Sixteen male patients with HBeAg positive chronic HBV infection were treated with Ara-A (adenine arabinoside) at dosages of 600mg/day for 28 days and 56 days. Its therapeutic effect in the 6th months after cessation of treatment in those patients was evaluated basically by Merigan et al.
The DNA-P activity was reduced 24 hours later significantly below the pre-treatment level in 11(91.7%)of 12 (p<0.05) and 10 (62.5%) were converted to negative. After cessation of treatment, the DNA-P activity returned to the pre-treatment level in 9 (90%)of 10 patients who had converted to negative during treatment.
Types II and II-III were identified in 5 (33.3%) of 15, confirming the effectiveness of Ara-A therapy. These 5 cases were all CAH with a low DNA-P activity below 500cpm and its effectivieness rate in CAH was 45.5% (5 of 11 cases). Otherwise, 4 cases who were NSRH and CPH with a high DNA-P activity above 1, 000cpm were all Type III.
The above results indicated that Ara-A had an obvious effect in reducing the DNA-P activity, although a limited the therapeutic effect, and may be useful in the treatment of CAH patients with a low DNA-P activity and high transaminase levels.

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Twenty patients with HBeAg positive chronic liver disease were given large doses of recombinant leucocyte interferon for 4 weeks. Changes of HBV DNA in livers and sera were analyzed by Southern blot-hybridization method in paired biopsies obtained before and two weeks after treatment.
Analysis of hepatic HBV DNA revealed 4 bands at 4.0, 3.2, 1.95 and 1.35 kb which appeared to represent various forms of replicative HBV DNA, i.e. relaxed circular, linear, supercoiled and single stranded HBV DNA, respectively. Out of 15 cases who were positive for hepatic HBV DNA before the treatment and in whom paired biopsies were obtained, hepatic HBV DNA became negative in 4 cases after interferon treatment and in these cases serum HBV DNA turned negative and remained negative during the observation period. Among several forms of replicative viral DNA in liver tissue, supercoiled HBV DNA tended to remain even after other forms had become undetectable. There was a close correlation between hepatic and serum HBVDNA(p<0.001).
These results indicate the usefulness of Southem blot-hybridization in studying the changes of intrahepatic replicative forms of HBV DNA induced by interferon. Supercoiled HBV DNA seems to play an important role in persistence of HBV infection.

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Fibronectin (FN) was prepared from human plasma by affinity chromatography with gelatinsepharose 4B. The distribution of FN in the liver was observed by technique of indirect immunofluorescence with rabbit anti-FN antiserum.
The distribution of FN in the liver coincided with that of collagen fibers, and increased according to increment of collagen fibers. FN was recognized in necrotic leisions and also along the reticular fibers around the sinusoids in the case of acute viral hepatitis, in periportal area in chronic hepatitis, and along extended collagen fibers, loose network between them and reticular fibers in hepatic cirrhosis. However, FN was not detected in hepatocytes.
The low levels of plasma FN in acute viral hepatitis and hepatic cirrhosis suggested increased deposition of FN to liver tissue.
Since the coexistence of FN with acid mucopolysaccharide was observed by histochemical technique, it was suggested that combination of FN and acid mucopolysaccharide was the base for promotion of fibrosis of human livers.

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In order to elucidate the pathogenesis of transient glucose intolerance in acute hepatitis, we measured serum immunoreactive insulin (IRI) during 100g-OGTT in 31 cases of acute hepatitis, of which insulin sensitivity index (ISI) was calculated 7 cases during acute stage and after recovery. The number of cases in which 125I-insulin specific binding to circulating mononuclear cells was measured in acute and recovery stage were 8 and 5 cases, respectively. During acute stage, BS and IRI were increased, whereas the peripheral insulin activity (A), defined as a peripheral insulin resistance and ISI were decreased. After recovery, BS, A and ISI returned to almost nomal value. Insulin binding was significantly decreased (0.34±0.06%) (M±SEM) during acute stage, compared with normals (1.03±0.57%) (p<0.01). However, it returned to normal (1.01±0.58%), after recovery. Scatchard plots revealed that its decrease in acute stage was mainly due to reduced binding site per cell. From these results, we conclude that the reduced insulin recepter may play significant role for the pathogenesis of transient glucose intolerance in acute hepatitis.

