[Plasma and tumor gastrin in patients with primary hyperparathyroidism]

It is well known that primary hyperparathyroidism is often associated with peptic ulcer. The purpose of this study is to confirm the relationship between the gastrin-levels before and after parathyroidectomy in fourteen patients with primary hyperparathyroidism, and to determine the localization of gastrin in the surgically resected parathyroid tumor. The results obtained were as follows: 1) Three patients had peptic ulcer (gastric ulcer and duodenal ulcer), the incidence being 21%. 2) The basal serum gastrin levels were 123.0% +/- 68.1 pg/ml before operation and decreased to 90.2 +/- 44.5 pg/ml after operation. In the 3 patients with slightly elevated gastrin levels, the mean level before operation was 209.1 +/- 61.2 pg/ml. The gastrin level decreased to 116.4 +/- 62.0 pg/ml after operation. 3) Gastrin immunoreactivity was detected in 10 out of 14 tumors and its localization was at the periphery of tumor cells. From these results, we conclude that extragastric gastrin secretion from parathyroid tumors may be one of the cause of peptic ulcer in patients with primary hyperparathyroidism.

[Changes in hepatic and renal tissue blood flows in cirrhotic rat in hemorrhagic shock]

The purpose of present study is to elucidate the influence of hypotension on hepatic and renal tissue circulations in cirrhosis. The changes of hepatic and renal tissue blood flows (TBF) were studied in hemorrhagic shock using cirrhotic rats. The hepatic and renal energy charges (EC) were measured in normal and cirrhotic rats. Hepatic TBFs of the cirrhotic rats decreased to 74% of the normal, portal pressure increased to 140%, but renal TBF was not changed significantly. In hemorrhagic shock induced by blood exsanguination, hepatic and renal TBFs of normal rats were restored to the preshock levels by transfusion of shed blood, but those of cirrhotic rats were not restored. Furthermore, the hepatic and renal ECs of normal-shocked rats were not different from those of control rats, but the ECs of cirrhotic-shocked rats were decreased significantly. These findings suggest that hypotension under cirrhosis disturbs hepatic and renal tissue circulations and energy metabolisms also in a period of after-shock phase.

[A screening index for primary hyperparathyroidism using discriminant functions]

In order to obtain a useful screening index for primary hyperparathyroidism (PHPT), seven patients with PHPT and fifty-one patients with nonparathyroid hypercalcemia (NPHC) were studied retrospectively. Serum calcium, inorganic phosphate (IP), alkaline phosphatase, albumin (Alb), chloride (Cl), total protein, urea nitrogen and creatinine (Cre) were analyzed at the same time. Discriminant analysis using a stepwise variable select method was applied to these patients. A discriminant function (F 1) was derived from three laboratory tests; F 1 = -0.660 x [IP] + 0.142 x [Cl] + 0.564 x [Alb] - 14.4 (PHPT: F 1 greater than 0.641). F 1 had sensitivity of 100% and specificity of 72.5% (14 false positives) in diagnosing PHPT. Next, another discriminant function (F 2) was derived from PHPT and the false positive patients; F 2 = -2.61 x [IP] + 0.286 x [Cl] - 4.24 x [Cre] - 19.3 (PHPT: F 2 greater than 0.412). When F 2 was applied to positive patients by F 1, final sensitivity was 100% and specificity was 98%. This screening method was tested prospectively in fifty-six consecutive samples of hypercalcemia (PHPT 4, NPHC 52), resulting in sensitivity of 100% and specificity of 98%. It was proved that our screening method using two step discriminant functions was very useful to diagnose PHPT.

The development and extension of hepatohilar bile duct carcinoma. A three-dimensional tumor mapping in the intrahepatic biliary tree visualized with the aid of a graphics computer system

Computer-assisted three-dimensional (3D) reconstruction of the biliary tree including extrahepatic and intrahepatic parts was performed from surgical or autopsy materials from 12 patients with hepatohilar bile duct carcinoma in an effort to visualize three-dimensionally the distribution of carcinoma and dysplasia. In each case, material including a hepatic lobe was reduced to serial slices 1 mm thick using a ham slicer, then the tumors, ducts with carcinoma in situ, and those with dysplasia were submitted to reconstruction. In a 3D map of biliary tree reproduced on a display, a dysplastic zone was shown in most cases surrounding a focus of carcinoma, justifying the assumption of a dysplasia-carcinoma sequence. The carcinoma itself proved to form multiple foci along bile ducts in as many as 42% of the patients, in some of whom the foci were independent without any intervening dysplasia. These results suggest that as extensive a surgical measure as possible should be taken in designing a strategy against this tumor.

