Yasuyoshi Kiryu

CASE REPORT: Haemorrhagic colitis associated with royal jelly intake

The case report of a 53‐year‐old woman with abdominal pain and bloody diarrhoea is described. Prior to the onset of symptoms the patient had taken royal jelly for 25 days. Colonoscopy revealed that the mucosa was haemorrhagic and oedematous throughout the 20 cm long sigmoid colon. Histopathologically, mucosal haemorrhage, oedema, and infiltration of inflammatory cells were observed. Transmission electron microscopic examination revealed platelet aggregation in 30% of capillaries in the mucosal lesions. The drug‐induced lymphocyte stimulation test was slightly positive for royal jelly (847 c.p.m., SI= 147%) compared with the control (576 c.p.m.). The patients signs and symptoms disappeared within a few days after the initiation of conservative therapy, and the colonic lesions disappeared after 2 weeks of this therapy. This is the first reported case of haemorrhagic colitis associated with royal jelly intake.

Microvascular disturbances in the colonic mucosa in antibiotic-associated haemorrhagic colitis: Involvement of platelet aggregation

An ultrastructural study of the colonic mucosa was performed in four patients with antibiotic‐associated haemorrhagic colitis and new findings are reported. Colonoscopy was performed and biopsy specimens were obtained within 24 h of the onset of bloody diarrhoea. Colonoscopy demonstrated diffuse oedematous and haemorrhagic mucosa with erosions and white coat. Light microscopy revealed mucosal haemorrhage and inflammatory cell infiltration. Ultrastructurally, platelet aggregation was frequently present in the lumina of colonic mucosal capillaries, causing engorgement of red blood cells in adjacent microvessels. Mild to severe damage was observed in capillary endothelial cells, including discontinuity of basement membranes, gaps between endothelial cells and the destruction of capillaries. There was no evidence of microvascular spasm. In conclusion, our findings suggest that antibiotics directly or indirectly cause microcirculatory disturbances, which result in tissue damage and haemorrhage, in the colonic mucosa.

Therapeutic effect of histidine decarboxylase inhibitor on chronic active hepatitis

SummaryThe effect of orally administered histidine decarboxylase inhibitor on liver function tests and histological appearance as well as on plasma histamine level were evaluated in biopsy proven 13 patients with chronic active hepatitis, whose liver function tests were refractory to other measures.Tritoqualine was used as histidine decarboxylase inhibitor and was administered in dose levels of 600 to l,600 mg per day. Before treatment the average value of SGOT, SGPT and plasma histamine showed 252±24U, 318±152U and 15.2±5.5µ/L, respectively. Results obtained at six weeks’ treatment, however, gave significantly improved values, indicating SGOP 57±24 (p<0.001), SGOP 40±28 (p<0.001) and plasma histamine 8.6±0.4 (p<0.001). Serum gammaglobulin also tended to fall (p<0.1). Marked improvement was noted in reexamined biopsied specimen, representing disappearance of fibrogenesis as well as round cell infiltration in and around the portal tract, together with pericellular fibrosis. Four cases have been proven to be healed.Despite long-term administration, no obvious side effect was observed. Investigation for HBsAg revealed to be positive in 4, however, no conspicuous difference was seen from that of negative cases in the improvement.

Herpes simplex encephalitis: an autopsy case with isolation of type 1 herpes simplex virus.

SummaryAn adult case of herpes simplex encephalitis was studied after autopsy. Postmortem examination revealed necrotizing encephalitis associated with Cowdry type A intranuclear inclusion bodies in glial cells. Herper simplex virus type 1 was isolated from the removed brain. Herpes simplex virus antigens were detected diffusely in wide areas of the brain by immunofluorescent test and viral particles characteristic to herpes simplex virus were demonstrated by electron microscopy. There was an apparent discrepancy between severity of histological changes and distribution of virus antigen.

Role of plasma histamine in liver injury clinical and experimental investigations

SummaryPlasma histamine level (PHL) was evaluated by a modified fluorometric assay (Suzuki) in the patients with various forms of liver disease as well as rabbits with liver injury. And the data obtained were compared with liver function tests in assessing the stage and prognosis of hepatic dysfunction.In acute hepatitis, if its prognosis was “good”, as was also shown in the animal group with single dose administration of CC14, the level of plasma histamine attained a peak before that of serum transaminases, and returned to normal prior to that of the latter. In persistent and chronic hepatitis, although correlation betweenPHL and other liver function tests was poor and variable,PHL remained high. And the estimation ofPHL during the course of this state showed that it was elevated prior to that of serum transaminases, indicating high level of plasma histamine in this state, even in apparent “steady state”,’ worsening of the disease. In liver cirrhosisPHL correlated with the degree of serum transaminases as well as serum gammaglobulin. In “poor prognosis” group (patients with hepatic coma and rabbits treated with consecutive administration of CCI4)PHL increased extremely high, which was contrasted with the lowered levels of transaminases.These results strikingly suggest that histamine is involved in liver injury and estimation of PHL in the course of hepatic disorder is useful, for a prediction of prognosis.

