To evaluate diagnostic tests of Helicobacter pylori (H. pylori), we compared polymerase chain reaction (PCR) for the specific detection of H. pylori, culture and positivity of serum antibody against the bacteria in 59 patients with gastroduodenal disease. PCR assay was designed to amplify 203bp of DNA fragments. PCR detected 10pg of H. pylori DNA, or 40 CFU of the bacteria. PCR was positive in 82.1% of histological gastritis with neutrophil infiltration. Culture and serum antibody to H. pylori were positive in 65.0%, and 94.1% of those patients. Detection rate by PCR was significantly higher than that by the culture methods in patients with chronic gastritis. These results demonstrate that PCR is a sensitive diagnostic test for H. pylori infection.
Expression of p53 was studied immunohistologically in 25 adenomas, 46 cancers in adenoma, and 18 cancers without adenoma, which were obtained by endoscopic polypectomy or mucosal resection. Positive ratio of p53 expression was 100% in cancer without adenoma, 78.3% in cancer in adenoma, and 48% in adenoma. We divided the positive case of p53 expression to three staining patterns, poorly stained type, focal type and diffuse type. The diffuse type was most of cancer without adenoma. In each diagnostic group there was no significant colleration between sex, age, and shape of polyp and the staining pattern. But in cancer without adenoma, there was significant colleration between size of polyp and the staining pattern, and number of the diffuse type increased as the polyp size was larger. Consequently, it was suggested that p53 takes a role of cancerization from adenomas at every step.
We performed periodical examinations by ultrasonography (US) and serum α-fetoprotein in 272 patients with liver cirrhosis (male, 167 ; female, 105) over long follow-up periods (1985. 1-1992. 9). The average period was 1934 days, and we prospectively studied the early detection of hepatocellular carcinoma (HCC). HCC was detected in 78 patients during the periods, with the average cumulative incidence rate being per year 7%. Tumor size at detection was 15mm or less in diameter in 37.2% HCC patients and 30mm or less in 89.7%. In spite of frequent ultrasonic examinations, it was difficult to detect small sized HCCs in blind spots of US or in the liver with the rough parenchymal echo pattern. Predictive factors important for development of HCC were analyzed using Cox's proportional hazards model. It showed that significant factors were serum AFP level, liver parenchymal echo pattern and small mass lesions (ultrasonic appearance) of the liver.
We analyzed the Con A affinity of serum AFP in patients with a serum AFP concentration greater than 50ng/ml by antibody affinity electrophoresis and Western blotting to distinguish hepatocellular carcinoma (HCC) from benign chronic liver diseases (CLD). Of 164 patients with HCC, 48 (29.3%) had a single band, while 116 (70.7%) had multiple bands. All but three of 65 patients with cirrhosis had a single band. All but one of 32 patients with chronic hepatitis had a single band. We concluded that multiple AFP bands are diagnosis of HCC. This method is a useful assay for distinguishing HCC from CLD.
Seventy five patients with nodular type of hepatocellular carcinoma (HCC) non-occluding the main portal vein were divided into the following groups and were compared for the prognosis : (I) administered intraarterial infusion therapy combining dibutyryl adenosine 3', 5'-monophosphate (DBcAMP) and mitomycin C (MMC) (n=13) ; (II) treated with transcatheter arterial embolization (TAE) (n=62). No marked difference was observed between two groups before treatment concerning the tumor size and the underlying clinical state confirmed by Child's method. Fifty % survival disclosed to be 21 months in both groups, whereas viewed from the tumor type of being single or multi-nodular, the median survival was as follows : 14 months (n=6) and 21 months (n=7) in group I, and 30 months (n=25) and 20 months (n=37) in group II, respectively. However, combination therapy exerted a reduced frequency of patients succumbing within one year after treatment : 1 (7.7%) as compared to 16 (25.8%) in group II. It is concluded that combination therapy with DBcAMP and MMC has an almost same salutary effect as TAE on HCC non-occluding the main portal vein.
In 10 adult patients with hepatic portal venous gas (HPVG), the clinical significance of HPVG and the efficacy of X-ray computed tomography (CT) were evaluated. HPVG was associated with ischemic bowel disease (n=3), trauma (n=4), liver abscess (n=1), sepsis (n=1), and unknown etiology (n=1). The diagnostic ability of CT for the detection of HPVG was far superior to that of plain abdominal radiograph. Of 9 patients who underwent CT, HPVG located in the left hepatic lobe in all patients, and also in right hepatic lobe in 7 patients. Gas could be recognized in the left lobe and the anterior segment of the right lobe more clearly than in the posterior segment of the right lobe because of its larger amount of intravenous collection. The mortality rate of our cases was 100%. Gas was demonstrated simultaneously in the portal vein radicles and hepatic veins on CT in 4 patients with no clinical evidense of sepsis, which suggested the possibility of intraparenchymal shift of gas from the portal vein into the hepatic vein. In a single case with sepsis, gas was noted in various vessels, including arteries, in addition to the portal venous system. The authors conclude that HPVG is still a grave sign in Japan and prompt appropriate treatment is required. CT may be of great value in the early detection of HPVG and may indicate its etiology.