Yoshiyata Takahashi

Aetiology and prognosis of fulminant viral hepatitis in Japan: A multicentre study

In 236 patients with fulminant viral hepatitis (FVH), type B (FBH) was most common (47.5%), followed by non‐A non‐B hepatitis (FNANB, 44.9%) and hepatitis type A (FAH, 7.6%). The survival rate was significantly higher in the FAH group than in the FBH and FNANB groups (61.1, 36.6 and 18.9% respectively), and was significantly higher in the FBH group than in the FNANB group. In spite of screening for hepatitis B virus (HBV), FBH was prevalent (27 of 41) in post‐transfusion cases; this phenomenon is discussed in relation to a recently revealed mutation of HBV. Within a month after the onset of hepatitis symptoms all cases in the FAH, 93% in the FBH and 79% in the FNANB group, developed encephalopathy. When the duration of illness before the onset of encephalopathy was more than 10 days (a subacute form), the survival rate was significantly lower than when encephalopathy developed in less than 11 days (an acute form). This difference could be accounted for by the difference in the relative frequency of aetiological viruses in the two forms and the higher survival rate in the acute, than the subacute, form in the FNANB group.

GASCHROMATOGRAPHIC ANALYSIS OF PLASMA FATTY ACID COMPOSITION IN ARTERIOSCLEROTIC PATIENTS

栄養学的見地より不飽和脂酸の抗粥状硬化性ないしは血清コレステロール低下作用が提唱されて以来,脂酸代謝と粥状硬化の関係が衆目を集めている.我々は,ガスクロマトグラフィーにより健常人及び動脈硬化性疾患々者血漿の脂酸を分析し,健常人においてはその脂酸構成がかなり一定性を保ちHomeostasisが保たれているが,動脈硬化群においては,リノール酸百分比が減少し,それを代償してオレイン酸,パルミチン酸,パルミトオレイン酸が増加し,このためL/O比(リノール酸/オレイン酸比)が最も著明な変化を示す事を見出した.この様なリノール酸百分比の減少は,他の脂酸相互間の平衡状態の変化を来たし,血清コレステロール及び血漿総脂酸濃度も,リノール酸百分比と負相関を示す.しかし動脈硬化群においてもリノール酸の絶対的欠乏は存在せず,コレステロールもリノール酸濃度とは相関せず,総脂酸濃度はリノール酸濃度と正の相関を示した.この様にリノール酸の他の脂酸に対する比の変化が,粥状硬化発生の原因ないしその進展と密接な関連を有する事を論じた.

Augmented utilization of branched-chain amino acids by skeletal muscle in decompensated liver cirrhosis in special relation to ammonia detoxication

SummaryFemoral arterio-venous (A-V) differences of blood free amino acids and plasma ammonia (NH3) were simultaneously determined after an overnight fast in 16 patients with decompensated liver cirrhosis in the absence and presence of encephalopathy, as compared with those in 8 control subjects. In spite of increased releases of phenylalanine (Phe) and tyrosine (Tyr) from the peripheral tissue, releases of isoleucine (Ile) and leucine (Leu) as well as alanine (Ala) were found to be significantly reduced in decompensated liver cirrhosis, particularly in the presence of hepatic encephalopathy. Furthermore, NH3 was found to be significantly taken up by the skeletal muscle of these patients, and a positive correlation was observed between arterial NH3 level and the A-V differences of Leu, of Ile and of Ala. These findings strongly suggest that net degradation (or utilization) of branched-chain amino acids (in particular, Leu and Ile) is enhanced in the muscle for detoxication of ammonia (i.e., glutamine synthesis) by supplying the carbon skeleton and energy in cirrhosis of the liver.

Age specific prevalence of anti HA in Japan--from multi-institutional analysis.

SummaryIn order to estimate age specific prevalence of Anti HA in Japan, 1757 serum samples from healthy subjects or patients with nonhepatic disease taken in 6 different districts of Japan were tested for Anti HA using HAVAB Kit.Very low prevalence, less than 10%, was observed in young adults or children. These facts indicate the young Japanese are quite susceptible to HAV infection and the effective preventive measures are urgently needed. Over all prevalence of Anti HA was 56.2%.Comparing the age specific prevalence of Anti HA in Japan with those in other countries, the situation in Japan was in intermediate between highly endemic South-East Asian region and developed European countries.

A controlled clinical trial of nicotinohydroxamic acid and neomycin in advanced chronic liver disease.

