To compare the efficacy of oral propranolol and sclerotherapy in the prevention of first hemorrhage from esophageal varices, 65 cirrhotic patients with moderate to large esophageal varices and no history of bleeding were included in the prospective controlled trial. After randomization, 33 patients received propranolol at a does reducing the heart rate by 25%; 32 patients were treated with intravariceal and extravariceal injection of ethanolamine oleate. On entry to the trial, the two groups were comparable in terms of clinical and biological parameters. The patients were observed for up to 60 months, with an average of 31 months. Nine patients bled (5 in propranolol and 4 in sclerotherapy) during follow-up. No significant difference were observed between propranolol and sclerotherapy in the cumulative bleeding rate and survival. The multivariate Cox model indicated that drug compliance in the propranolol group and high portal pressure in the sclerotherapy group were factors predictive of the first hemorrhage. These data support that propranolol and sclerotherapy are of comparable value in preventing the first hemorrhage in cirrhotic patients with esophageal varices.
We prospectively evaluated the clinical importance of abdominal imaging examinations (US, CT, upper gastrointestinal barium X-ray) in 233 consecutive patients who gave informed consent for the examinations. The examinations revealed intra-abdominal lesions in 99 of 233 patients. Intra-abdominal lymph nodes were most frequently affected, followed by stomach, spleen, liver, small intestine and large intestine. In Hodgkin's lymphoma, no gastrointestinal involvement was noted but one in the small intestine. Prognosis was poorer with advancing stage according to Ann Arbor classification. However, the presence or absence of intra-abdominal lesions did not influence the prognosis when patients were matched for the stage. Abdominal imaging examinations altered the bed-side staging to more advanced stages in 22 of 163 patients with stage I through stage III lymphoma, influencing prognosis as well as the decision of therapeutic modalities. These three diagnostic modalities were complementary to one another. In conclusion, every one of these abdominal imaging examinations is important for planning the management of patients with malignant lymphoma.
In 65 patients who underwent surgical resection of the gastric cancer invading to proper muscle layer (pm cancer), lymph node involvement at the time of resection and the site of recurrence were investigated. Patients who underwent gastrectomy for submucosal (sm cancer) or subserosal (ss α•β cancer) gastric cancers during the same period served as controls. Lymph node involvement was positive at a higher rate in the pm cancer than in the sm cancer, but the rate for number of lymph node metastases was not dependent on the stage of lesions. Of the lesions in the pm cancer, those of the Borrmann type involved lymph nodes at a particularly high rate. Of the metastatic pattern in the lymph nodes, the rate of severe metastases in pm cancer was higher than in the sm cancer. In the pm cancer, the cancer recurred in the liver and peritoneum, but not in any lymph nodes, thus suggesting that the surgical resection and the dissection of regional lymph nodes had been successful.
We studied on clinical availability of determination of serum anti-Helicobacter pylori (HP) IgG antibody in diagnosis of HP infection compared with bacterial culture. The population of this study consisted of patients who underwent endoscopic examination in our hospital. Detection and quantification of HP were made by the culture of biopsy specimens taken from the antrum and the body of the stomach. And, simultaneously, serum anti-HP antibody (HP-Ab) was measured by ELISA. The levels of HP-Ab in culture positive patients, 40.6±33.7U, are significantly higher than that of culture negative patients, 10.6±9.1U. Sensitivity and specificity in diagnosis of HP infection using determination of serum HP-Ab were 96.2% and 60.0% respectively. Significant correlation was found between the levels of serum HP-Ab and the amounts of HP bacilli in the biopsy specimen taken from body of the stomach.
Relationship between biliary excretion of sulfobromophthalein conjugated with glutathione (BSP-GSH) and glutathione disulfide (GSSG) was investigated in Sprague-Dawley rats. BSP-GSH solution was infused intravenously at three different rates. After administration of a glutathione-oxidizing agent, diamide, biliary excretion of GSSG increased temporarily and that of BSP-GSH decreased during the same period. A linear correlation was found between the increments in biliary excretion of GSSG and the decrements in that of BSP-GSH only when BSP-GSH was infused at a rate near its biliary transport maximum. The results may indicate competition in vivo between GSSG and BSP-GSH for a common transporter on canalicular membrane.
Duck hepatitis B virus (DHBV) carrier ducks of one week old were injected with Ara-A (adenine arabinoside) of different dose including 2.5 (11 ducks), 5.0 (11), 10.0 (10) and 20.0 (10) mg/kg for 14 days. This antiviral effect showed dose-dependence up to 5.0mg/kg and this dose seemed effective to obtain significant antiviral effect. Viral DNA and DNA polymerase activity were reduced significantly from the 1st week after starting the administration of Ara-A. This antiviral effect was maintained even at the 1st week after discontinuation of the drug. These findings were quite similar to those observed in HBV carriers. With the increasing necessity of Ara-A treatment in patients who will not respond to interferon therapy, DHBV seemed a suitable model for the investigation of the dose and antiviral effect of Ara-A treatment in humans.