A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature.

A case of severe drug-induced liver injury caused by over the counter (OTC) herb medicine, is reported here. A 40-year-old male took herb drugs "Za ga-doKowa®," "Ohta-Isan®." These two drugs contained the same two herb medicines (cinnamon, fennel). About 4 months later after taking medicine, jaundice appeared. Prothrombin time activation (PT) was 45%, aspartate transaminase (AST) was 1104 IU/l, and total bilirubin (T-bil) 14.7 mg/dL. Serum tests for hepatitis viruses (A, B, C, E) were negative. Lymphocyte stimulating test was positive for Za ga-do Kowa ® and Ohta-I Isan®. Liver 3D constructed by construct-CT revealed findings of the potato-like liver. The liver biopsy specimen revealed multilobular hepatic necrosis accompanied by scar formation, severe zonal degeneration and necrosis of hepatocytes mainly in the central area of the lobule. In the reported 13 cases of cinnamon-induced liver diseases, there has been a severe abnormality of PT and T-bil. Biopsy findings of these cases showed wide ranges of necrosis. Liver injury due to cinnamon shows very severe damages, and the possibility of liver failure due to cinnamon may be imminent. How to cite this article: Higaki H, Onji M, Takeji S, Uehara T, Kawasaki K, Kashimoto Y, Murakami T, Yamaguchi T, Miyaike J, Oomoto M, Abe M. A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature. Euroasian J Hepatogastroenterol, 2018;8(2):167-171.

Submucosal tumor-like lesion originating from colon tuberculosis: a case report and review of the literature.

A 76-year-old male had a solitary submucosal tumor-like lesion in the sigmoid colon originating from tuberculosis. The lesion, up to 1 cm in diameter, was found incidentally during a routine colonoscopy, which revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa in the center of the tumor. Histologically, the endoscopic biopsy revealed caseating granulomas and infiltration of Langhans giant cells and epithelioid cells, consistent with tuberculosis, were also observed. Five reports of similar lesions from colon tuberculosis were found in a literature review, including the present case. In all cases, the submucosal tumor-like lesions which originated from tuberculosis were small and in an active stage of tuberculosis. Five cases of submucosal tumor-like lesions from gastric tuberculosis were also reported, with characteristics very similar to those of the lesions from colon tuberculosis. Therefore, we propose that lesions originating from tuberculosis should be included in the differential diagnosis of submucosal tumor-like lesions in the colon and stomach.

A screening test for capsaicin-stimulated salivary flow using filter paper: a study for diagnosis of hyposalivation with a complaint of dry mouth.

OBJECTIVE: The purpose of this study was to develop a simple screening technique for diagnosis of hyposalivation with dry mouth by estimation of capsaicin-stimulated salivary flow using filter paper. STUDY DESIGN: An assay system comprising 5 spots containing starch and potassium iodide on filter paper incorporating or without capsaicin and a coloring reagent was designed. We investigated whether the number of colored spots using the filter paper incorporating capsaicin could distinguish between healthy subjects and subjects with hyposalivation and dry mouth. RESULTS: In the healthy group (>200 µL/min; n = 33), the capsaicin-stimulated salivary flow significantly increased as compared with the resting salivary flow, from 1.2 ± 1.4 to 2.9 ± 1.3 colored spots (P < .05). In contrast, the hyposalivation group with dry mouth (<100 µL/min; n = 32) hardly changed (4.4 ± 1.0 vs 4.9 ± 0.2), except for 3 subjects who had considerable elevated secretion on capsaicin stimulation. CONCLUSION: By measuring resting and stimulated salivary flows, this method should be useful for evaluating retained functional ability of salivary glands and screening of hyposalivation with dry mouth.

A pilot study of a simple screening technique for estimation of salivary flow.

OBJECTIVES: The purpose of this study was to develop a simple screening technique for estimation of salivary flow and to test the usefulness of the method for determining decreased salivary flow. STUDY DESIGN: A novel assay system comprising 3 spots containing 30 microg starch and 49.6 microg potassium iodide per spot on filter paper and a coloring reagent, based on the color reaction of iodine-starch and theory of paper chromatography, was designed. We investigated the relationship between resting whole salivary rates and the number of colored spots on the filter produced by 41 hospitalized subjects. RESULTS: A significant negative correlation was observed between the number of colored spots and the resting salivary flow rate (n = 41; r = -0.803; P < .01). For all complaints of decreased salivary flow (n = 9) having cutoff values <100 microL/min for the salivary flow rate, 3 colored spots appeared on the paper, whereas for healthy subjects there was < or =1 colored spot. CONCLUSION: This novel assay system might be effective for estimation of salivary flow not only in healthy but also in bedridden and disabled elderly people.