Shigeyoshi Harihara

Ulcerative colitis with skip lesions at the mouth of the appendix: a clinical study

Objective: We examined the clinical characteristics of ulcerative colitis patients who demonstrated endoscopically discontinuous lesions at the mouth of the appendix. Methods: Of patients with initial or recurrent active ulcerative colitis who underwent total colonoscopy during the past 3 yr at Osaka City General Hospital, we selected those who had skip lesions in the mouth of the appendix before treatment, and examined their gender, age, disease type, sites of lesions, inflammatory reaction, severity of disease, effects of treatment, and posttreatment course. Results: Discontinuous lesions at the mouth of the appendix were found in 10 patients, who had the following common clinical features: the major lesion was usually present in the lower part of the large bowel including the rectum, many of the patients had suffered an initial attack only, all patients had mild disease, and many of the patients responded quite satisfactorily to treatment with salicylazosulfapyridine. Conclusion: Numerous patients with ulcerative colitis with discontinuous lesions at the mouth of the appendix were observed and their clinical characteristics were examined. Determination of the clinical significance of skip lesions in the appendix will contribute to elucidation of the pathogenesis of ulcerative colitis.

EFFECT OF DRINKING ON THE OUTCOME OF CIRRHOSIS IN PATIENTS WITH HEPATITIS B OR C

Survival rates were calculated for 251 patients with cirrhosis of the liver but without hepatocellular carcinoma, primary biliary cirrhosis, or autoimmune cirrhosis who underwent laparoscopy during the past 21 years at the authors’ hospital. The survival rates were calculated by the Kaplan‐Meier method. Stored serum was assayed for hepatitis B surface antigen (HBsAg) and antibodies to the hepatitis C virus (HCV). Patients with alcoholic cirrhosis had significantly better survival rates than patients with HBsAg, HCV, or both. Differences in survival rates between patients with hepatitis B and C were insignificant. In both groups, habitual drinkers had a significantly lower survival rate. The results suggested that alcohol accelerates liver damage in subjects with viral hepatitis.

A comparison of transcatheter arterial embolization with one shot therapy for the patients with hepatic cell carcinoma

SummaryIt has been confirmed gradually that transcatheter arterial embolization is the most effective, conservative therapy for the treatment of unresectable hepatic cell carcinoma (hepatoma). Embolization or one shot therapy was carried out in a clinical trial involving 41 patients with unresectable hepatoma visiting our department. Embolization group (emboli G): 19 cases. 1 to 6 embolizations in each case. One shot group (one shot G): 22 cases. Medications: Mitomycin C 10–40 mg and others.Disappearance rate of icterus after treatment was 50% (emboli G) and 25% (one shot G). Decrease in size of hepatomegaly or tumor was seen in 84% (emboli G) and 32% (one shot G) which was statistically significant (< 1 %). Serum AFP titer after embolization decreased in all cases but in only 5 of 12 cases (ca 41 %) after one shot (< 1 %). Effective cases measured by Karnofsky’s method were 18 out of 19 cases (95%) in emboli G, but in one shot G only 10 out of 22 cases (ca 45%)(< 0.1%). Survival rate after each therapy was 67% (emboli G) and 38% (one shot G) after 6 months, and 59% (emboli G) and 19% (one shot G) at 1 year respectively.One study showed that transcatheter arterial embolization therapy was much more effective than one shot therapy.

A female case of type VIII glycogenosis who developed cirrhosis of the liver and hepatocellular tumor

SummaryThe case of a 17-year-old female with a rare form of type VIII glycogenosis who developed cirrhosis of the liver and hepatocellular tumor is reported. Laparoscopy showed a tumor 50 mm in diameter in the lower portion of the right lobe of the liver. The tumor was biopsied under ultrasonic guidance, and tentatively diagnosed as adenomatous hyperplasia. The patient was also diagnosed as having type VIII glycogenosis (phosphorylase kinase deficiency).

Regression of gastric MALT lymphoma after unsuccessful anti-H. pylori therapy

rates vary more than 50-fold worldwide (3). Variation of this magnitude, with the highest rates in developed countries, suggests that risk is principally determined by exposure to carcinogenic agents moderated by protective factors. For colon cancer, heterocyclic amines formed in the charring of meat and fish products may represent an important causal agent with physical activity (4) and cereals protective.

