Tatsuya Motoki

A case of Gilbert's syndrome- A study of bilirubin mono- and di-glucuronide in the liver and bile

Gilbert症候群で肝生検組織のUDPGT活性,BMG, BDG産生の割合,胆汁中のグルクロン酸抱合ビリルビンを測定した.肝組織でのBMG産生はBDG産生に比較して多く,UDPGT活性の低下(0.158mg/g/hr)と,胆汁中BMGの相対的増加はGilbert症候群におけるビリルビン,ジグルクロニド産生能の低下に起因するものと考えられた.

The measurements of serum trypsin concentrations in patients With various liver diseases

肝疾患における血清トリプシン値の変動をラジナイムノアッセイ法で検討した.健常者の血清トリプシン値256±57(SD)ng/mtに比較し,急性肝炎では383±150ng/mlと高値を示した.一方慢性肝炎,肝硬変症ではそれぞれ190±71ng/ml,208±49ng/mlと正常ないし低下を示す傾向があった.血清トリプシン値とGOT値の相関係数は0.29,GPT値との相関係数は0.39といずれも有意の相関は認められなかった.また慢性肝炎症例でトランスアミナーゼ値とトリプシン値の変動な調べたが一定の関係はみられなかつた.しかし急性肝炎症例で経過をみると,トランスアミナーゼ値とトリプシン値の変動はほぼ一致していた.腎静脈血と下大静脈血での血清トリプシン値を測定したが,一定の関係は認められなかった.しかし慢性腎不全症例では血清トリプシン値が著明な高値を示し,血中トリプシンの除去に腎が重要であることが示唆された.

Studies of serum binding-protein to Sulfobromophthalein (BSP) and Indocyanine green (ICG), and its clinical estimation

Indocyanine green (ICG), Sulfobromophthalein (BSP)は血清中で蛋白と結合しているが,その結合蛋白をSephadexのゲル濾過法,抗原ゲル単純免疫拡散法,アガロースゲル電気泳動法を用いて検討した.その結果,ICGの主たる血清結合蛋白はβリポ蛋白と考えられる成績であった.BSPの主要な結合蛋白は諸家の報告の如くアルブミンであった.このICG・BSP間の主要結合蛋白の相違がICG・BSPクリアランスにどの様に影響を及ぼすかを,肝疾患のない低アルブミン血症(アルブミン値2.5g/dl以下)16例について検討した.16例中9例では治療の前後においてICGおよびBSPクリアランスを施行し得た.その血清アルブミン濃度とKBSP間には相関係数γ=-0.603(P<0.01), KICG間にはγ=-0.331 (P<0.05)を示す成績が得られた.

Clinical evaluation of oral fructose tolerance test in liver diseases

Oral fructose tolerance test was performed in 95 patients with liver diseases and 21 normal subjects. The fructose concentration in venous blood was measured with Roes method in fasting and in 45, 60, 90, 120, and 180 minutes respectively after the oral adminstration of fructose (1 gm/kg of body weight). The highest fructose concentration in venous blood was observed in 45 or 60 minutes after the oral administration in all subjects. The fructose concentrations at each time of observation after the administration were significantly higher in patients with liver cirrhosis than in any other subjects (p<0.01) . The maximal fructose concentration which was observed in 45 or 60 minutes after the administration was 12 .2 i2 .3 mg/dl (mean-l-S.D.) in liver cirrhosis, 6 .9• in acute hepatitis, 7 .4 • 1.5 in chronic hepatitis and 5 . 4 • 1.4 in normal subjects. In patients with liver cirrhosis, the level of the maximal fructose concentration was found to correlate with the severity of the disease; the higher the maximal fructose concentration, the more serious the degree of portal hypertension. In the group of acute hepatitis, the maximal fructose concentration was 5 . 5 i 1.1 mg/dl in patients with the G P T less than 120, and 8.24-2.2 in patients with the G P T higher than 120. I t may be concluded that the oral fructose tolerance test seems to be useful in evaluating the condition and function of the diseased liver.

Clinical findings and cholecystographic gallstone shadows in cholelithiasis

33 squirrel monkeys fed a semipurified diet to induce a mild hypercholesterolemia had a high incidence of cholelithiasis. The diet consisted of casein, sucrose and butter (40% of total calories) with additional cholesterol (100 mg per 100 Cal). The gallstones which are composed of pure cholesterol began to appear 3 months after the start of the diet. The incidence in animals maintained on this diet over 9 months was 83%. The gallstones increased in size, number and total mass of the stones during feeding period. Monkeys fed natural diet had no stones and in another group of 33 monkeys fed semipurified diet which supplied 15% of the calories as corn oil 3 monkeys had stones of small amount. The cholesterol: phospholipid ratio in bile was highest in the group and in the individuals with the high butter diet and was very low in the group of natural diet.

Evaluation of the methods to diagnose the abnormal liver size and shape in liver cirrhosis and fibrosis

(1) We have 52 patients of hepatoma (85.2%) and 4 patients of cholangioma (6.1%) associated with schistosomiasis japonica out of 61 patients with primary of liver, so it comes to 91.8% in total. We found 53.1% of positive reaction by skin test of schistosomiasis japonica to the whole patients being in our hospital. This shows high percentage compared with autopsied patients of carrying schistosomiasis (71.4%) except primary carcinoma of liver and 68.2% of patients over 40 years old (positive skin test of schistosomiasis japonica). (2) Hepatoma associated with schistosomiasis japonica were chiefly observed in male, and no evident differences of mean age between male and female, 5 patients of hepatoma were male under 39 years old. (3) A high percentage were recognized in the group of 21 patients (27.6%) of hepatoma with liver cirrhosis carrying schistosomiasis japonica (76 patients) than 3 patients (7.1%) of hepatoma without carrying 42 patients of schistosomiasis. In those cases, 37.0% of schistosomiasis patients were revealed in autopsy and postmortem liver biopsy, 15.7% were not recognized schistosomiasis. (4) Though, the liver scintiscanning is effective method for diagnosis of liver carcinoma, but it brings various finding of abnormal figure that suggest defect or atrophic liver in spite of normal liver function and histologic examination in the cases of schistosomiasis japonica. We scintiscanned for 29 patients of hepatoma with schistosomiasis japonica, 23 patients (79.3%) were showed the type of right liver defect figure and impressed difficulty to make a correct diagnosis. 6 patients (20.7%) showed defect figure in left liver and a part of portal fissure were easily diagnosed.