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冠攣縮性狭心症 (VAP) において血管痙攣のない時期に, 体表面でのActivation Recovery Interval (ARI) Mapの空間分布を評価することによってVAPの診断および攣縮冠動脈枝の検出が可能か否か検討した, 非発作時に正常な標準12誘導心電図を示すVAP22例を対象にした, 対照は心疾患のない41例とした.体表面ARl mapは, 多目的心電計 (VCM3000, フクダ電子社製) にて87誘導点方法で冠攣縮のない時期に記録した.ARIは, QRS波の最小一次微分値の時点からT波の最大一次微分値の時点までの時間として各誘導点ごとに測定し, 等しいARIを結んでARI mapを作成した.ARI値は心拍数により変動するので, Bazettの式で補正してARIcを用いた.ARIc map記録は発作直後, 2週間, 1カ月, 6カ月後に記録した.攣縮冠動脈が右冠動脈であれば右前胸部下方に, 左冠動脈であれば前胸部中央やや左寄りにARIcの短縮領域が出現し, 虚血領域に対応する結果が得られた.VAPでは, 正常群に比し最小ARIc値が短縮していた.最小ARIc値の平均値はそれぞれVAP=160±28.8msec, 正常群: 196±14.8msecであった (p

A chimeric gene, AML1-MTG16, showing high homology to AML1-MTG8, was recently identified in adult leukemic patients with the abnormal karyotype t(16;21)(q24;q22). We recently saw a child patient of 11 years of age who developed acute myelogenous leukemia with the karyotype t(16;21)(q24;q22), 11 months after autologous peripheral blood stem-cell transplantation (PBSCT) for acute promyelocytic leukemia with karyotype t(15;17)(q22;q11). The reciprocal translocation was localized by fluorescence in situ hybridization (FISH) analysis, reverse transcription polymerase chain reaction (RT-PCR), and Southern blot analysis of bone marrow blood cells and peripheral blood cells. FISH analysis identified a reciprocal translocation between chromosomes 16 and 21. RT-PCR analysis identified expression of the chimeric gene AML1-MTG16. Southern blot analysis revealed a breakpoint occurring at a 1.4 kb Eco RI fragment between exons 3 and 4 of MTG16. The breakpoint is within the same region as that of secondary leukemias, which has been reported previously. This case suggests the possibility that the region of the breakpoint of MTG16 is a characteristic of secondary leukemia.

We herein report a case involving a 58-year-old female patient with multiple cystic lesions in the right lobe of the lung. The lesions were revealed on chest computed tomography in 2002 and followed up. Transbronchial lung biopsy showed no malignancy in June 2013. The lesions gradually increased in size and thickness and were associated with fluid-filled cysts. We performed a right lower lobectomy in November 2013. Pathological examination revealed inflammatory pseudotumor. Such a case of inflammatory pseudotumor presenting as a pulmonary cyst has not been previously described. Intractable infection and inflammation are regarded as common causes of inflammatory pseudotumor. This condition should be considered in patients with a medical history consistent with infectious disease and a pulmonary cyst found on chest computed tomography.

Calcineurin inhibitor (CNI) combined with mycophenolate mofetil (MMF) and steroid is mainly used as immunosuppressive therapy after the living-donor liver transplantation (LDLT). However, the nephrotoxicity caused by CNI remains a critical problem for patients with chronic renal failure, especially on early postoperative period. A 62-year-old woman with decompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11 points) and chronic renal failure due to diabetic nephropathy (Cr 1.56 mg/dl, GFR 27 ml/min/1.73 m2) experienced LDLT. During the reconstruction of hepatic vein, the supra-and infra-hepatic vena cava was totally clamped. The estimated right lobe liver graft volume was 540 g, representing 51.3% of the standard liver volume of the recipient. Because of the perioperative renal dysfunction due to diabetic nephropathy and the total clamping the vena cava which induced the congestion kidney, MMF (1500 mg/day) and steroid (250 mg/day converted into predonisolone) were mainly introduced as an immunosuppressive therapy after LDLT. The low-dose CNI, tacrolimus also induced the nephrotoxicity and was given for only a short time. Finally, according to the postoperative renal function, the low-dose CNI, cyclosporin (50 mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500 mg/day), steroid (20 mg/day converted into predonisolone) and cyclosporin (75 mg/day) continued to be given as the immunosuppressive therapy and neither acute graft rejection nor drug-induced renal dysfunction was occurred. This is a case report of introducing with mainly MMF and steroid as an immunosuppressive therapy after LDLT for a patient with perioperative renal dysfunction.

