Hiroshi Shimojo

Pilot clinical trial of the use of alpha-tocopherol for the prevention of hepatocellular carcinoma in patients with liver cirrhosis

Patients with chronic hepatitis C virus (HCV) infection often develop liver cirrhosis and hepatocellular carcinoma (HCC). The purpose of this study was to test the chemopreventive effect of alpha-tocopherol on hepatocarcinogenesis in patients with liver cirrhosis and a history of HCV infection. Eighty-three patients with liver cirrhosis and with positive history of HCV infection were divided at random into two groups. Forty-four patients were treated with alpha-tocopherol (Vit E group) while the other 39 were followed as controls. The clinical background (gender, age, and laboratory data) was similar in the two groups. Serum levels of alpha-tocopherol, albumin, alanine aminotransferase (ALT), and total cholesterol and platelet count were measured serially over a period of five years. The mean serum concentration of alpha-tocopherol was low in both groups at entry and was significantly higher in the Vit E group than in the control group one month after treatment. Platelet count, serum albumin, ALT, and total cholesterol were not different between the two groups during the five-year period. Cumulative tumor-free survival and cumulative survival rate tended to be higher in the Vit E group than in controls, albeit statistically insignificant. The serum level of alpha-tocopherol was low in patients with liver cirrhosis and positive for HCV. Although the administration of alpha-tocopherol normalized the level one month later, it could neither improve liver function, suppress hepatocarcinogenesis, nor improve cumulative survival. Patients treated with alpha-tocopherol tended to live longer without development of HCC but the difference was not statistically significant.

A case of multiple myeloma complicated by liver abscess perforating into the stomach

62才の男性が右季肋部痛にて来院.諸検査にて典型的な多発性骨髄腫(IgG-κ型)が確認された. MCP療法にて38°C台の発熱は下熱し小康を得たが,その後再度発熱し心窩部に圧痛が出現した.エコー, CT等により肝膿瘍と診断し,ドレナージを行ない黄白色の膿汁をえた.細菌培養は陰性,諸種抗生物質治療にも抵抗性で,入院後32病日,麻痺性イレウスの状態で死亡した.剖検にて,回盲部原発のアメーバ性大腸炎と,腹腔内と胃に穿破したアメ一バ性肝膿瘍と判明した.多発性骨髄腫に合併したアメーバ性肝膿瘍の報告は本邦初であり,アメーバ性肝膿瘍自体まれな疾患であるが,今後一種の日和見感染として常に念頭におくべき疾患と考えられ報告した.

A case of chronic hepatitis associated with chronic thyroiditis

慢性甲状腺炎を合併したHBs抗原持続陽性の慢性肝炎例を報告する.症例は23歳の女性で,11歳時,甲状腺腫を指摘されたが放置.入院時,甲状腺腫をみとめたが肝脾は触知しなかった.主な検査成績では,GOT 156, GPT 186, ICG 15分停滞率16.5%, γ-グロブリンは1.86g/dl, RAテスト(+).甲状腺機能検査には異常なく,免疫学的には抗核抗体,抗平滑筋抗体,サイロイドテスト,マイクロソームテストが陽性で,免疫グロブリンではIgGの軽度増加とIgMの上昇がみられだ.HRs抗原は持続陽性でありた.腹腔鏡下肝生検では慢性肝炎活動型の組織所見を示し,甲状腺生検では慢性甲状腺炎と診断された.慢性甲状腺炎に合併する慢性の肝疾患については,その肝病変は甲状腺病変と同じく自己免疫学的な機序に基づくといわれ,肝甲状腺炎症候群という名称が提唱されているが,合併例の肝病変を考える場合ウイルス感染を念頭におくことも必要と思われる.