The effect of bile acids such as chenodeoxycholic acid (CDCA), ursodeoxycholic acid (UDCA), deoxycholic acid (DCA) and cholic acid (CA) on the plasma membrane of the cultured cells (Chang's cells) was investigated. 10 minutes after addition of each bile acid to cultured cells, relative turbidity and protein concentration in culture medium were measured, and these cells were studied with an electronmicroscopy. Relative turbidity was decreased by addition of any of bile acids significantly, whereas protein concentration was increased by addition of bile acids except UDCA. Significant correlation between relative turbidity and protein concentration was obtained under the treatment with CDCA, DCA and CA, but that was not shown under the treatment with UDCA. Transmission electronmicrograms revealed the plasma membrane of the cells treated with CDCA having decrement in the number of microvilli and being edematous. These findings were hardly seen in cells under the treatment with UDCA even in great doses as 7.5mM. Scanning electronmicroscopically, reduction and dilatation of microvilli were shown by addition of CDCA. Although similar findings were observed by addition of UDCA, these were very slight.
These results suggest that the mechanism of membrane solubilization by CDCA and UDCA is different each other, and it may be consistent with the fact that UDCA is less toxic to cells than CDCA.

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Liver regeneration pattern and metabolic changes after major hepatectomy in children were studied based on our cases aged from 3 3/12 to 7 9112 year-old (average 1 9/12 year-old)
The results were as follows: 1) The residual liver volume after major hepatic resection were restored to preoperative volume at 8 weeks after operation and the shape of regenerated liver showed spheric. 2) Serum protein, alubumin and cholinesterase value were continued in low levels after operation but these returned to approximately to normal level at 4 weeks after oparation. Serum transaminase level was increased postoperatively but was normalized at 7th postoperative day.
From the above results, the liver regeneration after major hepatectomy in children is rapid, and is completed for the most part, functionally at 4 weeks and morphologically at 8 weeks.

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Diagnostic usefulness of modified competitive binding radioimmunoassay using protein A for the detection of immunoglobulin M (IgM) to hepatitis A virus (HAV) was studied in acute hapatitis A patients sera.
1) Diagnosis of hepatitis A was firmly made as a G index which is the ratio of IgG treated cpm to non treated cpm showing to be less than 2.0.
2) An IgG treated procedure was more reliable than an IgM treated one for the diagnosis of hepatitis A in the early acute phase sera of the illness.
3) Our study suggested the presence of IgG anti-HAV in early acute phase serum of hepatitis A.

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The histological features of the liver biopsy specimen taken from 28 patients with viral hepatitis Type A were compared with those of 10 patients with viral hepatitis Type B.
Liver biopsy specimens of viral hepatitis Type A were all obtained in the outbreak of viral hepatitis Type A at a primary school in Saga prefecture, 1977.
Liver biopsy was performed within 14 days after onset in 16 of 28 cases with viral hepatitis Type A and all of 10 cases with viral hepatitis Type B. Liver biopsy specimens were obtained over 30 days after onset in 12 of 28 cases with viral hepatitis Type A.
In viral hepatitis Type A, portal tracts are markedly enlarged with a dense mononuclear cell infiltrate. The hepatocytic alterations are mainly restricted to the periportal area, and the parenchymal alterations are less severe than the changes of the portal tract. Proliferation of Kupffer cells is less conspicuous.
In contrast, in viral hepatitis Type B, the hepatocytic alterations are more remarkable in the centrilobular areas while portal inflammation is less conspicuous.

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To inquire whether the establishment of HBsAg carrier state was genetically determined or not, HLA typing was carried out in 58 infants in whom HBs antigenemia persisted one year or longer since their contraction of infantile papular acrodermatitis (Gianotti's disease). The frequency of HLA Bw54 in the carrier infants (39.6%) was found to be significantly higher than that observed in normal Japanese population (12.8%) (X²=20.54, corrected P<6.8×10^-5). Furthermore the frequency of Bw54 increased with the age when the infants had infantile papular acrodermatitis. These findings showed that genetical factors were involved in the establishment of HBsAg carrier state in the infants who were infected with hepatitis B virus. However the high frequency of Bw54 was observed in male carrier infants, not in female. This finding indicates the genetical regulation in the establishment of HBsAg carrier state is affected by sex.

