Nagahisa Fujio

Induction of mRNAs for heat shock proteins in livers of rats after ischemia and partial hepatectomy.

SummaryWhen the body temperature of rats is elevated to 42°C, four heat shock proteins, with the molecular weights of 70000, 71000, 85000, and 100000 (hsp 70, hsp 71, hsp 85, and hsp 100, respectively), are induced in various tissues of rats (Fujio et al., J Biochem 101, 181–187, 1987). Heat shock proteins are induced by various stresses other than heat in varieties of cultured cells, so we studied whether heat shock proteins are induced in intact rats by different treatments. Analysis of the translation products of poly(A) + RNA isolated from the livers of rats recovering from ischemia of the liver showed that mRNAs for hsp 70, hsp 71, and hsp 85 were induced. These hsp-mRNAs were also induced in the livers of rats 6 h after a partial hepatectomy, and had returned to control levels 24 h after the surgery. These results suggested that heat shock proteins have not only the function of protection against various stresses but also physiological functions in the normal growth and development of animals.

Sarcoid reaction in the spleen after sigmoid colon cancer resection: a case report

BackgroundA sarcoid reaction is a phenomenon characterized by histologically proven granulomatous lesions without evidence of sarcoidosis. This pathology is a benign tumor itself, but several reports have described sarcoid reactions accompanying malignant tumors. Sarcoid reactions occur in various cancers, such as skin, lung, ovary, stomach, and breast cancers. However, only a few published reports have described sarcoid reactions in patients with colorectal cancer.Case presentationA 76-year-old woman underwent laparoscopic sigmoidectomy for sigmoid colon cancer. The postoperative follow-up computed tomography and 18-fluorodeoxyglucose positron emission tomography–computed tomography findings were suspicious for splenic metastasis of the sigmoid colon cancer. The patient then underwent laparoscopic splenectomy. Histopathological examination of the resected lymph nodes and spleen showed a non-caseating epithelioid cell granuloma. The patient was diagnosed with a sarcoid reaction.ConclusionsTo our knowledge, this is the first report of a sarcoid reaction in the spleen and regional lymph nodes after colon cancer resection. The effect of a sarcoid reaction on the prognosis in patients with colorectal cancer has not been fully determined because of the small number of such cases. Further analyses involving a larger number of cases are necessary to evaluate the relationship between sarcoid reactions and prognosis in patients with colorectal cancer. We herein present an extremely rare case of a sarcoid reaction in the spleen and regional lymph nodes.

Combination of Hepatic Arterial Infusion Chemotherapy and Portal Vein Occlusion for Unresectable Hepatocellular Carcinoma

We tried a combination of percutaneous transhepatic portal vein embolization (PVE) or portal vein ligation (PVL) and hepatic arterial infusion chemotherapy (HAI, with or without a reservoir) or transcatheter arterial embolization (TAE) for five patients with hepatocellular carcinoma (HCC) in whom the tumors were not resected. The patients were from 50 to 70 years old, and all had cirrhosis. The tumors were classified as being in stage III or IV by the UICC classification. Three of the five patients underwent PVE and the other patients underwent PVL. Adriamycin (ADR), epi-Adriamycin (epi-ADR), mitomycin C (MMC), or mitoxantrone (MIT), or some combination was used during HAI. These combinations of therapy was effective for hepatic tumors in all patients, as judged by decreases in tumor size and serum levels of α-fetoprotein (AFP) after treatment. The combination of HAI and portal occlusion may be effective for unresectable HCC.

Preoperative Portal Vein Embolization for Hepatocellular Carcinoma with Portal Thrombi

We investigated the usefulness of hepatic resection with preoperative transcatheter arterial embolization (TAE) and percutaneous transhepatic portal vein embolization (PVE) for advanced hepatocellular carcinoma (HCC) retrospectivel.Fifty-nine patients underwent hepatic resection and had portal thrombi (vp). Of the 59 patients, 28 underwent hepatic resection only (group N), 20 underwent hepatic resection with TAE (group A), and 11 underwent hepatic resection with TAEand PVE (group AP). The nonrecurrence survival rate for the patients in group AP was higher than in the other groups. Eight patients had vp in the first branch of the portal vein (vp3). Only two of these patients (both in group AP) survived long; in group AP, the vp was covered with the embolic material in the operative specimens. PVE seems to be useful not only as a preoperative treatment but also as one treatment for unresectable HCC.

