Haruo Kameda

Obliterative portal venopathy: A comparative study of 184 cases of extrahepatic portal obstruction and 469 cases of idiopathic portal hypertension

Abstract A total of 184 cases of extrahepatic portal obstruction (EHPO), mostly demonstrated by intraoperative portography and studied at 17 institutes during the period 1957–1983, were compared with 469 cases of idiopathic portal hypertension (IPH) similarly studied. Of the cases of EHPO, there were 101 males and 83 females; 93 were under 20 years of age and the average age was 25.9 years (i.e. much younger than that of IPH cases). There were two age peaks, one before age 19 years and the other at age 40–49 years. One out of three adult cases had a history of abdominal surgery, but otherwise the aetiologic factor was difficult to elicit. Bleeding was the initial symptom in the majority, and splenectomy and haematological findings of hypersplenism were less pronounced compared with IPH. Liver function tests were almost always normal. The liver appeared normal macroscopically in 69% and histologically in 35%. The changes seen in the remainder were similar to those in IPH; they were less frequent in young patients than in cases above age 20 years. Compared with IPH, the wedged hepatic venous pressure in patients with EHPO was lower and the gradient from the portal venous pressure was greater. It is concluded that extrahepatic portal obstruction is less common compared with IPH in Japan, and that there are cases particularly among adults that present clinicopathological features very similar to those of IPH. It is unclear at present whether these two disorders represent two different disease entities, or whether they represent one disorder with differences in the site of involvement along the portal vein system.

Gallstone Disease in Japan: A Report of 812 Cases

Summary Gallstones obtained from 812 Japanese subjects were submitted to infrared spectroscopic analysis with the use of a standard technique. Cholesterol stones made up 46.6 per cent of the total and bilirubin stones 41.5 per cent which indicated an increase in the incidence of cholesterol stones compared with previous Japanese data. The recent increase in the dietary fat of the Japanese is suggested as one of the causes. The increase in cholesterol stones was particularly noticeable in large cities with an incidence of 69.5 per cent in Tokyo, whereas in rural areas, especially in villages in northeastern districts of Japan, bilirubin stones were more common, with an incidence of 69.4 per cent. These findings emphasize the importance of considering regional differences in discussions of cholelithiasis.

Adenomyoma of the common hepatic duct

A very rare case of adenomyoma of the common hepatic duct is described. A 54-year-old woman was admitted with impending obstructive jaundice secondary to adenomyoma of the common hepatic duct. Our impression, formulated from her clinical presentation, endoscopic investigations, and biochemical and radiological findings, was a cancer of the proximal common hepatic duct. The patient was treated successfully by combination surgical resection and hepaticojejunostomy. Despite our obtaining an intraoperative frozen section, final histological examination was required to confirm the diagnosis. The patient remains well 16 months postoperatively. A survey of the world literature revealed that this is the second report of adenomyoma occurring in the common hepatic duct.

Human bile duct carcinoma cell line producing abundant mucinin vitro

SummaryA human bile duct carcinoma cell line, designated OZ, was established from ascitic effusion of a patient who suffered from obstructive jaundice due to the clogging of the common bile duct with mucinous substances secreted by the cancer cells. OZ was found to be capable of producing mucin in vitro and pools of mucin were macroscopically identified on the monolayer of the cells. On the electron micrographs, cell coat type mucin and abundant intracytoplasmic desmosomes were observed. The OZ cells secreted cardnoembryonic antigen in culture and had high enzymatic activity of γ-glutamyl transpeptidase. The tumor heterotransplanted into nude mice also showed mucin production.

Detection of Hepatic Shunts by the Use of 131I-Macroaggregated Albumin

Summary By scintiscanning the lung and liver following the injection of 131 I-macroaggre-gated albumin ( 131 I-MAA) into the spleen, the presence and degree of extra- and intrahepatic shunts were studied. On this basis, 13 patients among 15 cirrhotics and 1 patient with liver fibrosis had collateral circulation in the splenoportal system. Three patients with hemolytic anemias, 4 with hepatitis, and 2 with cirrhosis had no shunts. Shunt indices calculated from liver and lung counts in scintigrams ranged from 18 to 90 in patients with cirrhosis of the liver with shunts and below 6 in patients without shunts.The radioactivity accumulation curves were recorded over the liver and lung following MAA injection to detect the presence of intrahepatic shunts. An initial hump of the liver MAA accumulation curve was observed in 7 cirrhotics, suggesting the presence of intrahepatic shunts.The MAA transit time from spleen to liver was almost the same whether or not cirrhosis was present. Spleen to lung time through collateral veins ranged widely.The application of 131 I-MAA was considered to be an easy and useful method for the detection and semiquantitation of intra- and extrahepatic shunts in cirrhosis of the liver.

