Kanzo

A long term follow-up study on hepatic diseases and their relative risk of death after blood transfusion

Izumi YOSHINO, Toshihiko IIJIMA, Yasutomo IMAI, Akira TERANO

1986 Volume 27 Issue 12 Pages 1665-1669
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1665

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We performed a follow-up study about liver function tests and mortalities in male patients who had been transfused blood on operations of pulmonary tuberculosis.
After 20 years examined there was no difference about HBV markers, ZTT showed significant higher values in blood transfusion group than in non-blood transfusion group, and ZTT and GPT levels significantly elevated in cases with post-transfused acute hepatitis than in nonblood transfusion group. Five cases in 6 died cases from hepatic diseases had history of posttransfused acute hepatitis.
Relative risk of death caliculated by person-year method showed 13.3 of primary liver cancer and 4.0 of liver cirrhosis in blood transfusion group, and 25.9 of primary liver cancer and 12.1 of liver cirrhosis in cases with post-transfused acute hepatitis comparing with general male population in Japan. These results strongly suggested that blood transfusion cases, especially with post-transfused acute hepatitis, were high risk group of primary liver cancer and of liver cirrhosis.

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Diagnostic prospect of drug induced liver injury and NANB hepatitis using multivariate analysis

Kouichi HAMAGUCHI, Hiromi AONUMA, Mayumi YAMAMOTO, Noritugu FUCHIDA, M ...

1986 Volume 27 Issue 12 Pages 1670-1677
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1670

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In order to make a differenciation of drug induced liver injury from posttransfusion NANB hepatitis, discriminant analysis and theory of quantification were used. Discriminant function was obtained by factors such as GOT, total cholesterol, age, numbers of eosinophils in peripheral blood, TTT and ALP which were selected by stepwise method. According to this discriminant function, 31 (88.6%) of 35 with drug induced hepatitis and 33 (89.2%) of 37 with posttransfusion NANB hepatitis were correctly discriminated. In theory of quantification, discriminant function was obtained from 16 quantative and qualitative parameters. According to the discriminant function, 31 (91.2%) of 34 with drug induced liver injury and 34 (97.8%) of 35 were correctly differenciated. Partial correlation coefficients showed that the most available parameters for discrimination was GOT and followed by numbers of eosinophils, jaundice, gamma-globulin, total cholesterol and fever in this order. If external check for another 13 cases was performed, 84.6% and 92.8% was correctly differenciated by discriminant analysis and theory of quantification, respectively. This result was similar to that of internal check.

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Role of progesterone in the malignant transformation of macronodular liver cirrhosis in rats

A highly probable promoter

Kohdoh ISHII, Hitomi KARUBE, Yoshikuni FUJITA, Hisao SHIBATA, Haruya O ...

1986 Volume 27 Issue 12 Pages 1678-1683
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1678

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An animal experiment was performed, by means of which hepatocellular carcinoma (HCC) was produced in macronodular cirrhosis under the treatment with progesterone. "Irreversible" liver cirrhosis was induced in male Wistar rats by 3'-methyl-4-dimethylaminoazobenzene feeding (for 3 weeks on diet containing 0.06%) plus carbon tetrachloride injection (subcutaneously of 0.2ml/100g bw twice weekly for 14 consecutive weeks). Thereafter, the animals were divided into two groups: (I) control group with no treatment (n=39), (II) rats given progesterone 2.5mg/100g bw once weekly subcutaneously (n=39). Pseudonodules of the control rats were microangiographically hypovascular, and its histology showed hyperplastic nodules without definite HCC. On the other hand, pseudonodules were increased in size with time in animals receiving progesterone, and development of liver-cell adenoma was common. Malignant transformation into HCC was observed in 9 rats (23%) of this group. Microangiograms revealed hypervascular features typical of HCC. It is concluded that progesterone plays a large role in promoting malignant transformation in macronodular liver cirrhosis.

