Fumiaki Ikegami

Acute right-sided hemorrhagic colitis associated with oral administration of ampicillin

Among 56 cases who presented to Kanto-Teishin Hospital complaining of bloody diarrhea or considerable hematochezia of acute onset, 8 cases (14.3%) were considered due to colitis associated with oral ampicillin therapy. The bloody diarrhea, often with abdominal cramps, began 2–7 days after starting the treatment. The dosage of ampicillin taken ranged from 2.0 to 4.5 g. Early total colonoscopy and biopsy revealed marked mucosal hemorrhage with minimal or no inflammatory changes mainly in the right colon. Rectum and sigmoid colon are completely normal except in one case. Symptoms rapidly resolved after the endoscopy. At follow-up colonoscopy, performed 4–12 days later, the mucosal changes had cleared completely. There was no evidence to support a hypersensitivity reaction of the colonic mucosa to ampicillin. We believe that right-sided hemorrhagic colitis is one of the common forms of colitis associated with ampicillin. Its differentiation from other kinds of acute colitis and the importance of early total colonoscopy are discussed.

Regulation of Hepatic Thrombopoietin Production by Portal Hemodynamics in Liver Cirrhosis

Objective:This study was designed to clarify how thrombopoietin (TPO) functions in and, to some extent, causes thrombocytopenia complicating liver cirrhosis and portal hypertension.Methods:Our study population consisted of 19 cirrhotic and six noncirrhotic patients who underwent percutaneous transhepatic portography (PTP) and hepatic venography.Results:The platelet counts of the cirrhotic patients were significantly lower than those of the noncirrhotic patients (8.7 ± 4.1 vs 17.4 ± 7 × 104/μl; p < 0.01). The flow direction in the splenic vein was confirmed by PTP. Ten hepatofugal and nine hepatopetal flow directions in the splenic vein were noted among the cirrhotics. The hepatofugal group showed lower portal venous pressure (20 ± 10 vs 32 ± 4 cm H2O; p < 0.01) than the hepatopetal group and had a higher incidence of hepatic encephalopathy (six of 10 vs zero of nine; p < 0.01). The hepatic vein-portal difference in TPO did not differ substantially between the cirrhotics and noncirrhotics (0.12 ± 0.04 vs 0.24 ± 0.07 fmol/ml). Comparisons of this value among the three groups showed the TPO difference to be lowest in the hepatofugal group (hepatofugal: 0.04 ± 0.03, hepatopetal: 0.21 ± 0.07, noncirrhotic: 0.24 ± 0.07; p < 0.05).Conclusions:Our findings suggest that TPO production in the cirrhotic liver is regulated by the portal blood supply to the liver. Thus, portal hemodynamics may play a critical role in the development of thrombocytopenia.

Sustained viral response is rarely achieved in patients with high viral load of HCV RNA by excessive interferon therapy

Adequate dosing of interferon (IFN) and its cost-effectiveness for sustained virological response were evaluated in relation to viral load and subtype. Prospective analysis of IFN therapy on 326 patients with chronic hepatitis C free from cirrhosis was performed using 9 or 6 million unit (MU) of IFN for six months daily and/or three times a week. Sustained virological response was achieved in 50–94% of patients with ≤2 × 104 copies/ml (competitive RT-PCR) or <100 × 103 copies/ml (Amplicor monitor) of HCV RNA by 468–1206 MU of IFN, but response was only 0–25% of the patients with ≥2 × 105.5 copies/ml (competitive RT-PCR) or >200 × 103 copies/ml (Amplicor monitor), even with 468–1206 MU of IFN. A high sustained rate was demonstrated in patients with 100–200 × 103 copies/ml of HCV RNA by 901–1206 MU of IFN, in comparison to that with ≤900 MU of IFN. Multivariate analysis showed that IFN dose had a significant value for the efficacy of IFN therapy in patients presenting 100–200 × 103 copies/ml of HCV RNA. Cost efficacy analysis indicated that it cost approximately

Effects on Gastric Circulation of Treatment for Portal Hypertension in Cirrhosis

10,000,

Clinical features of paradiverticulitis

26,000, and

Incidence of hepatocellular carcinoma (HCC) in chronic hepatitis C patients treated with interferon (IFN).

