Yukihito Minato

Asymptomatic arteriovenous malformation of the pancreas. Demonstration by Doppler ultrasonography and magnetic resonance imaging.

SummaryWe reported a case of asymptomatic pancreatic AVM, incidentally found on routine ultrasonography and diagnosed noninvasively by means of Doppler ultrasonography and MRI. The diagnosis was confirmed by angiography. This is the first report to demonstrate the characteristics of pancreatic AVM by these two imaging techniques. They proved to be useful in identifying the vascular nature of AVM without the use of a contrast material, which is a definite advantage over DSA and CT. The quality of the image obtained was equivalent or superior to that obtained by DSA and contrast-enhanced CT. Doppler ultrasonography and MRI may serve as the primary imaging techniques of choice in suspected cases of AVM.

Evaluation of hepatic fibrosis by serum proline and amino-terminal type III procollagen peptide levels in alcoholic patients

In patients with alcoholic liver disease, serum proline and amino-terminal type III procollagen peptide levels were evaluated as a marker of hepatic fibrosis. Thirty-one patients with alcoholic liver disease (2 with nonspecific change, 3 with alcoholic hepatitis, 17 with hepatic fibrosis without cirrhosis, and 9 with cirrhosis) and 15 controls were investigated. Hepatic fibrosis was estimated in each liver biopsy specimen by morphometric analysis, and the ratio of fibrotic change to total area (AREA-F) was calculated by morphometric analysis. In patients with hepatic fibrosis, serum proline levels and routine liver function tests were not significantly correlated to AREA-F value, while serum peptide levels showed a significant positive correlation to AREA-F value (r=0.733,P<0.001). These results suggest that the determination of serum amino-terminal type III procollagen peptide level may serve as a good marker for the diagnosis of liver fibrosis in the alcoholic.

A lithium clearance study of sodium reabsorption at the proximal tubule in liver cirrhosis with ascites.

SummarySince the reabsorption of lithium occurs almost exclusively in the proximal tubule and is associated with that of sodium, the fractional excretion of lithium (FELit) ws examined in 18 patients with cirrhosis in order to examine the reabsorption rate of sodium at the proximal tubule. As expected, the fractional excretion of sodium (FENa) was significantly lower in cirrhotic patients with ascites (0.43±0.10%, mean±SEM) than in cirrhotic patients without ascites (0.75±0.14%, P<0.05) and healthy controls (0.82±0.17%, P<0.05). By contrast, there was no significant difference in FELit among cirrhotic patients with ascites (16.7±2.0%), cirrhotic patients without ascites (15.4±2.0%) and controls (17.4±1.5%). It is unlikely, therefore, that in cirrhotic patients with ascites, the impaired sodium excretion is solely caused by the abnormal sodium reabsorption capacity of the proximal tubule.

Acute hepatic insufficiency due to alcoholic liver disease without liver cirrhosis.

肝硬変の合併のないアルコール性肝障害で,肝性昏睡II度以上の肝不全を呈した6症例について臨床病理学的検討を行った.全例の血中HBs抗原は陰性で,大酒家である.肝性昏睡V度までが4例(死亡3例,生存1例),II度までが2例(生存)であった.肝組織像では,死亡例3例中2例は小葉全体に多数のアルコール硝子体を認める典型的なアルコール性肝炎であったが,他の1例には硝子体はなく,肝細胞の亜小葉性の壊死と著明なfoamy degenerationが認められるアルコール性肝炎であった.生存した3例は,蛍光抗体間接法および電子顕微鏡でもアルコール硝子体が認められず,炎症細胞浸潤もごくわずかであり,2例では強い肝内胆汁うっ滞と肝細胞の風船様変化を伴う肝線維症,他の1例は肝細胞の変化の乏しい肝線維症であった.重症のアルコール性肝障害でも組織学的には必ずしも典型的なアルコール性肝炎とは限らず,多彩な病理組織像を呈することを示した.