Light and electron microscopic findings of some livers from asymptomatic carrier of HBAg showing small lymphocytes and macrophages in close contact with partial lysis of variable degrees, necrosis and complete drop-out of hepatocytes with HBsAg in the cytoplasm, are demonstrated.
On the basis of these findings together with the result of immunofluorescent study of γ-globulin and complement, the pathogenesis of hepatic cell necrosis in hepatitis B are discussed with emphasis on the importance of host cellular immune response; the cytopathic and cytolytic activities of immunologically activated T-lymphocytes (killer cells) against liver cells which have antigenic targets associated with HBsAg in their cytoplasm.

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Hepatitis B antigen(HB Ag), anti-HB, subtypes of HB Ag and α₁-fetoprotein(AFP) were quantitatively analyzed in 13 carriers of HB Ag and 109 people related to them by blood. Frequencies of HB Ag and anti-HB were 34.8 and 30.3%, both significantly higher than in general Japanese donors. Respective male-to-female ratios were 48.2/20.8 and 20.8/39.6(%). When mothers were positive for HB Ag, the frequency in their children counted 70.6%, very significantly higher than 31.6% when fathers were positive. This substantiates the intensity of perpendicular infection. HB Ag subtypes were mostly adr without pure adw, suggesting biased inclination toward adr in the Sanin Area. AFP levels were abnormal in 41.2% of cases positive for HB Ag, in 18.2% positive for anti-HB and in 22.6% negative for both HB Ag and anti-HB.

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Clinico-pathological study was made on 57 autopsied cases with cholangiocarcinoma, which was classified into two gross anatomical types according to the location of the main tumor; 28 cases of the peripheral type and 29 cases of the hilar one. Clinical features, laboratory data and histopathology were studied in comparison with 134 cases of hepatocellular carcinoma, It was found that, 1) mean age was 62.2 years old with a male to female ratio of 1.7:1, 2) Jaundice, abdominal pain, general malaise and fever were the early common symptoms, 3) the peripheral type was similar to hepatocellular carcinoma in its laboratory and clinical features and course, whereas the hilar type, to extrahepatic bile duct carcinoma, 4) no correlation with hepatitis-B antigen was observed, 5) serum alpha-fetoprotein was demonstrated in one out of 23 cases assayed by M.O. method, and in 5 out of 10 cases by RIA, 6) there was no association with liver cirrhosis and portal hypertension, 7) procedures which proved most diagnostic were p rcutaneous transhepatic cholangiography and endoscopic retrograde cholangiography in the hilar type, and scanning, celiac angiography and laparoscopy in the peripheral type and 8) biliary drainage prolonged survival in some of the hilar type patients, with a maximum of 42 months.

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Celiac (hepatic) angiograms of good quality obtained in [4] cases of hepatocellular carcinoma with uneqivocal diagnosis were analyzed, of which comparison of angiograms with the gross anatomical feature on the cut-surface of the liver was possible in 64 either autopsy or resection. It was found that the angiograms reflect the gross anatomical findings fairily well, and particulary, the solitary massive type and encapsulated type were readily diagnosed. A thick fibrous capsule in the latter type was discerned as a radiolucent rim in the late phase angiograms.
In patients in whom no displacement of large intrahepatic arteries accurate diagnosis of gross types was not always easy, but some of the diffuse and the cirrhotic oligonodular type were diagnosed with certain accuracy. The typical angiographic alterations of hepatocellular carcinoma and pathognomic changes such as arterio-portal shunts and tumor thrombus associated findings are also discussed.

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Acute fatty liver of pregnancy has been recognized as the definite clinical and histopathological entity with high maternal mortality. Having the opportunity to treat one case complicated by DIC with peritoneal dialysis, we discussed on direct cause of death and treatment in addition to a review of reference.
Case: A-25-year-old multiparous woman had acute fatty liverof pregnancy on admisson. Soon after delivery due to premature separation of placenta, icterus, hemorrhagic tendency, and acute renal failure with delirium develoPed. It became apparent that she was suffering from DIC by the various clinical manifestations and laboratory findings. Because of oliguria and azotemia, peritoneal dialysis was carried out fornine days. After dialysis, her general condition was improved rapidly and coagulation abnormalities returned to normal values. Biopsy under direct view of laparoscopy was perfbrmedon the 30th hospital days and it revealed diffuse fine droplet of fatty infiltration of hepatocytes with no necrosis and inflammatory changes.
Acorrding to this report, we emphasize the need fbr recognition and therapy for the extrahepatic manifestations. The possibility that themultisystem involvement of this disease was related to the presence of DIC was suggestive.

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