Kanzo

A new rapid and simplified assay of major free amino acids in plasma and its clinical application

Development of the new assay method and its application to differential diagnosis in various diseases of the liver

Yosei FUJIKAKE, Junichi SUGIHARA, Toshiyulci NAKAMURA, Hiroo ONISHI, K ...

1981 Volume 22 Issue 10 Pages 1375-1381
Published: October 25, 1981
Released on J-STAGE: January 19, 2010

DOIhttps://doi.org/10.2957/kanzo.22.1375

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To establish early diagnosis and accurate prognosis for acute liver failure, the author developed a new rapid and simplified assay method of plasma major free neutral amino acids: valine, isoleu cine, leucine, tyrosine, phenylalanine and methionine.
High performance liquid chromatography was carried out, using an ion exchange resin (Kyowa Seimitsu Co., 6221OF) and citric acid buffers, pH 4.00, pH 4.25. By this method one sample was assayed within 20 minutes.
Discriminant analysis, carried out using six amino acids in various liver diseases, exhibited a complete (100%) correct classification between fulminant and acute hepatitis, and an absolute value of vector for methionine was found to be the greatest among 6 amino acids. Whereas that of vector for phenylalanine was the highest between presence and absence of encephalopathy in decom pensated liver cirrhosis. These results strongly suggest that methionine plays an important role in the development of hepatic coma in acute liver failure, whereas phenylalanine is the most responsible for encephalopathy due to chronic liver failure.

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Serum concentration and metabolic clearance rate of melatonin in patients with liver diseases

Haruo IGUCHI, Ken-ichi KATO, Hiroshi IBAYASHI

1981 Volume 22 Issue 10 Pages 1382-1385
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1382

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Serum melatonin concentrations were measured in 41 normal human subjects and 98 patients (liver cirrhosis; 22, chronic hepatitis; 11, acute hepatitis; 4, chronic renal failure; 9, various endo-crine disorders; 52).
The daytime (0900-1100h) concentrations of serum melatonin were significantly elevated in pa-tients with liver cirrhosis and acute hepatitis. Nocturnal rise of serum melatonin similar to that in the normal subjects was observed in patients with liver cirrhosis. A significant correlation was found be-tween the daytime concentration of serum melatonin and ICG (R₁₅) as well as serum total bilirubin concentration. The melatonin clearance from blood showed a biphasic first-ordered kinetics, and the half-time of melatonin in patients with liver cirrhosis was significantly delayed compared with that in the normal controls.
From these results, it can be presumed that elevation of serum melatonin concentration in pa-tients with liver cirrhosis and acute hepatitis is due, in a large part, to prolongation of the metabolic clearance rate of melatonin.

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Hepatitis A Chikugo Basin in 1979

Hiroshi SETOYAMA, Michio SATA, Paul Beninger, Hiromu UEDA, Tatsuro WAD ...

1981 Volume 22 Issue 10 Pages 1386-1392
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1386

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Between October 1978 and July 1979, we experienced 120 cases of acute hepatitis type A in the Chikugo Basin, Fukuoka prefecture. The population of the Chikugo Basin is approximately 400, 000, including five towns and accompanying rural districts. The incidence of reported cases is normally distributed with the first notable increase in January, the peak incidence in March, and the baseline incidence re occurring in July 1979. The total number of cases reported may be divided into two groups: family related outbreaks, 32 cases, and sporadic outbreaks, 88 cases. Seventy cases, or 87.5% of all sporadic outbreaks occurred between February and April. All communities experienced the peak incidence during March. Epidemiologic data reveal a three to one male to female ratio and a two third incidence between the ages of 20 and 39.
We suspected that this outbreak may be due to the dietary consumption of raw shellfish.

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Localization of HBcAg and HBeAg in liver tissue of type B hepatitis

Kenji SOGA, Hideo KOJIMA, Toshiaki WATANABE, Akira YOSHIKAWA, Shozo WA ...

