Morphological changes of the intrahepatic bile ducts, Glisson's capsule and hepatic parenchyma after loading obstruction and infection of the biliary tract on partial lobe of the liver of mongrel dogs were studied in order to examine the pathophysiology of the hepatolithiasis.
In the Glisson's capsule at the region of the large intrahepatic bile duct, in infective group, the large bile duct revealed the same proliferative cholangitis which is found most frequently in human hepatolithiasis. In the Glisson's capsule at the region of the septal and interlobular bile duct, in infective group, the degree of periductal fibrosis ratio gradually increased and caliber ratio of portal vein gradually decreased. The parenchyma of the liver in infective group developed atrophy. On the other hand, in non-infective group, mild liver atrophy was seen but there was no finding of proliferative cholangitis.
From the above, it is s uggested that proliferative cholangitis may be raised by bile stasis and biliary tract infection, and the degree of hepatic atrophy may become severer due to the decrease of the portal vein flow, when biliary tract infection is added to bile stasis.

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A caninee xperimentapla ncreaticocholec y stostmomodye l was developedb y duodenalw all patch methodt o investigatme echanismosf biliaryd ilatationi n the patientsw ith anomalousa rrangemenot f pancreaticobiliadryu ctals ystem. R efluxo f pancreaticju icei nto the biliaryd uctal systemc auseds ignificandti latationo f the commonb ile duct in thism odel. But mildd ilatations wereo bservedin controlg roupst hey performeds ham-operatioonr physiologicsaal line infusion into the gallbladdearl so. Manometrisct udyo f the duodenalp apillaw as performedto evaluate biliaryd ilatationf rom the view pointo f the duodenapl apillarys phincterm usclef unctiona nd revealedn o significandti f ferencbee tweenth eseg roups. T heser esultss uggesttsh at biliaryd ilatation in this modelm ay be causedb y increasedf low in the biliarys ystemo r some e ffectso f surgicaml anipulationh, o weverm, alfunctioonf the papillarys phincter muscle.

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On a total of 156 patients without anomalous arrangement of pancreaticobiliary ducts (APBD, ), amylase levels in bile were measured and clinicopathological studies were performed. There were not significant differences between males and females on amylase levels in bile. In 32 cases, amylase levels in bile were very high (over 1000 IU/ι), but their seru m amylase levels were within normal limits. In these cases, presence of b a cteria in bile were detected more often, and pancreatic duct reflux on intraoperative cholangiography were observed more frequently than in cases of low amylase levels. Histological findings revealed that metaplastic epithelium were often found in these cases. These results suggested that the source of amylase in bile was regurgitaton from the pancreatic duct and the refluxed pancreatic enzymes could play a role in the pathogenesis of the biliary tract diseases.

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It is well known that gallstones are frequently found in l i ver cirrhosis. Although several hypothesis have been proposed, no definite conclusion has been reached concerning this reason. The present study attempted to elucidate the lithogenic factors from the gallbladder function by examining the ejection rate of gallbladder bile and measurement of blood levels of cholecystokinin (CCK). Fasting patients were injected intravenously with 99mTc-pyridoxy1-5-methyltryptophan (PMT), then 60 minutes later, the patient ingested two egg yolks. Thirty minutes after ingestion of the egg yolks the rate of ejection of gallbladder bile was significantly lower (42.9%)than in healthy subjects (66.4%). Following egg yolk loading, high value of blood CCK levels were recognized before egg yolk loading in cirrhotic patients compared to that of the healthy controls and following the loading the more high value were recognized in cirrhotic patients. Our studies showed that poor gallbladder contraction and bile stesis are accompanied by abnormal CCK secretion in liver cirrhosis, and suggesting that this condition is predisposing to the formation of gallstones.

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The indication for and effect of lithotripsy on gall bladder stones by an extracorporeal shock wave were investigated in clinical application with 200 gall stones cases after fundamental studies for the determination of impulse condition had been performed. The gallstones could be disintegrated in 193 cases (96.5%). Dissolution therapy was performed in 181 cases. An endoscopic sphincterotomy (ES) was also performed for three gallstone cases accompanied by common bile duct stones, four cases which were accompanied by acute pancreatitis and for prevention of complications in one case, respectively. Percutaneous transhepatic cholecystoscopy was performed for the excretion of stones in five cases including the cases of calcium-bilirubin stones, one case of calcified mixed stone, and one case having 20 stones. The stones disappeared in 60 cases (30%). The disappearrance rate for single stone having a diameter of less than 20 mm was 51.7%, and for ultrasonographically presumed cholesterol stone, the cumulative disappearance rate was 58.2% in two years. Important factors of maximum and minimum diameters of cystic duct for the stone disappearance were estimated in 49 cases in which stone disappeared and 40 cases in which they persisted for more than one year. There were significant differences both in the mean maximum diameter of 6.2±3.1mm and mean minimum diameter of 2.5±1.5mm in the stone disappcarance group, and the mean maximum diameter of 4.2±1.5mm and mean minimum diameter of 2.0±0.7mm in the persisted group(t-test). The number of required days for stone disappearance and the diameters of cystic ducts correlated with R: 0.388 for the maximum diameters and R: 0.359 for minimum diameters.

