Hepatitis B virus carrier with low titer of antibody to hepatitis B core antigen.

Of 798 hepatitis B virus (HBV) carriers, 22 had low titers (lower than 80% inhibition in 200- or 400-fold diluted serum) of antibody to hepatitis B core antigen (anti-HBc). Among these 22 patients, there were 12 (1.50%) with viremia who were positive for hepatitis B e antigen and had a high titer of HBV-associated DNA polymerase activity. Among these 12 patients, four showed no significant change in the anti-HBc titer, while four others showed significant increases in the anti-HBc titer during the follow-up periods. The former all remained asymptomatic carriers (ASCs), while the latter all developed chronic hepatitis (CH). The liver histology of four patients (ASC: 2, CH: 2) showed mild inflammation, and the localization of hepatitis B core antigen (HBcAg) in the liver specimens showed a nuclear pattern in the two ASCs, but a nuclear plus cytoplasmic pattern in the two CH cases. In HBV carriers, the increase in anti-HBc titer seems to be closely correlated to the change in HBcAg localization from the nucleus to the cytoplasm in the liver. Therefore, rising titers of anti-HBc were assumed to be associated with increased expression of HBcAg on the hepatocyte, and hence increased immune-mediated hepatic damage and the onset of hepatitis in ASC with low titer of anti-HBc.

[Relationship between recurrence of esophageal varices and changes of portal circulation after endoscopic injection sclerotherapy: evaluation by single photon emission CT].

The relationship between recurrence of esophageal varices after endoscopic injection sclerotherapy (EIS) and changes of the blood pool of portosystemic collaterals was studied in 36 patients with liver cirrhosis. Examination of the blood pool of portosystemic collaterals was performed by single photon emission CT (SPECT). Seven hundreds and forty MBq of 99mTc-RBCs, labeled by an in vivo technique, were given intravenously, and tomographic imaging of the intraabdominal vascular blood pool was performed. Before EIS, the blood pool images of the coronary vein were demonstrated in 34 cases (94.4%). According to changes of SPECT images, the patients were divided into 3 groups, that is, the groups showing a disappearance, decrease, and no changes of the blood pool images of the coronary vein. The recurrence rates of esophageal varices after EIS were 11.1% (1 of 9 patients), 40.0% (6 of 15 patients), and 90.0% (9 of 10 patients) in the disappeared, decreased and unchanged groups respectively. These values were significantly different between the disappeared group and the unchanged group (P less than 0.01), and between the decreased group and the unchanged group (P less than 0.05). These results indicate that the abdominal blood pool SPECT is useful for evaluating the therapeutic effectiveness of EIS.

[Evaluation of intrahepatic distribution of inferior mesenteric blood flow by transrectally administered 123I-IMP].

Intrahepatic distribution of the inferior mesenteric blood flow was evaluated with scintigraphy with transrectally administered 123I-iodoamphetamine (IMP). Twelve patients without liver diseases were studied. The IMP image was divided into 3 types; bilateral, left lobar predominant and right lobar predominant. Bilateral, left lobar predominant and right lobar predominant types were observed in 5, 5 and 2 patients respectively. Furthermore, uneven distribution pattern in the left or right lobe was observed in 2 of 5 patients with bilateral lobar type, 4 of 5 patients with left lobar predominant type and 1 of 2 patients with right lobar predominant type. In one patient with left lobar predominant type, repeat examination demonstrated bilateral lobar type. These results suggest that intrahepatic distribution of the inferior mesenteric blood flow is not uniform and consistent.

[Estimation of portosystemic shunt by transrectally administered 123I-IMP].

Portosystemic shunt index was estimated in 7 patients without liver disease and 95 patients with various liver diseases by portal scintigraphy with transrectally administered 123I-iodoamphetamine (IMP). The shunt index was 0% in patients without liver diseases, 5.3% in acute hepatitis, 5.9% in chronic inactive hepatitis, 11.4% in chronic active hepatitis, 56.6% in compensated liver cirrhosis and 88.1% in decompensated liver cirrhosis. The shunt index was significantly higher in liver cirrhosis, especially decompensated stage. In 5 of 9 patients with acute hepatitis, shunt index was 0%. In 3 of remaining 4 patients with elevated shunt index, shunt index became 0% within 1-2 months. Significant relationship was observed between the shunt index and hepatic function tests such as ChE, albumin, gamma-globulin and ICG-R15. These results suggest that the shunt index is independent of hepatic cell necrosis and reveals the shunted blood flow exactly. Therefore, this technique is useful for evaluating the portosystemic shunt in various liver diseases.

Portosystemic collaterals in portal hypertension: visualization by using blood-pool SPECT imaging.

Single-photon emission CT (SPECT) was performed with technetium-99m autologous RBCs in 11 patients with chronic hepatitis and in 46 cirrhotic patients with portal hypertension to determine the value of the procedure for identifying portosystemic collateral blood flow. Twenty millicuries (740 MBq) of 99mTc-RBCs, labeled by an in vivo technique, were given IV, and tomographic imaging of the intraabdominal vascular blood pool was performed. Fourteen patients with cirrhosis also had arterial portography, and 37 had scintiphotosplenoportography. In 38 of 46 patients with cirrhosis, SPECT images showed portosystemic collaterals. The coronary vein was seen in 52% of the patients, the short gastric vein in 11%, the gastrorenal or splenorenal shunt in 24%, the umbilical vein in 11%, and the anterior abdominal wall vein in 17%. Portosystemic collaterals were not shown in any of the patients with chronic hepatitis. Collaterals were identified on SPECT images in 10 of 11 patients in whom collaterals were documented by arterial portography and in all 28 patients in whom collaterals were shown by scintiphotosplenoportography. Furthermore, SPECT clearly showed a patent portal vein in three patients and the coronary vein in two patients, when these veins were not identified by means of scintiphotosplenoportography. This experience suggests that SPECT is useful for the noninvasive identification of portosystemic collaterals in patients with portal hypertension.

