Isao Okazaki

Chylous Ascites Formation and a Review of 84 Cases

From the Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan. Chylous ascites are relatively rare. 1-4 In Japan only 84 cases have been reported during the past 80 years since the first report by Sato5 in 1891. Attempts have been made to classify milky ascitic fluids by their appearance and fat contents as chylous, pseudochylous and chyliform since Quincke (1875) and Lion (1893). Under recent biochemical progress, we must consider whether this classification is adequate or not. Recently, the authors experienced one case with pancreatic cancer accompanied with chylous ascites, and demonstrated the presence of free chyle in the ascites on ultracentrifugation method. The region of chylous effusion in lymph canals and its mechanism were studied by lymphangiography in the present

Assays of serum laminin and type III procollagen peptide for monitoring the clinical course of diabetic microangiopathy

Thickening of the capillary basement membrane is a characteristic feature of diabetes and is considered to cause diabetic microangiopathy. Serum levels of both laminin, a glycoprotein in the basement membrane, and type III procollagen peptide (P-III-P) were measured by specific radioimmunoassays according to the methods of Brocks et al. and Rohde et al. respectively and analyzed with regard to diabetic microangiopathy, glycemic control, diabetic duration and treatment. As a result, serum levels of both laminin and P-III-P showed higher values with development of diabetic microangiopathy, suggesting that progressive changes in diabetic microangiopathy occur with synthesis of laminin and P-III-P. Serum laminin and P-III-P appear to be good non-invasive markers for measuring basement membrane metabolism and type III collagen accumulation. High values of serum laminin and P-III-P levels were suspected to be due to improper treatment, using hypoglycemic agents without adherence to the diet regimen.

Aortitis syndrome associated with ulcerative colitis.

Department of Radiology, School of Medicine, Medicine, Keio University * Department of Radiology, School of Medicine, Keio University The authors experienced one case of aortitis syndrome associated with ulcerative colitis. The coexistence of these two 1~ 2 entities in the same patient is very rare. In Japan only two cases have been reported since the first description of aortitis syndrome by Takayasu3 in 1908. In Europe and the United States only one case of aortitis syndrome has been reported in which ulcerative colitis was described as the past history.4 4

Ten year survival rate of 131 patients with liver cirrhosis excluded the association of liver carcinoma at the establishment of diagnosis

SummaryThe present study reported 10 year survival rate of 131 patients with liver cirrhosis excluded the association of liver carcinoma. Survival rate was calculated according to the life table method of Cutler and Ederer. One hundred thirty-one patients were diagnosed between 1965 and 1972. The overall 5 and 10 year survival rates of 131 patients were 58.3 ± 4.7% and 36.5 ± 6.2%, respectively. The 5 and 10 year survival rates of 56 patients with decompensated liver cirrhosis were 32.9 ± 6.9% and 19.0 ± 6.9%. The 5 year survival rate of 28 patients with prominent ascites was 20.6 ± 8.4% and that of 14 patients with the rupture of esophageal varices was 29.4 ± 13.4%. The improved treatment of decompensated liver cirrhosis and the exclusion of the patients with the association of liver carcinoma might contribute to these improved survival rates.

A case of subacute hepatitis with reversible liver fibrosis

SummaryReversibility of hepatic fibrosis was demonstrated histologically in a case with subacute hepatitis. His first liver biopsy showed the transformation to liver cirrhosis. Gamma-globulin, TTT and ZTT gradually recovered to normal range, and serial second to fourth liver biopsy revealed the gradual decrease in newly formed fibrous tissues of the liver.

Pathology of Alcoholic Liver Disease with Special Emphasis on Alcoholic Hepatitis

It has been widely recognized that alcoholism is one of the major sociomedical problems of modern society. It is also known that excessive alcohol intake is a factor in a significant percentage of all deaths, roughly 10% in the United States. It is associated with half of all traffic deaths, many involving teenagers. Cirrhosis of the liver, which ranks among the ten leading causes of death, is largely attributable to excessive alcohol consumption (Lieber 1978; Eckardt et al. 1981).

