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Whipple disease mimicking inflammatory bowel disease
( Maiko Tatsuki ),( Takashi Ishige ),( Yoshiko Igarashi ),( Reiko Hatori ),( Akira Hokama ),( Junko Hirato ),( Aleixo Muise ),( Takumi Takizawa ),( Hirokazu Arakawa ) 대한장연구학회 2021 Intestinal Research Vol.19 No.1
Whipple disease is a systemic chronic infection caused by Tropheryma whipplei. Although chronic diarrhea is a common gastrointestinal symptom, diagnosis is often difficult because there are no specific endoscopic findings, and the pathogen is not detectable by stool culture. We present a female patient with Whipple disease who developed chronic bloody diarrhea and growth retardation at the age of 4 years. Colonoscopy showed a mildly edematous terminal ileum and marked erythema without vascular patterns throughout the sigmoid colon and rectum. Subsequently, a primary diagnosis of ulcerative colitis was made. Histopathological analysis of the terminal ileum showed the presence of foamy macrophages filled with periodic acid-Schiff-positive particles. Polymerase chain reaction using DNA from a terminal ileum biopsy sample amplified a fragment of 16S rRNA from T. whipplei. Antibiotic treatment relieved the patient’s symptoms. There was no evidence of immunodeficiency in the present case. Since Whipple disease worsens after anti-tumor necrosis factor inhibitor therapy, considering this infection in the differential diagnosis may be important in patients with inflammatory bowel disease, especially before initiation of immunotherapy. (Intest Res 2021;19:119-125)
Invasiveness Reduction of Recent Total En Bloc Spondylectomy: Assessment of the Learning Curve
Takayoshi Ishii,Hideki Murakami,Satoru Demura,Satoshi Kato,Katsuhito Yoshioka,Moriyuki Fujii,Takashi Igarashi,Hiroyuki Tsuchiya 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3
Study Design: Case-control study. Purpose: To evaluate the surgical magnitude and learning curve of “second-generation” total en bloc spondylectomy (TES). Overview of Literature: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. Methods: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. Results: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p <0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p <0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p <0.05). Postoperative creatine phosphokinase levels did not differ among the groups. Conclusions: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
Kazuya Shinmura,Hideki Murakami,Satoru Demura,Satoshi Kato,Katsuhito Yoshioka,Hiroyuki Hayashi,Noriaki Yokogawa,Takashi Igarashi,Moriyuki Fujii,Noritaka Yonezawa,Hiroyuki Tsuchiya 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6
Study Design: A retrospective study. Purpose: To evaluate the immunity-enhancing effect of implantation of a liquid nitrogen-treated tumor. Overview of Literature: We have developed a new technique of implanting a tumor frozen in liquid nitrogen after posterior decompression and stabilization, with the aim of enhancing antitumor immunity in order to prolong the survival period of the patient. In the current study, the immunity-enhancing effect of this new technique has been evaluated. Methods: The subjects were 19 patients in whom we had earlier performed decompression and stabilization between April 2011 and September 2013. The 19 subjects were divided into two groups, namely a frozen autologous tumor tissue implantation group (n=15; “implantation group”), which consisted of patients, who underwent implantation with autologous tumor tissue frozen in liquid nitrogen, and a control group (n=4), which consisted of patients, who did not undergo autologous cancer transplantation. To evaluate the immunity-enhancing effect of the protocol, plasma cytokines (interferon [IFN]-γ and interleukin [IL]-12) were analyzed before surgery and a month after surgery. Results: The mean rate of increase in IFN-γ was significantly higher in the implantation group (p =0.03). Regarding IL-12, no significant difference was observed between the groups, although the implantation group exhibited increased levels of IL-12 (p =0.22). Conclusions: Decompression and stabilization combined with autologous frozen tumor cell implantation can enhance cancer immunity in metastatic spinal tumor patients. It is hypothesized that this procedure might prevent local recurrence and prolong survival period.