Ischemic hepatitis induced by mesenteric volvulus in a patient with chronic obstructive lung disease.

A 66-year-old man with chronic obstructive lung disease was admitted to our hospital, presenting with mesenteric volvulus and mild liver injury. A superior mesenteric angiogram revealed that the arteries supplying the small intestine were twisted in the arterial phase, while the portal vein was not visualized in the late phase. A celiac angiogram demonstrated that portal blood flow from the splenic venous return was maintained. The patient's symptoms had almost resolved the day after admission, and his serum transaminases level had gradually decreased to normal with conservative therapy. A superior mesenteric angiogram on the 13th hospital day showed a normal arteriogram and the portal vein demonstrated blood flow from the superior mesenteric vein. Liver biopsy revealed hemorrhagic necrosis around the central veins, which was compatible with ischemic hepatitis. Since the patient's O2 saturation level on admission was not low enough to have caused ischemic hepatitis by itself, we suspect that a sudden decrease in portal blood flow was the additional factor that allowed the threshold for the initiation of ischemic liver damage to be reached.

[A CR case of amylase-producing tumor treated by hyperthermochemotherapy].

A 64-year-old female who was diagnosed with an amylase-producing tumor of unknown origin was treated by hyperthermochemotherapy. The patient was admitted with a complaint of abdominal fullness due to ascites. Laboratory examination showed high levels of serum amylase and tumor markers, including CA15-3, CA 125 and CA 72-4. Laparotomy showed peritoneal dissemination with histological findings of adenocarcinoma of unknown origin. After laparotomy, she was given hyperthermia combined with chemotherapy using carboplatin (CBDCA), mitomycin C (MMC) and doxifluridine (5'-DFUR). Hyperthermia (13.56 MHz radiofrequency for 40-50 min) was performed a total of six times within one and a half months. The total doses of CBDCA and MMC were 450 mg and 24 mg, respectively, and 600 mg of 5'-DFUR was orally administered every day. By these combined treatments, ascites disappeared and serum levels of amylase and all tumor markers were decreased and normalized. MRI and echo examination also showed complete disappearance of peritoneal metastasis. Two and a half years after the treatment, the patient is alive without any evidence of recurrence, which suggests that this combined therapy is one of the useful modalities for peritoneal dissemination as well as an inoperable tumor itself.

Preventive effect of hepatocyte growth factor on acute side effects of cyclosporin A in mice.

Cyclosporin A (CsA) is a potent, widely-prescribed immunosuppressant which has serious side effects. When recombinant human hepatocyte growth factor (rh-HGF) was co-administrated with CsA to mice, the severe digestive and/or neurological symptoms and degenerative changes in renal tubular cells and hepatocytes seen with cases of CsA administration were remarkably attenuated and mortality linked to CsA-administration was prevented by rh-HGF. HGF-administration stimulated the DNA synthesis of hepatocytes and renal tubular cells and facilitated reconstruction of hepato-renal tissue structure in vivo. Induction of HGF mRNA expression in the liver and kidney in CsA-administered mice was suppressed in the early stage of organ injury, while HGF mRNA levels increased in the lung three days after CsA-treatment. These observations suggest that the biological action of endogenous HGF is partly impaired after CsA-induced organ injury. Importantly, HGF had no apparent effect on the CsA-induced suppression of interleukin-2 mRNA expression in vitro, thereby indicating that the immunosuppressive potential of CsA was not affected by HGF. Whether or not HGF will prove to have such positive effects in patients requiring CsA-treatment is the subject of ongoing study.

Efficacy of perioperative portal venous inoculation with donor lymphocytes on skin graft survivals in the rat.

Although the administration of donor lymphocytes via portal vein (PV) on the day of transplantation significantly prolongs rat renal allograft survivals and the unresponsive state is mediated by an antigen-specific suppressor factor in the serum, significant variations exist among rodent models in terms of immunogenicity and mechanism of antigen presentation. The present studies sought to assess the effect of perioperative PV inoculation with donor lymphocytes on skin allograft survivals. Donor lymphocytes were prepared from Brown-Norway (BN, RT-1n) or third-party DA (RT-1a) rat spleens and lymph nodes and injected via PV or intravenously to Lewis (LEW, RT-1l) hosts on the day of skin grafting. Untreated LEW hosts rejected BN skin grafts at 9.0 +/- 1.4 days (n = 10). Intravenous administration of 1 x 10(8) BN cells into LEW hosts on day 0 did not prolong the skin graft survivals (MST = 8.6 +/- 1.2 days, n = 7, NS), whereas PV inoculation of 1 x 10(8) BN cells prolonged skin graft survival to 13.4 +/- 3.9 (n = 8, P < .01). PV administration of 1 x 10(8) DA cells to LEW hosts did not prolong the survival of BN skin grafts (MST = 8.6 +/- 1.5 days, n = 6). PV inoculation with BN cells inhibited the generation of anti-BN delayed-type hypersensitivity (DTH) response in the hosts, whereas untreated control hosts or hosts inoculated with third-party DA cells could not inhibit the anti-BN DTH response.(ABSTRACT TRUNCATED AT 250 WORDS)