Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity...Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as possible.Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs.Severity can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity factors.Moreover,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk factors.Thus,CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis.There was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria.Because the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.展开更多
BACKGROUND Rapid urinary trypsinogen-2 dipstick test and levels of urinary trypsinogen-2 and trypsinogen activation peptide(TAP) concentration have been reported as prognostic markers for the diagnosis of acute pancre...BACKGROUND Rapid urinary trypsinogen-2 dipstick test and levels of urinary trypsinogen-2 and trypsinogen activation peptide(TAP) concentration have been reported as prognostic markers for the diagnosis of acute pancreatitis.AIM To reconfirm the validity of all these markers in the diagnosis of acute pancreatitis by undertaking a multi-center study in Japan.METHODS Patients with acute abdominal pain were recruited from 17 medical institutions in Japan from April 2009 to December 2012. Urinary and serum samples were collected twice, at enrollment and on the following day for measuring target markers. The diagnosis and severity assessment of acute pancreatitis were assessed based on prognostic factors and computed tomography(CT) Grade of the Japanese Ministry of Health, Labour, and Welfare criteria.RESULTS A total of 94 patients were enrolled during the study period. The trypsinogen-2 dipstick test was positive in 57 of 78 patients with acute pancreatitis(sensitivity,73.1%) and in 6 of 16 patients with abdominal pain but without any evidence of acute pancreatitis(specificity, 62.5%). The area under the curve(AUC) score of urinary trypsinogen-2 according to prognostic factors was 0.704, which was highest in all parameter. The AUC scores of urinary trypsinogen-2 and TAP according to CT Grade were 0.701 and 0.692, respectively, which shows higher than other pancreatic enzymes. The levels of urinary trypsinogen-2 and TAP were significantly higher in patients with extended extra-pancreatic inflammation as evaluated by CT Grade.CONCLUSION We reconfirmed urinary trypsinogen-2 dipstick test is useful as a marker for the diagnosis of acute pancreatitis. Urinary trypsinogen-2 and TAP may be considered as useful markers to determine extra-pancreatic inflammation in acute pancreatitis.展开更多
AIM: To examine the influence of lipoprotein lipase (LPL) gene polymorphism in ulcerative colitis (UC) patients. METHODS: Peripheral blood was obtained from 131 pa- tients with UC and 106 healthy controls for DNA extr...AIM: To examine the influence of lipoprotein lipase (LPL) gene polymorphism in ulcerative colitis (UC) patients. METHODS: Peripheral blood was obtained from 131 pa- tients with UC and 106 healthy controls for DNA extrac- tion. We determined LPL gene polymorphisms affecting the enzyme at Ser447stop, as well as HindⅢ and Pvu Ⅱ polymorphisms using PCR techniques. PCR products were characterized by PCR-RFLP and direct sequencing. Polymorphisms were examined for association with clini- cal features in UC patients. Genotype frequencies for LPL polymorphisms were also compared between UC patients and controls. RESULTS: In patients with onset at age 20 years or younger, C/G and G/G genotypes for Ser447stop poly- morphism were more prevalent than C/C genotype (OR = 3.13, 95% CI = 0.95-10.33). Patients with H+/- or H-/-genotype for HindⅢ polymorphism also were more nu- merous than those with H+/+ genotype (OR = 2.51, 95% CI = 0.85-7.45). In the group with H+/+ genotype for HindⅢ polymorphism, more patients had serum triglyc- eride concentrations over 150 mg/dL than patients with H+/- or H-/- genotype (P < 0.01, OR = 6.46, 95% CI = 1.39-30.12). Hypertriglycemia was also more prevalent in patients with P+/+ genotypes for PvuⅡ polymorphism (P < 0.05, OR = 3.0, 95% CI = 1.06-8.50). Genotype fre- quency for LPL polymorphism did not differ significantly between UC patients and controls. CONCLUSION: Ser447stop and HindⅢ LPL polymor- phisms may influence age of onset of UC, while HindⅢ and PvuⅡ polymorphisms influence serum triglyceride in UC patients.展开更多
