[A case of hepatocellular carcinoma complicated with Caroli's disease].

A 29-year-old man was admitted with right hypochondralgia and fever. Markedly dilated bile ducts were observed, mainly in the right lobe of the liver. Based on both the clinical findings and imaging, we diagnosed Caroli's disease and choledochal cyst complicated with cholangitis. Hepatocellular carcinoma (HCC) was also observed in segment 3, and the tumor measured 4cm in diameter. The patient was successfully treated with hepatectomy of the right lobe, partial hepatectomy of the left lateral lobe, and bile duct reconstruction. A histopathological examination revealed moderately differentiated HCC without any components of cholangiocellular carcinoma (CCC). Although Caroli's disease is complicated with CCC, a case of Caroli's disease complicated with HCC, as in the present case, is quite rare and therefore is considered to be worthy of reporting.

Diagnostic value of the serum platelet-activating factor acetylhydrolase activity in inflammatory bowel disease.

Platelet-activating factor acetylhydrolase (PAF-AH) is an enzyme hydrolyzing platelet-activating factor (PAF), a potent inflammatory mediator, but the relationship between this enzyme and inflammatory bowel disease (IBD) is not fully elucidated. The aim of the present study was to examine the usefulness of the serum PAF-AH activity in order to differentiate ulcerative colitis (UC) from Crohn's disease (CD). The serum PAF-AH activity was measured in 57 patients with IBD (39 UC and 18 CD patients) and 13 control subjects by a spectrophotometric method. The serum PAF-AH activity was thus found to be significantly lower in patients with CD (median 265.5 U/l) than in those with UC (355 U/l) or control subjects (374 U/l). This marker at a cutoff level of 386 U/l demonstrated a sensitivity of 46%, a specificity of 100%, and a positive predictive value of 100% regarding its ability to distinguish UC from CD. Moreover, the marker responded inversely to the changes in the disease activity of IBD. These results suggest that measuring the serum PAF-AH activity is a useful diagnostic modality for making a differential diagnosis between UC and CD.

Increased activity and expression of phospholipase D2 in human colorectal cancer.

Phospholipase D (PLD) has been reported as relevant to some types of human cancer, but its role in human colorectal cancer still remains to be elucidated. Thus, this study was conducted to determine the activity and the expression of PLD2 in human colorectal cancer. A significant elevation of PLD2 activity and higher expression of PLD2 protein were detected in human colorectal cancer in comparison with corresponding normal mucosa. The tendency of higher expression of PLD2 mRNA was also observed. The ratio of PLD2 activity in cancer to that in corresponding normal mucosa was greater in colorectal cancer with nodal involvement and deeper tumor invasion. Our results indicate that PLD2 has a possible implication in carcinogenesis and progression and would be a new therapeutic target and a potential tumor marker for colorectal cancer.

Metronidazole plus ciprofloxacin therapy for active Crohn's disease.

OBJECTIVE: The aim of this study was to investigate the efficacy of metronidazole plus ciprofloxacin for the treatment of Japanese patients with active Crohn's disease. METHODS AND PATIENTS: Seven patients (counting one patient twice with 2 enrollments at a 5-month interval) with a flare-up of Crohn's disease were enrolled. While continuing the baseline treatment under which the patients relapsed, they received metronidazole 250 mg twice (4 patients) or three times (3 patients) daily plus ciprofloxacin 200 mg three times daily for 4 weeks. The efficacy was evaluated by the changes in the assessment score of IOIBD, the International Organization for the Study of Inflammatory Bowel Disease, and the inflammation markers: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count. RESULTS: Metronidazole plus ciprofloxacin decreased the CRP in seven patients and the IOIBD score in six patients. Significant differences were detected in these parameters at weeks 2 and 4 compared with baseline. Five of the patients achieved normalization of CRP and a reduction of the IOIBD score to zero or one. Although one patient complained of taste disturbance, no other adverse events occurred and all patients completed the 4 weeks of study medication. CONCLUSION: The addition of metronidazole plus ciprofloxacin could be a useful intervention for the treatment of Japanese patients with active Crohn's disease.