Abnormalities in the Hepatic Sinusoids: Pathological Basis of Self-perpetuation of Liver Cirrhosis

The hepatic microcirculatory system consists of four microvascular components: the terminal portal venule and hepatic arteriole as two afferent vessels, the sinusoids corresponding to the capillary bed, and the terminal hepatic venule as an efferent vessel. This microvascular unit is the basis for the simple liver acinus, which has been proposed as the smallest functional unit of the hepatic lobule [1]. The major components among these microvessels are the hepatic sinusoids, which are characterized by the presence of the sieve-like pores [2], i.e., the sinusoidal endothelial fenestrae (SEF), and by the absence of the basement membrane beneath the sinusoidal endothelial cells. These ultra-structural characteristics reflect the active exchange of metabolites between the sinusoidal blood and the hepatocytes, maintaining constant liver cell functions. In this respect, impairment of the sinusoidal blood flow directly leads to a variety of liver cell dysfunction.

The Splanchnic Circulation

The vasculature of the intestinal mucosa and that of muscle are in parallel. Therefore, the total pressure drop across each circuit is identical. However, structural and functional differences in the microvessels of each circuit may result in different micro pressure distributions (Bohlen et al., 1975; Gore and Bohlen, 1975). This possibility was tested by direct measurement of micro pressures, diameters, and relative flows in the muscle and mucosal circuits of the rat’s intestine. Relative pre- and postcapillary resistances within each circuit were calculated.

Statistical follow-up studies on146 cases of liver cirrhosis

SummaryThe present study reported 5 year survival curves in 146 cases of liver cirrhosis diagnosed between 1965 and 1972. The 146 subjects included 15 cases who were complicated with hepatoma at the first time of consultation. Five year survival curves were constructed by the life table method of Cutler and Ederer. Five-year survival rate was 53.1 ± 5.6% in 146 cases (liver cirrhosis with and without hepatoma), and 59.2 ± 6.2% in 131 cases (liver cirrhosis without hepatoma). Five-year survival rates of 75 cases of compensated and 56 cases of decompensated liver cirrhosis were 74.5% and 39.5% respectively. Five-year survival rate in the patients with jaundice was 41.9%, in the patients with ascites 11.7%, and three-year survival rate in the patients with rupture of esophageal varices was 50.8%. These results suggest improved survival rates compared with those of previous reports, most probably reflecting the improved treatment of decompensated liver cirrhosis. The therapeutic effects of adrenocortical steroids and diuretics were also investigated. No significant effects of steroid therapy on the survival rates of cirrhotic patients were observed. Diuretics were seemed to be slightly effective.

Histologic findings of the liver in “autoimmune diseases” with special reference to thymic abnormalities

94 cases of acute hepat i t is were observed in our clinic dur ing past 3 years. They included 48 cases of infect ious hepat i t is and 46 cases of serum hepati t is . F luminan t hepat i t is were 7 cases (7.5%), cholangioli t ic type were 11 ones (11.7%), included 6 who were older than 60 years. 3 cases (3.2%) of them were fatal, 6 (6.4%) progressed to l iver cirrhosis . 6 (12.5%) of infect ious hepat i t is progressed to prolonged or chronic hepati t is , while 14 (21.2%) of serum hepat i t i s did to them. Case report Case 1 was 61 years old female wi th dominant jaundice (total b i l i r u b i n > 2 0 m g / d l , total cho le s t e ro l>380mg/d l and a lka l inephospha tase>5 Bessey unites), under the diagnosis of extrahepat ic obs t ruct ion or in t rahepat ic cholestasis operat ion was done, but ext rahepat ic obstruct ion was not found. Her illness progressed to chronic cholangioli t is . Case 2 was 32 years old female. Dominant elevations of t r ansaminase act ivi ty were observed at six t imes dur ing 3 years, and she was diagnosed to acute hepat i t is by liver biopsy. In interval, her l iver funct ion tes ts showed normal value and biopsy specimens did normal feature. She was dignosed to chronic reccurent hepat i t is .