Kanzo

Studies on the family of HBs positive antigen whose different subtypes existing in the same family

Mariko KOBAYASHI, Hiromitsu KUMADA, Kenji IKEDA, Kazuaki CHAYAMA, Yasu ...

1989 Volume 30 Issue 4 Pages 403-407
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.403

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When histological diagnosis revealed chronic hepatopathies of B type in more than 2 patients in 30 familys of the same family during a period from April 1977 to June 1987, the same subtypes were found in 21 familys and the different subtypes in 9 within the same family.
The defferent subtypes in the 9 familys were subdivided by adr and adwr types in 7 familys, and adr and adyr types in 2.
It was suggested from the above findings that the subtypes of adwr and adyr may vary during the course of observation.
The childrens of persons of adwr and adwr have the subtypes of adr subtype.

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Study on the expression of hepatitis B virus X protein in hepatocellular carcinoma

Kentaro IGARASHI, Yutaka AOYAGI, Yasufumi SUZUKI, Norio OGATA, Atsushi ...

1989 Volume 30 Issue 4 Pages 408-414
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.408

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Three synthetic peptides spanning residues 71 to 85 (P-5), 100 to 116 (P-2) and 144 to 154 (P-3-2) were made, and used to raise peptide antibody in rabbits. The antisera to P-2 and P-5 reacted to recombinant HBx protein expressed in E. coli, while P-3-2 failed to raise antibody. Using these two antibodies, the expression of HBx protein was investigated in 33 patients with various liver diseases containing 24 hepatocellular carcinoma (HCC). Although a 17kDa protein deduced from the nucleotide sequence of HBx region was failed to detected, a 14kDa protein was detected in liver tissue with both anti-P-5 and anti-P-2 antibodies by Western blotting. The 14kDa protein was detected only in samples of HCC but not in those of other liver diseases. The protein was identified in 4 patients with HCC positive for HBsAg, anti-HBs and/or anti-HBc, and 2 from 11 patients with HCC negative for HBV-related antigen-antibody system.

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2'-5' oligoadenylate synthetase activity in peripheral blood mononuclear cells and serum during interferon treatment of chronic hepatitis non-A, non-B

Ken ARAI, Michiko SHINDO, Tadao OKUNO, Masayuki MATSUMOTO, Makoto TAKE ...

1989 Volume 30 Issue 4 Pages 415-422
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.415

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We measured 2'-5' oligoadenylate synthetase (2-5AS) activity in peripheral mononuclear cells (PBMC) and serum during interferon (IFN) treatment of 17 patients with chronic hepatitis non-A, non-B (CH-NANB). All 17 patients received IFN-α or-β in doses of 1 to 3 million units (MU) daily for 4 to 7 weeks. Before treatment, the levels of 2-5AS in PBMC and serum were not significantly different from those of chronic hepatitis B (CH-B) and of normal subjects. During treatment, the levels of 2-5AS in PBMC and serum increased from 2-to 81-fold greater than initial levels in all patients, although the peak levels varied widely between patients. The changes of 2-5AS activity in PBMC and serum were similar to those observed during IFN treatment of CH-B. During treatment, ALT levels normalized in 10 of the 17 (Group I), while in the remaining 7 (Group II), the levels did not normalize. All patients of Group II had significantly elevated levels of 2-5AS in PBMC just before treatment, while the 10 of Group I had normal levels of 2-5AS. This finding suggests that patient whose ALT levels did not normalize during IFN treatment may have an activation of in vivo IFN system before treatment, and such patients may become resistant to IFN treatment.

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The effect of short term corticosteroid administration on Polymerized human serum albumin receptor, DNA-Polymerase and eAg in chronic active hepatitis type B

Kazuaki CHAYAMA, Hiromitsu KUMADA, Kenji IKEDA, Yasuji ARASE, Satoshi ...

1989 Volume 30 Issue 4 Pages 423-428
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.423

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We assessed the effect of corticosteroid on polymerized human serum albumin receptor (PAR) and DNA-Polymerase (DNA-P) and eAg in 20 patients with eAg positive chronic active hepatitis type B. Marked increase in PAR and DNA-P value with corticosteroid administration and subsequent decrease with its abrupt withdrawal was noted in 14 whose PAR was greater than 2U/L and less than 90U/L before administration. In these 14, all 5 whose PAR value was increasing just before corticosteroid administration and 6 of 9 whose PAR value was not increasing became seronegative for eAg. Such increase in PAR and DNA-P with corticosteroid administration was not observed in 4 whose PAR before administration was less than 2U/L and 2 whose PAR was greater than 90U/L. Only two of the former and none of the latter became seronegative for eAg. Thus it is suggested that eAg was cleared highly in those whose PAR before corticosteroid administration was greater than 2U/L and less than 90U/L especially in those whose PAR value was increasing just before administration.

