Isamu Kaito

Usefulness of antithrombin III and α2-plasmin inhibitor in early differentiation of fulminant hepatitis and severe form of acute hepatitis

SummaryTo evaluate the usefulness of antithrombin III (AT III) and α2 -plasmin inhibitor (α2PI) in early differential diagnosis of fulminant hepatitis from the severe form of acute hepatitis, the activities of AT III and α2PI were measured in plasma of 15 patients with fulminant hepatitis and 6 patients with severe form of acute hepatitis. The activities of prothrombin time (PT), hepaplastintest (HPT) and thrombotest (TT) were also evaluated. The mean values and the standard errors (SE) for PT, HPT and TT were 21.1 ±2.6%, 14.0 ±1.6% and 10.3 ±1.7%, respectively, in the early stage of fulminant hepatitis and 25.3 ±2.4%, 21.6 ±4.6% and 15.8 ±3.6%, respectively, in the severe form of acute hepatitis. No significant difference in the tests between these two diseases was noted. On the other hand, the mean values ±SE for AT III and α2PI were 13.7 ±4.6% and 25.6 ±8.6% in fulminant hepatitis and 70.2 ±28.5% and 98.7 ±9.7% in the severe form of acute hepatitis. A significant difference between the two diseases was observed. From the above, it is concluded that measuring AT III and α2Pl along with PT, HPT and TT is useful for early diagnosis of fulminant hepatitis.

A case of posttransfusion Hepatitis A

SummaryA 63-year-old female case of cancer of the colon who developed posttransfusion hepatitis A was presented. She became ill 49 days after receiving a single unit of concentrated red cells from a donor who also developed hepatitis A 10 days after donation.

A Pedigree of Homozygous Familial Hyperalphalipoproteinemia

A new form of familial lipoprotein disorder, homozygous hyperalphalipoproteinemia (HALP) was studied in one pedigree through three generations. The proband was a healthy male, 50 years old, who was checked for a distinctive elevation of plasma high-density lipoprotein cholesterol (HDL-C) in a routine screening examination. An intensive family study revealed that the proband and one of his sisters were homozygotic carriers of familial HALP judging by their extremely high concentration of HDL-C (181 mg/dL and 163 mg/dL, respectively). In the homozygotes, the lipid composition of HDL was found to be normal while the ratio of HDL lipids to apoproteins A-I and A-II tended to be increased. All five children of the two homozygous individuals and two additional first degree relatives were considered to be heterozygous, since their HDL-C values were moderately elevated, with other lipid levels being normal. The family study thus substantiated the hypothesis, as Glueck et al insisted in 1975, that this lipoprotein disorder is inherited by autosomal dominant transmission. Longevity analysis revealed that the decreased family members showed life prolongation of 9.8 years on an average compared with the appropriate control population of the same district. Our report might be the first to demonstrate the homozygous form of this longevity syndrome.

Symposium (IV): Factors affecting the prognosis of chronic hepatitis

In 45 cases with chronic hepatitis and 40 cases with liver cirrhosis, prothrombin time (PT), thrombotest (TT) , normotest (NT) and blood coagulation factors I I , V, V I I , V I I I , IX, X were determined, and the comparat ive study to liver function tests, histological findings and the course of diseases was done. The following results were obtained. 1) In chronic hepatitis, the changes of N T and T T was paralled to liver function tests, especially S-GOT. 2) In chronic hepatitis, the blood coagulation tests and factors except factor V I I I showed lower level in active type than in inactive type. 3) The blood coagulation levels except factor V I I I were lower in incompensatory liver cirrhosis than in compensatory liver cirrhosis and chronic hepatitis, and the levels decreased with progress of hepatic damage. 4) The blood coagulation levels were lower in the cases of post-hepatitic cirrhosis that developed from chronic hepatitis in early t ime than in late time. 5) Therefore, it is believed that the determination of blood coagulation in chronic hepatitis is usefull to foresee the prognosis of the diseases.

The estimation of hepatic wedge pressure, hepatic blood flow and intrahepatic shunt in hepatic disease, especially the correlation with liver function tests and histological findings

were taken a f t e r in t ravenous admin is t ra t ions of 200 microcuries of l~ colloidal gold in 16 pat ients wi th chronic hepati t is , 11 wi th precirrhosis , and 21 wi th cirrhosis , and sizes of f ronta l as well as lateral project ing areas of these organs were compared. Both hepatic and splenic sizes were unchanged in chronic hepat i t is pat ients whose course remained s tat ionary, whereas splenic sizes were increased in chronic active hepatitis. In pa t ien ts with precirrhosis , e i ther increased or unchanged splenic sizes were observed, and the fluctuations of hepatic sizes were seen. While increases of splenic sizes concomitant with decreases of hepatic sizes were often seen in pat ients with compensated stage of cirrhosis , hepatic sizes were tended to decrease and splenic sizes were remained constant in pat ients wi th te rmina l stage of cirrhosis. Al though the n u m b e r of pat ients studied was small , we feel the findings on serial scintiphotogr phies of the l iver and the spleen in pat ients wi th chronic diffuse hepatic diseases are significant and w a r r a n t fu r the r invest igat ion wi th gamma camera.

Enzymological studies in metastatic hepatic cancer induced by transsplenic transplantation of ascites hepatoma

Change of LDH-isozyme is useful to be clear mechanism of the enzyme elevation in serum of liver diseases and to explain clinical findings reflecting the condition of the patients. We showed each cases of gall bladder tumor with metastatic liver tumor, metastatic malignant melanoma, hepatoma with cirrhosis and embryonal carcinoma with marked high LDH1 that LDH-isozyme in serum changed characterist ic pattern.

Examination of nonvisible cases on cholecystography (Subsequent Report)

did I go ahead with their operations. However, in the case of 9 patients suffering from cholecystitis, I decided not to operate. As for complications, out of the 29 cases, pain was observed in about half of them, but it disappeared in a few hours. 5 patients had a temperaure of 37~176 for one or two days af ter the test. A 10.000~15,000 increase of leucocytic number was observed in these 5 patients. In the case of the other patients, no noticeable change of leucocytic number was observed. There was no other complication whatsoever in any of the 29 cases. The test of percutaneous transphepatic cholecysto-cholongiography-following which an operation is optional, according to the patient s condition-can be performed with the greatest efficacy for biliary diseases. It is hrdly necessary to s t ress the absolute safety of this procedure.

Studies on the pathophysiology of bile flow with special reference to effect of phosphoryl cloline

We have reported experimental studies on the pathophysiology of bile outflow in this society. Recently, we performed experiments on the effect of phosphorylcholine on bile outflow, demonstrating a marked effect of augmenting the bile outflow and the movement of the biliary system. Adult dogs more than 10 kg were used in the experimental method III of our own device. Experiments of intravenous injection of phosphorylcholine in dogs revealed a marked effect of elevating the internal pressure of the gallbladder, augmenting the flow of hepatic bile, and relaxing of the sphincter of oddi. Based on such experimental results, cases with poor contraction of the gallbladder were selected clinicaly treatment with phosphorylcholine which was given 200 mg intramuscularly for 2 weeks. Subsequent cholecystography revealed an excellent contracting ability of the gallbladder. From these experimental and clinical studies, it might be concluded that phosphorylcholine increases outflow of bile, being effective in the treatment of diseases of gallbladder and biliary tract.