We evaluated the clinical usefulness of a protein induced by vitamin K absence, antagonist-prothrombin (PIVKA-II), in detecting hepatocellular carcinoma (HCC) specifically in patients with liver cirrhosis, and the possible correlation between levels of PIVKA-II and pathological features of HCC. Plasma levels of PIVKA-II and alpha-fetoprotein (AFP) were measured in 628 patients with various diseases, including 253 with liver cirrhosis and 116 with HCC. PIVKA-II was detected (greater than or equal to 0.1 arbitrary unit/mL) in 54.3% of HCC and the concentration showed a positive correlation with the tumour size. As a screening test for the detection of HCC, PIVKA-II produced values comparable with those of AFP with a sensitivity, specificity and validity of 52.8, 98.8 and 51.6% respectively. Sixteen of 45 patients (37%) with HCC who had low AFP (less than 100 ng/mL) levels were positive for PIVKA-II. No apparent relationship, however, could be found between the levels of PIVKA-II and the aetiology or pathological findings of HCC. These results suggest that PIVKA-II can be a reliable marker for detecting HCC in patients with liver cirrhosis.

Hepatitis E is endemic in developing countries and may occur as imported hepatitis in industrialized countries. A 46-year-old Japanese man developed immunoserologically diagnosed acute hepatitis E in Japan 4 months after he had made a trip to China. He had bought a Chinese herbal medicine there, taking it occasionally until approximately 6 weeks prior to the onset of acute hepatitis. Nucleotide sequencing of the 3' terminal region of the viral cDNA amplified from the patient's serum by polymerase chain reaction revealed a high degree of homology (99.8% of 752 nucleotides) with the Chinese strain. Thus, the results of sequencing suggest that his hepatitis E was caused by infection with the Chinese strain, via the Chinese herbal medicine.

The di-zhen (DZ) is an ancient type of acupuncture needle with a history dating back more than 2000 years. Unlike modern acupuncture needles, the DZ is not inserted subcutaneously, and is safely and commonly used at the bedside. The mechanisms underlying its effects are not known. In this study, we measured sublingual and cutaneous body temperature, pulse rate, oxygen pressure (PO 2 ), oxygen saturation (SO 2 ) and carbon dioxide pressure (PCO 2 ) before and after DZ application in 25 healthy male volunteers. Serum levels of catecholamines (adrenaline, noradrenaline and dopamine) and white blood cells (WBCs; ratio and number) were traced for one week. Soon after DZ application, pulse rate, body temperature, PO 2 and SO 2 all decreased. The serum levels of adrenaline and noradrenaline increased, indicating sympathetic dominance, and the number of granulocytes was elevated. One week after DZ application, the number of lymphocyte increased. We therefore suggest that DZ affects body temperature, pulse rate, catecholamine secretion and immune function by inducing transient sympathetic dominance via actions on the autonomic nervous system. These effects are similar to the effects observed with modern needles, which are inserted subcutaneously. Therefore, we consider DZ treatment to be advantageous and safe in modern clinical practice, especially in postsurgical and terminal care, as it avoids the issues with infection and tissue damage sometimes seen with modern acupuncture needles.

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A 60-year-old housewife was affected with adult T-cell leukemia (ATL) 10 years after her husband died of T-cell lymphoma, which was retrospectively diagnosed as ATL. She had never had a blood transfusion nor any indication of infection by human T-cell lymphotropic virus type I (HTLV-I) from her parents. The report suggested the wife to have developed ATL by horizontal transmission of HTLV-I from her husband 31 years after their marriage.