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Serum type III procollagen N peptide (PIIIP) and laminin levels and hepatic immunohistochemical study in patients with various liver diseases

Takato UENO, Takuji TORIMURA, Sadataka INUZUKA, Kunihide ISHII, Masao ...

1989 Volume 30 Issue 4 Pages 429-438
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.429

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Sera and liver biopsies obtained from 95 patients with various liver diseases were studied to determine whether serum PIIIP and laminin levels are related to hepatic collagen synthesis and degree of fibrosis. PIIIP and laminin in sera were measured by RIA-kit. Liver fragments were processed for light and electron microscopy, including immunoperoxidase methods for type III collagen and laminin. Serum PIIIP levels were elevated in the active stage of liver diseases. Direct correlation was found between serum PIIIP and portal fibrosis, intralobular fibrosis and focal necrosis. Serum laminin was also correlated with the degree of hepatic fibrosis. Type III collagen was intensely stained in the area of focal necrosis and fiber production. Laminin was localized in the increased basement membrane of fibrotic or cirrhotic liver.
These results suggest that increase of PIIIP and laminin in sera can be respectively related to an acitve fibrogenesis and to the degree of fibrosis in liver diseases.

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Fundamental studies on the lymphocyte stimulation test in patients with drug-induced allergic hepatic injury

Shigeyuki UCHIDA, Noriyuki KITAMI

1989 Volume 30 Issue 4 Pages 439-443
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.439

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The frequency of positive results reported for the lymphocyte stimulation test (LST) has varied considerably upon diagnosis of drug-induced allergic hepatic injury (DAHI). In order to clarify this relationship we defined the normal range for the stimulation index (SI) using the percentile method. Furthermore, evaluation of the optimal doses for the lymphocyte cultures in patients with DAHI induced by halothane, tiopronin, or methyldopa revealed that the optimal dose range for methyldopa was narrower than for others. The lymphocyte blastogenetic reactions under PHA or Con A in patients with hepatic injury tended to be less activated than those in the controls. These results formed a striking contrast to the LST reslults in patients with DAHI. The suppressive effect on lymphocyte proliferation induced by 20% added autologous serum could be negligible in the Con A-stimulation study.

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The efficacy of ATP and allopurinol (AL) pretreatment against hypothermic ischemia-reperfusion injury of liver

Yoshio OHTAKE, Hiroyuki HIRASAWA, Takao SUGAI, Shigeto ODA

1989 Volume 30 Issue 4 Pages 444-449
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.444

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The mechanism of ischemia-reperfusion injury of liver and its treatment were studied using an ex-vivo perfusion system with Collins solution alone or Collins plus ATP, AL, superoxide dismutase (SOD) and catalase (CAT). ATP plus AL improved not only glucose production and bile production during perfusion, but also wet/dry weight, Na/K and energy charge of the liver taken after perfusion compared with the liver from the control group perfused with collins solution alone. However other groups did not have any significant improvement compared with control group. The negative results with eigher AL alone or SOD/CAT suggest that oxygen free radical did not play an important role on reperfusion injury after hypothermic ischemia. These data indicate that the mechanism of action of AL with ATP might be not to prevent oxygen free radical generatio, but to preserve purine to be recycled via salvage pathways.

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Clinicopathological factors to determine the prognosis and clinical efficacy of plasma exchange in primary biliary cirrhosis

Yasutsugu MIZUNO, Masashi UNOURA, Yasuhiro HAYAKAWA, Yutaka INAGAKI, T ...

1989 Volume 30 Issue 4 Pages 450-458
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.450

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We clinicopathologically investigated the prognosis and treatment in 15 patients with symptomatic primary biliary cirrhosis. Although there was no correlation between the survival period after the serum level of total bilirubin first exceeded 3mg/dl and various pathological factors, upper gastrointestinal (UGI) hemorrhage was found in 9 of dead 11 cases, and all of 9 died in a short time after hemorrhage. Therefore it was suggested that the prevention and treatment for UGI hemorrhage might be important as a factor to determine the prognosis.
The mean survival period of cases positively treated with plasma exchange (PE), esophageal transection, endoscopic injection sclerotherapy for esophageal varices, and so on was 47.8±9.0 months, which was significantly longer than that of non-treated cases: 17.4±5.0 months. Each survival period of alive 4 cases positively treated ranges from 23 to 60 months now.
Concerning with methods of PE, we compared double filtration with single filtration. Changes of laboratory data in both methods were not so different. Therefore it was suggested that double filtration might be more desirable as far as possible in consideration of the prevention against side effects.

