[Histopathological study of the role of Helicobacter pylori in the occurrence and development of chronic active gastritis, acute erosive gastritis and gastric ulcer]
Saitoh K. Ohkura Y.
Department of Pathology, International Medical Center of Japan, Tokyo.
A total of 773 gastric mucosas taken from 653 patients who were endoscopically diagnosed as normal, or having reddening, irregular mucosa, erosion, small ulcer or scar were examined pathologically according to the Sydney system to study the role of H. pylori in the occurrence and development of chronic active gastritis, acute erosive gastritis and ulcer. H. pylori were detected in higher frequency in lesions showing active inflammation with neutrophil infiltration and necrosis of the mucosa. The presence of H. pylori was correlated with the degree of lymphocyte infiltration, but not with the degree of intestinal metaplasia, mucosal atrophy and location in the stomach. Reddening and irregular mucosas were found histologically to be chronic active gastritis. These results suggested that H. pylori causes active inflammation in the gastric rucosa, and that milder inflammation causes reddening or irregularity of the mucosa, whereas severer inflammation causes erosion and ulcer. There is no essential difference between chronic active and acute erosive gastritis.
[The study of genetic changes in colorectal cancer accompanied with ulcerative colitis]
Toda J. Nagasako K. Fujimori T. Kato Y. Hayashi N.
Institute of Gastroenterology, Tokyo Women's Medical College.
The usefulness of gene information was studied when used in conjunction with a morphological diagnosis of either dysplasia or carcinoma that later develops into ulcerative colitis (UC). The cases investigated consisted of those operated on for UC with carcinoma complications and those operated on for UC over 7 years previously without carcinoma complications. Ras and DCC were examined for the presence of any point mutations in codon 12 and polymorphism in codon 201 using the PCR-RFLP method, while p53 was also studied immunohistologically. A mutation in ras was found in 25% of the UC-IV cases and also in 17% of the UC-III cases, while no mutation at all was found in the UC-I and UC-II cases. p53 showed a high rate of positivity in the UC-IV and UC-III cases with carcinoma complications, while it was negative in all cases in the control group cases. Gly in DCC codon 201 was also found in many cases including the control group. This study demonstrated that a gene aberration can thus influence the pathophysiology and cancerization of UC and therefore the p53 findings were thus considered to be useful in the morphological diagnosis of dysplasia and carcinoma.
[Estimation of cell proliferation in hepatocellular carcinoma and in background liver cirrhosis, by using MIB-1 LI]
Department of 2nd. Int. Med., Kanagawa Cancer Center.
The 23 hepatectomized patients with hepatocellular carcinoma (HCC) were studied. Samples were biopsied from both cancerous portion and from non-cancerous cirrhotic portion at operation. MIB-1 LIs were measured in these biopsied samples. Then the relationships between MIB-1 LIs and pathologic feature, clinical data, and prognosis were investigated. LIs of the cancerous portion (10.2 +/- 6.8%, Mean +/- SE) were significantly (p < 0.001) greater than those of non-cancerous cirrhotic portion (3.8 +/- 2.1%). LIs of the cancerous portion in the patients who were dead with in 18 months after their hepatectomies, were significantly (p < 0.05) greater than those in the patients who survived more than 18 months after operations. LIs of the cancerous portion in the patients whose samples revealed Edmondson & Steiners classification grade III, were significantly (p < 0.05) greater than those in the patients whose samples revealed grade II. LIs of the cancerous portion in the patients whose serum AFP levels showed high level (> or = 100 ng/ml) were significantly (p < 0.005) greater than those in the patients whose serum AFP levels showed low level (< 100 ng/ml). And LIs of the non-cancerous portion in the patients whose thymol turbidity test (TTT) showed high level (> 5K-U), were significantly (p < 0.005) greater than those in the patients whose TTT levels showed within normal range. LIs of the non-cancerous potion in the patients whose zinc sulphate turbidity test (ZTT) showed high level (> 12K-U), were significantly (p < 0.01) greater than those in the patients whose ZTT levels showed within normal range. LIs of the non-cancerous portion in the patients whose PT levels were prolonged (14 sec
[The clinical significance of plasma tissue plasminogen activator (t-PA) levels in severe acute or fulminant hepatitis]
Hayashi T. Kobayashi Y. Yamaguchi K. Kamogawa A. Takahashi Y. Osada T. Tomoe M. Toyoma H. Yoshida H. Suzuki M. Iino S.
Second Department of Internal Medicine, St Marianna University, School of Medicine, Kawasaki.
