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In 1845 Budd' reported three cases of obstruction of the hepatic veins. In 1899, after studying the results of three of his own cases and seven cases from literature, Chiari'-' emphasized that obstruction of the hepatic veins due to obstructive phlebitis should be classified as a distinct disease. Following the report of three cases by Yamagiwa3 in 1906, additional cases were studied and reported in Japan. By recent progress of venous catheterization techniques, the authors could diagnose clinically obstruction of the hepatic veins and/or the inferior vena cava in the hepatic portion in eight patients. In Japan, obstruction of the hepatic veins is frequently associated with obstruction of the inferior vena cava in the hepatic portion, peculiar features of which were pointed out by Kimura et al. in 1963.4 Therefore, in this paper, we describe not only obstruction of the hepatic veins but also that of the inferior vena cava in the hepatic portion.As one of our patients of chronic type died of liver carcinoma, we reviewed the Japanese literature on obstruction of the hepatic veins and the inferior vena cava in the hepatic portion and found that liver carcinoma developed in 41 per cent of the patients with obstruction of unknown cause of the hepatic veins and/or the inferior vena cava in the hepatic portion. The unique features found in our eight cases and in the Japanese literature are reported in this paper. CASE REPORTS Case 1. S.S., a 49-year-old public official, was admitted to the Tohoku University Hospital in March 1963. He had had acute nephritis at the age of 9 years and an ulcer of the left leg caused by an uncured bruise sustained 13 years previously when he had struck his leg violently against a desk. In January 1963, x-rays showed elevation of the diaphragm, and hepatomegaly and splenomegaly were shown. On admission slight jaundice was seen on the conjunctiva. The hard liver with uneven surface was palpable four fingerbreadths below the right costal margin, and the spleen, three fingerbreadths below. There were vascular spiders on the anterior region of the chest and a slight, long, rounded ulcer 4 cm in diameter surrounded by pigmentation on the left leg.

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We examined the immunopathology and the expression of human immunodeficiency virus type 1 (HIV-1) in lumbosacral dorsal root ganglia (DRGs) from 16 patients with acquired immunodeficiency syndrome (AIDS) and 10 HIV-1-seronegative controls. Using in situ hybridization, we detected HIV-1 RNA in a few perivascular cells in DRGs from five of 16 AIDS patients (31%). In addition, using polymerase chain reaction, we detected HIV-1 DNA more frequently in DRGs from four of five AIDS patients (80%) examined. We detected interleukin-6 (IL-6) immunoreactivity in endothelial cells in DRGs from seven of 16 AIDS patients (44%) but from none of 10 HIV-1-seronegative controls (0%). We found more nodules of Nageotte, CD8+ T lymphocytes, and intercellular adhesion molecule-1 (ICAM-1)-positive endothelial cells and mononuclear cells in DRGs from AIDS patients than in DRGs from controls. Increased numbers of nodules of Nageotte in DRGs of AIDS patients were associated with detection of HIV-1 RNA by in situ hybridization and detection of IL-6 by immunohistochemistry. We conclude that low levels of replication of HIV-1, through cytotoxic T lymphocytes or expression of cytokines, may play a role in the subclinical degeneration of sensory neurons frequently observed in DRGs of AIDS patients.