Toshimi Hasui

Quantitative detection of hepatitis C virus genome in liver tissue and circulation by competitive reverse transcription-polymerase chain reaction

We quantified hepatitis C virus RNA in 25 Japanese patients with chronic type C liver disease by competitive reverse transcription-polymerase chain reaction. The amount of the viral RNA in the serum (2×105−2×108 copies/ml) correlated with that in the liver tissue (108−1011 copies/g) (N=23,r=0.727,P<0.0001). One gram of the infected liver tissue contained 102−104 (geometric mean, 103,N=23) times as many copies of the viral RNA as did 1 ml of the serum. Liver tissues of chronic aggressive hepatitis contained significantly higher amounts of the viral RNA than those of chronic persistent hepatitis (P<0.05). These observations suggested that this method is useful to evaluate viral amount, and the amount of the circulating hepatitis C virus RNA could be used as a marker of the intrahepatic viral amounts, which might contribute to disease activity.

Peritoneoscopic Findings of Autoimmune Hepatitis

Abstract: To clarify the morphologic differences between hepatitis C virus (HCVI‐negative autoimmune hepatitis (AIH) and HCV‐positive AIH, peritoneoscopic findings were studied. Among twenty three patients with AIH according to the Japanese criteria (1992), 15 were HCV‐negative and 8 were HCV‐positive. The terms grooved depression, coarse depression, coarse elevation, coarse undulation, and round‐shaped reddish marking (RM) were used in this study to evaluate the peritoneoscopic findings. Grooved depressions, coarse depressions, coarse elevations, coarse undulations and round‐shaped RMs were all common findings (53%, 87%, 73%, 80%, and 80%, respectively) in HCV‐negative AIH patients, but they were less common (13%, 25%, 13%, 13%, and 0%, respectively) in HCV‐positive AIH patients. This study revealed that HCV‐negative AIH patients had different peritoneoscopic findings from HCV‐positive AIH patients. Thus HCV‐negative AIH may be typical AIH, and HCV‐positive AIH may essentially be a subset of type C chronic hepatitis.

Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy

Background and study aims  Salvage therapy for esophageal cancer following chemo-radiation therapy (CRT) has not been established. We aimed to evaluate endoscopic submucosal dissection (ESD) as a salvage therapy based on histopathological features of lesions. Patients and methods  We compared 10 lesions in eight patients with local residual, recurrent, or metachronous esophageal squamous cell carcinoma treated by ESD after CRT (CRT group) and 59 lesions treated by ESD without CRT (non-CRT group) during the same period. Results  The en bloc resection rate was 100 % while the complete resection rate was 80.0 % in the lesions after CRT, indicating no difference between the CRT and non-CRT groups. Pathological examination showed that fibrosis was more intense in the lamina propria mucosa, muscularis mucosa, and submucosa. The muscularis mucosa was thicker in both non-tumor and tumor sites in the CRT group compared to the non-CRT group. However, severe submucosal fibrosis was observed only in one lesion in the CRT group. The maximum diameter of the submucosal artery was significantly larger in the CRT group ( P  < 0.001). Conclusions  Compared to the non-CRT group, the lesions in the CRT group were accompanied by fibrosis while the muscularis mucosa were thicker; however, severe fibrosis of the submucosa was rare. It is important to dissect the muscularis mucosa appropriately during ESD, which makes successful dissection of the submucosa possible. Attention should be paid to bleeding from large arteries.