A case of appendiceal mucocele showing massive mucous production with concomitant colonic cancer

SummaryA 58-year-old male patient presented with abnormal discharge of 200 ml transparent fecal mucus. Irregular protuberance of the ascending colon into the adjacent ileocecal region was observed by colonofiberscopy, and a cystic lesion in the ileocecal region was suggested by computerized axial tomography. Pale yellowish semitransparent jellied substances were observed exudating from the site of ileocecal resection. The diagnosis established was moderately differentiated colonic adenocarcinoma and a mucocele of the appendix. The mucus discharge disappeared after resection. Biochemical analysis of the mucus suggested the mucocele as a source of the discharged mucus. We report an extremely rare case of mucocele of the appendix that may be related to the cause of mucous stool.

An autopsy case report of primary hepatocellular carcinoma, cured by arterial infusion chemotherapy

56歳男性で昭和47年胃潰瘍の治療の為入院中に,肝腫大,肝機能異常,肝シンチグラムにて異常が指摘され,A.F.P.がSD法で陽性のため腹腔動脈撮影を施行,肝右葉下縁に30×17mmの腫瘍が発見された.2年後に肝右葉下縁に腫瘤を触知し,肝シンチグラムでも肝右葉下端に欠損像を認めた.A.F.P.はRadioimunoassay法にて10,217ng/mlであり腹腔動脈撮影では肝右葉は腫瘍血管で占められ原発性肝癌と診断された.この時Seldingerのカテーテルより腹腔動脈内にMitomycin C 20mgをone shot注入し,さらに家族の希望により4日目より蓮見ワクチンを使用した所,腫瘍は縮小し,A.F.P.も低下し正常化した.1年10ヵ月後,食道静脈瘤の破綻にて死亡し剖検したところ,肝癌のあったと考えられる所は瘢痕組織に置き換えられ病理組織学的にも癌細胞は発見されず,原発性肝癌は治癒したと考えられた.症例を呈示し,原発性肝癌の治療に関し若干の文献学的考察を加えた.

A CASE OF PERIODIC ATAXIA

47才の男性で一過性に数時間持続する失調性歩行,構音障害,協同運動障害,企図振戦の発作が反復する症例を報告する. 19才のとき全身の硬直があり倒れたことがある.その後も時々全身のこわばりがあり倒れることがあつたが,最近は1カ月に1～2回の頻度で発作がある,非発作時は何の症状もなく会社員として正常に勤務している.発作の誘因には精神的緊張,過労がある.発作は著明な失調性歩行,断綴性言語,協同運動障害,眼振および企図振戦が突然に起こる.そして何の処置をしないでも,発作後約2時間で構音障害が改善しはじめ, 6時間後には独力で歩けるようになり,約12時間後には水平および垂直方向の眼振以外は全く正常の状態となる.この眼振は非発作時にも認められる.諸検査成績はすべて陰性である.家族歴,既往歴に特記するものはない.周期性失調の1例と診断した.また周期性失調症の概念が混乱しているので従来の報告を整理し, I群Verger型周期性失調症, II群間欠性脊髄小脳変性症, III群器質疾患に伴う一過性周期性失調症状に分け,その特徴を論じた.本症例はI群のVerger型周期性失調症に属するものと考える.

Role of the splfen in hepatic disorders

SummaryExperimental studies, using albino rabbits, showed that following the sensitization with histamine and homologous liver antigen conspicuous liver injury, closely resembling chronic active hepatitis, which progressed into liver cirrhosis with pseudolobulus formation, could be induced. The splenic weight, obtained after the administration of several hepato-toxic substances, had intimate relation with serum gammaglobulin levels. Furthermore, in a group in which splenectomy was performed after the development of hypergammaglobulinemia, serum gammaglobulin resulted in a rebound increase in comparison with extremely low level of serum gammaglobulin in a group in which splenectomized prior to sensitization.These results may suggest that (1) autoallergic mechanism must be taken into consideration on the development of chronic liver disorders and the role of the histamine should never be ignored. (2) splenomegaly in chronic liver diseases should not be considered from hemodynamic disturbance alone, but one of the important reacting sites where many factors including antigen antibody reaction are involved.

The role of lymphatic truct on intestinal absorption (II) protein absorption in mackee’s dogs

ConclusionIt was emphasized that lymphatic truct played important role on intestinal absorption and transportation of protein as well as portal vein.