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A case of idiopathic portal hypertension (IPH) developing after renal transplantation is reported. A 33-year-old Japanese male who had undergone renal transplantation 8 years previously was transferred to our hospital because of hematemesis from ruptured esophageal varices. He had no history of any liver disease before the renal transplantation, but had a history of receiving blood transfusion. Abdominal computed tomography (CT) and ultrasonography revealed marked splenomegaly and collateral channels, but no obliteration which might cause portal hypertension in the hepatic or portal vein. No findings suggestive of hepatitis or liver cirrhosis were found either macroscopically on laparoscopy or by liver biopsy. Light microscopic study of the liver biopsy specimen showed mild periportal fibrosis, inconspicuous portal branches in the most peripheral tracts, but no pseudolobule formation or piecemeal necrosis. However collagen deposition was found in the perisinusoidal space and partly in intercellular space on electron microscopy. We consider that the development of portal hypertension in this case is responsible for the collagen deposition, which may be related to the administration of azathioprine after renal transplantation. There are few reports on IPH after renal transplantation, and it is stressed that a lower amount of azathioprine than previously reported may induce IPH under such conditions.

A 73-year-old woman with gallbladder carcinoma infiltrating to the liver presenting high serum values of AFP and CEA was reported. Serum values of AFP and CEA were remarkably high (165,000 ng/ml and 1,070 ng/ml). Immunohistochemically the tumor cells were stained for AFP and CEA by the PAP method. Serum AFP subfraction was analyzed by crossed immunoaffinoelectrophoresis with lentil lectin and concanavalin A, which showed most of the serum AFP bound to both lentil lectin and concanavalin A. As a case of gallbladder carcinoma presenting a high serum value of AFP is rare, it may imply a diagnostic challenge.

A case of leiomyosarcoma that appeared to have originated in the ligamentum teres hepatis of a 66-year-old female has been presented. The case was suspected of leiomyosarcoma originating in the ligamentum teres of the liver from the findings by preoperative examinations, and definitely diagnosed as such in a laparotomy and by histological examination of the resected tissue specimen.

To elucidate the mechanism of glucagon-insulin (G-I) therapy, the effect of insulin and/or glucagon on the insulin receptor was studied in an experiment utilizing cultured cells (JTC-16) of rat ascites hepatoma. Insulin specific receptors were present on JTC-16 cells and were similar in nature to the receptors of primary culture rat hepatocytes. There were two kinds of insulin receptors. One had a high insulin affinity and the other had low insulin affinity. In the experiment involving addition of insulin the number of insulin receptors decreased after 24 hrs incubation in proportion to the increase in added insulin concentration. On the other hand, the number of insulin receptors increased with glucagon addition and the increase in proportion to the concentration of glucagon added. In the experiment involving simultaneous addition of insulin and glucagon, a 20% decrease in the number of receptors induced with 10(-9) M insulin was restored to the control level with simultaneous glucagon addition of the same concentration. The number of insulin receptors increased as the concentration of additive glucagon increased. These results show that simultaneous addition of insulin and glucagon inhibits the decrease in number of insulin receptors with insulin alone. These facts may obtain more potent action of insulin in G-I therapy via insulin receptor.

The splenic enlargement is an important symptoms of portal hypertension, and various attempts have been made to objectively describe it. But, endoscopic diagnosis for splenomegaly in chronic liver diseases may be sometimes difficult for these uncharacteristic appearances. The pneumoperitoneography was performed in 141 chronic liver diseases just before laparoscopic procedure, size and form of the spleen on X-ray film were measured and analysed. We have compared these results with the laparoscopic findings (the gross appearance of liver and spleen, the degree of portal hypertension, etc), the patterns on scintigram and the histological findings of the liver. There were fairely good correlation between the splenic findings on radiogram and above factors, especially the size of the spleen was gradually increased according to the degree of portal hypertension and the fibrous change of the liver specimens. In conclusion, the findings of spleen on pneumoperitoneogram were valuable for diagnosis of splenomegaly in chronic liver diseases.