FORMATION OF HEPATIC LYMPH

Samples of hepatic lymph collected from isolated perfused rat livers or from livers of whole rats, during continuous infusion of BSP, showed two types of response with respect to content of BSP. One of these was characterized by lymph BSP concentrations below those in blood plasma, and a chromatographic composition of lymph BSP different from that in both plasma and bile. In the other response BSP concentrations in lymph were grossly higher than those in plasma, and the chromatographic composition of the BSP was identical with that in bile. The second response was observed whenever bile flow was deliberately arrested, but it also occurred when bile was apparently flowing freely, suggesting that a type of nonobstructive, nonhemolytic jaundice could exist, based on failure of labile mechanisms which normally prevent diffusion of biliary substances into the extracellular space. The chromatographic composition of the BSP in responses of the first type suggests that part of the BSP in hepatic lymph normally arises from the hepatic cells, rather than from either the blood plasma or the bile.

THE DIAGNOSTIC VALUE OF SERUM LEUCINE AMINOPEPTIDASE

Serum leucine aminopeptidase determination was found to be a useful screening procedure for hepatobiliary disease in jaundiced and unjaundiced patients. Values under 1,000 units are of no help in the differential diagnosis of jaundice but values above 1,000 units are highly indicative of biliary obstruction. The differentiation of intra- from extrahepatic obstruction as well as of malignant from benign jaundice cannot generally be established by this single test.

SERUM BILE ACID LEVELS IN HYPERCHOLESTEROLAEMIC PATIENTS

A shortened method of estimating serum bile acids is described, based on extraction and the measurement of fluorescence in sulphuric acid solution at 37 degrees C. The cholate and dihydroxy bile acid fractions are determined separately by measurements made one hour and 24 hours after preparing the solution. About 1% of the serum cholesterol escapes separation and appears in the sulphuric acid solution; in its fluorescent properties it behaves in a manner almost identical with dihydroxy bile acids. As a result, the normal serum bile acids are overestimated by about 2 mg./100 ml. This effect is unimportant in cases of jaundice. In non-jaundiced cases with hypercholesterolaemia, the apparently raised serum bile acid levels are accounted for by the interference from cholesterol and there is no evidence that a raised serum cholesterol level is usually associated with raised serum bile acids.

PRURITUS AND JAUNDICE

The records of 147 patients who had pruritus and jaundice (11% of a series of 1262 patients with jaundice) were reviewed in an effort to delineate more clearly the etiology of jaundice associated with pruritus.Fifty-two had obstructive jaundice caused by neoplasm, 51 had obstructive jaundice not caused by neoplasm, 42 had pruritus associated with hepatogenous jaundice, and two had jaundice and pruritus associated with a lymphoma.Pruritus occurred in 17% of all patients with non-neoplastic obstructive jaundice and in 45% of patients with neoplastic obstructive jaundice. Hepatogenous jaundice was the cause of pruritus in almost one-third of the patients in this series-occurring in 20% of patients with infectious hepatitis and in 7% of patients with cirrhosis.This large series confirms the clinical impression that pruritus occurs most often in association with extrahepatic biliary obstruction, and as well re-emphasizes the common association of pruritus with hepatogenous jaundice.