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A 61-year old male with jaundice was hospitalized in our department. Percutaneous transhepatic cholangiogram showed stricture in the intrapancretic portion of the common bile duct. At laparatomy biopsy was performed from the head of the pancreas and histology revealed chronic pancreatitis. Biliary d rainage was not performed but jaundice was subsided spontaneously and patient discharged. One year after the operation, the patient was readmitted with jaundice, due to stricture of the common hepatic duct. Liver central rese c tion was performed, and histology verified primary sclerosing cholangitis (PSC). This case was a PSC associated with chronic pancreatitis, a case which has been rarely reported. Radiographic features of the bile duct were evaluated twice in this case.

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79 years old woman who had no findings of jaundice two months befo r e the death of acute progressive jaundice. The au t opsy revealed bile duct carcinoma in the hepatic hilus and secondary biliary cirrhosis only in the latelar, inferior and posterior hepatic segment but not in the anterior segment. These findings suggest that the carcinoma had developed at the left hepatic duct branch and invaded to the posterior branch, which made seveier bile stasis in these segments but not in the anterior segment. Therefore, the secondary biliary cirrhosis had developed only in these segments. The bile metabolism would be compensated in the anterior segment. Finally, this branch was also invaded and jaundice developed promptly.

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A 40 year-old woman entired with a compliment of severe e p igastralgia and marked elevation of serum amylase. Ultrasonography (US) as well as computer tomography (CT) revealed polypoid tumor in bladder, and ERCP, anomalous arrangement of pancreatobiliary ductal system(APBD). According to clinical diagnosis of gallbladder cancer associated with APBD, radical cholecystectomy performed. Two years after the operation, she began to complain of abdominal back pain, and pancreatic body to tail tumor was discovered by abdominal US, CT and ERCP. The second laparotomy was performed to extract the tumor. Histopathologically both tumor showed same papillotubular adenocarcinoma, without any invasive proliferation in the first gallbladder carcinoma. In the later pancreatic lesion, epithelial malignancy was present in main pancreatic duct with partial invasion into pancreatic parenchyma. Addition to epithelial malignancy, some small endocrine adenomas showing immunocytochemical positivity to glucagon. This rare case with double cancer may suggest the risk factor, induced by the condition of APBD, acts on the carcinogenesis on pan creatic duct as well as biliary duct system.

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A 66-year-old female was admitted to our h ospital complaining of fever and jaundice. US showed an echogenic mass in the dilated lower CBD, suggesting the presence of a tumor of the CBD. ERC showed an tumorous irregular filling defect atthe distal CBD. EUS also demonstrated the echogenic tumor without invasion. Percutaneous transhepatic cholangioscopy (PTCS) inspected the papillary tumor with granular surface. Biopsy specimen taken through the PTCS histologically revealed an adenoma with severe atypia. Resected specimen with pancreatoduodenectomy showed a papillary tumor in the lower CBD without invasive finding. Its histological findings revealed papillary adenoma with focal malignancy. Hyperplastic and dysplastic changes were also detected at the CBD's mucosa. This case is thought to be very important in the study of the malignant potential of adenoma in the biliary tract.

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We report a case of intramural giant gallstone. It is composed of pure cholesterol and 3.0cm in diameter.
The p atient was a 73 years old woman who had felt upper abdominal discomfort. Cholecystectomy was was performed under a diagnosis of cholecystolithiasis. A yellow-white stone located within the wall of the fumdus which was measured 3.0× 1.7× 1.7cm, and composed of pure cholesterol.
The usual sizes of intramural gallstones which reported in the world literatures ranged from 2 to 5 mm in diameter and the largest gallstone of then had been 2.1 cm in diameter.
The intramural giant gallstone composed of pure cholesterol is unknown in origin.

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Two cases with agar-like biliary stones molded in the gallbladder and the proximal bile duct were reported. These wre hardly differentiated from the malignant tumors of biliary system on imaging diagnosis, because they did not show calcification nor liquescency on both ultra-sonography and computerized tomography.
The analysis of non-calcified biliary stones revealed tht the main absorption bands wee lying in protein region, i. e.1650 and 1550 cm^-1, on an absorption spectrum by infrared spectroscopy. The clinical feature of these two cases and a possible origin of agar-like biliary stones were discussed.

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