Kohdoh Ishii

A case of erythropoietic protoporphyria with liver cirrhosis suggesting a therapeutic value of supplementation with α-tocopherol

Erythropoietic protoporphyria (EPP) was diagnosed in a 27-year-old man based on a typical clinical history, and a marked increase in erythrocyte and fecal protoporphyrin concentrations. Although liver disease is not a common feature in EPP, he had slight liver dysfunction. A percutaneous liver biopsy was performed and it showed minimal hepatocellular damage and many reddish brown pigment deposits in hepatocytes, Kupffer cells, portal histiocytes, bile canaliculi and small biliary radicles. Electron microscopic findings confirmed that these deposits were composed of protoporphyrin crystals. Liver biochemistry remained well for >2 years, but deteriorated rapidly and second liver biopsy obtained 28 months after the first biopsy revealed the development of liver cirrhosis. We treated the patient with intravenous administration of dl-a-tocopherol acetate (vitamin E; 500 IU/body/day). Following the administration of vitamin E, the concentration of protoporphyrin in erythrocytes decreased significantly and the liver function tests were improved. Sixteen weeks later he showed the full clinical and biochemical recovery suggesting that vitamin E supplementation might be useful in treating patients with EPP who developed liver damage.

Therapeutic effect of histidine decarboxylase inhibitor on chronic active hepatitis

SummaryThe effect of orally administered histidine decarboxylase inhibitor on liver function tests and histological appearance as well as on plasma histamine level were evaluated in biopsy proven 13 patients with chronic active hepatitis, whose liver function tests were refractory to other measures.Tritoqualine was used as histidine decarboxylase inhibitor and was administered in dose levels of 600 to l,600 mg per day. Before treatment the average value of SGOT, SGPT and plasma histamine showed 252±24U, 318±152U and 15.2±5.5µ/L, respectively. Results obtained at six weeks’ treatment, however, gave significantly improved values, indicating SGOP 57±24 (p<0.001), SGOP 40±28 (p<0.001) and plasma histamine 8.6±0.4 (p<0.001). Serum gammaglobulin also tended to fall (p<0.1). Marked improvement was noted in reexamined biopsied specimen, representing disappearance of fibrogenesis as well as round cell infiltration in and around the portal tract, together with pericellular fibrosis. Four cases have been proven to be healed.Despite long-term administration, no obvious side effect was observed. Investigation for HBsAg revealed to be positive in 4, however, no conspicuous difference was seen from that of negative cases in the improvement.

Microcirculatory responses to estradiol benzoate in chronic liver damage induced by carbon tetrachloride in the rat

SummaryMicrocirculatory responses to estradiol benzoate (ES) under condition of chronic liver damage induced by long-term administration of carbon tetrachloride (CC14) was investigated in the rat. One hundred and five male rats were divided into the following groups receiving 0.1 mg/100 g body weight ES injected intraperitoneally 5 times per week: (1) controls, exposed to CC14 alone; (2) rats treated with ES from the fourth week of CCl4 exposure; (3) animals treated with ES from the 11th week of CC14 exposure. In rats receiving CC14 alone, liver cirrhosis was induced by 10 consecutive weeks of exposure. Microangiograms of the liver demonstrated conspicuous rarefaction of the vascular tree. On the other hand, animals treated with ES had neither atrophic liver nor rarefaction of the intrahepatic vascular tree. ES produced also intrahepatic neovascular proliferation in the cirrhotic liver. After long-term CCl4 administration, ES treated rats had extremely enlarged nodules with tumor-stain like findings, giving rise to a structure differing from hepatocellular carcinoma which latter generally displays a broom-swept appearance. It is concluded that in providing potent angiogenesis in the liver, ES protects the liver against microcirculatory derangement and parenchymal damage induced by CC14.

Role of plasma histamine in liver injury clinical and experimental investigations

SummaryPlasma histamine level (PHL) was evaluated by a modified fluorometric assay (Suzuki) in the patients with various forms of liver disease as well as rabbits with liver injury. And the data obtained were compared with liver function tests in assessing the stage and prognosis of hepatic dysfunction.In acute hepatitis, if its prognosis was “good”, as was also shown in the animal group with single dose administration of CC14, the level of plasma histamine attained a peak before that of serum transaminases, and returned to normal prior to that of the latter. In persistent and chronic hepatitis, although correlation betweenPHL and other liver function tests was poor and variable,PHL remained high. And the estimation ofPHL during the course of this state showed that it was elevated prior to that of serum transaminases, indicating high level of plasma histamine in this state, even in apparent “steady state”,’ worsening of the disease. In liver cirrhosisPHL correlated with the degree of serum transaminases as well as serum gammaglobulin. In “poor prognosis” group (patients with hepatic coma and rabbits treated with consecutive administration of CCI4)PHL increased extremely high, which was contrasted with the lowered levels of transaminases.These results strikingly suggest that histamine is involved in liver injury and estimation of PHL in the course of hepatic disorder is useful, for a prediction of prognosis.

Abstracts of selected papers presented at the 30th Annual meeting of the Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 30TH ANNUAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY October 20-22, 1988 -Kagoshima, Japan Chairman: Shuji HASHIMOTO, M.D.

A Hepatocellular Carcinoma of Massive Arterioportal Shunts Without Tumor Stain Treated with CDDP Two-Route Chemotherapy—A Case Report

Massive arterioportal shunts without tumor vessels or tumor stain are some times encountered in advanced cases of liver cirrhosis. Massive arterioportal shunts without tumor stain that responded well to intensive chemotherapy with cis-diamminedichloroplatinum II are reported.

Inhibitory effects of autologous hepatic tumor suspension on the development of liver cell carcinoma in rats

SummaryInoculation with a crude suspension prepared from autologous liver cell carcinoma inhibited the development of liver tumor in cirrhotic rats exposed to 3′-methyl-4-diethylaminoazobenzene (3′-Me-DAB). The suspension had also an inhibitory effect on the growth of tumor in rats bearing liver cell carcinoma. The results obtained suggest that a close relationship exists between tumor-associated antigens and onco-development.