H. Kuroda

Microfilaments around the bile canaliculi in patients with intrahepatic cholestasis

SummaryThe cytoplasmic microfilaments of hepatocytes, especially in the pericanalicular area, were examined in 25 liver biopsy specimens obtained from 15 patients with intrahepatic cholestasis. About 25 days after the onset of jaundice an increase in bile canaliculi dilation was noted, though an increase in amount of microfilaments was less conspicuous in comparison with the next stage. At about 55 days an increase in number was seen around dilated canaliculi. At about 100 days microfilaments decreased in amount and the dilation of canaliculi became less evident, while swollen microvilli protruded into the canaliculi with their microfilaments irregularly arranged. An increase of microfilaments in hepatocytes, particularly in the pericanalicular area, might be a reflection of the secretion of bile.

Detection of mitochondria in bile canaliculi in early stage primary biliary cirrhosis cases

SummaryBiopsy specimens of liver obtained from patients with early stages of primary biliary cirrhosis were examined by electron microscopy with special attention being paid to changes in bile canaliculi, as well as bile ducts and hepatocytes. Ultrastructural alterations of hepatocytes were minimal and non-specific. In bile canaliculi mitochondria were noted to be normal or slightly lack uniformity. These findings varied according to each case. This alteration was strongly considered to be specific in early stage primary biliary cirrhosis cases.

The constitutional indocyanine green excretory defect — report of four cases —

SummaryFour cases revealed high retention of ICG test and normal retention of BSP test were reported. The results of liver function test of these cases showed within normal limit except ICG retention. ICG disappearance rate ranged from 0.017 to 0.025, whereas BSP disappearance rate ranged from 0.069 to 0.126. The transfer rate of ICG from plasma to liver markedly decreased by two compartmental analysis of the decay curve and slightly reduced transfer rate of BSP from plasma to liver was also observed. The step on both ICG and BSP disappearance curve was observed during 20 to 25 minutes after the injection in all cases and in repeated observations. The step formation is one of the characteristic changes in these cases. The ICG binding capacity of serum protein decreased in the first peak and increased in the third peak eluted by gel filtration of Sephadex G-200. Light microscopic findings of the liver showed normal histology. The electronmicroscopic findings showed the increase of lipofuscin-like lysosome, modification and paracrystalline like array of mitochondria and increase of reticulum fiber in Disse’s space. Father of a case showed ICG retention without BSP retention. From these results it is suggested that these cases are a new type of dye excretory disorder of liver with heredity or constitution.

[A case of rheumatoid arthritis with chronic thyroiditis, primary biliary cirrhosis, and anti-centromere antibody].

症例は, 67才,女性で,慢性関節リウマチとその後併発した慢性甲状腺炎で外来経過観察中であったが,肝機能障害が出現したため入院となった.抗ミトコンドリア抗体陽性で,腹腔鏡下肝生検の結果,原発性胆汁性肝硬変と診断された.さらに抗セントロメア抗体陽性であったが, CREST症候群を示唆する所見は認めなかった.本症例は,慢性関節リウマチを先行し,その後慢性甲状腺炎と原発性胆汁性肝硬変を併発し, CREST症候群の病態を欠如しているにもかかわらず,抗セントロメア抗体を認めたまれな症例と考えられた.さらに,抗セントロメア抗体の原発性胆汁性肝硬変の病因への関与を示唆する興味深い1症例と考えられ報告した.

Pericanalicular microfilaments of hepatocytes in patients with familial non-hemolytic hyperbilirubinemia

SummaryWe observed pericanalicular webs (PCW) of liver cells in cases with familial non-hemolytic hyperbilirubinemia using electron microscopy. The area and width of PCW were determined by morphometric methods as a way of quantitating this feature. The mean PCW width was 0.175±0.003 μm (mean ± SE) in Dubin-Johnson syndrome and 0.184±0.005 μ,m in Rotor’s syndrome. In both of these syndromes PCW width was significantly larger than that in Gilbert’s syndrome (0.124±0.003 /μm) (p<0.01). The mean PCW area was 0.585±0.017 /xm2 in Dubin-Johnson syndrome and 0.582±0.030/i,m2 in Rotor’s syndrome. Values in these two syndromes were significantly larger than that in Gilbert’s syndrome (0.382±0.014ju,m2) (p<0.01). Widths and areas of PCW in these three syndromes were not significantly different between central, intermediate, and peripheral zones of the hepatic lobules. There was a positive correlation between serum direct bilirubin levels and widths or areas of PCW in these syndromes. These results suggested that disturbances of bile flow caused by the dysfunction of pericanalicular microfilaments are partly involved in the pathogenesis of Dubin-Johnson syndrome and Rotor’s syndrome.

