Masaaki Kametani

GB Virus C and Hepatitis C Virus Infections in Hemodialysis Patients in Eight Japanese Centers

RNA of a putative non-A to E hepatitis virus, designated GB virus C (GBV-C), was detected in 40 (6.2%) of 645 hemodialysis patients, at a frequency significantly higher than in 3 (0.9%) of 336 blood donors in Japan (p < 0.001). A history of transfusion was more frequent (88 vs. 58%, p < 0.001), the duration of dialysis was longer (13.2 +/- 7.9 vs. 7.9 +/- 6.5 years, p < 0.001), and the detection of hepatitis C virus RNA was more often (38 vs. 18%, p < 0.01) in the 40 patients with GBV-C RNA than in the 605 patients without it. The prevalence of GBV-C RNA varied widely from 0 to 10% among the 8 dialysis centers. These results indicate that hemodialysis patients would be at increased risk of GBV-C transmitted by transfusions. The detection of GBV-C RNA in the 5 patients without a history of transfusion and a high prevalence restricted to certain dialysis centers would reflect nosocomial infection.

Spontaneous Healing of Pancreatic Abscess After Fistulization to the Duodenal Bulb

A 70-year-old man was admitted to the hospital because of sudden, upper abdominal and back pain. Laboratory and image data indicated acute pancreatitis. Shortly after the admission, pancreatic and liver abscess with bacteremia developed. Antibiotic therapy seemed effective. A month later, spontaneous fistulization of the pancreatic abscess to the duodenal bulb was found by gastroduodenal fiberscopy. Injection of contrast medium into the duodenal orifice showed that the fistula was draining the abscess and that no other fistula formed from the abscess. Endoscopic retrograde cholangiopancreatogram indicated no fistula formation to the pancreatic duct. The pancreatic abscess became smaller and was not visible using computerized tomography and ultrasonography 3 months later and thereafter. Closure of the duodenal orifice was ascertained by the endoscopy. It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth. Pancreatic abscess usually necessitates operative treatment, even with fistulization to the alimentary tract. It seems likely that the single, small fistulization to the bulb, in addition to the lack of underlying disease and medical and nutritional support, facilitated the spontaneous healing process.

[An autopsy case of polymyositis associated with complete A-V block].

致死的な不整脈を呈した多発性筋炎の1剖検例にて,その原因を病理学的に検討した.症例は66才,男性.昭和56年7月より筋力低下が出現し,筋肉逸脱酵素の上昇を認め筋生検にて多発性筋炎と診断された.発症時から完全右脚ブロック,左脚前枝ブロックを認めていたが,昭和58年8月突然完全房室ブロックによる意識消失発作をきたした.体内式ペースメーカー植込術を実施し,小康を得るも翌年4月結核性髄膜炎を併発し死亡した.剖検では固有心筋の変化は軽度であったが,刺激伝導系には脂肪浸潤, fibrosisが著明で,多発性筋炎の刺激伝導系における一次的な障害であると思われた.多発性筋炎による完全房室ブロックはまれで,興味ある症例である.

Three cases of macroamylasemia.

3例のマクロアミラーゼ血症での血中アミラーゼの存在様式,アミラーゼ結合性免疫グロブリンの特異性などを検討した. 3例はいずれも男性(症例1: 55才,症例2: 69才,症例3: 58才)で,それぞれ,糖尿病,高血圧症及び高尿酸血症,或は肝硬変の治療中に,偶然高アミラーゼ血症が発見され,検索の結果, γ-globulin結合(いずれも主にIgAおよびG(κ+λtype))アミラーゼが見出された.これら症例でのアミラーゼアイソザイムの分析,家兎抗ヒトheavy chainおよびlight chain特異抗血清によるimmune precipitationの成績や, SephadexG-200でのcolumn chromatography等の検索結果,およびマクロアミラーゼ血症の臨床的意義について報告した.

[A case of primary hepatocellular carcinoma associated with hyperthyroxine-binding-globulinemia].

概 要: 高thyroxine binding globulin(TBG)血 症 を伴 つた原発 性 肝細 胞癌(肝 癌)の1例 で,血 清 中TBG,α-fetoprotein(AFP)値 が,肝 癌 の進 行 と共 に平行 して上昇,両 者 が解 離 し た死 亡 直前の値 を除 くと正 の相 関(r=0.846,p<0 .05)が 認 め られた.血 清thyroxine(T4), triiodothyronine(T3)値 はTBGと 平行 して増加 したが, free T4 (F-T4), free T3(F-T3) 値 は正常範 囲y-か 正 常 下限 で あつ た.ま た,本 例 のTBGのT3 T4に 対 す る結合 定数 は,低 値 で あ つた.以 上 か ら,本 例 の肝 癌組 織 よ りAFPと 同様,T3,T4結 合 能 の低下 した異 常 なTBGも 産 生 され た可能性 が示 唆 され た.ま た,末 期 には,血 中immunoreactive insulin(IRI)低 値 を 伴 つ た低血 糖 発 作が 頻発 し,insulin-1ike activity(ILA)産 生肝 癌 の可能性 も残 され た. 〔日内会誌 75:1644~1649,1986〕