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Peripheral blood lymphocyte subsets in primary biliary cirrhosis

Masayoshi YAMASHIKI

1986 Volume 27 Issue 12 Pages 1684-1691
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1684

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Lymphocyte subsets of peripheral blood of patients with primary biliary cirrhosis (PBC) were investigated by flow cytometry using various monoclonal antibodies. The fluorescence intensity of OKT11+ cells was increased specifically in PBC, but it was decreased during azathioprine administration in a case of PBC. Moreover, the fluorescence intensity of OKT11+ cells was also increased by PHA stimulation to lymphocytes from normal subjects. The percentage of DR+·Leu12- cells was significantly increased, in PBC as compared to normal controls, and in symptomatic PBC as compared to asymptomatic PBC. These findings suggest that activated T

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Affect of cytochalasin B (CB) and phalloidin (Ph) to the actin filaments of primary cultured rat hepatocyte

Masahiro TOMONO, Sumio WATANABE, Miyoko HIROSE, Makoto TAKEUCHI, Hiroy ...

1986 Volume 27 Issue 12 Pages 1692-1696
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1692

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The alterations of actin filaments were observed using doublet cells in primary cultured rat hepatocytes and were examined the effects of 50μM cytochalasin B and 1.27μM phalloidin. The observation was performed by phase contrast micrographs and fluorescent micrographs by means of DACM-HMM. In normal control, after 3 hours incubation, actin filaments were observed especially around the bile canaliculi between two hepatocytes. After 24 hours incubation, hepatocytes showed spreading and actin filaments bundles were appeared in the cytoplasm.
In CB treated group, hepatocytes did not show spreading even after 24 hours, and granular actin filaments were identified around the widely dilated bile canaliculi, but no actin filaments bundles were observed in the cytoplasm during the observation.
In Ph treated group, we observed the formation of protrusions from free cell surface membrane and hepatocytes did not show spreading even 24 hours incubation. In DACM-HMM fluorescent micrograph, actin filaments could be seen around the bile canaliculi between two hepatocytes. After 24 hours, the specific fluorescence around the bile canaliculi were increased, and granular actin filaments appeared in the cytoplasm. But normal actin filaments bundles did not appeare in the cytoplasm during the observation.

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Production of abnormal prothrombin (PIVKA-II) by hepatocellular carcinoma. A clinical and experimental study

Hiroaki OKUDA, Toshimi NAKANISHI, Ryuji FURUKAWA, Etsuko HASHIMOTO, Hi ...

1986 Volume 27 Issue 12 Pages 1697-1702
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1697

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We measured plasma abnormal prothrombin PIVKA-II levels in normal subjects and in patients with hepatocellular carcinoma (HCC) and various diseases by the enzyme immunoassay according to the enzyme-linked immunosorbent assay developed by Motohara. Fifty-eight percent of 52 patients with HCC had significantly elevated PIVKA-II levels. By contrast, 50 normal controls, 13 pregnant women and 10 patients with acute hepatitis had normal levels. Three of 55 patients with chronic liver disease, and 6 of 32 with other malignancies showed a slight increase. Thus, increased plasma PIVKA-II seems to be specific for HCC.
To elucidate the mechanism for the increase of PIVKA-II in HCC, we cultured a human hepatoma cell line, huH-2, and measured the levels of this abnormal prothrombin in the medium. The huH-2 cells produced large amounts of PIVKA-II into the medium without added vitamin K. It increased in a cell concentration and time-dependent fashion. These cells produced no detectable amount of PIVKA-II in the medium with added vitamin K.
Thus, human hepatoma cell line huH-2 produces PIVKA-II and its production is dependent on the amount of vitamin K available in the medium. PIVKA-II may be a useful tumor marker for the clinical diagnosis of HCC.

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Induction of lymphokine-activated killer (LAK) activity by recombinant interleukin 2 in patients with hepatocellular carcinoma

Mutsunori SHIRAI, Hiroyuki KAGAWA, Seishiro WATANABE, Mikio NISHIOKA

1986 Volume 27 Issue 12 Pages 1703-1707
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1703

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The in vitro lymphokine-activated killer (LAK) activity of peripheral blood lymphocytes from patients with hepatocellular carcinoma were investigated to determine the mechanism of deficient cellular immunity. Lymphocytes from normal volunteers exibited strong LAK activity after 72h in culture with recombinant interleukin 2 of≥25 units/ml (TGP3, Takeda), using 51Cr-labelled Daudi target cells. Depletion of adherent cells in lymphocytes didn't affected the development of LAK activity. LAK generation was observed in lymphocytes cultured with interleukin2 in patients as well as in normal volunteers. However, it was found that the patients' lymphocytes showed significantly less LAK activity than lymphocytes from normal volunteers. Especially, LAK activity was scarcely generated in 4 of 12 patients with large tumor(5cm≤in diameter).

