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Biomedical subjects

Terumi Kamisawa

Publications and source records attributed to Terumi Kamisawa.

At least 19 recordsLinked to original sources
PubMed2007

Does moderate celiac axis stenosis identified on preoperative multidetector computed tomographic angiography predict an increased risk of complications after pancreaticoduodenectomy for malignant pancreatic tumors?

OBJECTIVES: To identify any association between celiac artery compromise found on computed tomographic angiography and the incidence of postoperative and perioperative complications. METHODS: The computed tomographic angiograms of 36 patients who underwent the Whipple procedure for pancreatic adenocarcinoma were examined retrospectively. The association between the results and surgical course was investigated. RESULTS: Twelve patients (33%) had significant postoperative complications. Ten (28%) had evidence of celiac artery stenosis. Stenosis ranged from 20% to 60%. There was no evidence of a difference between the 2 groups. CONCLUSION: There seems to be no evidence of an increased risk of postoperative or perioperative complication in patients undergoing the Whipple procedure, with a celiac stenosis of up to 60%.

Adenocarcinoma↗
PubMed2006

Clinical implications of incomplete pancreas divisum.

CONTEXT: Incomplete pancreas divisum is a pancreatic anomaly that results in an inadequate communication between the ventral and dorsal pancreatic ducts. Although the relationship between complete pancreas divisum and pancreatitis has been contentious, clinical implications of incomplete pancreas divisum have not been noted. OBJECTIVE: This study was done to investigate the clinical significance of incomplete pancreas divisum. PATIENTS AND METHODS: We studied the anatomy of the pancreatic duct system in 3,220 cases using endoscopic retrograde pancreatography; 44 cases had complete pancreas divisum, and 41 had incomplete pancreas divisum. MAIN OUTCOME MEASURE: The prevalence of chronic and acute pancreatitis associated with complete or incomplete pancreas divisum was compared with that of cases with neither complete nor incomplete pancreas divisum (controls). RESULTS: All of the patients with complete or incomplete pancreas divisum who abused alcohol had chronic or acute pancreatitis. The prevalence of chronic pancreatitis in patients with complete or incomplete pancreas divisum was significantly higher than in controls (P<0.001 and P=0.001, respectively), but acute pancreatitis occurred more frequently only in patients with complete pancreas divisum (P=0.010). When we considered pancreatic-type pain as a pancreatitis-like disease, complete and incomplete pancreas divisum were suspected as the cause of pancreatitis-like disease in 39% (15/38: chronic dorsal pancreatitis, n=5; acute pancreatitis, n=7; pancreatic-type pain, n=3) and 30% (10/33: chronic dorsal pancreatitis, n=2; acute relapsing pancreatitis, n=1; pancreatic-type pain, n=7) of patients who did not abuse alcohol, respectively. CONCLUSIONS: Although the precise pathophysiology may differ, patients with complete pancreas divisum and patients with incomplete pancreas divisum may have similar presentations and a similar prevalence. The clinical implications of incomplete pancreas divisum may be similar to those of complete pancreas divisum.

Acute Disease↗
PubMed2006

Pancreatic cancer with a high serum IgG4 concentration.

Differentiation between autoimmune pancreatitis and pancreatic cancer is sometimes difficult. It has been reported that serum IgG4 concentrations are significantly elevated and particularly high (>135 mg/dL) in autoimmune pancreatitis. Measurement of serum IgG4 has become a useful tool for differentiating between autoimmune pancreatitis and pancreatic cancer. However, we present a 74-year-old female with a markedly elevated serum IgG4 (433 mg/dL) who underwent pancreaticoduodenectomy for pancreatic cancer. Elevated serum IgG4 levels continued after the resection. On histology, adenocarcinoma of the pancreas accompanied with moderate lymphoplasmacytic infiltration infiltrated the lower bile duct and duodenum, but there were no findings of autoimmune pancreatitis. Although a small metastasis was detected in one parapancreatic lymph node, regional lymph nodes were swollen. Abundant IgG4-positive plasma cells infiltrated the cancerous areas of the pancreas, but only a few IgG4-positive plasma cells were detected in the noncancerous areas. Pancreatic cancer cells were not immunoreactive for IgG4. An abundant infiltration of IgG4-positive plasma cells was detected in the swollen regional lymph nodes and in the duodenal mucosa. We believe that the serum IgG4 level was elevated in this patient with pancreatic cancer as the result of an IgG4-related systemic disease that had no clinical manifestations other than lymphadenopathy.

