Mitsuo Sugiura

Hepatic clearances of antipyrine, indocyanine green, and galactose in normal subjects and in patients with chronic liver diseases

Blood clearance of antipyrine, indocyanine green, and galactose were measured to evaluate the alterations of effective hepatic blood flow and hepatic intrinsic clearances in chronic liver diseases. Galactose blood clearance, which may be taken as effective hepatic blood flow, decreased by approximately 30% in patients with cirrhosis (12.49 ± 0.76 ml/min/kg; mean ± SE; n = 17) compared with normal subjects (18.17 ± 1.03 ml/min/kg; n = 5). In patients with cirrhosis, intrinsic clearances of antipyrine (0.178 ± 0.014 ml/min/kg; n = 17) and indocyanine green (6.19 ± 1.38 ml/min/kg; n = 7) showed 61% and 85% reduction, respectively, compared with those of normal subjects (0.462 ± 0.048 ml/min/kg; n = 5; 41.72 ± 7.75 ml/min/kg; n = 5). Considering that indocyanine green and antipyrine are eliminated by different hepatic mechanisms, these mechanisms may not be equally sensitive to decrements in hepatic function. In addition, fractional reductions of intrinsic clearances for these compounds are thus much greater than that of effective hepatic blood flow.

Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices *

This report describes 636 patients with portal hypertension in whom esophageal transections with paraesophagogastric devascularization were performed for the management of esophageal varices. The procedure was a prophylactic measure in 185 patients, elective surgery in 349, and an emergency procedure in 102. Portal hypertension was due to cirrhosis of the liver in 464 patients (40 alcoholic and 424 cryptogenic), idiopathic portal hypertension in 99, extrahepatic portal vein occlusion in 38, hepatoma in 22, and other causes in 13. The operative mortality rates were as follows: emergency 13.7%, elective cases 3.2%, prophylactic cases 4.3%, and overall 5.2%. There were no deaths in the 233 patients in Childs clinical class A; 232 class B patients had a 2% mortality rate, and 171 class C patients had a 17% mortality rate. The 10-year actuarial survival rates in patients with cirrhosis of the liver were 55% in emergency cases and 72% in both prophylactic and elective cases. In patients without cirrhosis the survival rates were 90%, 96%, and 95%, respectively. Recurrence of variceal bleeding or varices was less than 5%. We conclude that the Sugiura procedure is safe and effective in controlling esophageal varices and prolongs the long-term survival of patients with portal hypertension.

Effects of nonshunting operations on portal venous pressure and hepatic blood flow

A comparative analysis has been presented of the effect of the nonshunting operation on portal venous pressure and effective hepatic blood flow in patients with liver cirrhosis and idiopathic portal hypertension. A reduction of portal pressure after splenectomy with esophagogastric devascularization in 17 patients with idiopathic portal hypertension was significantly greater than that in 79 patients with liver cirrhosis (-21 +/- 4.1 percent versus -8.9 +/- 1.6 percent, p less than 0.01). Clearance of galactose from the blood, which approximates effective hepatic blood flow, was decreased after the nonshunting operation by 6.7 percent in five patients with liver cirrhosis (p value not significant). On the other hand, there was a 19.4 percent reduction (statistically significant) in galactose clearance in four patients with idiopathic portal hypertension (p less than 0.05). Based on these data, we suggest that in patients with idiopathic portal hypertension, the splenic circuit largely contributes to the portal hypertension, the effective hepatic blood flow, or both. We recommend a nonshunting operation for the treatment of esophageal varices from the hemodynamic viewpoint in cirrhotic patients.

Duplication of common bile duct—A case report

A case of double common bile duct is presented. Precise preoperative recognition of this anomaly is extremely rare. Preoperative adequate appreciation of these anomalies of the biliary tree prevents surgeons from impairing the anomalous bile ducts, or from going astray, being faced with these anomalies at operation accidentally.

Echo guided percutaneous transhepatic cholangiography with puncture transducer.

Conventional percutaneous transhepatic cholangiography (PTC) has some disadvantages because it is customarily performed blindly. If the bile duct is made visible, these disadvantages are eliminated. The biliary tree, if dilated, can be clearly delineated by ultrasound technique. By combining the B-mode examination of the biliary tract with the ultrasonic puncture transducer, percutaneous transhepatic cholangiography was performed successfully in 16 examinations on 12 patients. PTC needle could be inserted directly into the lumen of the bile duct without appreciable difficulty. The echo guided PTC was found to be an easier, safer, and more reliable method than the conventional blind technique.

