Katsuhiko Sugahara

Surgical treatment of primary carcinoma of the gallbladder based on the histologic analysis of 48 surgical specimens.

During the past 5 years, extended cholecystectomy and/or more radical procedures, including pancreatoduodenectomy and extended hepatic lobectomy, were performed on 48 patients with carcinoma of the gallbladder in an attempt to cure the disease. It was retrospectively proven from microscopic analysis of the surgical specimens taken from the 48 patients that 28 patients had received curative resections. The 28 consisted of all 4 patients with stage I carcinoma, all 9 with stage II, 6 of 8 with stage III, and 9 of 27 with stage IV. We reached the following conclusions: (1) extended cholecystectomy with resection of the bile duct in the hepatoduodenal ligament is the optimum procedure for patients with stage I and stage II carcinomas, and (2) for patients with stage III carcinoma, more radical procedures, including pancreatoduodenectomy and/or wider resection of the liver, might result in curative resection of the disease. For some patients with stage IV tumors, such as duodenal invasion or direct invasion of the liver, curative resection may be achieved by pancreatoduodenectomy or extended hepatic lobectomy.

Relationship between hepatic hemodynamics and biliary pressure in dogs: its significance in clinical shock following biliary decompression.

The changes in the hepatic hemodynamics were promptly reflected in the biliary pressure in dogs. Both wedged hepatic venous pressure and portal venous pressure increased in response to the elevated biliary pressure, and conversely decreased following rapid biliary decompression, suggesting that the changes in the biliary pressure might affect the hepatic hemodynamics post-sinusoidally. It was supposed that too rapid biliary decompression might trigger the following consequences; 1) decrease in sinusoidal pressure, 2) increase in sinusoidal inflow, and 3) extravasation of intravascular fluid in the perivascular space. When these were not sufficiently compensated, they could trigger shock in the jaundiced patients.

Bile flow analysis by hepatobiliary scintigraphy in the terminal bile duct in patients with congenital malformations of the pancreatico-biliary ductal system

SummaryThe authers employed hepatobiliary scintigraphy (HBS), to study a dynamic state of bile stasis in the common bile duct and bile flow through the papilla of Vater in patients with congenital malformations of the pancreatico-biliary ductal system, such as congenital cystic dilatation of the common bile duct (CCDB) and anomalous arrangement of the pancreatico-biliary ductal system (AAPB). The HBS data were evaluated by a cholestatic index (CI), as an indicator of bile stasis in the common bile duct, and passage time (PT), as an indicator of bile flow through the papilla of Vater. CI was significantly higher in CCDB (3.67±0.92), in AAPB (2.87±0.28) and in both CCDB and AAPB with symptoms (2.86±0.59), compared with patients without CCDB or AAPB (0.96±0.41). PT was prolonged only in patients with AAPB with/without CCDB (>30 minutes) compared to patients without AAPB (<12 minutes). This result suggested that bile stasis in the common bile duct was caused by a pooling of bile in the dilated common bile duct in CCDB, and by a disturbance of bile flow through the papilla of Vater in AAPB.

Overview of the general rules for the clinical and pathological study of primary liver cancer in Japan

The General Rules for the Clinical and Pathological Study of Primary Liver Cancer provides guidelines for case management and research in Japan. These rules were initially published by an individual Cancer Study Group in Japan and some of them were translated into English. In general, most of the information on malignant diseases has come from North America and Europe, but few studies have been forthcoming from Asia. Since primary liver cancer is the third most common malignant disease in Japan and its clinical features are different from those in occidental society, clinical classifications have been established to aide research and treatment.

The fundamental factor determining the clinical prognosis of prolonged jaundice—Relation to the arterial ketone body ratio

Factors related to the prognosis of patients with hyperbilirubinemia were investigated in 16 highly jaundiced patients. Patients who died within 3 weeks showed a deterioration of the hepatic energy status, measured by the arterial ketone body ratio, but patients who did not die within 3 weeks after the measurement of the ketone body ratio had a ratio within the normal range, despite high total bilirubin levels (18 mg/0.1 L). C3, C4 and CH50 in the former were also significantly lower than those in the latter. However, endotoxin and high fever occurred to the same extent, in the both groups. Thus, hepatic energy balance is the most pertinent factor related to prognosis, and is concerned with both the hepatocyte and reticuloendothelial systems. On the other hand, infection or endotoxin, when the energy balance is disturbed, becomes an aggravating but not a fundamental factor.

