Nobuyuki Hosokawa

Clinical values for an index predicting postoperative residual liver function by pre-operative liver-scintigraphy in patients with liver disease

Hepatic resection is essential in treating hepatocellular carcinoma. However, before an operation, it is difficult to predict the functional reserve in the remnant following massive resection. We devised an original method by which effective liver volume was measured by liver scintigraphy. In order to predict the residual liver function before hepatic resection in a preoperative radiocolloid study, we obtained a predictive index by combining the K values with effective liver volumes which seemed to have the estimated residual liver function. Twenty-one patients with liver or biliary tract disease were selected at random for the present study. We divided them into 3 groups in accordance with prognosis after hepatic resection. There were statistically significant difference between the deceased group who died from hepatic failure and the group who died from causes other than hepatic failure ; and between the deceased group who died from hepatic failure and the living group in the preictive index (p< 0.01). Our data suggest that if the predictive index is above 0.45, the probability of hepatic failure after hepatic resection is low. We concluded that our predictive index is useful to use in preoperative prediction of post-hepatectomic residual liver function.

Hypersensitivity Pneumonitis in a Pearl Nucleus Worker

A 37-year-old woman had worked for 4 years in a shell-processing factory where considerable airborne dust was produced cutting and polishing fresh water shells into pearl nuclei. She had a dry cough and dyspnea. Trans-bronchial lung biopsy showed noncaseating granulomas and cellular intraalveolar infiltrates. High-resolution lung computed tomography (HRCT) showed diffuse small nodules and ground-glass opacities. Hypersensitivity pneumonitis caused by shell dust should be considered in the appropriate clinical setting in a patient with the appropriate radiographic abnormalities.

A kinetic study on secretion and elimination of endogenous thyrotropin in the thyrotropin-releasing hormone test

Serum thyrotropin (TSH) concentrations in normal young men were measured by a highsensitivity immunoradiometric assay before and after intravenous administration of 500μg of TSH-releasing hormone (TRH). A kinetic model was applied to evaluate the secretion rate both before (V0) and after (V0+V* at maximum rate) the administration of TRH, the elimination constant (K), the latent time (L) between TRH administration and start of the stimulated secretion, and the total amount of TSH (T) released in response to TRH. Vo, V* and T varied widely from individual to individual, but correlated well with TSH before TRH administration (r=0.93, 0.80 and 0.87, respectively). A few minutes (1.89± 1.30 min) after the administration of TRH, the secretion of TSH (0.025±0.016μU/min ml) was stimulated, and the total release over about 1 h was 12.5±5.6,μU/ml. Serum TSH was maximum at 31.5±5.7 min. The half-time of disappearance of TSH was 42±9 min. These data confirm that the stimulated secretion continues for more than 30 min, and that the pituitary releases 43.2±22.9 mU of TSH (assuming the distribution volume of TSH is 5.8% of body weight) in response to TRH, an amount which correlates closely (r=0.91) with TSH before TRH administration.

Improved Method for Inflated-fixed Lung in Lung Cancer.

臨床画像を理解するために, 画像と切除標本とを対比検討することは重要である. そのため, 近年Heitzmanの成書に記載された伸展固定肺を利用した解析法が用いられることが多いが, その方法による材料を光顕用に染色すると染色性が極めて不良となることが本法の欠点であった. 我々はその改良法を基礎的研究で克服し, 今回肺癌の葉切除例での応用を検討した. 方法は切除肺の気管支断端よりホルマリンを注入しホルマリンに浸漬, その後Heitzmanの原法にしたがってポリエチレングリコール400などを混和した固定液に置換させ, 固定液を排除させて伸展固定肺を作成した. 病理所見はホルマリン固定時間1時間から4日間の症例で良好であり, 一方伸展程度はホルマリン固定2日間までの症例では良好であったが, それ以上の症例では伸展不良な場合も認められた. 歩ルマリン固定は1ないし2時間から1日間程度が適当と思われた.