A Gase of Dubin-Johnson' Syndrome
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A 28-year-old male patient was admitted to our hospital in April, 1963, with chief complaints of recurrent episode of jaundice, fatigue and abdominal discomfort since 1959. He was once diagnosed as Dubin-Johnson's Syndrome in past. In the beginning of 1963, the above chief complaints and increasing reduction of appetite developed again, thus he visited us.On admission, the liver was palpable 2 inches below the right costal margin, but spleen and kidneys could not be palpable. No disturbance of sensory or motor functions was detected.The laboratory examinations: There were ++ urobilinogen and + bilirubin in urine. The liver function tests showed normal level of turbidity tests, flocculation tests and enzymological examinations, but elevated retention of B. S. P.. The total bilirubin in serum showed 3.5mg% and 80% of it consisted of dircet type measured as 2.8mg%. The Icteric Index were between 18 to 39.Cholecystography was carried out with both biligraphin and telepaque without visualization of the gall bladder. The Icteric Index of B-bile obtained by duodenal drainage was 45.Laparotomy disclosed a black tinged liver with scattered green-brown pigments, looking as a granite-porphyry, but the gall bladder was normal sized and slightly white colored.Histological findings by biopsy in 1959 were as follows:1) The most characteristic was yellow-brown, grossly granulated pigments in the centrolobular hepatic cells. 2) Some degenerative changes could be seen to some extent in the hepatic cells in the centrolobular area. 3) Kupffer cell remained rather hypertrophic. 4) There were small round cell infiltration in portal area and slight fibrotic changes around portal tracts.Histochemical analysis of the pigments showed; Stein (+), PAS (+), Masson (+), Sudan-black B (+). Mallory (+), Schmorl (+), Fe (-), Zn (-), Ziel-Neelsen (blue), Azan (red), Van-Gieson (yellow), and silver-staining (black).Four years later, in June of 1963, biopsy specimens of the liver showed increased fibrosis in portal area and pigmentation in liver cells, but no degenerative changes were seen except atrophy of each lobulus.From the above investigations the patient is evaluated as a case of Dubin-Johnson's Syndrome. As many other reports have pointed out, he also has been fairly well until present in spite of recurrence of jaundice. A steroid therapy for 8 weeks was not effective for liver dysfunction but only for subjective complaints.
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
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