1981 Volume 22 Issue 10 Pages 1393-1402
Published: October 25, 1981
Released on J-STAGE: January 19, 2010

DOIhttps://doi.org/10.2957/kanzo.22.1393

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Localization of HBcAg and HBeAg in liver tissue was examined by immunofluorescent antibody technique for the analysis of correlation of them to various type B hepatitis, HBeAg system in serum and HBV specific DNA polymerase (DNA-P) activity. Most of HBcAg in liver tissue were demon strated in the nucleus and partially in the cytoplasm of hepatocyte. HBeAg in liver tissue was demon strated in a similar localization of HBcAg. With the use of the double staining procedure by FITC and Rhodamine, HBcAg and HBeAg in liver tissue were very often simultaneously demonstrated in the same nuclei and cytoplasm. On this finding, it was suggested that there was close correlation be tween HBcAg and HBeAg.
HBcAg and HBeAg in liver tissue were observed in the patients with HBeAg and/or DNA-P activity in serum, especially high level of DNA-P activity, indicating the replication of HBV in liver tissue.

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Rescrutinization of role of anti-HBc in pathogenesis of hepatitis B

Yoshio HANAOKA, Takashi SAKABE, Toshio SHIKATA

1981 Volume 22 Issue 10 Pages 1403-1409
Published: October 25, 1981
Released on J-STAGE: January 19, 2010

DOIhttps://doi.org/10.2957/kanzo.22.1403

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88 liver biopsies and necropsies from patients with or without anti nuclear factor (ANF) and/or anti DNA, or HBsAg were studied for rescrutinization of anti HBc in pathogenesis of hepatitis B. The specimens were fixed with 10% paraformaldehyde or 4% Zamboni solution for 24 hrs. and paraffin embedded. Microtome sections were stained for IgG with immunoperoxidase technique. IgG was detected in hepatocellular cytoplasm and/or nuclei. Intranuclear IgG was demonstrated in 14 HBsAg chronic carriers (including 5 healthy carriers) and 7 cases of chronic non B liver disease with ANF and/or anti DNA. In the cases without HBsAg, ANF or anti DNA, IgG was localized only in the cytoplasm. These indicate that IgG could be deposited in the nucleus with no evidens of hepatocellular injury when the nucleus has any antigens, not necessarily HBcAg. We conclude that intranuclear HBc antiHBc immune complex has nothing to do with pathogenesis of type B hepatitis.

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Non-A, non-B acute viral hepatitis in medical staff

Hiromichi NAKAYA, Akira TAKADA, Shujiro TAKASE, Yoshiro MATSUDA

1981 Volume 22 Issue 10 Pages 1410-1414
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1410

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During 6 years from January 1975 to December 1980, 11 cases of acute viral hepatitis were observed in the medical staffs of Kanazawa Medical University Hospital. Five out of 11 cases were non-A, non-B hepatitis and remained 6 cases were hepatitis B. In non-A, non-B type, 4 cases were nurses and 1 case was doctor. While, in B type, 3 cases were nurses and 3 cases were laboratory tech-nicians. All cases of hepatitis B were sporadically observed. However, 3 out of 5 cases of non-A, non-B hepatitis, who were nurses of intensive care unit, were epidemically observed during one month from April to May in 1980. These results suggested that the occurrence of type B or non-A, non-B type of acute hepatitis were different according to the occupational category. All cases of B type resolved within 2 months after the onset. On the contrary, the half cases of non-A, non-B hepatitis resolved within a few months, but the remaining half cases transitted to chronic hepatitis. These results strongly suggest that medical staff have a occupational hazard of both B and non-A, non-B types hepatitis infection. Especially, nurses who contact directly with patients and its excrements, were the highest risk group for infection to both types of hepatitis.

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Serume alkaline phosphatase isoenzymes in liver diseases by poly-acrylamide disc gel electrophoresis using Triton X-100

Shingo NISHIOKA, Yoshinobu YAMAMOTO, Nobuhito SHIOJI, Yoshihide IKEDA, ...