Prognosis of the patients with clinical symptom of acute hepatitis B

昭和50年1月より,52年6月までに入院した輸血の既往のないHBs抗原陽性の急性肝炎様症状により発見された43例につき検討した.対象の肝炎を初診時のHBc抗体価の高低と持続,HBs抗原の持続または一過性により4群に分類した.I群はHBc抗体が陰性もしくは低力価(29>)で経過とともに上昇し,HBs抗原一過性陽性群で35例,II群はHBc抗体価が高く(210<)持続し,HBs抗原一過性の3例,III群はHBc抗体が高力価で持続し,HBs抗原も持続性の5例,IV群はHBc抗体が低力価で経過とともに上昇し,HBs抗原は持続性のものとしたが,この群は認められなかった.3群を比較するとI群10例の肝生検像はいずれも急性肝炎,III群は5例のうち4例が慢性肝炎活動性,1例は急性肝炎であった.またIII群はI群に比しZTT, AFPが有意に高かった.II群の組織像は慢性肝炎活動性,急性肝炎の各1例で,検査所見はI群とIII群のほぼ中間値を示した.6ヵ月以上の経過観察により,III群の4例に,トランスアミナーゼの再上昇がみられた.

Carrier state and infectivity of HBs-Ag

It has recently been clarified by Magnius and others that e antigen and antibody system is closely related to HBV infectivity, i.e., HBsAg-positive sera detected e antigen (e-Ag) have an intensive infectivity, and those detected e antibody are no infective. Therefore, the authors tested e-Ag and e-Ab by the Micro-Ochteronys method in sera from 127 carriers, and, from the data, discussed as to intrafamilial infections with HBV and the clustering of the carriers. The results are as follows. 1. In eleven children of 6 e-Ag-positive carrier mothers, 10 children were positive for HBsAg, and 3 out of 6 children of 2 e-Ag-positive carrier fathers also were HBsAg-positive. Moreover, in one of 3 children living with their e-Ag-positive grandfather, HBsAg was detected in the serum. Accordingly, it can be said that an e-Ag-positive carrier produces new carriers at a high rate in the following generations, and the rate is extremely high in mother-to-child transmission. 2. In 103 asymptomatic carriers, the frequency of e-Ag-positive result was higher in the younger ages (75% in ages of below 10 years and 12% in ages of more than 41 years). On the contrary, the rate of e-Ab-positive carriers was higher in the older ages (17% in ages of below 10 years and 44% in ages of more than 41 years). This result implies that, in the majority of HBsAg carriers, although there are wide differences in the individuals, HBV infectivity declines with years and finally vanishes.

Clinical studies on Au-antigen and antibody

The present study investigated the relationship between Au-antigen (AG) and Au-antibody (AB), and the effect of AB on the blood recipient. Abnormal liver function was observed in four out of 18 recipients. Two of the four cases received both AG. AB negative blood, one received AG (+) AB(--) blood, and the last received undetermined blood. Two of the four cases changed to AG positive after blood transfusion, the third no AG. AB in the blood but showed the transient elevation of S-GOT and GPT, and only the fourth showed AB in the blood. However, the liver damage of the fourth case could be explained by the side effect of the antibiotics he had used. Therefore, the defensive effect of AB on the liver function was suggested from the observation. Comparison of infectious and serum hepatitis showed the rare or seldom appearance and low titer, if present, of AB in the former, and the frequent appearance and high titer of AB in the letter.

[Family survey of nine Australia-antigen positive patients with chronic hepatitis and cirrhosis of the liver].

Au抗原陽性慢性肝炎または肝硬変症を発端者とする家系を調査し,その結果9家系に家族的にAu抗原陽性者が高頻度に発見され,うち5家系には発端者以外にもAu陽性肝疾患患者または肝機能異常者が発見された.これらの家系内の感染様式は母から子へと考えられるものが最も多く,母親がAu抗原陽性であるとその子供は49% Au陽性であつた.また父から子,同胞内,同居における感染,夫婦共に陽性者なども認められた.これらの感染はAu陽性者との接触の機会が多く,かつ若年者であるほど高頻度のように思われた.これらの家系のうちAu陽性者とその両親,同胞,子供計66名を集計してみると, Au陽性者は40名(60%)で陰性者は26名であり, Au陽性の男性は18名中7名(39%),女性22名中11名(50%)に肝機能異常が認められたが, Au陰性男性14名はすべて,女性は12名のうち11名に肝機能は正常であつた.

Various courses of Australia antigen in serum with hepatitis and cirrhosis

Since there have been many discussions about Australian Antigen (AuAg) in hepatic diseases, we will further examine its meaning by long term observation in hepatic diseases. The detection of AuAg was performed by Immuno-adherence method. Its occurrence rate was as follows: inAcute hepatitis 35% (nine out of twenty-six cases) Chronic hepatitis (inactive type) 13% (three out of sixteen cases). Chronic hepatitis (active type )32% (nineteen out of fifty-nine eases) Liver cirrhosis 7% (two out of thirty cases). In acute hepatitis, the occurrence rate was not significantly different between serum hepatitis and infectious hepatitis, and AuAg was disappeared within three weeks after the onset except one. In chronic hepatitis, the occurrence rate was significantly higher in (active type) than in (inactive type). In three out of thirteen cases of chronic hepatitis (active type) AuAg was disappeared after one year coincided with clinical improvement, and in another one case AuAg was disappearecd after large amount of blood transfusion during operation of hepatoma resection, which had been secondally developed. In so far as acute hepatitis and chronic hepatitis are concerned, AuAg does not suggest their prognosis. The authors could not observe the change of AuAg negative to positive, even in acute exacerbation of chronic hepatitis and liver cirrhosis. These results suggest us that the acute exacerbation is not the reinfection of acute hepatitis but one course of chronic hepatitis and liver cirrhosis.