Adenocarcinoma↗
PubMed2006

Biliopancreatic and pancreatobiliary refluxes in cases with and without pancreaticobiliary maljunction: diagnosis and clinical implications.

The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice. A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall, as occurs in pancreaticobiliary maljunction; in such cases, the action of the sphincter does not functionally affect the junction. Thus, biliopancreatic and pancreatobiliary refluxes occur, resulting in various pathological conditions in the biliary tract and in the pancreas. Biliopancreatic reflux could be confirmed by operative or postoperative T tube cholangiography, computed tomography combined with drip infusion cholangiography, histological detection of gallbladder cancer cells in the main pancreatic duct, and reflux of bile on the cut surface of the pancreas. Pancreatobiliary reflux could be diagnosed on the basis of an elevated amylase level in the bile, secretin-stimulated dynamic magnetic resonance cholangiopancreatography, and pancreatography via the minor duodenal papilla. Recently, it has become obvious that these refluxes can occur in individuals without pancreaticobiliary maljunction. Biliopancreatic reflux is related to the occurrence of acute pancreatitis, and pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without pancreaticobiliary maljunction. Since few systemic studies exists with respect to diagnostic imaging techniques and clinical relevance of these refluxes in individuals with a normal pancreaticobiliary junction, further prospective clinical studies including appropriate management should be performed.

Bile Duct Diseases↗
PubMed2006

Sclerosing cholecystitis associated with autoimmune pancreatitis.

AIM: To evaluate the histopathological and radiological findings of the gallbladder in patients with autoimmune pancreatitis (AIP). METHODS: The radiological findings of the gallbladder of 19 AIP patients were retrospectively reviewed. Resected gallbladders of 8 AIP patients were examined histologically and were immunostained with anti-IgG4 antibody. Controls consisted of gallbladders resected for symptomatic gallstones (n = 10) and those removed during pancreatoduodenectomy for pancreatic carcinoma (n = 10), as well as extrahepatic bile ducts and pancreases removed by pancreatoduodenectomy for pancreatic carcinoma (n = 10). RESULTS: Thickening of the gallbladder wall was detected by ultrasound and/or computed tomography in 10 patients with AIP (3 severe and 7 moderate); in these patients severe stenosis of the extrahepatic bile duct was also noted. Histologically, thickening of the gallbladder was detected in 6 of 8 (75%) patients with AIP; 4 cases had transmural lymphoplasmacytic infiltration with fibrosis, and 2 cases had mucosal-based lymphoplasmacytic infiltration. Considerable transmural thickening of the extrahepatic bile duct wall with dense fibrosis and diffuse lymphoplasmacytic infiltration was detected in 7 patients. Immunohistochemically, severe or moderate infiltration of IgG4-positive plasma cells was detected in the gallbladder, bile duct, and pancreas of all 8 patients, but was not detected in controls. CONCLUSION: Gallbladder wall thickening with fibrosis and abundant infiltration of IgG4-positive plasma cells is frequently detected in patients with AIP. We propose the use of a new term, sclerosing cholecystitis, for these cases that are induced by the same mechanism as sclerosing pancreatitis or sclerosing cholangitis in AIP.

Autoimmune Diseases↗
PubMed2006

Consensus of primary care in acute pancreatitis in Japan.

The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as the diagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

Acute Disease↗
PubMed2006

MRCP and MRI findings in 9 patients with autoimmune pancreatitis.