1981 Volume 22 Issue 10 Pages 1415-1422
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1415

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By adding Triton X-100 to the polyacrylamide gel, alkaline phosphatase isoenzyme electro-phoresis was carried out in sera of 150 patients with various hepatic and other iseases. In the pres-ence of Triton X-100 the sharper bands were obtained, and the appearances of two new bands (T₁, T₂) were observed. Incidences of T₁ and T₂ band in all patients with liver diseases were 76.7% and 32.2%, respectively. In almost patients with hepatocellular carcinoma and acute hepatitis, T₁ band was seen, and T₂ was rare. But in about 40% of patients with hepatic cirrhosis and chronic hepatitis T₂ band was found, and in all of them accompanied with T₁ band. Inhibition studies of two bands suggested that they were similar to intestinal alkaline phosphatase.
It is considered that T₁ and T₂ band which had remained at origin, migrated into the gel with Triton X-100 and the detections of T₁ and T₂ may be helpful adjuncts in making the differential diagnosis of liver diseases.

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Distribution of secretory component and IgA in the livers using peroxidase-antiperoxidase method, with special emphasis

on primary biliary cirrhosis

Yasuni NAKANUMA, Hitoshi SUGIURA, Naoko KONO, Kenichi KOBAYASHI, Gorok ...

1981 Volume 22 Issue 10 Pages 1423-1434
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1423

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Distribution of secretory component (SC) and IgA was examined by peroxidase-antiperoxidase method in normal livers and livers of chronic inactive hepatitis, chronic active hepatitis, liver cirrho-sis, extrahepatic cholestasis (EHC) and primary biliary cirrhosis (PBC). SC and IgA were demon-strated in the hepatocytes as well as in the intrahepatic bile duct epithelium. SC and IgA were found in the hepatocytes of considerable numbers of livers examined, irrespective of liver diseases, and dis-tribution of IgA was relatively widespread compared to SC. SC was found in the epithelium of the intrahepatic bile duct of any size; among which large sized duct epithelium was apt to be stained positively to more degree and extent than smaller one in any livers. The duct epithelium of the livers with EHC and PBC also revealed much more intensely and widespread positive staining of SC, com-pared with that of the other liver diseases. Electronmicroscopical observation of the livers with EHC and PBC showed that rough endoplasmic reticulum and the Golgi apparatus were hyperplastic. Dis-tribution of IgA in the biliary tree, in which positive epithelium was much more in larger sizes, was irregular and inconstant compared with that of SC, but relatively diffuse in livers with PBC and EHC.
As to PBC livers, SC and IgA were widely distributed and intensely stained in the intrahepatic bile ducts with CNSDC changes as well as non-CNSDC changes, except the eithelium of a few normal appearing bile ducts and severely damaged bile ducts. It seemed likely that inflammatory changes of the intrahepatic bile ducts in PBC or EHC livers might promote an increase in degree and extent of the intra-epithelial SC production and IgA deposition, although exact nature of the two proteins remain unknown.

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Evidence of albumin synthesis in tumor cells of human and chemically-induced rat hepatomas: Immunohistologic and

radioprecursor investigations

Toshioki KANEKO

1981 Volume 22 Issue 10 Pages 1435-1444
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1435

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Hepatocellular carcinoma (hepatoma) cells retain certain synthetic functions of normal hepato-cytes. The present investigation studied albumin synthesis in human autopsy hepatoma tissue and 3'-methyl-diazobenzene induced rat hepatoma tissue. Human tissue was stained for albumin by per-oxidase anti-peroxidase and diaminobenzadine. Rat tissue was subjected for the same staining pro-cedure and also ¹⁴C-L-leucine radioprecurssor uptake by the antiserum-precipitated albumin frac-tion and albumin fraction measurement by the Laurell-Rocket method.
The following results were obtained: (1) positive staining of albumin was observed in human hepatoma cells as well as in hepatocytes tissue from 24 patients (77.4%) of a total of 31 patients with hepatoma and 87.1% of hepatoma tissue demonstrated positive staining; (2) positive staining was also observed in all 8 rats with hepatoma and in 62.5% of hepatoma tissue; (3) in ¹⁴C-leucine uptake studies, the incorp ration rate into the albumin fraction was 30.9% for hepatocytes from normal liver tissue and 40.1% for hepatocytes from hepatoma-bearing liver tissue; (4) tissue albumin con-centration as determined by Laurell-Rocket method was 4.2mg/wet.g. liver in hepatoma tissue and 0.98mg/wet.g. liver, in non-hepatoma tissue; and (5) the paradoxic results from the ¹⁴C-leucine uptake experiments and the tissue albumin concentration determinations that albumin release from hepatoma cells differ from that of normal hepatocytes.
In conclusion, both human and chemically-induced rat hepatoma cells perform albumin synthesis.

