 patients who underwent distal pancreatectomy, although segmental lesions showed typical histological findings of alcoholic chronic pancreatitis, appearances near the margin of these lesions were almost normal or indicated slight interlobular fibrosis. CONCLUSIONS: The pancreatic tail might represent the site of the initial lesion in some cases of alcoholic pancreatitis.

Adult↗