Masao Otsuki

Continuous removal of middle molecules by hemofiltration in patients with acute liver failure.

In patients with acute liver failure and hepatic coma, an increase in the abnormal “middle molecules” seen on the chromatograms of the sera is suspected of playing an etiologic role in the coma. A pilot study of continuous hemofiltration using a high-performance membrane was conducted in 16 such patients in an attempt to decrease the serum levels of the middle molecules. The procedure was used alternately with plasma exchange. High-performance liquid chromatography showed a notable removal of the substances in the filtrates and a sequential removal from the serum by hemofiltration. Eight (50%) of the 16 patients had amelioration in level of consciousness and were weaned successfully from hemofiltration. Although only three of the 16 patients survived the acute illness, 13 others lived an average of 15 days and five patients survived >3 wk. While the continuous removal of middle molecules from the serum may not reverse liver failure, this procedure used in conjunction with plasma exchange may provide a means of life support, e.g., for patients awaiting a liver transplant.

Non-septic endotoxemia in cirrhotic patients

SummaryWe have found that endotoxemia detected by conventional LCT (limulus colorimetric test) in patients with liver diseases could not be detected by endotoxin-specific LCT at all, and proposed that this β-glucan like activity (BGLA) should be termed as non-septic endotoxemia, distinguishing it from septic endotoxemia seen in gram-negative sepsis. In this study, we investigated non-septic endotoxemia through the clinical course of 8 cirrhotic patients. Non-septic endotoxemia appeared at the onset of DIC but tended to decline in level in the late terminal stage. This phenomenon cannot be consistent with the “spillover” theory which explains the mechanism of endotoxemia without sepsis in liver disease. We think it is an urgent problem to elucidate the nature of BGLA in liver disease, without recourse to the “spillover” theory.

Alteration of serum and urinary bile acid sulfates in intrahepatic cholestasis.

急性肝内胆汁うっ滞症8名の臨床経過中に採取した血清42検体,尿11検体につき硫抱合型胆汁酸(SBA)を分析しその動態について検討した.黄疸が増強するにつれて血清SBA濃度は上昇したが,その上昇率は高度黄疸時に低下する傾向がみられ,総胆汁酸濃度に占めるSBAの比率は正常群と比較して有意に低下していた. SBAの血清濃度と1日尿中排泄量はY=0.1101X-0.7844で表わされ,強い相関関係を示した(r=0.8978). SBAの腎クリアラン値は7.4±1.6ml/分であり,黄疸の経過を通じて常に一定の傾向を示した.以上の成績から高度黄疸時においてSBAの生成は増加していない可能性が示唆された.

Carrier state and infectivity of HBs-Ag

It has recently been clarified by Magnius and others that e antigen and antibody system is closely related to HBV infectivity, i.e., HBsAg-positive sera detected e antigen (e-Ag) have an intensive infectivity, and those detected e antibody are no infective. Therefore, the authors tested e-Ag and e-Ab by the Micro-Ochteronys method in sera from 127 carriers, and, from the data, discussed as to intrafamilial infections with HBV and the clustering of the carriers. The results are as follows. 1. In eleven children of 6 e-Ag-positive carrier mothers, 10 children were positive for HBsAg, and 3 out of 6 children of 2 e-Ag-positive carrier fathers also were HBsAg-positive. Moreover, in one of 3 children living with their e-Ag-positive grandfather, HBsAg was detected in the serum. Accordingly, it can be said that an e-Ag-positive carrier produces new carriers at a high rate in the following generations, and the rate is extremely high in mother-to-child transmission. 2. In 103 asymptomatic carriers, the frequency of e-Ag-positive result was higher in the younger ages (75% in ages of below 10 years and 12% in ages of more than 41 years). On the contrary, the rate of e-Ab-positive carriers was higher in the older ages (17% in ages of below 10 years and 44% in ages of more than 41 years). This result implies that, in the majority of HBsAg carriers, although there are wide differences in the individuals, HBV infectivity declines with years and finally vanishes.

Operative biliary endoscopy by means of laparoscope, romanoscope and broncoscope

The instruments are the romanoscope SLA type (Machida) the laparoscope SLD type (Machida) and the fiber-broncoscope L type (Machida). As the laparoscope and the romanoscope are not flexible observation of the intrahepatic bile ducts was easy but difficult for the choledochus. Conversely the fiber-broncoscope was easily manipulated for the observation of both the intrahepatic bile ducts to the second branchies possible. But the observation of choledochus is difficult in spite of mobilization of the duodenum by the Kocher maneuver.(AUTHORS MODIFIED)