[Gonadotropin and alkaline phosphatase-producing gastric carcinoma with widespread metastasis to the bones]

A case of advanced gastric carcinoma in a 47-year-old man with widespread metastasis of generalized bone and associated with high serum levels of human chorionic gonadotropin (hCG) and alkaline phosphatase (ALP) is reported. Macroscopically, the primary tumor was Borrmann type IV. Microscopically, it showed poorly differentiated adenocarcinoma. Bone metastasis, however, showed well-differentiated adenocarcinoma. These lesions did not manifest conspicuous trophoblastic differentiation. Immunohistochemical studies revealed that hCG-positive cells were observed sporadically in the primary tumor and lymph node metastasis, but remarkably in the bone metastasis. Cancer cells in the lymph nodes were positively stained by modified Burstone's ALP staining. The serum levels of hCG and ALP fluctuated with the clinical course. Therefore, the authors concluded that this gastric carcinoma produced hCG and ALP.

[The significance of the measurement of a serum gonadotropin-like substance in gastric cancer]

The serum concentration of hCG and CEA in 277 gastric cancers was extensively studied. 8.6% for hCG and 18% for CEA were regarded as positive. 9.4% of patients showed elevated serum level for both hCG and CEA, on the other hand 7% of the patients showed high hCG only. All of hCG positive patients had severe lymph nodal involvement. All cases of hCG positive and 85% of CEA positive cases were classified as stage 4. Macroscopically, 85% of hCG positive cases and 40% of CEA positive cases showed generalized type. Histological type was poorly differentiated adenocarcinoma in 72% of tumors with elevated serum hCG level, but in only 35% of tumors with elevated serum CEA level. The content of hCG subunits in serum and tumor showed different levels among patients. The hCG positive cases did not reveal endocrine symptom. The prognosis of these patients with elevated serum hCG and CEA level were poor. One year survival rates were 0% and 30%, respectively. These results showed that both hCG and CEA, especially when used in combination, was potentially useful marker for determination of staging, recurrence and prognosis in gastric cancer.

Intrahepatic venous collaterals forming via the inferior right hepatic vein in 3 patients with obstruction of the inferior vena cava

When the inferior vena cava is obstructed, collateral veins enlarge, connecting with the inferior (accessory) right hepatic vein (IRHV) and thence through various hepatic veins to the right atrium. Three such cases are described. In one patient, most contrast material flowed into the IRHV and from there to the left hepatic vein. The second patient had several large collaterals arising from the IRHV and flowing into the right and middle hepatic veins, while the third patient demonstrated anastomoses between the IRHV and the middle hepatic vein. All of these hepatic venous shunts eventually drained into the right atrium. There were no clinical manifestations such as ascites, edema, or dilatation of the abdominal veins. Cavography alone or combined with computed tomography proved to be diagnostic in the assessment of these intrahepatic collaterals.

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan. Report of two cases

A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.

Intrahepatic portal vein branches studied by percutaneous transhepatic portography

Percutaneous transhepatic portography was performed in 31 patients. Based on the anterior and lateral images, the authors have concluded that the portal vascular system described in most anatomy textbooks does not correspond to the anterior portogram. A more practical nomenclature and order of branches are proposed, in which the first order includes the proximal portal vein branches; the second order includes the right anterior and posterior segmental branches, the umbilical portion of the left lobe, and most of the caudate veins; and the third order includes the peripheral (subsegmental) branches. The liver is divided accordingly into three main segments and one secondary segment (the caudate lobe), with each of the main segments being divided into two subsegments. The authors suggest that this new nomenclature will be helpful in both diagnosis and surgery.

Studies on spinal braces. With special reference to the effects of increased abdominal pressure

Strong pressure exerted upon the abdomen by a fabric corset for a long period might cause abnormal increase in the intraabdominal pressure. This may possibly result in disturbance of the viscera. Therefore, we measured changes in the intraabdominal pressure and the pressures in the abdominal aorta, vena cava and portal vein. We also examined the histological changes in the liver in normal adult dogs wearing a fabric corset for a long time. We found that the pressure in the abdominal aorta remains almost constant, although the intraabdominal pressure and the pressures of vena cava and portal vein were increased. This may indicate the presence of congestion. Histological findings in the liver tissue of dogs suggest the presence of some abnormality. We have developed a dynamic and functional "Wakayama Medical College" type of spinal brace as a result of these findings.