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When the blood serum from patient with drug-induced allergic intrahepatic cholestasis was fractionated by a Sephadex G-75 gel filtration and the certain fraction was injected into mesenteric vein of rats, a marked reduction of bile flow was seen. Similar results were obtained when peripheral lymphocytes from the patient were stimulated with a specific drug in vitro in the presence of soluble liver specific protein fraction and the certain fraction which was fractionated with a Sephadex G-75 gel filtration followed by a DEAE-cellulose column chromatography was injected into mesenteric vein of rats. Histologically, a dilated bile canaliculus with the diminution of microvilli and increased vesicles around the dilated canaliculi were observed by an electron microscopy after injection of culture supernatant fraction into rats.
These results strongly suggest that not only the sensitized lymphocytes produce the cholestatic factor (factors) which causes the intrahepatic cholestasis, but also this factor involves significantly in the pathogenesis of intrahepatic cholestasis which frequently observes in the patients with drug-induced allergic hepatitis.

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Glucose tolerance and changes of insulin-glucagon molar ratio (I/G ratio) on oral glucose tolerance test was studied in fifteen patients with obstructive jaundice and ten normal persons as control. The former group showed glucose intolerance and lowered initial rise of I/G ratio which indicated relative hypoinsulinemia-relative hyperglucagonemia.
Changes of I/G ratio in the peripheral and in the portal vein on duodenal glucose administration were studied in five jaundiced dogs and in five normal dogs as control. The dogs acquired jaundice by the ligation of the common bile duct two weeks before the study. Jaundiced dogs showed lowered initial rise of I/G ratio in the peripheral vein comparing with control dogs. But I/G ratio in the portal vein of jaundiced dogs remained higher than that of control dogs during the study.
Therefore these findings suggest that there is the accelerated hepatic extraction of insulin behind the glucose intolerance and relative hypoinsulinemia-relative hyperglucagonemia in obstructive jaundice.

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Although anatomic extent of the cancer will be exactly an important factor in evaluating the prognosis of hepatocellular carcinoma (HCC), however, a clinical staging system for HCC should be based on functional matters rather than anatomical ones. Authers have tried to device a new staging system for HCC based on residual function of cancer bearing liver by using albumin, bilirubin, GOT, GOT/GPT, ICG-15' and existence of ascites as markers. According to the total score calculated from scoring method, clinical stages were devided into three such as stage I, stage II, and stage III. Cases of stage III, reflecting markedly impaired residual liver function, had poor prognoses, whereas, many of the cases of stage I had good prognoses probably owing to well preserved liver function. This newly developed classification was useful in evaluating the prognoses of the patients with HCC.
Intra-arterial one-shot injection therapy with dose-dependent anticancer drugs (mitomycin C and/or adriamycin) was of use in all the three stages, especially in the cases of stage I, from the viewpoint of survival time.

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Human α₁-microglobulin (α₁-m) is a new serum protein, widely distributed in various body fluids, such as serum, urine and cerebro-spinal fluid. Detection of the protein appeared to be another valuable indicator for the evaluation of degrees of a renal dysfunction just like the detection of β₂-microglobulin.
However, the physiolosical function and production site of α₁-m are not known yet.
We detected α₁-m in culture medium of the Alexander cell, an established human hepatoma cell line with production of hepatitis B surface antigen (HBsAg). The amounts of α₁-m was proportionately increased in the supernatant with increased numbers of the cultured cells.
Further-more, we performed immunohistochemical examination, α₁-m was localized in the cytoplasm of Alexander cells, detected with an indirect immunoperoxidase method us ing anti-α₁-m goat serum. The population and distribution of the positive cells were roughly correlated to the amounts of α₁-m produced. No positive staining was observed when normal goat serum was used as control.
The result of the present study together with the preveous report of the detection of α₁-m in other hepatoma cell line (C-CH₄) indicates that α₁-m is produced by malignant hepatocytes.
The evidence suggested that α₁-m is possibility one of onco-fetal proteins like α1-fetoprotein produced by hepatoma and fetal liver.

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An ectopic liver tissue was found at the serosal surface of the gallbladder, during cholecystectomy of a 46-year old women.
By histologic examination, the hepatic lobules of this ectopic liver appeared to be different from normal ones.
However, most of the portal area had a bile duct, artery and vein.
Some of the portal area showed imcomplete architecture.
Mild cholestasis and hepatocytic cell necrosis were noted in most of the centrolobular areas.

