慢性肝炎の臨床病理學的知見 : (3) 慢性肝炎の肝生檢所見に基づく病型分類とその病理學的檢討
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The histological studies on the characterization of chronic hepatitis and its relation between histological features and routine test of liver function have been the subjects of previous investigation.In this paper the investigation was carried out for the purpose of classifying histologically the type of chronic hepatitis, thereby enabling simplification of diagnosis and treatment of chronic hepatitis.No attempt is made here to discuss the etiology of this disorder.Type I was found to be compatible with so-called “Dubin-Johnsons syndrome”, and Type II was of the cholangiolitic type previously reported by Watson-Hoffbauer.Type III showing the interstitial cellularity chiefly was further classified as follows: A: presenting typical interstitial inflammation of the liver, B: presenting atypical inflammation and scarring which has been reported by Shiff et al., C: cases showing remarkable proliferation of fibroblast, where transition to cirrhosis may be expected., and D: presenting fatty metamorphosis of the liver.A type presenting chiefly degeneration of parenchymal cells was differentiated altogether from the former types and was designated as Type IV. None of these type IV changes were previously considered pathologically to be these of chronic hepatitis. In compliance with the authors opinion of chronic hepatitis so-called posthepatitis neurosis which has been reported by Caravati and Sherlock may fall into the category of Type IV.The clinical and laboratory findings were studied according to this histological classification of chronic hepatitis.The percussion tenderness of the liver was elicited most frequently in Type III.The abnormalities of serum colloidal reactions were found to be prominant in cases with changes of Type II and III.No clearcut of difference in the abnormality of B.S.P. retention and reduced oxidation (for example in Iodic Acid Value, Pyruvate and Citrate concentration of blood etc.) between the Type III and IV could be observed.Further discussion may be necessary in considering cases of Type I to be chronic hepatitis.
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