No abstract

Of the 205 patients treated by endoscopic injection sclerotherapy in the past 8 years and 4 months, 70 patients (34.1%) have survived more than 3 years. There were more Child's class A patients (p < 0.05) and fewer Child's C patients (p < 0.01) in this group as compared to 51 patients who died within 3 years. In addition, complications due to hepatoma were significantly lower (p < 0.01) in this group. The long‐term cumulative survival rates of those who had already survived over 3 years were 82% at the 5‐year and 78% at the 7‐year follow‐up. There was no significant difference among 3 groups classified by severity of liver damage or timing of the therapy. Rebleeding was noted in 13 patients (18.3%) and the cumulative bleeding rates were 9% at the 1‐year, 14% at the 3‐year, 18% at the 5‐year and 21% at the 7‐year follow‐up. In 12 of these patients hemostasis was obtained by the second sclerotherapy. There was no significant difference in the long‐term prognosis between patients who experienced repeat bleeding, and those who did not. Endoscopic findings in patients with rebleeding were characteristic in that the red color sign remained pronounced despite the fact that the varices had shrunk from F2 or larger to F1 in 6 patients. Bleeding occurred from the gastric varices in 4 patients. One of them died due to gastric bleeding, but 3 were operated on after sclerotherapy. For improving prognosis, it is important to carefully observe the clinical course and to perform additional aggressive treatments for complete obliteration of varices.

Thirteen patients with congenital biliary dilatation treated in our department were analyzed in relation to its complications and other features. Two of the 13 patients were associated with biliary tract cancer and Both lesions were unresectable, because of their advanced stages. The dilated bile ducts appeared cystic, and the cancers involved the intrahepatic bile ducts and dilated extrahepatic bile ducts. The level of amylase in bile was high, suggesting that prolonged regurgitation of pancreatic juice into the bile ducts had induced the canceration. Concomitant cholelithiasis was found in 5 patients, 3 of whom had bilirubin calciferous stones. Morpholog ically, the dilated bile duct was classified as type IV-A in 3 and type Ia and Ib in each one. Stones were intrahepatic in 2 of the 3 cases of type IV-A. Pancreatic lithiasis was found in 3 patients; stones were present in the Wirsung's canal, Santorini's canal and both canals in each one. Two of the 3 had no positive stones upon roentgenography. The pancreatic stones were removed by papilloplasty or accessory papilloplasty. The 3 patients were treated by resection of the dilated extrahepatic bile duct with bile duct reconstruction. Postoperative pancreatic fistula occurred in 2 patients undergone a second operation after cystoduodenostomy or cystojejunostomy, who could be successfully managed by conservative treatment alone. Prognosis was favorable in all patients except those accompanied by cancers.

To investigate the influence of chronic hepatic damage on liver regeneration, a 70% hepatectomy was carried out in male BDE rats in which chronic hepatic damage had been induced by i.m. injection of 0.1 ml CCl4/100 g b. w. twice a week for 4 weeks. After resection, we examined adenine nucleotide concentration in the remaining liver tissues, also body weight and wet and dry weight of the liver. The total adenine nucleotide concentration fell 6 h after resection from 2.89 +/- 0.22 mumol/g to 2.03 +/- 0.15 mumol/g and then recovered on the 3rd postoperative day. However, control animals showed lowest values 3 h after resection, and had already begun to recover at 6 h. Energy charges fell 3 h after liver both groups to the lowest values, but recovery was slower in the animals with chronic liver damage. These observations suggest that in animals with hepatic damage regeneration is delayed in the initial post-resection period. However, 5 days after resection the wet and dry weights of the liver were completely normalized and there was no difference between the two groups, i.e., 5 days after 70% liver resection we could not find any delayed regeneration tendency in animals with chronic liver damage.

A 60-year-old woman with gastric cancer had undergone partial gastrectomy in September 1989. Pathological examination revealed a poorly differentiated adenocarcinoma of pT3pN3pM0 (not resected for cure), stage IV. Postoperative adjuvant therapy comprised 1-(tetrahydro-2-furanyl)-5-fluorouracil plus uracil and OK-432. On 11 August 1990, two forefinger-tip-sized tumors were palpated beneath the operation scar. They increase in size, the superior tumor reaching 4x3 cm, the inferior tumor 5x3 cm on 5 September. Then, on 17 September, the inferior tumor was resected but the superior tumor remained; the histological type was poorly differentiated adenocarcinoma. After the operation, from 20 September, she was given 4 mg irsogladine maleate orally every day. On 8 October, there was no increase in the size of the superior tumor. By 29 October, the superior tumor had disappeared and no further tumor appeared thereafter; the patient showed no sign of relapse.