The development and extension of hepatohilar bile duct carcinoma. A three-dimensional tumor mapping in the intrahepatic biliary tree visualized with the aid of a graphics computer system

Computer-assisted three-dimensional (3D) reconstruction of the biliary tree including extrahepatic and intrahepatic parts was performed from surgical or autopsy materials from 12 patients with hepatohilar bile duct carcinoma in an effort to visualize three-dimensionally the distribution of carcinoma and dysplasia. In each case, material including a hepatic lobe was reduced to serial slices 1 mm thick using a ham slicer, then the tumors, ducts with carcinoma in situ, and those with dysplasia were submitted to reconstruction. In a 3D map of biliary tree reproduced on a display, a dysplastic zone was shown in most cases surrounding a focus of carcinoma, justifying the assumption of a dysplasia-carcinoma sequence. The carcinoma itself proved to form multiple foci along bile ducts in as many as 42% of the patients, in some of whom the foci were independent without any intervening dysplasia. These results suggest that as extensive a surgical measure as possible should be taken in designing a strategy against this tumor.

Genetic Analysis of Haploids from Industrial Strains of Baker's Yeast

Strains of baker's yeast conventionally used by the baking industry in Japan were tested for the ability to sporulate and produce viable haploid spores. Three isolates which possessed the properties of baker's yeasts were obtained from single spores. Each strain was a haploid, and one of these strains, YOY34, was characterized. YOY34 fermented maltose and sucrose, but did not utilize galactose, unlike its parental strain. Genetic analysis showed that YOY34 carried two MAL genes, one functional and one cryptic; two SUC genes; and one defective gal gene. The genotype of YOY34 was identified as MAT α MAL1 MAL3g SUC2 SUC4 gall. The MAL1 gene from this haploid was constitutively expressed, was dominant over other wild-type MAL tester genes, and gave a weak sucrose fermentation. YOY34 was suitable for both bakery products, like conventional baker's yeasts, and for genetic analysis, like laboratory strains.

Plasma amino acid abnormalities in liver disease: comparative analysis of idiopathic portal hypertension, extrahepatic portal occlusion and liver cirrhosis

To clarify the clinical significance of specific plasma amino acid abnormalities occurring in liver disorders with portal-systemic shunting, plasma amino acids and insulin levels were measured in idiopathic portal hypertension (IPH), extrahepatic portal occulusion (EHPO), and liver cirrhosis (LC). Three branched chain amino acids (BCAA: valine + leucine + isoleucine) were decreased in all three diseases in comparison with controls. Since plasma insulin measured during oral glucose tolerance tests did not specifically rise in LC, reduction of BCAA is not merely ascribed to hyperinsulinemia. Either portal-systemic shunting or some extent of liver damage may contribute to a fall in BCAA. Two aromatic amino acids (AAA: phenylalanine + tyrosine), which were within the normal range in EHPO and IPH, showed a marked increase in LC. Thus, changes of AAA probably mainly reflect the severity of the liver disease. The molar ratio of BCAA/AAA (MR) significantly correlated with ICG k, ICG R15, PT and the sum of blood ammonia in an oral ammonia tolerance test which may reflect the degree of hepatic disorder. MR diminished in the following decreasing order: controls, EHPO, IPH and LC.

Histologic findings and prognostic factors in carcinoma of the upper bile duct

The histopathologic features of 34 resected carcinomas of the upper bile duct were reviewed. Patients with papillary adenocarcinoma showed a 3-year survival rate of 75 percent, which was better than those with poorly differentiated adenocarcinoma with no 2-year survivors. Infiltration to the serosa of the bile duct, lymph node metastasis, and vascular invasion were important prognostic factors, since the survival was better for the patients without than those with these factors. Among patients with papillary adenocarcinoma, none had hepatic infiltration and lymph node metastasis and most had no infiltration to the serosa. Patients with poorly differentiated adenocarcinoma, in contrast, had extensive association of those prognostic factors. Seventy-five percent of the patients with papillary adenocarcinoma and only 22 percent of patients with poorly differentiated adenocarcinoma were considered to have curative resection. These findings suggest that the histologic type strongly influenced the prognosis of the patients with carcinoma of the upper bile duct and can be used for the determination of the extent of this tumor.

Principal-Component Analysis of the Characteristics Desirable in Baker's Yeasts

Twenty-seven properties considered to be required for good bakery products were examined in 56 industrial and 2 laboratory yeast strains. The data obtained were applied to principal-component analysis, one of the multivariate statistical analyses. The first and second principal components together were extracted, and these accounted for 77.7% of the variance. The first principal component was interpreted as the glycolytic activity of yeast in dough, and the second one was interpreted as the balance of leavening abilities in sweet and flour doughs from the factor loadings. The scattergram on the two principal components was effective in grouping the 58 yeast strains used.

Long-term survival in carcinoma of the biliary tract. Analysis of prognostic factors in 146 resections

In 146 consecutive patients undergoing resection for carcinoma of the biliary tract, various tumor characteristics that affected long-term survival of the patients were studied. Patients with gallbladder carcinoma whose tumors had no serosal infiltration or vessel invasion were grossly papillary, or were papillary or well-differentiated adenocarcinoma histologically survived longer than those without these tumor characteristics. In upper-third lesions, patients whose tumors showed no serosal infiltration or vessel invasion, were grossly papillary, were papillary or well-differentiated adenocarcinoma histologically, or were treated with hepatic lobectomy had a higher chance of long-term survival. Patients with the middle-third lesions, whose tumors were grossly papillary or nodular or whose margins were tumor-free, were apt to survive longer. Long-term survival for patients with lower-third lesions was obtained most often in patients without lymph node metastasis or vessel invasion.

