An outbreak of allergy-like food poisoning.

Eight cases of allergy-like food poisoning resulting from the ingestion of yellowfin tuna, which had been kept in stock for 10 days prior to being cooked, are described. The main symptoms were headaches, facial flushing and palpitation. Samples of the ingested fish were analyzed for histamine content, and a high level of histamine was confirmed (310 mg/100 g of fish). Corticosteroids were given to 3 patients who exhibited dyspnea or persistent symptoms, while the remaining patients improved without medication. In situations where allergy-like clinical features are present after the ingestion of food, the possibility of allergy-like food poisoning should be recognized and included in a differential diagnosis.

Portal and mesenteric vein and inferior vena cava thrombosis associated with antiphospholipid syndrome.

We report a 48-year-old man with thrombosis of the portal and superior mesenteric vein and inferior vena cava associated with primary antiphospholipid syndrome (APS). Primary APS was diagnosed by a positive reaction with anticardiolipin antibody (aCL) and the absence of any evidence suggesting the presence of other disease states known to be associated with aCL. A coeliac angiography showed obstruction of the portal and superior mesenteric vein with prominent collaterals and cavernous transformation. Femoral vein angiography showed total obstruction of the external iliac vein and inferior vena cava, and dilation of the pelvic veins, with contrast medium in the lumbar vein. This case is noteworthy as a report of primary APS accompanied by extensive abdominal and pelvic venous thrombosis.

[A case of non-small-cell lung cancer successfully treated using combination chemotherapy with CDDP and vinorelbine].

A 67-year-old woman presented to our hospital with a chief complaint of bloody sputum. A plain chest X-ray a CT scan revealed a tumor shadow 3 cm in size in the middle lobe of the right lung, multiple nodular shadows in the bilateral lung fields and enlarged hilar and mediastinal lymph nodes. A tumor biopsy done under bronchoscopy revealed poorly differentiated adenocarcinoma of the lungs (cT2N3M1). She was given two courses of combination therapy consisting of cisplatin (80 mg/m2) and vinorelbine (20 mg/m2). The primary tumor in the middle lobe of the right lung and the lung metastases were markedly reduced in size, and a complete response was obtained. The only adverse events were grade 4 neutropenia and grade 2 nausea and vomiting.

Hyponatremia with increased plasma antidiuretic hormone in a case of hypothyroidism.

We report a 70-year-old woman with hypothyroidism and severe hyponatremia. Her plasma antidiuretic hormone (ADH) level was inappropriately high for her low plasma osmolality. Her low serum sodium level was gradually corrected by water restriction and sodium supplementation prior to the initiation of thyroid hormone replacement. After a diagnosis of Hashimoto's thyroiditis had been made, the patient was treated with levothyroxine. Following this treatment, the patient's serum sodium level increased drastically. It is suggested that the elevated plasma ADH level played an important role in the development of hyponatremia in this case.

[Clinical evaluation of hepatic bruit audible in patients with alcoholic hepatitis].

It is well accepted that many patients with alcoholic hepatitis have an audible bruit over the liver (hepatic bruit) in western countries. However, this sign has not been discussed in Japan. The aim of this study was to assess the significance of the hepatic bruit in Japanese patients with alcoholic hepatitis. Hepatic bruit was specifically searched for on auscultation by two physician in consecutive patients (6 alcoholic hepatitis, 58 other alcoholic liver disease, 128 nonalcoholic liver disease including 16 hepatocellular carcinoma). Hepatic bruit was detected in 5 of 6 (83%) patients with alcoholic hepatitis, and in 1 of 16 (6%) patients with hepatocellular carcinoma. In any of other liver diseases, hepatic bruit was not detected. We conclude that hepatic bruit may be an important diagnostic finding in Japanese patient with alcoholic hepatitis as it is in western countries.

Malignant transformation of Nakamura type IV gastric polyp with CA 19-9 production.

