High serum alpha-fetoprotein concentration associated with pseudoinfarction of a cirrhotic liver: Report of a case

We report herein the case of a 65-year-old man with cirrhosis of the liver in whom a portal vein thrombus was found to be the cause of a marked elevation in serum alpha-fetoprotein (AFP). The patient presented with fever and abdominal pain, and a diagnostic work-up revealed a liver mass and an increased serum AFP concentration of 91000 ng/ml. The mass gradually regressed, and the AFP concentration simultaneously decreased to 163 ng/ml. However, because hepatocellular carcinoma (HCC) could not be ruled out, a partial hepatectomy was performed. Histological examination of the resected specimen revealed a thrombus of the portal vein surrounded by the fibrosis associated with liver cirrhosis, but no neoplastic lesion was found. Thus, portal thrombus associated with liver cirrhosis might induce an extremely high level of AFP production.     

Release of esterase from murine lymphokine-activated killer cells in antibody-dependent cellular cytotoxic reaction

Release of granule enzyme(s) (BLT esterase) in the antibody dependent lymphokine-activated killer (LAK) cell-mediated cytotoxic reaction (LAK ADCC) was studied using LAK cells induced from murine splenocytes and thymocytes, various human tumor cells and relevant monoclonal antibodies (mAbs) to the tumor cells. BLT esterase was not significantly released from LAK cells in direct LAK cell-mediated cytotoxic reactions (LAK CMC). However, cultures of LAK cells and IgG-coated target tumor cells resulted in release of the enzyme concomitantly with target cell lysis, although esterase release proceeded faster than target cell lysis. Anti-LFA-1 mAb showed an inhibitory effect on LAK CMC but not on either LAK ADCC or BLT esterase release in the ADCC. These results indicate that exocytosis of granule enzyme from LAK cells is triggered by stimulation of Fc receptor on LAK cells and that LAK CMC and LAK ADCC differ in their lytic mechanism in terms of the release of BLT esterase.     

A case of gastric cancer with peritonitis carcinomatosa which improved upon oral administration of UFT, mitomycin C and lentinan

A 29-year-old male visited our hospital because of lower abdominal pain. Acute appendicitis was suspected, and surgery was performed. However, no abnormality was found in the vermiform appendix. Instead, atrophy of the greater omentum, numerous nodes of varying sizes, and a small amount of ascites were observed. On the basis of histological examination, a diagnosis of metastatic glandular cancer was made. Gastric fluoroscopy performed 2 months earlier in another hospital had revealed irregularity of the stomach wall and a large concave area on the side of the greater curvature. Photogastroscopy and CT demonstrated progressive Borrmann type III cancer at the corresponding site and metastasis to regional lymph nodes. Biopsy findings were similar to the histological findings. After 1 week, treatment with UFT (400 mg/day), MMC (10 mg/month) and LNT (1 mg/week) was initiated. After about 3 months, i.e., following administration of 40 g UFT, 30 mg MMC and 8 mg LNT, gastric fluoroscopy and photogastroscopy revealed complete disappearance of the tumor. No abnormality was found by laboratory studies. The patient has since returned to a normal life.     

Postoperative pyuria after TUR-P: the study of postoperative pyuria by using NFLX

The postoperative duration of pyuria was studied in 35 patients who underwent transurethral resection of the prostate (TUR-P). The average postoperative duration of pyuria was 58.0 +/- 23.6 days. The age over 70 years, preoperative indwelling of urethral catheter and the preoperative urinary tract infection did not make the duration of pyuria longer. The volume of resected prostatic tissue over 20 g and the existence of diabetes mellitus make it significantly longer. It is effective and safe to use a low-dose antibacterial agent such as NFLX which has a broad spectrum and hardly develops bacterial resistance after TUR-P. It is suggested unnecessary to change the anti-bacterial agent even when pyuria continues.     

Intra-pancreatic, extra-tumoral perineural invasion (nex). An indicator for the presence of retroperitoneal neural plexus invasion by pancreas carcinoma.

A histopathologic study of 65 resected malignant lesions of the pancreas was done to search for a histologic predictor for the presence of extra-pancreatic neural plexus involvement by carcinoma cells. Extra-pancreatic neural plexus invasion by pancreas carcinoma cells, plx(+), was detected in 28 of 65 cases (43%). plx(+) was not significantly associated with tumor location, tumor size, histologic type, or lymph vessel invasion (ly) by carcinoma cells but was significantly associated with rpe. Plx(+) was also significantly associated with mixed moderate and severe degrees of intra-pancreatic neural invasion (ne2/ne3 group), but not with mixed no and slight degrees (ne0/ne1 group). However, fourteen plx(+) cases were excluded in the ne2/ne3 group; they were found in the ne1 group. Therefore, ne factors appear to have a certain but limited usefulness for the prediction of plx(+). When a perineural invasion by tumor cells was found within the pancreas but outside of the major mass of cancer, it was designated "intra-pancreatic, extra-tumoral perineural invasion (nex)". The presence of nex(+) was found in 37 cases, in which 24 out of the 28 plx(+) cases (85.7%) were included. A statistically significant association was found between plx(+) and nex(+). In particular, 12 out of the 14 plx- positive ne1 cases were nex(+). In ne1 cases, 33.3% (14/42) were plx(+), whereas in ne1 and nex(+) cases, 60% (12/20) were plx(+). There was a statistical significance between these two figures (p less than 0.05). Thus, nex(+) appears to be a useful indicator for plx(+), particularly in ne1 cases.     

A correlation between arterial ketone body ratio and concentration of β-hydroxybutyrate as an indicator of hepatic functional reserve

We have investigated the correlation between the arterial blood ketone body ratio (AKBR) and -hydroxybutyric acid (HBAC) in the course of a 75 g glucose tolerance test. The correlation was revealed to be represented by an equation of Y=A+BX [X=log(HBAC), Y=log(AKBR)] with high significance. This expression existed in both normal individuals and patients with liver, biliary tract or pancreas disease. The postoperative course was unsatisfactory because of liver dysfunction in cases whose value B was more than –0.6 in bisegmentectomy and more than –0.45 in uni- or subsegmentectomy. The coefficient B in the equation was suggested to contribute to the evaluation of hepatic functional reserve.