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AIP may also affect extrapancreatic organs, the serum of AIP patients may contain an IgG4 autoantibody to various organs and glucocorticoid therapy may improve such disorders.

palliative operations such as marsupialization with biliary drainage, Patients with alveolar echinococcosis of the liverand laparotomy were performed in 14, 5, and 1 cases, respectively.(AEL) can be cured by complete excision of the lesions;Mebendazole had been given before albendazole therapy in 9 cases. however, it is not always completely resectable in ad-Eight patients had lung metastasis, and 2 had lymph node metastavanced cases. Recently, benzimidazole-type drugs have sis. The staging system proposed by Nakajima et al. 10 was used.been reported to be effective in nonresectable AEL. One Five groups (I, II, IIIa, IIIb, and IV) are obtained according to three hundred fifty-two patients with AEL have been surgi-principal degrees of anatomic extent: apparent localization of the cally treated in our institution since 1937. Our clinical site of origin (occupied segments); evidence of regional spread to the adjacent tissue or organ, usually in the form of direct invasion; and trial with albendazole, one of the benzimidazole carba- A IIIb indicates, in addition to involvement of one to three segments, favorable response to albendazole, such as decreases in regional tissue or organ invasion and/or distant metastasis, but all the size of the lesions, changes in cyst morphology, and lesions should be resectable. Stage IV indicates intrahepatic lesions amelioration in clinical symptoms or signs, was achieved occupied in four segments and/or regional invasion and/or distant in 11 (55%) cases. These favorable responses were also metastasis of which every lesion is nonresectable (i.e., curative operation cannot be achieved).10 Advanced stages were seen frequently; seen in cases of noncurative resection and palliative opthere were 1, 3, 4, 6, and 12 cases in stages I, II, IIIa, IIIb, and IV, eration. The cumulative survival rate of the patients was respectively. 87%, 15 years after the operation. A complete responseHematological examination and liver function tests were perwas achieved in one case; the residual lesion in the liver formed every 2 weeks, and serological tests and ultrasound (US) and completely disappeared on the computed tomography computed tomography (CT) scans were carried out at approximately image 3.5 years after noncurative surgery. Palliative or 6-month intervals. The drug protocol for albendazole (200-mg tablets; mass reduction surgery combined with albendazole obtained from SmithKline Beecham, Tokyo, Japan) was 10 mg/kg/d therapy may be a strategy for advanced disease, espe-orally in a treatment cycle of 4 weeks with 2-week breaks.3 This cycle cially when complete resection might result in signifi-was repeated indefinitely unless there were adverse reactions. The average duration of treatment was 3.25 years. cant morbidity or mortality. (HEPATOLOGY 1997;25:The study protocol of chemotherapy was approved by the ethics 528-531.)committee of the Department of Medicine of Hokkaido University. Chemotherapy was performed in patients after their informed conPatients with alveolar echinococcosis of the live...

Physicians tend to overestimate when predicting survival in all palliative care patients, including those receiving chemotherapy.

The simplified PPI showed essentially the same predictive value as the original PPI and is an alternative when clinicians have difficulties in diagnosing delirium.

Simple liver cysts are rarely complicated by intracystic hemorrhage. We encountered a case of simple liver cyst that was morphologically similar to biliary cystadenocarcinoma, which was complicated by asymptomatic intracystic hemorrhage and successfully treated by right lobectomy. A large cystic lesion of the liver was detected in a 57-year-old woman during a mass screening health check. Abdominal ultrasonography (US) revealed that the cystic lesion, containing many hyperechoic papillary structures, occupied almost the entire region of the right hepatic lobe. In addition, a round mural nodule, measuring approximately 5 cm in diameter, was detected in the cystic wall. Abdominal computed tomography (CT) revealed that the inner part of the cystic lesion showed homogeneous low density, but CT did not show the round nodule detected by US. On T1-weighted sequence of magnetic resonance imaging (MRI), the lesion showed homogeneous high signals, together with a low-signal tumorous lesion in the cystic wall. T2-weighted sequence of MRI showed unhomogeneous high signals, together with high signals in the tumorous part. These findings did not exclude the possibility of a malignant cystic tumor, such as biliary cystadenocarcinoma. Therefore, right lobectomy was performed. Histological examinations of resected tissue specimens revealed that the lesion was a liver cyst containing a large amount of blood clot, and that the tumorous lesion detected by US and MRI was a large mass of blood clot which was partly liquefied. This case indicates the diagnostic importance of the morphological discordance between CT and US or MRI findings for liver cyst containing a large amount of blood clot.

We assessed T cell association with acinar cell apoptosis and a preventive effect of tacrolimus, a T cell suppressant, on the development of chronic pancreatitis in male Wistar Bonn/Kobori rats. At 15 wk, cellular infiltrates composed of F4/80-positive cells (monocytes/macrophages), CD4-positive cells, and CD8-positive cells were extensive in the interlobular connective tissue and parenchyma. In particular, CD8-positive cells invaded pancreatic lobules and formed close associations with acinar cells, some of which demonstrated features of apoptosis. At 20 wk, CD8-positive cells were still abundant in the fibrotic tissue formed with loss of acinar cells. Repeated subcutaneous injection of 0.1 mg x kg(-1) x day(-1) but not 0.025 mg x kg(-1) x day(-1) of tacrolimus for 10 wk completely prevented the occurrence of acinar cell apoptosis, infiltration of CD4- and CD8-positive cells, and development of pancreatitis at the age of 20 wk, but these maneuvers did not recover the decreased plasma corticosterone levels, which may be responsible for the development of disease. We demonstrated that T cells, possibly CD8-positive cells, are involved in inducing apoptosis of acinar cells, raising the possibility that tacrolimus might find clinical application in the treatment of autoimmune chronic pancreatitis.