13C-UBT using an infrared spectrometer for detection of Helicobacter pylori and for monitoring the effects of lansoprazole.

The stable isotope [13C]-labeled urea breath test (13C-UBT) is very useful for detecting Helicobacter pylori. Conventionally, a mass spectrometer is used to measure the presence of 13CO2 in breath. However, this technique is complex and expensive. Therefore, we carried out the 13C-UBT using an easy-to-operate infrared spectrometer, and we studied its usefulness. The 95 subjects included 35 patients with gastric ulcers, 32 with duodenal ulcers, 13 with gastroduodenal ulcers, some patients with nonulcer gastroduodenal disease, and normal controls. The 13C-UBT was negative in normal controls and positive in 86 of 91 (95%) patients with illness. Peaks appeared 15 to 30 min after [13C]urea administration. The 33 patients who were 13C-UBT-positive were then given lansoprazole 30 mg/day and the 13C-UBT was repeated after 8 to 16 weeks. Lansoprazole was found to be effective in patients who exhibited peak 13CO2 values that were at least two-thirds less than the pretreatment values. This effect was seen in 16 patients (48%), 13 of whom (81%) had gastric ulcers. Thirteen of the 17 patients (76%) who exhibited no effect had duodenal ulcers, and there were clear treatment response differences between the two types of ulcers.

[Clinical course of patients with hepatocellular carcinoma after surgical resection, with emphasis on the occurrence of hepatic failure].

Postoperative course including serial changes in values of liver function tests and occurrence of hepatic failure was investigated in 59 patients with hepatocellular carcinoma. Eleven cases out of 59 patients were associated with chronic hepatitis (CH group), while remained 48 cases were with liver cirrhosis (25 cases of group A and 23 of group B in Child's classification). There was no significant difference in survival rate or recurrence rate after operation among these three groups. Hepatic failure within one year after hepatectomy was observed in 9%, 28% and 91% of patients in groups CH, Child's A and Child's B, respectively, and the frequency of occurrence of hepatic failure in Child's B group was significantly higher than those of groups CH and Child's A. Hepaplastin test and serum albumin levels recovered from the decline after hepatectomy in groups CH and Child's A. On the other hand, no recovery was found in Child's B group as well as lower levels before operation and that was thought to be the major reason for the frequent occurrence of hepatic failure in Child's B group.

[An assessment of therapeutic effect of hepatocellular carcinoma by the serial changes in serum AFP value].

The therapeutic effect of hepatocellular carcinoma (HCC) was assessed by the serial change of serum AFP value before and after treatment. Subjects were 56 therapies for HCCs in 48 cases, who were diagnosed as inoperative HCCs, and were performed chemotherapy, transcatheter hepatic arterial embolization (TAE) and percutaneous ethanol injection therapy (PEIT). As the indicator of therapeutic effect, the angle (supplement) alpha was used, that was formed by the cross of two lines based on several points of serum AFP value on the hemilogarithm graph before and after treatment respectively. The alpha were distributed from -34 degrees to 118 degrees, and its mean value was 32 +/- 38 degrees (+/-SD). The angle alpha value of cases evaluated as CR or PR was high, and that of PD was low. We could quantitatively assess the effects evaluated as NC by tumor size. The survival curve of group with high alpha value was significantly longer than that of group with low value. It was concluded that this method using angle alpha based on the serial change of serum AFP value was useful for clinical assessment of HCCs treatment.

[A case with hepatocellular carcinoma with complete remission due to gamma-IFN therapy].

A 65-year-old male was admitted to our hospital with the aim of closer examination of SOL in cirrhotic liver. By abdominal echography, CT and angiography etc., he was diagnosed as LC with multiple HCC, one in S5 about 2.0 cm, another in S1 about 5.0 cm in diameter, and other four small nodules in right lobe. We treated him with recombinant gamma-IFN at dose of 1.6 X 10(7) units/day for 5 consecutive days biweekly. Although until two months the tumours were gradually enlarged in size, then they became smaller, and at five months later after the beginning of gamma-IFN therapy the tumor stains in angiogram disappeared. Then we performed the surgical treatment. Both macro and microscopical findings of tumor specimens in S5, 2. 2 X 2.0 X 1.9 cm in size, showed complete necrotic tissue. Additionally the yellowish small tumor was found on surface of S8, and it was adenomatous hyperplasia histologically.

[Serodiagnosis: tumor marker].

The researches of tumor markers started at the discovery of Bence Jones protein in 1848. Now, alpha-fetoprotein and carcinoembryonic antigen are popular tumor markers and recently several tumor markers using the methods of monoclonal antibodies have been invented. Usually we measure the tumor markers in sera, so the early diagnosis of cancer by the tumor markers are sometimes difficult. For the early diagnosis by tumor markers, inventions of new tumor markers, improvement of assay systems and materials and the combination assays of several tumor markers have been tried. The researches of tumor markers are progressing with those of cancer. We hope we will be able to diagnose early cancer or precancerous state by tumor markers.

Factors affecting serum levels of CA 19-9 with special reference to benign hepatobiliary and pancreatic diseases.

In order to elucidate the factors affecting the serum levels of CA 19-9, we analyzed sera of 79 patients with pancreatic cancer and 169 with non-malignant diseases, chiefly consisting of hepatobiliary and pancreatic diseases. Serum CA 19-9 values in patients with pancreatic cancer had no relation to the location of the tumor or presence of jaundice. Similarly, no tendency was observed as to the location and size of tumor or to the grade of differentiation in 12 CA 19-9-negative patients with pancreatic cancer. Serum levels of CA 19-9 in patients with cholelithiasis complicated by cholangitis frequently showed markedly high values, but then rapidly normalized in parallel with the subsiding of inflammation. The behaviour of serum CA 19-9 showed little relation to renal or hepatic failures or to intrahepatic cholestasis. However, slightly elevated levels of the antigen were found in more than half of those patients with fulminant hepatitis showing massive necrosis. In chronic pancreatitis, the prevalence was only 8%; however, an increase was observed at the time of exacerbation in 2 of 5 positive patients. There was hardly any increase in serum levels of CA 19-9 after endoscopic retrograde cholangiopancreatography (ERCP), although serum levels of pancreatic enzymes rose after ERCP in almost all patients. Thus, it appears that CA 19-9 does not easily escape into the bloodstream, unlike pancreatic enzymes.