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In previous experimental study, we found that the estimation of galactose tolerance test correlated with functional reserve cell mass of the liver after partial hepatectomy and that glucose-6-phosphatase activity was significant factor on galactose metabolism in regenerating rat liver.
In this paper, we studied the effect of glucagon on the estimation of galactose tolerance test after partial hepatectomy. Galactose tolerance test (T1/2) was most prolonged on 3rd day after partial hepatectomy and it was improved on 3rd day with glucagon treatment.
In regenerating rat liver, glucose-6-phosphatase activity was increased and blood lactate concentration was decreased by glucagon, suggesting that glucagon was effective in regenerating rat liver due to protect the carbohydrate metabolism from liver cell damage.

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Transcatheter arterial embolization (TAE) is an effective therapy for hepatocellular carcinoma. But complete necrosis of tumor is rare, i.e. the tumor cells invaded into the tumor capsule or small intrahepatic metastasis are viable. This is one of the most important problem in TAE. Then, the authors performed an iatrogenic localized hepatic infarction including tumor by embolizing both hepatic artery and portal vein at the same time. Gelfoam sponge was used as embolic materials. As a results, microscopically, marked necrosis of the capsulated main tumor and the surrounding liver parenchyma were obserbed. No viable tumor cells are exist in the tumor capsule connected with the infarcted liver parenchyma. Changes of the liver fanction tests after arterial and portal embolization were almost the same values as was treated by TAE, but its recovery seemed to be prolonged somewhat compared with TAE. These results indicated that this method could be regarded as extremely effective treatment for HCC.

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The changes in serum AFP levels after transhepatic arterial embolization (TEA) in hepatocellular carcinoma were studied in a group with pre-TAE AFP level above 400ng/ml (high group) and a group with a lower level (low group) in relation to the duration after TAE, the frequency of embolization performed and the embolization material. Correlations with various image findings were also examined. The AFP changes did not almost differ between the high and low groups, except a more rapid reduction in the former group. AFP stayed at a lower level more frequently in the group treated more than twice than the group treated only once. The combined use of gelatin sponge (GS) with Lipiodol resulted in more rapid reduction of post-TAE AFP and more frequently inhibited re-elevation of AFP than a single application of GS. The AFP levles were correlated with US, CT and AG findings in many cases.

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Hemodynamic change of the portal venous system was studied by the splenic artery occlusion with a balloon catheter in patients with portal hypertension. Five patients with cirrhosis, 7 with chronic hepatitis and 3 with idiopathic portal hypertension, in a total 15 patients were studied. The blood flow was measured by an ultrasonic duplex system. The splenic blood flow was changed from 646±353ml/min (mean±S.D.) to 262±161ml/min with statistical significance. The portal blood flow was changed from 1061±450ml/min to 830±461ml/min with no statistical significance. The superior mesenteric venous blood flow was changed from 448±66ml/min to 679±189ml/min with statistical significance. The portal venous pressure was reduced from 17.9±7.5mmHg to 14.5±5.9mmHg. The oxygen content was decreased in the splenic venous blood and increased in the superior mesenteric venous blood by splenic artery occlusion.

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In order to examine possible relationship between hepatic fibrosis and bile acids, studies were made on the influence of CA, CDCA, DCA and UDCA, and their conjugates with taurine and glycine on the uptake of thymidine or proline of the cultured human fetal fibroblasts in vitro. The thymidine and proline were measured as markers of synthesis of protein and collagen respectively. The thymidine uptake was inhibited with DCA, accelated with CA group, CDCA group and GDCA. The proline uptake was similarly accerelated with CA group, CDCA group and DCAgroup except GDCA. The possibility that some of bile acid fractions such as GCDCA and TC- DCA may enhance fibrosis in liver was suggested.

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An accomplishment of HBV carrier state has been thought to be due to HBV infection passing from a mother to the fetus or neonate, infection in childhood and in adult accompanied with immune disturbance state. Thus the condition in the healthy adult is thought to be very rare. We described 3 cases of adult accomplished HBV carrier state after sporadic infection of Btype hepatitis. All of these cases were confirmed that serum anti-HBc was negative in the early stage of the heatitis and, thereafter, showed a higher level of anti-HBc. Serum HBs antigen and HBe antigen were continued positive and high level in HBV-DNA-polymerase activity for more than 1 year after the occurence of hepatitis. These cases were non-icteric and the symptoms of the hepatitis were relatively slight.

