Kanzo

Risk factors for recurrence of esophageal varices following endoscopic injection sclerotherapy

A multivariate analysis using Cox's proportional hazards model

Hiroshi KOKAWA, Hiroshi SHIJO, Katsuhiko KUBARA, Koichi NAKAOKA, Hideo ...

1992 Volume 33 Issue 6 Pages 449-456
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.449

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Risk factors for recurrence of esophageal varices after endoscopic injection sclerotherapy (EIS) were studied in 121 patients using Cox's proportional hazards analysis. In the present study, recurrence of esophageal varices was defined as the re-bleeding from esophageal varices or appearance of red color sign on the varices after complete eradication of varices at initial EIS. Cox's proportional hazards analysis disclosed that consumed doses of 5% ethanolamine oleate (EO) was the most significant prognostic factor affecting the long term efficacy of EIS. Child's classification and coexistent portosystemic collateral circulation were also statistically significant and independent prognostic factors. These results strongly suggest that efficacy of EIS is mainly depends on consumed doses of EO, severity of liver function, portal venous hemodynamics, and extent of portal hypertension.
Prognostic index of recurrence of the esophageal varices was calculated using the Cox's proportional hazards model. We believe that this index would offer useful information in following up the patients after EIS.

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Dopaminergic modulation of aldosterone secretion in cirrhosis

Shigeto MURAKAMI, Akihiro OMSHI, Kazuhiro OSAKA, Makoto HARADA, Kouji ...

1992 Volume 33 Issue 6 Pages 457-465
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.457

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To investigate negative dopaminergic modulation to aldosterone secretion in cirrhotic patients having elavated plasma aldosterone (AD) and catecholamine levels, we measured AD, plasma norepinephrine (NE), dopamine (D), and creatinine clearance (CrCL) in 37 patients with hepatic diseases and 9 controls. Thereafter we compared plasma AD and prolactine (PRl) response induced by metoclopramide (MP, 20 mg i.v.), a D receptor antagonist, between in 7 cirrhosis and in 6 controls. These hormones in plasma were elevated significantly (p<0.05) in cirrhosis and chronic hepatitis patients compared with controls. Plasma AD was correlated negatively to D and CrCL was correlated positively (p<0.001) to plasma D/NE ratio. MP induced AD response was greater in cirrhosis than in contro1, whereas PRL response was greater in control. Although intravenous infusion of dopamine decreased PRL in both groups (p<0.05), it did not produce any AD reduction in the basal and the MP induced response in cirrhosis but the small decrease in ontrol. These results suggested that D plays an important role for both renal function and AD secretion in cirrhosis. Tonic dopaminergic suppression to AD appear to be enhanced in cirrhosis.

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Local treatment for large hepatocellular carcinoma

Combination therapy with percutaneous microwave coagulation therapy and percutaneous ethanol injection therapy

Toshihito SEKI, Koji KUNIEDA, Masahiro SATO, Haruhiko KANOU, Masayuki ...

1992 Volume 33 Issue 6 Pages 466-472
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.466

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Ultrasonically guided percutaneous ethanol injection therapy (PEIT) following percutaneous microwave coagulation therapy (PMCT) was performed in 7 patients with large (5-8 cm in diameter) nodular-type hepatocellular carcinoma in whom neither surgery nor transcatheter arterial embolization was carried out. The average extent of decrease in the main tumor 3 months after treatment was 40%. Two patients have died due to advanced liver cirrhosis, and the survival period of all patients to date ranges from 6 months to 14 months. Recurrence was detected in three patients, but recurrence at the treated site has not been observed.
A autopsy examination in one patient revealed that the treated main tumor (7 cm in diameter) including the area of capsular invasion showed complete necrosis. PMCT decreased the required frequency of and the amount of ethanol used in PEIT. On the basis of these findings we concluded that combination therapy is useful in the local treatment for large HCC.

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An interesting case of acute hepatitis A with thrombocytopenia and autoantibodies

Chang-Duk CHANG, Masahiko AMANO, Taizo SAKAMOTO, Hideyuki FUKUNAGA, Ts ...

1992 Volume 33 Issue 6 Pages 473-477
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.473

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An interesting case of 59-year-old woman of acute hepatitis A with thrombocytopenia and autoantibodies was reported. The patient consulted a physician with a complaint of fever and general fatigue. Laboratory data findings on admission showed remarkable liver dysfunction and slight jaundice. IgM-HA antibody was positive. HBs antigen, IgM-HBc antibody and HCV antibody were negative. In addition, thrombocytopenia and autoantibodies involving RA, ANA, LE cell etc. existed. Symptoms disappeared in one week after admission. Liver dysfunction normalized in five weeks after admission. Thrombocytopenia recovered to normal on sixth day after admission. Liver biopsy specimen taken on the 37th day after admission showed the recovery stage of acute hepatitis. Transient thrombocytopenia is sometimes associated with acute viral hepatitis. But autoantibodies very rarely appeares. We reported with philological consideration.

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A case of laparoscopic microwave coagulo-necrotic therapy for small hepatocellular carcinoma

Hidehiro SATO, Hideki SAITSU, Tadashi YOSHIDA, Nobuki OHGAMI, Atsushi ...