Obstructive jaundice secondary to pancreatic pseudocyst

A case of obstructive jaundice resulting from the compression of the common bile duct by a pancreatic pseudocyst is reported, which is of rare occurrence. Total excision of the cyst and choledochojejunostomy were performed. Postoperative course was uneventful with rapid disappearance of jaundice. Nine out of ten cases of pancreatic pseudocyst were treated by total excision with one death during 1951 through 1974.

The Tannaka Duality Theorem for Semisimple Lie Groups and the Unitarian Trick

Harish-Chandra [6] found that the Tannaka duality theorem almost holds for connected semisimple Lie groups but it does not hold exactly. It remained an open question when the Tannaka duality theorem holds for semisimple Lie groups. In this paper, we answer the question in the fol lowing way.

Paradoxic elevation of serum growth hormone levels after splenectomy and/or paraesophagogastric devascularization in patients with portal hypertension

Blood glucose, serum immunoreactive insulin (IRI), and serum growth hormone (GH) levels during 50-g oral glucose tolerance tests (OGTT) were determined before and after splenectomy with or without paraesophagogastric devascularization in patients with portal hypertension (13 liver cirrhosis and 8 idiopathic portal hypertension) and in 5 splenectomized patients with diseases other than portal hypertension. Before splenectomy with devascularization, only 1 of 15 patients with portal hypertension exhibited a paradoxic elevation of serum GH levels of more than 10 ng/ml above the fasting levels after glucose loads. After the operation, however, 10 of these 15 patients showed the paradoxic elevation. Frequency of the paradoxic elevation was significantly higher after the operation than before (p < 0.001). The abnormal response of serum GH levels to glucose loads did not correlate with any of the blood glucose concentrations, serum IRI levels, and values for liver function tests. The paradoxic elevation was also observed in 4 of 6 patients with portal hypertension who underwent splenectomy alone without devascularization. These 4 patients with paradoxic elevation were splenectomized 4 wk and 212, 20, and 29 yr previously. However, none of 5 splenectomized patients without portal hypertension showed the paradoxic elevation. The reason why the paradoxic elevation was observed after splenectomy only in patients with portal hypertension but not in patients without portal hypertension may be sought for in the changes of portal venous flow rather than splenectomy itself.

Hypotonic resistance and shape of erythrocytes in portal hypertension Special reference to influence of spleen

門脈圧充進症90例を対象にCoil Planet Centrifuge systemによる赤血球浸透圧抵抗の測定と赤血球形態の観察を試み,肝機能と脾機能の影響を検討した.脾摘出後の溶血終了点は著しく低張側に偏位する(浸透圧抵抗増強)とともに,標的赤血球の出現をみた.溶血終了点は標的赤血球が多数出現するほど低張側に偏位する一定の関係が判明した.脾摘出前の溶血終了点は,本症における肝障害の存在にもかかわらず健常群と変らず,基礎疾患群による差異も認めなかった.脾腫の存在により,赤血球の球状化,脆弱性獲得機転が働き,浸透圧抵抗が減弱するためと考えられた.脾摘出前後の肝機能は血清総コレステロールの上昇を除いて一定の傾向を認めず,脾機能亢進を伴う門脈圧充進症での赤血球の浸透圧抵抗性は,肝機能よりも脾機能の影響を強く受けることが判明した.脾摘出前に認められた貧血は脾摘出により改善し,血清ビリルビンは低下した.脾での溶血機転が除去された結果と考えられた.

Serum Bile Acid Concentration for Detection of the Connection Site of Portal-Systemic Shunt-A case report with Cruveilhiel-Baumgarten syndrome-

肝性脳症を呈したCruveilhier-Baumgarten症候群の1例で,肝静脈および大静脈各部位の血清総胆汁酸濃度を測定した.血清総胆汁酸濃度は,肝静脈血で最も低値を示した.右心房混合静脈血が肝静脈血より高濃度である事は,肝外シャントによる門脈血の大静脈系への流入の結果と考えられた.大静脈系は,混合静脈血濃度より更に高値を示した.大静脈各部位で胆汁酸濃度差がみられた事から門脈血の混入部位を推定したが,血管造影により,血清胆汁酸濃度の上昇部で門脈側副血行路の存在が証明された.以上から,血清胆汁酸は,門脈大循環シャントの存在または存在部位を示す生化学的指標として有用と考えられた.