Katsuro Sagara

An epidemic of hepatitis a related to ingestion of raw oysters

SummaryAn epidemic of hepatitis A occurred around Hondo City, Kumamoto Prefecture in Japan during the first six months of 1982. Clinical, immunological and epidemiological studies were carried out in 225 cases. Cases were distributed over a relatively wide area, and in small numbers of young children and school children. More than half of the patients were in their twenties or thirties. The clinical course was generally favorable with rapid resolution. No episode lasted more than six months. There was only one fatality in a cure which was a carrier of HBs antigen with liver cirrhosis. Titers of IgM anti-HAV measured by radioimmunoassay (RIA) or enzyme immunoassay (EIA) reached a peak during the second week after onset, followed by a gradual decrease. Conversion to negative results was never experienced within two months. We found a good correlation between RIA and EIA in terms of detecting IgM anti-HAV. The route of infection was thought to be fecal-oral in nature, with ingestion of raw oysters the major etiologic factor.

Cronkhite-Canada syndrome associated with gastric cancer: Report of a case

SummaryA 71-year-old man with characteristic clinical and pathological pictures of Cronkhite-Canada syndrome associated with gastric cancer is presented. Histological examinations of gastric and colonie polyps which resembled juvenile type revealed no malignant cells. The patient slowly recovered after subtotal gastrectomy and elemental diet supplement with antiplasmin agents. As for as is known to the authors, a total of 69 cases with this syndrome were reported in Japan including our patient. Of these cases 8 had cancer of the gastrointestinal tract. Two of them, including our case, had gastric cancer. Another one was associated with gastric cancer but not intestinal polyposis. The remaining 5 cases were associated with colonic cancer. Caution must be paid to the fact that cachexia or malabsorption in some patients with this syndrome results from gastrointestinal malignancy. The prognosis of this syndrome consisted of 20 deaths including 2 postoperative deaths, 33 of improvement including 4 of natural remission and 4 of remission after gastrectomy or colectomy, 7 unchanged and the remainder not described.

Hepatic granuloma. report of a case successfully treated by hepatectomy and antituberculous therapy

SummaryA 62 year-old male presented with high fever, weight loss and painful hepatomegaly. The clinical presentation, results of laboratory studies, angiography and laparotomy suggested hepatic abscess or cholangiocarcinoma. He underwent left lobe hepatectomy, and pathological examinations revealed granuloma. Acid-fast bacilli, fungi and parasites were not identified by special stainings. Hepatic tuberculosis was considered most likely because, after operation, an intermediate-strength purified protein derivative (PPD) skin test gave strongly positive results and his subsequent response to antituberculous treatment was excellent. His complex clinical features and the diagnostic difficulties were outlined.

Hypercholinesterasemia in patients with hepatocellular carcinoma: A new paraneoplastic syndrome

SummaryTwo cases of hepatocellular carcinoma (HCC) were described, in whom hypercholinesterasemia was found. Histochemical examinations revealed that there was a significantly increase in enzyme activity of cholinesterase in liver tissue slice obtained from the part of carcinoma in case 1. It was found that cholinesterase activity in homogenized liver tissue in part of carcinoma was much higher than that of non-carcinoma, and even in other HCC cases, hepatic cirrhosis and control liver tissues. These results suggested that HCC cells were capable of producing cholinesterase and, therefore, that hypercholinesterasemia was an additional paraneoplastic syndrome in HCC.

Usefulness of Mechanical Lithotripters in Endoscopic Sphincterotomy

We have been performing bile duct lithotripsy by EST at Kumamoto Regional Medical Center since January 1982. A balloon catheter is the method of choice for performing lithotripsy. For stone removal, a conventional FG‐22Q basket catheter was used from January 1982 to June 1984 (extraction rate: 88.5%), and a prototype EML BML‐1Q basket catheter was used with a FG‐22Q basket catheter from July 1984 to April 1990 (extraction rate: 91.5%). Since May 1990, lithotripsy has been performed in the following sequence with excellent results (extraction rate: 97.0%): EST‐balloon catheter, slide‐type EML BML‐3Q‐balloon catheter. Although the difference between the extraction rates for BML‐1Q and BML‐3Q basket catheters were only marginally significant, the difference between the conventional basket FG‐22Q and BML‐3Q was clearly significant. Lithotomy using the procedure employed since May 1990 is therefore recommended as a highly effective means of extracting gallstones and is considered to be superior to conventional methods.