[The pathogenesis of perineural tumor invasion--a computer reconstruction study on its relation with a lymphatic spread in human and experimental carcinomas of the bile duct]

The way in which tumors reach the perineural space of the nerves from adjacent tissues has been studied by a computer 3-D reconstruction of a bile duct wall invaded by a carcinoma, from the case histories of two patients with a bile duct carcinoma and from rabbits given a VX2 tumor that had been transplanted. It was found that while carcinomas readily grew along the perineural spaces in an axial direction these carcinomas also had, simultaneously, abundant connections with tumors growing outside, especially with lymphatic tumors. Thus it was likely that tumors reach the distant nerves mainly via this lymphatic connection, i.e., first forming satellite lymphogenous foci around the nerves and then, as a second step, breaking into the perineural space.

[Nuclear DNA pattern and various prognostic factors of the gallbladder cancer]

Nuclear DNA patterns which was obtained by the Feulgen staining and microspectrophotometric measurement in the gallbladder cancer were analyzed. DNA score was determined by the peak ploidy unit and decided numbers of frequency in each ploidy unit and compared with the various factors influencing prognosis of the patients. DNA score was significantly lower in cancer with papillary form and limited involvement to the mucosa compared with that with other forms and involvement beyond the proper muscle layer. DNA score was also significantly lower in cancer without hepatic infiltration, vascular invasion and lymph node metastasis than that with those characteristics. In experimental studies VX2 cancer cells which were implanted in the gallbladder subserosa in rabbits, DAN score did not show any changes with the growth of carcinoma implanted. Biologic nature of the tumor which was evaluated with nuclear DNA pattern of cancer cells was fundamental to define the spread of carcinoma and the prognosis of the patients.

Ampicillin vs. placebo for Yersinia pseudotuberculosis infection in children

For evaluation of the efficacy of early treatment with ampicillin on the clinical course of Yersinia pseudotuberculosis infection in children, 136 patients were randomly assigned to receive either ampicillin or placebo. Subjects were those who were diagnosed as having Kawasaki syndrome and those who satisfied three of the following four criteria: fever; rash; abdominal symptoms; and a history of ingestion of untreated drinking water. Fifty-six patients had evidence of Y. pseudotuberculosis infection bacteriologically and/or serologically. Twenty-six were assigned to placebo and 28 to ampicillin. Ampicillin therapy did not show a significant benefit in shortening the duration of fever, diarrhea and abdominal pain or in preventing rash, erythema nodosum and acute renal failure. After 5 days of treatment none of the patients in the ampicillin group excreted the organism in the stool whereas 19 (90%) of 21 in the placebo group did (P less than 0.001). Ampicillin did not show a clinical benefit but reduced the fecal excretion of the organism.

Purification and characterization of W-protein. A DNA-binding protein showing high affinity for the W chromosome-specific repetitive DNA sequences of chicken

A protein component, which binds with high affinity to the W chromosome-specific XhoI family repetitive DNA of chicken (Tone, M., Sakaki, Y., Hashiguchi, T., and Mizuno, S. (1984) Chromosoma (Berl.) 89, 228-237), was detected in the 0.35 M NaCl extract of the female chicken liver nuclei. This protein, designated as W-protein, was substantially purified by phosphocellulose, hydroxyapatite, and DEAE-Toyopearl column chromatography. Molecular weight of W-protein was estimated to be about 72,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, but it seems to form multimeric structure having apparent molecular weight of about 2.3 X 10(6) under nondenaturing conditions. W-Protein binds strongly to both 0.7- and 1.1-kb repeating units of the XhoI family, both of which show curved DNA characteristics, and weakly to the AATAT-satellite sequence of Drosophila melanogaster. Stable binding of W-protein requires greater than or equal to 300 base pairs of the 0.7-kilobases sequence, or more than 14 tandem repeats of the 21-base pair internal repeating unit of the 0.7-kilobase sequence. DNA footprint analysis and effects of some DNA-binding compounds suggest that the DNA double helix wraps around W-protein or its multimeric form contacting through A-T-rich minor grooves. A possible role of W-protein in the formation of W heterochromatic body is discussed.

[Significance of perioperative nutritional support and activation of the reticuloendothelial system on the resection of the cirrhotic liver]

The cirrhotic patients were in poor nutritional condition and deteriorated reticuloendothelial function, which were further aggravated after hepatic resection. Preoperative nutritional repletion treatment as well as preoperative administration of OK-432 improved the nutritional condition and reticuloendothelial function of the patients, resulting in uneventful postoperative courses. In experimentally induced liver cirrhosis, however, an excessive amount of glucose administration in the early postoperative period induced the reduction of hepatic energy charge and ATP content. An adequate amount of glucose should be administered in a period associated with marked glucose intolerance. To determine daily glucose disposal rate rapidly, blood glucose curve obtained from intravenous glucose tolerance test (IVGTT) and insulin tolerance test (ITT) was analyzed in hepatectomized cirrhotic rats. It was possible to calculate prospected values of glucose disposal rate by the analytic index of IVGTT and ITT. An adequate perioperative nutritional support and the activation of the reticuloendothelial system are thought to have important therapeutic value to prevent complications of liver cirrhosis after resection.