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Three cases of viral hepatitis type A with cholestasis

Hirohiko ABE, Michio SATA, Hiroshi SETOYAMA, Tatsuro WADA, Paul Richar ...

1981 Volume 22 Issue 10 Pages 1445-1452
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1445

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We presented three cases of viral hepatitis type A with cholestasis. The patients' ages were 26, 31 and 32 years. Their maximum levels of serum total bilirubin were 12.2, 39 and 58mg/dl, and the duration of hyperbilirubinemia for values greater than 10mg/dl was between one and two months. IgM anti-HA was detected in all three cases using HAVAB-M kit (Dainabott). The liver biopsy, taken from the first patient fourteen days after the onset of symptoms, showed characteristic findings of acute phase viral hepatitis type A, including portal tract enlargement with mononuclear cell infil-trate, hepatocytic alterations which were restricted to the periportal area, and parenchymal altera-tions which were less severe than the changes of the portal tract. A second liver biopsy, taken three months after the onset of symptoms, showed only moderate cholestatic findings. Biopsies taken from the other two patients showed similar cholestatic findings.

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A case of drug-induced liver injury with positive LE phenomenon caused by mercazole

Michio KOBAYASHI, Satoru HIGASHIYAMA, Syunji NAKAGIRI, Toshiaki ITO, K ...

1981 Volume 22 Issue 10 Pages 1453-1459
Published: October 25, 1981
Released on J-STAGE: January 19, 2010

DOIhttps://doi.org/10.2957/kanzo.22.1453

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A 38 year-old female patient with hyperthyroidism was treated with mercazole at a dose of 30mg per day. 15 days after starting therapy, Al-P, LAP and γ-GTP increased, and on the 20th day Al-P rose to 44K.A.U., LAP to 392 G.R.U. and γ-GTP to the extreme of 216mU, respectively. On the 25th day jaundice was observed and on the 50th day T-Bil rose to 37mg/dl. But transaminase was within the normal range throughout the treatment.
The liver biopsy specimen showed marked cholestasis in the area of the central vein. Parenchymal change and cell infiltration in the portal tracts were slightly present.
LE phenomenon on the 20th day and antinuclear antibody on the 27th day were seen to be positive, which was thought to be induced by mercazole.
In addition, thiurazile also caused liver injury and the lymphocyte stimulation test was positive to both mercazole and thiurazile. From the view point of drug cross reaction, the existence of a thioamide radical seems to be important.
These observations indicate a drug-induced intrahepatic cholestasis caused by mercazole.

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A case of primary acquired hypogammaglobulinemia complicated with chronic active hepatitis (2B)

With special reference to the findings of the peritoneoscopic examination

Shu MIYAKE, Hiroshi KOHNO, Masatoshi UEDA, Masahiro KUBOTA, Kimiaki ON ...

1981 Volume 22 Issue 10 Pages 1460-1465
Published: October 25, 1981
Released on J-STAGE: January 19, 2010

DOIhttps://doi.org/10.2957/kanzo.22.1460

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42 year-old male, who had been pointed out hypogammaglobulinemia at his age of 34, was admitted with chief complaint of nasal and conjunctival bleeding. He was small (147cm in height) and had hepato-splenomegaly. The laboratory findings showed serum gammaglobulin 1.2% with marked decrease in IgG, A, M, D and E and with slight elevation of C₃. The bone marrow demon strated hypoplastic change, marked fibrosis and no plasma cells all over the field. The Mantoux reac tion was negative, PHA test was strong positive and T and B lymphocytes were 88.6% and 12.4% respectively.
The surface of the liver accorded with code number 314, 9 after Shimada's classification on the peritoneoscopic examination. The biopsied liver revealed chronic active hepatitis (2B) according to the European classification. There are no papers which handles with a complicated case of primary acquired hypogammaglobulinemia and chronic hepatitis. The etiology of hypogammaglobulinemia in this case seems to be due to the impairment in maturity from B lymphocytes to plasma cells. Chronic hepatitis in this patient may come from non-A non-B hepatitis or from the immunological change such as antibody-dependent cellular cytotoxicity.

