K. Takeshige

On the recurrence of esophageal varices after endoscope assisted surgeries.

食道静脈瘤の手術的消滅は, 術中内視鏡使用による直視下直達手術で確実になった.しかし術後長期観察中に一部症例では静脈瘤再発はさけ難いので, その機構と対策を求め, 1978年以降直視下に手術した胃上部切除25例, 胃上部横断26例, EEA胃上部切除29例の計80症例を検討した.再発は予防手術7例中3例, 治療手術73例中21例あり, 術前の局在性はLsの症例が多く, 胃上部横断術に頻度が高かった. また再発時期は不定, 再発程度は術前またはそれ以下で増悪例はなかった.静脈瘤の術後再発には, 肝門脈側の循環異常増悪, 局所血行の再建状態と排出血の経路特徴が関与するので, これらに対して集学的管理を要する.

Development of neurological manifestation of wilson’s disease after portosystemic shunt: A case report

SummaryA case of Wilson’s disease, in which extrapyramidal motor singns manifested only three months and Kayser-Fleischer ring eight months after splenorenal anastomosis, is reported.The rapid progress from the “abdominal” Wilson’s disease to the “cerebral” type was considered to be caused by shunting of portal blood flow directly to the systemic circulation, which accelerated the transportation and deposition of excess copper in the basal ganglia of the brain and other tissues. Decrease of portal pressure after the surgery might hasten the manifestation of neurologic and corneal sings.

Gamna-Gandy body and splenomegaly in portal hypertension

The pathogenesis of splenomegaly in portal hypertension has been the focus of argument yet to be concluded. Conventional histological studies have proved inval id in this regard. The present report is based on a study of 303 cases in our series of portal hypertension totaling 516, cases with insufficient data being excluded. The spleen was histologically studied with special reference to Gamna-Gandy body. Gamna-Gandy body, also called fibrosiderotic nodule, is a fibrous scar tissue with iron deposit which appears in the parenchyma of the spleen subjected to portal congestion. Congestion and local hemorrhage which precede formation of Gamna-Gandy body are almost constantly observed in the spleen of portal hypertension, regardless of the type of the basic disease. Gamna-Gandy body was seen, again without predilection to any specific type of the disease, in approximately half of the cases of each group (51.2~ on the average). The correlation between these histological findings and portal pressure was obscure with wide dispersion. As the mean value, however, the portal pressure was increased as the pathological process advanced from simple congestion toward the formation of Gamna-Gandy body. The portal pressure was also higher in groups with each histological finding than in groups without it. Any difference was seen, however, neither between extrahepatic group (groups I & IV) and intrahepatic group (groups II &I I I ) nor between intrahepatic, cirrhotic group (group III) and non-cirrhotic group (group II). After all, the splenomegaly in portal hypertension has no group-specificity in relation to histological features pertinent to congestion. These results support our assertion that the splenomegaly in portal hypertension has in common an elevated portal pressure due to increased distal flow resistence as the basic causative factor.

Hepatic function and circulation: application of trapezoidal electromagnetic flowmeter to the studies of hepatic clearance with indocyanine green and198au colloid

62 pat ients were studied on liver funct ion tests before and af ter the improvement of congestive hear t failure. The re la t ionship between histological changes of the l iver and l iver function tes ts pr ior to death was also studied in 109 autopsied pat ients died of hear t failure. The se rum protein increased wi th the improvement of the protein fraction. The BSP re ten t ion decreased f rom average 14.4% to 7.4%. The high se rum t r ansaminase act ivi ty obserbed in 4 cases re turned rapidly to normal range af te r t r ea tmen t of the hear t failure. An increase of serum bil irubin, especially indirect bi l i rubin, was observed in some cases wi thout pu lmonaly infarction, however LDH1 and LDH~ did not increase as compared wi th those in hemolytic jaundice due to the ball valve replacement in rheumat ic hear t disease. Whereas elevat ions of a-hydroxybutylic acid in these cases seemed to be reflections of myocardial damage in the pat ients wi th hear t failure. Therefore hemolytic mechanism did not seemed to be a major fatcor to jaundice in hear t failure. The histological diagnosis of the l iver in hear t fa i lure was made on the classification of Nakash ima and Imazato. The prolonged BSP retent ion, a l terd serum prote in f ract ion and high venous pressure were re la t ively correla ted wi th the grade of histological changes. Cases wi th high se rum t r ansaminase act ivi ty were observed in the Grade 1N2 (necrosis and hemorrhage was observed in area more than the one-third including the central vein in lobules). The resul t s obtained in this s tudy were as follow; 1) a l terd l iver function tes ts were revers ib le by t r ea tmen t of congestive hear t failure, 2) the sever i ty and durat ion of congestive hear t fa i lure influenced on the histological changes of the liver, 3) hemolytic mechanism was not a major factor to jaundice in congestive hear t fa i lure and 4) clinical manifes ta t ions and l iver funct ion tes ts could evaluate the sever i ty of the histological changes of the l iver in congestive hear t failure.

Studies on alkaline phosphatase in biliary obstruction

liver carcinoma, high grade increase of alkaline phosphatase in 19s region was demonstrated. In cases of obstructive jaundice, gallbladder diseases or bile duct disorders, same tendency was seen. Sometimes, I have experienced very high titer of alkaline phosphatase value in cases of gastric cancer who have no metastasis of bone, liver or around bile ducts and no liver disorders. In these cases, fractination study of the enzyme showed that 19s fraction increased. Normal human liver showed enzyme activity in 7s region. Normal human small intestine have enzyme activity in 19s and 7s area.

Application of trapezoidal-wave electromagnetic flowmeter for the study of hepatic circulation (A Preliminary Report)

We studied in vivo the fate of catecholamines in the liver. The exper iment was performed on the normal adult dogs, CCla-admnistered dogs and jaundice dogs wi th obstruct ion of common bile duct, and the content of catecholamines in the portal vein, hepatic vein and femoral a r te ry were determined to s tudy the reduction ra te of catecholamines in the liver. In the normal dogs, adrenal ine reduced over 70% and noradrenal ine 56% passing th rough the l iver one minute af ter the inject ion of catecholamines into the femoral vein. In the CC14-administered dogs, the reduction rate of both was significantly lowered to 20%. In the jaundice dogs, the figure was between the above two groups. In general , injected catecholamines decreased rapidly in 3 minutes, and hepatic glucose output occured in 1~3 minutes.

Studies of hepatic hemodynamics using trapezoidal wave electromagnetic flowmeter

Postshunt bleeding is apt to occur in those patients who were made narrow anastomoses or had pathologic changes of the anastomosed vessels macroscopically, and whose portal pressure could not be lowered below 300mmH20 and consequently whose esophageal varices were not diminished. Most of the postshunt bleeding occured in early postoperative period, but after one year from shunt operation the first episode of postshunt bleeding rate became only 8.7 percent among the patients who had been followed for more than one year. Shunt operation should be performed taking into account of these factors so as prevent from postshunt bleeding.