We report our experience with percutaneous endoscopic gastrostomy (PEG) to assess the safety and usefulness of the PEG. We reviewed 21 cases (mean age, 72 years), including 20 patients with neurological impairment and one patient with cancer of the stomach.
Though two minor complications (wound infection and bleeding from the stomach) occurred, wound infection healed with antibiotics and bleeding stopped spontaneously. Six of these patients died (3 died from pneumonia, 2 from respiratory failure, and 1 from stomach cancer), but there were no PEG-related deaths. After PEG procedure, serum protein, albumin and cholesterol improved significantly. PEG was not only safe but also effective for the nutritional support and the 4-year survival rate was 56%. By this method, moreover, half of the patients could leave hospital and return home.
In conclusion, PEG, is thought to be the procedure of choice for the long-term enteral nutrition.

Tranilast, an anti-allergic drug, was originally made in Japan, and is now being frequently used. Though ill effects of Tranilast in urology have been known widely, the adverse effect of Tranilast on liver function has been scarcely reported. Having experienced 7 cases of liver disease due to cholestasis by the drug, we summarized these cases and reported the characteristics of liver injury induced by the drug.
All the patients, who had took Tranilast orally and developed liver injury, first manifested hematuria and micturition pain, and then developed jaundice. Though the degree of liver injury was various depending on individuals, the clinical course turned better about 27 days after cessation of Tranilast.

Using RIBA NS5 antibody was measured in 31 HCV RNA positive serotype 1 patients, and the serum levels of ALT were monitored for an average of three years. As a result, 22 asymptomatic HCV carriers (group A) were found to be NS5 antibody negative (-) and nine to be NS5 antibody positive (4+). By contrast, in 25 patients with chronic inactive hepatitis C (group B), three patients were NS5 antibody negative (-), and 22 patients were NS5 antibody positive (4+), indicating a significant difference between the two groups (p<0.01 chi square test).Furthermore, in group A, 22 NS5 antibody (-) patients (group I) maintained normal serum levels of ALT significantly longer than the 9 NS5 antibody (4+) patients (group II) (p<0.01, Kaplan-Meier Method). Therefore, the measurement of NS5 antibody of RIBA was clinically useful in identifing asymptomatic (HCVRNA positive, serotype 1) HCV carriers.
Antibodies ; Hepatitis C virus ; Absence of symptoms ; Measurement ; Confirmation of

We examined the usefulness of serum leptin concentration as an index for the diagnosis of fatty liver. Twenty-two patients diagnosed with fatty liver by abdominal ultrasonography, participated in this study together with 7 indinduels as controls. As laboratory findings showed, body fat percentage (29.5±1.4 vs 19.1±1.6%, P<0.001), BMI (25.7±0.7 vs 20.8±1.0 kg/m2, P<0.005), procollagen III peptide (P III P) (0.58±0.04 vs 0.42±0.04 U/ml, P<0.05), and serum leptin levels (7.3±1.0 vs 2.9±0.5 ng/ml, P<0.001) were significantly higher in the fatty liver group than in the control group. Serum leptin levels were correlated significantly with body fat percentage (r=0.76, P<0.0001) and BMI (r=0.61, P<0.001), though there was a significant correlation between serum leptin levels and liver-kidney contrast (r=0.47, P<0.05) only in males. In addition, when the fatty liver group was classified into two groups by GPT levels, m-GOT (mitochondrial glutamate-oxaloacetate transaminase) (8.6±1.0 vs 5.7±1.0 IU/l/37°C, P<0.05) and P III P (0.65±0.06 vs 0.49±0.04 U/ml, P<0.05) were significantly higher in the elevated GPT group than in the normal GPT group.These results suggest that serum leptin levels may be indicative of fatty liver and that fatty liver is not always a reversible disease.
upper case pea ; Fatty Liver ; Leptin ; Serum ; Lower case are

Eosinophilic gastroenteritis (EG) is characterized by infiltration of eosinophils into the wall of the digestive tract, and the clinical spectrum seems to depend on the predominant site of eosinophilic infiltration of the wall.
We experienced four cases of EG, and two of them (Cases, 1 and 2) manifested massive ascites, suggesting the principal lesion is located on the serous coat. Case 3 manifested abdominal pain and vomiting, and muscle layer involvement of the duodenum was detected by ultrasonography and CT scan. In case 4, epigastralgia was a main symptom. An endoscopic examination revealed marked redness and erosion of the gastric mucosa associated with massive infiltration of eosinophils. In this case, mucosal involvement seemed to be the main lesion because hypertrophy of the gut wall thickness was not found by ultrasonography and CT scan.
Although the pathogenesis of this disease is obscure, allergic mechanism may play an important role. Three cases had histories of allergic diseases, and steroid therapy resulted in prompt disappearance of symptoms.

  Recently, the relevance of Helicobacter pyroli (H. pylori) infection to atrophic gastritis and gastric cancer in has been elucidated. Therefore, to diagnose H. pylori infection is important for suspecting the existence of those diseases of the stomach. We investigated the relationships of the H. pylori IgG antibody to H. pylori infection, atrophic gastritisor various stomach lesions to understand the significance and usefulness of evaluating the antibody level in the annual multiphasic health check-up participants. The subjects in this study were 148 people (male: 93, female: 55, average age: 56.4) in Toride city, which is located in the suburb of Tokyo. They had visited our hospital for medical checkups. Eighty-seven subjects underwent upper gastric endoscopy and 55 (63%) tested positive for H. pylori IgG antibody and H. pylori infection was confirmed in 41 (75%). Although 32 subjects tested negative for the antibody, 8 cases (25%) was diagnosed with H. pylori infection. The frequencies of positive antibody in atrophic gastritis, erosion and ulcer, fundic gland polyp, hyperplastic foveolar polyp, adenoma and malignancy were 17%, 70%, 61%, 77%, 31%, 62%, 0% and 100%, respectively. On the other hand of 80 subjects were who underwent barium X-ray examination, 44 tested positive for the antibody (55%). The frequency of positive antibody in no lesion, depressed lesion, elevated lesion and malignant lesion were 61%, 59%, 36% and 100%, respectively. Taken together, H. pylori antibody was a good marker for H. pylori infection and the positive antibody indicated high frequencies of atrophic gastritis and malignancy. Therefore, advices to have participants who have a positive antibody should be strongly an endscopic examination stomach lesions.

A 65-year-old man was referred to our hospital in April 2003 with a pancreas tumor detected by a thorough medical checkup. Computed tomography (CT) showed swelling of the pancreatic body and tail, and magnetic resonance cholangiopancreatography (MRCP) showed only the main pancreatic duct in the head of the pancreas. Diagnosing autoimmune pancreatitis, we observed the patient without medication. However, one year later CT showed stenosis of the splenic artery and portal vein accompanied by development of collateral circulation around the pancreas. He had no symptoms, and CT showed no changes in the pancreatic swelling.;;He was admitted to our hospital on January 6, 2005, presenting with a history of jaundice which first appeared on January 1, 2005, and increased collateral circulation around the pancreas with pancreatic swelling were seen on CT. We started prednisolone therapy at 40 mg/day for exacerbation of autoimmune pancreatitis. Serum bilirubin levels improved from 11.9 mg/dl to 2.5 mg/dl, and pancreatic swelling also improved four weeks after starting therapy.;;We present a rare case of autoimmune pancreatitis that developed marked collateral circulations.
X-Ray Computed Tomography ; Pancreatitis ; Collateral Circulation ; Pancreatic polypeptide, avian ; Swelling