Lung water accumulation in rats after repeated challenges of a sublethal dose ofE. coli and its relation to the hepatic energy charge

We produced a septic model of rats in which lung water accumulation was developed. The degree of lung water accumulation was then compared with the hepatic energy status because the liver is not only a metabolic central organ but also one of the central organs of the reticulo-endothelial system (RES), and clinically, lung edema in sepsis seems to relate to failure of the RES. Three experimental models were examined to form lung water accumulation, namely: the lethal model, givenE. coli 6.0×106 CFU/g BW, the sublethal model, givenE. coli 2.0×106 CFU/g BW and the repeated sublethal dose injection model, givenE. coli 2.0×106×2 at 12 hour intervals. In the lethal models, the energy charge (EC) of the liver decreased markedly (p<0.001) without recovery and the lung water accumulated (p<0.05). In the sublethal models, EC decreased transiently (p<0.05) and the lung water did not increase. However, when the microbial challenge with a sublethal dose was repeated, the decreases in EC were prolonged and the lung water increased significantly after the second injection (p<0.001) despite a 4.9 per cent mortality during the subsequent 24 hours. It is suggested that when the decrease in liver EC is prolonged, even if it is not fatal, an accumulation of lung water is possible in septic states. This finding may help further analyses of the interrelationship between the lung and the liver in severely infected patients.

Jejunojejunal Intussusception in a Patient with von Recklinghausen's Disease

Abstract: A 63‐year‐old female with von Recklinghausens disease was referred to us because of intermittent periumbilical pain and vomiting. Abdominal ultrasonography showed a segment of the bowel with intussusception in the left ripper quadrant. After intestinal decompression, small‐intestinal endoscopy was performed. Endoscopy revealed multiple protruding lesions in the esophagus, stomach, and jejunum, the largest one markedly stenosing the proximal jejunum. We were able to identify a tumor as the lead point preoperatively. Segmental jejunectomy was performed for the resection of the tumor. Pathological studies revealed that the tumor was leiomyosarcoma.

Differential diagnosis for the cystic lesion of the pancreas with a special references to analysis of intracystic fluids.

過去20年間の自験膵嚢胞性疾患20例中, 仮性嚢胞は9例, 真性嚢胞は11例であった. 腹痛は仮性嚢胞の全例にみられたのに対し, 真性嚢胞では6例が腹痛を伴わない腹部腫瘤を主訴とした. 血清アミラーゼ値は仮性嚢胞の9例中8例が229～1,580IU/lと高値を示した. 嚢胞の存在診断にはCTおよび超音波検査が有用であったが, 質的診断には不十分であった. 嚢胞内容液のアミラーゼ値は真性嚢胞が4.398±9.1311U/lであるのに対して仮性嚢胞では199, 360±135,58IIU/lと著しく高値であった. また, 細胞診では悪性例6例中4例がclass IV, またはclass Vであった. 内容液のCEA値は, 悪性例では50,278±83,948ng/mlで, 良性例の256±141ng/mlと比べ有意に高値を示した. 以上より, 嚢胞内容液のアミラーゼ値, 細胞診, CEA値は膵嚢胞性疾患の質的診断に有用と考えられた.

Clinical aspects and surgical treatments in patients with anomalous arrangement of the pancreatico-biliary ductal system.

胆管と膵管の合流点が十二指腸壁外に認められる先天性総胆管拡張症ならびに正常な胆管の内腔例103例について共通する臨床症状および治療法を検討した. これらに共通する臨床像は上腹部痛ならびに背部痛であり, 発作時の臨床化学的検査で急性膵障害および胆汁うっ滞型の急性肝障害が大部分の症例に, 同時に認められることである. これは胆管と膵管の「共通の導管」が膵管であろうと考えられるところから, この部分に胆汁の通過などによる後天的な通過障害が生じ, 胆汁, 膵液の膵管内および胆管内への振子様移行現象が起り臨床症状が発生するものと考えられる. したがって胆汁をこの共通の導管部を通さない目的でのbiliary diversionが最も良好な成績であった.

Proceedings Of The 21St Autumn Meeting From October 15th-17th, 1979-Maebashi, Japan

When the peripheral blood lymphocytes from patients with various types of hepatitis were stimulated in vitro with liver specific protein, lymphocyte transformation and MIF production were detectable in many cases, especially in chronic active hepatitis. The macrophage activating factor (MAF), a kind of lymphokines, was also detected in the culture medium of activated lymphocytes from patients who showed positive blastogenesis. The activated macrophages by MAF were shown to be cytotoxic to the separated liver cells causing the marked inhibition of albumin synthesis. MAF-containing culture supernatants of these active lymphocytes activated guinea pig macrophages which inhibited the albumin biosynthesis of the isolated liver cells. These observations suggest that the macrophagemediated cytotoxicity may play and role in pathogenesis of chronic active hepatitis.