Electron microscopy and x-ray scanning microanalysis of needle biopsy material from human liver

A study has been made of the fine structure of hepatic parenchymal cells of human biopsy material in a case of pancreatic tumor with obstructive jaundice. Dense particles about 60 A in diameter have been found in the cytoplasm, which are considered to be ferritin molecules by electron microscopy. They are encountered throughout the cytoplasmic matrix and are often aggregated in electron-transparent areas, most of which are enclosed by an apparently single-layered membrane. Identification of the elemental iron has been pursued by the application of the x-ray scanning microanalyser which reveals a quantitative value within 1.0 per cent of the pure iron sample. The use of x-ray scanning microanalysis enables one to obtain accurate data from extremely small and precisely defined volumes of biological specimens.

ASSOCIATION OF INTRAVENOUS ALBUMIN WITH ALKALINE PHOSPHATASE ACTIVITY

After albumin transfusion levels of alkaline phosphatase are raised. These levels were studied in selected groups of patients and in albumin prepared for transfusion using a heat sensitivity test, and by this means the significance of raised levels of alkaline phosphatase may be interpreted correctly.

THE VALUE OF JIRGL'S FLOCCULATION TEST IN THE DIAGNOSIS OF JAUNDICE

Jirgl's serum flocculation reaction was examined in a series of 121 patients with varying types of liver disease. Positive results were found in 90% of patients with proven extrahepatic obstructive jaundice. Strongly positive reactions were also obtained in primary biliary cirrhosis and chlorpromazine jaundice. One out of three cases of ;cholestatic' hepatitis gave a weakly positive reaction and the test may be of value in the diagnosis of this condition and in the rare recurrent conjugated hyperbilirubinaemia in which it is also negative.Eighty-four per cent of cases of portal cirrhosis were negative and the finding of a positive result in this condition may indicate the presence of a hepatoma.No correlation could be found either in intra- or extrahepatic obstructive jaundice between the degree of flocculation present and the severity of the obstruction as judged by serum bilirubin and alkaline phosphatase levels.

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.