Factors related to renal dysfunction in patients with anorexia nervosa.

OBJECTIVE: Anorexia nervosa (AN) patients were surveyed to determine which disease factors were related to AN influenced renal dysfunction. METHODS: Data were from forty-five AN patients hospitalized in our department between 1995 and 2002. The patients were classified into three groups based on the type of anorexia: restricting (n=18), self-induced vomiting (n=13), and laxative abuse (n=14). Twenty-four hour-creatinine clearance (Ccr) was calculated within two weeks of hospitalization for comparison among the three groups. RESULTS: The Ccr level of the laxative abuse group was significantly lower than that of the restricting group (65.8+/-31.4 ml/min vs restricting type: 104+/-23.3 ml/min, p=0.002). The laxative abuse group had a significantly longer duration of illness than the restricting group (p<0.0001). Multiple regression analysis revealed the duration of illness to be a risk factor for renal function deterioration in AN patients (r=0.580, p<0.001). DISCUSSION: Renal function should be carefully followed during the treatment of AN patients with a long duration of illness, especially those with long-term laxative abuse.

A study of colloidal scintigraphy in alcoholic liver diseases: discordance from asialo-scintigraphic findings.

BACKGROUND: Our study was undertaken to check the discordance between findings from 99mTc-Sn colloidal reticuloendothelial scintigraphy (RESS) and 99mTc-GSA asialo-scintigraphy (GSA, a technique for evaluation of liver parenchymal cell density and function) and to analyze the discordance in relation to functional disturbances. We compared data between patients with alcoholic liver diseases (ALD) and patients with viral liver diseases (VLD). METHODS: The subjects of this study were 40 patients with chronic liver disease (17 with ALD and 23 with VLD). We used the liver uptake ratio of the tracer of the Sn colloid (SnL15, %), the liver uptake rate (GSAL15, %), and the Rmax (an indicator of total liver receptors) as indices of liver scans. RESULTS: GSAL15 was sometimes nondiscordant from SnL15. The patients were divided into two groups: the nondiscordant group (26 cases where the balance/sum of the two variables was <25%) and the discordant group (14 cases where the balance/sum was > or =25%). SnL15 was 41.6 +/- 16.2% in the nondiscordant group and 42.7 +/- 16.3% in the discordant group (p = 0.80). GSAL15 was 34.3 +/- 12.1% in the nondiscordant group and 21.5 +/- 8.1% in the discordant group (p = 0.001). Rmax was 0.33 +/- 0.17 in the nondiscordant group and 0.113 +/- 0.008 in the discordant group (p = 0.002). Thus, the SnL15, as determined by RESS, did not differ significantly between the nondiscordant and discordant groups, whereas GSAL15 was significantly unfavorable in the discordant group as compared with the nondiscordant group. SnL15 as determined by RESS did not differ significantly between the ALD group (40.4 +/- 18.7%) and the VLD group (43.5 +/- 15.0%) (p = 0.59), whereas Rmax as determined by GSA was significantly improved in the ALD group (0.34 +/- 0.20) compared with the VLD group (0.20 +/- 0.4) (p = 0.02). CONCLUSIONS: Liver cell function was lower in cases that showed discordance between liver cell function and reticuloendothelial function compared with cases without such discordance, although reticuloendothelial function did not differ between discordant and nondiscordant groups. Liver cell function was better in cases of ALD than in cases of VLD, whereas reticuloendothelial function did not differ between the ALD group and the VLD group.

Water immersion-restraint stress induces expression of immediate-early genes in gastrointestinal tract of rats.

