Toshihiko Takenami

Early lesions and development of primary hepatocellular carcinoma in man--association with hepatitis B viral infection.

SummaryIt is well known that primary hepatocellular carcinoma could be derived from chronic hepatitis and liver cirrhosis in epidemiologic studies. However, it is still not clear what kinds of hepatocyte are premalignant cells. Recently we have focused on liver cell dysplasia as a possible premalignant cell, and showed localization of α-fetoprotein in the cytoplasma of these cells. Although the dysplastic cells were often seen in the liver of chronic active hepatitis, hepatitis B virus associated DNA polymerase activity was also significantly high in the sera from the patients with chronic active hepatitis. In this paper, we discuss the possible role of hepatitis B virus through hepatocarcinogenesis in human.

Carcino-fetal proteins and gastric cancer

SummaryAlthough several investigators have reported serum α-fetoprotein positive gastric cancer with or without metastasis to the liver, its site of production is still unclear. We studied on the site of α-fetoprotein synthesis in our cases which showed remarkably high level of serum α-fetoprotein, and clarified the presence of αfetoprotein producing gastric cancer by means of direct immunofluorescent technique. However, we also knew the hepatocytes adjacent to the metastatic lesions could also synthesize α-fetoprotein, although these hepatocytes were not known whether under regeneration or degeneration. Through this study, the other carcinofetal proteins such as carcino-placental alkaline phosphatase and CEA were examined using the sera or tumor tissues. Our results will support the idea that cancer is the disease of cell differentiation.

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.

Clinical course on patients with primary hepatocellular carcinoma surviving longer than one year.

当内科において,1969年から1975年まで化学療法をうけた原発性肝癌患者70例中12例は少なくとも1年以上の長期生存例であった.ここ2～3年,このような長期生存患者数は増加傾向にあった.これは早期診断と治療法の進歩による. 長期生存12症例について,既往歴,臨床経過,臨床生化学的所見ならびに病理解剖所見を検討した.8例は慢性肝疾患の経過観察中に発見されたもので,これら患者の5例は糖尿病を合併していた.長期生存例12症例中7例にHB抗原が認められた.したがって,HB抗原陽性,また糖尿病合併慢性肝疾患を厳重に追跡すべきである. 患者の血清アルブミン値や末梢血リンパ球数は末期では初期に比し有意に低下し,AFPや血清ビリルビンは増加した.これらは患者の予後判定因子として有用であろう.