The hepatitis virus has a long and elusive history. In Japan, hepatitis resulting from blood transfusions became an urgent problem after the World War II due to an increase in the number of transfusions after the establishment of blood banks. Social measures, such as the “yellow blood” compaign, soon became necessary. The Group for Investigation and Research on Serum Hepatitis was established by the Ministry of Health and Welfare in 1963 even though there was at that time no sign of the causal virus. The elusive virus was discovered quite unexpectedly soon afterward.
The scope of the research has been deepened further, and the hepatitis virus, especially prevalent in Asia, is gradually being brought under control. The practical utilization of hepatitis virus B vaccine, which was recently developed in Japan and also in the other coun-tries, is planned in Asian countries. For this purpose, a workshop on hepatitis B vaccine sponsored by the World Health Organization was recently held.
On the other hand, some of anti-virus agents and immunomodulators have been applied to treat chronic viral hepatitis, and we look forward to the results of ongoing research, much of which has already showed a great promise.

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Both bile acid and bilirubin are metabolized in liver cell. The change in concentrations of bile acid and bilirubin and the relationship between these two substances have not been elucidated in liver diseases.
The present study was done on 10 cases of acute hepatitis, 26 active chronic hepatitis, 23 liver cirrhosis, 8 liver cirrhosis with hepatoma, 11 asympotomatic HBV carrier and 10 healthy subjects. Serum bile acids, bilirubins, GOT & GPT, alkali-phosphatase and cho-linesterase were measured and following results were obtained:
1) Concentrations of total bile acid and cholylglycine in asymptomatic HBV carrier were in normal range.
2) Significant correlation was found between total bile acid and cholylglycine concentra-tions in patients with chronic hepatitis, but not in patients with liver cirrhosis. The con-centrations of both total bile acid and cholylglycine were higher in liver cirrhosis than in chronic hepatitis.
3) The difference in total bile acid level was not statistically significant between liver cirrhosis and liver cirrhosis wtih hepatoma, bit the latter showed significantly lower value than the formar in cholylglycine level.
4) Comparison of the change in bile acid concentration with the change in bilirubin concentration was evaluated. In additoin, the ratio of bile acid to bilirubin and GOT & GPT, alkali-phosphatase and cholinesterase levels were calculated. Relation between the change in alkali-phosphatase and the ratio of bile acid to bilirubin change was significant, that is, the change in bile acid was greater than the change in total bilirubin concentration.

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A biliary tract scintigram is used to investigate the hepatobiliary tract function. We examined 57 men using a biliary tract scintigram, and 21 of these cases were examined by the drip infusion cholangiography (DIC). The basic detecting capacity of the scintig-ram was also examined.
In the basic experiment, we connected three tubes with different diameters, and counted radioactivity in the tubes, which contained ^99mTcO-₄ liquid and measured the diameters in the scintigram.
The diameters of the tubes in the scintigram were highly affected by the isotope volume and by the counting time.
In the clinical cases, the scintigram diameters of the common bile duct did not highly correlate with the cholangiographic diameters (r=0.59).
The detecting capacity of the scintigram was compared with that of DIC by using dif-ferent concentrations. Scintigram showed better detectability than DIC in the common duct. DIC showed better detecting capacity in the hepatic bile duct. There was no dif-ference between them in the gallbladder.
As for the symptoms and the signs, we examined the data separately. The scintigram and DIC gave different diagnosis in five out of 21 cases: two cases with liver cirrhosis, one with cholangitis, one with biliary cirrhosis and one with cancer of pancreatic head.
In conclusion, it could be suggested that the diameter of the biliary tract should be examined with caution using scintigram. Since some of the case examined by these two methods turned out to have different diagnosis, it was not very meaningful to compare which one was a superior method. It was recommended to use both methods concom-itantly.

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Strictly speaking, a silent stone should be defined as one which is entirely free of complaints, in spite of the presence of a stone throughout the clinical course.
However, it is difficult to prove that the patient is completely asymptomatic.
Thus, it would seem more appropriate to interprete the term as a comprehensive ex-pression including cases which occasionally have such slight and indefinite abdominal symp-toms as not interfering with the daily life.
The reason is that it is difficult to ascribe these complaints to cholelithiasis.
From such a viewpoint, 58(6.07%) out of 954 cases of cholesystectomy operated between 1973 and 1980 were considered the so-called silent stone cases. The cases were broken down to 23 female (38-69 years of age) and 35 female cases (25-74 years of age), cases over 50 years of age was 65.5 percent.
When surgical findings, histopathological findings of resected gallbladder and DIC find-ings were examined, more than 80 percent of the cases showed evidence of inflammation, there being many choesterol calcli.
The majority of the cases showing evidence of adhesion, RAS, thickening of the wall and cholesterosis had floating stones irrespective of the size of stone;nearly half of the cases with negative cholecystograms showed thickening of the wall, floating calculi being seen in many cases.
The followings are indications for surgery in silent stone cases.
1) Where roentgenograms reveal many floating, stones where cholecystograms are negative, where the wall is irregular and where the contraction is poor.
2) Cases over 60 years of age, showing good general conditions. Cases under 60 years of age, complicated with diabetes.
3) Cases not responding to lithotriptics.

