Fortysix cases of chronic alcoholics consuming daily more than 110g of alcohol were studied histologically and histochemically on liver biopsy specimens. At the same time, 46 of nonalcoholics, in which the clinical data strongly suggested to be viral in origin were also studied comparing with alcoholic group. In alcoholics, variant extents of necrosis were recognized in 58% in parenchyma and 69% around portal area, associated with mild or slight infiltrates of mononuclear cell mixing polymorphonulcear leukocytes. Forty in 46 had a mature collagenous fibrils in their connective tissue, accompanied with unmature newly formed fibers. The accumulation of histochemically demonstrable acid mucopolysaccharides was recognized in portal area, increasing connective tissue fibers, perisinusoidal space and especially necrotic areas. These necrotic areas assumed to play a leading role in fibrogenesis of livers in alcoholics. Alcoholic hyaline could be demonstrated in 2 cases. Infiltration with fat was mild in 18 and moderate in 3 cases. In nonalcoholic group, 39 of intralobular and 32 of periportal necrosis were seen with mononuclear cell infiltration. Twentyfour had mature collagenous fibers with unmature fiblils concomitantly. Six showed unmature, young fiblils only, though they had alreadly pseudolobular formation. Acid mucopolysaccharides were demonstrates in portal area, necrosis in periportal area and increased connective tissue fibers, but they all showed poor accmulation in contrast with alcoholic group.
Cholangiography visualized by puncturing intrahepatic bile duct has been performed only prior to surgery because of its complications. The author contrived a new method in performing percutaneous transhepatic cholangiography. The puncture site and direction for the lateral approach in the seventh or eighth intercostal space were decided from the cholangiotomographic research for the location of the intrahepatic bile ducts. Our technic under X-ray television control was proved to be very safe and we believe that it is appliable to a routine examination for the bile duct in the ward of internal medicine. In our series using this new procedure in 105 cases, there was neither death nor severe complications which needed urgent surgical laparotomy. Only seven cases had mild complications as following. One case of probable bie leakage into peritoneal cavity, two cases of bacteriemia, two cases of puncture into gallbladder and two case of tension pneumothorax were experienced.
I have obtained the following results by the clinical use of a radiocapsule for intragastric pH measurement. 1) The pH value of gastric juice was between 1 and 7 in the healthy persons, but the low pH value was found in the majority of peptic ulcer patients, on the other hand, in the most gastric carcinoma patients, the pH value was high. 2) The gastric juice showing the pH value of below 4 was found to contain free hydrochloric acid. I calculated the concentration of hydrochloric acid in the stomach juice secreted in one minute from the alkalitest curve, in which free hydrochloric acid was neutralized with sodium bicarbonate. This concentration had no correlation to the organic changes of the stomach, but the higher the pH value of the gastric juice was, the lower the hydrochloric acid concentration was. I suppose that this test is more valuable to examine the acid-secretion function of the stomach rather than the organic changes of it. 3) Considerable cases of the peptic ulcer operated upon by the Billroth-II gastrectomy showed below 4 in the pH value of the remnant stomach within several weeks postoperatively, but the pH value of all cases was found above 4 after several months. 4) When the remnant stomach showing above 4 in the pH value was stimulated with subcutaneous injection of 0.5mg. of histamine, the pH value became below 4 in 7 cases out of 16. This implies the matter; some remnant stomach have ability to produce hydrochloric acid if stimulated with histamine, even though no acid under the normal condition.
The in vitro synthesis of the hepatic proteins, especially of collagen was examined from C14proline, using liver homogenate taken by biopsy in patients with and without liver disease. Under certain assumptions, 13.8mg N protein are synthesized per gram liver per day, and the half-lives of hepatic proteins, were calculated to be 3.50 days for the Hot-TCA soluble fraction (Hepatic collagen), 1.45 days for the TCA insoluble fraction (Hepatic protein). In chronic liver disease, the specific activity of the TCA soluble fraction (Free amino acid) increased. The specific activity of the Hot-TCA soluble fraction increased in chronic active hepatitis and liver cirrhosis. In the latter, the specific activity of the Hot-TCA insoluble fraction (non-collagen protein) was also increased. The specific activity of the Hot-TCA soluble fraction was well correlated with serum gamma-globulin, ZST, GOT, and was inversely proportional to serum Albumin.
The effect of short-term treatment of corticosteroid and anabolic steroid on the 13 patients with compensated non-alcoholic liver cirrosis was assessed by the study on the hepatic protein synthesis in vitro. The results were following; 1) In 6 patients treated with corticosteroid, the specific activity of the Hot-TCA soluble fraction (Hepatic collagen) decreased slightly but that of other four hepatic protein fractions did not change significantly. 2) Anabolic steroid treatment on 7 patients improved the specific activity of the TCA soluble fraction (Free aminoacid) decreasing and that of the TCA-ethanol soluble fraction (crude Hepatic Albumin) increasng. 3) Clinical studies resulted in an improvement serum protein pattern and BSP retention in anabolic steroid treatment, and transaminase in corticosteroid treatment, but no effect on hepatic histology in both of these treatment.