A case of hypercarotenemia, especially electronmicroscopic observation of the liver

カロチンは生体内に通常みられる色素であるが,動物体内では合成されず,もっぱら食物からの摂取によっている.臨床的には,カロチン含有物の過剰摂取による柑皮症は良くみられるが,問題となることは少ない.我々はカロチン血中停滞が著明で,精神神経症状を呈した症例を経験し,これについて肝の電顕的観察を行った.Disse腔はreticulum fiberが軽度に増生し,mitochondriaは腫大,変形とmatrixの電子密度の増加を認め,paracrystalline inclusionの出現を認めた.また,滑面小胞体は発達し,細分化し,小円形状となり,内腔に小顆粒を認め,粗面小胞体は層状構造が乱れ,細分化し,内腔の拡大を認めた.発達したGolgi装置は内腔に小顆粒を認めた.以上の電顕的にみた細胞内小器官の変化により,本症の色素停滞の一部を解明することができるものと考え,また体質性黄疸との関連についても考察した.

Studies on the hepatic transport and metabolism of dyes

bile drainage after the surgery. Experimental analysis, using dogs with obstruction of the common bile duct and successive reconstruction procedures, revealed the same as seen in the human. Results obtained in 7 cases of portal hypertension, including 4 cases of cirrhotics and 3 cases of non-cirrhotic intrahepat ic portal hypertension (2 cases of end-to-side portacaval shun t and 5 cases of direct interruption surgery of esophageal varices such as proximal gastrectomy) revealed that the radioactive tracing test reflected the change of the hepatic blood flow at the first place. The results also reflected the change of hepatic functions after surgery at the second place. Though there is some question on the extrahepatic uptake of the radioactive BSP, this simplified external procedure could be helpful to examine the situation of the hepatic blood flow and the function before and after the surgical t rea tment in those hepatobiliary diseases.

Examination of dye metabolism in liver (VII) with respect to bind with serum protein to I.C.G. (Indocyanine green)

ConclusionThe data suggested that the binding activity of I.C.G. with serum protein provided by concentration of albumin, α1 globulin and α2 globulin.

Diagnosis of liver diseases by ultrasonic echography

The technique of pneumoperitoneum-tomography is as follows: After fast ing and enema the patient was usually made to lie in the dorsal position. The puncture was made at external 1/3 of the line connecting the navel and anterior iliac spine or the middle of the line connecting the navel and pubic symphysis, and 1,000~1,500cc of air was injected. Tomography was taken in the ventral, dorsal, r ight or left lateral or oblique position that allows to give the clearest contour of the organ. The results from the 6 cases are as follows: The tumefaction was clearly demonstrated in 4 casesin 2 on the phrenic surface of the liver, in each 1 on the frontal surface and lower edge of the right lobe. In the other 2, the swelling was found in the interior of the liver, but its presence could be est imated by this method because it was as large as an egg. The pneumoperitoneum-tomography was thus diagnostic for superficial tumefaction of the liver, and could est imate its size, form and extension. This method is especially useful to find out the tumefactions on the phrenic and posterior surface or lower edge of the liver which are difficult to know by palpation. But when the swelling is in the interior of the organ, its diagnosis is generally difficult unless it is grown to such an extent as to elicit change in the contour of the organ. It is also difficult in general to judge by this method whether the tumor is benign or malignant. Any significant side effect was not produced by this method.

The study of hepatic coma during the treatment with diuretics

Seventyone patients with cirrhosis of liver have been admitted to our clinic over the past five years (1962~1966). Of these, 26 cases (36.7%) were fatal and 45 cases survived. Oedema or ascites were found in 37 of 71 patients with liver cirrhosis. Twenty-two of them (59.5%) died, and 15 of them (40.5~) survived. Diuretic therapy was performed in the case of 26 of 37 patients with ascites or oedema. Their mortali ty rate was 69.3% (18 cases). It was raised by about 10% as a result of diuretics. There were 11 patients with ascites or oedema, on whom diuretic therapy was not performed and only 4 of them died. The mortali ty rate of patients with ascites or oedema who were treated with diuretics was higher than that of patients not treated with diuretics. We found serum electrolytes imbalance in the fatal cases of hepatic coma during the t reatment with diuretics. The serum sodium and chloride level were inclined to decrease, especially in the case of hepatic coma. On the other hand, the potassium was irregular. We are impressed that diuretic therapy of liver cirrhosis must be performed carefully and must be watched the electrolyte balance, especially that of sodium.