Kozo Mizuiri

Studies on the relationship between the histological changes and liver cell function or plasma proteins in hepatic diseases.

SummaryHistological changes of liver biopsy specimens were compared with functioning liver cell mass estimated by an index, ICG capacity, and with plasma levels of various proteins, in 85 patients with liver diseases. ICG capacity was inversely proportional to the degrees of liver cell degeneration and lymphocyte infiltration in the portal tracts and parenchyma, in contrast to plasma disappearance rate of ICG (K), which was inversely proportional to the degrees of portal tract fibrosis and bridge formation. Among the plasma proteins synthesized in the liver, the plasma levels of prealbumin, and α1-acid glycoprotein showed the tendencies to decrease with the increase in the degrees of liver cell degeneration. The levels of ceruloplasmin, haptoglobin, β1A/C and transferrin were proportional to the degree of the degeneration. Plasma albumin had no correlation to any histological change. The plasma levels of γ-globulin and IgG were both proportional to the degrees of portal tract fibrosis and bridge formation. IgM also paralleled to the degree of the fibrosis. The level of IgA was inversely proportional to the degree of liver cell swelling. The levels of γ-globulin and IgM were inversely proportional to the degree of fatty infiltration. It was concluded that quantitative estimations of some histological changes in the liver are valuable for the estimations of liver function and the grade of the diseases of the liver.

Peritoneoscopic examination using intravenous administration of indocyanine green in the fatty liver

Forty patients with fatty liver were studied by peritoneoscopic examination after intravenous administration of indocyanine green (ICG). Although diffuse or centrilobular steatosis was observed in both nonalcoholic and alcoholic fatty liver, periportal steatosis was seen only in alcoholic fatty liver. Vascular markings were more prominent in alcoholic fatty liver, especially in those with fibrosis, compared with nonalcoholic fatty liver. Fat was not stained with ICG. Unstained red patches, observed after ICG administration in both nonalcoholic and alcoholic fatty liver, were thought to be due to congestion in the former and to lobular inflammation as well as congestion in the latter. Acinar markings were indistinct in the fatty liver with fibrosis but became clearer after ICG administration.

Report of a case with fulminant hepatitis a associated with acute renal failure

SummaryA 34-year-old male presented with fulminant hepatitis A associted with acute renal failure. The patient was admitted four days after flulike symptoms developed. Physical examination was unremarkable except for icteric sclerae. Laboratory studies showed SGOT 10719 U/l, SGPT 5780 U/l, prothrombin time 22%, BUN 25.5 mg/dl, and creatinine 2 mg/dl. Serum complements were within normal ranges, and circulating immune complexes were not detected. Anti-HAV IgM was positive.He developed hepatic coma on the fourth hospital day, and his renal function deteriorated progressively. He was treated with hemodialysis, but there was no improvement in consciousness. Although acute liver failure improved, he died on the 74th hospital day of subendocardial infarction. Autopsy examination showed acute renal tubular necrosis. The liver was enlarged and was in the residual stage of acute hepatitis without submassive necrosis. The development of fulminant hepatitis in hepatitis A has been rare, but in recent years acute renal failure in hepatitis A has been reported.Although the mechanisms responsible for renal failure in liver diseases are uncertain but could be multifactorial, immune complexmediated nephritis and/or endotoxemia have been considered.

Studies on the relationship between the plasma concentration of proteins synthesized in the liver and liver cell function measured by ICG

SummaryThe plasma levels of nine liver-made proteins were compared with functioning liver cell mass estimated by an index, ICG capacity, in 98 patients with liver diseases. ICG capacity was parallel to the functioning liver cell mass estimated by the severelity, acuteness, type and nature of the disease. Plasma levels of prealbumin, haptoglobin and α1 acid glycoprotein were in proportion to the change in ICG capacity in acute and chronic liver cell injuries. Plasma levels of albumin and transferrin were parallel to ICG capacity only in chronic liver cell injuries. Plasma levels of α1 antitripsin were high in the active stage of liver diseases and were pallalel to ICG capacity only in inactive stage. Plasma levels of ceruloplasmin, α2 macro globulin and β{1}C/β1A globulin were not parallel to ICG capacity in any stage or state of liver disease. It was concluded that synthetic rates and plasma half times of the former 5 liver made proteins are the main factors for the determinations of their plasma levels in liver diseases.

Report of a case of fulminant alcoholic hepatitis.

アルコール性肝硬変にアルコール性肝炎を伴い,急性肝不全で死亡した1例を報告した.症例:46歳,主婦.皮膚黄染,皮下出血を主訴として来院.5～6年のアルコール歴と輸血歴があった.入院時,発熱,著明な黄疸と貧血を認め,右季肋下で肝臓を2横指触知した.皮下出血が両側大腿部から股関節部に認められ,昏睡度II度であった.血液検査で白血球の増多,高色素性・大球性貧血がみられた.HB関連抗原・抗体は陰性.プロトロンビン時間の延長,フィブリノーゲンの低下,FDPの上昇よりDICを併発していると考えheparin, gabexate mesilateを投与し,肝不全に対してprednisolone, glucagon-insulin療法を施行したが効果なく,DICを契機として消化管出血で第42病日死亡した.肝臓のnecropsyで多数のアルコール硝子体を認めた.本邦のアルコール性肝炎111例中37例(33.3%)が死亡例で,女性の報告例は少ない.アルコール硝子体の出現頻度は,肝硬変合併の死亡例で最も高かった.