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A 59-year-old male who had been treated for liver cirrhosis was admitted to our hospital because of elevation of AFP and abnormality of echogram. Ultrasonography performed on admission demonstrated a hypoechoic mass adjacent to a hyperechoic nodule. Angiography showed two hypervascular nodules such as a snowman, but each vascularity was the same. Because of his refusal of operation, intraarterial infusion of carcinostatics was performed twice, and then serum level of AFP fell from 252 to 80ng/ml and continued to show lower level than 200ng/ml. But AFP increased to 1200ng/ml 19 months later, and angiography revealed that tumor grew larger to the size of 4.5 × 2.7cm. Because residual liver function was preserved, hepatectomy was performed. Ultrasonogram of resected specimen also showed hyperechoic tumor adjacent to the hypoechoic mass. Histological examination revealed that the former was of grandular type of hepatocellular carcinoma with production of AFP and the latter was of compact type (Edmondson IV type) without the production of AFP.

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56 year-old female, with suspect of hepatocellular carcinoma, was referred to National Cancer Center Hospital for hepatectomy.
Liver function was almost within normal limits and diabetes mellitus had been controlled with diet and insulin. By ultrasonogram, the hypoechoic lesion was in the left medial segment of the liver but, after 2 months, contrast between liver parenchyma and the lesion decreased. CT scanning showed high density area and fatty liver. In celiac angiography, tumor stain was visualized from early arterial phase to late portal phase. Partial resection of left medial segment was carried out.
Microscopically, the lesion consisted of nodular proliferation of large clear hepatocytes and contained Glisson's triads and central veins. It was not hepatocellular caroinoma and diagnosed hyperplastic nodular lesion.
This case revealed the difficulty and importance in differentiation of small lesions of the liver.

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A 68-year-old man was admitted to the hospital because of an enlarged mass in the upper abdomen. Liver scintigram demonstrated a massive defect in the left lobe and CT scan revealed a horseshoe-shaped low density area. Liver function test disclosed an increase in the serum levels of LDH, Alkaline Phosphatase, γ-GTP, and LAP. In spite of chemotherapy, his jaundice increased and he died of cachexia 10 months after the onset of symptoms. Autopsy showed a huge tumor mass in the left lobe of the liver and a small metastatic nodule in the right lobe. Histologic examination demonstrated that this tumor consisted of various tissue elements such as fibrous histiocytomatous, fibrosarcomatous, giant cell tumor like, myxomatous, chondromatous, osteoid like, fascial like, liposarcomatous, and malignant pericytomatous tissue which contained matured and/or atypical mononuclear cells and giant cells. Similar findings were also observed in the metastatic lesion. No tumorous tissue was found in the other organs.

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The case reported of a woman contracting drug-induced allergic hepatitis after taking a herbal medicine (Kaigen), available on the market, in treatment for her cold. The patient was a 31 year-old woman, after taking the herbal medicine, fever, general fatigue, eruption and jaundice were observed, with elevated serum levels of Alk-P, LAP, γ-GTP and GPT. Even after jaundice disappeared, the elevated serum levels of Alk-P, LAP and γ-GTP continued for a considerable period. Although lymphocyte transformation was not detectable upon culturing the patient's peripheral blood mononuclear cells together with the medicine in the presence of a carrier protein, positive lymphocyte transformation was induced by adding interleukin-2 to the culture. Among various components of the herbal medicine (Kaigen), the substance derived from the cinnamoni cortex, most probably cinnamic aldehyde, was presumed to be the causal substance for the induction of allergy, because lymphocyte transformation was induced by extract of cinnamoni cortex in the presence of carrier protein and interleukin-2.

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A 4-year-9-month-old boy with subacute type fulminant hepatitis was treated with THF and glucagon-insulin therapy successfully.
With sudden decrease of previously high SGOT and SGPT, prolongation of prothrombin time and rapid reduction of the liver size, the patient fell into coma. Thirty minutes after THF was started, he regained his consciousness and slow wave in his EEG disappeared. THF was given nine times totally. After measurement of cyclic AMP in response to glucagon loading test, ration of the liver and the patient's condition has improved.
THF and Glucagon insulin therapy might have been effective in our case.

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An autopsied case of Wilson's disease, Who had an abrupt onset With hematuria and nausea at 7 years old and was followed during 10 years, was reported. Hematuria at onset time was suspected to be caused by acute hemolytic attack. The treatment with D-peuicillamine was effective on preventing the neural symptom, but not effective on improvement of hepatic damage. Post necrotic liver cirrhosis and splenomegaly had gradually progressed and spleen became huge. In the last several years, spontaneous infarction of the spleen has repeatedly occured due to hemostasis and release of the clotting factors from platelet, red blood cell and so on, and induced peritonitis and hepatic failure.

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