Tohru Hisauchi

A case of gallbladder carcinoma producing both α-fetoprotein (AFP) and carcinoembryonic antigen (CEA)

SummaryA 73-year-old woman with gallbladder carcinoma infiltrating to the liver presenting high serum values of AFP and CEA was reported. Serum values of AFP and CEA were remarkably high (165,000 ng/ml and 1,070 ng/ml). Immunohistochemically the tumor cells were stained for AFP and CEA by the PAP method. Serum AFP subfraction was analyzed by crossed immunoaffinoelectrophoresis with lentil lectin and concanavalin A, which showed most of the serum AFP bound to both lentil lectin and concanavalin A. As a case of gallbladder carcinoma presenting a high serum value of AFP is rare, it may imply a diagnostic challenge.

A case report of leiomyosarcoma originating in the ligamentum teres of the liver

SummaryA case of leiomyosarcoma that appeared to have originated in the ligamentum teres hepatis of a 66-year-old female has been presented. The case was suspected of leiomyosarcoma originating in the ligamentum teres of the liver from the findings by preoperative examinations, and definitely diagnosed as such in a laparotomy and by histological examination of the resected tissue specimen.

The diagnostic value of pneumoperitoneogram for splenomegaly in chronic liver diseases

SummaryThe splenic enlargement is an important symptoms of portal hypertension, and various attempts have been made to objectively describe it. But, endoscopic diagnosis for splenomegaly in chronic liver diseases may be sometimes difficult for these uncharacteristic appearances.The pneumoperitoneography was performed in 141 chronic liver diseases just before laparoscopic procedure, size and form of the spleen on X-ray film were measured and analysed.We have compared these results with the laparoscopic findings (the gross appearance of liver and spleen, the degree of portal hypertension, etc.), the patterns on scintigram and the histological findings of the liver.There were fairely good correlation between the splenic findings on radiogram and above factors, especially the size of the spleen was gradually increased according to the degree of portal hypertension and the fibrous change of the liver specimens.In conclusion, the findings of spleen on pneumoperitoneogram were valuable for diagnosis of splenomegaly in chronic liver diseases.

Birth weight and cardiovascular risk factors in Japanese young adults.

A number of studies have recently shown a significant inverse relationship between birth weight and incidences of chronic and metabolic disorders such as hypertension and type 2 diabetes, though the findings are not consistent. So far, few investigations have been performed to determine whether this relationship exists in Japanese young adults. We investigated the influence of birth weight on cardiovascular risk factors such as blood pressure and several metabolic variables in Japanese young adults. The data of 299 medical students of Dokkyo University School of Medicine (207 men, 92 women; mean age +/- SD: 23 +/- 2 years) who underwent a medical check-up in 1998 were analyzed. Information on pregnancies and measurements at birth were obtained from The Maternal and Child Health Handbook, which is provided to every pregnant woman by the Ministry of Health and Welfare of Japan. Blood pressure was measured twice in the sitting position using an automated device based on the cuff-oscillometric method. The systolic and diastolic blood pressure in young adulthood was positively correlated with current body weight and body mass index (BMI) in both genders. Although birth weight was not significantly correlated with blood pressure in the young adults examined in the present study, male birth weight was inversely correlated with serum total cholesterol and triglyceride concentrations in young adulthood, independently of current BMI. These results partly support the hypothesis for the first time that low birth weight may be one of the risk factors for subsequent cardiovascular disease in Japanese men.

A case of idiopathic portal hypertension after renal transplantation

SummaryA case of idiopathic portal hypertension (IPH) developing after renal transplantation is reported. A 33-year-old Japanese male who had undergone renal transplantation 8 years previously was transferred to our hospital because of hematemesis from ruptured esophageal varices. He had no history of any liver disease before the renal transplantation, but had a history of receiving blood transfusion. Abdominal computed tomography (CT) and ultrasonography revealed marked splenomegaly and collateral channels, but no obliteration which might cause portal hypertension in the hepatic or portal vein. No findings suggestive of hepatitis or liver cirrhosis were found either macroscopically on laparoscopy or by liver biopsy. Light microscopic study of the liver biopsy specimen showed mild periportal fibrosis, inconspicuous portal branches in the most peripheral tracts, but no pseudolobule formation or piecemeal necrosis. However collagen deposition was found in the perisinusoidal space and partly in intercellular space on electron microscopy. We consider that the development of portal hypertension in this case is responsible for the collagen deposition, which may be related to the administration of azathioprine after renal transplantation. There are few reports on IPH after renal transplantation, and it is stressed that a lower amount of azathioprine than previously reported may induce IPH under such conditions.

