Prognostic factors and the efficacy of therapy were studied on 518 patients with fulminant viral hepatitis collected as a joint study from the active members of the Japanese Gastroenterological Society during the period from 1983 to 1988. Using five independent prognostic variables (patients' age, occurrence of infection, gastrointestinal bleeding, renal failure and coexistence of accompanying diseases), a prognosis discriminating logistic model was constructed. A risk score was calculated from the model and patients were classified into two groups with high and low probabilities of survival according to the score. In patients with the duration of illness more than ten days before development of encephalopathy, survival rate of patients given Fischer's amino acid solution was significantly low compared with those not given in the group of low survival probability. A similar deleterious effect of the amino acid solution was proven with another logistic model comprising three more covariates (prothrombin percent, total birirubin level on the day of development of hepatic encephalopathy and the duration of illness before encephalopathy) on 391 patients without missing data on these items. No significant life saving effect was observed on plasma exchange, charcoal hemoperfusion, glucagon-insulin therapy, H2 receptor antagonist and steroid. By Cox's proportional hazard model, plasma exchange was found to double the survival period of patients after development of encephalopathy (p<0.001).
We succeeded in establishing a human gastric carcinoma cell line (KE-97) from oncocytes obtained from the mesentery disseminated metastatic focus of a 52-year-old male stomach cancer patient. From a histopathological point of view the gastric carcinoma was clearly a mucin-producing mucinous carcinoma, portion of which were mixed with poorly differentiated adenocarcinoma and signet-ring cell carcinoma. The oncocytes were fused into a mass and exhibited a suspended proliferating system, with a doubling time of about 28.8 hours. Transplantation of the cancer cells into skid mice resulted in a tumor system in all cases, and histologically, mucinous vacuoles were found in the cell membranes. With immunological staining they were found to be positive for anti-CEA antibodies, anti-CA19-9 antibodies and anti-ICAM-1 antibodies. Autopsy found extensive hematogenous metastasis (lung, liver) and cancerous peritonitis. KE-97 is mucinous carcinoma, and it was reported with the belief that it is a useful cell line upon the investigation of its cancer metastasis mechanism and cytological characteristics.
We report 12 patients who ate raw firefly squid, Watasenia scintillans. The patients experienced abdominal pain one or two days after eating them. Ileus was suspected by abdominal X-ray, but abdominal muscle guarding was not recognized. No specific findings was revealed on laboratory data. Patients were recovered two or three days after admission by only drip infusion. Recently, type X larva of the suborder Spirurina is recognized in 3.3% of firefly squid viscus. Indirect fluorescent antibody test using antigen of the type X larva was evaluated for the sera of the 8 ileus patients who were admitted in 1993. The antibody titers were positive in 5 patients and were negative in 3 patients. These results suggested that the ileus like symptom we reported here was attributed to the type X larva of the suborder Spirurina.
Therapeutic efficacy of Elental and Enterued as home enteral nutrition (HEN) for the maintenance of remission in 32 patients with quiescent Crohn's disease was studied retrospectively. Their cumulative rates of continuous remission and non hospitalization were statistically compared in relation to following five factors ; type of disease, history of bowel re-section, duration of disease, oral bile acid tolerance test (OBATT) and radiological lesion score (RLS). As to the cumulative rates of continuous remission and non hospitalization, there was no significant difference between two groups treated with Elental and Enterued. In patient with ileocolitis type, ≥5-year history, and a high score of RLS, few cases could continuously maintein remission following a long-term HEN. Especially, patients with low absorption in OBATT had a significantly lower cumulative rate of continuous remission than those with normal absorption in OBATT. The present results suggest that above factors may be useful in the application of HEN to patients with Crohn's disease.
Hepatic hemangioma is the most common benign tumor of the liver, but there are a few reports on chronological changes in size of hepatic hemangioma. To elucidate natural history of hepatic hemangioma, we evaluated consecutive ultrasonograms of 27 hemagiomas in 23 patients. Underlying liver disease in these 23 patients included seven cases with chronic hepatitis, five cases with liver cirrhosis and three cases with fatty liver. The remaining eight cases showed no evidence of liver disease. Follow-up period ranged 12 to 114 months (average 44). During the follow-up, six (22.2%) hemangiomas changed in size on US, which included three lesions with increase in size, one lesion with decrease in size and two lesions with spontaneous regression. Of 12 patients with chronic liver disease, only one patient showed significant change in the hemangioma size, which regressed spontaneously. These results showed that there was no case showing increase in size of hemangioma in patients with chronic liver disease. Thus, if clinically diagnosed hemangioma which tends to increase in size is detected on US or other imaging modalities in patients with chronic liver disease, aimed aspiration biopsy should be preferably performed considering the possibility of hepatocellular carcinoma.
A clinical study on efficacy of prophylactic sclerotherapy for esophageal varices was carried out on 220 patients with unresectable hepatoma treated with TAE. They were classified into 3 groups : 1) Prophylactic group with prophylactic sclerotherapy for RC sign positive varices (45 cases), 2) Non-prophylactic group with RC sign positive varices without prophylactic sclerotherapy (31 cases), 3) RC negative group in which RC sign was negative in whole time (144 cases). Although atypical RC sign or venous dilatation was noticed in 54% of patients in prophylactic group at 1-year after sclerotherapy, cumulative bleeding rates after detection of RC sign positive varices in prophylactic group (27% at 2-years) were significantly lower (p<0.001) than those in non-prophylactic group (91% at 2-years). The incidence of death by variceal bleeding in prophylactic group (6%) was significantly lower (p<0.005) than that in non-prophylactic group (36%). 50% survival period of prophylactic group (25.0 months) was significantly longer (p<0.001) than that of non-prophylactic group (12.5 months), and there was no significant difference of 50% survival period between pro-phylactic group and RC negative group (21.6 months). We conclude that, prophylactic sclerotherapy not only decrease incidence of variceal bleeding and of death due to bleeding, but also improve survival rate in hepatoma patients with RC sign positive esophageal varices.
Chronic hepatitis C patients (n=115) were treated with interferon (IFN). Total dose employed was more than 500 MU. The response rate was assessed among the three treatment groups : 2W continuous + TIW, 4W continuous + TIW, 8W continuous + TIW. The IFN treatment effect predictive factors were also assessed. Complete response (CR) rate, CR with serum HCV-RNA disappearance rate, responders' histology activity index score changes between before and after treatment, and responders' hepatocytes HCV-RNA disappearance rate did not differ among the three treatment regimens. CR to IFN treatment was dependent on serum HCV-RNA and HCV serotype. Patients of low serum HCV-RNA and serotype II were responsive to IFN treatment.
The effect of ursodeoxycholic acid (UDCA) treatment for more than one year on chronic hepatitis in regard to responder and non-responder and influence of UDCA administration on serum bile acid metabolism were studied. All of non-responders (16 patients) were hepatitis B or C patients, and seven of fifteen responders were negative for hepatitis B and C virus marker and could be considered autoimmune hepatitis. These patients got drastic improvement of liver function test, anti-nuclear antibody in five patients and anti-smooth muscle antibody in three patients were decreased. Although HAI scores for liver pathology before UDCA treatment were not different between responders and non-responders, the intralobular necrosis was improved in responders after UDCA treatment. Concerning serum bile acid analysis, total bile acid and UDCA concentration in responders were lower than non-responders. Percentage of iso-ursodeoxycholic acid in responders was significantly higher than non-responders. These results suggest the effectiveness of UDCA therapy on autoimmune hepatitis.