Correlative evaluation of serum lipid, blood glucose, blood pressure, serum immunoreactive insulin, and liver function in persons undergoing regularly scheduled health evaluations.

Two hundred and thirty eight persons were examined to evaluate the interrelations among seven key factors for arteriosclerosis: body mass index (BMI), systolic blood pressure (BPs), plasma glucose (PG), serum cholesterol (CHO), serum triglyceride (TG), serum glutamic-pyruvic transaminase (SGPT), and serum insulin (IRI). BPs showed the significant positive correlation with PG (r = 0.346), BMI (r = 0.318), and IRI (r = 0.200). However, there were no significant correlations between BPs and CHO, between BPs and TG, between BPs and SGPT. SGPT showed the significant positive correlation with IRI (r = 0.367), BMI (r = 0.268), and TG (r = 0.343); but no significant correlations were observed in relations between SGPT and PG, between SGPT and BPs, between SGPT and CHO. IRI showed the significant positive correlations with TG (r = 0.234), and PG (r = 0.427). These data suggest that IRI has an effect on BPs and SGPT. The effect of IRI on BPs relates with PG but does not relate with serum lipid. The effect of IRI on SGPT relates with TG but not with PG.

[A case of intractable status asthmaticus treated by isoflurane inhalational anesthesia and bronchial lavage].

A case of severe asthmatic attack treated by isoflurane inhalational anesthesia and bronchial lavage is reported. A 24-year-old woman was admitted to our hospital with severe asthmatic attack. Although she was treated by intravenous administration of aminophylline and corticosteroids, pulmonary function and consciousness deteriorated. Therefore, she was intubated nasally and mechanically ventilated by IPPV with administration of aminophylline, corticosteroids and epinephrine. Despite this treatment, she remained in status asthmaticus with high airway pressure and barotrauma causing pneumomediastinum and subcutaneous emphysema. On the 3rd hospital day, a system was arranged so that isoflurane could be given in an air and oxygen mixture, and administration was started with a concentration of isoflurane of 1.5%. In addition, bronchial lavage via bronchoscopy was performed in order to clear any mucous plugs. After 24 hours, there was marked improvement of wheezing, airway pressure and arterial blood gas level. Eventually, she was weaned from the ventilator on the 6th hospital day without significant side effects. The use of halothane inhalational anesthetic treatment for status asthmaticus is widely known, but it has serious side effects such as arrhythmia and liver injury. Isoflurane may be the inhalational anesthetic agent of choice in the treatment of status asthmaticus.

[A basic study of cytotoxic effect of tumor necrosis factor-alpha on the hepatoma cell line, PLC/PRF/5].

In order to investigate the effect of tumor necrosis factor (recombinant TNF-alpha) on hepatoma, we assessed the antitumor activity of TNF-alpha on hepatoma cell line, PLC/PRF/5 in vitro, and combined effects of interferon-gamma (IFN-gamma), that is thought to increase TNF-receptors. TNF-receptors. TNF-alpha for itself, had no significant effect on DNA synthesis and viability, and the production of HBsAg from PLC/PRF/5. On the other hand, treatment of IFN-gamma- combined with TNF-alpha inhibited DNA synthesis and production of HBsAg. The decrease of viability of PLC/PRF/5 was also found in this combination treatment. According to these findings, antitumor activity of TNF-alpha had no effect on PLC/PRF/5 in itself, but was significantly enhanced when treated with IFN-gamma at the same time.

Diabetes insipidus with spontaneous remission.

Pathogenesis of idiopathic diabetes insipidus is unknown and the clinical course of the disease is permanent. However, we observed one patient who was diagnosed of idiopathic diabetes insipidus spontaneously reverted after approximately 13 months. The cause and pathogenesis of the disease were not evident. However, some reversible abnormalities should have been encountered in the hypothalamic-neurohypophyseal system. It is suggested that some unknown reversible impairments of the supraopticohypophyseal tract can cause diabetes insipidus. This case represents a well-documented description of idiopathic diabetes insipidus with spontaneous remission.

