Atsushi Onodera

Obstruction of the Inferior Vena Cava in the Hepatic Portion and the Hepatic Veins

From the First Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan. In 1845 Budd’ reported three cases of obstruction of the hepatic veins. In 1899, after studying the results of three of his own cases and seven cases from literature, Chiari‘-’ emphasized that obstruction of the hepatic veins due to obstructive phlebitis should be classified as a distinct disease. Following the report of three cases by Yamagiwa3 in 1906, additional cases were studied and reported in Japan. By recent progress of venous catheterization techniques, the authors could diagnose clinically obstruction of the hepatic veins and/or the inferior vena cava in the hepatic portion in eight patients. In Japan, obstruction of the hepatic veins is frequently associated with obstruction of the inferior vena cava in the hepatic portion, peculiar features of which

Physiologic Measurement of Intrahepatic Shunted Blood Flow By Means of D-Galactose-1-C 14:

In hepatic cirrhosis, abnormal anastomoses are found between the portal veins, the hepatic veins, and the hepatic arteries.1-5 In animal experiments, the development of porto-hepatic venous anastomoses, which were found in almost all rats with nodular cirrhosis, correlated well with the decrease in effective hepatic blood flow.5 In other experiments, T-1824 dye which was infused into the portal vein of cirrhotic rats appeared in the hepatic vein before it stained the liver surface blue, whereas T-1824 dye stained the parenchyma of normal rats before it appeared in the hepatic vein Thus abnormal blood flow develops which by-passes the hepatic parenchyma, namely, intrahepatic shunted blood flow. Moreover, basement membranes, which are not found in the normal he-

Measurement of Intrahepatic Shunted Blood Flow by Means of Heat-Denatured Radioiodinated Serum Albumin in Experimental Hepatic Injuries

moses (intrahepatic shunts) the blood flowing into the liver by-passes the hepatic parenchyma, and resultant decrease of the hepatic functional blood flow leads to hypofunction of the liver. Decrease of the functional blood flow also accelerates hepatocellular degeneration and necrosis, and depresses regenerating ability of the hepatic cells. Moreover, toxic substances such as ammonia produced in the intestine flow into the vena cava without being removed by the liver. A similar disadvantageous effect is produced by capillarization of the sinusoids.6> 7 Nakamura et al.8, 9 devised methods for clinical measurement of this intrahapatic shunted blood flow by means of galactose and D-galactose-1-Cl~. By these methods, the intrahepatic shunted blood flow was found to in-

Measurement of intrahepatic shunted blood flow by means of D-galactose-1-C14 in experimental hepatic injuries.

From the First Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan. Pathological studies show that the anastomoses between the portal veins and the hepatic veins and between the hepatic arteries and the hepatic veins appear in hepatic cirrhosis.1-5 Through these pathological anastomoses (intrahepatic shunts) blood bypasses the hepatic parenchyma, and the functional hepatic blood flow decreases. Similar disadvantageous effect is also produced by capillarization of the sinusoids. 6, This intrahepatic shunted blood flow

Clinical and experimental studies on intrahepatic shunted blood flow

This study was undertaken to clear the mechanism of intrahepatic shunt formation during the course of chronic hepatit is by means of determinat ion of ratio of parenchym to connective t issue of the liver, portal venous pressure, hepatic accumlation rate of radiogold colloid and plasma disappearance rate of Indocyanine green (ICG) respectively. Intrahepatic shunt flow was obtained from galactose excretion rate which was caliculated by continuous injection method of galactose reported by Nakamura. The ratio of parenchym to connective t issue of the liver was measured by the caliculation with the use of microscopic photograph ( • liver specimens taken by liver needle biopsy. 1) Most of the cases with chronic hepatitis showed normal pat terns of galactose excretion rate and ratio of the connective tissue to the parenchym. On the other hand, A few cases of chronic hepatit is and all of the cases with precirrhosis and cirrhosis showed a decrease in galactose excretion rate and ratio of the connective tissue to the parenchym. 2) Some of the cases of non cirrhotic stage showed a marked decrease in galactose excretion rate when the portal venous pressure in these cases were elevated over 250mmH~O. The reduction of galactose excretion rate was est imated as the functional shunt flow concerned to the increase of portal pressure, because the existence of portal vein-hepatic vein anastomosis could not be considerable with these cases from their morphological findings. 3) Effective hepatic blood flow measured by galactose clearance method, plasma disappearance rate I .C .G. and hepatic accumulation rate of radiogold colloid were compared respectively. Similar results were obtained with galactose method and I .C.G., but the result of radiogold colloid differed to some extent . It was noted that the ratio of I .C.G. with radiogold colloid (ICG/Au 19s colloid) was closely related to galactose excretion rate.