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Eighty patients with portal hypertension due to various hepatic diseases were subjected to the oral ammonia tolerance test (OATT). Blood samples were collected before and at 30-min intervals after the administration of ammonium chloride (50 mg/kg). The ammonia levels, and the OATT curve patterns and ~NH3-N values were determined and it was investigated whether there are correlations between these values and various other parameters of hepatic function. The results of OATT correlated with the plasma disappearance rate of indocyanine green and the molar ratio of branched chain amino acids to aromatic amino acids. Our findings suggest that the OATT may reflect the degree of hepatic parenchymal disorders rather than the hepatic circulatory abnormalities and that they may represent a valuable aid in the differential diagnosis of hepatic diseases and in determining the operative indication.---oral ammonia tolerance test; ammonia metabolism; portal hypertension; hepatic failure Ammonia is thought to be an important factor in the manifestation of hepatic failure, and has been investigated in patients with hepatic disorders, especially hepatoencepalopathy in portasystemic shunt (McDermott 1957;Conn 1969). The increased ammonia level in the blood of patients with hepatic diseases is thought to be ascriable to the sum of ammonia derived via two routes, decrease in ammonia metabolism and the inability of ammonia to enter the metabolic cycle due to the existence of an intra-and/or extrahepatic shunt. It is difficult to determine which of these routes represents the major contributor to the increased ammonia level in the blood of the patients with hepatic disease.In this report, the results of the oral ammonia tolerance test (OATT) in patients with portal hypertension are described. PATIENTS AND METHODSEighty patients with portal hypertension were treated in our department, of these cases 58 had liver cirrhosis, 17 idiopathic portal hypertension with hepatic fibrosis and 5 extrahepatic portal obstruction. Four gastric cancer patients without hepatic abnormalities served as the controls. Before inception of this study, voluntary informed consent was obtained from all participating patients.

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Using AFP-secreting AH66 rat hepatoma cells and AFP-bound acrylic beads (AFP-B), artificial cells expressing surface antigen, the effect of blood AFP level on the accumulation of radiolabeled rabbit anti-AFP antibody in the site of tumor and beads implanted in rats was examined. Scintigrams of hepatoma-bearing rats with implanted AFP-B showed a marked localization in AFP-B site, but not in the tumor site on day 5 after the injection of radiolabeled antibody. The imaging of AFP-B was most satisfactory in normal rats with extremely low blood AFP. Tissue/blood radioactivity ratio in AFP-B on day 5 was found to be significantly higher in normal rats (17.43±5.55), compared with 6.66+ 1.67 in the tumor-bearing rats (p <0.01), while the ratio of AFP-B in tumor-bearing rats remarkably recovered to 11.20+0.25 (p <0.01) after whole blood exchange to reduce an elevated serum AFP level. The accumulation of anti-AFP antibody in the tumor was not observed irrespective of AFP-B. Microautoradiography of tissue sections showed the specific localization of radioactivity on the surface of AFP-B but not on the surface or the inside of the tumor cells. Immune complexes were detected in plasma of tumor-bearing rats 1 min to 7 days after the administration of the radiolabeled antibody. In conclusion, the application of anti-AFP antibody for the diagnosis and treatment of tumors is limited to the case of the expression of AFP on the surface of tumor cells and lower AFP level in circulation.radioimmunodetection ; AFP ; anti-AFP antibody ; whole blood exchange

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