Masahiro Akaike

Regional Differences in Peripheral Circulation between Upper and Lower Extremity in Patients with Cirrhosis

In 42 patients with compensated cirrhosis and 31 control subjects, blood flow (BF) and vascular resistance (VR) were measured at the forearm and calf, using a pneumoplethysmograph. In some of the subjects deep-body temperature (DBT) was also measured by the zero heat flow method. In cirrhosis, BF and DBT were significantly higher and VR was significantly lower in the forearm than in the calf. Corresponding differences were not observed in control subjects. When these indices of the forearm were compared between cirrhosis and controls, BF and DBT were significantly higher and VR was significantly lower in cirrhosis than in controls. In cirrhotics in whom the gradient between forearm BF and calf BF was 1 ml.dl-1.min-1 or more (forearm greater than calf), the vascular response of the forearm to cold stimulation was reduced, whereas in the remaining patients and in controls the forearm BF and VR responded significantly. These results suggest that there is a regional difference in peripheral circulation in cirrhotics, partly with participation of impaired sympathetic nervous activity, which may account for the selective distribution observed in the clinical manifestations of vascular spider, palmar erythema, and warm hand, inclined toward the upper extremities or the upper part of the body.

Severe hepatitis during ketoconazole therapy

SummaryKetoconazole is an imidazole derivative recently developed as an antifungal agent. There have been only a few established cases of hepatotoxicity in the literature. This report describes a case of presumed ketoconazole hepatotoxicity characterized by the development of severe hepatitis with marked centrilobular necrosis. The lack of hypersensitivity reactions in clinical findings and centrilobular location of necrosis suggested a host idiosyncrasy with metabolic abnormality as the effect of ketoconazole in the present case.

Case report of primary biliary cirrhosis, followed over a period of 19 years.

我々は19年間follow upされた59歳の原発性胆汁性肝硬変の女性を報告する.患者は1965年,高血圧の検査の為に入院し,肝機能異常を発見され,第1回の肝生検が行われ,軽度の細胞浸潤を伴った線維化の診断であった.第1回の入院14年後に,胆のう腫瘍の疑いで胆のう摘出術が行われ,肝組織もとられた.1980年血清ビリルビンとIgMの増加と抗ミトコンドリア抗体陽性となり,第3回目の肝生検が行われ,chronic nonsuppurative destructive cholangitisの組織像がえられた.1984年肝性脳症の治療で入院中,肺炎を合併して死亡,剖検された.5回えられた肝の組織変化,19年間follow upされた肝機能検査と抗ミトコンドリア抗体の変化について記載した.