Shoshi Matsuda

Clinical use of glucagon and insulin in therapy of fulminant hepatic failure

SummaryWe have reported 5 cases of fulminant hepatic failure who were treated with a combination of glucagon and insulin. Marked improvement of hepatic coma was characteristically noted in all cases.

Clinical evaluation of glucagon and insulin in therapy of fulminant hepatitis

SummaryForty five patients were examined in order to evaluate the usefulness of glucagon and insulin as a therapy of fulminant hepatitis. Thirty patients were treated with simultaneous infusion of glucagon and insulin, whereas prednisolone was given at a daily dose of 60 to 90 mg in 15 cases. In the former group, 1 mg of glucagon and 10 units of regular insulin were infused over a period of 2 to 6 hours. Two such treatments were given per day in the early critical period of fulminant hepatitis. The therapeutic effect of glucagon and insulin was evaluated in comparison with that of prednisolone, and additionally, with a combination therapy of either blood exchange or plasmapheresis in both groups. The survival rate was superior in the group treated with glucagon and insulin (46%) and in the one with combined infusion of these hormones plus plasmapheresis (33%).

A CASE OF PRIMARY ACQUIRED AGAMMAGLOBULINEMIA ACCOMPANIED WITH NODULAR LYMPHOID HYPERPLASIA OF THE GASTROINTESTINAL TRACT FROM DUODENUM TO HALF OF JEJUNUM

原発性後天性無γ-globulin血症, WHOの分類試案ではvariable common immunodeficiencyに属するとおもわれる33才の男性症例を経験したので報告する.患者は乳幼児期に麻疹,流行性耳下腺炎に罹患したが正常に回復した.とくに感冒に罹患しやすいということはなかつた. 20才頃から肺炎に反復罹患し,再三37.5°C前後の微熱を生じ,胆嚢炎にも罹患したことがある. 32才のとき無γ-globulin血症を発見された.下痢の反復など消化器症状はない.本症例は,末梢リンパ球数は正常であるが,骨髄に形質細胞はほとんど認められない.免疫グロブリンはIgG, IgA, IgM, IgD, IgEすべてにきわめて低値を示した. T cell, B cel1はほぼ正常に存し,皮内反応(PPD, Candida)は正常に反応した.消化管X線検査,内視鏡では十二指腸球部から空腸上部にかけて微細な半円形の隆起性病変をびまん性に多数みとめ,結節性リンパ過形成(nodular lymphoid hyperplasia; NLH)とおもわれた.以上のように十二指腸から空腸にかけてNLHを有する原発性後天性無γ-globulin血症の1例について報告するとともに,本邦報告例の集計を行ない報告例との比較検討をおこなつた.

THERAPEUTIC EFFECT OF SECRETIN IN PATIENTS WITH JAUNDICE ; DOUBLE-BLIND PLACEBO-CONTROLLED MULTICENTRIC TRIAL

Secretin, a gastrointestinal hormone, has been shown to have a potent choleretic effect. Having already obtained some beneficial effects with secretin in patients with intrahepatic cholestasis, we sought to confirm its effects in a double-blind placebo-controlled study in patients with mild jaundice after acute or during chronic hepatitis, where total bilirubin level was in excess of 4.0 mg/dl for 3 days or more. Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and familiar hyperbilirubinemia were excluded from the study. Ninety-three patients were included in this analysis, but the final evaluation covered 69 of them. No statisticaly significant differences were found in the reduction of serum bilirubin levels between secretin and placebo groups. As a number of patients with liver cirrhosis had been included, the subjects were subdivided into one group with cholestasis in hepatitis and one with liver cirrhosis. In the subgroup of cirrhotic patients who received secretin, serum levels of AST were significantly increased compared with the placebo group. However, since the choleretic effect of secretin is unique, further studies seem to be warranted.

Promotive effect of phenobarbital through hepatocarcinogenesis by 2-fluorenylacetamide in rats

肝細胞癌の発生機転(initiation)にHBウイルスやAlfatoxin B1などの化学物質の関与が論じられているが,未だ癌発生のもう1つの機転であるpromotorについては不明である.そこで,promotor解析のスクリーニング法を確立する目的でPerainoらの実験を追試し,彼らが38週という長期間の観察を要したことも,前癌性病変の出現に焦点をあてた場合,13週という短時間でもフェノバルビタールの発癌促進効果を明らかにしえた.さらに成熟ラットと離乳期ラットではフェノバルビタールの促進効果に違いがみられ,年齢による薬物代謝の相違点が明らかにされた.