Temporary metabolic support by extracorporeal blood therapy for liver failure after surgery

With the aim of temporarily assisting deterioration of liver function developing after surgery, extracorporeal blood purification therapy (EBPT) (plasma exchange and/or hemofiltration) was carried out in 26 postoperative patients. Initiation of EBPT was instituted according to the criteria of either a serum bilirubin greater than 15 mg/dl or Grade 2 or more coma. Plasma exchange was carried out 235 times in 23 patients and hemofiltration was performed 28 times for seven patients. In addition, hemodialysis and CAPD were linked in eight cases. Plasma exchange was found to control the progression of DIC and endotoxemia. Nine patients (35%) were weaned from EBPT. In the survivors the levels of blood ammonia and number of major complications were significantly lower compared to the nonsurvivors. Three patients treated only with hemofiltration were all lost. Among co-morbid factors present, incidences of renal failure, respiratory failure, and associated liver cirrhosis significantly increased poor clinical outcome on EBPT for postoperative liver failure.

Significance of activation of reticuloendothelial function after hepatectomy in cirrhotic rats

Effect of hepatectomy on the prognosis of cirrhotic rats prepared by oral administration of thioacetamide was studied from the standpoint of the reticuloendothelial function and energy metabolism of the liver. OK-432, a streptococcal preparation, was used to activate reticuloendothelial functions. Administration of OK-432 to cirrhotic rats prior to 70% hepatectomy significantly prevented the elevation of serum GOT, GPT and LDH, the prolongation of blood coagulation and the decrease of serum complement level. Hepatic ATP synthesis and RNA content were significantly increase by the use of OK-432. These findings suggest that activation of reticuloendothelial functions at the time of massive hepatectomy in cirrhotic rats may diminish hepatic injury, maintain serum complement level, and improve protein synthesis of the liver.

The significance of activation of reticuloendothelial function on hepatectomy

The prognosis of patients after massive hepatectomy is poor in certain cases whose hepatic reserve, including reticuloendothelial function, is deteriorated. We administered OK-432 before 70% hepatectomy on rats to activate the reticuloendothelial function and studied its effect on postoperative course. The elevations in plasma endotoxin, GOT and GTP were attenuated, and the deterioration of the complement activity after hepatectomy was greatly improved by OK-432 treatment. The RNA content in the liver was significantly increased by OK-432 administration. These findings suggest that activation of the reticuloendothelial function at the time of massive hepatectomy enhances endotoxin clearance from blood and thereby contributes in lessening the magnitude of hepatic injury, maintaining the serum complement, and improving liver protein synthesis.

Activation of reticuloendothelial function for prevention of endotoxemia after hepatectomy in cirrhotic patients

In order to prevent endotoxemia after hepatectomy in cirrhotic patients, we administered OK-432 before and after hepatectomy to activate the reticuloendothelial function and studied its effect on postoperative endotoxemia. In the cirrhotic group without OK-432 administration (7 patients), the value of endotoxin increased significantly after hepatectomy, compared to the cirrhotic group which received OK-432 administration (5 patients) and the non-cirrhotic group (12 patients), and the endotoxin level was still higher than the preoperative value even on the 14th day. On the other hand, the cirrhotic group with OK-432 administration and the non-cirrhotic group showed minimal increases of endotoxin levels at the first day, which returned to the preoperative values at the third day. Base on these findings, it is suggested that activation of the reticuloendothelial function bears substantial significance as one of the therapeutic modalities for prevention of endotoxemia after hepatectomy in cirrhotic patients.

Effects of superselective arterial embolization and chemoembolization on energy charge and total blood flow of the rat liver

The superselective transcatheter arterial embolization (TAE) and chemoembolization (TAC) of the periphery of the left and median lobes of the rat liver were performed using 1.5 mg of gelatin sponge dissolved in saline solution and mitomycin (MMC) at a dose of 1.6 mg/kg b.wt. The energy charge (EC) of the embolized and chemoembolized lobes decreased after the embolization but was restored 3 h later. The total hepatic blood flow (THBF) was reduced to about one half and required 1 week to be restored to the preembolization levels in both groups. Microscopic centrilobular necrosis and vacuolization were found. The addition of MMC did not produce marked untoward effects. Thus, the normal liver is able to restore its energy pool despite a reduction in the THBF after superselective arterial embolization, and this recovery is not altered even by the use of a high dose of MMC.