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Idiopathic portal hypertension (So-called Banti syndrome) associated with auto-immune hemolytic anemia; report of two cases

Kazuhiko YOSHIKAWA, Kaoru UMEYAMA, Takafumi YAMASHITA, Kasei KOH, Eija ...

1981 Volume 22 Issue 10 Pages 1466-1472
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1466

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Two cases of idiopathic portal hypertension (IPH) with auto-immune hemolytic anemia (AIHA) were presented.
Case 1: A 33 year-old female was admitted to our hospital complaining of splenomegaly and jaundice.
On hospitalization, severe anemia and moderate jaundice were noticed. The spleen was palpable 2.5 fingerbreadths below the umbilicus. Direct Coombs' test was positive.
Splenectomy was performed. The weight of the removed spleen was 1050g; the pressure of the portal vein was 350mmH₂O on laparotomy.
Histological examination of biopsied liver specimens showed mild fibrosis; spleen specimens showed marked sinushyperplasia.
After splenectomy, laboratory investigation showed normal hemoglobin and bilirubin levels. Coombs' test changed to negative.
Case 2: A 47 year-old female was admitted complaining of splenomegaly and anemia. Abdominal examination showed a palpable spleen 1 fingerbreadth below the umbilicus. Direct and indirect Coombs' test were positive. She had several episodes of hemolytic attack but jaundice decreased under treatment with pledonisolone.
Splenectomy was performed and the weight of the removed spleen was 940g; the pressure of portal vein was 290mmH₂O.
Histological examination of biopsied liver specimens revealed no cirrhotic changes; removed spleen specimens showed prominent sinushyperplasia.
After the operation, hemoglobin and bilirubin levels were entirely normal.
We suspected that this complication of IPH and AIHA was not merely coincidental but both diseases had somewhat same pathogenesis of immunological disturbance.

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A case of primary biliary cirrhosis complicated with progressive systemic sclerosis, sjögren's syndrome and Hashimoto's thyroiditis

Eiji TANAKA, Toshisuke IMAI, Keiichi NOSAWA, Yoichi SUSUKI, Yoshihiro ...

1981 Volume 22 Issue 10 Pages 1473-1479
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1473

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Fifty-four year-old woman had been complained of palmar iching, Raynaud's phenomenon and noted abnormal liver function tests and also hypothyroidism over several years. She had been administered prednisolone and desiccated thyroid for these illnesses. At 54 years of age, she developed an overt jaundice and was referred to our clinic. Her physical findings and laboratory datas were compatible for the diagnosis of progressive systemic sclerosis, Sjogren's syndrome and Hashimoto's chronic thyroiditis. These diagnoses were confirmed by histological findings of biopsied specimens of thyroid gland, salivary gland and skin. As regards the jaundice, her liver function tests showed the jaundice of cholestatic type, but ERCP findings ruled out the extrahepatic obstruction. Anti-mito-chondrial antibody in her serum was negative on repeated tests. Serial sections of wedge-biopsied liver obtained under surgical laparotomy revealed chronic non-suppurative destructive cholangitis, compatible for primary biliary cirrhosis. The underlying mechanisms of these complications of wide varieties in primary biliary cirrhosis were discussed.

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1480
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1480

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese]

1981 Volume 22 Issue 10 Pages 1481
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1481

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1482
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1482

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1483
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1483

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1484
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1484

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1485
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1485

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1486
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1486

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[title in Japanese]

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1981 Volume 22 Issue 10 Pages 1487
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1487

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[title in Japanese]

1981 Volume 22 Issue 10 Pages 1488-1506
Published: October 25, 1981
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.22.1488

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