Takeshi Takasaki

Hepatitis viruses in southern taiwan—mass survey of 2985 inhabitants

SummaryA survey of 2985 apparently healthy Taiwanese in southern Taiwan revealed a high prevalence (18.2%) of hepatitis B surface antigen (HBsAg). It was significantly higher in males (22.3%) than in females (13.6%), but no correlation with family origin, socioeconomic status or residence was established. About one-third of the breeding female HBsAg carriers were HBeAg-positive, and these may be an important source in the spread of HBV. Subtyping of HBsAg in 63 subjects showed adw to be dominant in this area, and 8 subjects with suspicious results had overlapping heterotypic HBV’s (7 adwr and 1 adyw) in addition to 2 subjects in which coexistence of HBsAg and anti-HBs was recognized. The association between HBsAg positivity and serum transaminase elevation was significant, especially in the older groups who had a higher abnormal rate. Hepatitis A virus infection was serious too, with nearly 100% of people above 20 years of age being anti-HA antibody positive.

Hepatocellular carcinoma not associated with cirrhosis. A clinicopathological study in 41 patients including 29 resected cases

Abstract Clinicopathological features were studied in 41 patients with histology‐proven hepatocellular carcinoma without cirrhosis. Of these, 13 (31.7%) were positive for hepatitis B virus surface antigen (HBsAg) and 28 were negative. Twenty‐six of 28 (92.9%) HBsAg negative cases had anticore antibody (anti‐HBc) of low titres. The age of patients at the time of diagnosis of hepatocellular carcinoma was significantly younger in the HBsAg positive cases compared with the negative. The initial diagnostic clue was either abdominal mass or abdominal pain in 18 (43.9%) patients. However, the number of patients in whom hepatocellular carcinoma was detected by imaging in the absence of such clinical signs has increased recently. The tumour was encapsulated in 31 cases (75.6%) and most solitary encapsulated tumours were growing expansively. Tumours were resectable in 29 (70.7%) cases, and the prognosis of resected cases was much better than that of 12 non‐operated cases. Twenty‐one out of 29 (72.4%) resected tumours were solitary and encapsulated. However, recurrence of tumour occurred in 12 out of 28 (42.9%) cases, and it was within 2 years of resection in 11 cases. These observations and data seem to indicate that early detection and resection of tumour is very important in management, but tumour recurrence is inevitable in a considerable proportion of the patients with non‐cirrhotic hepatocellular carcinoma.

Living related orthotopic liver transplantation: A pathological feature of 64 liver biopsies from 24 patients.

生体部分肝移植後の肝生検組織を臨床病理学的に検討した. 対象は, 1991年1月から97年7月までに当院で生体部分肝移植を施行した46例のうち移植後肝生検を施行した24例 (男10, 女14, 0～14歳18, 15歳以上6) 64標本である. 原疾患は先天性胆道閉鎖症12例, 劇症肝炎5例, 原発性胆汁性肝硬変3例, 新生児肝炎, 原発性硬化性胆管炎, 肝芽腫, C型肝硬変各1例である. 標本の組織所見は急性拒絶反応38標本, 慢性拒絶反応3標本, 血流障害3標本, 胆汁流出障害14標本, 原疾患の再発3標本, Functional cholestasis 13標本, Neutrophilic infiltrates 10標本, Fatty liver 9標本, その他9標本であった. このうち急性拒絶反応と他の病態との合併は胆汁流出障害6標本, 原疾患の再発1標本, Functional cholestasis 10標本, Neutrophilic infiltrates 3標本, Fatty liver 2標本で, 38標本中24標本 (63%) に合併病変を認めた. 移植後の病態は複雑であり肝生検所見, 臨床所見より病態を総合的に判断することが重要である.

Sero-epidemiological survey of hepatitis virus infection in Taiwan: A study in 6863 subjects from the general population

Abstract A sero‐epidemiological study was made of 6863 apparently healthy randomly selected volunteers from various parts of Taiwan. It revealed an 18% incidence of hepatitis B surface antigen (HBsAg) carriers amongst the general population, the prevalence being significantly higher in males than females (21.7% vs 14.1%). The Takasago natives showed the highest HBsAg carrier rate (27.0%). Those who are primarily derived from Ming Nan had a significantly higher prevalence (19.0%) than those from Hakka (14.7%) and recent immigrants from Mainland China (14.6%). About one‐third of female carriers of child‐bearing age in southern Taiwan were positive for e antigen (HBeAg) in a limited study; they may be an important source of HB virus (HBV) infection. The positivity rate for HBeAg was significantly higher in subjects below 40 years of age (36.7%) than those above 40 years (7.5%). There was a significant association between HBsAg positivity and elevated serum transaminase levels, especially in males; 20.3% of carriers had elevated transaminase in comparison with 11.1% of female carriers. Among HBsAg seronegative individuals, the frequency of abnormal transaminase increased with age with an overall abnormality rate of 10.6% in males and 5.0% in females, suggesting that factors other than HBV may also contribute to liver disease in Taiwan. Altogether, 9.3% had elevated transaminase. Out of 82 randomly selected HBsAg carriers who were evenly distributed in geography, serum antidelta antibody was positive in only five men (6.1%), of whom four had a mild elevation of transaminase levels (< 100 KU). The overall positivity rate for anti‐hepatitis A (HA) antibody was 93.0% in southern Taiwan, indicating poor sanitation. These findings indicate that HB and HA virus infections are highly endemic in Taiwan and that delta infection is infrequent despite a high prevalence of HB virus infection.

1) Diagnosis of benign papillary lesions by cholangiography and biliary pressure study

Diagnosis of benign papillary lesions including organic and functional changes is significant clinically because of a close relationship of the lesions and the diseases of the liver, biliary tract and pancreas 1). The X-ray study was made by PTC and to analyse videotaped images. The pressure study was done by using Microt ip Catheter Transducer that was inserted through T tube into the common duct. From the pressure curve, the value of the closing and opening pressure were found. The histological study was made to investigate the specimens obtained by papilloplasty and by autopsy as the control materials~L The results are as follows : 1) The pathologic findings of the papilla of Vater were divided into 3 types; inflammation type (I), glandular and/or fibrous proliferation type (II) and adenosis (adenomyosis) type (III) . 2) The pathologic findings of cholangiograms are rigidity and stenosis. The former was histopathologically based on the type I and the latter was chiefly based on the type I I or I I I . The cholangiograms of the lower end of the common bile duct were divided into 4 types; normal type, fingertip type, funnel type and sclerosed-tapering type. The fingertip type was seemed to be chracteristic of primary papillary stenosis. 3) The findings of the biliary pressure were divided into 3 types based on the level of the opening pressure; hypertensive, hypotensive and normotensive types. In cases with the hypertensive type with high level of the closing pressure, functional disturbance ot the papilla may be considered, whereas organic changes may be present in cases with low level of the closing pressure. References 1) Hess, W.: Surgery of the biliary passages and tile pancreas. D. Van fflostrand Company, Inc. 1965. 2) Tanabe, T.: Pathological study of papilla of Vater including the relationship between the biliary tract and the pancreas. Japanese Journal of Gastroenterology 71: 973-988.