AIM:To verify the performance of a lesion size measurement system through a clinical study.METHODS:Our proposed system,which consists of a conventional endoscope,an optical device,an optical probe,and a personal compu...AIM:To verify the performance of a lesion size measurement system through a clinical study.METHODS:Our proposed system,which consists of a conventional endoscope,an optical device,an optical probe,and a personal computer,generates a grid scale to measure the lesion size from an endoscopic image.The width of the grid scale is constantly adjusted according to the distance between the tip of the endoscope and lesion because the lesion size on an endoscopic image changes according to the distance.The shape of the grid scale was corrected to match the distortion of the endoscopic image.The distance was calculated using the amount of laser light reflected from the lesion through an optical probe inserted into the instrument channel of the endoscope.The endoscopist can thus measure the lesion size without contact by comparing the lesion with the size of the grid scale on the endoscopic image.(1)A basic test was performed to verify the relationship between the measurement error eM and the tilt angle of the endoscope;and(2)The sizes of three colon polyps were measured using our system during endoscopy.These sizes were immediately measured by scale after their removal.RESULTS:There was no error atα=0°.In addition,the values of eM(mean±SD)were 0.24±0.11 mm(α=10°),0.90±0.58 mm(α=20°)and 2.31±1.41mm(α=30°).According to these results,our system has been confirmed to measure accurately when the tilt angle is less than 20°.The measurement error was approximately 1 mm in the clinical study.Therefore,it was concluded that our proposed measurement system was also effective in clinical examinations.CONCLUSION:By combining simple optical equipment with a conventional endoscope,a quick and accurate system for measuring lesion size was established.展开更多
Introduction In contrast to familiar developmental anomalies,such as pancreatobiliary maljunction and pancreas divisum,a double orifice of the ampulla of Vater is a much more rare congenital malformation.We encountere...Introduction In contrast to familiar developmental anomalies,such as pancreatobiliary maljunction and pancreas divisum,a double orifice of the ampulla of Vater is a much more rare congenital malformation.We encountered a patient with pancreatolithiasis associated with anatomic variation of Wirsung duct showing a single major duodenal papilla with a double orifice and no minor papilla.展开更多
基金Supported by A Grant-in-Aid to the Research Committee on Intractable Pancreatic Diseases provided from the Ministry of HealthLabour and Welfare of Japan
文摘Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as possible.Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs.Severity can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity factors.Moreover,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk factors.Thus,CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis.There was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria.Because the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.
文摘BACKGROUND Rapid urinary trypsinogen-2 dipstick test and levels of urinary trypsinogen-2 and trypsinogen activation peptide(TAP) concentration have been reported as prognostic markers for the diagnosis of acute pancreatitis.AIM To reconfirm the validity of all these markers in the diagnosis of acute pancreatitis by undertaking a multi-center study in Japan.METHODS Patients with acute abdominal pain were recruited from 17 medical institutions in Japan from April 2009 to December 2012. Urinary and serum samples were collected twice, at enrollment and on the following day for measuring target markers. The diagnosis and severity assessment of acute pancreatitis were assessed based on prognostic factors and computed tomography(CT) Grade of the Japanese Ministry of Health, Labour, and Welfare criteria.RESULTS A total of 94 patients were enrolled during the study period. The trypsinogen-2 dipstick test was positive in 57 of 78 patients with acute pancreatitis(sensitivity,73.1%) and in 6 of 16 patients with abdominal pain but without any evidence of acute pancreatitis(specificity, 62.5%). The area under the curve(AUC) score of urinary trypsinogen-2 according to prognostic factors was 0.704, which was highest in all parameter. The AUC scores of urinary trypsinogen-2 and TAP according to CT Grade were 0.701 and 0.692, respectively, which shows higher than other pancreatic enzymes. The levels of urinary trypsinogen-2 and TAP were significantly higher in patients with extended extra-pancreatic inflammation as evaluated by CT Grade.CONCLUSION We reconfirmed urinary trypsinogen-2 dipstick test is useful as a marker for the diagnosis of acute pancreatitis. Urinary trypsinogen-2 and TAP may be considered as useful markers to determine extra-pancreatic inflammation in acute pancreatitis.