In a double-blind clinical trial, 24 patients with advanced chronic liver disease received 1.2 g of nicotinohydroxamic acid daily and 23 patients received 1.5 g of neomycin. Patients receiving nicotin

Histopatological findings of the liver before and during hepatic coma in fulminant hepatitis

SummaryThe histopathological findings of the liver taken by needle biopsy before and during hepatic coma of fulminant hepatitis were studied in 3 patients; two died and one survived. In the first fatal case, massive hepatic necrosis was already present 7 days before the development of hepatic coma. In the second fatal case, submassive hepatic necrosis was seen during coma grade IV. In both cases, histological findings of the biopsy liver specimens were in accord with those of the autopsied liver. In the third survived case, diffuse degeneration and multilobular liver cell necrosis were found on the biopsy specimen taken immediately after the development of hepatic coma, grade IV.

Application of a Circular Polarizing Device to an Electronic Endoscope for the Purpose of Prevention of Catch‐Light Phenomenon

Abstract: In recent years the electronic endoscope has been increasingly used by medical practitioners in Japan. However, it has been noted that the problem of too strong light refection, which, not only hampers the procedure but also causes eye exhaustion, at the same time making photographic or computerized image processing difficult, is more frequently experienced and is more serious in magnitude when compared with using a conventional fiberoptic endoscope (catch‐light phenomenon). In order to ameliorate this problem the authors experimented with the use of circularly polarized light. The combined use of a circular polarizing device to the efferent light path and a filter which blocks certain types of Circularly polarized light to the afferent path has proved to be very effective in eliminating the incidence of catch‐light troubles, thus making the endoscopic procedure smooth and efficient.

An epidemiological study of hepatitis B surface antigen subtypes among hepatitis B virus carriers.

岐阜県における献血者でHBs抗原陽性者672名および病院受診のHBVキャリアー122名のHBs抗原subtypeを測定した.献血者672名の検討では,1)年齢別にみると16～19歳ではadwがadrより多数例であったが加齢と共にadrが多数になり年齢によってsubtypeの分布が異なっていた.2)subtype別HBe抗原陽性率はadr 459名中26.8%, adw 192名中10.4%であり有意差を認めた(p<0.001).3)HBe抗原陰性例におけるHBs抗原価は若年者ではadwの方がadrより高い傾向にあるが30歳以降は逆転していた.一方,当院受診のHBVキャリアー122名ではadr 68名中垂直感染69.1%,水平感染30.9%であるのに対してadw 44名中垂直感染29.5%,水平感染70.5%であり,subtypeにより感染様式に差を認めた(p<0.001).小児HBe抗原陽性のadwではHBV-DNA量の高値例が多くみられ児から児への水平感染を来しやすいと考えられ,岐阜地方でのadrとadwのsubtypeのHBVのstrainでの違いが示唆された.

Astudy on the false-positive hepatic cancer

原発性肝癌の診断のもとに開腹した46例のうち,肝癌の認められなかった症例が4例(9%)ある.うち2例は血管造影にて診断され,各々右葉切除,左外側区域切除をおこない,他の2例はCTにて診断されいずれも試験開腹術にとどめた.血管造影にて診断された2例のうち1例は左肝動脈より分岐したaccessory left gastric arteryによる胃壁の濃染像を肝癌と誤診した症例で,超撰択的肝動脈造影がroutineに行なわれるようになった現在,同様のあやまちをおかす可能性があるので,肝癌との鑑別点につき検討を加えた.1.胃壁の濃染像は肝癌のそれと異なり均一である.2.静脈相におけるdrainage veinは左胃静脈の走行を示す.3.胃壁の濃染像は胃穹隆部の伸展度の差により形態が変化する.4.accessory left gastric arteryはumbilical pointの中枢側より左肝動脈から分岐する.5.立体造影,読影によりその走行はさらに明瞭となり肝癌との区別も容易となる.

Prognosis of the patients with clinical symptom of acute hepatitis B

昭和50年1月より,52年6月までに入院した輸血の既往のないHBs抗原陽性の急性肝炎様症状により発見された43例につき検討した.対象の肝炎を初診時のHBc抗体価の高低と持続,HBs抗原の持続または一過性により4群に分類した.I群はHBc抗体が陰性もしくは低力価(29>)で経過とともに上昇し,HBs抗原一過性陽性群で35例,II群はHBc抗体価が高く(210<)持続し,HBs抗原一過性の3例,III群はHBc抗体が高力価で持続し,HBs抗原も持続性の5例,IV群はHBc抗体が低力価で経過とともに上昇し,HBs抗原は持続性のものとしたが,この群は認められなかった.3群を比較するとI群10例の肝生検像はいずれも急性肝炎,III群は5例のうち4例が慢性肝炎活動性,1例は急性肝炎であった.またIII群はI群に比しZTT, AFPが有意に高かった.II群の組織像は慢性肝炎活動性,急性肝炎の各1例で,検査所見はI群とIII群のほぼ中間値を示した.6ヵ月以上の経過観察により,III群の4例に,トランスアミナーゼの再上昇がみられた.