Shwartzman reaction is a phenomenon originally produced experimentally in rabbits, but the same sort of changes have also been observed in various conditions of human cases. And recently, we succeeded to produce fulminant hepatitis in rabbits using Shwartzman reaction mainly focused on the liver. on the other hand, the fact that hepatitis is apt to become severer in pregnant women has long been noticed chnically, and there actually are many reports on fulminant hepadtis occurring in pregnancy.
This time, we further extended the work on fulminant hepatitis caused by Shwartzman reaction, and compared the character of acute hepatic necrosis thus produced in the liver between pregnant and non-pregnant groups of rabbits. Acute necrosis of the liver was definitely severer in pregnant cases, which was especially so just befbre and after the delivery. Hepatic necrosis with severe fatty metamorphosis, which has been documented as a characteristic finding of severe hepatitis in pregnancy, was also observed in some pregnant rabbits.
From the stand point of the fact that pregnancy is a preparative status for Shwartzman reaction, we want to point out such a possibility that at least a part of the cause of aggravation of hepatitis in pregnant women could be attributed to Shwartzman reaction occuring in the liver.

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Evidence has recently been accumulating toindicate that the e antigen system is a marker of the HBV infectivity. In this study, sera from 115 symptorn-free HBsAg carriers aged 1-85 years (male 55, female 60) were tested for e antigen and anti-e, and the results as given below Were obtained.
1. The e antigen was detected in 32 (28%) and anti-e in 35 (30%). The frequencies of e antigen and anti-e were observed in 5 age groups of 1-10, 1 1-20, 21-40, 41-60, and over 61 years. The positive rate of e antigen was 77% in the youngest group, and the rate fell stepwise by 41% in the 2nd and by 17% in the 3rd age group. In the 2 more older groups, however, the frequency scarcely changed as compared with that of the former group, respectively.
Although 42% of the all had neither e antigen nor anti-e, it is likely from the above results that all the HBsAg carriers are positive for e antigen in the beginning of the HBV carrier state, and, with advancing years of life, most of them become negative for e antigen and positive for anti-e, though there are wide differermces among the individuals in the age of the conversion of e antigen to anti-e. The decreasing prevalence of e antigen and increasing prevalenco of anti-e with age may be reflected in the difference in infectivity of young and old carriers; younger HBsAg carriers may be much more contagious than those in older age groups.
2. In family studies of the carriers, We have obtained a result that 10 out of the 11 offspring of 6 e antigen-positive mothers were HBsAg-positive. This suggests that HBV is vertically transmitted with an extremely high frequency when the carrier mother has e antigen.
Moreover, findings suggesting a father-to-child transmission were obtained, in which 3 out of the 6 offspring from 2 pairs of the e antigen-positive carrier father and HBsAg-negative mother, were HBsAg-positive. In one of the other families, 1 of the 3 children living with their grandfather with e antigen was positive for HBsAg, despite both the parents being HBsAgnegative. These results suggest that, even if the mother is HBsAg-negative, the infant is exposed with a considerably high frequency to the risk of becoming a long-term HBsAg carrier, when an e antigen-positive carrier exists among the family members.

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The technique of scintiphotosplenoportography permits visualization of portal venous system and estimation of regional hepatic blood flow by injecting ¹³³Xe into the spleen. This technique is easily, rapidly and repeatedly performed. Portosystemic collateral channels were detected in 1 of 13 patients with chronic hepatitis and 10 of 17 patients with liver cirrhosis. In 2 cirrhotic patients intrahepatic shunts were detected.
Measurement of regional hepatic blood flow in right and/or left lobes was performed in 33 patients. The right and left lobar flows were 86.2±12.8, 44.3±5.9ml/100g/min in 3 patients without liver disease, 75.1±13.0, 58.6±8.9ml/100g/min in 13 patients with chronic hepatitis and 52.2±18.3, 46.6±18.2ml/100g/min in 17 patients with liver cirrhosis respectively. These results suggest that heterogeneity of flow in right and left lobes exists and in patients with liver cirrhosis right lobar flow is significantly decreased.

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Present days, diagnosis of fatty liver or fatty change is difficult because of scanty of specific laboratory examination. In a previous report (Part 1) 5 cases with hypercholinesterasemia were reported, Two cases of the 5 reported cases had fatty liver. The purpose of this paper was to evaluate the diagnostic value of the enzyme cholinesterase. This was done as follows:
1) The cholinesterase level of cases with fatty liver was determined respectively. In almost all cases with fatty liver high levels were revealed.
2) The livers of the patients with hypercholinesterasemia (over 1.3pH of 6.5μ. Levine method) were examined by biopsy and 36 out of 37 cases had fatty liver or fatty change in the liver.
3) In the cases of fatty change with cell infiltration or fibrosis cholinesterase activity was normal or abnormally low.
From these results, it was concluded that the detection of hypercholinesterasemia is an excellent adjunct for the diagnosis fatty liver or fatty change in the liver.

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A 57-year-old female patient with active chronic hepatitis was reported. The predominant clinical feature was characterized by marked hepatomegaly. Laboratory investigations revealed rapid sedimentation of the erythrocytes, an extremely high serum gamma globulin due to an increase of IgG, elevations in serum alkaline phosphatase and γ-glutamyl transpeptidase, the hightitered ANF and cold hemagglutinins, and marked impairment of plasma unconjugated bilirubin clearance. The liver biopsy showed a striking accumulation of lymphocytes and plasma cells in the portal tracts. Corticosteroid treatment caused resolution of clinical, biochemical, and immunochemical abnormalities.

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