G. Kiyonaga

A case of chronic veno-occlusive disease of the liver

SummaryA case of chronic veno-occlusive disease of the liver manifested by ascites in a 59-year-old Japanese male is described. The patient had not been exposed to pyrrolizidine alkaloids, but had been receiving allopurinol for hyperuricemia, the only drug taken throughout the period in which the hepatic lesion developed. The hepatic veins and inferior vena cava were patent according to angiography. The first biopsy showed histological characteristics of the disease and the following two biopsies demonstrated the progression of the hepatic lesion from central fibrosis to non-portal cirrhosis. Morphometric analysis of the sublobular and central veins in the three serial biopsy specimens demonstrated stepwise decrease of the ratio of the veins per portal triad and stepwise increase of severely obliterative veins.

A quantitative study on distortion of hepatic lobular architecture in needle biopsy specimens obtained from alcoholics

アルコール多飲者の肝生検標本のうち,アルコール性肝炎に特徴的といわれる所見に乏しくかつ線維化がほとんどない程度から一部のグ鞘間またはグ鞘・中心静脈間にbridgingの形成をみる程度までの組織像を有する例において,グ鞘域の分布の偏りが対照とした非アルコール多飲群のそれよりも大きいことを見出した.このグ鞘域の分布の偏りはある種の小葉構造の歪みを表わすと考えられるがこの歪みの程度の数量的表現を試みた.これによりアルコール群(46標本)では線維化が同程度の非アルコール群(33標本)に比し小葉の歪み度が有意に大きいことが分り(P<0.001),アルコール多飲者の肝組織像の一つの特徴と考えられた.又組織の線維化の程度の数量化も試み歪み度との関連を検討したが,アルコール群では歪み度と線維化度の間に有意の相関を認め(p<0.01),非アルコール群では相関を認めなかった.

Studies on the primary hepatic carcinoma in our clinic

patients had fever and ascites was observed on 16 patients in which bloody ascites was prooved in 10 cases. Jaundice also appeared on 16 patients. Abdominal pain was severe in patients who had remarkable hemorrhage and necrosis of the liver and there were no distinct relations between abdominal pain and weight of the liver, extention and metastasis of the tumor. Ascites was remarkable in cases which had pressure or obstruction around the porta hepatis and cirrhosis of the liver, and tendencies of hypoalbuminemia have been noticed in these cases. Bloody ascites was mainly observed in case which had livers weighed over 2500 grams or in cases which had very extensive tumors. Also all cases that had ascites and died whithin a month showed bloody ascites. Jaundice was not so remarkable in cases which had pressed porta hepatitis but was remarkable in cases which had extensive tumor invasion in the liver. In the cases that showed jaundice, depositions of bile pigments were eminently seen in liver cells and the aspects which were suggestive of the secretion of bile pigments by tumor cells were observed partly. High fever appeared in cases which had marked infiltration of leukocytes combined with infection, hemorrhage and necrosis of the liver. Antibiotics were effective in these cases. However, they were not effective in the most of cases which had slight fever under 38~ and had little complication of infection.

Clinical study on sarcoidosis with hepatic sarcoid lesion (I)

Sarcoidosis is a mult i -systemic disease. Al though repor ts about the hepat ic sarcoid lesion are found in theworld l i terature , those are rare ly reported in Japan. We performed peri toneoscopy and liver biopsy in the histologicaly confirmed sarcoidosis patients , and sarcoid nodules were foud by peri toneoscopy as the sporadic dim whi t i sh spots scat tered on the l iver surface near the lig. teres hepat icum, which were histologicaly proved a t l iver biopsy showing non-caseating epitheloid cell granuloma. Fu r the r we followed up the clinical course of those hepat ic lesion in re la t ion to thoracic lesion and other clinical features . Because of ra r i ty of repor ts on hepat ic sarcoidosis in Japan, one of the hepatic sarcoidosis cases is presented now. This case of 24 years old man had, at his onset, marked bi la tera l h i lar lymphadenopathy (BHL) wi th hepatic sarcoid lesion found by peri toneoscopy and histologicaly proved a t l iver biopsy. 5 months la ter BHL has cleared but the repeated peri toneoscopy and l iver biopsy have proved the pers is tence of the hepat ic lesion.