Hikohito Nakagawa

Scirrhous carcinoma of the stomach: a clinical and pathological study of 106 surgical cases.

SummaryClinical and pathological characteristics of scirrhous carcinoma of the stomach were studied in 106 cases treated by gastrectomy between 1973 and 1983. The male to female ratio was 0.58. The percentage of scirrhous carcinomas to all gastric carcinomas resected in the same period was three times higher in females than males. The age distribution of the patients suggested that there were two peaks in the forties and sixties in the male, and in the thirties and fifties in the female. The incidence of scirrhous carcinoma in all types of gastric carcinoma was significantly higher in the twenties, thirties and forties compared to the lowest incidence in the seventies. In the female group the primary lesion had a tendency to be adjacent to the fundic gland area and to avoid intestinal metaplasia. In the male the opposite was recognized. Cancer nests with single cells or only several cells were common in this type of carcinoma. These findings suggest that there might be two biologically different scirrhous carcinomas both in the male and the female, the appearance of single carcinoma cells might be favored by female sex hormones and young ages, and not only the original gastric mucosa but also mucosa with intestinal metaplasia could be precursors of single carcinoma cells.

A case report of the vertical infection from HBsAg-negative mother.

症例は26歳, 女性. 平成6年8月に第1子を妊娠. HBVスクリーニングではRPHA法にてHBs抗原陰性であった. 平成7年3月に第1子を出産. 平成8年1月, 母親に食欲低下が出現. AST 1, 573IU/l, ALT 2, 092IU/lと肝障害を指摘され入院となった. 入院時のウイルスマーカーはHBs抗原 (EIA法) 陽性, HBe抗原 (EIA法) 陰性, HBe抗体 (EIA法) 陽性. HBc抗体 (PHA法) は224と高値であり, HBV関連ポリメラーゼ活性 (RA法) は202cpmとHBVキャリアー状態であった. HBs抗原は4カ月間持続陽性であった. 第1子のHBVマーカーを調べたところHBs抗原 (EIA法) 陽性, HBe抗原 (EIA法) 陽性, HBe抗体 (EIA法) 陰性とキャリアー状態であった. HBs抗原陰性のキャリアーの存在が知られており, HBV母子感染防止事業においても輸血事業と同様にHBs抗原, HBc抗体測定の併用が必要と考え報告した.

A case performed living related liver transplantation for fulminant hepatitis.

症例は, 15歳男児. 黄疸と食欲不振を主訴に入院し, 症状出現13日目に肝性昏睡II度となった. 肝障害の原因は不明で, 非A非B非C型劇症肝炎亜急性型と診断し血漿交換療法を1週間行うも改善せず肝性昏睡IV度へと進展した. 父親をdonorとする生体部分肝移植 (LRLTx) を施行したところ翌日には意識清明となり, 術後24日で肝機能値は正常化した. しかし, LRLTx後3カ月で汎血球減少が出現し骨髄生検にて再生不良性貧血と診断した. プレドニゾロン, cyclosporineやATGなどの投与は無効であり, 骨髄移植を施行し経過観察中である. 現在, 劇症肝炎に対する治療としてLRLTxが開始されたところであるが, 肝移植適応基準や移植後の予後・合併症などさまざまな問題が存在しており今後の症例の集積が必要と考えられた.