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Hepatic blood flow mapping by dynamic CT method in liver diseases

Shigeo SUGANO, Hideo MIZUYOSI, Tsugio OKAJIMA, Kouji ISHII, Tohru ABEI ...

1986 Volume 27 Issue 12 Pages 1708-1713
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1708

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Two parameters of dynamic CT, peak time (PT) and first moment(M1), were compared among healthy control, chronic hepatitis (CH) and liver cirrhosis (LC). The means of PT and M1 in each 9 (3×3) pixels on a slice of hepatiC CT were computed and converted to gray spots by gray scale, so that deep gray represented high values and light gray low values of these parameters. The distribution of these gray spots in each pixels was depicted on the slice as a blood flow mapping, and it was compared among the groups. In normal control, dynamic CT showed the shortest PT and deep gray spots were distributed diffusely in the slice. In CH, where PT was longer than control, lighter gray spots were diffusely seen. LC had the longest PT and its mapping showed mottles of light gray and black, the latter indicating the presence of spots with scanty blood flow, scattering throughout the slice. The mapping of M1 gave almost the same picture as PT for each group, revieling that the disappearring time of the media in CH and LC was impaired in the same manner as in PT.
This method of hepatic blood flow mapping was thought to be useful to add evidences for the understanding of abnormal blood flow in liver diseases.

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Determination of biliary ionized Ca²⁺ concentration and its aspect in human gallbladder bile

Naoki TAMASAWA, Isao MAKINO, Masashi YONEDA, Kazuo TAKEBE, Ken SONE, R ...

1986 Volume 27 Issue 12 Pages 1714-1719
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1714

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We analyzed total and ionized calcium in pathological human bile in association with biliary lipids. Ca²⁺ concentration was directly determined using conventional Ca²⁺ selective ion meter and a new type of sample container. The accuracy and precision of our ion selective electrode analysis were confirmed by similarity to ultrafiltrable Ca level cut-off molecular weight 1, 000.
Total Ca levels ranged from 5.6 to 16.3mg/dl, and these levels were well correlated with biliary lipid concentrations. Unlike total Ca, Ca²⁺ concentration remained almost constant level (2.40±0.63mg/dl), regardless of the change in biliary lipid concentration. This findings was confirmed by the recovery test for addition of Ca²⁺ and dilution test adding saline solution to gallbladder bile.
In conclusion, total Ca level was dependent on biliary lipid concentration, while Ca²⁺ level was independent and kept a constant value, probably owing to the regulating role of the mixed micelle in gallbladder bile.

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A case of subacute hepatitis associated with diabetes mellitus

Yuuji NOGUCHI, Kenji HAYASHIDA, Hajime TANIOKA, Junji SUZUYAMA, Mitsur ...

1986 Volume 27 Issue 12 Pages 1720-1727
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1720

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Seventeen year-old girl was admitted because of mental disturbance and jaundice. Physical examination on admission showed no abnormality except generalized jaundice and somnolence.
However labolatory data on admission revealed prolonged prothrombin time and elevated total bilirubin and fasting blood sugar. She was diagnosed as subacute hepatitis with diabetes mellitus, because of those symptomes and laboratory data. The patient was treated with various therapies including plasmaphoresis during four months. After these treatments, mental disturbance disappeared and the control of diabetes mellitus was improved. This case was also accompanied with primary hypothyroidism. The relationship between subacute hepatitis and other diseases such as diabetes mellitus and primary hypothyroidism was discussed.

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A case of drug induced hepatitis due to warfarin potassium

Kojiro TAKASE, Noritsugu FUCHIDA, Hiromi AONUMA, Mitio KOBAYASHI, Masa ...

