Spontaneous cell-mediated cytotoxicity (SCMC) against cultured rat liver cells (Coon cells) was investigated in healthy peripheral blood Iymphocytes using microcytotoxicity assay. Cytotoxic activity was found in fraction of EA-RFC, EAC-RFC, low affinity ERFC, aminoethylisothiuronium bromide (AET)-treated E-RFC and weak adherent cell showing % cytotoxicity of 40.0±6.3 (Mean±SD), 38.3±7.0, 21.8±16.2, 20.6±14.3 and 35.1±10.9, respectively. These results indicated heterogeneity in subpopulation of the cytotoxic lymphocytes mediating SCMC. Analysis of lymphocyte subsetS adherent to target Coon cells after 15 hrs incubation revealed that EA-RFC, EAC-RFC and E-RFC were 50.2±1.8%, 50.9±9.1% and 12.6±4.7%, respectively.
Some E, EA and EAC were found adherent to target Coon cells showing cytopathological alterations which appears attributable to the lymphocyte cytotoxicity, whereas, only few E, EA and EAC, if present, were adherent to normal Coon cells. It would appear, therefore, that receptor-like structures to E, EA and EAC might be formed on the surface of damaged target cells during incubation time with cytotoxic lymphocytes. Also, it is likely that changes of the membrane charge due to cytopathological alterations may cause non-specific bindings. And possible significance of SCMC in hepatocyte injury was discussed.

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In order to investigate the mechanism of oral ursodeoxycholic acid (UDCA) tolerance test for patients with hepatic diseases the concentration of UDCA in serum and bile, which were obtained from healthy subjects and patients with hepatic diseases after oral or intravenous administration of UDCA, was measured by radioimmunoassay, enzyme immunoassay, and mass fragmentography.
Almost all UDCA administered to subject with normal liver function was recovered in bile within 3 hours.
When UDCA (25-300mg) was orally administered to healthy subjects, a hepatic fractional clearance was constant in doses up to 300mg.
When UDCA (50mg) was orally administered, area under curve (AUC) in patients with hepatic diseases was larger than that in healthy subjects, and the enhancement of AUC was parallel to the severity of hepatic diseases.
It is concluded that AUC in oral UDCA tolerance test reflects changes in liver function occuring with hepatocellular damage.

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The hepato-biliary scintigraphy with ^99mTc-HIDA and ^99mTc-PI and the measurement of hepatic clearance have been studied on constitutional hyperbilirubinemia and ICG excretory defect disease. The results obtained are as follows:
1) In Dubin-Johnson's syndrome cases, the hepatic uptake of ^99mTc-HIDA was faster, but the excretion was extremely slower than in normal cases.
2) Hepatic uptake and excretion of ^99mTc-PI were both almost normal in DubinJohnson's syndrome.
3) In Rotor's disease, hepatic uptake of ^99mTc-HIDA was very poor, showing almost no hepatic image.
4) In Gilbert's disease and ICG excretory defect disease, hepatic uptake and excretion of ^99mTc-HIDA were both within normal limit.
From these results it can be presumed that Dubin-Johnson's syndrome and Rotor's disease differ in morbid condition. Dubin-Johnson's syndrome, Rotor's disease and Gilbert's disease show the different patterns between hepatic uptake and excretion on ^99mTc-HIDA hepatoscintigraphy and these patterns contribute to the differential diagnosis of constitutional jaundice.

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Mesocaval H shunt operation was performed for 37 patients with portal hypertension from April 1974 through March 1977. The following conclusions were obtained.
1) Mesocaval H shunt operation was considered safe procedure because intraoperative blood loss was samll and operative time was short. This method was successfully performed in emergency cases with bleeding esophageal varices.
2) Post-shunt portal pressure was between 200 and 300 mmH₂O in 70% of patients. Decompression to this level of portal pressure was enough to prevent recurrent variceal hemorrhage.
3) Continued perfusion of the liver was identified in 26 patients by posoperative celiac arteriography. Interposed synthetic vascular graft appeared to work as optimal resistance between the superior mesenteric vein and the inferior vena cava, which served for maintaining hepatopetal portal blood flow.

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Peritoneoscopic liver surface figures of 192 cases with alcoholic liver injury were studied by comparison with histological findings of simultaneously obtained liver biopsy specimens.
We classified liver surface figures into six patterns according to the unevenness: smooth, beginning protuberant, advanced protuberant, beginning nodular, advanced nodular and hemispherically nodular surface pattern. Each protuberant and nodule was small with a diameter of 0.5 to 1.0mm, but the nodules in the hemispherically nodular surface pattern was bigger and sometimes more than 10mm in diameter. In addition to themicrosized protuberances and nodules, "waves" were observed on the surfaces of about 70% of all cases except those with smooth and hemispherically nodular surface pattern. The waves had a period of 5 to 10mm and each was covered with several protuberances and nodules.
Analysis of the histological architecture of biopsy specimens with waves showed that the area under each peak was in better condition than that under each trough between waves.

