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( Taku Tabata ),( Terumi Kamisawa ),( Seiichi Hara ),( Sawako Kuruma ),( Kazuro Chiba ),( Go Kuwata ),( Takashi Fujiwara ),( Hideto Egashira ),( Koichi Koizumi ),( Junko Fujiwara ),( Takeo Arakawa ),( 대한간학회 2013 Gut and Liver Vol.7 No.2
Background/Aims: Few studies have differentiated immunoglobulin G (IgG) 4-related sclerosing cholangitis (IgG4-SC) from hilar cholangiocarcinoma (CC). Thus, we sought to investigate useful features for differentiating IgG4-SC from hilar CC. Methods: We retrospectively compared clinical, serological, imaging, and histological features of six patients with IgG4-SC and 42 patients with hilar CC. Results: In patients with hilar CC, obstructive jaundice was more frequent (p<0.01), serum total bilirubin levels were significantly higher (p<0.05), serum CA19-9 levels were significantly higher (p<0.01), and serum duke pancreatic monoclonal antigen type 2 levels were frequently elevated (p<0.05). However, in patients with IgG4-SC, the serum IgG (p<0.05) and IgG4 (p<0.01) levels were significantly higher and frequently elevated. The pancreas was enlarged in all IgG4-SC patients but only in 17% of hilar CC patients (p<0.01). Salivary and/or lacrimal gland swelling was detected in only 50% of IgG4-SC patients (p<0.01). Endoscopic retrograde cholangiography revealed that the hilar or hepatic duct was completely obstructed in 83% of hilar CC patients (p<0.01). Lower bile duct stenosis, apart from hilar bile duct stenosis, was more frequent in IgG4-SC patients (p<0.01). Bile duct wall thickening in areas without stenosis was more frequent in IgG4-SC patients (p<0.01). Conclusions: An integrated diagnostic approach based on clinical, serological, imaging, and histological findings is necessary to differentiate IgG4-SC from hilar CC. (Gut Liver 2013;7:234-238)
( Yuji Miyamoto ),( Terumi Kamisawa ),( Taku Tabata ),( Seiichi Hara ),( Sawako Kuruma ),( Kazuro Chiba ),( Yoshihiko Inaba ),( Go Kuwata ),( Takashi Fujiwara ),( Hideto Egashira ),( Koichi Koizumi ) The Editorial Office of Gut and Liver 2012 Gut and Liver Vol.6 No.4
Background/Aims: Autoimmune pancreatitis (AIP) is frequently associated with diabetes mellitus (DM). This study evaluated the effect of steroid therapy on the course of DM in AIP. Methods: Glucose tolerance was examined in 69 patients with AIP. DM onset was classified as either a simultaneous onset with AIP or an exacerbation of pre-existing DM. Based on the changes in the HbA1c levels and insulin dose, the responses of DM to steroids were classified as improved, no change, or worsened. Results: Thirty (46%) patients were diagnosed as having DM (simultaneous onset, n=17; pre-existing, n=13). Three months after starting the steroid treatment, the DM improved in 13 (54%) of 24 DM patients. The DM improved in 55%, had no change in 36%, and worsened in 9% of the 11 simultaneous onset DM patients, and it improved in 54%, had no change in 31%, and worsened in 15% of the 13 pre-existing DM patients. At approximately 3 years after starting the steroid treatment, the DM improved in 10 (63%) of 16 patients. The pancreatic exocrine function improved in parallel with the changes in the DM in seven patients. Conclusions: Because approximately 60% of DM associated with AIP is responsive to steroids in the short- and long-terms, marked DM associated with AIP appears to be an indication for steroid therapy. (Gut Liver 2012;6:501-504)
