Spontaneous regression of multiple pulmonary recurrences of hepatocellular carcinoma after hepatectomy: report of a case

Spontaneous regression of hepatocellular carcinoma (HCC) is an extremely rare phenomenon. We herein report the case of a 73-year-old man who showed the spontaneous regression of multiple pulmonary recurrences of HCC that had occurred after hepatectomy. The patient was undergoing dialysis due to diabetic renal failure when ultrasonography revealed a liver tumor (diameter ~ 10 cm). A preoperative diagnosis of HCC with hepatic vein thrombosis was made. The liver function was well preserved and then the right hepatic vein area was resected. Two months after hepatectomy the α-fetoprotein level increased, and multiple lung nodules were observed on follow-up computed tomography. A diagnosis of multiple lung metastases was made, but no therapy was started because of the patient’s renal failure. Five months after hepatectomy the α-fetoprotein level normalized, and the metastases regressed completely. The patient is now doing well without any recurrence at 13 months after the surgery. The associated literature on spontaneous HCC regression is also reviewed.     

Effectiveness of outpatient percutaneous endoscopic gastrostomy replacement using esophagogastroduodenoscopy and propofol sedation

AIM: To evaluate the effectiveness of outpatient percutaneous endoscopic gastrostomy (PEG) replacement using esophagogastroduodenoscopy (EGD) and propofol sedation. METHODS: We retrospectively assessed the outcome and complications of consecutive patients referred for PEG replacement which was performed using EGD under propofol sedation in the outpatient setting. The success rate, the mean dose of propofol, procedure time, EGD findings, discharge time from endoscopy unit, respiratory depression, and complications within 72 h of the procedure were evaluated. In a subset of these patients, the blood concentrations of propofol were measured.RESULTS: All 221 patients underwent successful PEG replacement. The mean dose of propofol was 34 mg (range, 20-60 mg) with a mean procedure time of 5.9 min (range, 3-8 min). Reflux esophagitis (12 patients), gastric ulcer (5), gastric neoplasm (2), and duodenal ulcer (1) were newly diagnosed at replacement. Discharge from endoscopy unit was possible in 100% of patients 45 min after the procedure. Only 3.6% (8) required transient supplemental oxygen. No complications occurred within 72 h of the procedure. During EGD the level of sedation and propofol blood concentrations after administration of propofol (30 mg) in these PEG patients corresponded to those of propofol (60 mg) in middle aged subjects (control).     

Intrafamilial transmission of adult T cell leukemia virus

In an investigation of the mode of transmission of adult T cell leukemia virus (ATLV) in family settings, 275 male and 444 female subjects positive for antibody to ATLV-associated antigen (anti-ATLA) were studied. Their children were surveyed for anti-ATLA status. None of the 82 children of a positive father and a negative mother were positive for anti-ATLA. In contrast, the antibody prevalence among children with a positive mother and a positive or negative father was 27.9% and 19.9%, respectively. Of 39 parents who had one or more anti-ATLA-positive children less than 20 years old, 56.3% of the fathers and 97.1% of the mothers were anti-ATLA positive. Algorithm computation showed the possibility of ATLV transmission from husband to wife to be 60.8% and from wife to husband to be 0.4% over a 10-year period. These data suggest that ATLV is transmitted from mother to child and from husband to wife in family settings.     

Analysis of the core region of HCV genome isolated from patients with chronic hepatitis C during intervals of normal ALT concentration

We determined the core region nucleotide and amino acid sequences in specimens from two patients with chronic hepatitis C during intervals of normal and elevated alanine aminotransferase (ALT) concentrations. When the ALT concentrations remained normal, the serum HCR-RNA concentration exceeded that before therapy and most of the clones that could be sequenced had a deletion or an amber mutation. The clones isolated from a HLA B44-positive patient had a mutation at amino acid 91. These results suggest that expression of the wild-type HCV core region genome may be associated with liver cell damage.     

Intracellular sodium concentration in lymphocytes and erythrocytes of patients with essential hypertension

In order to investigate the abnormalities in intracellular sodium concentration ([Na]i) in essential hypertension, [Na]i in lymphocytes and erythrocytes was determined in 37 outpatients with essential hypertension and 35 normotensive controls matched for sex and age. [Na]i in lymphocytes was higher in hypertensive patients than in normotensive controls, while no difference was observed in [Na]i in erythrocytes between the 2 groups. There was no significant correlation between [Na]i in lymphocytes and erythrocytes in either group. In hypertensive patients, plasma renin activity had a negative correlation with [Na]i in lymphocytes, but not with [Na]i in erythrocytes. These results suggest that the increase in [Na]i may be associated with essential hypertension with suppressed plasma renin activity and that lymphocytes are more suitable than erythrocytes for the analysis of [Na]i.     

Role of Bile Acids in Duodenal Migrating Motor Complexes in Dogs

Previous studies have suggested thatenterohepatic circulation of bile acids is essential forregular cycling of duodenal migrating motor complexes(MMCs). The present study was an attempt to clarify the role of bile acids in the enterohepaticcirculation system in initiating duodenal MMCs. Sevendogs underwent total external biliary diversion thatresulted in the loss of MMCs originating from theduodenum. Sodium ursodeoxycholate (6 mg/kg/hr) was thengiven either through the portal vein or a peripheralvein, and motility of the gastrointestinal tract wasserially recorded. When sodium ursodeoxycholate was given either through the portal vein or aperipheral vein during external biliary diversion,duodenal MMCs restarted. The cyclic change in plasmamotilin levels during an MMC cycle as induced by sodium ursodeoxycholate was almost the same as in anormal MMC cycle. Total bile acid concentration in theportal vein changed cyclically with MMC cycles when bileflow was intact but did not change cyclically with MMC cycles restarted by intravenous bilesalt infusion. Bile acid stimulation of putativereceptors existing between the portal vein andintrahepatic bile ducts may be involved in initiatingnormal duodenal MMC cycles.     

Factors determining sodium chloride sensitivity of patients with essential hypertension: evaluation by multivariate analysis

Factors which determine sodium chloride sensitivity, defined as the difference between the mean blood pressure after 1 week of a low sodium chloride diet (3 g/day) and that after 1 week of a high sodium chloride diet (20 g/day), were studied in 60 inpatients with essential hypertension using a multivariate analysis. The sodium chloride sensitivity was independently correlated with the change in erythrocyte sodium concentration (r = 0.47) and with the change in plasma renin activity (r = 0.29); but it was not related to basal blood pressure, the change in plasma volume of the change in plasma norepinephrine concentration. These data suggest that both intracellular sodium accumulation and inadequate suppression of the renin-angiotensin system may be independently involved in the elevation of blood pressure after sodium chloride loading. We could not find the independent importance of volume retention, hyperadrenergic activity or basal blood pressure in the sodium chloride sensitivity.