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급성 virus성 간염에 있어서의 중심정맥반응 : Central Vein Reaction of the Hepatic Tissue in Acute Viral Hepatitis Postulated Mechanism and Its Diagnostic Implication

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서울대학교 의과대학
Seoul J Med, Vol.17 No.2, pp. 75-82
Hepatic needle biopsy specimens from fifty two
cases of acute viral hepatitis were analyzed and the
central vein reaction of the hepatic tissue was
investigated along with its histologic characteristics,
prevalence and its diagnostic value.
Of the fifty-two acute viral hepatitis specimens,
4:'1 (82.7%) accompained a variety of reactions to
the central veins. Those alterations were able to
be categorized largely into two forms; a phlebitic
change and a smudging effect. The former represented
the combined phenomena featuring simply
from focal or diffuse circumferencial necrosis of
the wall, neutrophilic exudation, segmental disrupdisruption
of the limiting plates, to fibrinoid necrosis,
with or without thrombosis and collapse: the latter
smudging effect, on the other hand, was charac..
terized by edema and loss of fibrillar architectures.
faint stainability and wrinking but without disruption
of centrilobular limiting plates.
The prevalence of the phlebitic changes in icteric
type was 72.2% in acme phase, and 53% in subsi..
ding period; but those lesions remained in all cases
of persisting phase and anicteric type, whereas in
cholestatic and fulminant ones the changes were
only found in one quarter and two-fifths, respectively.
The smudging effect, a residual phenomenon,
was identified in 14.3% of acme phase and 23.5%
of subsiding period of icteric type. But this type
of smudging was found rarely in cholestatic and,
fulminant types. The above vascular alterations
showed a tendency to subside with clinical recovery
but became intensified in cases undergoing persis..·
ting course or even in chronic aggressive hepatitis.
The exact mechanism of these central vein reaction
in acute viral hepatitis is not clearly postulated",
but seemed to be the cumulative results of reflecting:
the initial hepatic cell fall-out adjacent to the centr'ilobular
limiting plates with subsequent inflammatory'
exudative satellitosis and other degenerative changesextending
to the limiting plates and eventual development
of disruption and necrosis of vascular wall;
as a feature of convalescence most of vasculitic:
process appeared to undergo a smudging effect.
which is foIl owed by a healing process completely
returning to normal structures. Demonstration of
the central vein reaction was helpful for the differential
diagnosis from other hepatic disorders resem..
bling acute viral hepatitis morphologically, Relationship
of phlebitis to the presence of HBsAg is
not clearly understood because of the limited mate..
rials in this investigation, but further study with,
more accurate informations on hepatitis B surface
or core antigen and antibody positivity should be'
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