It has been reported that acetylcholine hyperpolarizes the maximum diastolic potential of canine Purkinje fibers through a pathway involving a G protein and induces a decrease in their automaticity. It is unclear, however, whether the negative chronotropic action of acetylcholine in the presence of beta-adrenergic stimulation is due to the hyperpolarization of the maximum diastolic potential or a decrease in the slope of phase 4 depolarization. We used standard microelectrode techniques to study the negative chronotropic mechanism of acetylcholine in the presence of isoproterenol in adult canine Purkinje fibers. Fibers were incubated for 24 hours in Tyrode's solution alone (n = 10) or plus pertussis toxin (n = 10), and then superfused with acetylcholine (10(-9) to 10(-4) M) in the presence of isoproterenol (10(-7) M). Acetylcholine in the presence of isoproterenol significantly decreased automaticity without hyperpolarization of the maximum diastolic potential, and decreased the slope of phase 4 depolarization. The effects of acetylcholine on automaticity and the slope of phase 4 depolarization were attenuated by pertussis toxin. The present findings indicate that the negative chronotropic action of acetylcholine in the presence of isoproterenol is due to the decrease in the slope of phase 4 depolarization through a pathway involving a pertussis toxin-sensitive G protein and that it is not the result of hyperpolarization of the maximum diastolic potential.

Background —Microvascular obstruction within an area of myocardial infarction indicates worse functional recovery and a higher risk of postinfarction complications. After prolonged coronary occlusion, contrast-enhanced MRI identifies myocardial infarction as a hyperenhanced region containing a hypoenhanced core. Because the time course of microvascular obstruction after infarction/reperfusion is unknown, we examined whether microvascular obstruction reaches its full extent shortly after reperfusion or shows significant progression over the following 2 days. Methods and Results —Seven dogs underwent 90-minute balloon occlusion of the left anterior descending coronary artery (LAD) followed by reflow. Gadolinium-DTPA–enhanced MRI performed at 2, 6, and 48 hours after reperfusion was compared with radioactive microsphere blood flow (MBF) measurements and myocardial staining to define microvascular obstruction (thioflavin S) and infarct size (triphenyltetrazolium chloride, TTC). The MRI hypoenhanced region increased 3-fold during 48 hours after reperfusion (3.2±1.8%, 6.7±4.4%, and 9.9±3.2% of left ventricular mass at 2, 6, and 48 hours, respectively, P r =0.99 and thioflavin S, r =0.93). MRI hyperenhancement also increased (21.7±4.0%, 24.3±4.6%, and 28.8±5.1% at 2, 6, and 48 hours, P r =0.92). The microvascular obstruction/infarct size ratio increased from 13.0±4.8% to 22.6±8.9% and to 30.4±4.2% over 48 hours ( P =0.024). Conclusions —The extent of microvascular obstruction and the infarct size increase significantly over the first 48 hours after myocardial infarction. These results are consistent with progressive microvascular and myocardial injury well beyond coronary occlusion and reflow.