In a 68-year-old Japanese man, a gastric polyp 24mm in diameter with a stalk 15 mm in diameter was diagnosed as well differentiated adenocarcinoma and treated by endoscopic polypectomy. Histologically, most of the resected tissue was adenoma, and atypical cells were papillarily proliferating to form adenocarcinoma in adenoma, a Nakamura type IV gastric polyp. Infiltration of carcinoma was limited to within the mucosal layer. Immunohistochemical study with anti-CA19-9 antibody revealed positive staining in carcinoma cells. Serum CA19-9 level, which showed slight elevation, returned to the normal range 1 month after the polypectomy. The proliferating cell nuclear antigen (PCNA) labeling index and DNA ploidy pattern were analyzed in the resected tissue. The PCNA labeling index was 30% in carcinoma, 17% in adenoma, and 0.1% in the normal tissue. The DNA ploidy pattern was diploid in adenoma and aneuploid in adenocarcinoma. These findings suggest that gastric adenoma, as well as colonic adenoma, may have the potential for malignant transformation.

Distribution of 3 alpha-hydroxysteroid dehydrogenase (bile acid binder) in rat small intestine: comparison with glutathione S-transferase subunits.

We identified and quantitated the Y' bile acid binder, i.e., 3 alpha-hydroxysteroid dehydrogenase (3 alpha-HSD), in rat small intestinal mucosa, and compared its longitudinal distribution with that of glutathione S-transferases (GST). The enzyme activity of 3 alpha-HSD in intestinal mucosa was approximately one-third of that in liver, and it had similar activity in the proximal, middle, and distal portions of the intestine. Immunoreactive protein corresponding to hepatic bile acid binder was detected in all segments of rat small intestine mucosal cytosol by Western blot analysis. There was no significant difference in the concentration of bile acid binder, assayed by enzyme-linked immunosorbent assay (ELISA), between the proximal and the distal intestine, this being 2.93 +/- 0.03 and 3.29 +/- 0.95 nmol/g tissue, respectively (mean +/- SD of four animals). On the other hand, the concentration of GST 1-1 showed sharp longitudinal decline and that of GST 3-4 was negligible in the small intestine, as we previously reported, indicating that bile acid binder was a prominent cytosol binding protein in the distal intestine. These results suggested the possible role of bile acid binder in the intracellular transport of bile acids in the ileum.

Zonal distribution of cysteine uptake in the perfused rat liver.

When in situ perfused rat livers were administered tracer or physiologic concentrations of [35S]cysteine, a zone III (perivenous) predominance of uptake was observed in either antegrade or retrograde single-pass perfusion, as determined by quantitative densitometry of autoradiographs of liver section. This pattern remained unchanged from 30 s to 5 min observed. At higher supraphysiologic doses a more uniform acinar distribution of cysteine uptake was observed. Uptake rates of cysteine in antegrade perfusion indicated an apparent saturable component at low but physiologic cysteine concentrations. That uptake rather than metabolic trapping accounts for this perivenular pattern was supported by finding identical zonal distribution under conditions in which GSH and protein synthesis were markedly inhibited. Furthermore, increasing or decreasing hepatic cysteine pool sizes did not affect the extraction or zonation. These results suggest that a low Km transport system for cysteine is localized in zone III of the hepatic acinus.

[Studies on the mode of progression of alcoholic liver disease].

In order to elucidate the mode of progression of alcoholic liver disease, relationships among the drinking style, laboratory data, anti-HCV antibody and histological changes were investigated on 36 patients in whom the liver biopsy was repeatedly done. Following results were obtained (1) In the group of continuous drinking over 100g ethanol per day, histological progression was found in 11 of 13 patients (85%) regardless of positive anti-HCV. On the other hand, in the group of abstinence or temperance less than 60g daily alcohol intake, histological improvement was found in 6 of 11 patients (55%). (2) Histological improvement was predominantly seen by abstinence or temperance in the cases with lower levels of serum IgA and adenosine deaminase (ADA) on hospitalization and those with rapid decrease in serum gamma-GTP after hospitalization. In conclusion, the amount of ethanol was considered to be the most important factor to affect on a progression of alcoholic liver diseases. Assessment of laboratory data such as IgA and ADA on hospitalization and change in gamma-GTP after hospitalization were also thought to be useful in foreseeing the prognosis of alcoholic liver disease.

[Distribution of glutathione S-transferase isozymes in rat small intestinal mucosa].