[Evaluation of changes in portal collaterals by single photon emission CT: effects of endoscopic injection sclerotherapy].

The changes in portal collaterals before and after Endoscopic Injection Sclerotherapy (EIS) for esophageal varices were studied by Single Photon Emission CT (SPECT). SPECT was performed for the intra-abdominal blood pool with 99mTc autologous red blood cells (RBC) in 17 patients with liver cirrhosis before and after EIS. Twenty mCi of 99mTc-RBC labeled by in vivo technique were administered intra-venously and tomographic imaging of the intra-abdominal vascular blood pool was performed as follows. For each subjects, 64 views were obtained over 360 degrees of elliptic rotation at 30 seconds per view. In 15 of 17 patients, blood pool images over coronary vein and/or short gastric vein area were clearly demonstrated on coronary images. In 9 of 15 patients, the pool of coronary vein or short gastric vein was disappeared or decreased after EIS. It is considered that intra-abdominal blood pool SPECT study is clinically useful for following up of hemodynamics of portal collaterals before and after EIS.

Portosystemic shunting in portal hypertension: evaluation with portal scintigraphy with transrectally administered I-123 IMP.

Portosystemic shunting was evaluated with rectal administration of iodine-123 iodoamphetamine (IMP) in seven patients without liver disease and 53 patients with liver cirrhosis. IMP (2-3 mCi [74-111 MBq]) was administered to the rectum through a catheter. Images of the chest and abdomen were obtained for up to 60 minutes with a scintillation camera interfaced with a computer. In all patients, images of the liver and/or lungs were observed within 5-10 minutes and became clear with time. In patients without liver disease, only liver images could be obtained, whereas the lung was visualized with or without the liver in all patients with liver cirrhosis. The portosystemic shunt index was calculated by dividing counts of lungs by counts of liver and lung. These values were significantly higher in liver cirrhosis, especially in the decompensated stage. Transrectal portal scintigraphy with IMP appears to be a useful method for noninvasive and quantitative evaluation of portosystemic shunting in portal hypertension.

Three-dimensional demonstration of liver and spleen by a computer graphics technique.

Three-dimensional demonstration of the liver and spleen has been developed using a computer graphics technique. Three-dimensional models were constructed from organ-surface information derived from computed tomographic images. Three-dimensional images could be displayed as wire-frame or solid models on a color display tube. After examining the accuracy of this technique using a liver phantom, this technique was applied to the human liver and spleen. The anatomic surface of the liver and spleen appeared realistic when viewed from any direction. In liver cirrhosis, abnormal configuration of the liver and spleen was vividly demonstrated. The liver was displayed as a wire-frame, while a hepatoma was presented as a solid form in the same image. This combined display clarified the intrahepatic location of the hepatoma together with its configuration. It is thus expected that this technique will prove clinically useful in the noninvasive evaluation of patho-morphologic changes in the liver and spleen.

Orcein-positive material in Kupffer cells from the liver.

Orcein-positive material in Kupffer cells obtained from 1,377 needle biopsies of the liver was studied for hepatitis B surface antigen (HBsAg). Fifty-five (57%) out of 96 cases with orcein-positive Kupffer cells had acute hepatitis, and 46 (84%) of these 55 were in the late stage of their illness. Orcein-positive material in Kupffer cells was not associated with HBsAg as evaluated by the immune peroxidase method. Orcein-positive material in Kupffer cells appears to consist mainly of lipofuscins developing in the course of acute hepatitis.

[Efficacy of arterial infusion chemotherapy with neocarzinostatin on inoperable hepatoma].

The characteristic of a slow infusion technique of angiography provided a new method of selective intraarterial administration. We named this new method "high pressure one hot injection." When we tried to apply this method to patients with inoperable hepatoma, we considered that Neocarzinostatin (NCS) was a very applicable antitumor drug in terms of cell killing kinetics. Fifteen patients with inoperable hepatoma were treated with NCS by the selective intra-hepatic arterial infusion method. Administration of NCS was given by using a technique of high pressure one shot injection. The administration dose of NCS was 6000u. or 10000u., and 10 patients received once, and the others twice or three times. Results were as follows: 1) According to both Karnofsky's criteria and the criteria of direct response for solid cancer, an objective response was observed in 6 patients (40%). In proportion to the increase of the total dose and frequencies the individual efficacy increased. 2) The median survival was 5.5 months. 3) Decrease of serum AFP was seen, prominently within one month after injection. 4) The major side effects were fever (93%), liver dysfunctions (53%), leukopenia (46%), thrombocytopenia (33.3%), and their frequencies were related to the dose of one injection and that of the total. These results suggest that the high pressure one shot injection of NCS is very effective to inoperable hepatoma, but both dose and interval of injection remain to discussed.