基本情報
経歴
7-
2018年5月 - 現在
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2014年4月 - 2018年4月
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2008年4月 - 2014年3月
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2003年5月 - 2008年3月
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2002年5月 - 2003年4月
学歴
1-
1993年4月 - 1999年3月
受賞
3-
2019年6月
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2018年4月
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2013年6月
論文
82-
Biologics: Targets and Therapy 2024年1月
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Internal medicine (Tokyo, Japan) 2023年6月21日A 54-year-old man was admitted with obstructive jaundice. Computed tomography showed common bile duct stricture and a tumor around the celiac artery. Repeated endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) as well as a laparotomic biopsy around the celiac artery were diagnostically unsuccessful. Since the bile duct stricture progressed, EUS-FNA and ERCP were performed a third time, finally leading to the diagnosis of diffuse large B-cell lymphoma. The treatment plan and prognosis of obstructive jaundice differ greatly depending on the disease. It is important to conduct careful follow-up and repeated histological examinations with appropriate modifications until a diagnosis is made.
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PloS one 18(8) e0289698 2023年BACKGROUND AND AIMS: Emergency endoscopic hemostasis for colonic diverticular bleeding is effective in preventing serious consequences. However, the low identification rate of the bleeding source makes the procedure burdensome for both patients and providers. We aimed to establish an efficient and safe emergency endoscopy system. METHODS: We prospectively evaluated the usefulness of a scoring system (Jichi Medical University diverticular hemorrhage score: JD score) based on our experiences with past cases. The JD score was determined using four criteria: CT evidence of contrast agent extravasation, 3 points; oral anticoagulant (any type) use, 2 points; C-reactive protein ≥1 mg/dL, 1 point; and comorbidity index ≥3, 1 point. Based on the JD score, patients with acute diverticular bleeding who underwent emergency or elective endoscopy were grouped into JD ≥3 or JD <3 groups, respectively. The primary and secondary endpoints were the bleeding source identification rate and clinical outcomes. RESULTS: The JD ≥3 and JD <3 groups included 35 and 47 patients, respectively. The rate of bleeding source identification, followed by the hemostatic procedure, was significantly higher in the JD ≥3 group than in the JD <3 group (77% vs. 23%, p <0.001), with a higher JD score associated with a higher bleeding source identification rate. No significant difference was observed between the groups in terms of clinical outcomes, except for a higher incidence of rebleeding at one-month post-discharge and a higher number of patients requiring interventional radiology in the JD ≥3 group than in the JD <3 group. Subgroup analysis showed that successful identification of the bleeding source and hemostasis contributed to a shorter hospital stay. CONCLUSION: We established a safe and efficient endoscopic scoring system for treating colonic diverticular bleeding. The higher the JD score, the higher the bleeding source identification, leading to a successful hemostatic procedure. Elective endoscopy was possible in the JD <3 group when vital signs were stable.
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Scientific reports 11(1) 3015-3015 2021年2月4日Pruritus is known to be a common complication in hepatitis patients, but the exact frequency and degree are not fully elucidated. Thus, we evaluated pruritus of 450 patients with chronic liver disease at our hospital. Pruritus was observed in 240 (53%) of the patients. Pruritus was significantly associated with males (OR = 1.51, P = 0.038) and patients with alkaline phosphatase (ALP) ≥ 200 U/L (OR = 1.56, P = 0.0495) and was significantly less in HBsAg-positive patients (OR = 0.449, P = 0.004). Seasonally, there was no difference in the frequency of pruritus between summer and winter. Of the 24 refractory pruritus patients treated with nalfurafine, 17 (71%) indicated improvement of itch, which is defined as a decrease in the visual analog scale score ≥ 30 mm. Pruritus was improved by nalfurafine both during daytime and nighttime in the Kawashima's scores evaluation. All patients who received nalfurafine exhibited improved Kawashima's scores ≥ 1 point during the daytime or nighttime. In conclusion, pruritus occurred in > 50% of patients with chronic liver disease, and predictors of pruritus were males and ALP ≥ 200 U/L. Nalfurafine may be useful for pruritus, regardless of whether daytime or nighttime.
MISC
5-
GASTROENTEROLOGY 152(5) S1038-S1038 2017年4月
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自治医科大学紀要 34 87-95 2012年3月1日食道・胃静脈瘤の治療指針はほぼ確立されているが,異所性静脈瘤の治療法については一定の見解が得られていない。我々は,十二指腸静脈瘤破裂に対して,透視下に行った内視鏡的硬化療法が有用であった1例を経験した。症例は73歳,肝硬変の女性で十二指腸静脈瘤破裂にて当院へ紹介となった。内視鏡検査にて,十二指腸下行脚に出血点と思われるびらんを伴うF3の静脈瘤を認めた。腹部CTでは膵十二指腸静脈を供血路としRetzius静脈に排血路を伴う十二指腸静脈瘤を認めた。n-butyl-2-cyanoacrylateとlipiodolを3:1に混合し,X線透視下に確認しながら3ヶ所に計6.0ml静脈瘤内に供血路,排血路が造影されるまで局注した。6日後の造影CTでは,静脈瘤から連続する供血路と排血路の一部にlipiodolの集積を認め,静脈瘤はほぼ硬化剤により置換されていた。透視下に硬化剤の注入範囲を確認しながら内視鏡的硬化療法を行うことで合併症なく,また追加治療を必要としない十分な十二指腸静脈瘤の治療が可能であった。
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PANCREAS 40(5) 804-804 2011年7月
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膵臓 = The Journal of Japan Pancreas Society 25(5) 578-584 2010年10月25日