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Renal angiomyolipoma is a relatively rare mesodermal mixed tumor. In Japan, 124 cases have been reported. This paper describes our recent experience with a case of renal angiomyolipoma without accompanying nodular sclerosis. The patient was a 48-year-old woman who was admitted under the condition of acute heart failure and was unexpectedly found by abdominal echography to have a mass at the upper pole of the left kidney. Because detailed examination suggested a malignant tumor in the left kidney, the kidney was excised. Histopathological examination of the excised specimen showed a mixture of abundant fatty, muscular and vascular tissues, leading to a diagnosis of renal angiomyolipoma. Preoperative diagnosis of this condition is relatively easy in patients with a complication of nodular sclerosis, who show the triad of epilepsy, mental disturbance and facial sebaceous adenoma. In contrast, cases without that complication are difficult to differentiate from renal carcinoma. The number of cases diagnosed preoperatively has increased recently with the use of CT, because the CT value of the fatty tissue in this tumor is low.

薬剤に起因したと思われる慢性肝内胆汁うっ滞症を経験したので,肝の組織学的所見を中心に報告した.症例は52歳の女性で,昭和51年10月発熱,咽頭痛を訴えエリスロマイシン,スルピリンなど服用したところ,皮膚・粘膜症状次いで黄疸の出現をみた.ステロイド,D-ペニシラミン,フェノバルビタール,6-MPなどにより治療したが,効果なく3年5カ月経過した現在も黄疸が持続している.開腹下楔状生検により組織学的に観察した.肝小葉内には小葉中心性の胆汁栓形成,肝細胞のfeathery degeneration,肝細胞内・Kupffer細胞内の胆汁色素沈着などの肝内胆汁うっ滞像が存在し,グリソン鞘は線維性にやや拡大しP-P結合もみられた.肝内胆管系の計測では外径74μ太さ以下の動脈に伴走する小型小葉間胆管の消失が著明であり,かつ連続切片によりその消失像が観察された.しかしRubinらの慢性非化膿性破壊性胆管炎(CNSDC)型の胆管炎あるいは類上皮肉芽腫は認められなかった.

急性肝炎と劇症肝炎における動的赤血球膜物性検査(CPC system)による最終溶血浸透圧の差異についての検討を行った.急性肝炎では一般肝機能検査の推移とほぼ平行して,最終溶血浸透圧は変化したが,劇症肝炎では肝機能検査,特にビリルビン値が不変あるいは悪化するにも拘らず,最終溶血浸透圧は正常値へ向う傾向を示した.GOT, GPT,コリンエステラーゼ,α1-Lp,総コレステロール,アルブミン,ビリルビンとのStepwise analysisによって得られる最終溶血浸透圧予測値と実測値の差は急性肝炎では±5mOsm以内に84%がおさまったが,劇症肝炎では70%が実測値が予測値より5mOきm以上高い値を示した.又経過と共にその差が正の方向に拡大していくことは重症化を意味した.以上の成績から,実測値と予測値の差を早期から経過を追って測定すること,又ヘパプラスチンテストetc.の肝機能検査と対比して経過をみることは,肝炎の重症化の予測に有用である.

The patient, a 54-year-old man, had received a fracture of the left rib two years previously, and subsequently suffered from upper abdominal pain in July 1983. In September of that year, he was admitted to our Department of Internal Medicine complaining of pyrexia, left abdominal pain and tarry stool. Cholelithiasis, splenic abscess and diverticulosis in the sigmoid colon were diagnosed by abdominal echoscope, CT, enema and so on. In October of the same year. cholecystectomy, splenectomy and sigmoidectomy were performed. The size of the spleen was equal to that of a child's head, from which approximately 300ml of pus flowed out, and colibacillus and anaerobes were isolated. The gall baldder showed strongly inflammatory, signs and c concretion was found trapped within Hartmann'spouch. Inflammatory findings of diverticulum in the colon were not strong. Splenic abscess is a relatively rare diease and only 25 cases have been reported in Japan. The causes of isolated splenic abscess are thought to be as follows; (1) hematogenous spread of bacteria from a focus of infection, (2) trauma, (3) inflammation occurring due to the influence of peripheral organs, (4) splenic infarction, (5) hemoglobin abnormality. The cause in our case was thought to be (1), and totalization of the cases reported in Japan revealed that the most common cause was also (1).