Kenshi Watanabe

Spontaneous rupture of hepatocellular carcinoma: An approach with delayed hepatectomy

Two cirrhotic patients with ruptured hepatocellular carcinoma (HCC), presenting with hemoperitoneum, were successfully treated by elective hepatectomy. Both of these patients, a 67-year-old female and a 76-year-old male, had first been taken to other primary hospitals by ambulance due to hypovolemic shock. They were then found to have a mass of approximately 5 cm in the cirrhotic liver. In the initial management, however, neither any direct hemostasis by surgery nor indirect measures such as transcatheter hepatic arterial embolization were performed in either case. Instead, conservative treatment consisting mainly of fresh blood and plasma transfusions were continued for more than a month until the liver function stabilized. In both hepatectomies, the use of a microwave tissue coagulator resulted in minimal intra-operative blood loss and an appreciably excellent post-operative course. These cases point to the effectiveness of a “wait and see” policy for selected patients with ruptured HCC.

Effect of anti-ICAM-1 and anti-LFA-1 antibodies on rat liver transplantation.

The effect of the anti-cell adhesion molecule anti-bodies, anti-ICAM-1 (1A29) and anti-LFA-1 (WT1), on rat liver transplantation was investigated. Livers from ACI rats were transplanted into Lewis rats by Kamadas method and during the recipient operation 1A29 1 mg/kg, and WT1 1 mg/kg were administered intravenously to one group of rats (treated group). The survival time of the treated group was significantly longer than that of the untreated group, but permanent unresponsiveness could not be induced. Postmortem examination revealed little histological evidence of acute rejection in the treated rats, in which the main cause of death was thought to be chronic rejection.

A NONSPECIFIC COLONIC ULCER OCCURRING AFTER HEPATECTOMY : REPORT OF A CASE

We herein report the case of a 53-year-old man with a nonspecific acute colonic ulcer whose liver function deteriorated after he had undergone hepatectomy. He was referred to our hospital for a hepatoma caused by hepatitis B virus and a right hemihepatectomy was performed. His liver function was poor after the operation, and minor complications such as pleural effusion and biliary fistula developed. A large amount of melena was seen 29 days after the hepatectomy and he developed hemorrhagic shock. Superior mesenteric arteriography revealed pooling of blood in both the hepatic flexure of the ascending colon and the cecum. An emergency right hemicolectomy was performed. There was a 5 x 1-mm ulcer 18 cm distal to the ileocecal valve. Numerous erosions were observed to be scattered throughout the colonic mucosa. The patient recovered slowly and was discharged 6 months after the hepatectomy. This is the first report of an acute colonic ulcer that could have been caused by liver dysfunction.

The synergistic effect of bactobolamine and tacrolimus on in vitro and in vivo experiments

The aim of this study was to examine the immunosuppressive effect of bactobolamine (BBL) alone and in combination with tacrolimus (FK) using in vitro proliferation assays on human peripheral blood lymphocytes (PBLs) and in vivo liver allografts in rats. In the latter setting, the immunosuppressive activity of BBL alone and in combination with FK was compared to that of mizoribine (MIZ). The interactions between BBL and FK and between MIZ and FK were assessed by the combination index (CI) proposed by Chou and Kahan. In the in vitro study, the combination of BBL and FK displayed stronger inhibitory effects on T-cell proliferation than when each drug was applied alone. The mean CI values for the BBL/FK combination were below 1.0, rangin from 0.19 to 0.86, indicating synergism between BBL and FK. In the in vivo study, 50–200 mg/kg/day BBL monotherapy significantly prolonged survival compared with a control group, and the effect was dose-dependent. Conversely, the efficacy of MIZ monotherapy at 2.5–10 mg/kg/day did not increase dose-dependently. The CIs for MIZ at doses of 2.5 and 5.0 mg/kg/day with FK 0.08 mg/kg/day were 0.48 and 0.42, respectively, indicating therapeutic synergism between MIZ and FK. The CI for BBL 100mg/kg/day with FK was 0.26, which indicated further synergism between BBL and FK.

Case report of ten adults who underwent or desired to undergo liver transplantation abroad.

肝移植が末期肝不全に対する標準的な治療法として世界で確立されている現在, 日本でも肝移植が普及することが予想されるが, 臨床面での問題点も多い. そこで, 海外で肝移植を受けることを希望した成人10例の臨床経過を検討したので報告をする. 原疾患の内訳は, 肝硬変7例, 慢性活動性肝炎, 原発性胆汁性肝硬変, 薬剤性肝炎各1例であった. 実際に肝移植を受けた5例のうち2例は術後に肝不全または敗血症のために死亡した. 4例は肝移植を受けることができずに死亡し, 薬剤性肝炎の1例は待機中に肝機能が軽快したため肝移植を受けずに生存している. 肝移植術後生存中の3例はいずれも肝炎ウイルスの再感染を認めた. 今後日本国内で脳死肝移植が可能となっても, 適応疾患の選択, ウイルス性肝炎や肝癌などの原疾患の再発, 待機中の死亡, 拒絶反応や免疫能低下による感染症の発生の問題など, なお解決せねばならない諸問題が残されている.