Jugoro Takeuchi

Essential hypertension and multiple renal arteries

Abstract Two hundred forty-three consecutive renal arteriograms were studied. Thirty-seven of 110 cases of essential hypertension (31 per cent) and 9 of 41 normotensive cases (22 per cent) revealed multiple renal arteries, showing that there is no significant difference in the incidence of multiple renal arteries between the two groups. Renal function study by intravenous pyelography, renogram, and angiography showed no difference between essential hypertension with multiple renal arteries and that with single renal artery. Plasma renin activity in peripheral and renal venous blood also showed neither increase nor difference in both kidneys, suggesting no significant ischemic changes in the kidney with multiple renal arteries. The general cause of hypertension observed in multiple renal arteries also cannot be related to renal anomaly or dysplasia itself. We conclude that multiple renal arteries are not an etiological factor in essential hypertension.

Intrarenal Blood Flow in Essential Hypertension

Intrarenal blood flow was measured by the 133Xe washout method in 22 patients with essential hypertension. Mean RBF, the percentage of flow in component I, and fraction of renal mass supplied by component I were significantly reduced in patients with proteinuria, severe nephrosclerosis, cardiomegaly, and retinal changes of Keith-Wagener III and IV. Flow rate in component I was also reduced in the patients with severe nephrosclerosis, retinal changes of Keith-Wagener III and IV, and proteinuria. We conclude that redistribution of intrarenal blood flow occurs in essential hypertension with renal, cardiac, and retinal complications.

Gastroenteric Clearance of Albumin in Liver Cirrhosis; Relative Protein-losing Gastroenteropathy

Gastroenteric clearance of albumin was measured to explore the role of an extrahepatic factor related to the development of hypoalbuminemia in liver cirrhosis. Loss of albumin into the gastrointestina

Distribution of Intrarenal Blood Flow after Renal Denervation in the Dog

The effect of acute denervation of the kidney on renal sodium and water excretion, and hemodynamics including intrarenal blood flow, was studied in anesthetized dogs. The intrarenal blood flow was measured by the radioactive microsphere method. In all experiments denervation natriuresis and diuresis was observed without significant change in glomerular filtration rate, renal blood flow and distribution of intrarenal blood flow. There was, however, an associated increase in potassium excretion. We suggest that denervation natriuresis and diuresis may be caused by the elimination of a direct nervous control of sodium and water reabsorption.

Peripheral lymphocyte culture in the diagnosis of drug induced liver injury.

SummaryIn order to evaluate the usefulness of the peripherl lymphocyte culture method for the diagnosis of drug-induced liver injury, a study was carried out on 21 cases of drug-induced liver injury (Group A). Nine cases in Group A showed a positive lymphocyte stimulation test. Out of 9 cases which showed positive stimulation six cases were cholestatic type of liver injury, and the remaining three were of hepatitic type.The results suggest that peripheral lymphocyte culture method is a useful method for diagnosis of drug-induced liver injury.

Effects of Long-Term Alcohol Administration on the Development of Fatty Cirrhosis in Choline-Deficient Rats

Administration of alcohol in the drinking water (15% solution by volume) for 5–6 months was conducted to elucidate how the progression of cirrhosis in choline-deficient rats would be modified by alcoh

Acute effects of low aortic pressure on cardiac performance

SummaryAortic pressure has dual effects on the heart: One as the afterload pressure for the left heart and the other as a determinant of coronary perfusion pressure. As aortic pressure becomes subphysiological, these two effects may come to an imbalance. In dogs in which aortic pressure, aortic flow and heart rate were controlled at constant levels, a critical level of low aortic pressure (CAP) was studied below which an acute and progressive rise of left atrial pressure was observed. In normal heart, an elevation of CAP was observed from 15 to 36 mm Hg, as aortic flow was increased from 30 to 180 ml/min/kg. The elevation was less marked in response to the increase of heart rate from 100 to 250 beats/min. Coronary ligation or administration of a large amount of propranolol (1 to 2 mg/kg) caused a significant elevation of CAP. The results obtained from the present study is suggestive of the role of low aortic pressure in the development of cardiac deterioration during shock.

