Endoscopic intravariceal injection sclerotherapy (EIS) using sclerosant mixed with contrast medium was done in 100 patients without hepatocellular carcinoma. They were followed longer than 12 months (mean ; 58±29 months) after EIS. The recurrence rate of esophageal varices in cases with complete eradication (n=79) and cases with incomplete eradication of (n=21) was 8.9% and 85.7%, respectively (p<0.01). In 21 cases, complete eradication was achieved by intravariceal injection and additional therapy using paravariceal injection was not performed. The recurrence rate of this group was only 4.8%. Endoscopic varicealography during injection sclerotherapy were evaluated in 91 cases. At final session of EIS, narrowing of diameter (less than 1 mm) and irregularity of vessel walls were observed in small vessels (devastated vessels). Appearance rate of devasted vessel in 75 cases with completely eradicated esophageal varices was 65.3%. In contrast, among 16 cases with incomplete eradication of varices, devastated vessels were seen only in 6.3% (p<0.01). It is concluded that the important point in preventing the recurrence of esophageal varices after EIS was the complete eradication of esophageal varices by intravariceal injection sclerotherapy resulting in the eradication of the routes to esophageal varices from port-splenic venous system. For the sake of accomplishment of this treatment, appearance of devastated vessel is very useful.
The clinicopathological characteristics of the diffuse gastric mucosal redness were studied in 235 patients with liver cirrhosis. Moreover, in 96 patients in whom percutaneous transhepatic portal catheterization was carried out, the relationship was studied between gastric mucosal lesions and portal hemodynamic aspect with reference to portal vein pressure and extrahepatic collaterals. Extrahepatic collaterals were divided into three groups, which related either of cephalad, caudal and peri-abdominal as the most prevalent extrahepatic collateral on portographic findings. The frequency of the diffuse gastric mucosal redness was increased with the elevation of portal vein pressure, and it was seen more frequently in patients with cephalad collaterals than in caudal. However, the diffuse gastric mucosal redness was seen less frequently in patients with cephalad collateral accompanied with the development of renal shunts. Multiple logistic model analysis showed significant correlation between the diffuse gastric mucosal redness and the development of cephalad collaterals. These results suggest that the gastric mucosal circulation in liver cirrhosis is strongly affected by the development of portosystemic collaterals in portal hypertension.
To clarify the mechanisms of action of immunoglobulin (IgG) in intravenous immunoglobulin therapy for the ulcerative colitis (UC) patients, we studied the therapeutic effect of IgG on experimental rat colitis induced by dextran sulfate sodium and on the production of inflammatory cytokines such as TNFα, IL-1α and IL-8. The administration of rat IgG demonstrated to suppress the development of blood stool and the induction of the ulcerative lesion in large intestine. The levels of TNFα, IL-1α and IL-8 were increased in blood and mucosa of the large intestine in this model. Rat IgG showed a tendency to decrease the levels of the cytokines in colonic mucosa. This result seems to provide a piece of explanation of how massive administration of IgG shows an improvement in the ulcerative lesion of UC patients.
Percutaneous ethanol injection (PEI) was performed on 183 tumors in 147 patients with small hepatocellular carcinoma (HCC), of no larger than 3 cm in size and less than three in number, during 9 years and 4 months between August 1983 and December 1992. The 1-, 3and 5-year survival rates of all 147 patients calculated by the Kaplan-Meier method were 96.3%, 62.5% and 40.7% respectively. Multivariate analysis (Cox's proportional hazard model) demonstrated that the most significant factor contributing to the prognosis of the patients was the severity of liver dysfunction (clinical stage) before treatment. Recurrence was seen in different areas of the liver from the original lesion in 26.9% in one year and 61.5% in three years. Multivariate analysis demonstrated that the most significant factor contributing to the recurrence was the number of tumors before treatment. Regrowth of the original tumor occurred in two patients (1.4%). There was no serious complication due to PEI. To evaluate the therapeutic effect of PEI, contrast-enhanced CT with intravenous bolus injection was considered to be indispensable. We conclude that PEI can be indicated in most patients with small HCC and is also effective.
It is widely believed that BT-PABA is a specific substrate for pancreatic chymotrypsin, and based on this concept, BT-PABA test is used to evaluate the exocrine pancreatic function. But this test shows unusual clinical results particularly in patients after total pancreatectomy. In order to reevaluate the specificity of BT-PABA for chymotrypsin, we investigated the intestinal influence on this substrate in in vivo and in vitro studies using mongreldogs under the conditions of complete absence of pancreatic juice in the alimentary tract. In vivo study showed that serum PABA increased after BT-PABA administration in the models of complete absence of pancreatic chymotrypsin and in vitro study demonstrated BT-PABA splitting activity of jejunum and ileum mucosal homogenate which increased after total pancreatectomy. Hence, we concluded that BT-PABA is not a specific substrate for pancreatic chymotrypsin in vivo in human and in dog.