A case of primary carcinoma of the cystic duct which is a rare condition in biliary malignancies is reported. A 64-year-old woman was admitted to the hospital because of right hypochondralgia. Laparotomy was carried out under a diagnosis of cholelithiasis and acute cholecystitis. As intraoperative cholangiography revealed a defect in the choledocus, a tumor in the choledocus was detected accidentally. In rapid intraoperative frozen section diagnosis, the tumor was proved adenocarcinoma and a resection of the bile duct with lymph node dissection was added to cholecystectomy. A papillary elastic hard tumor measuring 1.4×1.1cm was found out in the cystic duct in the resected specimen. Microscopically it was moderately differentiated adenocarcinoma infiltrating into the fibromuscular layer of the cystic duct. Carcinoma of the cystic duct presents difficulty in preoperative diagnosis, and is commonly detected only in the course of operation or pathological examination of the resected specimen. In paticular, if the gallbladder is not visualized by cholangiography, preoperative examination and operation should be performed by entertaning a possible existence of carcinoma in the cystic duct.

肝内胆管癌の診断にて手術を施行したが, 腫瘤を形成せずに胆管内のみに発育増強した1例を経験したので報告した. 症例は62歳の女性で心窩部痛を主訴に近医を受診し, 肝内胆管癌の診断を得て手術を目的に当院を紹介された. 腹部超音波検査およびCT検査にて肝右葉に径約4cmの腫瘤を認め内部に肝内胆管の拡張を認めた. 術中超音波検査を用い腫瘍を確認し肝右葉切除術を施行したが, 腫瘤形成はなく肝内胆管の拡張とその内腔に多数の腫瘍栓を認めるのみであった. 組織学的には胆管壁および腫瘍栓とも高分化型腺癌であった. 腫瘤を形成せず肝内胆管の内腔のみに発育する肉眼形態像は, 現在, 分類上一定の見解がない. また術前に胆管内発育型の肝内胆管癌を診断することは難しく, さらには進展範囲の確認が困難で切除範囲の決定に際しても慎重を有すると考えられた.

To identify the characteristics indicative of involvement of occult tumors in the remnant breast on breast conservative surgery, we clinicopathologically examined the breast tumors and tissues surrounding the tumors in unilateral breast cancer with gross multiple tumors at the surgical specimen. Gross multiple tumor was found in 6 out of 98 cases of primary breast cancer (6.1%). Of these 6 cases, 5 cases (83.3%) were classified as intraductal spreading type, 1 case (16.7%) as multicentric type, and none as intramammary metastatic type. Histological type of 5 cases showing intraductal spreading type was either non-invasive intraductal cracinona or papillotubular carcinoma, and in 2 cases of them, component of comedo was found. Additionally, in the tissues surrounding tumors, benign breast diseases were found in 3 cases (50.0%), including atypical hyperplasia in 2 cases. We think that it is useful to know the degree of intraductal spreading, histological type of tumors, existence of comedo component and pathological features of tissues surrounding the tumors for predicting the existence of the occult tumors in the remnant breast on breast conservative surgery.

Recent studies have suggested that the appearance of solitary new lesions after a curative resection of hepatocellular carcinoma (HCC) may be closely related to the metachronous multicentric development of HCC. It is therefore extremely important to investigate the histological characteristics of solitary new nodular lesions confirmed to be HCC by an ultrasound(US)-guided needle biopsy. Thirty-five patients with small HCC, ⩽ 3 cm in diameter, who underwent a curative hepatic resection between 1987 and 1992, were observed for possible recurrence over a period of ⩾1 year. Solitary new lesions confirmed to be HCC were noted in 7 (20.0%) out of 35 cases 10-65 months after operation. All solitary new lesions underwent US-guided needle biopsy, and a histological examination of the biopsy specimen was performed. All seven solitary new lesions were then classified into the following two groups according to the histologic differentiation of biopsy specimens and were found to consist of five well-differentiated HCCs (71.4%) and two moderately differentiated HCCs (28.6%). Three of the five well-differentiated HCCs were accompanied by varying degrees of fatty changes. These morphologic observations suggest that approximately 70% of the solitary new lesions confirmed to be HCC after a curative resection of small HCC may thus be related to the metachronous multicentric origin of HCC. However, it is difficult to estimate the exact incidence of such cases. As a result, curative treatment may sometimes be feasible, even when treating solitary new lesions after resection of HCC. Therefore, we can better evaluate such solitary new nodular lesions after a resection of HCC by means of a histologic evaluation using US-guided needle biopsy. © 1994 Wiley-Liss, Inc.