基金Supported by the Research Committee of Intractable Diseases of the Pancreas (Chairman M. Otsuki) provided by the Ministry of Health, Labour, and Welfare, Japan
文摘AIM: To examine the influence of lipoprotein lipase (LPL) gene polymorphism in ulcerative colitis (UC) patients. METHODS: Peripheral blood was obtained from 131 pa- tients with UC and 106 healthy controls for DNA extrac- tion. We determined LPL gene polymorphisms affecting the enzyme at Ser447stop, as well as HindⅢ and Pvu Ⅱ polymorphisms using PCR techniques. PCR products were characterized by PCR-RFLP and direct sequencing. Polymorphisms were examined for association with clini- cal features in UC patients. Genotype frequencies for LPL polymorphisms were also compared between UC patients and controls. RESULTS: In patients with onset at age 20 years or younger, C/G and G/G genotypes for Ser447stop poly- morphism were more prevalent than C/C genotype (OR = 3.13, 95% CI = 0.95-10.33). Patients with H+/- or H-/-genotype for HindⅢ polymorphism also were more nu- merous than those with H+/+ genotype (OR = 2.51, 95% CI = 0.85-7.45). In the group with H+/+ genotype for HindⅢ polymorphism, more patients had serum triglyc- eride concentrations over 150 mg/dL than patients with H+/- or H-/- genotype (P < 0.01, OR = 6.46, 95% CI = 1.39-30.12). Hypertriglycemia was also more prevalent in patients with P+/+ genotypes for PvuⅡ polymorphism (P < 0.05, OR = 3.0, 95% CI = 1.06-8.50). Genotype fre- quency for LPL polymorphism did not differ significantly between UC patients and controls. CONCLUSION: Ser447stop and HindⅢ LPL polymor- phisms may influence age of onset of UC, while HindⅢ and PvuⅡ polymorphisms influence serum triglyceride in UC patients.
基金Supported by The Special Coordination Fund(SCF)for Pro-moting Science and Technology commissioned by the Ministry of Education,Culture,Sports,Science and Technology(MEXT)of Japan
文摘AIM:To verify the performance of a lesion size measurement system through a clinical study.METHODS:Our proposed system,which consists of a conventional endoscope,an optical device,an optical probe,and a personal computer,generates a grid scale to measure the lesion size from an endoscopic image.The width of the grid scale is constantly adjusted according to the distance between the tip of the endoscope and lesion because the lesion size on an endoscopic image changes according to the distance.The shape of the grid scale was corrected to match the distortion of the endoscopic image.The distance was calculated using the amount of laser light reflected from the lesion through an optical probe inserted into the instrument channel of the endoscope.The endoscopist can thus measure the lesion size without contact by comparing the lesion with the size of the grid scale on the endoscopic image.(1)A basic test was performed to verify the relationship between the measurement error eM and the tilt angle of the endoscope;and(2)The sizes of three colon polyps were measured using our system during endoscopy.These sizes were immediately measured by scale after their removal.RESULTS:There was no error atα=0°.In addition,the values of eM(mean±SD)were 0.24±0.11 mm(α=10°),0.90±0.58 mm(α=20°)and 2.31±1.41mm(α=30°).According to these results,our system has been confirmed to measure accurately when the tilt angle is less than 20°.The measurement error was approximately 1 mm in the clinical study.Therefore,it was concluded that our proposed measurement system was also effective in clinical examinations.CONCLUSION:By combining simple optical equipment with a conventional endoscope,a quick and accurate system for measuring lesion size was established.
文摘Introduction In contrast to familiar developmental anomalies,such as pancreatobiliary maljunction and pancreas divisum,a double orifice of the ampulla of Vater is a much more rare congenital malformation.We encountered a patient with pancreatolithiasis associated with anatomic variation of Wirsung duct showing a single major duodenal papilla with a double orifice and no minor papilla.