Kenji Hirai

Mechanism of thrombocytopenia in liver cirrhosis: kinetics of indium-111 tropolone labelled platelets

Using indium-111 tropolone-labelled platelets, a study of platelet kinetics was performed on the basis of the relationship between platelet count, platelet survival time, platelet dynamics, platelet-associated immunoglobulin G (PA-IgG) and splenic volume in 31 patients with liver cirrhosis and a platelet count of less than 100 × 109/l. The mean platelet count was 46.6±25.3 × 109/l, and the mean platelet survival time was 6.50±1.33 days. The mean uptake into the spleen was 43.2%±14.8% on the 1st day, and 53.7%±14.3% on the 7th day. The mean PA-IgG level was 107.6±66.0 ng/107 platelets in five patients with chronic active hepatitis who were studied as controls, the mean platelet count was 197±30 × 109/l, the mean platelet survival time 9.33±0.78 days, and the mean PA-IgG 21.2±2.9 ng/107 platelets. The former two parameters were significantly higher (P<0.05), and the latter significantly lower (P<0.05). In liver cirrhosis, the platelet count showed a positive correlation with the platelet survival time and a negative correlation with PA-IgG and the splenic volume. These results suggest that the increases in both the splenic platelet pool and platelet destruction in the spleen through immunological mechanisms may influence thrombocytopenia in liver cirrhosis.

Arterial chemotherapy and transcatheter arterial embolization therapy for non-resectable hepatocellular carcinoma

SummaryAn assessment was made on the therapeutic effects of arterial chemotherapy and transcatheter arterial embolization (TAE) therapy on 378 cases with non-resectable hepatocellular carcinoma (HCC). For the 191 cases who had undergone arterial chemotherapy, 22% had a 1-year survival rate, 8.9% survived for 2 years, and 4.0% for 3 years. Of these, for the 128 cases who were compatible with our criteria for patient selection, the three survival rates were 31.4%, 12.2% and 5.9% respectively. However, for the other 63 cases, who were incompatible with our criteria, the 1-year survival rate was 1.6% and it was worse for the cases who had received supportive care alone. For the cases who had undergone arterial chemotherapy, the highest survival rates were obtained by the alternate administration of different anticancer agents, and the three survival rates were 39.0%, 13.1% and 4.9% respectively. For the 187 cases who had undergone TAE therapy, the 1-year survival rate was 66.2%, the 2-year survival rate 36.5%, and the 3-year survival rate 21.9%. For the 124 cases with a tumor progression rate of less than 20% in the liver (E1), the survival rates were 77.8%, 50.1% and 30.8% respectively. The peripheral venous drug concentrations of mitomycin C and adriamycin were lower, but were maintained for a longer period in TAE therapy than in arterial chemotherapy. These results suggest that consideration of the criteria for patient selection and the alternate administration of anticancer agents are necessary in arterial chemotherapy, and that the best therapeutic effects can be obtained by TAE therapy combined with chemotherapy for cases of non-resectable HCC because of the chemotherapeutic and ischemic effects on the tumors.

A patient with hepatocellular carcinoma who underwent resection of the primary lesion 10 years ago and resection of a giant adrenal metastasis 8 and a half years later.

SummaryA 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular carcinoma of the left lobe about 3 cm in diameter. Ultrasound examination of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainly by the inferior adrenal artery. PIVKA-II was increased. Adrenal metastasis of hepatocellular carcinoma was suspected, and adrenalectomy was carried out. No intrahepatic metastasis was noted. The tumor was histopathologically identified as a pseudo-glandular type of moderately differentiated hepatocellular carcinoma with a trabecular pattern similar to the primary lesion. In this patient, a resectable giant metastasis was observed only in the left adrenal gland and no intrahepatic metastasis was demonstrated 8 and a half years after resection of hepatocellular carcinoma. The patient has survived 10 years after the first operation. This case is considered to be important for evaluation of the treatment for distant metastasis of hepatocellular carcinoma.

Small hepatocellular carcinoma with intravascular tumor growth into the right atrium

A 66-year-old man with ascites and marked edema in the lower extremities was suspected of having secondary Budd-Chiari syndrome due to primary liver cancer, based on imaging diagnosis, i.e., ultrasonography, computed tomography, and inferior venacavogram. At autopsy, an encapsulated small liver cancer was found to have extended into the inferior vena cava and right atrium. There have been few reports of small hepatocellular carcinoma with intravascular tumor growth into the right atrium.

MRI in thorotrastosis

Magnetic resonance imaging (MRI) and computed tomography (CT) were performed in four patients with thorotrastosis. On CT scan, Thorotrast (thorium oxide) deposition was shown as high-density areas in the liver and spleen and the abdominal lymph nodes. These deposits were not found on MRIs. Splenic volume was significantly small due to atrophy. The contrast-noise ratio in the spleen on T1-weighted images was significantly lower. Thorotrast deposition does not affect MRI appearance; therefore it may be useful for the early detection of malignant tumors as a complication of thorotrastosis.

Abstracts of selected papers presented at the 29th annual meeting of the japanese society of gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 29TH A N N U A L MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY K0fu, Japan, November 5--7, 1987 Chairman: Katsuhiko SUGAHARA, M.D.

Clinical studies of hepatocellular carcinoma (HCC) in the aged patients.

老年人口の急速な増加に伴い,老年者肝細胞癌(以下肝癌)を診断,治療する機会も増えた.1973年から10年間に経験した肝癌379例を59歳以下,60～69歳,70歳以上の3群に分け,高齢者肝癌の特徴について検討した.70歳以上の高齢者肝癌は55例(14, 5%)で,1979年までは増加したが,その後減少した.男女比は加齢と共に低下し,高齢者では4.5:1であった.肝硬変を合併する肝癌は61%と少なく,大酒家も少数であった.HBs抗原,HBc抗体陽性率は加齢と共に低下したが,HBVマーカー陰性例には差がなかった.肝癌の自然発育速度は加齢と明確な関係はなかった.高齢者では手術可能例が少なく,動脈塞栓療法の予後は加齢と共に不良となった.動脈内注入化学療法は高齢者で骨髄抑制などの副作用の出現率が高いが,予後は若年者と差がないことから,これらに注意して積極的に施行すべきであると考えられた.死因は腫瘍破裂と腫瘍死が多く,肝不全は少なかった.

Type B hepatitis with extrahepatic manifestation Report of three cases

B型肝炎でextrahepatic manifestationを呈した3例を経験した.第1例はHBsAg持続陽性を示す40歳男性.筋痛,脱力感を主訴として,蛋白尿,肝機能悪化を3回くり返した.性期での蛋白尿,筋由来の酵素上昇及び血清補体価の軽度低下よりHBsAgの免疫複合体の関与を考慮し,筋生検標本にて蛍光抗体法を施行したが,免疫複合体は証明できなかった.レノグラムでは入院時の一過性の腎機能低下が認められた.第2例は38歳男性.B型肝炎の経過中に溶血性貧血を合併した例.クームステストは直接間接とも陰性で,他の検査でも溶血の原因を示唆する結果はえられなかった.肝機能改善につれ貧血も改善した.第3例は61歳男性.蕁麻疹を初発症状とした重症型肝炎の例.蕁麻疹は数日間で消退した.皮膚生検は施行しなかった.