The prognostic value of peritoneoscopic findings in patients with liver cirrhosis

SummaryThis study was conducted on 139 patients with liver cirrhosis with diffuse formation of the nodules on the liver surface demonstrated by peritoneoscopic examination. In all of these patients, the diagnosis had been established more than 5 years ago, and the cumulative survival rates were calculated by the life table method. The relationship between the survival rate and macroscopic findings on the surface of the liver was studied and the following conclusions were drawn.1)The 5 and 10 year survival rates in patients with cirrhosis with swelling of the right lobe were as high as 71.2 and 53.4% respectively and were significantly higher than the corresponding figures of 30.0 and 12.7% in patients with cirrhosis with right lobe atrophy (p< 0.001).2)The 5 year survival rate in patients with cirrhosis of the small nodular type with a predominance of nodules with diameters less than 3mm was as high as 70.6%. This was significantly higher than that in patients with cirrhosis of the medium and large nodular type with nodules measuring more than 3 mm in diameter where the 5 year survival rate was 36.0% (p< 0.001).3)The 5 year survival rate in patients with cirrhosis of the narrow stromal type was as high as 61.4%, being significantly higher than that in patients with cirrhosis of the broad and mixed stromal type where the 5 year survival rate was 43.2% (p< 0.05). The observation of the surface pattern of the liver by peritoneoscopy appears to be of great predictive value for the prognosis of liver cirrhosis.

Autopsy case of hepatocellular carcinoma associated with lupoid hepatitis and complicated by malignant lymphoma

SummaryAn 81-year-old woman in whom liver dysfunction had been pointed out 3 years previously was diagnosed as having liver cirrhosis due to lupoid hepatitis. Considering the poor prognosis of cirrhosis and her age, immunosuppressive therapy was not adopted. Nine months later, a small liver tumor was found by ultrasonography and was diagnosed as hepatocellular carcinoma (HCC). The tumor was treated with trans-catheter arterial embolization, but grew continuously. She also developed gingival lymphoma that was successfully treated. Three years after initial diagnosis of lupoid hepatitis, she died of hepatic failure. An autopsy was performed and confirmed the clinical diagnosis, liver cirrhosis with HCC. HCC is regarded as a rare complication of lupoid hepatitis, but cases of HCC complicating lupoid hepatitis may increase with progress in treatment methods and elongation of survival. The present case suggests that any malignancy can be developed in long-term surviving patients with lupoid hepatitis.

Portal circulation before and after sclerotherapy for oesophageal varices studied by radionuclide angiography

Radionuclide angiography was used to generate curves of first‐pass radioactivity vs. time for the right hepatic lobe and both kidneys following the rapid intravenous injection of 10 mCi of 99mTc‐phytate. By analysis of the right hepatic curve, the arterial and portal components of the liver circulation were calculated in 21 healthy subjects and 183 patients, 39 with chronic hepatitis and 144 with cirrhosis of the liver.

Hepatitis B virus and alcoholic liver damage in the airin district. (Osaka’s skid row area)

SummaryHealthy adults and non-liver disease patients in the Airin district gave a positivity rate for HBs antigen of approximately 2%, which is not so much different from the average of the entire Japanese population.In this district, the positive rate of HBs antigen 5% (11 out of 244) in chronic liver disease is much lower than that (31 %) of control group patients at Osaka City University Hospital (O.C.U.H.).However the positive rate of anti-HBs antibody in this district is 46% which is extremely high compared with that (23.4%) in the rest of Japan.The positive for anti-HB antibodies (including of anti-HBs and anti-HBc antibody) accounted for 67% of non-liver disease patients and 68% of chronic liver disease patients in the Airin district. Corresponding values for patients at O.C.U.H. were 44% and 43% respectively.There were no significant differences in the histological picture between HBs antigen-negative patients with and those without demonstrable anti-HBs antibodies. Changes in the liver exhibited by heavy drinkers inhabitating the Airin district were primarily those of alcoholic liver damage.

High prevalence of hepatitis C virus infection in Airin district, Osaka, Japan: A hospital‐based study of 1162 patients

Aim:  The Airin district, located in Nishinari‐ku, Osaka, is known as Japans largest slum area, and has the largest concentration of day laborers in the country. We conducted a large hospital‐based study to determine the prevalence of hepatitis C virus (HCV) infection in the district.