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The purpose of this paper was to explain a significance of intravascular tumor thrombus in hepatocellular carcinoma (HCC).
The relationship between intravascular tumor thrombus and growth fashion, the presence or absence of cirrhosis, distant metastasis and splenomegaly was studied in 61 autopsy cases of HCC.
In 33 cases, tumor thrombus was seen in the portal veins and it was seen in the hepatic veins in one case. In 22 cases, it was seen in both portal and hepatic veins. 5 cases had no intravascular tumor thrombus. In concern to growth fashion, the intravascular tumor thrombi were recognized more frequently in the infiltrative and mixed types rather than the expansive types. Tumor thrombus in the portal veins was recognized frequently in the cases with cirrhosis, and tumor thrombus in the hepatic veins was frequent in the cases without cirrhosis.
Close relationship between tumor thrombus in the portal veins and distant metastasis was not recognized, but some relationship was seen between metastasis and tumor thrombus.
The mean weight of the spleen increased in the cases with both cirrhosis and tumor thrombus in the portal veins.

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Clinical and pathohistological studies on the 44 cases with hepatitis or cirrhosis of the liver histologically confirmed by biopsy except 5 cases, who developed hepatoma in variable periods of time of follow-up, were reported.
The prevalence of HBsAg in their sera was 35.7% and that of anti-HBc was 67.4%. All cases whose sera were positive for HBsAg at death showed positive HBsAg in the liver obtained by biopsy on the first occasion. This indicated that they had persistent infection of HBV.
Retrospective studies suggested that HBsAg positive, latent cirrhosis appeared to have a higher risk to develop hepatoma. Frequent determination of serum AFP could not be a clue for the early detection of the hepatoma so far in cases reported. In the biopsied liver of a case with chronic active hepatitis was found a minimal deviation hepatoma 4 years befbre the full-development of hepatoma. This finding suggested that hepatoma with cirrhosis might develop in some cases already in a stage of chronic hepatitis.

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Among 180 patients with unresectable hepatocellular carcinoma, 100 patients were treated with one shot injection of anticancer agents through the hepatic artery. The rest of them had palliative care. Studies were made on the therapeutic effects, indicative selection of patients and untoward effects of the chemotherapy by means of clinical, biochemical, angiographic data and histological examinations.
The results were as follows.
1) 33 cases (33%) survived longer than 6 months after the start of chemotherapy (one shot chemotherapy), and 13 cases (13%) of them lived longer than one year. The longest survival was 35 months.
2) Alleviation of upper abdominal pain, regression of liver size and decrease of serum AFP level after the chemotherapy were observed in 45.7%, 31.9% and 46.6%, respectively.
3) Autopsy specimens revealed replacement of fibrous tissue in the tumor area suggesting the chemotherapeutic effect.
4) Patients with intractable ascites and/or overt jaundice were contraindicated for the chemotherapy, and those with sGOT>250u., LDH>600u. and BSP retension (at 45min.) >30% might be not considered for indication of the chemotherapy.
5) Patients with tumors occupying more than 75% of the liver and those with portal trunk opacification in arterial phase of celiac angiograms, had no indication for the chemotherapy.
6) Myelosuppression was observed as a untoward effect of repeated chemotherapy.

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This is a 46 year-old female who has had no remarkable symptoms besides high level of alkali-phosphatase, elevated blood sedimentation rate and positive rheumatoid factor. The patient showed itching, jaundice and fever after administration of Sulfisomesole. After treatment of this patient with steroid for eight months, jaundice disappeared and rheumatoid factor became negative but high levels of alkali-phosphatase and γ-GTP remained. On admission in our clinic, low titer of anti-mitochondria antibody (AMA) with normal level of immunoglobulin was observed. The histological examination of biopsy specimen of her liver showed a finding of acute intrahepatic cholestasis.
After stopping the steroid-therapy, rheumatoid factor became positive with high level of IgM and titer of AMA increased. Two years later, histoligical examination of her liver removed surgically showed a finding of primary biliary cirrhosis (PBC).
In surveying the clinical course of this patient, this case was considered to be a case of presymptomatic primary biliary cirrhosis whose sera showed increased characteristic serological findings after stopping steroid therapy for drug-induced hepatic injury.

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A 20 year-old male complaining of hepatomegaly, which had already been noted at 12 years old, was admitted on March 28, 1978.
The elastic hard liver was palpable five finger-breadths below the costal arch in the right midclavicler line. The liver function tests were normal, but the liver scan with 99mTc-colloid showed a decreased activity and focal defect in the anterior segment of the right lobe.
A scintigram of the liver and biliary tract with 99mTc-PI was almost norlnal Celiac angiography demonstrated the enlarged and tortuous right hepatic artery, and many arterial branches radiated centrifugally from the area initially supplied by the feeding arteries. On the capillary phase, a tumor stain with clear boundaries was showed. A right hepatic lobectomy was performed on April 12, 1978. The mass was reddish brown in color and about a man's head in size. It was divided into nodules of various sizes by fibrous septa. Microscopic examination of the tumor revealed nodular hyperplasia of mature liver cells and vessels with thick walls distributed in the surrounding fibrous connective tissue. There were bile duct proliferation and lymphocyte infitration in boundary regions of both. The final diagnosis was focal nodular hyperplasia. The patient's postoperative course was uneventfil. He was discharged one month after surgery and was in good health, when last seen in January 1979.

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