Tetsu Nomiyama

Changes in serum levels of metalloproteinases and their inhibitors by treatment of chronic hepatitis C with interferon.

We treated 18 patients with chronic hepatitis C by recombinant interferon-α (6 MIU for 24 weeks). In seven patients, serum aminotransferase levels declined to normal (responders). To evaluate the effect of interferon on matrix metalloproteinases (MMPs) and their inhibitors, namely tissue inhibitors of metalloproteinases (TIMPs), the serum levels of these enzymes were determined by enzyme immunoassay (EIA) using a specific monoclonal antibody. In responders, there was a tendency, but not a significant one, towards either an increase in serum MMP 1 levels or a decrease in serum TIMP 1 levels. In contrast, in nonresponders, both a significant decrease in MMP 1 and MMP 3 and a significant increase in TIMP 1 were observed. The number of cases of either increase in serum MMP levels or decrease in serum TIMP levels was significantly larger in responders than in nonresponders. Furthermore, the ratio of MMP 1 to TIMP 1 significantly increased in responders, suggesting that the balance between matrix formation and degradation in hepatic fibrosis tended to move toward degradation. These data indicate that interferon may exert a beneficial effect on hepatic fibrosis in parallel with improvement of aminotransferase activity.

Gastric emptying in normal subjects and patients with peptic ulcer

SummaryGastric emptying in patients with peptic ulcer and normal subjects was studied using the acetaminophen method. The subjects consisted of 15 normal subjects, 52 gastric ulcer patients and 65 duodenal ulcer patients, who were studied in active stage of the ulcer. As an indicator of gastric emptying rate, the plasma acetaminophen concentration was measured by dye method (diphenylhydrazyl), as meg/ml, at 45 minutes after ingestion of a high calory pasty test meal (200 ml) with 1.5gr of acetaminophen.In normal subjects, the plasma acetaminophen concentration was 9.4±3.6mcg/ml. In gastric ulcer patients, the concentration was 7.4±3.2mcg/ml, which showed significantly delayed gastric emptying (P< 0.05). In duodenal ulcer patients, the concentration was 11.6±3.3mcg/ml, which suggested significantly rapid gastric emptying (P< 0.05).In consideration of gastric acid secretion, gastric ulcer cases with lower acid secretion have more delayed gastric emptying. In duodenal ulcer cases with hypersecretion, gastric emptying is more rapid than normoand/or hyposecretory cases (P< 0.005).The delayed gastric emptying may play a role in etiology of gastric ulcer. On the other hand, the rapid gastric emptying with gastric acid hypersecretion may be important in the pathogenesis of duodenal ulcer.

Lesions of the upper gastrointestinal tract in patients with chronic renal failure

SummaryEndoscopy of the upper gastrointestinal tract was performed on 84 patients with end-stage chronic renal failure undergoing hemodialysis. Gastric acid secretion and fasting plasma gastrin levels were also examined in these patients.Hemorrhagic gastritis was most frequently observed (23 cases) followed by erosive gastritis (18 cases). No patients had gastric ulcers. Duodenal ulcers were observed in only two patients. Gastrointestinal bleeding was observed in 15 cases (17.9%). Thirteen of these 15 cases had hemorrhagic gastritis, one of which had a duodenal ulcer as a complication.Fasting plasma gastrin levels (359.6 ± 336.5 pg/ml) were significantly higher than those of normal subjects (35.2 ± 37.1 pg/ml), but no acceleration in gastric acid secretion was observed either in the basal condition (BAO 0.8± 0.7 mEq/h) or following tetragastrin stimulation (MAO 9.0 ± 6.9 mEq/h).Our results were inconsistent with the previous reports that high frequencies of peptic ulcers and increased gastric acid secretion were observed in patients with chronic renal failure.Our data suggest that the defensive factors rather than the aggressive factors of the gastroduodenal mucosa may be involved in chronic renal failure.

Acute hepatitis in an adult with acquired rubella infection

We report a case of acute hepatitis in a 28-year-old male with acquired rubella infection. Serological tests revealed acute rubella virus infection and ruled out infection by other common viruses, including type A and type B hepatitis viruses. The patient showed not only marked increase of lactate dehydrogenase (LDH) activity, with only slight liver dysfunction, but also platelet and kidney injury, suggesting systemic rubella virus infection. Because the liver dysfunction was slight, liver biopsy was not performed. When a patient has mild, transient hepatitis accompanied by high LDH activity in comparison with both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, we should take a common viral infection such as rubella into consideration when making a diagnosis.

GASTRIC EMPTYING IN PATIENTS WITH GASTRODUODENAL DISEASE FIRST REPORT

試験食として自然食を主とした流動食を用いたacetaminophen(以下APAPと略す)法で胃排出機能検査をおこない,服用後45分の血中APAP濃度(mcg/ml)をもつて胃排出能とした.消化性潰瘍の胃排出能,酸分泌能と胃排出能に検討を加え胃潰瘍と十二指腸潰瘍の相違を胃排出能の面から考察した.又消化性潰瘍の再発とそれぞれの潰瘍の胃排出能との関係についても検討した.活動期の胃潰瘍,十二指腸潰瘍の胃排出能はそれぞれ, 7.7±3.3mcg/ml, 11.3±3.4mcg/mlであり,健康正常者のそれは9.4±2.6mcg/mlであつた.胃潰瘍では明らかに胃排出能の遅延(p<0.05)が認められ,十二指腸潰瘍では明らかに胃排出能の亢進が認められた(p<0.05).酸分泌能との関係では胃潰瘍では低酸,正酸,過酸をとわず胃排出能の遅延が認められたのに反し,十二指腸潰瘍では過酸ほど胃排出能の亢進が認められた(p<0.025).再発のあきらかな胃潰瘍患者の胃排出能は6.8±3.0mcg/mlであり,再発未確認例(10.4±4.3mcg/ml)に比し有意に胃排出能の遅延が認められた(p<0.005),一方,十二指腸潰瘍においては再発のあきらかな例の胃排出能は11.9±4.0mcg/mlと,再発未確認例の9.3±3.5mcg/mlに比し明らかに胃排出能の亢進が認められた(p<0.025).