[Histological appearance of carcinoma of the upper bile duct and the mode of its spread]

The histopathology of 34 resected cases of carcinoma of the upper bile duct was reviewed in relation to its mode of spread and prognosis of the patients. The patients with papillary adenocarcinoma showed 3-year survival rate of 75 percent which was better than those with carcinoma of other histologic types. There were no 2-year survivals in patients with poorly differentiated adenocarcinoma. Infiltration to the serosa of the bile duct and to the liver, lymph node metastasis, and venous, lymphatic or perineural invasion of carcinoma were thought to be important prognostic factors, since the chance for survival was definitely better for patients without those factors than with those factors. In four patients with papillary adenocarcinoma, no involvement of hepatic parenchyma and lymph node metastasis was found. Three of these patients had no cancer infiltration to the serosa of the bile duct. Most cases of poorly differentiated adenocarcinoma, in contrast, had positive and extensive association of those prognostic factors. Seventy-five percent of patients with papillary adenocarcinoma and only 22 percent of those with poorly differentiated adenocarcinoma were microscopically considered curable by resection. It is noteworthy that histological appearance of carcinoma may be valid as a fundamental factor to determine mode of spread of carcinoma of the upper bile duct and prognosis of the patients.

Prognostic factors in the surgical treatment of gallbladder carcinoma

A clinical and pathologic review was undertaken of 36 patients with primary carcinoma of the gallbladder who could tolerate curative resection. The 5-year survival rate of the patients with tumor exposed to the serosa (n = 17) was significantly lower than that of the patients with tumor limited to the mucosa (n = 7), muscularis (n = 7), or subserosa (n = 5). Macroscopically, all tumors limited to the mucosa and 6 of 7 limited to the muscularis were of the papillary form, which was associated with a better patient survival (p less than 0.05) than the nodular or infiltrative form present in 11 of 17 tumors that penetrated to the serosa. The papillary or well-differentiated carcinoma--present in all patients with tumors superficial to the gallbladder subserosa--had a higher survival (p less than 0.001 and p less than 0.01) than the moderately or poorly differentiated carcinoma present in 7 of 17 tumors with spread to the serosa. Incidences of venous, lymphatic, or perineural invasion were higher in tumors that spread beyond the serosa than those limited to the mucosa (p less than 0.05), and survival differed between patients with and without these characteristics (p less than 0.001). Analysis for nuclear DNA pattern of those tumors limited to the mucosa revealed its lower cellular malignancy. Patients with tumors superficial to the subserosa survived longer after undergoing extended cholecystectomy than those who underwent simple cholecystectomy (p less than 0.05). The prognosis of gallbladder carcinoma was highly influenced not only by the biologic nature of tumor but by the surgical procedures used.

[Endotoxemia after surgery in digestive diseases]

The blood level of endotoxin after operations in patients with digestive diseases, mainly liver cirrhosis and obstructive jaundice, and the complications most likely related to the presence of endotoxemia were investigated. Twenty-seven patients without either liver cirrhosis or obstructive jaundice showed a minimal elevation of the endotoxin level in blood, as shown by 6.1 +/- 3.9 pg/ml at the first postoperative day and there was only one anastomotic leakage. On the other hand, 18 patients with liver cirrhosis showed a notable and persistent endotoxemia after surgery. The cirrhotic patients who especially underwent splenectomy and hepatectomy showed marked elevations of endotoxin level at the first postoperative day, with values of 151.0 +/- 46.1 pg/ml and 101.3 +/- 36.2 pg/ml, respectively, and one of these patients died of hepatic failure. Thirteen patients with obstructive jaundice developed endotoxemia evidenced by the value of 21.6 +/- 4.8 pg/ml at the first day after surgery. Among these patients, two had gastrointestinal bleeding and one developed DIC. The markedly high and persistent levels of endotoxin in patients with liver cirrhosis or obstructive jaundice may be possibly related with the development of MOF.

[FT, 5-FU and uracil concentrations of the blood, bile and tissue of hepatoma with liver cirrhosis after oral administration of UFT]

UFT was orally administered to eight patients with hepatocellular carcinoma (HCC) combined with liver cirrhosis and to five patients with normal liver. The concentrations of FT-207 (FT), 5-FU, and uracil in blood, tissue and bile were then respectively determined. The FT level in cancer tissue and non-cancer tissue was almost identical in patients with HCC. On the other hand, the 5-FU level in normal liver tissue was significantly higher (P less than 0.05) than that in cancer tissue, and the uracil level in normal liver tissue was lower than that in cancer tissue (P less than 0.05). Transportation of FT from blood to liver was significantly correlated with clearance of indocyanine green from the blood (ICGK). These results suggested that transportation of FT from blood to liver and activation of FT were impaired in HCC with liver cirrhosis. However, the 5-FU level in the cancer tissue of HCC tended to be higher than that in non-cancer tissue. The 5-FU level in the tissue had a significant correlation with the FT level in the tissue. In addition, it was presumed that cancer tissue was able to produce 5-FU from FT more quickly than non-cancer tissue.

