Obliterative portal venopathy: A comparative study of 184 cases of extrahepatic portal obstruction and 469 cases of idiopathic portal hypertension

Abstract A total of 184 cases of extrahepatic portal obstruction (EHPO), mostly demonstrated by intraoperative portography and studied at 17 institutes during the period 1957–1983, were compared with 469 cases of idiopathic portal hypertension (IPH) similarly studied. Of the cases of EHPO, there were 101 males and 83 females; 93 were under 20 years of age and the average age was 25.9 years (i.e. much younger than that of IPH cases). There were two age peaks, one before age 19 years and the other at age 40–49 years. One out of three adult cases had a history of abdominal surgery, but otherwise the aetiologic factor was difficult to elicit. Bleeding was the initial symptom in the majority, and splenectomy and haematological findings of hypersplenism were less pronounced compared with IPH. Liver function tests were almost always normal. The liver appeared normal macroscopically in 69% and histologically in 35%. The changes seen in the remainder were similar to those in IPH; they were less frequent in young patients than in cases above age 20 years. Compared with IPH, the wedged hepatic venous pressure in patients with EHPO was lower and the gradient from the portal venous pressure was greater. It is concluded that extrahepatic portal obstruction is less common compared with IPH in Japan, and that there are cases particularly among adults that present clinicopathological features very similar to those of IPH. It is unclear at present whether these two disorders represent two different disease entities, or whether they represent one disorder with differences in the site of involvement along the portal vein system.     

The difficulties of prosthetic management of endentulous cases with hemi-mandibulectomy following cancer treatment

The presenting features of edentulous subjects who have undergone hemimandibulectomy for the removal of squamous cell carcinoma of the mouth are described. Suggested methods of prosthetic treatment are discussed and the means of assessing problems of speech and swallowing with sequential radiography are reported.     

Steroid therapy in IgA nephropathy in Japan

Summary: We performed prednisone (PSL) therapy which was done in the manner of a prospective multicentre paired controlled trial. We collected 196 patients with biopsy-proven IgA nephropathy (IgA-N). the patients were divided into prednisone group receiving prednisone (PSL group, n = 111) and antiplatelet group receiving anti-platelet drugs only (AP group, n = 85). the mean follow-up duration was 4.7 ± 2.5 years. We observed that PSL showed beneficial effects in maintaining renal function and decreasing proteinuria for the first 3 years. In stratified subgroups with proteinuria (UP>2 g/day) and with UP>2 g/day and creatinine clearance (Ccr)< = 70 mL/min, the renal death rate at the end of follow-up in patients of PSL group showed a tendency to be less than that of AP group ( P = 0.067, P =0.095, respectively) although the renal survival rate between both groups were not significantly different. We speculated that steroid therapy might be effective in IgA-N patients with UP>2 g/day and Ccr< = 70 mL/min. Further trials should be carried out in a properly controlled, randomized, stratified manner with long-term follow up.