Clinicopathological study on subacute hepatitis (III); The differential diagnosis at the early stage

An attempt was made to differentiate subacute hepatitis, which shows histological change of submassive hepatic necrosis and serious clinical signs, i.e., hemorrhagic tendency, ascites, edema and or mental disturbance, from acute hepatitis at the early stage before the development of these signs. Present history and various hepatic tests at the early stage of disease were analyzed in 16 cases of subaeute hepatitis, 4 cases of acute hepatitis with submassive or zonal necrosis but with no serious signs, and 18 cases of classical type of acute hepatitis with spotty hepatic cell necrosis. Loss of appetite and general malaise improved after the appearance of jaundice in 16 of 18 cases of classical acute hepatitis. On the contrary, these symptoms persisted or worsened after the appearance of jaundice in 15 of 16 cases of subacute hepatitis and 2 of 4 cases with submassive necrosis but with no serious signs. A combined abnormality of ZTT and TTT was found in 4 of 5 cases of subacute hepatitis (11 cases were excluded, because the hepatic tests were not performed at the early stage) and all 4 eases of acute hepatitis with submassive necrosis, while it was detected in only 3 out of 18 cases of classical acute hepatitis. The difference of the incidences between the former two groups and the latter one was statistically significant (p<0.01). The cases showing both of abnormal values of ZTT and TTT and no improvement of appetite or general malaise after the appearance of jaundice were 4 of 5 cases of subacute hepatitis, 2 of 4 cases of acute hepatitis with submassive necrosis, and only 2 out of 18 cases of classical acute hepatitis. From these results, it was suggested that most of subacute hepatitis would be possible to diagnose even at the early stage of the disease before the development of severe signs mainly from an analysis of history and liver function tests, especially ZTT and TTT. The diagnosis of acute hepatitis with submassive hepatic necrosis might be also predictable.

The clinical and histological studies on subacute hepatitis (II)

We previously reported tha t the values of the ratios of the mesenchymal areas, which were stained in blue in the s taining sections of the liver specimens with azan, to the total areas (M/ T) were all above 17.3% in 17 pat ients of subacute hepatit is diagnosed according to the criteria of Tisdale, and were significantly higher tean those in acute hepatit is or chronic hepatitis. The M/T ratio of the patients died of hepatic coma were all above 71.6% and were significantly higher than those of the survived cases. Severe clinical signs, such as prolonged jaundice, ascites, edema, neurological findings and gastrointest inal bleeding tended to be found more frequently in the cases showing the larger M/T ratios among the survived cases. However, the development of hepatic cirrhosis was not correlated to the area ratios in the initial biopsy specimens. The resul ts indicated tha t the quant i ty of the initial destruction in the hepatocytes was closely related to the fatality or the development of the servere clinical s igns in the relatively early stage. However, the prognosis in the late stage, which means the development of hepatic cirrhosis, may be influenced by the reaction in the host following the hepatocytic destruct ion ra ther than the quant i ty of the hepatocellular damage.

Histological studies of the liver in extrahepatic obstructive jaundice with special reference to morphogenesis of hepatic fibrosis

In order to study the fibrogenesis of bi l iary cirrhosis, histological studies were carr ied out on liver specimens obtained by needle biopsy, laparotomy or autopsy in 46 cases (calculosis of the bile duct, 11; carcinoma of the head of the pancreas, 10; carc inoma of the bile duct, 17 and miscellaneous, 8). Among these 46 cases, no fibrotic change was revealed in 16 (34.8%), sl ight fibrosis in 12 (26.1%), considerable degree of fibrosis in 13 (28.3%) and definite pictures of bil iary c i r rhosis in 5 (10.9%), respectively. Mean durat ions of jaundice due to the extrahepat ic obst ruct ion in each group was 40.3+_9.3, 87.2+--33.2, 181.2_+44.2 and 873.6 days, respectively. Concerning the fibrogenesis of the l iver in extrahepat ic obs t ruct ive jaundice, fibrosis began mainly f rom the periportal areas, and in a few cases it began f rom the centrolobular areas. In some eases, the two pat terns of fibrosis coexisted more or less in termingl ing wi th each other. At the early stage of obstruct ion, s l ight fibrosis of the l iver was predominant ly found in the portal and perihepatocellular areas. As the fibrosis progressed, per iductular fibrosis became prominent . Serial microscopic examinat ion of the liver specimens revealed tha t fibrous bands or iginated f rom the per iportal and /or in t ra lobular areas accompanied wi th marked bile ductular proliferat ion mainly connected wi th the fibrous bands in the neighboring portal tr iads. And part ly, they also connected wi th the small fibrotic s t r ings around centra l veins caused by parenchymal degeneration. It was assumed that these connections of the fibrous bands might gradually divide hepatic lobules into small pseudolobules.