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Evidence that oxygen-derived free radicals are involved in ischemic liver cell injury

Setsuo TAKEKAWA

1989 Volume 30 Issue 4 Pages 459-467
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.459

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Mechanism of ischemic liver cell injury were examined from the both view points of oxygen derived free radicals and its radical scavengers. The hepatic artery and the portal vein of Wistar strain male rats were clamped for 45 minutes under pentobarbital anesthesia fallowed by 15 minutes reperfusion of the blood. The hepatic venous blood was collected and a portion of the liver was used for histological analyses.
We counted the leukocytes-emitted chemiluminescence by Chemiluminescence analyser as a marker of oxygen-derived free radicals from leukocytes and also measured serum GPT, ADH activities and hepatic lipid peroxide content. After ischemia reperfusion, serum GPT and ADH activities were markedly increased and hepatic lipid peroxide content was concomitantly increased. The chemiluminescence emitted by the leukocytes was significantly increased compared to the control rat. The pretreatment of the tats with SOD or catalase prevented the elevation of the chemiluminescence counts, activities of serum enzymes and the hapatic lipid peroxide content as well as hepatic cell necrosis. In summary, ample oxygen supply after the ischemia to the liver enhanced the production of free radicals assessed by chemiluminescence resulting in the hepatic necrosis. Thus, these data suggest that oxidative radical formation is involved in the pathogenesis of the hepatic injury.

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Direct histopathological correlation analysis of ultrasonographical image of minute hepatic cancer nodules: Using formalin-fixed autopsied liver

Tohru INOUE, Junji SHIGA, Rikuo MACHINAMI

1989 Volume 30 Issue 4 Pages 468-476
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.468

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To estimate the direct histopathological correlation analysis of ultrasonographical image of minute hepatic cancer nodules (<15mm in diameter), we used formalin fixed autopsied liver and created the identical liver cut surface to US image plain. The subjects were 12 nodules (hepatocellular carcinoma: 4, metastatic cancer nodule: 8). The size of nodules of liver cut surface (average 8.2×8.1mm) were identical to the size of US image (average 8.4×8.3mm) within 1.0mm difference.
The results were as follow;
1. Medullary cancer cells nests were hypoechoic, although only one HCC nodule was hyperechoic. The microscopical differences were not found between hypoechoic HCC ones and hyperechoic one.
2. Fibrous stroma, scar, and coagulation necrosis were isoechoic.
3. Small vessel foci, small hemorrhagic foci, hemorrhagic necrosis, fatty metamorphosis and dilated lymphatics foci were hyperechoic.
4. Perinodular degenerated hepatocytes layer showed hyperechoic ring. Further examination by our method would improved the qualitative ultrasonographical diagnosis of minute hepatic nodules.

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Transcatheter arterial embolization of hepatic arterial aneurysm

Yutaka MORITA, Hiroya SAITOO, Noriyuki YASUTOMO, Shunichi OKUSHIBA

1989 Volume 30 Issue 4 Pages 477-483
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.477

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Based on the review of 69 cases of hepatic arterial aneurysm in Japan including 5 cases of our own, the indications, techniques, complications and results of transcatheter arterial embolization (TAE) for hepatic arterial aneurysm were discussed and the following conclusions were made.
1) Due to the increase of idiopatic hepatic arterial aneurysm, TAE for hepatic arterial aneurysm were widly performed.
2) It is possible to recover on a long term basis by applying proximal TAE only.
3) In the case of TAE for common hepatic artery where the gastroduodenal artery has been ligated as in the case with the proper hepatic artery, it is necessary to confirm that there is a possible colaterales.
The biggest problem is that hemostasis does not necessarily bring about a good prognosis but as TAE allows for rapid hemostasis, we believe it should be considered before surgery.

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A case of hepatocellular carcinoma with Lipiodol flow into the greater circulatory system after transcatheter arterial embolization

Radiological and pathological investigation

Takao SHIBAYAMA, Motoichiro TAKAHASHI, Yoshiharu MAEDA, Seishu HAYASHI ...

