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I. New Voek }tlEDICAL JOVBMAL. KICVERSIONARY PSEUDOBILE CANALIC- I'LI FORMATION IN THE CIRRHOTIC LIVER OF A VULPINE PHALANGER. By Fred D. Wkidman, M. D., Philadelphia. \l-rom the Laboratory of Comparative Pathology, Philadelphia Zoological Gardetts.] It is common knowledge that there has long Generic Cialis 5mg Online been a difference of opinion regarding the genesis of the bile ducts which we see so conspicuously in microscopic sections of the various cirrhoses of the liver. Passing the older textbook discussions and opinions, we find the following ideas current among modern ])alhologists : Adami and NichoUs (i) state that three modes of origin are possible: new Generic Cialis 5mg Online ducts derived by proliferation of the original bile capilla- n'c'^ : hill- capillnrios that have persisted after dc- I'TG. I. — Darker parts arc- centres of lobules. The lighter are the reversionary peripheries. Fat globules in reverting and reverted cells appear as minute vacuoles, more numerous at Generic Cialis 5mg Online left. Veo' 'ow power. struction of the lobules to which they belonged; or reversionary degeneration of liver cells. They state that on careful examination the new formed capil- laries often resemble atrophic columns of liver cells more than bile capillaries because the cytoplasm of their component cells strikes a color with Generic Cialis 5mg Online hematoxy- lin and eosin similar to that of normal liver parenchyma. "Such pseudocapillaries, therefore, lirobably re])resent columns of liver cells that have reverted to a more jirimitive condition." They favor, then, the reversionary theory. McFarland (2) says that in cirrhosis of the liver he bile ducts "a]>pear distinctlv more numerous than normal,"' in some cases suggesting adenoma. In explanation he suggests first that "some may have preexisted antl become conspicuous by loss of hepatic cells," but that in extreme cases they are certainly more numerous than could ever have been normal. He also mentions the reversionary idea, that they represent isolated and atrophic columns of liver cells. He gives, in the third place, as the usual interpretation, that they Generic Cialis 5mg Online are efforts at regen- eration on the part of the bile ducts to compensate for atrojjhicd liver parenchymal cells. He names the same three possibilities as Adami and Xicholls, but dees not commit himself to any theory. Mallory (3) strikes a median position, stating that Generic Cialis 5mg Online probably both true and apparent bile duct formations occur in alcoholic cirrhosis. He seems to prove the rever- sionary idea by citing the same kind of fat globules and hyaline material in the apparent bile ducts as Generic Cialis 5mg Online appeared in the parenchymal cells. He speaks of these ducts as compressed liver cells. McCallum (4) in spite of Adami's and Mallory's statements, cuts the Gordian knot most boldly by saying that "everything goes to show that they are bile ducts for the greater part newly fomied from the stumps of those which were left, and now growing to re- establish connection with the liver cells." Kelly (5) seems to come nearest to the truth when he says: "Doubtless the great increase of these structures in cirrhosis is relative only, and due in small part to mutual apjiroximation of al- ready" existing bile ducts occurring in consetiuence of loss of the liver tissue; but that most of them are newly formed is generally conceded and is quite apparent from their excessive number and the evi- dences of active proliferation (mitosis) that they commonly exhibit. Their origin has not been de- termined definitely for all cases. It seems quite certain that some, at least, of them result from pro- liferation of previously existing Generic Cialis 5mg Online bile ducts; on the other hand, since they are found in a wide Generic Cialis 5mg Online variety of disorders, such as all fomis of cirrhosis, acute jellow atrophy, in the neighborhood of hydatid cysts, tubercles, gummas, etc.. in other words, in diseases alike onlv in that they destroy liver tissue ; since they diiTer from normal bile ducts Generic Cialis 5mg Online in the ab- sence or relative paucity of encircling elastic tissue : since they have been found by Ackermann and others to be directly continuous with liver cells ; and since in cases in which the liver cells have been much destroyed they are found in large numbers in what may be interpreted as the remains of the skeleton of the lobule, we are tjuite warranted in the opinion that they may result from proliferation of the liver cells themselves, constituting in this event a reversion to a less highly specialized type of structure." The only part of Kelly's statement that is open to objection is the one in reference to Ackermann's findings. That the transition occurs is certain. The writer has seen it repeatedly, and a drawing of it is shown in Delafield and Prudden's Textbook of F'atlioloijy (6) where these authors also lean to the reversionary theory. Tiie objection lies in the interpretation. A little thought will show that the continuity /'iv .fi- simply indicates that the ducts and liver cords comnumicate ; and no more ►hat the new duct is derived from within the lobule Jl iriilDM.lX: REVERSION AKY I'SEL'DOBILE CANALICUU. 439 tlian from without. In either event they should be