We studied the tissue plasminogen activator (t-PA) levels in the plasma of patients with acute hepatitis (AH), severe acute hepatitis (AHs) and fulminant hepatitis (FH). Plasma t-PA levels were measured consecutively on the first, third and seventh days of hospitalization. Plasma t-PA levels were markedly higher in AHs and FH than in AH (p < 0.05, p < 0.01, respectively) on the first day, but did not differ significantly between AHs and FH on this day. The t-PA levels decreased markedly on the third and seventh days in AHs (both p < 0.05), but did not change from the first day to the third and seventh days in FH. The t-PA levels on the third and seventh days were higher in FH than in AHs (both p < 0.05). There was a significant increase in the plasma t-PA level before an episode of encephalopathy in FH compared with levels in AHs. These observations suggest that t-PA level may be useful as a prognostic parameter in patients with acute hepatic injury.
[Transjugular intrahepatic portosystemic shunt for the treatment of refractory ascites]
Kanazawa H. Osada Y. Yoshimoto H. Narahara Y. Mamiya Y. Saitoh H. Matusaka S. Tada N. Kobayashi M. Kawamata H. Kumazaki T.
3rd Department of Internal Medicine, Nippon Medical School.
Five cirrhotic patients with refractory ascites were treated with transjugular intrahepatic portosystemic shunt (TIPS). Before TIPS, although patients were received salt restriction (5 g/day), diuretic therapy (furosemide 112 mg/day, spironolactone 140 mg/day), albumin infusion and paracentesis, ascites did not show improvement. After TIPS, urine volume and urinary sodium excretion increased significantly. Mean body weight decreased significantly from 73 kg before TIPS to 63 kg a month after TIPS. Improvement of ascites after TIPS were associated with a significant reduction in the dose of diuretics. On discharge, complete resolution of ascites was found in 2 patients and mild ascites remained in 3 other patients. Four patients presented 6 episodes of shunt stenosis in the follow-up period, and were treated with balloon dilatation. Ascites increased on shunt dysfunction and showed improvement after balloon dilatation. Post-TIPS encephalopathy was seen in 2 patients and one of 2 was disabled. In conclusion, although post-TIPS shunt dysfunction and encephalopathy are common. TIPS is an effective therapy for refractory ascites in patients with cirrhosis.
[Diagnosis of the wall-thickened lesions of the gallbladder with dynamic MRI]
Takashima T. Nakazawa S. Yoshino J. Inui K. Kanemaki N. Wakabayashi T. Okushima K. Kobayashi T. Nakamura Y. Ukai H. Hattori T. Miyoshi H. Anno H.
Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine.
We studied 32 patients with the thickened lesions of the wall of the gallbladder by using dynamic MRI. We tried the differential diagnosis of gallbladder lesions according to the time intensity curve (TIC) and enhanced pattern. TIC of carcinoma was elevated more seeply from plain to arterial phase than the inflammatory diseases. The Inflammatory diseases were keeping three-layer structures of the wall of the gallbladder, but gallbladder carcinoma destroys the wall-structure. We could diagnose as direct liver invasion of the carcinoma clearly. We could exactly diagnose adenomyomatosis in dynamic MRI by small low intensity spots within the wall of the gallbladder. In the patients with gall stones, the wall of the gallbladder were more clearly observed in dynamic MRI compared with US and EUS.
[Frequent chemolipiodolization and prostaglandin E1 administration for hepatocellular carcinoma with advanced liver cirrhosis]
Kakizoe S. Kakizoe Y. Kakizoe S.
Dept. of Surgery, Kakizoe Hospital.
"Frequent Chemolipiodolization & Prostaglandin E1 administration Therapy (FCPT)" which performed frequent chemolipiodolization to Hepatocellular carcinoma (HCC) and Prostaglandin E1 (PGE1) intra-hepatic arterial administration for avoiding serious liver damage by using reservoir was carried out for 7HCC cases with severe liver cirrhosis. Chemolipiodolization was performed every 4 weeks to 6 cases. PGE1 was given to all cases with 10 or 20 micrograms/4 hours every week after 7 days administration. In 6 cases that carried out Chemolipiodolization, FCPT demonstrated complete response in a case and partial response in 3 cases. Two other cases showed the progression of HCC in spite of the frequent chemolipiodolization. The serum hepaplastin levels were stable or improved in 5 cases. Improvement of the serum total protein levels was seen in the long survival cases. The general malaise of all cases was disappeared after FCPT. In 5 cases who had ascites before FCPT, the ascites was gradually decreased. We concluded that the FCPT was useful to treat HCC with advanced liver cirrhosis, and also the intra-hepatic arterial administration of PGE1 might have the possibility that is contributing to the liver function improvement of a liver cirrhosis.