AIM: To evaluate magnetic resonance cholangiopancreatography (MRCP) findings in conjunction with magnetic resonance (MR) images in autoimmune pancreatitis (AIP) patients. METHODS: Nine patients with AIP underwent MRI, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography, and ultrasonography. The MRCP and MR images taken before and after steroid therapy were reviewed and compared with other imaging modalities. The MRCP findings of the AIP cases were compared to those of 10 cases with carcinoma of the head of the pancreas. RESULTS: On MRCP, the narrowed portion of the main pancreatic duct noted on ERCP was not visualized, while the non-involved segments of the main pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder than that seen in cases of pancreatic carcinoma. Stenosis or obstruction of the lower bile duct was detected in 8 patients. MR images showed enlargement of the pancreas with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images, and, in 3 patients, a hypointense capsule-like rim. After steroid therapy, the previously not visualized portion of the main pancreatic duct was seen, along with improvement of the bile duct stenosis. Pancreatic enlargement decreased, and the abnormal signal intensity on both T1- and T2-weighted MR images became isointense. CONCLUSION: MRCP cannot differentiate irregular narrowing of the main pancreatic duct seen with AIP from stenosis of the main pancreatic duct seen with pancreatic carcinoma. However, MRCP findings in conjunction with MR imaging of pancreatic enlargement that shows abnormal signal intensity on T1- and T2-weighted MR images are useful in supporting a diagnosis of AIP.

Autoimmune Diseases↗
PubMed2006

Autoimmune pancreatitis metachronously associated with retroperitoneal fibrosis with IgG4-positive plasma cell infiltration.

Retroperitoneal fibrosis is an uncommon disorder characterized by the formation of a dense plaque of fibrous tissue in the retroperitoneum, and its etiology remains unknown. Autoimmune pancreatitis is a rare type of chronic pancreatitis characterized by fibrosis with abundant infiltration of IgG4-positive plasma cells and lymphocytes and obliterative phlebitis in the pancreas. We present a case of autoimmune pancreatitis that developed 10 mo after the occurrence of retroperitoneal fibrosis. Histological findings of the resected retroperitoneal mass were marked periureteral fibrosis with abundant infiltration of IgG4-positive plasma cells and lymphocytes and obliterative phlebitis. These findings suggest a common pathophysiological mechanism for retroperitoneal fibrosis and autoimmune pancreatitis in this case. Some cases of retroperitoneal fibrosis might be a retroperitoneal lesion of IgG4-related sclerosing disease.

Aged↗
PubMed2006

Usefulness of biopsying the major duodenal papilla to diagnose autoimmune pancreatitis: a prospective study using IgG4-immunostaining.

AIM: To examine the histological and immunohistochemical findings of biopsy specimens taken from the major duodenal papilla of autoimmune pancreatitis (AIP) patients. METHODS: The major duodenal papilla in the resected pancreas of 3 patients with AIP and of 5 control patients [pancreatic carcinoma (n = 3) and chronic alcoholic pancreatitis (n = 2)] was immunostained using anti-CD4-T cell, CD8-T cell and IgG4 antibodies. Forceps biopsy specimens taken from the major duodenal papilla of 2 patients with AIP and 5 control patients with suspected papillitis were prospectively taken during duodenoscopy and immunohistochemically examined. RESULTS: Moderate or severe lymphoplasmacytic infiltration including many CD4-positive or CD8-positive T lymphocytes and IgG4-positive plasma cells (>or=10/HPF), was observed in the major duodenal papilla of all 3 patients with AIP. The same findings were also detected in the biopsy specimens taken from the major duodenal papilla of 2 patients with AIP, but in controls, there were only a few (<or=3/HPF) IgG4-positive plasma cells infiltrating the major duodenal papilla. CONCLUSIONS: An abundant infiltration of IgG4-positive plasma cells is specifically detected in the major duodenal papilla of patients with AIP. Although this is a preliminary study, IgG4-immunostaining of biopsy specimens taken from the major duodenal papilla may support the diagnosis of AIP.

Aged↗
PubMed2006

Pancreaticopleural fistula visualized by computed tomography scan combined with pancreatography.