Sonographic detection of large spontaneous spleno-renal shunts and its clinical significance

The ultrasonographic findings of large spleno-renal shunts seen in five patients with liver cirrhosis and confirmed by CT and/or portography, are described. These spleno-renal shunts were seen in the left inter- or subcostal sections as transonic, mass-like lesions located between the splenic hilum and the left kidney, and by continuous scanning, they were found to be part of a tortuous, large tubular structure. Oesophageal varices were absent or minimal in these patients, and none of them had ever bled.

[Studies on tissue concentrations of cefoperazone and piperacillin classified by the site of the wall of gallbladder and concentration of piperacillin in the bile after operation]

In selection of drugs to be used in the treatment of biliary tract infections, sensitivity of causative organisms to drugs and tissue concentrations of the drugs constitute important factors. In the present study we treated patients with cholelithiasis with cefoperazone (CPZ) and piperacillin (PIPC), both of which have been reported to show high concentrations in the bile, and concentrations of the drugs in serum, cholecystic bile and various sites of the wall of gallbladder were determined. In addition the drug concentrations in the serum and bile at the 1st and 7th postoperative days were also determined. The following results were obtained. Comparison of concentrations of CPZ and PIPC at various sites of the wall of gallbladder revealed that both drugs showed high levels in the bottom, body and neck areas of the gallbladder with no difference by sites. The concentration ratios against serum for these drugs were 71.8 and 83.6%, showing good transference into tissue. The mean concentrations of CPZ and PIPC in the cholecystic bile were as high as 448.8 and 381.6 micrograms/ml, the ratio against serum being about 4:1. The serum concentrations of PIPC at the 1st and 7th postoperative days were 116 and 137 micrograms/ml at 60 minutes after starting drip infusion, with no difference between these 2 days. In the bile concentrations of PIPC on both postoperative days showed the peak levels of 2,587 and 1,157 micrograms/ml at 120 minutes after starting drip infusion. The concentrations at the 1st postoperative day were higher. The recovery rate of PIPC from the bile was also higher at the 1st postoperative day. From the results that both drugs showed high levels in the wall of gallbladder and also showed high levels in the bile immediately after the operation, PIPC and CPZ are considered to be effective drugs for biliary tract infections.

[A case of gastric carcinoid associated with multiple early gastric cancers and atypical epithelium]

A 69-year-old man was admitted to our hospital complaining of the sensation of abdominal fullness and tarry stool. X-ray and endoscopic examination revealed a gastric tumor measuring 6.5 X 7.5 cm in the antrum along the greater curvature. Histologically, the tumor was diagnosed as carcinoid; five lesions of early gastric cancer and one lesion of atypical epithelium were also detected. Through 1982, 24 Japanese patients with gastric carcinoid associated with gastric cancer have been reported.

Spontaneous portal-hepatic venous shunt via an intrahepatic portal vein aneurysm

In this unusual case, a portal-hepatic venous shunt was first demonstrated as an abnormal lesion in the liver using a contrast-dynamic computed tomographic scan. It was subsequently shown by percutaneous transhepatic portography to be an intrahepatic portal vein aneurysm communicating with a hepatic vein.

The characterization of invertebrate troponin C

TNCs from lobster, mussel, and squid migrated with rabbit TNC at an apparent mol. wt of 18,000. Electrophoretic mobilities in the presence or absence of Ca2+ were compared: the electrophoretic mobility of rabbit TNC was greater in the presence of Ca2+ than it its absence, but all invertebrate TNCs tested migrated identically, whether Ca2+ was present or not. The Ca2+-binding capacity of invertebrate TNCs was only one Ca2+ ion per molecule. The alpha-helix contents in the presence or absence of Ca2+ were compared: rabbit TNC changed by a value of 16% and invertebrate TNCs by 4%. Antibodies to loligo TNC did not cross-react with rabbit TNC, but did interact with their molluscan TNCs.

False-positive liver scans due to portal hypertension: correlation with percutaneous transhepatic portograms in 33 patients

Tc-99m-phytate scanning of the liver and percutaneous transhepatic catheterization of the portal vein were performed in 33 patients--26 with cirrhosis, 3 with chronic active hepatitis, 2 with idiopathic portal hypertension, and 2 with unresolved acute hepatitis. A discrete defect in the porta hepatis area was seen in 6 of 28 patients who had portal vein pressure above 200 mm H2O. In 5 of the 6 patients with a false-positive scan, the umbilical portion of the left portal vein branch was dilated (larger than 25 x 20 mm) on the portogram, with or without a patent paraumbilical vein. The anatomical basis of this phenomenon is discussed, and it is suggested that this area be given special attention.