K. Okuda

Biliary Excretion of Conjugated Sulfobromophthalein (BSP) in Constitutional Conjugated Hyperbilirubinemias

Sulfobromophthalein (BSP) and its three major forms of conjugates were determined in bile or duodenal aspitate, plasma and urine following intravenous administration of free BSP and synthetic BSP-glutathione (BSP-GSH) in five patients with the Dubin-Johnson syndrome and two patients with the Rotor syndrome, using alumina column chromatography. It was found that in Dubin-Johnson patients the biliary excretion of conjugated BSP was selectively impaired, conjugated BSP increased in plasma replacing free BSP after 30 min, and plasma retention of BSP-GSH was greater than that of free BSP when administered intravenously. In contrast, biliary excretion of BSP and its conjugates was not impaired and regurgitation of conjugated BSP into plasma was minimal in the Rotor syndrome. Thus, these two constitutional hyperbilirubinemias can be separated by their basic defects in BSP metabolism.

Inactivation of Vitamin B12 by a Binder in Rat Intestine and the Role of Intrinsic Factor

Using the rat intestinal loop technique, it has been demonstrated that in the absence of intrinsic factor, small amounts of 57Co-B12 placed in the loop are either adsorbed onto t

Surgical Results of Pancreatoduodenectomy for Disease in the Pancreatic Head Region

Between January 1965 and September 1995, 330 patients underwent pancreatoduodenectomy in our institution. In 249 cases, we performed the Child method of reconstruction after pancreatoduodenectomy. Of these patients, 299 underwent pancreatoduodenectomy because of malignant disease and 19 died in the hospital after the operation; the mortality rate was 5.8%. We must be aware of certain complications after pancreatoduodenectomy, especially anastomotic leakage of the pancreatiocojejunostomy. It 16 cases of pancreatic fistula, 7 patients died of this complication. Five-year survival rates of patients with carcinoma of the pancreas, bile duct, and papilla of Vater were 17.3%, 19.7%, and 56.2%, respectively. In cases of carcinoma of the papilla of Vater with no lymph node involvement, the 5-year survival rate was 64.9%; for cases with lymph node involvement, it was 40.0%. Many more strategies must be developed to obtain a better outcome in cases of carcinoma of the pancreas and bile duct. The most important need is to prevent metastasis of carcinoma to the liver in these patients.

Intestinal Vitamin B12 Absorption and Gastric Juice in the Cat

Intestinal absorption of 57Co-B12 (cyanocobalamin) was studied in the cat. Oral doses of B12 in the range of 5-1,000 ng were absorbed with little difference percentage

Liver scintillation scanning in the diagnosis of chronic schistosomiasis japonica.

Thirty-seven scans were made in 27 cases of chronic schistosomiasis japonica in our series of over 800 liver scans. The spleen was visualized in the majority of the patients. In 7 (26%), the liver con

Intestinal absorption of35S-labeled reduced gultathion. (II)

We have already reported that a disorder of amino-acid metabolism appeared as the ratio of essential amino-acid to nonessential , even in the early stage when the serum albumin showed still normal level. In order to clarify the mechanism of this phenomenon, the following three exper iments were carried out. The results obtained were as follows: 1. Behavior of homeostasis for amino-acids was compared between the totally gastrectomized dog and the mal-nourished one, by measur ing the amount of free amino-acids in the intestinal tract. The homeostasis for amino-acid was disturbed much earlier in the gastrectomized dog than in the mal-nourished one. 2. When a mixture of amino-acids which was lack of one of the essential, was intravenously administered, a low level of the proper amino-acid in the se rum was observed for longer duration in the gastrectomized dog than in the mal-nourished one. It was assumed from the above findings tha t stability of amino-acid balance in the serum was not easily established due to a poor intestinal homeostasis , in the gastrecotmized dog. And we could insist that the homeostasis , for amino-acids exists also in the blood as well as in the gastro-intest inal tract. 3. In the rats which were fed with a protein-free diet, the homeostasis ability for amino-acids was analysed following an oral adminis t ra t ion of zein, in two different g roups : the one which had been infused intravenously with a mixture of essential amino-acids, lacking of threonine and the other which had been given by 5% glucose. Better homeostasis was obtained in the group of administrat ion of the amino-acid. It was proved herein also tha t the homeostas is for amino-acids was well carried out in the blood.