We have investigated the longitudinal distribution of glutathione S-transferase (GST) isozymes in the trisected small intestine mucosa of rats. Only GST subunits 1 and 7 were detected by Western blot analysis of the intestinal cytosol using antiserum for GST1-1, 1-2, 3-4 and 7-7. Cytosolic GST1-1, 3-4 and 7-7 were assayed by the quantitative ELISA. There was a marked decline of the concentration of GST1-1 from proximal (35.17 nmol/g tissue) to distal intestine (1.67 nmol/g tissue). GST3-4 was hardly detected in the intestinal mucosa. Among the GSTs, GST7-7 existed in the highest concentration in any segment of intestine, i.e. 58.76 nmol/g tissue (61% of GSTs) in the proximal intestine and 32.38 nmol/g tissue (93% of GSTs) in the distal intestine.

[Clinical study of male patients with primary biliary cirrhosis (PBC)].

We studied 10 male and 23 female patients with PBC to determine whether the clinical and histological features of this disease differed in male and female patients. There were no significant difference between men and women in age distribution and biochemical examinations. In female patients, autoimmune associated conditions such as sicca syndrome, Raynaud syndrome and arthritis were observed 22%, 13% and 36%, respectively. By contrast, no male patients developed those conditions. 80% of the male patients and 70% of the female patients belonged to asymptomatic PBC, and early histological stage, such as Scheuer's I and II were observed 90% of the male patients and 78% of the female patients, respectively. No male patients showed clinical or histological progression during follow-up period (median was 64 months). Nevertheless, not a few female patients showed progression including 3 cases who died during the follow-up period (median was 47 months). We concluded that male patients with PBC tend to have favorable prognosis comparing to female patients.

[Metabolism of sulfobromophthalein in jaundiced rat].

We observed previously in humans that loading with BSP in obstructive jaundice resulted in elevated blood levels, of cysteine-conjugated BSP (Cyst-BSP). In order to clarify the mechanism of this phenomenon, an investigation was made into the origin of Cyst-BSP in rats with experimentally produced obstruction of bile duct (O-J). Using untreated rats as controls, the animals were determined for glutathione content and glutathione S transferase activity (GST) in liver cytosol. The influence of nephrectomy upon and the role of liver cell membrane in biodisposition of BSP were also investigated. The results are summarized as follows: 1) In the O-J group, the excretion in bile of glutathione-conjugated BSP (GSH-BSP) was markedly decreased. 2) O-J livers were found to have higher glutathione content and GST activity as compared to control livers. 3) Nephrectomy in O-J rats was followed by no gross change in the proportion of Cyst-BSP in blood and liver cytosol. 4) Following administration of individual liver cell membrane components change from GSH-BSP to Cyst-BSP was noted to occur only in O-J rats. These results led us to surmise that GSH-BSP accumulated in the liver in O-J is hydrolyzed to Cyst-BSP in the liver cell membrane.

[The use of Pugh score to evaluate the prognostic and therapeutic influence of drinking in patients with decompensated liver cirrhosis].

The aim of this study is to evaluate the clinical usefulness of Pugh score in the prognosis of the patients (pts.) with decompensated liver cirrhosis (DLC). To determine the influence of heavy drinking with respect to the prognosis of DLC patients, 128 cases of DLC were divided into two groups including the 31 heavy drinker group (Group A) and 97 non-alcoholic group (Group B). At the time of admission, the both groups showed similar Pugh score. However, after initial two hospitalized weeks, Group A started to show significantly lower points of Pugh score than that of in Group B. Fifteen pts. (48%) in Group A and 55 pts. (57%) in Group B had greater than 9 in Pugh score at the time of admission. In Group A, 10 of 15 pts. declined the scores after initial two weeks and 9 of them lived more than one year after admission. In contrast, none of those 55 pts. in Group B declined their Pugh score after admission and 45 of them died within one year. It was concluded that Pugh score was extremely useful to evaluate the prognosis of DLC pts., and DLC pts. who had greater than 9 Pugh score were seemed to be critical. It was suggested that DLC pts. due to heavy drinking tend to improve Pugh score comparing to no alcoholic DLC pts.