Yoshio Fukuyama

Nonsurgical, percutaneous transhepatic cholangiography—Diagnostic significance in medical problems of the liver

Percutaneous transhepatic cholangiography has been carried out from the right flank on 314 patients with hepatobiliary disease, using a very thin needle. Practically no complication has been encountered in 80 cases with medical problems of the liver. In contrast, such complications as bile leakage, bleeding, shock, fever, and blood pressure drop were experienced in patients with biliary obstruction and stones, though less frequently than reported. The intrahepatic bile ducts were visualized in 67.5% of the patients with no to minimal dilatation, and this high success rate is accounted for by the policy of injecting contrast medium instead of suctioning bile in search of an intrahepatic duct. This technique has proved of value in the diagnosis of intrahepatic cholestasis, inflammation or infection of the bile ducts, space-occupying lesions of the liver, and in elucidating the cause of biliary colics. It sometimes provides unexpected information. It may also serve the same purpose as portography and hepatic arteriography, since these vessel systems run together with the bile duct.

Hepatic Lymphatics as Opacified by Percutaneous Intrahepatic Injection of Contrast Medium: Analysis of Hepatic Lymphograms in 125 Cases

Hepatic lymph vessels were opacified in 125 patients with various hepatobiliary diseases during percutaneous transhepatic cholangiography or portography. Contrast medium deposited in the parenchyma flowed relatively quickly in winding channels, usually toward the hepatic hilus. No correlation was demonstrated between the locus of the intraparenchymal deposit and the direction of the flow. Contrast medium also opacified the lymphatics near the hepatic hilus and abdominal aorta. Neither jaundice nor liver disorder were prerequisite for the visualization of the hepatic lymphatics. The intrahepatic injection of contrast medium provides a safe and useful method for the study of hepatic lymph and its pathways.

A case of secondary hepatic amyloidosis.

アミロイドージスは臨床的に稀な疾患であり,生前診断は難かしく,従来の報告は剖検例に基くものが多かった.従って検査成績はretrospectiveなものとなり,肝に関する臨床病理は未だ十分確立されていない.最近経験した症例は,両側肺結核症で治療中の51歳の男性で,肝腫を指摘され,検査でAl-pの上昇,BSPの停滞,胃X線で圧排像があり,198Au肝スキャンで右葉全体および左葉一部に欠損様所見がみとめられ,初め肝の悪性腫瘍が疑われた.しかし腹腔鏡では肝に異常なく,両葉から採取した組織に大量のアミロイド沈着がみとめられた.アミロイド沈着による肝病変は右葉に高度で,これは肝血管像からも証明された.この肝病変の部位による差異については,生体反応としての代償性肝細胞再生部位にアミロイド変化が軽いのではないかと考えられるが,これは今後の検討が必要である.(要旨の一部は第9回日本肝臓学会東部会で発表した.)

Statistical Studies on Liver Function Tests in Toxemia of Pregnancy

妊娠10カ月の晩期妊娠中毒症妊婦の各種肝機能を正常妊婦の肝機能と比較検討し,つぎの成績を得た.(1) 血清総蛋白とGPTの平均値と分散は両群間で差を認めない.(2) GOTとアルカリフォスファターゼの平均値は両群間で差を認めない.しかし,中毒症候群の分散は有意に大きい.中毒症では,GOT 41.3単位,アルカリフォスファターゼ10.08 B-L単位まで上昇し得るが,それ以上の上昇は肝障害などの合併が疑われる.(3) 中毒症群の総コレステロールの平均値は正常妊婦より有意に低値である.総コレステロールが155.1mg/100ml以下のばあいは肝障害やその他の障害が考えられる.(4) 硫酸亜鉛混濁反応は両群ともに正常範囲内で,かつ,母平均に差は認められない.しかし,妊娠末期では膠質反応が軽度異常でも肝障害の合併を疑う必要がある.

Studies on the hepatic circulation (I): retrograde porotgraphy

In t rahepat ic aneurysm is an uncommon lesion which is very ra re ly diagnosed preoperatively and only a smal l number of cases have been succesfully treated. A 34-years-old male admitted in our hospital because of bleeding gas t r ic ulcer, and gas t ro je junos tomy was performed on 15. March, 1966. The bleeding was pointed out rup tured a r te ry on the bot tom of the ulcer by histologic examinat ion. After this operat ion serum hepati t is was developed and SGT elevated to 260 u., SGPT was 420 unit . For the purpose of making accurate diagnosis needle biopsy of liver was done under control ing by laparoscopy, and no serious bleeding was noted on liver surface. However following this procedure severe r igh t upper quodrant pain occured and vigorous t a r ry stool wi th hematoemesis came out continiously dur ing several weeks. Then selective cel iacography was performed by Seldinger s method and the X-ray film revealed two round aneurysm in the area of lobus quadora tus of the liver, which had small flngr top size and belong to the 3rd b ranch of hepatic ar tery. On the next day, par t ia l hepatectomy was performed and no more aneurysm was found by direct hepatic a r te r iography dur ing surgery. Now, pa t ien t has no hematoemesis or t a r ry stool af ter hepateetomy and has been very well. Numerous factor have been implicated in the etiology of this disease, bu t in our case needle biopsy tha t has been performed on severe stageof serum hepat i t i s was chief role of making this aneurysm.