[Retrospective analysis concerning AFP-producing gastric cancer].

The α-fetoprotein(AFP)-producing gastric cancer is a group of gastric cancers with poor prognosis because of its rapid growth and aggressive metastatic character. We examined AFP-producing gastric cancer in our department from 2008 to 2010. Of 12 patients studied, the median of the AFP level was 16, 038(96. 1-167, 360)ng/mL. All patients had liver metastasis. Four patients were ECOG performance status(PS)3, and were unable to receive chemotherapy. Eight patients received chemotherapy. Two cases who received cisplatin+paclitaxel(CDDP+PTX)therapy showed partial response(PR). Median survival time was 5. 6 months. Compared to AFP non-producing gastric cancer, this disease is definitely considered to have a poorer prognosis. The clinical effect and survival time seemed to have a relative correlation. PR and SD groups tend to have longer survival. Those with a decline of serum LDH levels at the first three weeks after chemotherapy have a strong tendency to be PR and SD(p=0. 11). Changing the serum LDH level may enable us to estimate the clinical effect while still in the early stages of chemotherapy.

Retrospective evaluation of tumor-mass-reduction therapy for the prognosis of recurrent hepatocellular carcinoma.

Although hepatocellular carcinoma (HCC) is the liver cancer that requires repeated treatments because of a high tendency for recurrence, few data have been available about whether repeated treatments, including those to reduce tumor mass, are effective in prolonging survival. We retrospectively analyzed the effectiveness of tumor-mass-reduction therapy for the prognosis of patients with recurrent HCC. To analyze the effectiveness of various modalities of therapies with a single criterion, we defined a tumor-mass-reduction grade (TMRG), which was retrospectively evaluated by dynamic CT or MRI. Grade A: no evident HCC remains untreated; Grade B1: more than 50% of lesions are treated; and Grade B2: less than 50% of lesions are treated. Subjects were stratified by Child-Pugh classification and the number of admissions for HCC treatment. In those classified as Child-Pugh A, a better survival rate was obtained, depending on the degree of TMRG from the first to the fifth admission (P < .01), suggesting that these patients are endurable for repeated therapies and benefit from the many sessions of treatment. In those classified as Child-Pugh B, on the second to the fifth admissions, survival rates showed statistical difference depending on the TMRG (P < .01), which may suggest that only a few sessions of treatment are meaningful. In those classified as Child-Pugh C, any number of mass-reduction treatment sessions did not improve the survival rate. In conclusion, repeated tumor-mass-reduction therapies for recurrent HCC are most beneficial in Child-Pugh A patients. Patients with Child-Pugh B who experience several recurrence episodes and any patients with Child-Pugh C may benefit more from modalities other than tumor-mass-reduction therapies.

Living related liver transplantation for acute fulminant hepatitis B: experience from two possible hyper-acute cases.

Fulminant hepatic failure, which is represented by fulminant hepatitis, is fatal in most cases unless prompt liver transplantation is performed. Even if liver transplantation is performed, irreversible neurological damage is often complicated. In this case report, we describe two cases of fulminant hepatitis induced by acute hepatitis B virus infection, both of which were successfully rescued by living related liver transplantation without significant complications. The case 1 was a 45-year-old Japanese male. He complained general malaise and anorexia. His local physician diagnosed him as acute hepatitis B, and referred to our hospital. Due to severe coagulopathy, plasma exchange was performed 3 times. However, his hepatic coma progressed rapidly along with rapid decrease of both his direct/indirect bilirubin (D/T) ratio and serum blood urea nitrogen (BUN) levels. Living related liver transplantation was performed under the diagnosis of acute fulminant hepatitis B. The case 2 was a 34-year-old Japanese male. His complaints were fever and skin rush. He was referred to our hospital under the diagnosis of acute hepatitis B. On the second day after admission, he developed grade II hepatic coma, which deteriorated into grade III in spite of intensive therapy including plasma exchange. He also demonstrated rapid decrease of both D/T ratio and serum BUN level. Living related liver transplantation was performed on the next day. Both cases recovered without any evidence of neurological sequelae. In general, it is extremely difficult to rescue fulminant hepatitis by conservative treatments, particularly in cases with rapid progression. Although emergency liver transplantation may be an only option to rescue in such a case, living related liver transplantation has an advantage in view of urgent organ donation over cadeveric transplantation.

Lack of common mutation in the alfa-subunit of the mitochondrial trifunctional protein and the polymorphism of CYP2E1 in three Japanese women with acute fatty liver of pregnancy/HELLP syndrome.

BACKGROUND:: Acute fatty liver of pregnancy (AFLP) and the HELLP syndrome are the serious disorders during pregnancy. The aim of this study is to clarify the prevalence of common mutation in the alpha-subunit of the mitochondrial tri-functional protein: hydroxyacyl-CoA dehydrogenase (LCHAD)/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase as well as to determine the correlation with the polymorphism of microsomal cytochrome P4502E1 (CYP2E1) in these conditions. METHODS:: Genomic DNA was extracted from three patients with AFLP/the HELLP syndrome. Exon 15 of LCHAD and 5'-flanking lesion of CYP2E1 was amplified by PCR and analyzed by RFLP with either of Pst I or the combination of Pst I and Rsa I, respectively. RESULTS:: None of the patients demonstrated the 1528G-C mutation in LCHAD gene. All the patients had homozygous wild-type genotype (c1/c1) in the 5'-flanking lesion of CYP2E1. CONCLUSIONS:: Although limited size of study, our observations suggest the low incidence rate of LCHAD common mutation among Japanese patients with AFLP/HELLP syndrome. Moreover, all of the patients had wild-type genotype of CYP2E1 in this study. Considering with the fact that the neonates from these patients has been in good health for at least 6 years from birth, there might be diverse etiologic factors of Japanese patients with AFLP/HELLP syndrome other than reported genetic mutations.