The aims of this study were to determine 1) which cells are involved in stress-induced acute gastric mucosal lesion and 2) what kinds of molecular alterations are induced by stress, using immediate-early genes (IEG) as tools for detection of cellular activation. Male Wistar rats were exposed to acute water immersion-restraint stress. Protein and mRNA for IEG were detected by immunohistochemistry and in situ hybridization, respectively. This stress induced the expression of c-fos and nerve growth factor-induced gene (NGFI-A) mRNA in gastric epithelial cells, the smooth muscle layer of small blood vessels, and the stomach wall. Stress upregulated the mRNA levels of these IEG in the duodenal epithelial cells and induced de novo expression of IEG in the smooth muscle layer of small blood vessels and the duodenal wall. These findings indicate that these cells are activated in response to stress. Expression of these IEG and/or transcriptional factors may reflect an initiation of mechanisms for repairing the lesions induced by stress as well as an adaptation to the stress.

[Visual evaluation of liver function with 99mTc-GSA scintigraphy: interobserver variation and intraobserver variation].

We introduced a new imaging grade to evaluate liver function with 99mTc-GSA and studied its diagnostic value using interobserver variation and intraobserver variation. One hundred four patients with liver disease were injected 185 MBq/3 mg of 99mTc-GSA. Anterior images of cardiac blood-pool and liver at 5 min after injection were divided into four grades on the basis of following four categories. Faint cardiac blood-pool image, without clear demonstration of its peripheral boundary was classed in grade I; weaker cardiac blood-pool than liver was grade II; almost same appearance of blood-pool with liver was grade III and stronger blood-pool than liver was grade IV. Three radiologists reviewed the images independently. They followed the same process three months after initial evaluation. kappa-Test was employed to evaluate the goodness of agreement. Three pairs in the first reading showed excellent interobserver agreement (0.88, mean kappa-value) and another three pairs in the first and second reading also showed excellent intraobserver agreement (0.87, mean kappa-value). Quantitative indices obtained from time-activity curves for blood-pool and liver showed significant differences across four groups. Plasma retention rate of indocyanine green also showed significant difference between grade II and grade III. Imaging grade possesses high intra- and interobserver agreement and provides a good discrimination for liver function.

[Change in lobar uptake of 99mTc-galactosyl serum albumin after transarterial embolization therapy].

Liver function was studied by hepatic scintigraphy with 99mTc-galactosyl serum albumin (GSA) before and after transarterial embolization (TAE) therapy in 16 patients with hepatocellular carcinoma. The percent uptake of GSA in liver was measured separately in the treated and non-treated areas. GSA uptake increased in both areas. The change was more marked in the non-embolized lobe than the embolized lobe. We conclude that the increase in GSA uptake reflects the regeneration of liver cells after TAE.

[Vanishing tumor thrombus in IVC after oral administration of UFT and TAE in a patient with HCC; a case report].

A 74-year-old man was diagnosed as hepatocellular carcinoma (HCC) in the area of S6-7 with tumor thrombus continuously developed from hepatic vein to inferior vena cava (IVC). AFP value remained high despite two transcatheter arterial embolizations with adriamycin, mitomycin and Lipiodol (Lp-TAE). The AFP value gradually decreased two weeks after oral administration of UFT. Nine months after, the AFP level was 26.4 ng/ml and the tumor thrombus in the IVC disappeared. The size of the main tumor did not change. This case suggests Lp-TAE and UFT are useful for suppressing the growth of the main tumor and to extinguish the tumor thrombus.

Hepatic parenchymal changes after the intraarterial injection of lipiodol in tumor-bearing rabbits.

RATIONALE AND OBJECTIVES: The influence of lipiodol injection on hepatic morphology and function was investigated in 119 rabbits with hepatic VX2 tumors. METHODS: The rabbits were divided into the following three groups, according to the materials injected via the proper hepatic artery: group 1 received doxorubicin (Adriamycin [ADM]); group 2 received lipiodol (LPD); and group 3 received LPD plus ADM. Groups 2 and 3 were each divided into three subgroups, according to the dose of LPD injected (0.3, 0.6, and 1.2 mL). Non-tumorous regions in the tumor-bearing lobe and the tumor-free lobe were examined histologically; low-kilovolt x-ray studies and computed tomography (CT) also were performed in 84 rabbits. Liver function tests were performed in 35 rabbits. RESULTS: Elevation of the serum aminotransferase levels was observed after the administration of LPD. Hepatocellular degeneration was marked in the tumor-free lobe, but was much more severe in the tumor-bearing lobe in groups 2 and 3. The degree of degeneration depended on the dose of LPD. Both low-kilovolt x-ray studies and CT showed the heavy accumulation of LPD in the tumor-bearing lobe. CONCLUSIONS: The current study shows that the histologic and functional adverse effects of oily chemoembolization depend on the dose of LPD administered to the liver.

