Tohru Abei

Incidence of ultrasound-detected intrahepatic hematomas due to Tru-cut needle liver biopsy.

This is a prospective study in which 120 patients with diffuse liver disease undergoing liver biopsy were followed by serial ultrasounds to determine the incidence of postbiopsy intrahepatic hematoma formation. Forty-five of the patients had a blind biopsy, while the remaining 75 patients had a biopsy performed during laparoscopy. In both groups a 2.0-mm Tru-cut needle was employed. The overall incidence of postbiopsy hematoma formation was 18.3%, with approximately the same results occurring in blind biopsy patients (20%) and laparoscopy-guided biopsy patients (17%). Only two patients had significant pain associated with the hematoma formation (one from each group), one of whom had evidence of intraperitoneal bleed and rebleed. Our results suggest that postbiopsy asymptomatic hematomas occur more frequently than had been generally thought and that laparoscopy-guided biopsy is not safer than blind biopsy.

A simple infrared spectroscopic method for the measurement of expired 13CO2.

Abstract For the analysis of 13CO2 and 12CO2 in exhaled breath the mass spectrometer has been employed in general, but it is not convenient for clinical use and maintenance. We have been successfully performing the continuous measurement of expired 13CO2 and 12CO2 with a new analyzer using infrared spectroscopy which is easy to manipulate and maintain. This analyzer measures 12CO2 in a short cell with an absorbancy of around 2360.2 cm−1 and 13CO2 in a long cell with an absorbancy of around 2272.0 cm−1, recording the volume percentage of 12CO2 and the atom percentage excess of 13CO2. In our experiment, using a normal male rat weighing 210 g, a maximum expired 13CO2 of 1.7 atom% excess was recorded 10 min after an intraperitoneal injection of 10 mg of [13C]-sodium bicarbonate containing 49.0 atom% of the isotope.

Studies on the relationship between the histological changes and liver cell function or plasma proteins in hepatic diseases.

SummaryHistological changes of liver biopsy specimens were compared with functioning liver cell mass estimated by an index, ICG capacity, and with plasma levels of various proteins, in 85 patients with liver diseases. ICG capacity was inversely proportional to the degrees of liver cell degeneration and lymphocyte infiltration in the portal tracts and parenchyma, in contrast to plasma disappearance rate of ICG (K), which was inversely proportional to the degrees of portal tract fibrosis and bridge formation. Among the plasma proteins synthesized in the liver, the plasma levels of prealbumin, and α1-acid glycoprotein showed the tendencies to decrease with the increase in the degrees of liver cell degeneration. The levels of ceruloplasmin, haptoglobin, β1A/C and transferrin were proportional to the degree of the degeneration. Plasma albumin had no correlation to any histological change. The plasma levels of γ-globulin and IgG were both proportional to the degrees of portal tract fibrosis and bridge formation. IgM also paralleled to the degree of the fibrosis. The level of IgA was inversely proportional to the degree of liver cell swelling. The levels of γ-globulin and IgM were inversely proportional to the degree of fatty infiltration. It was concluded that quantitative estimations of some histological changes in the liver are valuable for the estimations of liver function and the grade of the diseases of the liver.

Evaluation of hepatic density change by dynamic CT in healthy humans and in patients with chronic liver diseases

Dynamic computed tomography using 0.4 ml/kg of 65% meglumine diatrizoate was performed to estimate pharmacokinetics of contrast media in the liver in healthy controls (N=11), in patients with chronic viral hepatitis (N=17), posthepatitic liver cirrhosis (N=21), and alcoholic liver cirrhosis (N=23). The time of peak enhancement (the time interval between peak aortic and liver enhancement) was significantly different between each group. Alcoholic liver cirrhosis was the most prolonged, followed by posthepatitic liver cirrhosis, chronic viral hepatitis, and finally controls. A peak enhancement time of 28 sec had a diagnostic accuracy of 97% for chronic liver diseases. A time greater than 44 sec had a diagnostic accuracy for cirrhosis of 96%. The decay time (the time from peak enhancement of the liver to the curves center of gravity) was also significantly different between each group. Again, alcoholic liver cirrhosis was the longest, followed by posthepatitic liver cirrhosis, chronic viral hepatitis, and then the controls. Dynamic computed tomography has many potential applications in studying intrahepatic physiologic events and may contain diagnostic information for chronic liver diseases.