[Clinical trial of cefuzonam in biliary infection]

For the evaluation of efficacy of cefuzonam (CZON) on biliary infection, the drug was administered to 12 cases of hepatic, biliary, and pancreatic diseases with postoperative/post-percutaneous transhepatic biliary drainage (PTBD) infections. The results were summarized as follows: The bacterial eradication rate was 33.3% (9/27 strains). Nine strains of bacteria appeared during the administration of CZON. MIC's of CZON against 14 strains including 4 of K. oxytoca out of 53 strains tested were below 1.56 micrograms/ml, whereas MIC's against 39 strains including 22 Pseudomonas spp. were higher than 12.5 micrograms/ml. Leukocyte counts in bile decreased in 6 cases, increased in 2 cases, and not detected in 1 case, showing no correlation with changes in bacteriology or clinical symptoms. Improvements of clinical symptoms such as reduced pain and decreased fever were noted in all cases. No case of adverse reaction was observed. The results indicated that CZON would be an antibiotic with a high efficacy and safety on biliary infections.

Endotoxemia after abdominal surgery

The blood level of endotoxin after operations in patients with digestive diseases, mainly liver cirrhosis and obstructive jaundice, and the complications most likely related to the presence of endotoxemia were investigated. Twenty-seven patients without either liver cirrhosis or obstructive jaundice showed a minimal elevation of the endotoxin level in blood, as shown by 6.1 +/- 3.9 (mean +/- S.E.) pg/ml at the first postoperative day and there was only one anastomotic leakage. On the other hand, 18 patients with liver cirrhosis showed a notable and persistent endotoxemia after surgery. The cirrhotic patients who especially underwent splenectomy and hepatectomy showed marked elevations of endotoxin level at the first postoperative day, with values of 151.0 +/- 46.1 pg/ml and 101.3 +/- 36.2 pg/ml, respectively, and one of these patients died of hepatic failure. Thirteen patients with obstructive jaundice developed endotoxemia evidenced by the value of 21.6 +/- 4.8 pg/ml at the first day after surgery. Among these patients, two had gastrointestinal bleeding and one developed disseminated intravascular coagulation (DIC). The markedly high and persistent levels of endotoxin in patients with liver cirrhosis or obstructive jaundice may be possibly related with the development of multiple organ failure (MOF).

Blood purification of bilirubin and bile acids by plasma exchange for patients with liver failure

To evaluate the efficacy of blood purification by plasma exchange in patients with liver failure, blood levels of total bilirubin and total bile acids, known to be a part of protein-bound toxins, were measured before and after plasma exchange. With one plasma volume exchange the percent reduction was 39 for bilirubin and only 25 for bile acids. The declining of the reduction efficiency appeared to be well correlated with the prolongation of the treatment time for bilirubin and the augmentation of the initial concentration for bile acids. These data suggested that the equilibration between intra-and extra-vascular pool takes place slowly for bilirubin and comparatively rapidly for bile acids, though they are both mostly bound to albumin in the blood. In addition, the presence of protein-bound toxins like bile acids, predominantely accumulated in the tissue, may make it more difficult to support patients with liver failure by only blood purification therapy with plasma exchange.

[Spreads of gallbladder carcinoma: significance of histological classification of the tumor]

Mode of spread of the primary gallbladder carcinoma was investigated in 40 curatively operated and 91 non-curatively operated patients. Fifty-seven percent of curatively operated patients showed papillary adenocarcinoma (pap.) and 44% of non-curatively operated patients did poorly differentiated tubular adenocarcinoma in histology. The curatively operated patients who showed pap. had the best prognosis, showing 5-year survival rate of 67%. It could be pointed out that pap. tended to limit in the gallbladder wall, since 61% and 74% of pap. showed negative serosal infiltration and hepatic invasion, respectively. Tubular adenocarcinoma (tub.), in contrast, tended to spread to adjacent viscera, since only 23% of cases showed negative serosal infiltration. In non-curatively operated patients, there was no significant difference in the survival period among different histological types of the tumor. Even in pap. with advanced stage, incidences of lymph node metastasis, invasion to the bile duct and peritoneal dissemination were closely similar to those in tub.. In conclusion, histological type of the tumor strongly influenced the spread of carcinoma and an outcome of the patients, consequently.

[Carcinoma of the gallbladder--a clinical appraisal and review of 40 cases]

Prognosis of 40 patients with gallbladder carcinoma who had undergone curative resection was investigated. Five-year survival rate calculated from Kaplan & Meier's method was 67% in 16 cases in Stage I, 43% in 8 cases in Stage II and 22% in 10 cases in Stage III, respectively. In 6 cases, classified as Stage IV, no case survived more than 2 years postoperatively. Most patients in Stage I had the tumors of papillary type in macroscopic appearance, papillary adenocarcinoma, and negative vascular and perineural invasions and showed better prognosis. In Stages II, III and IV, in contrast, most tumors were infiltrative or nodular type, tubular adenocarcinoma, and positive vascular and perineural invasions and demonstrated poorer prognosis. Patients in Stage I who had undergone simple cholecystectomy showed 5-year survival rate of 57%, and who underwent cholecystectomy with wedged resection of the gallbladder bed of the liver and regional lymphadenectomy (extended cholecystectomy) showed that of 100%. Extended cholecystectomy, therefore, is the procedure of choice in patients in Stage I. In patients in Stages II, III and IV, extended cholecystectomy yielded 5-year survival rate of 33%. More radical procedure or combined modality therapy must be indicated in advanced stage of the disease.

