Yoshikiyo Yamazaki

Florid duct lesions and extensive bile duct loss of the intrahepatic biliary tree in chronic liver diseases other than primary biliary cirrhosis.

Intrahepatic biliary tree with either florid duct lesions or a moderate to severe degree of the duct loss in four livers with chronic hepatic diseases other than primary biliary cirrhosis were studied with histometric and serial section observations. Florid duct lesions, distributed segmentally in the liver, were found in one case with incomplete septal cirrhosis and one case with idiopathic portal hypertension. The florid duct lesions including marked plasma cell infiltration and occasional periductal granulomas, were not associated with any bile duct loss in the two cases. The duct lesions were reversible in one case during a long clinical course. On the other hand, a moderate to severe bile duct loss with biliary epithelial degeneration and necrosis was associated with no or little periductal inflammatory cell infiltration in one other case with chronic intrahepatic cholestasis, probably drug‐induced, and in one case with idiopathic portal hypertension. Although florid duct lesions and bile duct loss were important diagnostic features of primary biliary cirrhosis, one of them was observed to develop independently in severely diseased livers, not consistent with a diagnosis of primary biliary cirrhosis, sclerosing cholangitis or intrahepatic bile duct paucity syndrome.

A case of temporal arteritis complicated with bilateral scalp ulcerations

症例は80才男性で,昭和60年10月中旬より食欲不振,頭痛,視力障害,両側頭部皮膚潰瘍あり, 11月30日当院入院.血沈値145mm・CRP強陽性で側頭動脈炎を疑い, 61年2月より,プレドニゾロン30mg/日を開始. 2カ月後潰瘍は治癒し,検査成績も正常化した. 9月12日右側頭動脈の生検にて,側頭動脈炎と確診された.視力低下は1年後に回復した.本疾患に側頭部皮膚潰瘍の合併は非常にまれとされ,本例はその本邦第1例目である.

A case of anomalous origin of the right coronary artery from the left coronary sinus of Valsalva.

49才女性.労作時の前胸部圧迫感を主訴にて来院し,亜硝酸薬にて症状は軽快したが,精査のため入院.血圧110/60mmHg,脈拍68拍/分,整.胸部写真では心胸郭比53%と軽度の心拡大を,マスターのダブル負荷心電図ではV3～6のST下降を認めた.心カテーテル検査にて左冠動脈は左Valsalva洞より派生し,通常の走行をしていたが,右冠動脈も同様に左Valsalva洞より派生していた.そしてdynamic CTにて,右冠動脈近位部は大動脈と肺動脈の間を通過していた.なお左右冠動脈に狭窄病変はなく,心内圧も正常であった.以上,まれな右冠動脈左Valsalva洞起始症の1例と診断し,冠動脈の走行の確認にdynamic CT法を応用した.