Contrast-enhanced intraoperative ultrasonography of small hepatocellular carcinomas

Nine patients with small hepatocellular carcinomas, ranging up to 2 cm in size (phi: 1.7 +/- 0.2 cm, mean +/- SD), have been encountered, and in two of these patients the cancer was not identifiable by intraoperative ultrasonography. Thus to achieve a better detection of such small hepatic cancers, enhanced intraoperative ultrasonography was tested. Detection by enhanced intraoperative ultrasonography proved successful in all cases. These preliminary results indicate the potential of carbon dioxide as a contrast agent to enhance intraoperative visualization of small liver cancers.     

Tumor markers in human breast cancer

We described tumor markers which are considered to be useful for the detection of recurrence, index of the efficacy of treatment and assessment for the prognosis of the patients with breast cancer. CEA and CA 15-3 are relatively useful markers among various serological ones. However, although accuracy of the diagnosis with CA 15-3 and CEA is generally thought to be not superior to those of imaging method, CA 15-3 and CEA seems to be clinically useful tools for making diagnosis because of its simplicity and less cost. Estrogen and progesterone receptors shows good responses to endocrine therapy. Response rate was 70 to 80% in both receptor-positive patients. Presence of ER shows higher rate of recurrence and shorter survival of the patients than those with absence of ER. Recent attention has been focused on EGF and proto-oncogene, suggesting relationship of those to prognosis.     

Effects of tension on local blood flow in experimental intestinal anastomoses

In intestinal anastomoses, local blood flow is one of the most important factors contributing to the success of the healing process. While submucosal local blood flow is maintained better in the colon than in the small intestine, the incidence of anastomotic leakage is higher in the former than in the latter. To resolve this conflict, we have examined differences in the reactivity of the intestinal segments toward the application of tension. Anastomosis was performed with a stapler on the jejunum, ileum, and colon of experimental dogs. The anastomotic sites were subjected to tensile loads applied in incremental steps to measure and compare local blood flow, measured by the hydrogen clearance method, in the submucosal layers of the anastomoses in these intestinal segments. The results of these comparative evaluations indicate that, at a tensile stress level of more than 4 g/mm2, local blood flow in the colon is significantly smaller than that in the jejunum and ileum. These findings were corroborated by microangiographical observations carried out during stress application. The microangiographical data suggest that the rate of filling of the contrast medium is lower with colonic anastomosis than with jejunal and ileal anastomoses. In addition, the intraluminal pressure of the colon was higher than that of the small intestine during the induced peristalsis. The different sensitivity of the local microcirculation systems of the intestinal segments to tension may thus be considered one of the factors accounting for the higher incidence of clinical suture failure in colonic than in small intestinal anastomoses.     

Nationwide investigations of intestinal obstruction in Japan

Two nationwide questionnaire surveys of intestinal obstruction in Japan were undertaken, covering two two-year periods, from January, 1975 to December, 1976 and from January, 1985 to December, 1986, respectively. The findings of a comparative review of these two surveys indicated that although the overall mortality of intestinal obstruction had not changed between 1975/76 and 1985/86, being 6.8 per cent and 6.5 per cent, respectively, simple adhesive obstruction had decreased from 3.2 per cent in 1975/76 to 2.0 per cent in 1985/86. The main cause of adhesion was laparotomy and in cases of both simple adhesive obstruction and strangulated adhesive obstruction, the rate of adhesion secondary to laparotomy of the upper gastrointestinal tract and colon and rectum had increased between 1975/76 and 1985/86. Obstructions caused by neoplasms had increased from 8.2 per cent in 1975/76 to 10.0 per cent in 1985/86, while those caused by adhesions had incresed further still, from 42.5 per cent in 1975/76 to 60.8 per cent in 1985/86. Among the latter group, nonoperatively treated cases had increased, which may be accounted for by the fact that facilities which adopt non-operative treatment using intestinal decompression as the first choice for simple adhesive obstruction cases have increased. In both surveys, the mortality of cases receiving nonoperative treatment was lower than that of operative cases.     

Production of monoclonal antibodies against rice dwarf virus and characterization of antigenic proteins with affinity media

Hybridomas were developed which secreted antibodies to the core and outer capsids of rice dwarf virus (RDV). The reactive proteins of RDV were simply and rapidly analyzed using monoclonal antibody (MoAb)-coupled Affi-Gel 701 beads and SDS polyacrylamide gel electrophoresis and were isolated with a MoAb-coupled Sepharose 4B affinity column.     