1989 Volume 30 Issue 4 Pages 484-491
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.484

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A 76-year-old male was diagnosed as having hepatocellular carcinoma (HCC), and a subsegmentectomy of the posterior part of the right hepatic lobe was performed. One year after the operation, recurrence of HCC was recognized, prompting transcatheter arterial embolization (TAE) to be performed several times in response to each HCC recurrence. About 5 hours after the 4th TAE (the 2nd Lipiodol-TAE: Lip-TAE) [8mg of mitomycin C (MMC), 10mg of lipiodol ultra-fluid (Lipiodol) and several gelation sponge cubes cut into 1-to 2-mm pieces (sp-cubes) were injected into the patient via the common hepatic artery: 6mg of MMC, 20mg of adriamycin (ADM), 8mg of Lipiodol and several sp-cubes were injected via the right inferior phrenic artery], disturbance of consciousness was recognized and cerebral metastases and Lipiodol accumulation toward these metastases were suspected by brain CT scans conducted over the next day. About 10days after this 4th TAE (about 3 years and 4 months after the initial operation), the patient died of pulmonary failure. The autopsy revealed that the disturbance of consciousness resulted from a combination of bleeding at the cerebral metastases and multiple cerebral infarctions due to both cancer cells and micro-fatty emboli (Lipiodol emboil) of Lipiodol flowing into the greater circulatory system after TAE. Moreover, the direct cause of death was pulmonary failure owing to Lipiodol-related interstitial pneumonitis. The cause of Lipiodol flow into the greater circulatory system was understood to be a consequence of the inferior phrenic artery-pulmonary vein anastomosis present.
When Lip-TAE is performed via the inferior phrenic artery, it should thus be noted whether or not this anastomosis exists, and if so, indication of Lip-TAE should then be decieded carefully. Furthermore, only a small amount of Lipiodol should be infused via the common hepatic artery.

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Idiopathic portal hypertension following viral hepatitis (B) and rheumatoid arthritis: Report of an autopsy case

Kazuaki HASHIMOTO, Ryuichi YAMAMOTO, Yuro SHIBAYAMA, Katsuji NAKATA, M ...

1989 Volume 30 Issue 4 Pages 492-495
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.492

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An autopsy case of idiopathic portal hypertension (IPH), 62 years old female, was reported. The onset of illness was acute viral hepatitis 20 years ago. Thereafter, she had chranic hepatitis (HBsAg+, HBsAb-, HBeAb+, HBcAb+) and rheumatoid arthritis with positive ANA and Anti DNA. Pancytopenia, splenomegaly, ascites and minor change of liver function tests were seen in her course. Hematoemesis from esophagial varicies occurred and she died of hemorrhagic shock. On autopsy, cirrhotic change of the liver was not seen. There was no significant change in the extrahepatic portal vein. Histology of the liver showed fibosis of Glissan's sheath, marked stenasis of peripheral branches of portal vein and moderate lymphocytic infiltration in some Glisson's sheaths.
It is suggested, in the present case, that viral hepatitis is a trigger of development of IPH, and that an immunological abnarmality being documented as rheumatoid arthritis and presence of autoantibodies may participate in development of IPH.

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A case of alcoholic hepatitis with transient appearance of multiple nodule like lesions in the liver

Akihide MASUMOTO, Fumiaki YAMAMOTO, Hikaru TAKAHASHI, Shunichi KOGA, H ...

1989 Volume 30 Issue 4 Pages 496-501
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.496

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A 42-year-old man with a history of chronic alcoholism was admitted to our hospital because of general malaise, nausea, vomiting and abdominal pain. Physical examination revealed facial and pretibial edema, jaundice, fever and marked hepatomegaly with severe tenderness. He was diagnosed as alcoholic hepatitis. In addition, ultrasonogram of the liver showed multiple hyperechoic nodules, and CT scan revealed multiple low density areas in the liver. Celiac arteriogram indicated no masses in the liver. In the course of 30 hospital days, rapid improvement of liver function and rapid disappearance of hyperechoic nodules in the liver were recognized. These findings are compatible with alcoholic focal fatty liver.

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Immunohistochemical studies on the mechanism of hepatocellular injury of acute CMV hepatitis in previously healthy adults

Susumu IMOTO, Shunjiro MATSUI, Takashi KOJIMA, Kyoichi INOUE, Hiroshi ...

1989 Volume 30 Issue 4 Pages 502-503
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.502

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Appearance of albumin positive cells induced by administration of 3'-Me-DAB in the liver of female Nagase Analbuminemic Rat (NAR)

Keiichiro SHIMIZU, Seishi MAGAMORI, Kiyotaka FUJISE, Satoshi HASUMURA, ...

1989 Volume 30 Issue 4 Pages 504-505
Published: April 25, 1989
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.30.504

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