The diagnostic accuracy of using electrocardiographic findings to identify affected vessels in cases of myocardial infarction and angina pectoris treated by percutaneous transluminal coronary angioplasty was assessed. From the anterior wall leads, ST segment elevation in leads I and aV(L) showed diagnostic accuracy (sensitivity, specificity and positive predictive value) in identifying proximal lesions of the left anterior descending coronary artery of 89%, 58% and 62%, and the diagnostic accuracy of the QS wave in V(1) was 62%, 83% and 72%, respectively. For the posterior wall leads, the corresponding values for the diagnosis of affected vessels based on R/S>1 in V(1) for the left circumflex coronary artery were 50%, 89% and 60%, respectively. The inferior wall leads with ST segment elevation in leads II, III and aV(F), and ST segment depression in aV(L), showed diagnostic accuracy for the right coronary artery of 90%, 90% and 92%, respectively. Bifurcation of the first diagonal branch, dominance of the posterior descending branch, the normal subtypes of the coronary artery and the occurrence of spontaneous recanalization may have influenced the accuracy of diagnosis. Adding a high lateral wall lead one intercostal space above V(4) and a posterior wall lead located one intercostal space below V(6) appeared to increase the diagnostic accuracy of detecting the coronary artery lesions responsible for myocardial ischemia.

Recently, the multicentric origin of hepatocellular carcinoma (HCC) has been recognized, but its clinical importance has still not yet been clarified. The histological characteristics of small hyperechoic HCCs coexisting in 44 consecutively resected Japanese patients whose main HCCs were < 5.0 cm in size were studied. Twelve small hyperechoic HCCs were found and classified into the following two groups: eight nodules in seven patients (15.9%) were early-stage HCC, and four nodules in four patients (9.1%) were more advanced HCC. Thus, early-stage HCC comprised 66.7% of the small echogenic HCCs. Eight HCCs detected as small hyperechoic lesions (found in 15.9% of the patients) showed varying degrees of fatty change yet proved to be well differentiated and retained the preexisting liver structure of either associated liver cirrhosis or chronic hepatitis. Moreover, the histologic characteristics of the eight early-stage HCCs were different from those of the main HCCs. In conclusion, approximately 15% of HCCs in Japanese patients may have a synchronous multicentric origin, and small hyperechoic lesions should be carefully evaluated. However, in the United States or other areas where the occurrence of fatty liver is common, that advice for small hyperechoic lesions may be overly cautious.

An 80 year old Japanese man had adenosquamous carcinoma of the gall-bladder characterized by an adenocarcinoma (AC) in the gall-bladder lumen and a squamous cell carcinoma (SCC) in the invaded region of the liver. In the AC, the tumor cells consisted of atypical columnar epithelium with pseudostratification, mimicking gastric foveolar epithelium, while atypical signet-ring cells were scattered within the SCC. There was an abrupt transition between the AC and SCC areas. The tumor cells in the AC area were intensely positive for galactose oxidase-Schiff staining, and paradoxical concanavalin A staining revealed these tumor cells to have Class II mucins. Immunohistochemically, the tumor cells in foveolar-type adenocarcinoma were diffusely positive for cathepsin D. Flow cytometrical analysis of DNA content showed the AC area to be diploid and the SCC area to be aneuploid. The S-phase fraction of the SCC area (46.9%) was larger than that of the AC area (19.5%). The positive rate of immunostaining for proliferating cell nuclear antigen in the SCC area (mean 50.627%) was larger than that of the AC area (mean 3.048%, P < 0.01). These results suggest that the AC area of this tumor, histochemically and immunohistochemically, showed gastric foveolar-type characteristics, the SCC component was squamous cell metaplasia of the pre-existing AC, and that the SCC area had a greater proliferating capacity than the AC area.

