[in Japanese]

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[in Japanese]

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To evaluate the prognosis of the sustained biochemical responder after interferon (IFN) therapy, we retrospectively studied 252 chronic hepatitis C patients who were treated with IFN.
Patients were divided into four groups: group A, sustained virological responders (n=84); group B, sustained biochemical but not virological responders (n=43); group C, incomplete responders (n=64); group D, non responders (n=61). The levels of several liver function tests were evaluated at the end of the observation period (4.2±1.6 years, mean±SD) compared with those at just before IFN therapy.
The levels of cholinesterase, albumin, γ-globulin, zinc sulfate turbidity test, platelet count and clearance rate of indocyanine green test improved in group A (p<0.05), became worse in group D (p<0.05) and did not change in group B. The incidence of hepatocellular carinoma was significantly higher in group D than in group B (P<0.01; KaplanMeier method, log-rank test). The hazard ratio for hepatocarcinogenesis of the patients in group A and B was significantly lower than that in group C and D (hazard ratio: 0.27, range of 0.08-0.98; p=0.046) adjusted for age, gender, stage and total alcohol consumption.
These results suggest that the progress of liver disease and liver carcinogenesis was more suppressed in sustained biochemical responders than in non responders.

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The expression of Fas on the epithelial cells of bile ducts was examined in liver specimens from 10 patients with primary biliary cirrhosis (PBC), and 14 patients with chronic hepatitis by both light and electron microscopy using the indirect peroxidase-labeled antibody method. In all patients with PBC, Fas was observed on the surface of epithelial cells of interlobular bile ducts.
By electron microscopy, electron-dense reaction products of Fas were detected on the basolateral plasma membrane of the bile duct epithelial cells, as well as on some membranes of the endoplasmic reticulum. Fas was expressed more strongly on the surface of the epithelial cells of interlobular bile ducts in PBC than of those in chronic hepatitis. These findings suggest that increased expression of Fas on such bile ducts may play some role in the pathogenesis of PBC.

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We hypothesized that a high level of phospholipase A₂ (PLA₂) in bile juice works as a growth factor on biliary epithelial cells and causes hyperplastic change of the bile duct in pancreaticobiliary maljunction. In order to examine this hypothesis, we established a primary culture system of biliary epithelial cells from the extra-hepatic bile duct of rats. We successfully excluded fibroblasts from the epithelial cells using D-valine-containing medium and the single-cell cloning method. The established cells exhibited the characteristic features of rat bile duct epithelial cells. They were stained with anti-cytokeratin antibody, a marker protein of epithelial cells, were positive with PAS stain, and possessed the architectures of microvilli, tonofilament fibers and desmosomes. The effect of PLA₂ on proliferation of these cells was then examined. We clearly demonstrated that PLA₂ at nano-molar concentration (50nM, 100nM), that is, equivalent to the level of PLA₂ in the bile juice of pancreaticobiliary maljunction cases, caused a significant enhancement of epithelial cell proliferation.

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We have analyzed the usefulness of contrast-enhanced ultrasonography with Levovist for the evaluation of therapeutic effects on hepatocellular carcinoma (HCC). Therapeutic effects following treatments of HCC, including transcatheter arterial embolization and percutaneous microwave coagulation therapy, were confirmed with only dynamic CT in group A (8 cases, 10 tumors), or with both dynamic CT and contrast-enhanced ultrasonography with Levovist in group B (7 cases, 8 tumors). Local recurrence of HCC was chekced 6 months after therapy. While recurrence was observed in 6 out of 10 tumors (60%) in group A, only one out of 8 tumors (12.5%) exhibited local recurrence in group B. The rate without recurrence of HCC in the follow-up 6 months (Kaplan-Meier method) was significantly higher in group B than in group A (P=0.045, Log-rank test). These findings suggest that contrastenhanced ultrasonography with Levovist is useful for the evaluation of therapeutic effects on HCC.

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We encountered two cases of unnatural death occurring indoors in early spring in Okayama Prefecture. The two cases were both females aged 31yearsold and 88yearsold. Autopsies revealed death from hypothermia as the cause of death. The diagnosis of death from cold was not based solely on the characteristic findings of the dead body. After confirming that there were no other accidents and diseases that may cause death, an overall evaluation should be made considering the conditions surrounding occurrence of death from cold. We describe these procedures using these two autopsy cases of death from hypothermia.

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