Morphological changes of interlobular bile ducts in asymptomatic or symptomatic primary biliary cirrhosis (PBC) and chronic hepatitis with ductal lesions were investigated. It was supposed that bile duct lesions found in PBC and chronic hepatitis could be distinguished histologically. There were identical epithelial changes between symptomatic PBC and asymptomatic one, but granulomas were more often found in asymptomatic PBC than in symptomatic PBC. Numbers of interlobular bile ducts per portal tract and the rates of portal tracts without interlobular duct in asymptomatic PBC were intermediate between symptomatic PBC and chronic hepatitis. Serial sections revealed that somebile ducts were able to be followed by ductules in asymptomatic PBC. From these results, numbers of interlobular bile ducts are undoubtedlydecreased in asymptomaticPBCbut not so muchas in symptomaticone. This observation maybe attributable partially for taking asymptomatic course.

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To assess the diagnostic significance of CA19-9, the serum levels in 225 healthy subjects, 201 patients with cancers, 423 patients with benign diseases and 21 pregnant women, weredetermined by RIA. The mean CA19-9 level of the healthy subjects was ll.2 ± 0.4 U/ml (range, 6-100 U/ml). Only 3.1% of them were above 37 U/ml. The CA19-9 levels were elevated above 37 U/ml in 7.9% of 293 patients with non-carcinomatous diseases of the digestive system. Amongdigestive system cancers, elevated levels were found in 18.2% of ll patients with esophageal cancer, 42.7% of 68 patients with gastric cancer, 39.1% of 23 patients with colorectal cancer, 27.8% of 18 patients with primary hepatic cancer, 71.4% of 35 patients with biliary cancer, and 75% of 20 patients with pancreatic cancer. Most of the patients with levels above 100 U/ml had carcinomatous diseases. The CA19-9 positive rates for patients with gastric cancer and colorectal cancer were extremely low at stages I, II and III, while in patients at stage IV and in patients with recurrent cancer, a tendency for rapid increase in the positive rates and concentrations of CA19-9 was noted. Based on combination assay of CA19-9, CEAand ferritin, in comparison with the positive rates for CA19-9 alone, it was found that the rates were raised to 42.7% in gastric cancer, to 39.1% in colorectal cancer, and to 71.4% in biliary cancer, suggesting the simultaneous determination with these tumor markers mayserve to elevate their usefulness.

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The after discharges following grip and percussion in myotonia of 4 cases with myotonic dystrophy were evaluated in repetitive percussion or grip, in cold exposure and in warmexposure electromyographically. By repetition, the after discharges reduced markedly. After 2 or 3 trials, after discahrges disappeared or became short duration. During local cooling (15°C-20°C), the amplitude and the prolongation in the duration of after discharges were marked, although these enhanced after discharges were reduced by repetition even in cooling. During local warming (40°C-42°C), the after discharges became less marked or disappeared. Both the warmingof muscle and the repetitive movementsreduced the duration of abnormalafter discahrges. These effect might be explained on the same mechanismwhichwas the change of the ion transport in muscle membrane, and could be called as warming up phenomenontogether. The degree of these after discharges are close related to the degree of myotonic phenomenon.Myotonia is the disorder of primarily the electrical excitabilities, not the contractile properties. So the method of evaluation of after discharges electromyographically is very valuable comparedto the measurementof the relaxation process which was used popular in evaluation of myotonia in the past.

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To elucidate the immunopathogenesis of intrahepatic cholestasis in alcoholic liver disease, the authors investigated the possible participation of a cholestatic factor. The peripheral lymphocytes from patients with intrahepatic cholestasis in alcoholic liver disease were stimulated with ethanol and liver specific lipoprotein in vitro and the culture supernatant was fractionated by gel filtration, using a Sephadex G-75 column. When a definitive fraction (fraction 4) was injected into the mesenteric vein of rats, a marked reduction in bile flow was observed. Similar results were obtained when the blood serum of patients was fractionated in an identical manner and the same fraction was injected into rats via the mesenteric vein. Histologically, dilated bile canaliculi with diminution of microvilli and increased vesicles around the dilated canaliculi were observed by electron microscopy after injection of the active fraction into rats. These results strongly suggest that not only the sensitized lymphocytes produce the cholestatic factor which caused the intrahepatic cholestasis by specific stimulation, but also this factor is involved significantly in the pathogenesis of intrahepatic cholestasis which is observed in patients with intrahepatic cholestasis in alcoholic liver disease.