Twenty-one patients with hepatocellular carcinoma (HCC) larger than 10 cm diameter were treated during the 18year period from 1971 to 1988. The mean tumor size was 13 cm (range 10–18 cm). Nineteen patients (90.5%) had subjective symptoms. Eight patients (38.1%) had alpha-fetoprotein (AFP) levels over 10,000 ng/ml, and in 18 patients (85.7%) the levels were over 20 ng/ml. Nevertheless, only three (14.3%) were detected by AFP. Scintigraphy before 1981 and ultrasonography after 1982 appears to be most helpful for detection of HCC. Nineteen lesions (90.5%) were localized in the right hepatic lobe. Large HCC showed a low incidence of histologically verified concomitant cirrhosis (33%; 7 of 21) and a relatively well preserved hepatocellular function (indocyanine green test; 13.9 ± 6.6%). Curative resection could be done for all 21 patients. There were three (14.3%) operative deaths. The 1-, 3-, and 5-year survival rates were 72.2, 32.9, and 8.2%, respectively. One patient who underwent a left hepatic lobectomy has survived for over 5 years, with recurrence. There were 14 recurrences (66.7%) in 21 patients: 11 were hepatic and three were in the lungs. In patients with large HCC, surgical resection shoald be done, provided the clinical status and hepatocellular reserves are adequate. © 1992 Wiley-Liss, Inc.

To investigate clinicopathologic characteristics of hepatocellular carcinoma (HCC) in young adults, excised tumors from 21 patients younger than 45 years (young group) were compared with findings in tumors from 204 patients older than 45 (old group). In the young group HCC showed (1) a high incidence of positive hepatitis B virus surface antigen (HBsAg) (young 71.4% versus old 20.1%); (2) relatively well-preserved hepatocellular function (indocyanine green test; young 10.7 +/- 8.8% versus old 20.6 +/- 10.8%); (3) low incidence of histologically verified concomitant cirrhosis (young 52.4% versus old 78.4%); and (4) a more advanced stage of the disease in TNM classification (Stage III; young 52.4% versus old 18.1%). With respect to survival rates achieved by surgery, there was no statistically significant difference between the two groups. Thus, hepatitis B virus may relate to the occurrence of HCC in the young patients. Despite the advanced stage in the young group, survival rate after surgery was comparable with that achieved in the old group. These observations mean that a close periodic surveillance of young adults with a positive HBsAg is required to detect HCC at an early stage. Treatment of patients with HBsAg using interferon or vidarabine and hepatitis B vaccine should be made to convert HBsAg to negative in these individuals.

Fourteen patients with benign symptomatic non-parasitic cysts of the liver were either surgically treated, had alcohol injected into the cysts, underwent deroofing of the cyst or in 5, a cystectomy was done. Alcohol was injected into 6 patients and there has been no recurrence for as long as 5 years and 8 months after the treatment. Liver dysfunction occurred in 3 patients given blood transfusion during the surgery and/or postoperative course, an elevated temperature (over 39℃) occurred in one patient. Adverse effects of alcohol injections were minor and transient. Based on our experience, the injection of alcohol is an effective treatment for benign symptomatic cyst of the liver. When a malignancy is suspected on imaging and/or cytologic studies, or when alcohol administration is ineffective, then surgery is indicated.