( Sawako Kuruma ),( Terumi Kamisawa ),( Taku Tabata ),( Seiichi Hara ),( Takashi Fujiwara ),( Go Kuwata ),( Hideto Egarashira ),( Koichi Koizumi ),( Keigo Setoguchi ),( Junko Fujiwara ),( Takeo Arakaw 대한소화기학회 2013 Gut and Liver Vol.7 No.1
Background/Aims: The objective of this study was to compare the clinical characteristics of patients with autoimmune pancreatitis (AIP) with or without Mikulicz`s disease (MD) and with MD alone. Methods: We investigated the clinical findings in 15 AIP patients with MD (group A+M), 49 AIP only patients (group A), and 14 MD only patients (group M). Results: The male-female ratio was significantly higher in group A+M (73%, p<0.05) and group A (78%, p<0.01) than group M (21%). Serum immunoglobulin G (IgG) levels were significantly higher in group A+M than in group A (p<0.01) and group M (p<0.05). Serum IgG4 levels were significantly higher in group A+M than in group A (p<0.01). Other organ involvement was observed in 73% (11/15) of patients in group A+M. The number of patients with diabetes mellitus was significantly higher in group A+M (66%, p<0.01) and group A (51%, p<0.05) than in group M (7%). All of the patients responded well to steroid therapy, but the relapse rate in group A+M (33%) was significantly higher than that in group A (3%, p<0.01). Salivary gland function was impaired in all groups compared with the control group, but the degree of dysfunction was less in group A compared with group A+M and group M. Conclusions: The relapse rate of AIP in MD patients was significantly higher than that of AIP in patients without MD. (Gut Liver 2013;7:96-99)
Organ Correlation in IgG4-Related Diseases
Satomi Koizumi,Terumi Kamisawa,Sawako Kuruma,Taku Tabata,Kazuro Chiba,Susumu Iwasaki,Go Kuwata,Takashi Fujiwara,Junko Fujiwara,Takeo Arakawa,Koichi Koizumi,Kumiko Momma 대한의학회 2015 Journal of Korean medical science Vol.30 No.6
IgG4-related disease (IgG4-RD) is a potentially multiorgan disorder. In this study, clinical and serological features from 132 IgG4-RD patients were compared about organ correlations. Underlying pathologies comprised autoimmune pancreatitis (AIP) in 85 cases, IgG4-related sclerosing cholangitis (IgG4-SC) in 12, IgG4-related sialadenitis (IgG4-SIA) in 56, IgG4-related dacryoadenitis (IgG4-DAC) in 38, IgG4-related lymphadenopathy (IgG4- LYM) in 20, IgG4-related retroperitoneal fibrosis (IgG4-RF) in 19, IgG4-related kidney disease (IgG4-KD) in 6, IgG4-related pseudotumor (IgG4-PT) in 3. Sixty-five patients (49%) had multiple IgG4-RD (two affected organs in 36 patients, three in 19, four in 8, five in 1, and six in 1). Serum IgG4 levels were significantly higher with multiple lesions than with a single lesion (P < 0.001). The proportion of association with other IgG4-RD was 42% in AIP, the lowest of all IgG4-RDs. Serum IgG4 level was lower in AIP than in other IgG4-RDs. Frequently associated IgG4-RDs were SIA (25%) and DAC (12%) for AIP; AIP (75%) for IgG4-SC; DAC (57%), AIP (38%) and LYM (27%) for IgG4-SIA; AIP (26%) and LYM (26%) for IgG4-DAC; SIA (75%), DAC (50%) and AIP (45%) for IgG4-LYM; SIA (58%), AIP (42%) and LYM (32%) for IgG4-RF; AIP (100%) and SIA (67%) for IgG4-KID; and DAC (67%) and SIA (67%) for IgG4-PT. Most associated IgG4-RD lesions were diagnosed simultaneously, but IgG4-SIA and IgG4-DAC were sometimes identified before other lesions. About half of IgG4-RD patients had multiple IgG4-RD lesions, and some associations were seen between specific organs.
