急性肝炎時の胃幽門部,十二指腸における機能的ならびに器質的変化に関する研究

Abstract

For the purpose to study histopathological conditions of the duodenum in acute hepatitis, biopsy examinations of the mucosa at the third part of duodenum were done under fluoroscopy by the intestinal biopsy capsule after Crosby. The subjects of the present study were 5 cases of normal controls and 12 patients with acute hepatitis admitted to our clinics, and on the latter group similar examinations were given at two stages; one at icteric stage and the other at convalescent stage. Biopsy specimens were stained with hematoxylin-eosin, Azan stain, Pap's method of a modified form of Bielschowsky's silver impregnation, Van Gieson's stain, and PAS-Schiff reaction. Each group of these specimens were prepared into 100 serial sections of 15μ in thickness, and theses were examined according to the following items:The length and width of villi, the arrangement and morphology of epithelial cells; the abnormality in the array of epithelial cell nuclei; the number of lymphocytes within vacuoles of epithelium; the number of goblet cells among epithelial cells; breakages of basement membrane: the lymphocytes in tunica propria; infiltration of plasmocytes, the thickness of mucosa, mitotic index in lacuna; and arrangement and morphology of epithelial cells in crypt; the number of lymphocytes in epithelial cells, the number of goblet cells among epithelial cells; exsdative pathological changes in the neck of crypt and in villi; and accumulation of mucus. As the result the following were obtained.For computing the mitotic index the method of Leblond was used.1. Normal controls: The morphology of villi in normal controls may be classified into three; those of normal shape villi (88.5%). those of branching villi (8.4%), and those fused villi (3.0%).Average length of villi proved to be 487±57μ, average width of 140±41μ, and average thickness of mucosa 142±28μ.Histological findings were similar to those reported by other workers, but there could be observed some lymphocytes sparsely scattered in the edithelial cells. In no case, however, there could be detected eosinophils within epithelial cells. Mitotic index was fonnd to be 2.99±0.19.2. Acute Hepatitis in icteric stage: As for the morphology of villi at the icteric stage in acute hepatitis, some were mixed with short villi, and there were club-shaped villi (13.5%) and mushroom-shaped ones (8.6%). The length of villi tended to be shortened (413±53μ) and in parallel with this shrinkage the mitotic iudex was markedly decreased (1.87±0.59). However, there were no significant differences in the width of villi and the mucosal thickness as compared with those in normal controls. Histological findings revealed disarrangement of epithelial cells, and increase in the number of lymphocytes among epithelial cells, infiltration of lymphocytes and plasmocytes in tunica propria, an increase in goblet cells of villi and crypt, exudative pathological changes in between villi, as well as atrophy and exudative inflammatory changes of duodenal mucosa at the icteric stage in acute hepatitis.3. At the convalescent stage in acute hepatitis: Morphology of villi approaches to that of normal ones, but there could be obesvred long branching villi (16.7%) and average length of villi tended to increase (537±52μ). Paralleling with these changes, mitotic index increased (3.30±0.52). Histologically, no exudative and inflammatory changes were at all observed in villi and tunica propria.