Hiroyasu Hirakawa

Scanning electron microscopy of the bile ductule.

SummaryScanning electron microscopy of a liver biopsy specimen from a patient 6 months after the onset of acute hepatitis revealed a normal appearing bile ductule. The bile ductule was 13 μm in outer diameter and 1.5–2.7 μm in inner diameter. The ductular lumen was surrounded by two ductular cells and ampullary dilated at the canalicular side. In the lumen, intracytoplasmic diverticles were observed with an orifice d ameter of 0.9 μm. About 15 microvilli 0.4–0.6 μm in length and 0.1 μm in thickness were observed on 1 μm2 of luminal surface. The number of microvilli was calculated to be approximately 1,500 per ductular cell. A single cilium 0.15 μm in diameter at the base and 0.10 μm at the trunk, and 7–15 μm in length was found on each ductular cell. The cilium arose from p. recess at the canalicular side of the ductular cell, and the free-end was on the bile-duct side. The cilia seemed to play an important role in bile flow to the duct. Sometimes between the ductular cells at the edge of the basal portion a cell was intercalated with thin processes. Such thin processes were not observed on ductular cells.

Kupffer cell hyperplasia in liver diseases. Demonstration by scanning electron microscopy of biopsy samples.

SummaryKupffer cells were observed in liver biopsy tissues of 9 cases of liver diseases by scanning electron microscopy to prove Kupffer cell proliferation numerically. Kupffer cell count per 0.01 mm2 of cracked surface of liver lobule was 1.2 ± 0.3 in the convalescent stage of a mild acute hepatitis case and 1.2 ± 0.1 in a chronic persistent hepatitis case with slight inflammation. Wheras it was increased to 2.4–5.5 (p<0.01) in the convalescent stage of moderate to severe acute hepatitis cases, 1.8 ± 0.1 (p< 0.05) in a chronic active hepatitis case, 2.5 ± 0.3 (p< 0.001) in an alcoholic portal fibrosis case and 2.2 ± 0.4 (p< 0.001) in a liver cirrhosis case. Kupffer cell count per mm3 of liver lobule was estimated roughly 3,500 in the convalescent stage of a mild acute hepatitis case and in a mild chronic persistent hepatitis case and 7,000 to 16,000 in the convalescent stage of moderate to severe acute hepatitis cases.

Alpha-fetoprotein-producing early gastric cancer accompanying liver cirrhosis: A case report

A rare case of alpha-fetoprotein (AFP)-producing early gastric cancer with liver cirrhosis is presented. A 61-year-old man was admitted to Shimane Medical University Hospital in 1988 because of abnormal liver function test results suggestive of liver cirrhosis with mild elevation of AFP. Liver cirrhosis was confirmed laparoscopically and histologically. Gastric cancer was found in fluoroscopic and endoscopic studies. After partial gastrectomy, the serum AFP level fluctuated transiently within normal limits, and then gradually increased soon after the operation. Therefore, complication of hepatocellular carcinoma was suspected, but no tumor in the liver was detected by any imaging examination, including angiography. Two years after the operation, swelling of abdominal periaortic lymph nodes was noted at a periodic checkup, but still no hepatic tumor was found. At this point, AFP-producing gastric cancer was suspected, and an AFP staining test was carried out on the tissue of the resected specimen. AFP-positive cells were recognized immunohistochemically. Thus, we diagnosed the condition as post-operative recurrence of an AFP-producing gastric cancer accompanying liver cirrhosis.

Gallbladder Cancer Laparoscopy

The role of laparoscopy in the diagnosis of gallbladder cancer was evaluated. Fifteen patients who were suspected of having gallbladder cancer, following physical examination, laboratory tests, and imaging techniques, received laparoscopy at our clinic, and the laparoscopic findings and histologies were analyzed. Five patients in whom the gallbladder was observed were laparoscopically confirmed as having gallbladder cancer, and in 2 of these cases metastases to the liver were observed. Among the 10 patients in whom the gallbladder could not be observed, metastases to the liver and the peritoneum were observed in 6 and 4 cases, respectively. In 3 cases neither the gallbladder nor metastases to other visceral organs could be observed. Thus, the qualitative rate of laparoscopic diagnosis was 80% (12/15 cases). Five cases (42%) among the 12 cases in which laparoscopy suggested gallbladder cancer, were histologically confirmed after biopsy specimens were obtained. Only one of these cases was diagnosed by direct forceps biopsy of the gallbladder wall.

Alcoholic cirrhosis with repated attacks of hepatitis

長期間にわたる多量の常飲者で,過飲による増悪と,断酒による軽快を繰り返した2症例につき,2年以上経過を追跡して,経時的に腹腔鏡検査と肝生検を繰り返し検索した.アルコール性肝炎では,その繰り返しにより約2年間で壊死後性肝硬変が完成され,門脈性肝硬変では,アルコール性肝炎が繰り返されると約1年間で壊死後性肝硬変へと進展した.これらの観察から,アルコール性肝硬変の進展にはアルコール性肝炎が重大な影響を及ぼしていることが明らかにされた.