Y. Ide

Studies on the hepatic transport and metabolism of dyes

bile drainage after the surgery. Experimental analysis, using dogs with obstruction of the common bile duct and successive reconstruction procedures, revealed the same as seen in the human. Results obtained in 7 cases of portal hypertension, including 4 cases of cirrhotics and 3 cases of non-cirrhotic intrahepat ic portal hypertension (2 cases of end-to-side portacaval shun t and 5 cases of direct interruption surgery of esophageal varices such as proximal gastrectomy) revealed that the radioactive tracing test reflected the change of the hepatic blood flow at the first place. The results also reflected the change of hepatic functions after surgery at the second place. Though there is some question on the extrahepatic uptake of the radioactive BSP, this simplified external procedure could be helpful to examine the situation of the hepatic blood flow and the function before and after the surgical t rea tment in those hepatobiliary diseases.

Examination of dye metabolism in liver (VII) with respect to bind with serum protein to I.C.G. (Indocyanine green)

ConclusionThe data suggested that the binding activity of I.C.G. with serum protein provided by concentration of albumin, α1 globulin and α2 globulin.

Diagnosis of liver diseases by ultrasonic echography

The technique of pneumoperitoneum-tomography is as follows: After fast ing and enema the patient was usually made to lie in the dorsal position. The puncture was made at external 1/3 of the line connecting the navel and anterior iliac spine or the middle of the line connecting the navel and pubic symphysis, and 1,000~1,500cc of air was injected. Tomography was taken in the ventral, dorsal, r ight or left lateral or oblique position that allows to give the clearest contour of the organ. The results from the 6 cases are as follows: The tumefaction was clearly demonstrated in 4 casesin 2 on the phrenic surface of the liver, in each 1 on the frontal surface and lower edge of the right lobe. In the other 2, the swelling was found in the interior of the liver, but its presence could be est imated by this method because it was as large as an egg. The pneumoperitoneum-tomography was thus diagnostic for superficial tumefaction of the liver, and could est imate its size, form and extension. This method is especially useful to find out the tumefactions on the phrenic and posterior surface or lower edge of the liver which are difficult to know by palpation. But when the swelling is in the interior of the organ, its diagnosis is generally difficult unless it is grown to such an extent as to elicit change in the contour of the organ. It is also difficult in general to judge by this method whether the tumor is benign or malignant. Any significant side effect was not produced by this method.

The study of hepatic coma during the treatment with diuretics

Seventyone patients with cirrhosis of liver have been admitted to our clinic over the past five years (1962~1966). Of these, 26 cases (36.7%) were fatal and 45 cases survived. Oedema or ascites were found in 37 of 71 patients with liver cirrhosis. Twenty-two of them (59.5%) died, and 15 of them (40.5~) survived. Diuretic therapy was performed in the case of 26 of 37 patients with ascites or oedema. Their mortali ty rate was 69.3% (18 cases). It was raised by about 10% as a result of diuretics. There were 11 patients with ascites or oedema, on whom diuretic therapy was not performed and only 4 of them died. The mortali ty rate of patients with ascites or oedema who were treated with diuretics was higher than that of patients not treated with diuretics. We found serum electrolytes imbalance in the fatal cases of hepatic coma during the t reatment with diuretics. The serum sodium and chloride level were inclined to decrease, especially in the case of hepatic coma. On the other hand, the potassium was irregular. We are impressed that diuretic therapy of liver cirrhosis must be performed carefully and must be watched the electrolyte balance, especially that of sodium.

Dye excretion and metabolism in liver diseases

of bilirubin in the supernatant fraction was minimal 3 minutes af ter the injection, while a large amount of radioactivity was incorporated into bilirubin in the microsome fract ion in the same minutes. However, when bilirubin-l*C was intravenously given, most of radioactivity of bilirubin in lever was found in the supernatant fract ion in the first 3 minutes af ter the injection, and thereafter it migrated to the microsome and mitochondria fract ions in 15 and 30 minutes. These facts suggest a pathway of direct hepatic synthesis of bilirubin f rom glycine through &aminolevulinic acid in rat liver. Next, kinetics of plasma bilirubin was studied with 14C or 3H-labeled bilirubin, in order to obtain the quantitative informations about the bilirubin ell iminating functions of the liver as well as bilirubin turnover in human subjects, when three compar tment model was applied for this purpose.