Heterotopic gastric mucosa of the gallbladder

A case of heterotopic gastric mucosa in the fundus of the gallbladder is reported. A 23-year-old man, who had been healthy and asymptomatic, visited our hospital because of abnormal findings in a liver enzyme test given during a routine health screening. Ultrasonography demonstrated a highly echogenic polypoid mass in the fundus of the gallbladder. The gallbladder mass was confirmed by both computed tomography and intravenous cholangiogram. After a 10-month follow up, laparoscopic cholecystectomy was performed. Intraoperative touch smear cytology of this lesion revealed class II cells. The surgical specimen revealed a 15×10×5 mm polypoid lesion in the fundus, with no gallstones in the gallbladder. Histologically, the polypoid lesion consisted of both fundic type and pyloric type gastric glands located in the mucosa of the gallbladder. In the literature, 42 cases of heterotopic gastric mucosa of the gallbladder have been reported, only 3 of which, including this present case, were found incidentally, with no apparent symptoms.

Detection of hepatitis B virus infection in hepatitis B surface antigen-negative hemodialysis patients by monoclonal radioimmunoassays

We studied 375 chronic hemodialysis patients for evidence of hepatitis B virus infection using first- and second-generation monoclonal radioimmunoassays. These assays employ high-affinity monoclonal antibodies produced against antigenic determinants that reside on hepatitis B surface antigen. Such assays have a lower limit of detection for hepatitis B surface antigen-associated determinants in serum of approximately 55 and 15 pg/ml, respectively. We found that 14 of 375 chronic hemodialysis patients were positive for hepatitis B surface antigen by both polyclonal and monoclonal radioimmunoassay. However, an additional 17, some of whom had chronic hepatitis and hepatocellular carcinoma, were identified as harboring hepatitis B virus infection only by the monoclonal radioimmunoassays. Thus the monoclonal radioimmunoassays improved the hepatitis B virus detection rate by 120% (3.7% vs. 8.3%). More importantly, 6 of the 17 monoclonal radioimmunoassay-reactive patients had no serologic evidence of recent or past hepatitis B virus exposure as shown by the absence of antibodies to the hepatitis B core and surface antigens in the blood. We conclude that there are hemodialysis patients with hepatitis B virus infection undetectable by conventional polyclonal radioimmunoassays.

Carcinoembryonic character of gamma-glutamyltranspeptidase in primary hepatocellular carcinoma

SummaryAs a characteristic isoenzyme of gamma-glutamyl transpeptidase (γ-GTP) has been detected in sera of patients with primary hepatocellular carcinoma, which migrates to α-globulin region on polyacrylamide-gel electrophoresis, biochemical studies on human fetal liver, Morris hepatoma (7316-A, 7794-A), and human hepatoma were carried out to elucidate its carcinoembryonic character. The highest distribution of the enzyme was found in particle fraction of human fetal liver as well as of Morris hepatoma, and an isoenzyme of γ-GTP with the same electrophoretic mobility as detected in human hepatoma was obtained, which reflected to the pattern of the serum zymograms.Histochemically, the enzyme was distributed in plasma membrane of the fetal hepatocytes and Morris hepatoma cells, while it was distributed diffusely throughout the cytoplasm of human hepatoma cells. These findings may strongly suggest that γ-GTP in hepatoma has a carcinoembryonic character and the detection of a serum isoenzyme in the a-globulin region is a quite diagnostic as well as the detection of α-fetoprotein in the field of neoplasma of the liver. The physicochemical and kinetic properties of the enzyme in human hepatoma were also discussed.

A autopsied case of hypercitrullinemia in adult caused by partial deficiency of livcr arginosuccinate synthetase

46歳の男性で,反復する意識障害,高アンモニア血症,高シトルリン血症などの臨床所見を示しながら,明らかな肝機能障害や門脈大循環短絡を認めない1症例を経験した.剖検にて類瘢痕型肝脳疾患の病理診断を得,また剖検肝および腎にて尿素サイクル酵素系の酵素化学的検討を行い,本症例の病因が,肝Arginosuccinate Synthetase活性の低下であることを明らかにし,本症の病因と病態に関して文献的考察を行った.

Development of a second generation monoclonal immunoradiometric assay: increased sensitivity leads to enhanced detection of hepatitis B viral infection

We have developed and employed a second generation monoclonal immunoradiometric assay (M2-IRMA) using antibodies of high affinity for epitopes that reside on hepatitis B surface antigen (HBsAg). This assay is capable of detecting as little as 15 pg/ml of HBsAg in serum. Improvements in sensitivity over a first generation immunoradiometric assay (MI-IRMA) was achieved by increasing the sample volume and time of incubation, and subjecting the reaction to a mechanical rotary devise. We then studied 164 subjects with chronic hepatitis, 105 with cirrhosis, 67 with hepatocellular carcinoma, six with acute hepatitis A, seven with acute hepatitis B, 167 chronic carriers of hepatitis B virus (HBV) and 235 healthy individuals from Japan and compared the results of the M2-IRMA to a conventional polyclonal radioimmunoassay (P-RIA). By using a more sensitive assay design (M2-IRMA), a significant number of additional cases of HBV infection heretofore unsuspected in the etiology of chronic liver disease were identified. We conclude that improvement in assay sensitivity for HBsAg is important in the serologic diagnosis of HBV in patients with chronic hepatitis, cirrhosis and hepatocellular carcinoma.