From September 1981 to December 1988, 163 patients underwent hepatic resection for hepatocellular carcinoma. The patients were divided into two groups: those operated on from September 1981 to March 1985 (n = 55) and those operated on from April 1985 to December 1988 (n = 705). There was an increase in the number of relatively small hepatocellular carcinomas in 1987–88. Differences in the incidence of accompanying liver cirrhosis (72 versus 62 per cent) were not statistically significant; however, values of the indocyanine green test (21·5 versus 77·0 per cent, P < 0·01) aided in strict patient selection. In more recent years, initial hepatic hilar dissection for control of vascular structures was undertaken and an ultrasonic dissector was used in about three-quarters of these patients. Consequently, the mean estimated blood loss (2500 versus 1300ml, P

There has been no report on T wave alternans (TWA) in patients with cardiac sarcoidosis. In this study, we investigated TWA in patients with cardiac sarcoidosis. Electrocardiographic recording for TWA was performed in 6 patients, using the CH2000 (Cambridge Heart). TWA was defined as positive in cases where alternans voltage of >1.9 μV and alternans ratio of >3.0 persisted more than 1 minute during exercise with ergometer with heart rate above 105 beats/min. TWA was positive in 3 patients, negative in 2 patients, and not determined in 1 patient. Arrhythmia was noted on Holter electrocardiogram in all 3 patients with positive TWA: sustained ventricular tachycardia in 1 patient and nonsustained ventricular tachycardia in 2 patients. Mean left ventricular ejection fraction in the 3 patients with positive TWA was 39.0%, whereas in the 2 patients with negative TWA it was 58.5%. A close relationship was suggested between TWA and severity of cardiac sarcoidosis.

Intrasplenic administration of OK-432, an immunostimulant derived from Streptococcus, prevented hepatic failure induced in rats by D-galactosamine. When OK-432 was given 1.0 K.E. (Group I) or 0.1 K.E. (Group II) into the subcutaneously transpositioned spleen three times prior to dosing with D-galactosamine, survival rates were 100 and 87%, respectively. On the contrary, with a splenic injection of saline (Group III), the survival rate was 47 and 32% in rats given OK-432 1.0 K.E. intraperitoneally (Group IV). The poisoned rats given no pretreatment (Group V) survived at a rate of 26%. These results show that intrasplenic administration of OK-432 leads to a significant enhancement of survival. Metabolic data and histological findings were compatible with survival rates, in each group. Activation of the reticuloendothelial function by the intrasplenic administration of this immunostimulant seems to have prevented acute liver failure.

術後肝不全に対し高圧酸素療法が有効であった1例を報告する.症例は,57歳,男性,原発性肝癌にて右二圧域肝切除術な施行した.術後約1ヵ月目に肝性脳症を発症し直ちに血漿交換を行ったが,肝性脳症の改善は認められなかったため高圧酸素療法を施行した.本療法開始後,脳症は消失し.全身状態の改善も著明となり,第78病日に退院し得た.以上の経験は,高圧酸素療法が肝不全に対する新しい治療法となり得る可能性を示唆するものと考えられる.

A case of hemangioma of the spleen which was diagnosed as benign splenic tumor preoperatively is reported.The patient, a 62-year-old woman, was examined for a chief complaint of abdominal and back pain during treatment for rheumatoid arthritis. Current diagnostic imaging modalities including ultra-sonography, computed tomography and celiac angiography revealed a primary tumor in the spleen and the patient underwent standard splencetomy. The spleen was slightly enlarged and showed a hemispheric appearance. The cut surface revealed a capsulated tumor 4.1×3.6 cm in size. The tumor was clearly delineated from the surrounding splenic tissues and the histopathological diagnosis was cavernous hemangioma. The patient made a good postoperative recovery and is currently leading a normal life one year after the operation.Cavernous hemangioma of the spleen is relatively rare and the preoperative diagnosis is naturally very difficult. However recent progress in radiology has made early diagnosis possible.In this report, the detailed preoperative radiological findings are described together with a discussion of the relevant literature.