Studies of serum succinic dehydrogenase (II) Changes in hepatic diseases

The act ivi ty in normal controls ranged f rom 0 to 3 units . In 122 pat ients of acute hepat i t is 64 cases (52.4%) showed over 6 uni ts and 40 cases (32.7%) showed over 10 units . In 47 pa t ien ts of l iver c i r rhos is 19 cases (40.4%) were over 6 uni ts and 9 cases (19.1%) were over 10 units . In 24 pat ients of obst ruct ive jaundice (chiefly p r imary or secondary hepatob i l ia ry carcinoma) 12 cases (50.0%) were over 6 uni ts and 11 cases (41.6%) were over 10 units . There were several types of increas ing se rum activi ty in acute hepati t is , such as cont inued elevated type and t rans ien t elevated type. In general the act ivi ty in l iver c i r rhos is d is t r ibuted in normal range, though the act ivi ty elevated before death. In hepatobi l iary carc inoma the act ivi ty showed normal value in ear l ie r cases and elevat ion of the act ivi ty was observed in spreading cases. The elevat ion of succinic dehydrogenase had no re la t ion to the elevat ion of t r a saminase and of lactic dehydrogenase.

Ultrasonic diagnosis in liver diseases (I) Hepatic tumor

Most difficult problem in hepatic resect ion is to control hemor rhage f rom the l iver parenchyma. Various methods have been tried to complete hemostas is in the process of hepatic surgery. Nagata reported the sa t i s fac tory resu l t in bloodless hepatic resect ion in rabb i t s by the following method. The to-be-resected area of the l iver is solidified in vivo by the infusion of polyethylene glycol th rough the portal branch, and is resected remain ing solidified liver parenchyma of cer ta in th ickness on the cut surface of the remnant . We followed this method, as the previous process of clinical application, in dogs which have more voluminous and human-like l iver than rabbi ts . We successful ly improved this solidification method in the following points : 1) Using a new inser t ion equipment 2) Divise the method of infusion of polyethylene glycol only to the resect ing zone of the liver 3) Application of cooling off i n s t rumen t in the aim of gaining more high and speedy solidification of infused polyethylene glycol in the liver. By these improvements on the method of hepatic resect ion will give some contr ibut ion in advance of hepatic surgery. This s tudy is sti l l on the way and we will continue to s tudy on further improvement of this method to apply in clinical cases.

A study of nadp-linked enzymes (III)

The dynamics of var ious serum enzymes in chronic liver damage were investigated. 1) In chronic hepat i t is GOT (mean 90), GPT (100), ICD (260) and Al-pase (3.1) were observed to increase in some degree, however LDH and Ch-E were remained normal . While in l ivercirrhosis ICD (178), LDH (0.25), GPT (49) and GOT (77) stayed normal or slightly elevated, A1-Pase (3.6)also elevated slightly, and marked decrease of Ch-E (0.46)was observed. 2) Slight correlat ion was found between ICD and GOT, GPT in chronic l iver damages examined. In chronic hepat i t is Ch-E was 0 .6< and ZnTT was 20>, while in l ivercirrhosis Ch-E was 0.6> and ZnTT was 15<, so these levels were useful for differential diagnosis of these two diseases. 3) Chronic hepati t is was divided into two groups histologically i. e. active type (27 cases) and inactive type (16 cases). In active chronic hepat i t i s the increase or f luctuation of icterus index, ZnTT, GOT, GPT and ICD were f requent ly observed. These l iver funct ion tes ts are impor tant indices to determine prognosis and t r ea tmen t in chronic hepat i t is .