Marked retention of indocyanine green and sulfobromophthalein with chronic persistent hepatitis

A hepatitis B virus (HBV) carrier with marked retention of indocyanine green (ICG) and sulfobromophthalein (BSP) was admitted to our hospital for assessment of liver function. On admission, he was asymptomatic and blood chemistry tests showed normal values for transaminases and bilirubin. Serum hepatitis B surface antigen (HBsAg) and antibody to hepatitis B e antigen (anti-HBe) were positive. A history of drug abuse or alcoholism was denied. Dye excretion tests revealed marked retention of ICG (R₁₅= 70%) and BSP (R₄₅= 23%). Histopathological examination of a liver biopsy specimen obtained during laparoscopic observation showed chronic persistent hepatitis (CPH). Familial research of the patient failed to prove the existence of dye excretory defect in his siblings. Usual cases of CPH due to continuous HBV infection do not show such severe disturbance of organic anion transport. This pattern of the dye excretory defect with CPH has not been reported. Although the relationship between this dye excretory defect and HBV infection is unclear, the existence of the constitutional dye excretory defect due to abnormal organic anion transport in the liver might be considered.     

Solid phase peptide synthesis of human endothelin precursor peptide using two-step hard acid deprotection/cleavage methods

Syntheses are described for the putative human and porcine biosynthetic precursors (hET-38 and pET-39) of endothelin, with the sequence previously deduced from human- and porcine-cDNA coding for prepro-endothelin. The Boc based solid phase synthetic method was applied, followed by weak hard acid, trimethylsilyl bromide, cleavage. The peptide removal from the resin was optimally accomplished with hydrogen fluoride. Disulfide bridges were formed by air-oxidation, and the linkage modes determined by enzymic (Endoproteinase Asp-N) digestion and HPLC. Five additional C-terminally elongated endothelin homologs were also synthesized. For alternative synthesis of pET-39, the use of trimethylsilyl tri-fluoromethanesulfonate for the removal of peptide from the resin generated a major side product, which was characterized. hET-38 was found to be less effective in vitro, when compared to endothelin. The vasoconstrictor activity in vitro of other related peptides was comparable to that of hET-38.     

A Case of Neurofibromatosis of the Whole Gastrointestinal Tract

An unusual case of neurofibromatous of the gastrointestinaltract is described. Diffuse neurofibromatous involvement ofthe whole gastrointestinal tract was incidentally found in acancer patient at autopsy. Immunohistochemical examination fornervous tissue-specific S100 protein was helpful in identifyingthe tumor cells as neurogenic cells.     

Exocrine Pancreatic Function Test by a Synthetic Peptide

A new synthetic substance, N-Benzoyl-L-tyrosyl-p-aminobenzoic acid, is specially cleaved by pancreatic chymotrypsin after oral administration and the released p-aminobenzoic acid (P.A.B.A.) is absorbed and excreted in the urine. The P.A.B.A. recovery in the urine was examined to evaluate its diagnostic value as an exocrine pancreatic function test. The data permit the following conclusions: 1. There is a significant correlation between this test and maximal bicarbonate concentration, amylase output and volume of P.Z./C.C.K. secretin test. 2. More than one-half to two-thirds proximal or one-third distal of the pancreas must be removed before one can expect an abnormal result in this test. 3. This is a simple and useful test to detect exocrine pancreatic insufficiency of more than moderate degree but normal results may be obtained in minimal to mild exocrine pancreatic insufficiency. Only six of 11 cases (54.5%) with one abnormal factor of P-S test showed decreased P.A.B.A. recpvery, whereas 22 of 23 cases (95.7%) with two or three abnormal factors of P-S test showed decreased or borderline P.A.B.A. recovery.     

Micropapillary variant of transitional cell carcinoma of the bladder

A 77-year-old man visited the Kobe City General Hospital complaining of macroscopic hematuria. A computed tomography scan found a bladder tumor with left iliac and para-aortic lymph node metastasis. Two courses of cisplatin, cyclophosphamide and doxorubicin chemotherapy resulted in a minimal response. Radical cystectomy and a retroperitoneal lymph node dissection with bilateral ureterocutaneostomy reconstruction were then performed. A pathological examination revealed a micropapillary variant of transitional cell carcinoma (Grade 3, pT1pN2M1). The patient died of pelvic recurrence 7 months after the initiation of chemotherapy. Peritonitis carcinomatosa and lung metastases were observed at autopsy.