We evaluated the postoperative course of 50 patients who underwent hepatic resection, using the ratio of indocyanine green (ICG) retention rates measured on the third postoperative day to values estimated immediately after the operation. This ratio was expressed as the remnant liver ICG index. Group A included 22 patients with a remnamt liver ICG index of less than 1.0, which meant that the ICG retention rate at 15 minutes on the third postoperative day showed improvement, compared to events immediately after the operation. In group B, there were 28 patients whose index on the third postoperative day was over 1.0, thereby indicating exacerbation of the ICG clearance rate after hepatic resection. Serious complications including intraabdominal sepsis and hyperbilirubinemia occurred postoperatively in 2 (9.1%) in group A and 16 (57.1%) in group B (p

水溶性制癌剤をリピオドールに懸濁化するため“リピオドール・ウログラフィン”システムを考案し,これを肝癌55症例の治療に応用した.その結果,次の結論を得た.(1) 制癌剤含有油性造影剤を腫瘍栄養血管内に投与すると,腫瘍部に選択的に停滞するが,その程度は腫瘍血管が豊富なもの程顕著であった.(2) 制癌剤の組織内濃度は83%の症例で腫瘍部が非腫瘍部に比べ高値であった.(3) 抗腫瘍効果に関しては,血中α-フェトプロテイン値低下を78%に,CT像上での腫瘍縮小を14%の症例に認めた.(4) 組織学的には主腫瘍の完全壊死が得られた症例でも,周辺組織へ浸潤した癌巣の一部は死滅していない所見もみられた.(5) 以上,本療法の有効性を確認したが,根治性には疑問があり,切除不能肝癌の治療手段,あるいは肝切除術の補助療法として位置付けられるべきものであろう.

術後肝不全に対する血漿交換療法は,黄疸や肝性脳症等の肝不全症状が確立した時点でこれを施行しても救命の可能性は少ない.しかし我々は,血漿中Lecithin cholesterolacyltransferase (LCAT)活性を指標として早期に肝不全発症を予知し,非代償性になる以前に血漿交換を施行したところ,14例中5例(36%)に生存を認め,4例(29%)に1ヵ月以上の延命効果を認めた.我々の用いた適応基準は,1)LCAT活性0値により肝不全発症を予知し,2)群姓脳症grade 1ないし2(Sherloek),3)プロトロンビン時間35%以上,4)総ビリルビン値10mg/dl未満内に施行することであった.また施行中の有効性判定指標として,LCAT活性値が上昇してくるものは効果が期待できた(100%, n=5).肝硬変症等の術後に発生する肝不全は,血漿交換療法を早期に適切に用いることにより救命される可能性が大きいことを示した.

Twelve-day-old VX2 carcinoma was inoculated in the hind leg of 24 rabbits and, after 12 days, Doxorubicin (Adriamycin) suspended in Lipiodol Ultra-Fluid (Lipiodol) was then given through the femoral artery. A selective deposit of the contrast material in the tumor for an extended time was evident on the x-rays and the antitumorous effect was remarkable. Lipiodolized antitumor agents warrant further investigation for possible clinical application.

Between 1982 and 1987, selective regional cancer chemotherapy using Lipiodol plus an anticancer drug (lipiodolization) was prescribed for 200 patients with hepatocellular carcinoma. One hundred forty-nine patients were given lipiodolization alone, and the remaining 51 underwent hepatic resection following lipiodolization. The grades of deposits of the oily contrast medium in the neoplastic tissue seen on the plain X-ray correlated well with the antitumor effect. In the resected specimens of 17 patients treated with lipiodolization prior to surgery, concentrations of adriamycin in the malignant liver tissues were 13.2 +/- 18.2 micrograms per gm, whereas the adjacent liver parenchyma contained 1.4 +/- 2.0 micrograms per gm of adriamycin; the difference was statistically significant (p less than 0.05). In the 149 patients treated with lipiodolization, 1-, 2-, 3- and 4-year survival rates were 56.1, 28.9, 17.3 and 7.4%, respectively. Thus, lipiodolization was considerably more effective, compared to the results achieved by hepatic artery ligation and cannulation into the hepatic artery for patients in Stages I and II. In this sequential nonrandomized study, the survival rates for patients undergoing hepatic resection were superior to those for patients in Stage I and treated with lipiodolization. The significant difference appeared to depend on incomplete killing of tumor cells, which are most often present in the fibrous capsule, by lipiodolization. We conclude from these data that lipiodolization is an effective treatment for hepatocellular carcinoma when the tumor is not curatively resectable. When the clinical status is good, then surgery is warranted.