CONTEXT: We report a case of a pancreaticopleural fistula which was clearly demonstrated by computed tomography (CT) scan following pancreatography and which was successfully treated with endoscopic nasopancreatic drainage combined with octreotide. CASE REPORT: A 52-year-old male was admitted to our hospital for additionally evaluation of bilateral pleural effusion. The pleural fluid amylase level was markedly elevated. Endoscopic retrograde pancreatography showed a cyst in the body of the pancreas and extravasation of contrast medium extending cranially from the cyst. The disease was treated successfully with endoscopic nasopancreatic drainage combined with the administration of octreotide. A pancreaticopleural fistulous route was clearly demonstrated by CT scan following pancreatography through the nasopancreatic drainage tube. CONCLUSIONS: A CT scan following pancreatography was useful in demonstrating a pancreaticopleural fistulous route.

Drainage↗
PubMed2006

Involvement of pancreatic and bile ducts in autoimmune pancreatitis.

AIM: To examine the involvement of the pancreatic and bile ducts in patients with autoimmune pancreatitis. METHODS: Clinical and cholangiopancreatographic findings of 28 patients with autoimmune pancreatitis were evaluated. For the purposes of this study, the pancreatic duct system was divided into three portions: the ventral pancreatic duct; the head portion of the dorsal pancreatic duct; and the body and tail of the dorsal pancreatic duct. RESULTS: Both the ventral and dorsal pancreatic ducts were involved in 24 patients, while in 4 patients only the dorsal pancreatic duct was involved. Marked stricture of the bile duct was detected in 20 patients and their initial symptom was obstructive jaundice. Six patients showed moderate stenosis to 30%-40% of the normal diameter, and the other two patients showed no stenosis of the bile duct. Although marked stricture of the bile duct was detected in 83% (20/24) of patients who showed narrowing of both the ventral and dorsal pancreatic ducts, it was not observed in the 4 patients who showed involvement of the dorsal pancreatic duct alone (P=0.0034). CONCLUSION: Both the ventral and dorsal pancreatic and bile ducts are involved in patients with autoimmune pancreatitis.

Aged↗
PubMed2006

Autoimmune pancreatitis: proposal of IgG4-related sclerosing disease.

Autoimmune pancreatitis (AIP) is a peculiar type of pancreatitis of presumed autoimmune etiology. Many new clinical aspects of AIP have been clarified during the past 10 years, and AIP has become a distinct entity recognized worldwide. However, its precise pathogenesis or pathophysiology remains unclear. As AIP dramatically responds to steroid therapy, accurate diagnosis of AIP is necessary to avoid unnecessary surgery. Characteristic dense lymphoplasmacytic infiltration and fibrosis in the pancreas may prove to be the gold standard for diagnosis of AIP. However, since it is difficult to obtain sufficient pancreatic tissue, AIP should be diagnosed currently based on the characteristic radiological findings (irregular narrowing of the main pancreatic duct and enlargement of the pancreas) in combination with serological findings (elevation of serum gamma-globulin, IgG, or IgG4, along with the presence of autoantibodies), clinical findings (elderly male preponderance, fluctuating obstructive jaundice without pain, occasional extrapancreatic lesions, and favorable response to steroid therapy), and histopathological findings (dense infiltration of IgG4-positive plasma cells and T lymphocytes with fibrosis and obliterative phlebitis in various organs). It is apparent that elevation of serum IgG4 levels and infiltration of abundant IgG4-positive plasma cells into various organs are rather specific to AIP patients. We propose a new clinicopathological entity, "IgG4-related sclerosing disease", and suggest that AIP is a pancreatic lesion reflecting this systemic disease.

Autoimmune Diseases↗
PubMed2006

Clinicopathologic features of ampullary carcinoma without jaundice.