Acute hepatitis in the elderly with special reference to subacute hepatitis

Statistical analyses have been made on various liver function tests, done on admission, time required for normalization of liver function tests, and death rate in 53 cases over 60 years of age with infectious hepatitis, serum hepatitis and drug hepatitis, admitted to our department and hospitals affiliated to our department. The following results have been obtained. 1) Of 53 cases, 41 was infectious hepatitis and 10 was serum hepatitis and 2 was drug hepatitis. 2) The number of days required for the normalization of liver function tests, such as serum bilirubin, GPT and BSP test, between infectious hepatitis and serum hepatitis showed no satistical significance, and death rate between these group of hepatitis was insignificant. 3) Liver function tests at the onset was compared with three groups,--normalized group, prolonged group and died group. The various liver function tests indicated some tendency among thsse groups and especially high value of serum bilirubin and r-globulin at the onset suggested poor prognosis in both groups of hepatitis. 4) 11 patients died of subacute hepatitis or fulminant hepatitis and a mortality rate was 24.40 % in infectious hepatitis and 10.0% in serum hepatitis. Ten of 11 death cases had some complication, such as diabetes mellitus, hypertension, pulmonary tuberculosis and so on, It is suggested that such complication in addition to aging factor are important for the cause of death in acute hepatitis of the elderly.

Acute hepatitis in the elderly

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 .

Fine structure and function of the intestine (1) fine structure of normal small intestine and fat absorption

The ill effect of the blind loop was elucidated in this paper, using dogs. They were divided into three groups (I: loop, II: intest inal resection wi thout loop, III: Excision of the loop of the I: group). In each group the si te of the anastomosis was one meter from the duodeno-jejumal flexure. The longest observat ion was 200 days postoperatively. To evaluate an absorpt ive capacity of fa t exactly, the chromic oxide indicator method was used. The evident differences were observed both in fa t content of feces (normal 0.8, I: group 4.0, II: group 2 .4gm/100gm wet feces, in an average) and in the absorpt ion coefficient. The dogs hav ing blind loop lost the i r body weight remarkably, compared to the dogs deprived of about a hal f of the i r small intestine. By the III procedure the absorpt ive capacity recovered soon and general state became well. They gained the i r body weight gradually. From these experiments it can be concluded tha t the blind loop has ill effect to the absorptive capacity of fat beside the short-circuit ing effect. The t rue mechanisms involved in these s tea tor rhea is yet controversial and not fully settled. We th ink tha t the s tasis of the intest inal content and the prol i ferat ion of the bacter ia may have grave influence.

Mechanism of bile regurgitation in experimental bile duct obstruction (III) participation of the lymphatic system

This study a ims at c lar i fy ing par t ic ipat ion of the lymphat ic system in bile regurg i ta t ion in bile duct obstruct ion. In dogs in which bile was regurgi ta ted f rom the bile duct by a pressure of 10 mmH20 above bile excret ion pressure , b i l i rubin appeared promptly in the lymph of the hepatic h i la r lymph vessel and reached 18 mg/d l six hours later. In contrast , a s l ight increase of b i l i rubin was noted in the blood. Au colloids, infused at the pressure indicated f rom the bile duct, appeared in the hepatic hilar lymph within one hour of regurg i ta t ion and about th ree per cent of total infused colloid was demonst ra ted in the lymph in six hours. On the other hand, no increase of Au colloid was detected in the blood. In dogs wi th bile regurg i ta t ion and ligated hepat ic lymph vessel, se rum bi l i rubin increase was delayed and Au colloid, infused in the bile duct, was not detected dur ing six hours. Electron microscopic observat ion of the l iver of the dog to which Au colloid was infused revealed tha t the colloid par t ic les were numerously seen in the lumen of the bile ductule, bu t very few in the bile canaliculus. The par t ic les were also seen in the cytoplasm of the bile ductular epi thel ium and the t issue space around the bile ductule. These findings suggest tha t bile contents in the bile duct regurg i ta te mainly th rough the bile ductule to the lymphat ic sys tem and via the hepatic h i la r lymph vessel and the thoracic duct to the blood s t ream, at least in the early stage of bile duct obstruct ion.