We report eight cirrhotic patients with liver cancer of less than 2 cm in diameter, and who were successfully treated by surgery. The sensitivities of diagnostic procedures for small lesions showed that alpha-feto-protein (AFP) was 75 per cent, radionuclide scanning 25 per cent, CT 33 per cent, ultrasonography 40 per cent and angiography 88 per cent. Serial measurement of AFP appears to be the most helpful for detection of hepatocellular carcinoma at the early stage, particularly in cirrhotic patients. Although hepatic imagings are of limited value for small hepatic tumors, those tools are often useful as a back-up for the routine tests but not for initial procedures. It should also be kept in mind that hepatic arteriography performed in the high risk group often leads to detection of small cancers. In cirrhotic patients with small hepatocellular carcinoma, surgical resection should be done, providing the clinical status and hepatocellular reserve are adequate.

When Lipiodol Ultra-Fluid (Lipiodol) was given through arteries feeding the tumor, this material was retained in the tumor. After mixing Lipiodol and doxorubicin (adriamycin; ADR), the effect of this antitumor agent on VX2 carcinoma inoculated into the hindlimb in 57 rabbits was investigated. Size of the tumor remarkably decreased in the rabbits treated with ADR 2 mg/kg suspended in Lipiodol and given through the femoral artery. Intraarterial injection of ADR 2 mg/kg alone led to a transient decrease in size of the tumor, but there was a regrowth. The result was comparable to a finding in a group in which half the dose of ADR (1 mg/kg) suspended in Lipiodol was given intraarterially. When ADR 2 mg/kg mixed with Lipiodol was injected directly into the tumor, growth of the tumor was not completely inhibited. Lipiodolized ADR has a prominent antitumor effect, and Lipiodol has the potential to be applied as a carrier of anticancer drugs.

We evaluated in retrospect the applicability of limited hepatic resection in cases of primary liver cancer in cirrhotic patients. According to the severity of impaired liver function, 37 patients underwent limited resection, and for 13, standard major hepatic resection was done. The mortality rate in case of limited resection was 10.8%, and the rate in case of massive excision was 15.4%. One, two- and five-year survival rates of limited operation were 79.9, 60.3, and 32.6%, respectively. After standard resection, the rates were 78.7, 67.5, and 22.5%, respectively. There were no significant differences in the mortality and survival rates between the two groups. These results indicate that, for the patient with a small liver cancer, and poor liver function, the limited procedure leads to a comparatively longer survival. This limited resection can be selectively used to treat cancer associated with cirrhosis and encapsulated tumors. For the preoperative evaluation, hepatic arteriograms aid in patient selection.

Changes in portal pressure before and after hepatic resection were monitored in 65 patients. Significant increases in portal pressure, from 226 +/- 13 mm saline to 277 +/- 16 mm saline were noted in 17 cirrhotics undergoing major hepatic resection. In 14 noncirrhotics undergoing major resection of the liver, pressure in the portal vein changed significantly from 198 +/- 10 mm saline to 226 +/- 9 mm saline. Conversely, there were no differences in the 26 cirrhotic and eight noncirrhotic individuals who underwent minor hepatic resection. Clinical analysis of these patients showed that acute portal hypertension induced by liver resection was not linked to increases in early postoperative death.