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A 14-yearold female with acute hepatitis (severe form) was submitted to peritoneoscopy on the 80th day after admission.
The liver lobes have undergone a great deformation due to extensive necrosis and subsequent regeneration of hepatocytes. As a result, the right liver lobe showed a funnel liver and the left liver lobe showed a classical potato liver of H. Kalk. It is interesting that α-fetoprotein (AFP) has been detected from the 30th day to the 61th day after admission (max. 940ng/ml), because such a transient elevation of AFP may also represent active hepatocyte regeneration after extensive necrosis. By these findings, we considered that this case would have very good prognosis and peritoneoscopy should be done during the convalescent stage of acute hepatitis.

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We reported an alcoholic case of B-type chronic hepatitis with transient ascites, edema and pancytopenia.
A bone marrow tap done on 10th hospital day showed hyperplasia.
On 17th hospital day, laparoscopy revealed the white liver with the surface of multiple small irregular concavities.
Pathology showed swelling of liver cells, pericellular bibrosis and Mallory bodies.
Portal fibrosis, eosinophilic degeneration of liver cells and proliferation of Kupffer cells, however, were not so remarkable.
Shikata's bodies were positive with Orcein stain.
The ascites and pancytopenia were atributed to swelling of liver cells and pericellular fibrosis followed by sinusoidal narrowing resulted in portal hypertension and hypersplenism.
In spite of positive HBsAg and HBcAb in this case, we cannot neglect the alcoholic damage to the liver.
Alcoholic liver damage superiuposing on B-type chronic hepatitis must be most likely diagnosis of this case.

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A 31-year-old female who had a 4 or 5 year history of heavy alcohol ingestion was admitted for evaluation of jaundice and generalized convulsions. At out patient clinic, the hemoglobin was 10.1g/dl, the hematocrit 30.7%, the reticulocytes 53‰, the serum bilirubin 12.1mg/dl (direct 6.4), the serum cholesterol 300mg/dl, the TG 613mg/dl, the GOT 441mU/ml, the GPT 61mU/ml, and the γ-GTP 2090mU/ml.
An osmotic fragility test performed on 7th hospital day was normal and survival halflife for ⁵¹Cr erythrocytes were 19 days. A bone marrow aspiration revealed normochromic erythroid hyperplasia and a liver biopsy carried out on 9th hospital day showed alcoholic hepatitis.
Of 36 cases of Zieve's syndrome which had been reported in Japan until 1979, 11 were confirmed a decompensated hemolytic anemia by either osmotic fragility test or survival halflife for 51Cr erythrocytes.

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A 16-year-old man was admitted to Jichi Medical School Hospital with complaints of jaundice and hepatomegaly. He has been photosensitive since the age of 3 years old.
On admission, microcytic hypochromic anemia, slight disorders of hepatic function tests and remarkable increase of protoporphyrm in the stools were confirmed, leading to the diagnosis of erythropoietic protoporphyria.
An enlarged dark green liver was peritoneoscopically observed. Histological findings of a liver needle biopsy revealed micronodular liver cirrhosis of small sized pseudolobules surrounded with slender fibrotic septa, containing brownish red pigment deposits perilobulary in bile ductules, bile canaliculi, kupffer cells and parenchymal cytoplasma.
Electroscopically, the pigments were confirmed as protoporphyrin, showing characteristic features of hair like star-burst deposits.
The patient died finally of hepatic failure after 4 years of clinical course and in the acute excerbation periods of which, increased activity of ALA synthetase was observed.
From the results obtained the case is considered to belong to the category of erythrohepatic protoporphyria, in which the metabolic disorders of porphyrin might have taken place not only in the bone marrow but also in the liver itself.

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This study demonstrated the most valuable factors of endoscopic findings by the classification of Portal Hypertension Society. The endoscopic findings of esophageal varices in 172 patients including 148 cirrhotics, were analyzed.
As a result, it became apparent that the Fundamental Color of the varices and the Red-Color Signs were indicative to rupture of the varices. Bleeding rate was 79.4% in the patients with blue varices, whereas it was 45.7% in the patients with white varices (P<0.001), furthermore, only 5.3% of the patients with white varices on which the Red-Color Signs were not observed. Bleeding rate were 58.7% in the patients with the Red-Color Signs on the varices, Whereas it was 9.1% in the patients without the Red-Color Signs (P<0.001). There was no correlation between the bleeding rate and each categories of the Form and Location of the varices except Erosion of the esophagus.

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