Studies on the relationship between the plasma concentration of proteins synthesized in the liver and liver cell function measured by ICG

SummaryThe plasma levels of nine liver-made proteins were compared with functioning liver cell mass estimated by an index, ICG capacity, in 98 patients with liver diseases. ICG capacity was parallel to the functioning liver cell mass estimated by the severelity, acuteness, type and nature of the disease. Plasma levels of prealbumin, haptoglobin and α1 acid glycoprotein were in proportion to the change in ICG capacity in acute and chronic liver cell injuries. Plasma levels of albumin and transferrin were parallel to ICG capacity only in chronic liver cell injuries. Plasma levels of α1 antitripsin were high in the active stage of liver diseases and were pallalel to ICG capacity only in inactive stage. Plasma levels of ceruloplasmin, α2 macro globulin and β{1}C/β1A globulin were not parallel to ICG capacity in any stage or state of liver disease. It was concluded that synthetic rates and plasma half times of the former 5 liver made proteins are the main factors for the determinations of their plasma levels in liver diseases.

A case of acute viral hepatitis diagnosed by liver biopsy 3 days before the onset of prodromal phase

症例は58歳の男性,膿胸の治療中であったが,慢性肝障害を疑って肝生検を施行したところ,比較的定形的な急性ウイルス性肝炎の組織像を認め,生検施行3日後より典型的な急性肝炎の臨床経過を認めた.HB抗原は陽性で,3週後に陰性化した.組織像は,小壊死巣,肝細胞および核の大小不同と染色の多様性,好酸体,Kupffer細胞の肥大・増殖,静脈洞内の各種細胞浸潤,Glisson鞘の細胞浸潤・浮腫等を呈し,中心静脈の肥厚・硝子様化,細胆管増殖は明確ではなかった,志方法によるHB抗原染色では,陽性所見は得られなかった.

Ultrastructural studies on pathogenesis of intrahepatic cholestasis

The present study aimed to clarify the pathogenesis of intrahepatic cholestasis by means of electron microscopy. In acute intrahepatic cholestasis bile thrombi consisted of granular substances and fibrillar structures, associating with loss of microvilli and increase of microfilaments in the pericanalicular ectoplasm. Golgi apparatus was hypertrophied and their vacuoles contained amorphous materials. Similar materials were also found in the smooth endoplasmic reticulum and vacuoles located near the bile canaliculus. These materials were discharged into the bile canaliculus by exocytosis, thus forming the bile thrombi. Hepatocellular bile pigments were found in the cytoplasm without limiting membrane. The pigments became much dense in electron opacity and were finally surrounded by single membrane. The bile pigments were occasionally found in the hepatocytes without canalicular dilatation. These findings indicated that the condensated bile constituents stored in the endoplasmic reticulum were discharged into the bile canaliculus, thus suggesting that the primary lesion of acute intrahepatic cholestasis was localized in the endoplasmic reticulum. In early primary biliary cirrhosis without overt jaundice middle-sized bile ducts showed loss of microvilli and degeneration of mitochondria. Bile ductules revealed marked bleb formation and bile pigments in the cytoplasm. Hepatocytes contained also bile pigments, associating with no canalicular dilatation. Mechanism of cholestasis in the hepatocytes and ductular cells in cases of early PBC remained to be proved.

Studies on the removal of albumin-bound substances from blood with albumin-conjugated agarose beads

ブロムシアンによってアルブミン結合アガロースビーズを作り,その作用を検討した.Sepharose 4Bは血液潅流には適さなかった. Bio-Gel A 5 m 100-200meshが適した.ビーズ1g wet weightに結合したアルブミンは30～50mgであった.カラムに含まれるビーズの蛋白量と同量の蛋白を含む血液を流すと,ビリルビンは大体半量に減少した.バッチ法で検討したところ,ビーズの摂取するBSPまたは181I-BSP量は,溶液中のBSP濃度に比例し,浮遊蛋白量が増えると減少した.溶液をカラムを通して循環させると,カラムに取込まれるBSPのパーセントは,全蛋白量に対するビーズ蛋白のパーセントとほぼ一致した.人と牛のアルブミンは同じ作用を示した.ビーズを50%アルコールで洗滌すると,取込まれた色素が回収され,ビーズは再び色素を取込んだ.以上ビーズの作用は遊離アルブミンから固定アルブミンへの色素の拡散によるものであることを確めた.

A trial to increase nutritional intake in patients with liver diseases

One hundred patients with cirrhosis were compared with blood donors in blood group substances and haptoglobin phenotypes. There were no siginificant differences between blood donors and cirrhotics for blood group ABO and MN systesm. In haptoglobin phenotypes, there were no differences in blood donors with positive and negative hepatitis-associated antigen, but an increased gene frequency of Hpx was noticed in liver cirrrhosis (p(0.001). In cirrhosis patients, Hpl gene was associated with posthepatitic etiology, and with the condition of hyperbilirubinemia and high BSP retention. These results suggest that Hp2 gene confers resistence to posthepatitic cirrhosis, if the diminished Hp2 gene is not acquired by cirrhotic process.