The auther has studied relationship between hepatic venous wedge pressure and hepatic venous catheterization method in the group of patients with heart disease or diabetes not accopanid by any evidence for hepatic parenchymal disease and also in the group of patients with hepatic disease. Following are the results and conclusion: (1) Minimal positive correlation and negative correlation were found between hepatic venous wedge pressure (HVWP) and the ratio of effective hepatic blood flow to cardiac output (EHBF/CO) in the non-hepatic group and hepatic group, respectively. From these findings, in the non-hepatic group, HVWP appears to be proportional to the hepatic blood, flow, and in the hepatic group, the elevation of HVWP would be suggestive of the intrahepatic disorder of portal circulatory system, furthermore, indicative of increase in the intrahepatic vascular resistence. (2) In the hepatic group, no significant correlation was found inbetween disappearance rate of BSP and EHBF/CO, meanwhile in the non-hepatic group, modest positive correlation was found inbetween these two parameters. In the non-hepatic group no significant correlation was found between disappearance rate and HVWP, while in the hepatic group modest negative correlation was found. These would imply that disappearance rate could be proportional to hepatic blood flow in the non-hepatic group, while in the hepatic group the decrease in disappearance rate could be indicative of hepatic parenchymal damage. (3) Negative correlation between A-H BSP difference and EHBF/CO was significant in the hepatic group.Modest negative correlation was found in between A-H differenceand disappearance rate in the non-hepatic group, while no significant correlation in the hepatic group.Similarly minimal negative correlation was found inbetween A-H difference and HVWP in the non-hepatic group, and no significant correlation was found in the hepatic group.Although, in the hepatic group, if cases of acute hepatic disease are omitted, significant positive correlation was found. Therefore, generally speaking, reduction or increase in A-H difference would possibly be reflections of acceration or deceleration of hepatic blood flow rate.
The author has induced toxic injury of the livers experimentally in dogs by intramuscular injection of 2-3 Dithiopropinol (BAL) or carbon tetrachloride (CCl4). Hepatic venouscatheterization was performed in these animals, and interrelation between hepatic venous wedge pressure (HVWP) and parenchymal clearance of BSP was studied. Followings are the results and conclusion: 1) In the BAL group statistically significant elevation of HVWP was observed as compared to the control group, meanwhile in the CC14 group significantly higher HVWP was observed as compared to the BAL group. These findings appear to be suggestive of the fact that the more extensive the parenchymal damage of the liver, the higher the HVWP. Furthermore, the elevation of HVWP in case of induced toxic injury of the liver by BAL and CC14 is suggestive of the presence of intrahepatic resistance. 2) Disappearance rate of BSP has shown statistically significant decrease in the BAL group relative to the control group, while in the CCl4 group farther decrease ralative to the control group. Significant corelation is noted between disappearance rate of BSP and HVWP in the control group, while in the group of induced hepatic injuries, significant negative corelation is found. These findings appear to be suggestive of the fact that the decrease in disappearance rate in the BAL and CCl4 group is due to the impaired uptake of BSP by hepatic cells. 3) In the BAL group, statistically significant decrease in A-H BSP difference relative to the control group is observed, and in the CCl4 group farther decrease is noted as compared to the control group. In group of induced hepatic injuries, A-H difference has shown significant negative corelation to the HVWP, whereas A-H difference has shown significant positive corelation to the disappearance rate of BSP. From these findings it will be postulated that the decrease in A-H difference in the group with experimentally induced injuries is due to acceleration of the hepatic blood flow velocity.
The author has performed hepatic venous catheterization in normal adult mongrel dogs and estimated the disappearance rate of BSP and A-H BSP difference before and after the administration of ATP, Dechychol and adrenaline. The results are followings: 1. 15 minutes after i. v. injection of ATP, disappearance rate has shown increase, while A-H difference has shown decrease. These findings support the the theory which advocates that ATP tends to increase hepatic blood flow and at the same time accelerate hepatic blood flow velocity. Administration of the other type of nucleic acid preparations or nucleic acid precursor has failed to show any significant change. 2. 15 minutes after i. v. injection of Dechychol, the author has observed reduction in disappearance rate and marked decrease in A-H difference. These findings are appeared. to be suggestive of temporary reduction in BSP excretion-efficiency, because of tremendously accelerated hepatic blood flow velocity by Dechychol. Administration of the other type of cholagoga has failed to show any significant effect. 3. 15 minutes after i. v. injection of adrenaline, disappearance rate has shown increase, suggesting the presence of increase in hepatic blood flow due to elevation of pressure. The author has studied effects of various type drugs on hepatic circulation and found activating effects on hepatic cells as well as on vasomotor activity.
The author studied the stractural changes of liver in case of cholelithiasis, undertaken as a part of the serial researches performed in the laboratory under the guidance of Prof. Matsukura, histopathologically mainly, based upon the electron microscopic observations of biopsy materials available from 103 patients, namely 41 cases of cholecystolithiasis, 12 cases of choledocholithiasis, 6 cases of cholecysto-choledocholithiasis, 7cases of cholecystitis without stones, 7 caces of neoplasma of bile ducts, 14 cases of gastroduodenal ulcer, 11 cases of gastric cancer and 10 cases of postoprative serum hepatitis. The relations between the findings and the results of the test of the liver function were also studied. 1) Nuclei of liver cells In regenerative process of liver seen in such cases as neoplasma of bile ducts, choledocholithiasis or hepatitis in which highly progressed and acute functional disturbances occur, invagination of nucleic membrane and appearance of the polynuclear cells were observed. 2) Mitochondria No specific, slgnificant change was observed in each group of diseases but with more intensified jaundice the decrease of the number of the mitochondria and the dilatation were more frequently seen. 3) Endoplasmic reticulum In cases of cholecystitis without stones or of hepatitis, disintegration of endoplasmic reticulum was appeared in high percentage and in such cases as in groups of cholelithiasis or choledocholithiasis in which pathologic changes occur in the cnmmon bile duct, the enlargement of the endoplasmic reticulum or the decrease of the granules was conspicuously observed. 4) Inclusion of liver cells Around the nuclei of liver cell or bile canaliculi, lipid-like inclusion with highelctron density was observed every kind of the liver diseases. 5) Bile canaliculus Enlargement of the bile canaliculi and microvilli were observed in such cases with extrahepatogenic obstructive mechanism but even in such cases as cholelithiasis or cholecystitis without any obstructive mechanism some of them showed the enlargement of the canaliculi. The communication of the canaliculi with Disse's lumen was seen only in several cases with manifestation of severe jaundice. 6) Sinusoid Few cases showed the conspicous changes of the sinusoid but there were several cases in which fibrils increased. 7) According to the findings of biopsies available from the patients who showed functional disturbances of liver even after 4 months from the operative correction of the obstructive jaundice or from the patients who showed no disturbance of liver function at the time of 6 months, one year and three years postoperatively, of which diseases were of bile ducts, particularly cholelithiasis-, there were some changes of the bile canaliculi and of mitcondria, namely, so called “intrahepatic cholestasis”. These finding let us feel the necessity of the longterm postoperative follow-up of these patients. 8) The morphologic changes of liver structure, particularly of mitochondria and the endoplasmic reticulum showed some relation with the results of the liver function tests such as B. S. P, GOT, GPT, A/G and etc. Also some correlation between the excretory functional test with I131 Rose Bengal and the morphologic changes was assured.