50,000–227,000 for one person-viral eradication in the patients with <100, 100–200, and >200 × 103 copies/ml, respectively. High-dose IFN is only cost effective in patients with intermediate viral loads, and IFN therapy could be recommended in patients with <200 × 103 copies/ml of HCV RNA.

Transjugular intrahepatic portosystemic shunting improves splanchnic hemodynamics and renal Na excretion in cirrhosis with refractory ascites

We evaluated the gastric circulatory effects ofthe type of treatment administered for portalhypertension. Of 14 patients with cirrhosis, sevenreceived a transjugular intrahepatic portosystemic shunt (TIPS; group T) and seven received percutaneoustranshepatic portographic embolization (PTPE; group P).Patients were evaluated over the course of one year.After treatment, portal venous pressure wassignificantly reduced from 39 ± 6 cmH2O to 32 ± 5 (P < 0.001) in groupT and was significantly elevated from 29 ± 10 to33 ± 8 (P < 0.05) in group P. The portal flowvelocity (Vmean) was significantly higher in group T vs group P (P < 0.0001).The congestion index was significantly lower in group Tthan in group P (P < 0.0001). The gastric mucosalblood flow was increased in group T but was unchanged in group P. Esophageal varices showed someimprovement in both groups, but the portal hypertensivegastropathy was improved only in group T. These findingshelp to explain the differing effects on the gastric circulation related to the type of treatmentused for portal hypertension.

Analysis of sustained responders in the treatment of chronic hepatitis C with interferon: viral clearance is more associated with genotype III or IV (2a, 2b) than genotype II (1b)

Colonic diverticula have been generally acceptedas a source of massive hemorrhaging. Little is known,however, about fecal occult blood loss from colonicdiverticula and diverticulosis. We retrospectively investigated the possibility of minor bleedingin 737 diverticula cases diagnosed from April 1989 toMay 1994. Thirty-seven cases (5%) of diverticula areexplained as the sources of positive occult blood testing ascertained clearly by colonoscopy.These divide into three types: (1) fromintradiverticular bleeding (intradiverticulitis), (2)from peridiverticular bleeding (peridiverticulitis), and(3) from interdiverticular colonic mucosal erosion(interdiverticulitis). These findings account for theoccult blood loss that we call paradiverticulitis. Thetwo-year prospective study found 67 cases (11.3%) of paradiverticulitis in 595 diverticula cases.We concluded that paradiverticulitis is one of thecauses of positive occult blood tests.

Radiotherapy for advanced hepatocellular carcinoma.

C型慢性肝炎に対し, インターフェロン (IFN) 治療を施行し, 治療終了後2年以上, 平均44カ月間定期的に経過観察されている371例を対象に肝細胞癌の発生率を検討した. 著効群 (治療終了6カ月後の血中HCV-RNA陰性かつalanine aminotransferase (ALT) 正常) 98例及び有効群 (治療終了6カ月後の血中HCV-RNA陽性かつALT正常) 27例からの発癌は経過観察期間中認められなかった. 無効群 (著効, 有効以外) 246例中7例に0.79%/年/人の割合で肝細胞癌の発生を認め, Staging別では, 1, 2, 3, 4でそれぞれ0%/年/人, 0.73%/年/人, 1.95%/年/人, 4.76%/年/人に肝細胞癌の発生を認めたが1～3においてはコントロール群に比し有意に低率であった.

Clearance of hepatitis B surface antigen and hepatitis C virus antibody in hepatitis B virus carriers.

Abstract To clarify the pathogenesis of ascites in patients with liver cirrhosis, we explored the effects of transjugular intrahepatic portosystemic shunting in six cirrhotic patients with refractory ascites. The portal pressure decreased from 39 ± 7 cmH 2 O before treatment to 32 ± 5 cmH 2 O immediately after the procedure. Liver function transiently deteriorated after the procedure, but recovered within 1 week. Urinary Na excretion increased 1 week after treatment. In five patients, ascites improved within 3 weeks. Along with the decrease of portal congestion, there was an improvement of esophageal varices, and an increase of gastric mucosal blood flow, and an inhibition of the renin-angiotensin-aldosterone system in all of the patients after 2–4 weeks. Manageable shunt encephalopathy occurred in three patients. These findings strongly suggest the pivotal role of increased portal pressure in the formation of ascites in patients with liver cirrhosis.