Keijiro Ando

Clinicopathological studies of the Dubin-Johnson syndrome complicated with chronic hepatitis

SummaryEleven patients with Dubin-Johnson syndrome (DJS) were studied clinicopathologically. In three patients with DJS, concomitant chronic hepatitis was observed. They showed long-standing jaundice with the symptoms of general fatigue and anorexia. Laboratory tests revealed mild hypertransaminasemia, elevated serum bilirubin (over 5.0 mg/dl) and a high level of serum Bromsulphalein (BSP) retention at 45 min (above 18%). Two patients complicated with chronic hepatitis showed a rather slow secondary rise in the BSP excretion curve in comparison with the patients who had no complication. One patient accompanied with the most severe fibrosis showed no secondary rise in the BSP excretion curve. After the treatment of the patient with phenobarbital, however, a secondary rise in the BSP excretion curve appeared and the serum BSP level was also significantly decreased at all points on the BSP excretion curve. Histological examination of the liver revealed the decreased number of the Dubin-Johnson pigments in the patients complicated with chronic hepatitis. Laparoscopically, a patient with a chronic aggressive hepatitis showed a dark gray decololization of the liver surface and another patient with a chronic aggressive hepatitis showed a black color of the liver surface with partial nodule formation.

Evaluation of conservative therapeutic modalities for hepatocellular carcinoma —analysis of 206 cases

SummaryThe clinical effectiveness of conservative therapeutic modalities for hepatocellular carcinoma (HCC) was evaluated in terms of extension of survival. The therapeutic methods included one-shot therapy (OST) using Mitomycin C (MMC), Adriamycin (ADM), simultaneous ADM & MMC, with or without transcatheter arterial embolization (TAE). Prior to estimating the effectiveness, the subjects were graded into three stages according to the pretreatment severity of their residual liver function, based on total bilirubin, aspartate aminotransferase/alanine aminotransferase ratio, and ascites as constituent factors. OST with or without TAE significantly prolonged the mean survival time in stage I cases in good condition and in stage II cases in fair condition, but not in stage III cases in poor condition. Concerning OST without TAE, the results of ADM were slightly better than MMC in terms of extension of survival. OST combined with TAE was far more effective than OST without TAE. Extension of survival by simultaneous ADM & MMC is now under observation, but the toxicity of the modality has so far not proved serious. The long-term influence of repeated TAE on liver function was revealed to be mild within an average observation period of approximately one year. This study confirmed the validity of the present staging system in evaluating the efficacy of OST and TAE in terms of extension of survival.

Effects of calcium-ion on biliary excretion of loaded bile acid and ICG

カルシウム(Ca)を前投与したラットについて,タウロコール酸(TCA),インドシアニングリーン(ICG)を静注し,胆汁中への排泄におよぼすCaの影響を調べた.まず,Ca投与後の胆汁および胆汁中胆汁酸の基礎排泄量を測定し,TCA(1.4μmol/100g体重)負荷による変化をさらに検索した.胆汁中胆汁酸は酵素法および高速液体クロマトグラフィーで測定した.ICGはそれぞれ0.5, 1.5, 3.0mg/100g体重量を静注し,胆汁への排泄および5, 10, 20分目の血中ICG値の変化を認べた.その結果,基礎排泄量には変化はみられなかったが,TCA投与後の胆汁量,胆汁中TCA排泄量はともに対照群に比して有意に上昇し,ICGの胆汁への排泄もそれぞれの群で有意に亢進した.一方,ICGの血中消失には差はなかった.これにより,負荷胆汁酸およびICGの胆汁への排泄は,Caの投与で亢進することが明らかになり,毛細胆管でのexocytosisにもCaの影響が示唆された.