LIVER CHANGES IN HEPATOCEREBRAL DISEASE*

An attempt of pathogenetic analysis of Wilson's disease and Inose's disease, the two most important varieties of hepatocerebral diseases, was made from the facette of the hepatic pathology. The liver changes of a total of 43 human autopsy cases(19 of Wilson's and 24 of Inose's disease) were reevaluated. Concurrently an attempt of experimental production in animals of hepatic lesions compatible with those of Wilson's disease was made. Inose's special type of hepatocerebral disease is divided into two subgroups, a shunt form and a nutritional form. Cerebral damage in the shunt form is attributed to the portal-systemic collaterals, while the clinicopathological survey of the cases with the nutritional form indicates that functional disturbances, related unbalanced diet or endocrine abnormality, seem to cause brain damage. In Wilson's disease, three stages are noted from the analysis of the liver changes; fibrosis or monolobular cirrhosis in the first stage, submassive necrosis or active postnecrotic cirrhosis in the second stage and multilobular cirrhosis or arrested postnecrotic cirrhosis in the third stage. Experimentally, monolobular cirrhosis could be produced in animals by copper administration alone, whereas postnecrotic cirrhosis was first reproduced by a combination of copper administration and low protein diet, anti-kidney serum, or copper nephrosis. It is suggested that for the development of postnecrotic cirrhosis in the second and third stages of Wilson's disease an additional factor other than copper is needed, and that this second factor may be the deficiency of SH- containing aminoacids.     

Non-A, non-B hepatitis related AN6520 Ag is a normal cellular protein mainly expressed in liver. II

Detection of AN6520 Ag/Ab in human sera had indicated a close association with non-A, non-B hepatitis (NANBH). In this study, we investigated the immunochemical nature of AN6520 Ag and measured the amounts in various human and chimpanzee organs in order to clarify the association with NANBH. AN6520 Ag was found to be composed of polypeptide(s) with an apparent molecular weight of 45,000 daltons (45 kD), which are noncovalently linked together. Human antibodies in convalescent sera from NANBH patients as well as monoclonal antibodies were found to recognize only the high-order structure of the antigen, whereas rabbit antibody recognized both the high-order structure and the reduced form of 45 kD polypeptide(s). AN6520 Ag could be detected in most of the livers tested including those without any liver damage and fetal livers; their amounts varied considerably from each other. The antigen could be detected also in organs other than liver, but in contrast to liver, the amounts were small and did not vary as much between individuals. From the data of immunoblotting using rabbit antibody, our observed variation of antigen content in liver was considered to be due to the difference in expression of 45 kD polypeptide(s). Although no specific relationship was found between the amount of the antigen in liver and NANBH, the antigen was found to increase several times in livers of chimpanzees after the inoculation of NANBH virus. These data suggest that AN6520 Ag is a normal cellular protein existing mainly in liver and that its quantity may vary under some conditions such as NANBH.     

Probable implication of mutations of the X open reading frame in the onset of fulminant hepatitis B

A pathogenic role of precore-defective mutation in the onset of fulminant hepatitis B has been suggested. However, precore-defective mutants do not always cause fulminant hepatitis B and are not always isolated from affected patients. These findings strongly suggest the presence of some additional important mutations outside the precore region in fulminant hepatitis. In the present investigation an attempt was made to sequence the X open reading frame of hepatitis B virus DNA isolated from seven patients with fulminant hepatitis B and five patients with acute hepatitis B. The latter were used as controls. Since the X open reading frame encodes the X protein and contains the core promoter/enhancer II complex, some critical mutations may enhance or disrupt the replication and expression of hepatitis B virus DNA leading to fulminant hepatitis. A C-to-T substitution was found at nucleotide (nt) 1655, an A-to-T substitution at nt 1764 and a G-to-A substitution at nt 1766 in 4, 5 and 5 patients, respectively, out of the seven with fulminant hepatitis. These substitutions were not recognized in the patients with acute hepatitis. These mutations might change the function of the X protein and core promoter/enhancer II complex. It is suggested, therefore, that these mutations, as well as the precore-defective mutation, may play an important role in the pathogenesis of fulminant hepatitis. © Wiley-Liss, Inc.