Superselective arterial embolization of the rat liver

The superselective transcatheter arterial embolization has currently become an accepted treatment of hepatic tumors. We have developed an experimental model for the evaluation of this therapy in the rat liver. Using the retrograde catheterization of the superior pancreaticoduodenal artery, only the peripheral intrahepatic arterial branches and sinusoids of the median and left lobes of the liver were embolized with 1.2 and 1.5 mg of Gelfoam powder. This method resembles the clinical practice because the superselective embolization could be performed adequately and allows the comparative evaluation of the responses of the embolized and non-embolized lobes.

[Significance of cross-circulation on obstructive jaundice in rats with special reference to the mitochondrial function of the liver and kidney]

Cross-circulation was performed to investigate the mitochondrial respiratory function of the liver and kidney in rats after 1, 2 and 3 weeks of biliary obstruction. Serum bilirubin and total bile acids concentration in blood in rats with biliary obstruction markedly decreased with 3 hours cross-circulation. There demonstrated, however, no significant change in mitochondrial function in the liver after cross-circulation. In contrast, mitochondrial function in the kidney showed significant improvement after 3 hours cross-circulation. Mitochondrial respiratory function in normal partner rats cross-circulation with jaundiced rats demonstrated temporal deterioration in the kidney and prolonged deterioration in the liver. It can be concluded that cross-circulation or plasma exchange might be useful for the prevention of renal failure in obstructive jaundice, since cross-circulation induced persistent improvement of the mitochondrial respiratory function in the kidney deteriorated by biliary obstruction.

Alternations of liver pathophysiology in experimental hepatic failure treated by two forms of plasma purification procedure

Plasma cross-circulation which resembles plasma exchange and plasma perfusion over charcoal and resin adsorbents were carried out using rats with galactosamine (GalN)-induced hepatic failure to investigate the effects of those plasma purification procedures on damaged liver function. Twenty-four hr after the injection of GalN, the plasma treatment procedures were performed at a plasma flow rate of 0.1 ml/min for 6 hr. Forty-eight hr after the injection of GalN, ATP synthesis in liver mitochondrial function, and ATP and total adenine nucleotide contents in the liver, which were markedly reduced by the GalN administration, were increased by both plasma cross-circulation and plasma perfusion over adsorbents. These results suggest that both plasma purification procedures improve the deterioration of mitochondrial phosphorylation activity and produce an augmented high energy status in the liver. In the histological study of the liver, volume ratio of hepatic parenchyma in the GalN-treated liver to that in the normal liver was significantly higher in rats treated with plasma perfusion than those with sham-perfusion. An efficient removal of the hepatotoxic metabolites from the plasma, therefore, decelerates the progress of GalN induced-liver tissue necrosis, if rats with GalN-induced hepatic failure are treated in an early stage.

[Long-term cross-circulation on galactosamine induced hepatic failure rats]

Cross-circulation was carried out in between galactosamine treated hepatic failure rats and normal rats and its efficacy was mainly evaluated by measuring mitochondrial respiratory function of the liver. Twenty-four hours after the injection of galactosamine, cross-circulation was performed at a blood flow rate of 1 ml/min for 8 hours. Survival rate of the rats in 48 hours and 60 hours after the injection of galactosamine was 86% and 57% in a cross-circulation group and 66% and 23% in a sham-circulation group, respectively. In a cross-circulation group, there showed significant increases of ATP synthesis per 100 gr. body weight, turnover number of phosphorylation and Cyt a (+a3) which were markedly reduced in a sham-circulation group. These appear to suggest that cross-circulation provides augmented mitochondrial energy supply in the liver and contributes higher survival rate of the rats.

[Homologous plasma cross-circulation on galactosamine induced hepatic failure rats]

Plasma cross-circulation which resembles plasma exchange clinically was carried out in between galactosamine (GalN) treated hepatic failure rats and normal rats. Twenty-four hours after the injection of GalN, plasma cross-circulation was performed at a plasma flow rate of 0.1 ml/min for 6 hours. In eighteen hours after the completion of a procedure, survival rate was 75% (6 out of 8 survived) in GalN injected rats treated with plasma cross-circulation, as compared to 40% (4 out of 10 survived) in GalN injected rats treated with sham-circulation. State 3 oxygen consumption and ATP synthesis in the liver mitochondrial respiratory function, and ATP and total adenine nucleotide contents in the liver in the former group were significantly higher than those in the latter group at the time of sacrifice of the survived animals. These appear to suggest that plasma cross-circulation enhances mitochondrial phosphorylative activity in the liver and may contribute higher survival rate of the rats. Plasma exchange using a large amount of fresh plasma, therefore, would be effective for the treatment of acute liver failure in its early stage.

