Wereport two cases of drug-induced hepatitis refractory to therapy of ursodeoxycholic acid and prednisolone, who were relieved of icterus and pruritus immediately by the oral administration of colestimide. Their liver dysfunction was not improved, by withdrawal of causative drugs or by treatment with prednisolone and ursodeoxycholic acid. Colestimide (3.0 g/day), a strong basic anion-exchange resin, was orally taken before breakfast and evening meal, leading to rapid and complete relief of icterus and pruritus. These cases suggested that colestimide would be useful for patients with cholestasis in drug-induced hepatitis, because this agent has few side effects and it is easy to take.

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A 69-year-old man underwent laparoscopy-assisted resection for transverse colon cancer. He visited our department approxiately 1 month after operation suffering from nausea and epigastric discomfort. Endoscopy and X-ray examination showed a severe stenosis in the second portion of the duodenum, which we believe was caused by the previous colectomy as indicated by no evidence of other causative event or factor found in his history or through thorough examination. He was then successfully treated by endoscopic balloon dilatation using of a controlled radial expansion wire-guided balloon dilatation catheter. We report a case of postoperative duodenal stenosis as an early complication following laparoscopy-assisted resection of transverse colon cancer. This case would be the first report documented in Japan that we are aware of. Furthermore, this experience suggested that endoscopic balloon dilatation for postoperative duodenal stenosis is effective.

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We conducted in vivo and in vitro studies of the reductive metabolism of the cholagogue, dehydrocholic acid (DHCA). Immediately after the intravenous administration of 1 g of DHCA in normal subjects (n = 6), the concentration of the reductive metabolite, 3 alpha-hydroxy-7,12-dioxo-cholanoic acid (unconjugated form), increased sharply in the systemic circulation, rising to 95.8 microM 10 min after administration. The results of in vitro experiments with DHCA and whole blood showed that 3 alpha-hydroxy-7,12-dioxocholanoic acid were produced from DHCA. In vitro experiments using DHCA and the red blood cell fraction, and DHCA and the red blood cell cytoplasmic fraction gave similar results to those described above with whole blood. However, a reductive metabolite was not formed by the incubation of DHCA and the red blood cell membrane fraction. These findings indicated that, contrary to the conventional theory that intravenously administered DHCA is subjected to reductive metabolism only in the liver, reduction also occurs in the systemic circulation, and the mechanism for this reductive metabolism is present in the cytoplasmic fraction of red blood cells. Further investigation to characterize this reductive metabolic system revealed an optimum temperature of 37 degrees C, an optimum pH of 7.4, a Km value of 2.0 x 10(-3) M, and inactivation by heat treatment (70 degrees C for 2 min).