1986 Volume 27 Issue 12 Pages 1728-1732
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1728

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A 55-year-old man underwent a cardiac surgery requiring aortocoronary bypass on March 7 1984. For the preceeding the operation, he had not had any history of liver disease. After the surgery, warfarin potassium was prescribed. About 50 days later, he developed jaundice, and loss of appetite. The serum bilirubin level was 2mg/dl with gamma glutamyl transpeptidase of 1075 iu. and glutamic pyruvic transaminase of 1360 iu.. Serum HBsAg and IgM-anti-HA were negative. Warfarin potassium was withdrawn because drug induced hepatitis due to warfarin potassium was suspected, and over the next 4 weeks liver function tests recovered completely.
Liver biopsy showed focal liver cell necrosis with mild inflammatory infiltration. Warfarin potassium was prescribed again because of a strong demand of anti-coagulation therapy. 3 days later, he developed severe general fatigue and nausea, and there was a second rise of serum enzymes. Peripheral lymphocyte culture with warfarin potassium was positive with stimulation index of 320%. It was concluded that warfarin potassium provoked drug induced hepatitis.

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An autopsy case of distal splenorenal shunt with splenopancreatic disconnection

Hiroshi ASHIDA, Masato TABUCHI, Michio ITOH, Naoki HASHIMOTO, Izumi OI ...

1986 Volume 27 Issue 12 Pages 1733-1737
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1733

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The main cause of loss of selectivity of distal splenorenal shunt (DSRS) is development of collaterals within and/or around the pancreas. A modification of DSRS-splenopancreatic disconnection-is suggested to be effective for preservation of selectivity. Portography was taken in a 55-year old man's autopsy of DSRS with splenopancreatic disconnection 3y8m before for evaluation of selectivity. Several fine collaterals from the proximal splenic vein to the distal side was shown, but portal malcirculation was not recognized. The modification of DSRS was effective for prevention of potal malcirculation. However, a collateral from the inferior mesenteric vein to the distal splenic vein was shown. It is impossible that the modification of DSRS separates the distal splenic vein from the portamesenteric system with portal hypertension.

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A case of portal vein thrombosis with cavernous transformation of the portal vein, accompanied by chronic pancreatitis

Kiyoshi WATANABE, Kazuhiko HOSHINO, Atsushi HIGASHIONNA, Mitsuhiro KID ...

1986 Volume 27 Issue 12 Pages 1738-1743
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1738

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A 50-year-old male who had undergone many surgical treatments (such as partial resection of the pancreas tail and splenectomy) repeatedly had chronic pancreatitis due to heavy drinking, and visited our department by complaining of epigastric pain. At the time of ultrasonography (US), portal vein thrombosis was found. Computed tomography (CT), superior mesenteric arterial portography (SMAP) and percutaneous transhepatic portography (PTP) revealed that the thrombosis was fully distributed from the superior mesenteric vein (SMV) to intrahepatic portal branches, and that collateral vessels were well developed around the portal trunk, resulting in cavernous transformation (CTPV). US showed therapeutic effects of the thrombin inhibitor MD-805 which was newly developed for anticoagulant therapy and with warfarin after about 1 week. When SMAP and PTP were again performed at the 2nd month, it was determined that the large portion of the thrombosis disappeared from the intrahepatic portal branches, the thrombosis in the portal trunk was organized, and that the development of CTPV was more marked.

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Congenital hepatic fibrosis associated with Cruveilhier-Baumgarten syndrome

Tugio OKAJIMA, Shigeo SUGANO, Kouji ISHII, Wataru YAMAMURO, Yasukiyo S ...

1986 Volume 27 Issue 12 Pages 1744-1750
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1744

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32 years old male was admitted to the Toho University Hospital with the chief complaint of hematemesis and was diagnosed as rupture of esophageal varices. No liver disease was found in his past or family history. Laboratory findings showed no hepatic disoder. Various imaging diagnostics revealed hepatosplenomegaly and an ascending collateral running from the umbilical portion into intrathoracic veins.
Moreover, he had C-B syndrome, manifesting a continuous venous hum, which was the strongest point at the xiphoid process. By the diagnosis of ideopathic portal hypertension (IPH), esophageal transection and splenectomy were performed. However, histopasological findings revealed the development of fibrous septum containing many dilated bile ducts. The liver lobules were otherwise normal, which was the feature of congenital hepatic fibrosis (CHF). This case did not show polycystic kidney, and histopathological findings alone was a finding to discriminate it from IPH.
Only 31 cases has been reported in Japan, including our case, and this was the 3rd case complicated with C-B syndrome in the world literature.