The distribution of secretory immunoglobulin A in the intrahepatic biliary epithelium of patients with hepatolithiasis

In the treatment of hepatolithiasis, liver resection helps to prevent recurrence and may reduce the incidence of infection by removal of the atrophic tissue. This study was conducted to determine if the affected liver tissue in hepatolithiasis is inflamed or has lowered local immunity by examining the distribution of secretory immunoglobulin A (sIgA) and proliferating cell nuclear antigen (PCNA) in the intrahepatic biliary tracts of 27 patients with hepatolithiasis. Operative specimens were sectioned and stained with avidinbiotin complex, and the labeling index for both sIgA and PCNA was calculated as a percentage of the biliary epithelial cells stained. Cells stained for sIgA increased to a certain point as the cholangitis became more severe; however, in advanced cholangitis, with severe parenchymal atrophy or actively proliferating biliary epithelium, there were fewer cells stained for sIgA than in mild cholangitis. In hepatolithiasis, the decreased local immunity related to sIgA accompanied severe chronic proliferative cholangitis and parenchymal atrophy.

Case of Caroli's disease associated with intrahepatic cholangiocellular carcinoma at cystic dilatation of the bile ducts.

症例は57歳の女性,繰り返す上腹部痛の精査時,肝左葉を中心とする限局性肝内胆管拡張によりCaroli病(以下本症)と診断,尾状葉を含む肝左葉切除を施行した.肉眼的に悪性所見はなかったが,病理組織学的に拡張胆管の粘膜上皮内に限局する胆管細胞癌と診断された.諸家の報告では本症の約8%に胆管細胞癌を合併し,その要因として肝内結石による慢性刺激,長期間の胆汁鬱滞,繰り返す胆管炎さらには先天性の胆道奇形が考えられている.これらの発癌機序は総胆管拡張症や膵胆管合流異常症でも指摘されているが自験例は総胆管拡張や肝内結石を合併しない上皮内癌症例であった.また本例は拡張胆管上皮に著明な過形成や腸上皮化生がみられ,その部分に連続して癌化が認められ,発癌の背景を推測するには貴重な症例と考えられた.

A case of hepatocellular carcinoma with a huge portal-systemic shunt via the inferior mesenteric vein and liver cirrhosis.

巨大な門脈下大静脈短絡路を有する肝硬変併存肝細胞癌の切除例を経験した.経皮経肝門脈造影像上,傍食道静脈への側副血行路は存在しなかったが,拡張蛇行した下腸間膜静脈から下大静脈への側副血行路が確認され,大部分の門脈血は遠肝性に逆流していた.門脈圧は26cmH2Oで,ICGR15値32.6%,血中アンモニア値141μg/dlと高値を示していたが,肝性脳症の既往はなかった.術中,電磁流量計を用いて門脈および下腸間膜静脈の血流を測定するとともに,S5亜区域切除を施行したが,側副血行路の遮断は行わなかった.術後,血中アンモニア値は上昇せず,肝性脳症の発症および食道静脈瘤の進展もみていない.以上より,巨大な側副血行路を有する肝硬変併存肝細胞癌症例の手術に際して,シャント遮断による門脈圧の亢進ひいては他の側副血行路の増悪も考慮し,肝性脳症や消化管出血の既往がなければ,肝切除のみでもよいと考えられる.

A Case of Resected Minute Hepatocellular Carcinoma Detected by Laparoscopy

症例は62歳男性.腹腔鏡検査時, 肝左葉表面より肝外に突出した腫瘤が認められた.しかし超音波検査, computed tomography検査, 血管造影によって腫瘤は同定されず, 腫瘍マーカーも正常であった.腹腔鏡所見によってのみ肝癌と診断され, 肝部分切除が施行された.切除標本において径1.1cmの主腫瘍とその近傍に2個の肝内転移が認められ, 組織学的に肝細胞癌と診断された.肝表面に存在した肝癌の早期発見と診断に腹腔鏡検査が有用であった症例を報告した.

EXPERIMENTAL STUDIES OF HEPATIC HYPERTROPHY AFTER PORTAL VEIN EMBOLIZATION

穿刺 し,塞栓物質を0.lml注入,塞栓 した。塞栓物質に は isobutyl‐ 2、cyanoac呼lateとLipiodolを等 量ず つ 混和したものを用いた。術後経 日的に肝を摘出,そ の 重量を測定 した。また非塞栓肝の組織像 よりmitOdc indexを算出した.さ らに非塞栓肝の DNA合 成能を みるために,肝における 3H_thymidineの酸不溶性分画 へのとりこみを測定した。すなわち3H_thymidineを体 重100gあた り10/Ci腹腔内注射し,2時 間後に非塞栓 肝実を摘出,DNAの 酸不溶性分画を抽出,定 量した。 その DNAあ た りの放射活性を測定 した。 結果 :非塞栓肝の体重比は塞栓 7日後まで増加し, 術前値の約 3倍 になった。Mitotic indexは 塞栓 3日後 に明らかに上昇 した。また非塞栓肝の DNA合 成は 70%肝 切除群 と同様の変化がみられ,24時 間後に高値 を示した くF七). 広橋 一 裕 街 保 敏 藤尾 長 久