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To assess clinical significance of breath-by-breath variation of tidal volume and its distribution pattern displayed as a histogram, continuous measurementof tidal volume was madewith electrical impedance pneumography for about 60 minutes. Subjects were composed of 26 normal male and 46 patients including 17 patients with restrictive lung disease and 29 patients with obstructive lung disease. To evaluate variation of tidal volume quantitatively, coefficeint of variance (C.V.) was used. In comparison to the normal pattern of distribution (C.V. = 26.0 ± 7.5%, mean ± S.D.), patients with restrictive lung disease showed extremely narrow pattern of the distribution and significantly smaller C.V. (17.5 ± 4.6% in old pulmonary tuberculosis, P < 0.005 and 18.9 ± 9.3% in pneumonitis, P < 0.025). Whereas, patients with obstructive lung disease showed widespread pattern of the distribution and significantly greater C.V. (43.2 ± 13.0% in pulmonary emphysema with hypercapnia, 33.0 ± 7.5% in normocapnia and 35.8 ± 9.4% in asthmatic attack, P < 0.005). In all the patients with bronchial asthma after the treatment, the extremely widespread pattern of histogram was returned toward the normal one and the C.V. was decreased (22.4 ± 6.4%). It was suggested that the distribution pattern of tidal volume was affected by the change of clinical condition, and was well correlated to the pathophysiological process related to restrictive or obstructive lung disease. Weconclude that anlysis of tidal volume distribution by the histogram is one of the useful approach to managepatients with respiratory diseases.

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A 23-year-old male was admitted to hospital with severe dehydration and hypokalemic myopathy due to secondary aldosteronism. Onadmissionserum sodiumand chloride were markedlyelevated to 198 mEq/1 and 169 mEq/1, respectively, and serum potassium was down to 2.3 mEq/1. Serum electrolytes were normalized by transfusion therapy, but subsequently rhabdomyolysis grew worse due to metabolic abnormalities such as dehydration, hypothermia, oppressive ischemia and metabolic acidosis, at the same time transient polyuria and the elevation of serum myoglobin and enzymesoriginating in muscle tissue were observed. Serum CPKwent up to 26, 532 IU/1 on the sixth day and other enzymes reached a peak following CPK. Dexamethasone was administered when the increase in enzyme levels caused the patient to fall into a stupor. Herapidly regained consciousness from the 15th day after admission, and he was able to stand up on the 29th day. Serumenzymes originating in muscle tissue decreased gradually to the normal range by the 30th day and no renal failure occurred.

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We report a patient with progressive systemic sclerosis (PSS) and Sjogren's syndrome (SS) who developed B cell malignant lymphoma ll and 10 years after the onset of signs of PSS and SS, respectively. As her lymphoma developed, autoantibodies such as rheumatoid factor and antinuclear antibody disappeared from the serum, the lupus erythematosus test yielded negative results and her immunoglobulin levels declined. A good response to chemotherapy was obtained but she died of acute interstitial pneumonitis. Postmortem examination revealed marked diffuse interstitial fibrosis of the lungs.

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A case of intralobar bronchopulmonary sequestration associated with aspergilloma was reported. It was suggested by radionuclide venoangiography and aortic cineangiography. The diagnosis was confirmed by subsequent pathologic examination of the lobectomized lung tissue. The pulmonary per fusion scan with ^99mTc-MAAshowed a per fusion defect in the right lower lung field. Perfusion defect could also be traced in the sameanatomical location in the pulmonary phase of radionuclide venoangiography with ^99mTc-pertechnetate. However, the area of per fusion defect was visualized as hot area, when the injected radionuclide was pumpedinto the aorta after its first pass through the lung. The radionuclide venoangiography can efficiently detect abnormal systemic blood supply of the lung tissue. It can be an useful methodfor suggestive diagnosis of bronchopulmonarysequestration.

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Heaptic hydrothorax occurred in a 38-year-old womanof severe hepatic failure complicated with pulmonary tuberculosis. The transdiaphragmatic passage of ascitic fluid to the pleural cavity was visually shownwith a scintigram using technetium-99m macroaggregated albumin and also shownwith a tracer analysis using indocyanine green. The ascites was suggested to be transported to the pleural cavity via the defect in the right diaphragm.

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