Tomoki Hatori

Incidence of ultrasound-detected intrahepatic hematomas due to Tru-cut needle liver biopsy.

This is a prospective study in which 120 patients with diffuse liver disease undergoing liver biopsy were followed by serial ultrasounds to determine the incidence of postbiopsy intrahepatic hematoma formation. Forty-five of the patients had a blind biopsy, while the remaining 75 patients had a biopsy performed during laparoscopy. In both groups a 2.0-mm Tru-cut needle was employed. The overall incidence of postbiopsy hematoma formation was 18.3%, with approximately the same results occurring in blind biopsy patients (20%) and laparoscopy-guided biopsy patients (17%). Only two patients had significant pain associated with the hematoma formation (one from each group), one of whom had evidence of intraperitoneal bleed and rebleed. Our results suggest that postbiopsy asymptomatic hematomas occur more frequently than had been generally thought and that laparoscopy-guided biopsy is not safer than blind biopsy.

Malignant transformation of Nakamura type IV gastric polyp with CA 19-9 production.

Abstract: In a 68-year-old Japanese man, a gastric polyp 24 mm in diameter with a stalk 15 mm in diameter was diagnosed as well differentiated adenocarcinoma and treated by endoscopic polypectomy. Histologically, most of the resected tissue was adenoma, and atypical cells were papillarily proliferating to form adenocarcinoma in adenoma, a Nakamura type IV gastric polyp. Infiltration of carcinoma was limited to within the mucosal layer. Immunohistochemical study with anti-CA19-9 antibody revealed positive staining in carcinoma cells. Serum CA19-9 level, which showed slight elevation, returned to the normal range 1 month after the polypectomy. The proliferating cell nuclear antigen (PCNA) labeling index and DNA ploidy pattern were analyzed in the resected tissue. The PCNA labeling index was 30% in carcinoma, 17% in adenoma, and 0.1% in the normal tissue. The DNA ploidy pat-tern was diploid in adenoma and aneuploid in adenocarcinoma. These findings suggest that gastric adenoma, as well as colonic adenoma, may have the potential for malignant transformation.

Report of a case with fulminant hepatitis a associated with acute renal failure

SummaryA 34-year-old male presented with fulminant hepatitis A associted with acute renal failure. The patient was admitted four days after flulike symptoms developed. Physical examination was unremarkable except for icteric sclerae. Laboratory studies showed SGOT 10719 U/l, SGPT 5780 U/l, prothrombin time 22%, BUN 25.5 mg/dl, and creatinine 2 mg/dl. Serum complements were within normal ranges, and circulating immune complexes were not detected. Anti-HAV IgM was positive.He developed hepatic coma on the fourth hospital day, and his renal function deteriorated progressively. He was treated with hemodialysis, but there was no improvement in consciousness. Although acute liver failure improved, he died on the 74th hospital day of subendocardial infarction. Autopsy examination showed acute renal tubular necrosis. The liver was enlarged and was in the residual stage of acute hepatitis without submassive necrosis. The development of fulminant hepatitis in hepatitis A has been rare, but in recent years acute renal failure in hepatitis A has been reported.Although the mechanisms responsible for renal failure in liver diseases are uncertain but could be multifactorial, immune complexmediated nephritis and/or endotoxemia have been considered.

Laparoscopic Findings of Asymptomatic Primary Biliary Cirrhosis —Particular investigation in early PBC—

Abstract: of 17 cases of asymptomatic primary biliary cirrhosis (PBC), seven cases whose ALP (alkaline phosphatase) was less than twice the upper limit of the normal range were defined as being “early PBC”, and ten cases whose ALP was more than twice the upper limit of the normal range were defined as being “classical PBC” in order to investigate their clinical pictures and laparoscopic findings.

Report of a case of fulminant alcoholic hepatitis.

アルコール性肝硬変にアルコール性肝炎を伴い,急性肝不全で死亡した1例を報告した.症例:46歳,主婦.皮膚黄染,皮下出血を主訴として来院.5～6年のアルコール歴と輸血歴があった.入院時,発熱,著明な黄疸と貧血を認め,右季肋下で肝臓を2横指触知した.皮下出血が両側大腿部から股関節部に認められ,昏睡度II度であった.血液検査で白血球の増多,高色素性・大球性貧血がみられた.HB関連抗原・抗体は陰性.プロトロンビン時間の延長,フィブリノーゲンの低下,FDPの上昇よりDICを併発していると考えheparin, gabexate mesilateを投与し,肝不全に対してprednisolone, glucagon-insulin療法を施行したが効果なく,DICを契機として消化管出血で第42病日死亡した.肝臓のnecropsyで多数のアルコール硝子体を認めた.本邦のアルコール性肝炎111例中37例(33.3%)が死亡例で,女性の報告例は少ない.アルコール硝子体の出現頻度は,肝硬変合併の死亡例で最も高かった.