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Hepatic inVolvement in protoporphyria

Yasuji MIYATA, Seiji MOTOMURA, Shunichi KOGA, Hiroshi IBAYASHI, Yuji T ...

1986 Volume 27 Issue 12 Pages 1751-1756
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1751

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Two brothers of protoporphyria were studied with special references to their hepatic involvement. They were in their third decade and had photosensitivity since their childhood. Case 1 (25 y.o.) showed slightly increased values for bilirubin, GOT, GPT and γ-GTP. Case 2 demonstrated normal liver function test except for slightly increased activity of γ-GTP. Protoporphyrin concentration of erythrocyte in case 1 and 2 were 1717 and 1350μg/dl RBC, respectiVely.
Histopathology of the liver: By light microscopic examination, both cases showed pictures resembling to chronic active hepatitis with cholestasis, accompanied by brown pigments in bile canaliculi, Kupffer cells, hepatocytes and even in interlobular bile ducts. By fluorescence microscopy, a transient red autofluorescence were observed in all parts of frozen section of the liver under blue light. By electron microscopic examination, wavy filamentous crystals were observed in bile canaliculi. The cholestatic liver damage in patients with protoporphyria may be induced by the hepatotoxic properties of protoporphyrin and exacerbated by the precipitation of protoporphyrin in bile canaliculi and bile ducts.

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A case of gallbladder carcinoma producing both α-fetoprotein and carcinoembryonic antigen and responding effectively to methotrexate, 5-FU sequential therapy

Takao SHIBAYAMA, Seishu HAYASHI, Kuniaki NAKAO, Kazutomo KACHI, Hiroo ...

1986 Volume 27 Issue 12 Pages 1757-1765
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1757

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A 70-year-old woman was admitted to our hospital with complaints of feeling fullness in the abdomen. A hard mass was palpable until 12cm below the left costal arch. The AFP and CEA serum levels were 15, 400ng/ml and 53.8ng/ml respectively at the time of admission.
Ultrasonography and CT-scan revealed a mass filling the lumen of the gallbladder and many space-occupying lesions in the liVer. Hepatic arteriography revealed an irregular cystic artery and many tumor stains in the liver. Biopsied specimens of the liver tumor obtained under laparoscopy were found to be histologically adenocarcinoma papillotubulare and a diagnosis of gallbladder carcinoma was made. The AFP pattern analyzed by crossed immuno-affinoelectrophoresis with concanavalin A and Lens culinaris agglutinin was like that of yolk sac tumors rather than that of hepatocellular carcinoma.
Methotrexate, 5-FU sequential therapy was effective in this case. At the second admission, this therapy was given for 5 times with a subsequent reduction in AFP obtained from 74, 000ng/ml to 8, 600ng/ml and in CEA from 3, 500ng/ml to 326ng/ml. Furthermore, decrease in the tumor size was recognizable through palpitation and CT scan. The patient died after about 1 year from hepatic failure. The autopsy showed a hard mass filling the lumen of the gallbladder and many metastatic lesions in the liver, lungs, and hepatic hilar lymphnodes. Histologically, the tumor was adenocarcinoma papillotubulare.
Immunohistochemically, the carcinoma cells showed positive staining for AFP and CEA by peroxidase-conjugated antibody methods. The carcinoma was thus responsible for producing both of them.

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[title in Japanese]

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

1986 Volume 27 Issue 12 Pages 1766
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1766

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[title in Japanese]

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

1986 Volume 27 Issue 12 Pages 1767
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1767

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[title in Japanese]

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

1986 Volume 27 Issue 12 Pages 1768
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1768

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[title in Japanese]

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

1986 Volume 27 Issue 12 Pages 1769
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1769

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[title in Japanese]

1986 Volume 27 Issue 12 Pages 1770-1822
Published: December 25, 1986
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.27.1770

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