Prognosis of unresectable hepatocellular carcinoma: an evaluation based on multivariate analysis of 90 cases.

A multivariate analysis of data from 90 patients with unresectable hepatocellular carcinoma was performed using Cox's regression model to identify factors possibly affecting their prognoses. Thirty-one patients underwent arterial anticancer chemotherapy, and the remaining 59 patients received transcatheter arterial embolization with anticancer agents. Four of 27 variables tested for all the patients (i.e., encapsulation [p less than 0.05], gross appearance of hepatocellular carcinoma [p less than 0.01], clinical stage [p less than 0.01] and therapy [p less than 0.01]) were found to be prognostically significant. Five of 27 variables tested were prognostically significant for the transcatheter arterial embolization group; they were an extension rate of hepatocellular carcinoma (p less than 0.01), encapsulation (p less than 0.01), alpha-fetoprotein (p less than 0.01), prothrombin time (p less than 0.01) and serum sodium (p less than 0.01). Regression equations were used to describe a prognostic index. A prognostic index was defined as the regression equation derived from the results of a total of 90 patients; PI-1 = eY, where PI-1 = prognostic index 1 Y = 1.549 (gross appearance of hepatocellular carcinoma - 1.344) + 0.778 (encapsulation - 1.622) + 0.818 (clinical stage - 1.800) + 1.760 (therapy - 1.344) and prognostic index 2, the regression equation derived from the results of the transcatheter arterial embolization group of patients; PI-2 = eY, where PI-2 = prognostic index 2 Y = 1.210 (extension rate of hepatocellular carcinoma - 1.576) + 1.179 (encapsulation - 1.475) + 0.0001277 (alpha-fetoprotein - 1420.792) -0.039 (prothrombin time - 72.237) - 0.214 (serum sodium - 138.427).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hepatic parenchymal changes after intraarterial administration of lipiodol: an animal experiment].

The effect of Lipiodol (LPD) on the hepatic parenchyma bearing VX2 tumor was investigated in 12 rabbits. In these rabbits Adriamycin (ADM) soluble Urografin and LPD were injected through the hepatic artery. As the control another 12 rabbits bearing VX2 tumor which were intraarterially injected with ADM solution in saline were used. Liver function tests revealed significantly higher values of serum transaminases in the LPD group than in the control group. Histologically in the LPD group, hepatocellular degeneration was observed and the severity was at its peak 3 days after injection whereas control animals preserved almost normal structure. The degeneration of the tumor-bearing lobe was more severe than that of the tumor-free lobe. This study showed the histologically and functionally demonstrable adverse effects of LPD.

[A clinical evaluation of distant metastases from a hepatocellular carcinoma with reference to location, frequency, symptoms, treatment & prognosis].

A clinical analysis of patients with hepatocellular carcinoma (HCC) associated with a distant metastases has been undertaken by the authors. Studied were eight patients (Group A) whose distant metastases were detected at the time of their initial examination, and 24 patients (Group B) whose distant metastases had been diagnosed during the course of treatment of their primary lesions. Complications arising from liver cirrhosis in Group A was less than in Group B. The location of the metastases were the bone in 16, the lung and the adrenal gland in four, the brain and the skin in two and the kidney in one. The mean survival times were 4.6 months (Group A), and 6.3 months (Group B). The cause of death was chiefly a progression of the primary lesion, except for one brain metastases. This analysis had shown that treatment of a bone metastasis is necessary for the relief of pain, and that care should be taken for the prevention of a fracture or paralysis, and that control of the primary lesion is necessary for improving the chances of survival.