Makoto Miki

Diagnosis and Clinical Features of Small Hepatocellular Carcinoma With Emphasis on the Utility of Real-Time Ultrasonography: A Study in 51 Patients

The clinical features and usefulness of various methods for diagnosis of small hepatocellular carcinoma, no greater than 5 cm in diameter, were studied in 51 patients. The diagnosis was verified in 28 patients by hepatic resection and in 4 patients at autopsy. The tumor was less than 3 cm in diameter in 23 patients. In 37 patients (72.5%), the tumor was first discovered by real-time linear scan ultrasonography, generally during a routine periodic follow-up examination of patients with chronic liver disease, mostly cirrhosis. Clinically, 62.7% of the patients were asymptomatic, and symptoms in the remainder were not suggestive of carcinoma. Most patients showed only mildly abnormal liver function tests that did not suggest the diagnosis. Serum alpha-fetoprotein level was normal in 25.5%, and it was elevated above 200 ng/ml in only 33.3%. Among the various imaging modalities, ultrasonography had the highest detection rate (92.2%) for these small hepatocellular carcinomas compared with computed tomography (73.2%), scintigraphy (50.0%), and angiography (86.0%). False-positive lesions, however, were also found frequently by ultrasonography, requiring ultrasonography-guided biopsy for differential diagnosis in some of the patients. Routine examination at regular intervals of patients with chronic liver disease using a combination of real-time ultrasonography and alpha-fetoprotein measurement is currently the most effective approach to detecting small hepatocellular carcinoma.

Extrahepatic portal vein obstruction in adults detected by ultrasound with frequent lack of portal hypertension signs

Extrahepatic portal vein obstruction (EHPO) was seen in 54 adult patients at the Chiba University Hospital and affiliated hospitals from 1978 to 1991. They were classified according to the background disease (Group A, unknown aetiology; Group B, benign disease; Group C, malignant disease).

Do high levels of viral replication contribute to fulminant hepatitis A

Abstract: Background: The possible correlation between the severity of hepatitis A and the levels of viral replication has not been established.

Analysis of hepatitis A virus protein 2B in sera of hepatitis A of various severities

BackgroundIn our recent study of the full-length hepatitis A virus (HAV) genome from some patients with fulminant hepatitis and acute hepatitis, possible associations were suggested between the severity of hepatitis A and the amino acid substitutions in the nonstructural protein 2B. We therefore analyzed HAV 2B from many patients with various clinical disease severities.MethodsSerum samples from 30 Japanese patients with sporadic hepatitis A from five widely separated regions of Japan, comprising nine patients with fulminant hepatitis (FH), six with severe acute hepatitis (AHs), and 15 with acute hepatitis (AH), were examined for HAV RNA. The entire sequences of HAV 2B were analyzed.ResultsCompared with the sequence of the wild-type HAV strain GBM, nucleotide sequences of 2B had homology of 94.5 ± 1.0% in FH, 95.2 ± 1.2% in AHs, and 95.1 ± 1.8% in AH. Deduced amino acid sequences had homology of 97.5 ± 2.1% in FH, 97.9 ± 2.4% in AHs, and 98.5 ± 1.3% in AH. Differences were not statistically significant among the three groups. The average number of amino acid mutations between amino acids 100 and 200 was 5.0 ± 5.2 per case in FH, 4.0 ± 6.0 in AHs, and 1.9 ± 2.9 in AH. The differences between FH and AH, AHs and AH, and between severe cases (FH and AHs) and nonsevere cases (AH) were not statistically significant (P = 0.13, P = 0.45, and P = 0.10, respectively).ConclusionsThere were no obvious differences in the sequences among FH, AHs, and AH throughout the 2B region, but there seemed to be more mutations in the strains obtained from FH and AHs patients than in those obtained from AH patients in the central part of HAV 2B.

Liver changes revealed by cholangiography in biliary diseases

A comparative study was made on the presence or absence of cirrhosis as well as the relationship between splenomegaly and sex in cases of chronic schistosomiasis japonica permitting histologic investigation of the liver. 1) 81 (22.4%) of 332 patients presented cirrhosis of the liver associated with the condition (portal form in 75 and postnecrotic in 6 cases). Of non-cirrhotic patients, 125 (41 males and 84 females) had fibrotic and 126 (74 males and 52 females) normal hepatic tissues. There was cirrhosis of the liver in 61 (34.7%) of 176 male patients and in 20 (12.8%) of 156 female patients, the incidence being higher in males. The rate of cirrhotic patients under 39 of age was 83.3~ or 15 out of 18 for males and 8.0~ or 2 out of 25 for females. Thus, males accounted for 75.3~ of cases of cirrhosis associated with the disease and especially as much as 88.2 % of those of younger generations. 2) Splenomegaly was observed in 96 (28.9%) of 332 cases permitting histologic study of the liver (39 of I56 or 22.2~ for males and 57 of 156 or 36.5% for females). Of 81 cirrhotic patients, 45 (53.6%) had splenomegaly. There was no substantial difference by sex in the incidence: 32 of 61 cases or 52.5% for males and 13 of 20 cases or 65.0% for females. Splenomegaly was present in 20.3% of 251 non-cirrhotic patients with the disease. The incidence was higher in females: 44 out of 136 cases or 32.4% as compared with 6.19/o or 7 out of 115 male patients. In short, hepatic were cirrhotic in 82.1% or 32 out of 38 male splenomegalic patients with the disease, but not cirrhotic in 77.2~ or 44 out of 57 such female patients.