Marked atrophy of the right lobe seen in idiopathic portal hypertension confirmed by laparoscopy

A 70‐year‐old‐male was hospitalized for the treatment of esophageal varices and close examination of the liver. Blood chemistry tests revealed mild liver dysfunction. Abdominal ultrasound and computed tomography scan revealed marked atrophy of the right and quadrate lobes of the liver without abnormalities of the biliary system. Abdominal angiography revealed marked atrophy of the right lobe of the liver, without obliteration in the portal venous system, but it could not be determined whether the atrophy was congenital or secondary. Subsequently performed laparoscopy revealed marked atrophy of the anterior segment of the right lobe and quadrate lobe with the whitish scarred edge demarcating the border between the edge and neighboring liver parenchyma. The liver surface appeared to be undulant, but non‐cirrhotic. These findings suggest secondary lobar atrophy of the liver, without cirrhosis. Liver biopsy of the left lobe showed the findings to be compatible with idiopathic portal hypertension (IPH), and we diagnosed IPH based on these findings and hepatic lobar atrophy was attributable to IPH. There have been few reports of cases with hepatic lobar atrophy associated with IPH, and the mechanism of atrophy is unclear. We report a case of IPH with marked liver atrophy in which laparoscopy is a decisive means whether liver atrophy is congenital or secondary.

The diagnostic value of pneumoperitoneogram on laparoscopy

SummaryLaparoscopy is widely used for the diagnosis of liver diseases. However, the accurate size of the liver and spleen, and the rigidity of the liver can not be known objectively on laparoscopy. In order to make up these weak points of this procedure, we have used pneumoperitoneogram in combination with laparoscopy. And we tried to express quantitatively of these abnormal findings.The study was performed in 223 patients with chronic liver diseases.After infusion of air or nitrous oxide (2 — 2.5L) into the abdominal cavity as a procedure for laparoscopy, X-ray films were taken on various position. On these films the various values of the hepatic and splenic shadows were measured as follows: those were an angley (it means the rigidity of the liver), A (length of the right lobe of the liver), S (area of the splenic shadow) and L (area of the hepatic shadow).Results werea)The angley has a trend of increase as the nodularity of liver surface, and it tends to increase in proportion to the degree of liver fibrosis on biopsy.b)Value A shows the atrophie tendency of the right lobe of the liver in chronic liver diseases.c)Area of the splenic shadow (S) tends to increase on nodular liver on laparoscopy. Besides value S/L were thought to reflect the chronicity of liver disease. Then, various values measured on pneumoperitoneogram may be useful indices for diagnosis in chronic liver diseases.A pneumoperitoneogram may be safty as a procedure for laparoscopy, and also it is useful for determining an appropriate inserting point of laparoscope.Laparoscopy alone could not make perfect observation in the abdominal cavity, so rarely only pneumoperitoneogram can give an accurate diagnosis in such cases whose lesions are missed on laparoscopy.

Abstracts of selected papers presented at the 73rd general meeting of the Japanese Society of Gastroenterology Tokyo, Japan, April 7–9, 1987

S OF SELECTED PAPERS PRESENTED AT THE 73RD GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY Tokyo, Japan, April 7-9, 1987 Chairman : Shinroku ASHIZAWA, M. D.

A follow-up study of liver function tests after surgical treatment for gallstone diseases.

SummaryThe follow-up study of liver function tests was made to 204 cases operated for gallstone diseases. The cases were divided to five groups according to alterations in liver function tests checked by the value of S-GOT, S-GPT, S-ALP activity and serum bilirubin.The location of stones, surgical procedures, effects of the use of anesthetics, and blood transfusion were studied.Concernig the locations of gallstones, the incidence of liver dysfunction tends to be high in a group of choledocholithiasis, compared with that in a group of cholecystolithiasis.For the surgical procedure, the incidence of liver dysfunction is high in the cases of choledochotomy, compared with that in the cases operated by cholecystectomy.The incidence of liver dysfunction is high in the group with blood transfusion, compared with that in the cases without blood transfusion.The survey of postoperative subjective symptoms by the questionnaire method revealed that prognosis was favourable in 73.2%, relatively favourable in 17.1%, slightly poor in 8.0% and poor in 1.8% of 164 patients. And the postoperative subjective symptoms were diarrhea (25.9%), back pain (25.9%) and abdominal pain (22.1%).