Primary biliary cirrhosis associated with idiopathic thrombocytopenic purpura.

A case of primary biliary cirrhosis (PBC) associated with idiopathic thrombocytopenic purpura (ITP) is reported. The patient is a 59-year-old man. When he was 49 years old, he was diagnosed with ITP and received steroid therapy that successfully increased platelet numbers. However, the steroid therapy failed to normalize the elevated gamma-glutamyl transpeptidase. Ten years after this episode, he suffered from general itching and malaise and exhibited a gradual increase of serum biliary enzyme levels. Immunologically, IgM was increased and anti-mitochondrial antibody was positive. Histological findings of liver needle biopsy showed chronic non-suppurative destructive cholangitis, confirming the diagnosis of PBC. To date, very few PBC cases associated with ITP have been reported. Our case is the second one in Japan. PBC and ITP in our patient seemed to develop simultaneously, but the effect of steroid therapy on the two conditions was different. This result suggests that the autoimmune process may have been different in PBC and ITP in the present patient.

[Intracystic infusion therapy of minocycline hydrochloride for benign hepatic cysts].

This paper describes ultrasonically-guided infusion of minocycline hydrochloride solution (MINO infusion therapy) in benign nonparasitic cysts of the liver. MINO infusion therapy was performed in 7 large hepatic cysts and successful results were obtained in 6 lesions. The infusion procedure in the initial 4 hepatic cysts a 7 Fr catheter was placed into the cyst and MINO solution was left in the cyst according to the procedure of ethanol infusion therapy. In the most recent 2 cases the cyst was punctured with a 21G needle, washed with physiologic saline and then infused MINO solution without placement of an indwelling drainage tube. This modified procedure is simple and safe and also yields a good therapeutic result. MINO infusion therapy for benign hepatic cyst is very useful and the modified procedure can be performed safely in elderly patients and in patients with several complications.

Importance of cytotoxic T lymphocytes in the rejection of transplanted hepatocellular carcinoma.

Fischer rats became resistant to syngeneic hepatocellular carcinoma (FAA-HTC1) cells on repeated sensitization with mitomycin C-treated FAA-HTC1 cells. In contrast, FAA-HTC1 cells injected into the liver killed normal control Fischer rats within 2 months. Histopathological studies revealed massive accumulation of mononuclear cells in the tumor tissues of sensitized rats that rejected syngeneic FAA-HTC1 cells, whereas very few mononuclear cells were found in the tumor tissues of control rats. Cell populations infiltrating the tumor tissues were identified by flow cytometric analysis. Mononuclear cells found within the regressing tumors of the sensitized rats were identified as mostly T cells, and two-thirds of these T cells were CD8-positive. Compared with the activity in control rats, the killer activity of mononuclear cells infiltrating tumors was significantly increased in the sensitized rats 7 days after tumor inoculation. Depletion of CD8(+) T cells significantly reduced the cytotoxicity of mononuclear cells infiltrating tumors obtained from sensitized rats. In contrast, depletion of CD16(+) cells reduced the cytotoxicity of mononuclear cells infiltrating tumors obtained from both control and sensitized rats. Furthermore, the CD16(+) cell-depleted fraction of mononuclear cells infiltrating tumors showed significant cytotoxicity against FAA-HTC1 cells, but failed to show cytotoxicity against other syngeneic tumor cells or allogeneic hepatoma cells.

[A case of type B chronic hepatitis showing rapid progression to liver cirrhosis with prolonged positive IgM anti-HBc].

We reported a case of type B chronic hepatitis with high titer of IgM anti-HBc continuously, which progressed to liver cirrhosis rapidly. The patient was a 37-years-old man, and was diagnosed as chronic type B hepatitis with severe activity by laparoscopy and liver biopsy. The titer of IgM anti-HBc persisted high level for more than 2 years. Then the second liver biopsy showed the progression to liver cirrhosis within only about 2 years. It is a very rare case to prolong positive IgM anti-HBc for such a long time. Anti-HBc production of PBMC was enhanced remarkably in this case. We considered that HBc antigens released into serum from hepatocytes with severe exacerbations had enhanced the anti-HBc producing activity of B lymphocytes. And the rapid progression in this case would be due to the episodes of severe exacerbations.