Nuclear DNA pattern of the gallbladder cancer

Nuclear DNA of the gallbladder cancer was stained by the Feulgen method and analyzed using a new concept of DNA score. DNA score was determined by the peak ploidy unit and decided numbers of frequency in each ploidy unit. As the result, a significant correlation between DNA score and the depth of cancer invasion was demonstrated. The depth of cancer invasion, as reported already, has close correlation to the prognosis of the patients of gallbladder cancer. These results indicate that the nuclear DNA analysis is useful for the determination of malignancy and the prediction of the prognosis of the patients.

Effects of homologous plasma cross-circulation on liver function in galactosamine-induced hepatic necrosis in rats

Plasma cross-circulation that resembles clinical plasma exchange was carried out in rats with galactosamine (GalN)-treated hepatic failure to investigate its effect on the damaged liver function. Twenty-four hours after the injection of GalN, plasma cross-circulation was performed at a plasma flow rate of 0.1 ml/min for 6 h. At 48 h after the injection of GalN, survival was obtained in 6 of 8 GalN-injected rats treated with plasma cross-circulation as compared with 4 of 10 GalN-injected rats treated with sham circulation. State 3 oxygen consumption and ATP synthesis (mitochondrial respiratory function) and ATP, ADP, and total adenine nucleotide contents in the liver were significantly higher in the former group than in the latter group at that period, as determined by sacrificing the surviving animals. Although the survival rate was not significantly improved, evidence suggests that plasma cross-circulation enhanced mitochondrial phosphorylative activity and produced an augmented high-energy state of the liver, which had been markedly reduced by GalN administration. An efficient removal of toxic metabolites as well as an influx of a large amount of fresh plasma by plasma cross-circulation would be beneficial for the regenerative process of the necrosing liver tissues.

Yersinia pseudotuberculosis infection in children, resembling Izumi fever and Kawasaki syndrome

Yersinia pseudotuberculosis infection was diagnosed in 12 children on the basis of recovery of the organism from stool cultures and a 4-fold or greater titer change in agglutinating antibody. Eight of the 12 Yersinia isolates were recovered from stool cultures only after cold enrichment. Clinical findings in 50% or more of patients were fever, rash, diarrhea, desquamation, strawberry tongue, vomiting, red and cracked lips, abdominal pain, arthralgias, hepatomegaly and conjunctivitis. The patients' clinical manifestations and courses of illness resembled those of Izumi fever, an illness that occurs epidemically in Japan. Additionally the finding in two children fulfilled the strict criteria for Kawasaki syndrome, and signs in the other 10 children were consistent with that diagnosis.

The effects of vitamin E on the indicator enzymes of organella membranes in the injured liver

Acute and chronic liver damage was caused by the administration of either galactosamine or carbon tetrachloride. Consequently, the rats with damaged livers were killed after vitamin E was administered. The livers were removed and were homogenated. Indicator enzymes (5'-nucleotidase, arylsulfatase, cytochrome C oxidase and glucose-6-phosphatase) of organella membranes were measured in the homogenates of the normal and damaged livers. The effects of vitamin E resulted in the stabilizing of the impaired membranes of plasma, lysosome, mitochondria and microsome; (1) the abnormal decrease of 5'-nucleotidase activity and glucose-6-phosphatase activity, and the abnormal increase of arylsulfatase activity, which induced galactosamine or carbon tetrachloride, and (2) the abnormal decrease of cytochrome C oxidase activity induced by galactosamine- HCl, were normalized.

A polyhydric phenol sulfokinase and chronic liver injury

The sulfokinase, that transfers activated sulfate from PAPS (3'-phosphoadenosine-5'-phosphosulfate) to nitrocatechol sulfate was studied. 1. It is thought that the enzyme plays an important role in detoxication by the sulfation of polyhydric phenols in liver. 2. The enzyme had an optimum at pH 8.0 in Tris-acetate buffer. Km was 0.105 x 10(-3)M. The rate of conjugation was linear within 1 min. 3. The main distribution of the sulfokinase was found in the liver, lungs, spleen and various other organs in the rat. The activity of the enzyme in rat liver was the highest in soluble fraction. In chronic hepatic injury caused by carbon tetrachloride injection, the activity of the enzyme gradually decreased to below about one half of the control value.

The effect of oral administration of amphotericin B on the incorporation of 5-fluorouracil into human gastric cancer tissue

Amphotericin B (AmB)-5-fluorouracil (5-FU) combination therapy against cancer was evaluated when both were given orally. Seven gastric cancer patients were treated in this manner, and 4 gastric cancer patients treated with 5-FU alone to serve as the control. AmB syrup and 5-FU syrup were administered orally for 3 days before surgical operation. Then, the drugs were given through a gastric tube into the stomach 4 hr before the start of the gastric surgery. Lesion tissues and healthy tissues were collected from each patient and the 5-FU titers were measured by bioassay. It was shown in the majority of the gastric cancer cases that the 5-FU levels in the lesion tissues were substantially higher than those in the surrounding normal tissues, whereas in the gastric cancer patients who received 5-FU alone, most of the lesion tissues showed lower 5-FU content as compared with that of the surrounding tissues.