A case of primary sclerosing cholangitis

SummaryA case of primary sclerosing cholangitis (PSC) is reported.A 16 year-old female developed right hypochondralgia and nausea without jaundice. Examination on admission showed elevation of SGOT, SGPT, Al-P, γ-GTP and LAP activities, but T-Bil, AFP and CEA were within normal limits. Peripheral eosinocytes increased by 10%, and tests for HBsAg, antiHBs, antimitochondrial antibody and anti-smooth muscle antibody were all negative. ERCP revealed a narrowing of the proximal portion of the common hepatic duct, and beading of the intrahepatic bile ducts. Liver scintigram and CT revealed no tumors in the liver, biliary tract or pancreas. Laparoscopy showed a smooth liver without swelling and a slightly swollen gallbladder. Histologically, the liver biopsy specimen showed ductal proliferation of small interlobular bile ducts and periductal fibrosis. No bile plugs, granuloma or distinct cholangitis were observed. No abnormal findings, including evidence of inflammatory bowel disease, were detected by barium enema. At present, one year after discharge, although her symptoms and liver function test abnormalities continue, she has been attending high school.Although 58 cases of PSC have been reported in Japan, juvenile cases occurring before the third decade number only 3 including ours.

Clinical usefulness of serum cholylglycine determination in various liver diseases

SummaryIn order to study the clinical significance of cholylglycine (CG), CG in both fasting levels and after oral loading of 300 mg ursodeoxycholic acid (UDCA) were determined by radioimmunoassay in 313 patients with various liver diseases. Elevated fasting CG levels were found in 66.6% of patients with acute hepatitis (AH), 34.8% chronic inactive hepatitis (CIH), 79.3% chronic active hepatitis (CAH), 97.1% liver cirrhosis (LC), 94.7% hepatocellular carcinoma (HCC), and 80% of gall stone (GS). Changes of fasting CG during the course of AH were found to be parallel with values of transaminases. On oral loading of UDCA, different CG responses were found in CIH and CAH, and in compensated and decompensated LC. From these results we concluded that the determinations of serum CG gave additional informations of various liver diseases.

Blood flow, acidity and atrophic changes of the gastric mucosa in Mongolian gerbils infected with Helicobacter pylori

We used a Mongolian gerbil model to evaluate the effects of long‐term Helicobacter pylori infection on blood flow, gastric acidity and atrophic change of the gastric mucosa.

A case of bleeding duodenal varices located in the third portion

SummaryWe described a patient with isolated duodenal varices of the third portion, preoperatively diagnosed by hypotonic duodenography and endoscopy. These varices seemed to be caused by portal hypertension due to liver cirrhosis. The third to the fourth portion of duodenum should be examined carefully in patients with liver cirrhosis, especially with gastrointestinal bleedings of unknown origin.

Efficacy and safety of hepatitis B vaccination in haemodialysis patients

Antibody response to vaccination with hepatitis B vaccine was evaluated in 39 haemodialysis patients. Three injections of 20 μg of the vaccine were given at time 0, 1 and 6 months. The seroconversion rate for the antibody to hepatitis B surface antigen (anti‐HBs) was 2.6% at 1 month, 15.4% at 2 months, 33.3% at 4 months, 41.0% at 6 months and 59.0% at 7 months (males 53.6%, females 72.7%). Thus, with three injections, the seroconversion rate was significantly smaller and antibody titres were lower compared with 348 healthy control subjects. No correlation was observed between the anti‐HBs seroconversion rate and lymphocyte subsets (OKT4/OKT8). When two additional injections were given at 9 and 10 months to 19 haemodialysis patients with an S/N ratio (the ratio of ct/min in the sample to mean ct/min in negative controls) smaller than 10 at 7 months, 16 patients (84.2%) developed anti‐HBs and elevated antibody titres. Accordingly, the response rate of all haemodialysis patients 12 months after the first injection was elevated to 92.3% and was as high as that in normal subjects. At 24 months, the response rate had gradually declined to 64.1% accompanied with lowered antibody titres. There were no serious side effects.