Original Article : Ulcerative Colitis and Immunoglobulin G4
( Go Kuwata ),( Terumi Kamisawa ),( Koichi Koizumi ),( Taku Tabata ),( Seiichi Hara ),( Sawako Kuruma ),( Takashi Fujiwara ),( Kazuro Chiba ),( Hideto Egashira ),( Junko Fujiwara ),( Takeo Arakawa ),( The Editorial Office of Gut and Liver 2014 Gut and Liver Vol.8 No.1
Background/Aims: Ulcerative colitis (UC) is sometimes associated with autoimmune pancreatitis (AIP). Infiltration of immunoglobulin G4 (IgG4)-positive plasma cells is sometimes detected in the colonic mucosa of AIP or UC patients. This study aimed to clarify the relation between UC and IgG4. Methods: Associations with UC were reviewed in 85 AIP patients. IgG4 immunostaining was performed on biopsy specimens from the colonic mucosa of 14 AIP and 32 UC patients. Results: UC was confirmed in two cases (type 1 AIP, n=1, suspected type 2 AIP, n=1). Abundant infiltration of IgG4-positive plasma cells in the colonic mucosa was detected in the case of suspected type 2 AIP with UC and two cases of type 1 AIP without colitis. Abundant infiltration of IgG4-positive plasma cells was detected in 10 UC cases (IgG4-present, 31%). Although 72% of IgG4-absent UC patients showed mild disease activity, 70% of IgG4-present patients showed moderate to severe disease activity (p<0.05). Conclusions: UC is sometimes associated with AIP, but it seems that UC is not a manifestation of IgG4-related disease. Infiltration of IgG4-positive plasma cells is sometimes detectable in the colonic mucosa of UC patients and is associated with disease activity. (Gut Liver 2014,8:29-34)
IS-27 : Compilation of Physical Input-output Table for Describing Regional Biomass Flow
( Masato Yamada ),( Tomonori Ishigaki ),( Koichi Tachio ),( Taku Fujiwara ) 한국폐기물자원순환학회(구 한국폐기물학회) 2013 한국폐기물자원순환학회 추계학술발표논문집 Vol.2013 No.-
In the sustainable society, the recycling of resources should achieve the preservation of regional and global environment and should be coordinated with regional agricultural and industrial activities. Especially for waste biomass resources, it will be supplied or discharged by multiple industries as agriculture, forestry, fisheries, manufacturing, commerce and living, and will be demanded by multiple purposes as foods, supplements, feeds, fertilizers, industrial materials and fuels. Therefore, waste biomass flows connecting these supplies to demands will be extremely complex. In order to judge the effectiveness of introducing technologies for recycling, a comprehensive framework, which can estimate impacts of technologies on regional material cycles and regional and global environment, is need. For this purpose, we are developing a physical input-output table (PIOT) for describes complex material flows of waste biomass, water and their constituents (e.g. carbon, nitrogen and phosphorus) in a region by integration of quantity data. This PIOT sets not only industries but also activities on recycling, waste disposal and wastewater handling in detail as sectors. Import and export between regions, and emissions to environment are also set in the table. Applying content rates of carbon, nitrogen and phosphorus to mass flows of each item, elemental flows of those are accounted for estimating emission to water (as organic pollutant and nutrients) and atmosphere (as greenhouse gas) from the whole system. The energy consumed by activity in each sector is also accounted for estimating greenhouse gas emission. Another originality of this PIOT is that physical data obtained from relevant statistics will be directly integrated to values in the table. As a case study, we are surveying the waste biomass flow at the Kochi prefecture, Japan. Administrative information on industrial waste was acquired from the Kochi Prefecture and the Kochi City with their cooperation. For municipal waste, annual survey on municipal solid waste business by the ministry of the environment was used. For by-product, generation amount, sort, composition and usage of biomass waste were surveyed by hearing, sampling and questionnaire at recyclers of biomass waste. Amounts of generation, recycling and disposal of each biomass waste item, disposal method and municipality were built up from these reports and survey. Using above information, flows of each lot (the annual generation an item of waste from a source) of biomass waste from generation via treatment to disposal or reuse were compiled in the database and set into the PIOT. The current biomass PIOT for Kochi Prefecture is shown in Figure. This table shows weight of materials as wet basis. The 1.43 × 108 tons/year of total demand and the 1.34 × 108 tons/year of total supply were accounted at this time. The difference between demand and supply would mainly be resulted from unrecorded flows in our database, especially on supply of water from the waterworks and the natural water, and the biomass production. We will survey constituents of carbon and nutrients in materials and expand our PIOT to depict the substance flows of elements, in order to estimate quality and quantities of emissions.