Background. Changes in tumor necrosis factor‐alpha (TNF‐α), interleukin‐1 alpha (IL‐1α), interleukin‐1 beta (IL‐1β), interleukin‐6 (IL‐6), and granulocyte macrophage‐colony‐stimulating factor (GM‐CSF) were investigated before and after operation in patients with hepatocellular carcinoma (HCC), metastatic liver carcinoma, and gastrointestinal carcinoma. Results. Serum levels of TNF‐α, IL‐1α, and IL‐1β were high in patients with liver carcinoma (HCC and metastatic liver carcinoma) before operation in comparison with those of normal controls (P < 0.01). In patients with gastrointestinal carcinoma, serum levels of cytokines, except those of TNF‐a, were the same as in patients with liver carcinoma. The level of TNF‐α in patients with gastrointestinal carcinoma was low compared with that in patients with liver carcinoma. Within 1 day after operation, the peak level of TNF‐a was observed at 15 hours, IL‐1α at 18 hours, IL‐1β at 21 hours, and IL‐6 at 24 hours after operation. Subsequently, these cytokine levels peaked again: TNF‐α at 48 hours, IL‐1α at 72 hours, IL‐1β at 120 hours, and IL‐6 at 168 hours after operation. GM‐CSF levels increased gradually after operation. Moreover, in HCC, serum levels of TNF‐α were high in patients with recurrence compared with those without recurrence (P < 0.01). The difference in IL‐1α and IL‐1β levels between patients with recurrence and those without recurrence can be regarded as significant (P < 0.01). Conclusion. These results suggest that TNF‐α, IL‐1, IL‐6, and GM‐CSF may play an important role in the pathogenesis of cancers; TNF‐α may be especially important as a tumor marker in HCC and metastatic liver carcinoma. Cancer 1992; 70:709–713.

Recently, two conflicting articles about recurrence of hepatocellular carcinoma (HCC) after direct acting antivirals (DAA) against hepatitis C virus (HCV) were published. We investigated the relationship between DAA and HCC recurrence. Eligible patients were (1) history of HCC and treated curatively with interventions, and (2) interferon-free DAA therapy was initiated after eradication of HCC. We analyzed contributing factor for HCC recurrence. Ten out of 23 participants (43%) encountered recurrence of HCC. Age, sex, diabetes mellitus, fibrosis score, chemistry, and alpha-fetoprotein did not differ between patients with recurrence and patients without recurrence. The patients with recurrence had significantly higher values of antibody to hepatitis B core antigen (anti-HBc) than the patients without recurrence, 6.06±3.75 vs. 0.91±2.43 (p=0.0019). The relative risk of HCC recurrence comparing anti-HBc positive to negative was 5.2 (95% confidence interval 1.40 to 19.32). Odds ratio was 22.0 (95% confidence interval 2.5 to 191.1). We conclude that anti-HBc positivity was a strong contributing factor for HCC recurrence after DAA therapy.

This method can achieve safety and en bloc mucosal resection to the submucosal layer. This novel approach may be promising for clinical application as a new form of endoscopic surgery.

Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding, usually due to rupture of a visceral artery aneurysm in chronic pancreatitis. Other causes of HP are rare. We present a case of HP which occurred in a patient with chronic calcifying pancreatitis and a pancreatic pseudocyst documented by ultrasonography and computed tomography. With detectable fresh blood in the descending duodenum, an aneurysm in the pancreatic head was revealed by superior mesenteric angiography as the suspected origin of intermittent bleeding from the pancreatic duct. Because an artery feeding the pseudocyst could not be identified, angiographic embolization was not possible. Surgical resection or ligation was difficult by laparotomy; therefore, intraoperative packing of the pseudocyst with absorbable gelatin sponges was achieved via a cannula through a directly punctured site in the pseudocyst wall. The patient has been followed for 4.25 years with no further episodes of HP. It is possible that the packing of a pancreatic pseudocyst with gelatin sponges is a method that can be used in similar cases, where control of hemostasis is the primary concern. The packing of a pancreatic pseudocyst with gelatin sponges is a technique that can be performed not only via laparotomy but also via laparoscopy or concomitant angiography and ultrasonography.

The TCTS stiffening tube was as easy to use as the standard stiffening tube, and is considered to be both safe and useful.