1992 Volume 33 Issue 6 Pages 478-483
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.478

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Laparoscopic microwave coagulo-necrotic therapy (lapa. MCN) for a case of small Hepatocellular carcinoma (small HCC) using microwave tissue coagulator under laparoscopy was performed for the first time in Japan, employing a newly developed surgical device. The patient was a 63-year-old male, and small HCC was 22×21mm which partially appeared on the surface of the abdominal side in the posterior inferior segment. Levels of GOT and GPT increased to 423 K.U and 241 K.U, and levels of HPT and PT decreased to 42% and 48.3% postoperatively, because fresh frozen plasma was not used at all. However, all of these levels recovered to preoperative levels on postoperative day 7 after lapa. MCN. The gastric tube was extubated on the first postoperative day, and the patient was able to eat. The treated area was seen as markedly low density area including HCC and was not enhanced on CT image three weeks after MCN. Therefore, the effect of lapa. MCN was judged to be adequate. There was no postoperative complication, and this method was considered to be useful as a new surgical treatment for small HCC.

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An autopsy case of hepatocellular carcinoma with metastasis in the thoracic vertebrae through the azygos and vertebral venous system

Toru URANO, Shosaku ASAKA, Jiro MAETANI, Masato ARAKI, Akira NISHIJIMA ...

1992 Volume 33 Issue 6 Pages 484-488
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.484

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A 63-year-old man, previously well, presented with the rapid development of compression myelopathy due to metastatic tumor in the 8-10th thoracic vertebrae. He died of serious infection of the lungs on 48th day after admission. At autopsy, hepatocellular carcinoma (Edmondson's grade III) with liver cirrhosis was found. The metastasis occurred in the 8-10th thoracic vertebrae, and the hemiazygos vein and the external vertebral venous plexus were packed with the tumor cells. However, there was no other conspicuous metastasis, except in capillaries of the adrenals, veins in the spleen and small branches of the pulmonary artery. The present case demonstrated that metastasis of hepatocellular carcinoma in the vertebrae can occur through the azygos and vertebral venous system, namely the portal vein, esophageal veins, the hemiazygos vein and the external vertebral venous plexus, as predicted by Batson.

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A case of hepatocellular carcinoma associated with sarcomatous change and ossification

Masayuki WAKABAYASHI, Toshihito SEKI, Tomohiro SHIRO, Yoshitaka TAGAWA ...

1992 Volume 33 Issue 6 Pages 489-494
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.489

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We report a case of hepatocellular carcinoma associated with sarcomatous change and ossification in a 77-year-old male. The hepatic mass with calcification was detected in the right posterior segment of the liver using abdominal ultrasonography in June, 1990. Pathological findings for the tumor after fine needle biopsy of the hepatic mass was performed consisted of sarcoma with osteoid cells. Pathological findings for a fist sized tumor with tenderness detected at the right iliac bone consisted of poorly differentiated hepatocellular carcinoma. Serum alpha-fetoprotein (AFP) was 45, 449 ng/ml, carcinoembryonic antigen 32.7ng/m/, and protein induced by vitamin K absence or antagonist-II 1.22 Au/m/, AFP subfractions separated by affinity electrophoresis with Lens culinaris agglutinin A (LCA-A) revealed pattern consistent with hepatocellular carcinoma. On the basis of clinical course, value of tumor marker, and histological findings for the tumors, this hepatic mass was diagnosed as primary hepatoma with sarcomatous change, ossification, and osseous metastasis.

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A case of intrahepatic schwannoma

Kazuhiro KARIKOMI, Tetsuaki MIZUTA, Yukio ISHIHARA, Masayoshi ITO, Tad ...

1992 Volume 33 Issue 6 Pages 495-499
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.495

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A case of intrahepatic schwannoma is reported. A 55-year-old female was studied with ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) and angiography and was found to have a 5cm-sized liver tumor at the right lobe along the right hepatic bile duct. A fragment of US guided fine needle biopsy revealed schwannoma. Right hepatectomy was performed for the slowly growing tumor. The tumor, well-defined with thin capsule, measured 4.0×2.0×2.0cm.
Histologically, the tumor consisted of fusiform cells with long-elliptical nuclei arranged fascicular fashion without definite nuclear palisading, and immunohistochemically exhibited positive staining for S-100 protein. The tumor was diagnosed histologically and clinically as a benign schwannoma arizing from the peripheral nerve around the right hepatic bile duct. This case is the 8th report of liver schwannoma, and the 1st report diagnosed preoperatively to our knowledge.

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Genotypical classification of hepatitis C virus genome isolated from Japanese patients with chronic hepatitis type C

Kazuaki CHAYAMA, Akihito TSUBOTA, Yasuji ARASE, Satoshi SAITOH, Kenji ...

1992 Volume 33 Issue 6 Pages 500-501
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.500

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Changes in N₁₄ antibody levels after IFN treatment for chronic hepatitis C

Hiroyasu OKUNO, Kazuo TAKEDA, Masashi TAKASU, Haruhiko KANO, Toshihito ...

1992 Volume 33 Issue 6 Pages 502-503
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.502

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Evolution of various HCV antibodies following interferon (IFN) therapy in patients with chronic hepatitis type C

Akihiko URUSHIHARA, Yoshiyuki NAKANO, Eiji TANAKA, Takeshi SODEYAMA, K ...

1992 Volume 33 Issue 6 Pages 504-505
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.504

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Multicyclic RT-PCR: A new quantitative method for hepatitis C virus and its comparison with modified CRT-PCR

Narihiro ISHIYAMA, Kazuhiko KATAYAMA, Norikuni ISHIMI, Shin'ichi TAKAH ...

1992 Volume 33 Issue 6 Pages 506-507
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.506

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A study of the mechanism of cytoprotective bile acid with reference to intracellular bile acid analysis

Takayuki OHIWA, Makoto HOSHINO, Tomihiro HAYAKAWA, Yasutaka KAMIYA, Ak ...

1992 Volume 33 Issue 6 Pages 508-509
Published: June 25, 1992
Released on J-STAGE: July 09, 2009

DOIhttps://doi.org/10.2957/kanzo.33.508

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