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The case records of 267 patients with pancreatic cancer, 113 gallbladder cancer and 63 liver cancer were collected from 20 National Hospitals in Japan. The records were reviewed and the following results were obtained.
Pancreatic cancer frequently occurs between the age of 50 and 79. Most signs and symptoms are not specific for pancreatic cancer. However, jaundice is an important clue to the detection of cancer of the pancreatic head. An important problem to be solved is how to detect cancer of the pancreatic head without jaundice. In order to detect cancer of the pancreatic body and tail, we have to pay attention to the slight abnormalities in amylase or glucose levels and to carry out ultrasound examination or ERCP in patients with such abnormalities.
Gallbladder cancer was more common in females with male-to-female ratio of 1 to 2.1. The highest incidence occurred between the age of 50 and 79. Cancer of the gall-bladder was often accompanied by cholelithiasis. Correct diagnosis was made only in 32.7% of the cases preoperatively. Female patients with cholelithiasis at the high risk age should be examined fully and surgical intervention can not be avoided for questionable cases.
Cancer of the liver is predominant in males. The peak incidence occurred at the age of 40 and 69. About 80% of the cancer of the liver was accompanied with liver cirrhosis. Patients with liver cirrhosis should be examined fully and followed up very closely.

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A 54-year-old female patient was admitted to the hospital because of the tumor in the epigastric region which had been developed for 6 years prior to admission. The patient had no specific hormonal symptoms.
Laparotomy showed irregularly enlarged liver with miliary or walnut-sized multiple solid nodules and adult fist-sized protruded mass. Hepatoma was suspected clinically and partial resection of the tumor was performed for histological examination. No tumor could detec-ted in gastro-intestinal tract, pancreas, bile buct and other organs. There were no ascites or peritoneal disseminations.
The cut surface of the resected specimen revealed multiple gray-white or pale yellow nodules often with extensive bleeding. Histologically, the tumor was composed of rela-tively uniform small cells arranged in trabecular, solid-alveolar glandular or papillary pat-tern. Occasionally, rosette-like structures were noted. Histochemically, the tumor cells wese positive for the argyrophil reaction by Grimelius' method, but negative for the argentaffin reaction by Fontana-Massons' method. Furthermore, the tumor cells had cha-racteristic neuro secretory granules by electron microscopy. From these results, the patho-logical diagnosis of this tumor was determined as a primary carcinoid tumor of the liver.
The patient died of DIC three weeks after the operation. Autopsy was not performed.

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Tuberculosis of the liver is a rare disease in Japan nowadays, especially solitary type is extremely rare. Recently we experienced one case of tuberculous lesions of the liver as follows.
The patient had complained of recurrent fever and general fatigue for more than three years. Laboratory data showed general inf lammmation and the increases in bile duct enzymes. He was suspected to have liver tumor by liver cintigram, CT scan, and selective celiac angiography, and was operated. Two quail and hen-egg sized nodes were found in both lobes. Right partial lobectomy of the liver was performed and tuberculoma with cas-eating necrosis was revealed by histological examination.
Among 53 cases of tuberculosis of the liver reported in Japan from 1953 to 1978, there were only seven solitary cases. When one tries to diagnose this disease, other liver tumor must be differentiated because of the similarity of the clinical picture and laboratory findings.

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A 57-year-old female patient underwent hepatic lobectomy for her small hepatocellular carcinoma. She had been treated as active hepatitis since Jan. 1979 and was diagnosed as postnecrotic liver cirrhosis by liver biopsy. On Feb. 1981, an abnormal elevation of alphaf etoprotein, 3200 ng/dl, was found which strongly suggested the presence of hepatoma. She was further examined using CT-scan and angiography which revealed a small hepatic tumor shadow. Histological findings showed 2×2×2 cm size of well delineated tumor. Postoperative complications were evaluated and the other liver function tests were also described.

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Fluminant hepatitis isseen in about two percent of patients with acute hepatitis and its mortality is high. It is generally divided into two types according to the duration of the survival after the onset of the disease. In fulminant hepatitis, death occurrs about 10 days after the onset. Those cases survived longer than 10 days are diagnosed as subacute hepatitis. We experienced a case of subacute hepatitis and described it in this report.
A 53-year-old male with chief compliants of general fatigue, jaundice, and ascites was admitted to the hospital. In blood biochemistry, the GOT level was higher than the GPT level. Colloid reaction was abnormally high and change in jaundice was seen. After ad-mission, the concentration of ammonium in the blood was elevated and transaminases were decreased. However, jaundice was in creased and psychic symptoms developed from the fifth day of the disease. In spite of various treatments including the steroid therapy, the liver patient died about 30 days after the onset. Autopsy findings revealed severe atrophy of the and diffuse necrosis of hepatic cells.

