Seiji Sakurai

Transcatheter arterial embolization-induced bilious pleuritis in a patient with hepatocellular carcinoma.

A 52-year-old man with hepatocellular carcinoma (HCC) was admitted with cough and fever. He had undergone four series of treatments, including transcatheter embolization and chemoembolization with lipiodol and anticancer drugs, over the previous 2 years. Computed tomography demonstrated dilated hepatic ducts, localized necrosis in the right hepatic lobe, and subphrenic abscess. He died of respiratory failure, because of increased effusion of the right pleura, about 3 weeks after admission. Autopsy revealed adhesions in the lower lobes of the right lung, diaphragm, and liver, with granulomas with bile pigment. A fistula was observed from the necrotic regions of the right hepatic lobe to the pleura through the diaphragm. A tumor thrombus in the portal trunk was histologically confirmed as well and moderately differentiated HCC with trabecular arrangement. Direct invasion of HCC with necrotic tissue to the pleura through the diaphragm appeared to have caused the respiratory failure. Although bilious pleuritis is a rare complication of transcatheter arterial embolization (TAE), it should be considered as an adverse effect of TAE in patients with a dilated hepatic duct.

Elevation of N1-acetylspermidine and putrescine in hepatic tissues of patients with fulminant hepatitis and liver cirrhosis

Hepatic polyamines were assayed in 15 patients with liver diseases, 5 with fulminant hepatitis (FH); 3 with exacerbated liver cirrhosis (ELC); and 7 with liver cirrhosis (LC). Hepatic putrescine and N1-acetylspermidine, as percentages of total polyamines, were elevated and spermine was decreased in all 15 patients. The increase in hepatic N1-acetylspermidine levels appeared to be greater in patients with FH and ELC than in those with LC. These results suggest that the production of N1-acetylspermidine in human liver is closely associated with the induction of spermidine/spermine N1-acetyltransferase activity in liver diseases.

α‐Fetoprotein Producing Early Gastric Cancer

Abstract: A 53‐year‐old male suspected of having a testicular tumor associated with a moderately high titer of α‐Fetoprotein (AFP), was shown to have a IIa + IIc type early gastric cancer in the cardia. The urological diagnoses made from the operated specimen were orchitis and epididimitis. Because of the moderately high titer of AFP (30–80 ng/ml), it was suspected that he had a hepatocellular carcinoma (HCC). A routine upper gastrointestinal endoscopy performed prior to the celiac angiography to assess for a liver tumor revealed gastric cancer. HCC was ruled out using celiac angiography and a total gastrectomy was performed. The operative findings of: P0 H0 N4 S0 corresponded with stage IV gastric cancer. Subsequently his AFP decreased to an undetectable level and the patient is in a good postoperative condition.

Survival of patient with late onset hepatic failure by living-related liver transplantation from maternal donor with incompatible blood type

Abstract: A 14-year-old girl with blood type B with late onset hepatic failure (LOHF) of unknown cause has survived through living-related liver transplantation (LRLT). No hepatitis virus, including HAV, HBV, HCV, and HGV, was positive at the onset of LOHF. Autoimmune hepatitis was thought to be the cause because of positive results for serum anti-nuclear antibody at 80 times dilution and elevated gamma-globulin, but treatment with glucocorticoid did not suppress the progressive hepatic failure. Supportive therapy, including pulse therapy with 1 g methylprednisolone for 3 days, ursodesoxycholic acid, branched-chain amino acid, and azathioprine did not resolve the hepatic failure. She was treated by repeated plasmapheresis and plasma absorption for 10 months, and then received the left lobe of her mothers liver. (Her mothers blood type was AB). The patient had been well, being treated with tacrolimus and prednisolone, although the serum titer of anti-blood type B antibody was high just after LRLT and mild liver dysfunction continued for more than 3 years after LRLT. Follow-up biopsy 3 years after LRLT revealed chronic hepatitis and progression to liver cirrhosis. Re-transplantation is now under consideration; the patient is now aged 19 years.

Hepatocellular Carcinoma Associated with Extrahepatic Primary Malignant Neoplasms

BackgroundWe studied hepatocellular carcinoma (HCC) with extrahepatic primary malignant neoplasms (EPMNs) and investigated its clinical and pathologic relevance.MethodData from autopsies performed during the last 10 years (January 1985 to December 1994) on 146 patients with HCC were analyzed at Maebashi Red Cross Hospital. The 146 patients consisted of 116 men and 30 women ranging in age from 38 to 87 years at the time of death.ResultsEPMNs were found in 21 patients: in the large bowel (6 cases), stomach (4 cases), thyroid (2 cases), urinary bladder (2 cases), small intestine (2 case), liver (1 case) and 1 case in the lung, pancreas, prostate, and breast, respectively. One patient had a malignant lymphoma in the small intestine. Ten EPMNs (47.6%) were latent or found at autopsy. The frequency of blood transfusion was significantly higher in the patients with EPMNs than in those without EPMNs. Those with EPMNs tended to be older and more likely to be male. Sixteen of the 21 patients died of liver-related causes. Two patients died of a second cancer, and 3 died of reasons other than malignancy, such as brain hemorrhage and pneumonia.ConclusionFully 14.4% of patients whose autopsies showed HCC had EPMNs. Survival from the time of diagnosis of HCC did not differ significantly in the patients with EPMNs. These observations suggest that EPMNs did not change the prognosis of these patients with HCC, even when their EPMNs had been detected and treated early.

A case of familial mediterranean fever with paroxysaml pseudo-obstruction of bowel.

症例は44才,男性. 37才より発熱を伴う腹痛発作を繰り返していた.発作時には著明な腹部膨隆と腹部単純X線写真上腸管内の著明なガス像を示した.消化管を中心に精査したが異常なく,開腹術を施行するも試験開腹に終った.周期熱の一種である家族性地中海熱を疑いレセルピンやコルヒチンを投与したところ発作が消失し,メタラミノール投与により発作が誘発され,この発作はコルヒチンにより抑制された.以上より,家族性地中海熱と診断した.診断にあたって,白血球数, CRPや血沈などの検査値は一定しなかったが,メタラミノール発作誘発試験が陽性で有用であった.