[An autopsy case of double cancer (Hepatocellular carcinoma and mixed germ cell tumor of the testis)--significance of alpha-fetoprotein and human chorionic gonadotropin as tumor markers]

A 43-year-old male suffering from liver cirrhosis was admitted with complaints of general malaise and anorexia. Admission laboratory data evidenced high levels of serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Histopathologically, the resected left testis and supraclavicular enlarged lymph nodes revealed mixed germ cell tumor. After castration, the serum HCG level normalized, but AFP continued to increase. Autopsy findings did not unequivocally show mixed germ cell tumor, however, massive type hepatocellular carcinoma was present. These findings suggest that the hepatocellular carcinoma produced AFP, while the mixed germ cell tumor produced HCG.

Characterization of alpha-fetoprotein secreted from cultured reuber H-35 hepatoma cells

Reuber H-35 hepatoma cells were examined for their ability to synthesize protein in vitro, especially to produce alpha-fetoprotein (AFP). The presence of AFP in the culture supernatant solution was determined immunologically by the micro-Ouchterlony method. Charge heterogeneity of AFP was examined electrophoretically in continuous gradient polyacrylamide microgels. With regard to the duration of culture, there was no remarkable change in the ratio of two peaks of AFP, and which came out as a major combined peak and a similar peak by PAS staining on the condition of added SDS. These findings indicated that Reuber H-35 hepatoma cells had potential to produce two charge variants of AFP in vitro.

Liver pathology of idiopathic portal hypertension. Comparison with non-cirrhotic portal fibrosis of India. The Japan idiopathic portal hypertension study

Morphological changes of the liver were studied in 24 autopsy cases of noncirrhotic portal hypertension of unknown etiology (idiopathic portal hypertension, IPH), and in 123 surgical biopsies from such patients. For comparison, 15 whole-cut liver slices from autopsy cases of noncirrhotic portal fibrosis (NCPF) from India were also studied. Liver pathology was very similar in IPH and NCPF, characterized by phlebosclerotic changes and perivascular fibrosis of the portal vein system, and parenchymal atrophy perhaps secondary to portal circulatory insufficiency. The distribution of lesions was uneven, and despite marked fibrosis and occasional surface nodularity, there was no diffuse pseudonodule formation in the parenchyma. Surgical specimens showed similar changes except for more frequent portal cellular infiltrates, but the changes seen in one biopsy specimen were limited and not always diagnostic. It seems that IPH of Japan and NCPF of India are the same disease, and perhaps hepatoportal sclerosis elsewhere is also the same disease.

Therapeutic effects of tiopronin on chronic hepatitis: a double-blind clinical study

The efficacy of tiopronin (2-mercaptopropionyl glycine) 600 mg daily in the treatment of chronic active or chronic persistent hepatitis has been assessed in a double-blind controlled clinical trial of 12 weeks involving 165 Japanese patients with histologically proven disease. Treatment with the drug was associated with a significant improvement in abnormalities of serum transaminase and gamma glutamyl transpeptidase, with reversion towards baseline values on stopping the drug. Improvement was independent of the histological classification of the disease, or HBsAg status. The drug was well tolerated with few side-effects. The results of this short-term study indicate that tiopronin may be of value in the treatment of chronic hepatitis.

Major depressive episode and low dose dexamethasone suppression test

The authors studied the validity of a low dose (0.5 mg) dexamethasone suppression test (DST) in identifying depression. Nine patients who met the criteria of major depressive episode (MDE) in the Diagnostic and Statistical Manual of Mental Disorders, another nine psychiatric patients and one normal subject underwent the DST. At least one of the two blood samples obtained either at 8 a.m. or at 2 p.m. from each of the nine patients with MDE showed a cortisol concentration of over 5.0 micrograms/dl, while the cortisol concentration in the other 10 subjects was uniformly suppressed under this level. All the patients with MDE could be identified by nonsuppression of the cortisol secretion at 8 a.m. or at 2 p.m. An "early escape" phenomenon in depressed patients reported by Carroll et al. (1976) was absent in a 0.5 mg DST, and the blood samples at 8 p.m. were less useful for identifying the depressive patient. The reason why the one point sampling method used by previous investigators was insufficient to identify the depressed patient was discussed.