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The patient was a 33-years-old female. She was admitted to other hospital in June, 1978, suffering from weakness of the lower extremities and general fatigue after her first delivery. She had weakness of grasping power, and markedly elevated serum CPK & LDH levels, so was diagnosed as polymyositis.
She got improvement by continuous administration of adrenal cortical steroids. How-ever, one and half years later, she was pointed out the elevation of serum transaminase activity, and admitted to our hospital for two months from April, 1980. Laboratory data was as follows;serum total bilirubin 2.17 mg/dl, SGOT 238 mU/ml, SGPT 248 mU/ml, LDH 296 mU/ml, Al-P 318 mU/ml, Ch-E 0.65, LAP 1304 GRU, γ-GTP 351 U, CPK 254 U, total cholesterol 288 mg/dl.
In the course of follow-up in our out-patient clinic, symptoms of pruritis and jaundice increasingly developed, and she was re-hospitalized in July, 1982. The laboratory data showed hyperbilirubinemia (8.08 mg/dl), hypercholesterolemia (580 mg/dl), increase in activity of serum alkaline phosphatase (500 mU/ml), and furthermore antimitochondrial antibody was demonstrated. From these findings she was diagnosed as a case of primary biliary cirrhosis (PBC). The liver biopsy specimen revealed histological findings corre-sponding to the second stage of PBC by Scheuer's classification.
Following re-hospitalization, general condition has been gradually improved under trea-tment with adrenal cortical steroids.

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We discussed about the meaning of bleeding from the anastomotic region part after alimentary tract surgery in patients with liver cirrhosis.
The diseases for which we performed operation were as follows: esophageal varices 10 cases, stomach bleeding…2 cases, cardiac varix…1 case.
Among 10 cases of esophageal varices, we experienced suture insufficiency in 2 cases, but we never recognized bleeding from the anastomotic region in these 2 cases in spite of major suture insufficiency in one case.
Contrary to these facts, in 2 cases for which we performed stomach operation (stomach resection or total gastrectomy), we experienced suture insufficiency and uncontrollable bleeding from the anastomotic region, which eventually brought about fatal hepatic failure.
The reason why bleeding occurred in stomach operation while no bleeding in esophageal varices even with suture insufficiency, was because in esophageal transection we performed devascularization elaborately around the anastomosis and used many sutures.
Thus, we concluded that also in stomach resection in patients with liver cirrhosis we must perform elaborate devascularization around the anastomatic regions and use many sutures in anastomosis.

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A case of 16-year-old woman with congenital cystic dilatation of the common bile duct and anomalous pancreaticobiliary tract anastomosis was reported. The patient was admitted with chief complaints of recurrent pain in the hypochondrium and fever. No abnormal findings were observed by physical examination and laboratory examination except slight elevation of theurinary amylase level but a cystic dilatation of the common bile duct and dilated hepatic ducts were revealed by a screening ultrasonography. By further examina-tion such as endoscopic retrograde cholangiopancreatography (ERCP) and drip infusion cho-langiography (DIC), thecystic dilatation of the biliary systems and an anomalous pancreati-cobiliary tract anastomosis were confirmed. The dilated common bile duct was resected and the reconstruction of the biliary system was carried out by choledocho-jejunostomy with Roux-en Y fashion. The post-operative course was uneventful and the patient was relieved from the long illness.
The authors presented details of this case and discussed about pathtophysiology and treatment of this disease.

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Although the diagnostic method for pancreatic cancer has made a rapid progress in recent years to the point of allowing detection of a minute cancer with a considerable fre-quency, the current status of the approach to this problem is still far from perfect, with the 5-year survival rate being disappointingly low. The reason for this is primarily the unavailability of an effective, easy-to-use means of early detection for pancreatic cancer. We applied high performance liquid chromatography (HPLC) to the diagnosis of pancreatic cancer and obtained findings specific for this particular malignancy. This procedure employs 100 μl untreated serum as sample, which is allowed to pass through Super 8 con-sisting of eight GA-150 columns (Asahi Kasei) for an analysis time of 100 minutes. The chromatogram thus obtained is subject to statistical processing with respect to 3 indications developed by us. This diagnostic test was positive in 11 (79%) of 14 cases of pancreatic cancer and in 39 (83%) of 47 cases of other malignant tumors. We have a plan of making further research efforts, including detailed analysis of the test results in relation to disease stage and refinement of the column and solvent, to establish the availaility of the procedure as a simple biochemical diagnostic test for pancreatic cancer.

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