A case report of transcatheter arterial embolization of cholestatic type of hepatoma.

A 57-year-old man with hepatocellular carcinoma (HCC) invading the hepatic duct was treated with transcatheter arterial embolization (TAE). The dilated hepatic duct was decompressed his jaundice disappeared and he survived for 10 months after the first TAE, succumbing due to bleeding from gastric erosion. Although total bilirubin was 26.7 mg/dl and massive ascites was noted on occasion of the first TAE, hepatic dysfunction did not worsen and both icterus and ascites decreased, disappearing one month after the therapy. Autopsy revealed HCC with trabecular arrangement originating in the left lobe and growing into the left hepatic duct accompanied by liver cirrhosis and follicular carcinoma of the thyroid gland. Severe icterus caused by bile duct obstruction does not correlate with the grade of hepatic failure in HCC with liver cirrhosis, so TAE was effective and should be tried as a first choice therapy in such a poor risk case.

[Radiation therapy of hepatocellular carcinoma].

After the transhepatic arterial therapy, irradiated 11 patients with hepatocellular carcinoma were investigated clinically and pathologically. As the effect to the main tumors except for 3 cases who dropped out because of the side effect of irradiation, partial response (PR) was found in 1 case, minor response (MR) was in 2. There was no change (NC) in 4 and 1 had progressive disease (PD), so the rate of effectiveness was 12.5%. Irradiation to the tumor thrombosis of the portal vein were done for seven cases, 2 of them (28.6%) showed the decrease of the thrombosis or improvement of the blood stream in the portal vein on angiography or histology. AFP decreased in four of seven measurable cases within one month after the irradiation. Side effects were jaundice, fever, appetite loss and so on, which were seen especially in cases of Child's B or C. Liver dysfunction and bone marrow suppression were also observed though not so severe. For the cases received lipiodol injection before radiation, lipiodol collection to the tumor was beneficial for the determination of the irradiated field.

[Effect of combination therapy with an adriamycin-lipiodol emulsion and a mitomycin C microcapsule in hepatocellular carcinoma complicated by portal thrombosis].

An intra-arterial injection of an Adriamycin-Lipiodol emulsion and a Mitomycin C microcapsule has been given to two patients of hepatocellular carcinoma (HCC) complicated with a tumor thrombosis of the portal trunk. One patient showed a partial response, while the other evidenced no change, alpha-Fetoprotein decreasing from 4510 to 419 ng/ml in the partial response case, and from 328 to 283 ng/ml in the no change case. In each instance the hepatic injury treated by this combination therapy was mild and reversible. Bone marrow suppression by this therapy was not demonstrated. Thus, this therapy is thought to be applicable to cases of hepatocellular carcinoma complicated with a tumor thrombosis of the portal trunk who should not be indicated for transcatheter arterial embolization.

Hepatocellular carcinoma growing in the pulmonary arteries, complicated with venous thrombosis.

A case of hepatocellular carcinoma (HCC) complicated with vascular invasion of the portal vein, hepatic vein, and pulmonary artery, accompanied by inferior vena caval and renal vein thrombosis, is reported. The patient was a 38-year-old female, positive in serum HBsAg and anti-HBe. Because portal trunk thrombosis was pointed out at the first diagnosis, incomplete transcatheter hepatic arterial embolization was carried out three times and one-shot therapy of anti-cancer agent given once. Four months after the first therapy, the patient died of oliguria and hypotension of sudden onset. The autopsy revealed not only intrahepatic vascular invasion but also tumor growth in the bilateral pulmonary arteries and thrombosis from the inferior vena cava to both renal veins unaccompanied by right atrial growth. Because the renal vein was thrombosed and HCC was accompanied by vascular invasion, especially pulmonary arterial invasion, the patient was thought to have become oliguric and hypotensive before severe hepatic failure. The metastatic tumor had grown in the pulmonary trunk without intra-atrial expansion because of the histological tight junction between the tumor and the wall of that vessel.