Anatomical basis of hepatic venographic alterations in idiopathic portal hypertension

Hepatic venograms made in 40 authentic cases of idiopathic portal hypertension (Banti's syndrome) were compared with 13 normal venograms and venograms obtained in 88 cases of cirrhosis, and analyzed in the light of the pathological changes seen in 16 postmortem liver specimens. There were frequent anastomoses between hepatic vein radicles, approximation of middle-size branches to the liver surface, reduction in the angles between the main hepatic vein and its tributaries, and difficulty in opacifying portal vein branches in wedged retrograde portography. These angiographic alterations were corroborated by gross pathological findings which comprised displacement of middle-size hepatic vein branches closer to the liver surface and their approximation among themselves, and seem to be accounted for by the disappearance of liver parenchyma secondary to the peripheral portal circulatory failure.

Hepatic venography in noncirrhotic idiopathic portal hypertension. Comparison with cirrhosis of the liver

Free and wedged hepatic venography were carried out in 37 patients with idiopathic portal hypertension (IPH) and the findings compared with those in 88 patients with cirrhosis of the liver. Characteristic changes in IPH included frequent vein-to-vein anastomoses, narrower angles between large veins and their tributaries, smooth and wavy middle-sized to large branches (giving a general "weeping willow" appearance), homogeneous sinusoidal filling, and minimal to absent filling of the portal venous system on wedged retrograde portography. In cirrhosis, by contrast, changes included rare vein-to-vein anastomoses, wide angles between veins and tributaries, irregular stenoses of large veins and branches at various levels, spotty sinusoidal filling, and frequent retrograde flow in the portal venous system. Hepatic venography is helpful in differentiating IPH from cirrhosis.

Portographic liver changes in idiopathic noncirrhotic portal hypertension

Intraoperative and transhepatic portograms in patients with noncirrhotic portal hypertension, or idiopathic portal hypertension, were compared with portograms of patients with liver cirrhosis. Although the portograms in idiopathic portal hypertension varied from case to case, they were distinctly different from those in cirrhosis. The most common features of the former included a paucity of medium-sized portal branches, irregular and often obtuse-angled division of the peripheral branches, occasional abrupt interruptions of them, an avascular area beneath the liver surface, nonopacification of some of the large intrahepatic portal branches and of their periphery, and increase of very fine vasculature around large intrahepatic portal branches. These findings are compatible with occlusion of intrahepatic portal vessels at various levels.

[Effects of labetalol on the circulatory system (author's transl)]

Effects of labetalol on the cardiovascular system were studied in dogs, guinea pigs, rats, rabbits, and bullfrogs. In dogs anesthetized with pentobarbital, labetalol decreased heart rate, arterial blood pressure, and myocardial contractile force, and inhibited carotid sinus reflex, without affecting pO2 and pH of circulating blood, urine volume, and urinary excretion of sodium and potassium. Alpha- and beta-adrenergic blocking action of labetalol was demonstrated in dog hearts, arterial preparations of guinea pigs and rats, isolated rabbit hearts, and bullfrog hind limb and rabbit ear preparations. In bullfrog hind limb and rabbit ear preparations, labetalol dilated blood vessels in concentrations larger than those which produced alpha- and beta-adrenergic blockade. The dilatation of blood vessels was observed only when labetalol was added to the perfusate, whereas alpha- and beta-adrenergic blockade continued even after removal of labetalol from the perfusate. It is concluded that labetalol blocks alpha- and beta-adrenergic receptors in the heart and blood vessels of the species used herein, and that this compound inhibits carotid sinus reflex in dogs. In addition, the dilatation of the blood vessels of the bullfrog hind limb and rabbit ear as evoked by labetalol probably involves a mechanism different from that of adrenergic blockade.

[The present state of cholelithiasis research in Japan (author's transl)]

Research on cholelithiasis in Japan deals with such different aspects as development and composition of gallstones, geographical distribution of the disease, intrahepatic formation of gallstones, diagnostic and surgical procedures. This paper presents results on these current research topics.