Debré R
Proc R Soc Med. 1939 Jul;32(9):1173-84. doi: 10.1177/003591573903200935.
The author reports the history of a family of six children, of whom two, the eldest and the fifth, are normal; three died, a boy when 6 months old and two girls when 9 and 10 years old, from the same familial disease that also attacked another boy now 7 years old. The essential features of this disease are hypertrophy of both liver and spleen, chronic icterus with evidence of salts and bile-pigments in the blood and urine, retardation of physical, mental, and sexual development, slight deafness in one case and clubbing of the fingers in another. This condition is a good example of biliary cirrhosis of the liver.After reviewing recent French observations, the author recalls the large contribution of English authors on the subject.HE THEN DISTINGUISHES THREE TYPES OF FAMILIAL CIRRHOSIS: Laennec's type with enlarged liver, the type of splenomegalic anascitic and anicteric cirrhosis, resembling Banti's syndrome, and the commonest type or biliary cirrhosis.The author describes particular histological lesions, and when dealing with differential diagnoses, excludes dyslipoidic, polycoric, and other acquired cirrhosis in children. He then summarizes the relationships between this disease and the obstructive cirrhosis to a congenital defect of the bile-ducts, the cirrhosis in young Indians, the syndrome of hepatic lenticular degeneration, and the syndrome of cirrhosis of the liver combined with haemangiomatosis. Finally, after recalling the close analogy of the condition with renal dwarfism, the author shows how the interpretation of these relationships may throw light on the pathogenesis of various progressive congenital diseases.
作者报告了一个有六个孩子的家庭的病史,其中两个,即最大的和第五个孩子,发育正常;三个孩子死亡,一个男孩6个月大时死亡,两个女孩分别在9岁和10岁时死亡,他们都死于同一种家族性疾病,这种疾病也侵袭了另一个现在7岁的男孩。这种疾病的主要特征是肝脏和脾脏肥大、慢性黄疸,血液和尿液中有盐类和胆色素的迹象、身体、智力和性发育迟缓,一例有轻度耳聋,另一例有杵状指。这种情况是肝胆汁性肝硬化的一个典型例子。在回顾了近期法国人的观察结果后,作者回顾了英国作者在该主题上的巨大贡献。然后,他区分了三种类型的家族性肝硬化:肝肿大的Laennec型、类似于班替氏综合征的脾肿大性无腹水无黄疸型肝硬化,以及最常见的类型或胆汁性肝硬化。作者描述了特殊的组织学病变,在进行鉴别诊断时,排除了儿童的血脂异常、多囊性和其他后天性肝硬化。然后,他总结了这种疾病与梗阻性肝硬化、胆管先天性缺陷、印度年轻人中的肝硬化、肝豆状核变性综合征以及肝硬变合并血管瘤病综合征之间的关系。最后,在回顾了这种情况与肾性侏儒症的密切相似性之后,作者展示了对这些关系的解释如何能够阐明各种进行性先天性疾病的发病机制。