GOALS: To evaluate clinicopathological features of ampullary carcinoma without jaundice. BACKGROUND: : Obstructive jaundice is the most common symptom of patients with ampullary carcinoma. However, some patients with ampullary carcinoma do not have jaundice at the time of diagnosis. STUDY: Clinicopathologic findings of 23 patients with ampullary carcinoma showing no visible jaundice (serum total bilirubin <3.0 mg/dL) and 38 patients with ampullary carcinoma showing jaundice at the time of diagnosis were retrospectively compared. RESULTS: Fifteen of 23 patients with nonjaundiced ampullary carcinoma complained of fever and/or abdominal pain. Five asymptomatic patients were found to have a dilated bile duct on screening ultrasound or to have a tumor-like swelling of the papilla of Vater during routine upper gastrointestinal endoscopy. There was no significant difference in age, sex, size, macroscopic type, histologic type, rates of duodenal invasion, pancreatic invasion, and lymph node metastasis, and prognosis between the two groups. The cumulative 5-year and 10-year survival rates of nonjaundiced patients were 70.2% and 49.0%, compared with 33.6% and 29.4% of jaundiced patients. Ten of the 23 nonjaundiced ampullary carcinomas (43%) were in Stage I, whereas 4 of the 38 jaundiced ampullary carcinomas (11%) were in Stage I (P < 0.01). Mechanisms of nonjaundice in ampullary carcinoma were suspected to be determinant by the infiltrating pattern of the carcinoma to the lower portion of the bile duct. CONCLUSIONS: Mechanisms of nonjaundice in ampullary carcinoma might be determined by the infiltrating pattern of the carcinoma to the lower portion of the bile. As a greater number of nonjaundiced ampullary carcinomas were in an early stage, detection of them may provide an improved clinical outcome.

Aged↗
PubMed2006

Autoimmune pancreatitis in young patients.

GOALS: To examine whether there is a difference in the autoimmune pancreatitis (AIP) seen in young and elderly patients. BACKGROUND: AIP has a preponderance for elderly males, although the reason is unknown. STUDY: A total of 64 patients with AIP were divided into a young (<40 y old) group and a middle-aged or elderly group (> or =40 y old) according to the age at diagnosis. The clinical findings of each group were compared. RESULTS: The young group consisted of 6 patients (3 men, 3 women) with a mean age of 33.0 (range, 28 to 37) years. In the middle-aged or elderly group, there were 58 patients with a mean age of 66.4 (range, 46 to 83) years; males predominated (79%). Abdominal pain as the presenting symptom was significantly more frequent in the young group than in the middle-aged or elderly group (100% vs. 43%, P<0.05). Obstructive jaundice was detected in only 17% (1/6) of patients in the young group compared with 59% (34/58) of patients in the middle-aged or elderly group. Serum amylase elevations were detected more frequently in the young group than in the middle-aged or elderly group (83% vs. 40%, P<0.05). One young patient also had ulcerative colitis. CONCLUSIONS: Although rare in Japan, young patients with AIP show different clinical features from middle-aged or elderly patients with AIP; young patients are more likely to have abdominal pain and serum amylase elevations.

Abdominal Pain↗
PubMed2006

Influence of steroid therapy on the course of diabetes mellitus in patients with autoimmune pancreatitis: findings from a nationwide survey in Japan.

OBJECTIVE: The aim of this study was to estimate the number of autoimmune pancreatitis (AIP) patients in Japan and evaluate the influence of steroid therapy on the course of diabetes mellitus (DM) in AIP. METHODS: A total of 2972 departments were randomly selected with hospital stratification throughout Japan. We sent a questionnaire asking the selected departments to report the number of patients who had visited their hospital in 2002 and who fulfilled the diagnostic criteria for AIP set by the Japan Pancreas Society. We then sent a second questionnaire asking for the details of the clinical course of DM, if any, and the treatments used for AIP. RESULTS: The annual number of AIP in Japan was estimated as approximately 900 (95% confidence interval 670-1100) or 0.71 per 100,000 individuals in the Japanese population. In the second survey, 66.5% of the 167 patients of AIP were reported as being complicated with DM. Among the AIP patients with DM (n = 93), 52% of the patients started to show DM simultaneously with the onset of AIP, and 33% of the patients had DM before the onset of AIP. Following steroid therapy, 55% and 36% of these patient groups showed improvement of DM control, respectively. On the other hand, less than 20% of patients showed newly developed DM or showed exacerbation of DM control after steroid therapy. The older the patients were, the higher were the rates of new development or exacerbation of DM. CONCLUSIONS: These findings indicated that steroid therapy has a beneficial effect on the clinical courses of DM in approximately half of AIP patients. However, it also has negative effect on glucose tolerance in some patients, particularly older patients, and thus, careful observation for involvement of DM should be required in AIP patients treated with steroids.

Adrenal Cortex Hormones↗