Using the single injection method with a dosis of 0.5mg/kg ICG and the technique ofhepatic venous catheterization, a series of observations were conducted on ICG disappearancerate, ratio of ICG concentration in th peripheral arteries versus that in the hepatic vein, aswell as the curves of ICG disappearance level in peripheral arteries. The results were briefly summarized in the following. 1) The disappearance rate of ICG in the three cases of chronic hepatitis without intrahepaticshunt flow proved to be 76.1-89.5%, in one case with intrahepatic shunt flow it was 53.1%and in one case of precirrhosis of liver it was 78.0%. The rate in the four cases of liver cirrhosiswas 29.0-62.5%. When the actual blood flow that is in contact with liver cells, is calculated by subtractingthe quantity of intrahepatic shunt flow as computed from the galactose disappearance rateobtained by means of Nakamura's method, it amounted to 53.9-96.8% in the entire nine casescovering chronic hepatitis to liver cirrhosis. 2) When the ratio of ICG concentration between the peripheral artery and hepatic veinis studied from the ICG plasma disappearance curves, the curve is found to fall with the lapseof time and the concentration ratio likewise diminishes at the same time. The curves ofconcentration ratio are studied case by case at the lapse of 3 min, 5 min, and 10 min. In twocases out of the seven chronic hepatitis the inclination of the curve to the base line shows aslight fall, and after 15 minutes six cases out of the seven demonstrate the decline of this inclination.On the contrary, among the cases of liver cirrhosis three out of the four cases showedan appreciable fall of the inclination and the remaining one also showed only an extremelyslight fall between 3 to 15 minutes. In addition, the cases of precirrhosis of liver as well aschronic hepatitis revealed values intermediate between these two groups. 3) The ICG disappearance curve of peripheral artery showed a linear descent at the intervalsof 3 min, 5 min and 10 min in all the cases when it was expressed on semilogarithmic scale.However, the curves of all seven cases of chronic hepatitis deviated from the straight line anddeclined in drawing a slow arch after 15 minutes. The curves in liver cirrhosis had no deviationfrom the stright line and was paralled to the horizontal axis (time). In the comparisonof the values of ICG plasma disappearance rate calculated at the intervals of 3 min, 5 min and 10 min with those calculated at 5 min, 10 min, and 15 min, respectively, those chronic hepatitiscases without portal hypertension revealed considerably high values in the former as comparedwith the latter, however, the cases of liver cirrhosis showed only a slight difference in thevalues between the two groups. From these findings it was assumed that for the calculation of the plasma disappearancerate after the administration of ICG (0.5mg/kg) the most appropriate time is within 10 min. The author wishes to express his profound thanks to Professor K. Kosaka for kind guidanceand proof reading of this paper, and acknowledgement is also due to Dr. Y. Shimada for hiskind supervision and advices throughout this work.
Sixty-nine subjects consisting of 9 acute hepatitis, 27 chronic hepatitis, 10 precirrhosis ofliver, 14 liver dirrhosis and 9 normal persons were studied by means of ICG test in an attempt tocompare the rate of ICG disappearance from the plasma with the resuts of liver function testand histological findings of the liver tissue. The disapperance rate was obtained by withdrawing the plasma in 5, 10 and 15 mins.after intravenous administration of 0.5 mg of ICG per kilogram of body weight. 1) The average rates of ICG disappearance from the plasma were found to be 0.183±0.04 in the normal, healthy persons, 0.130±0.024 in acute hepatitis, 0.158±0.046 in chronichepatitis, 0.129±0.029 in precirrhosis of liver, and 0.092±0.03 in liver cirrhosis. In otherwords, the average values among the patients with liver diseases are lower than those in normalpersons, and the ICG disappearance from the plasma decreases in accordance with the serrerityof the disease. 2) In chronic hepatitis group the disappearance rate of plasma ICG also decreased furtheras they progressed from types I and H of our pertoneoscopic classification, which are believedto be in the normal state of hepatic hemodynamcis, to types III and IV, which are consideredto be abnormal state of the liver circulation. Among type I and II of the peritoneoscopic classification, those belonging to type IIA in our histological classification of liver (Glisson's sheathinflammation type) showed somewhat lower values than those belonging to histological classificationtype I (liver parechymal type) and type JIB (Glisson's capsule scar type). 3) Correlations were found between the plasma disappearance rate of ICG and theresults of the following liver function tests; direct bilirubin level, A/G ratio, gamma-globulinlevel, TTT, CCF, ZTT, S-GOT, 198Au colloid accumulation coefficient of liver, and BSI'.Among these the correlation was significant with the probability of less than 1 % in direct bilirubinlevel, gamma-globulin, BSP, and 198Au colloid accumualtion coefficient of liver. 4) In general, there was a significant negative correlation between the plasma disappearancerate of ICG and BSP; however taking chronic hepatitis group alone, the cases showingabnormal BSP level with normal ICG disappearance rate were higher than those withnormal BSP and abnormal rate of plasma ICG disappearance. 5) Significant negative correlations were found between the disappearance rate of ICGand the following histological findings; liver cell degeneration and kupper cell mobilizationespecially with periportal fibrosis.
Leucine aminopeptidase is a proteolytic enzyme widely distrib uted in human tissue andbody fluid. This report deals with a study of LAP which acting on L-leucyl-beta-naphthyamide.LAP activity in serum, bile and liver tissue of normal subjects and of patients withsurgical upper abdominal disorders was assayed by the method of Goldbarg et al. The results are summarized as follows: 1) Serum LAP activity increased in hepatobiliary obstraction, especially in malignantconditions. 2) The serum LAP test was the more useful in indicator than serum AP for hepatobiliarydisease. 3) It was difficult to differenciate the causes of biliary obstruction by the level of serumLAP activity. 4) Liver tissue LAP activity increased in choledocholithiasis and malignant biliary obstruction.It was suggested that serum LAP activity in hepatobiliary disorders reflects thesealternations of tissue LAP levels. 5) LAP activity markedly decreased in white bile. 6) If the patient's liver function within normal limits, serum LAP activity increasedand liver tissues (LAP) activity decreased during the operative procedure. In icteric patientsnot only serum LAP activity was decreased but also liver tissue activity was decreased bythe relief of biliary obstruction. 7) Unfortunately, biliary obstruction was not rescured the serum LAP activity more elevatedthan before operation. 8) The measurement of LAP activity is reliable indicator for the effects of operation ofhepatobiliary tree.