Kenji Kawaguchi

Peritoneoscopy of the liver stained by intravenous injection of indocyanine green-experimental and clinical studies.

SummaryLiver surface patterns were observed by peritoneoscopy after intravenous injection of indocyanine green (ICG). The normal rat liver was diffusely stained dark greenish-brown 5 minutes after the injection of ICG 25 mg/kg body weight into the tail vein. Green spots persisted longer in the centrolobular area, clearly revealing lobular markings. This regional difference in hepatocyte staining suggested differing abilities of hepatocytes to take up or excrete ICG. This dyeing technique was applied to liver disease patients. The liver was diffusely stained light greenish-brown 5 minutes after the injection of ICG 5 mg/kg body weight. In patients, especially those with obscure lobular markings before ICG injection, lobules were clearly demarcated by reddish terminal portal veins against a green background. This simplified detection of lobular distortions. Prenodular patches (Kalk’s Bunteflecke) on the liver surface were stained green more intensely than surrounding areas, which supports the hypothesis that patches are composed of active hepatocytes.

Peritoneoscopic study on rat liver cell necrosis induced by carbon tetrachloride and allyl formate

SummaryThe surface changes of acute centrolobular and perilobular necrosis were studied in rat liver using peritoneoscopy. Centrolobular necrosis was induced by carbon tetrachloride and perilobular necrosis by allyl formate. Vessels observed on the control rat liver surface were identified as terminal hepatic veins by irrigation of the hepatic vein with a barium solution. Polygonal whitish markings were observed on the liver surface 48 hours after carbon tetrachloride administration. Terminal hepatic veins were regularly distributed throughout the central portions of the whitish areas. Reddish spots about 0.1 mm in diameter were scattered about the terminal hepatic veins. The reddish spots and whitish areas corresponded to the histological findings of central liver cell necrosis and infiltration by Kupffer and white blood cells. Six hours after allyl formate administration, round reddish spots about 0.3 mm in diameter were regularly distributed on the liver surface among the terminal hepatic veins. These spots corresponded to the histological findings of liver cell necrosis around the portal area. In summary, acute centrolobular and perilobular liver cell necrosis were newly observed as reddish spots by peritoneoscopy.

Kupffer cell hyperplasia in liver diseases. Demonstration by scanning electron microscopy of biopsy samples.

SummaryKupffer cells were observed in liver biopsy tissues of 9 cases of liver diseases by scanning electron microscopy to prove Kupffer cell proliferation numerically. Kupffer cell count per 0.01 mm2 of cracked surface of liver lobule was 1.2 ± 0.3 in the convalescent stage of a mild acute hepatitis case and 1.2 ± 0.1 in a chronic persistent hepatitis case with slight inflammation. Wheras it was increased to 2.4–5.5 (p<0.01) in the convalescent stage of moderate to severe acute hepatitis cases, 1.8 ± 0.1 (p< 0.05) in a chronic active hepatitis case, 2.5 ± 0.3 (p< 0.001) in an alcoholic portal fibrosis case and 2.2 ± 0.4 (p< 0.001) in a liver cirrhosis case. Kupffer cell count per mm3 of liver lobule was estimated roughly 3,500 in the convalescent stage of a mild acute hepatitis case and in a mild chronic persistent hepatitis case and 7,000 to 16,000 in the convalescent stage of moderate to severe acute hepatitis cases.

Differential diagnosis of liver parenchymal diseases by likelihood method using 12 laboratory data and age

SummaryLiver parenchymal diseases were statistically diagnosed by likelihood method using 12 routine liver function tests and age. 444 cases of liver diseases were classified into 8 groups by histological diagnosis. A score diagnosis table was made from the data of these cases. For the likelihood diagnosis, data of each case were adapted to the score table and the probable diagnosis was calculated. Correct diagnosis rate of the first probable diagnosis was 50 % in all cases and that of the first and the second was 71%. Descending order of the correct diagnosis rate of the first diagnosis was fatty liver (76%), liver cirrhosis (67%), slight histological changes (61%), acute hepatitis (51%), alcoholic liver injury (48%), chronic aggressive hepatitis 2A (43%), chornic persistent hepatitis (40%) and chronic aggressive hepatitis 2B (26%). In conclusion, differential diagnosis of liver parenchymal diseases was made easily with the score table of 13 informations with a considerable success.

Ranking of liver tests for differential diagnosis of liver parenchymal diseases

SummaryLiver function tests were ranked in the order useful to differentiate 8 liver parenchymal diseases in combination of tests by forward selection and backward elimination procedures in the likelihood method using a microcomputer. The orders were almost same in both procedures: indocyanine green plasma disappearance rate, glutamic pyruvic transaminase (GPT), zinc turbidity test, alkaline phosphatase, age, HBsAg, RA test, glutamic oxaloacetic transaminase (GOT)/GPT ratio, GOT, cholesterol, total protein, total bilirubin, albumin/globulin ratio and γ-globulin. The first 9 tests had almost all informations of all tests. The first likelihood diagnosis using the 9 tests was correct in 53% and the first or the second diagnosis was correct in 71 % of 444 cases of 8 liver parenchymal diseases. A score table of likelihood diagnosis using the 9 tests was presented for manual application to new cases.