摘要:

AbstractForty‐three patients with spontaneous bacterial peritonitis (SBP) between 1973 and 1978 were identified. Criteria for SBP included a positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3. Chronic liver disease was documented by varices in 91%, severe histologic fibrosis or cirrhosis in 94%, splenomegaly in 91%, and past hospitalization for liver disease in 57% of the patients. SBP was detected within 7 days of admission in 17 patients (40%) and within 35 days in 38 patients. Single organisms were isolated from 38 patients and multiple organisms from 5 patients. Twenty‐six of 43 patients survived the episode of SBP, but only 13 survived the hospitalization. Analysis of the survival curve from the onset of SBP revealed a rapid death rate and a slow death rate set of patients. Rapid death (<7 days from SBP onset) correlated with a lack of prior hospitalization for liver disease (p<0.001), hepatomegaly (p<0.001), increased serum bilirubin (p<0.005), serum creatinine (p<0.05), and peripheral white blood cell concentrations (p<0.05). Survival during hospitalization was associated with prior hospitalization with liver disease (p<0.001) and chills during the episode of SBP (p2.1 mg%; Group 2 patients had lower values. Survival was greater in Group 2 patients with advanced, relatively quiescent liver disease compared to Group 1 patients for both the episode of SBP (91 vs. 29%; p<0.001) and for hospitalization (50 vs. 9%; p<0.05). Death in Group 2 patients was related to inadequate antibiotic therapy (p<0.05), nonhepatic factors, and new onset of renal failure. Although SBP in the setting of severe acute liver injury has a dismal prognosis, SBP with minimal acute liver injury has a relatively good prognosis for hospital survival even with advanced chronic liver disease. Long‐term survival is also possible since 4 of 9 patients with prolonged follow‐up have survived

ISSN:0270-9139    

DOI:10.1002/hep.1840020402

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractFifty‐six patients with alcoholic cirrhosis and ascites were studied. The ascitic fluid was analyzed for pH, PO PCO2, glucose, protein, specific gravity, amylase, lactic dehydrogenase, white blood cell count, polymorphonuclear count, and cytology. It was also cultured aerobically and anaerobi‐cally. Simultaneously, arterial blood was analyzed for pH, PO2, and PCO2. Venous blood was analyzed for complete blood count, protein, aspartate transaminase, and it was also cultured under aerobic and anaerobic conditions. Six patients had spontaneous bacterial peritonitis (SBP), i.e., culture was positive forEscherichia coliin five andStreptococcus faecalisin one. The mean (±S.E.) ascitic fluid pH in the SBP group was 7.25 ± 0.06 with a range of 7.12 to 7.31, while the ascitic fluid pH in the group with sterile ascites was 7.47 ± 0.07 with a range of 7.39 to 7.58. The pH of the blood in both groups was 7.47 ± 0.03. The pH of the ascites in the SBP group was significantly different from the pH in the group with sterile ascites, p<0.001. It was also significantly different from the blood pH, p<0.001. Highly significant inverse correlations existed between the ascitic pH in the SBP group and the ascitic white blood cell count (r = –0.84, p<0.01) and between the ascitic pH in the SBP group and the ascitic polymorphonuclear count (r = −0.87, p250 per mm3in which false positive interpreta

ISSN:0270-9139    

DOI:10.1002/hep.1840020403

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractAll of the methods proposed for measuring portal blood flow are either invasive, estimate total rather than nutrient flow, and none has proved reliable in cirrhotic patients. A method has been derived from pharmacokinetic principles used for the calculation of bioavailability of drugs according to the route of administration (i.v. or p.o.) and tested experimentally in 20 pigs. A tracer dose of [14C]ursodeoxycholic acid, a biliary acid with a high‐liver first‐pass effect, is administered in the duodenum, and serial peripheral blood samples are taken. Later, the same dose of the same drug is administered i.v. The shunt fraction of portal blood F is obtained by the ratio of the areas under the plasma level vs. time curves (“AUC”) after p.o. and i.v. administrations:The pigs were divided into three experimental groups, (i) Group I: undisturbed portal flow; (ii) Group II: total diversion of portal blood with an end‐to‐side portacaval shunt, and (iii) Group HI: partial diversion of portal blood through a side‐to‐side portacaval shunt.Portal flow was measured during surgery with an electromagnetic flowmeter above and below the shunt and the degree of shunting calculated.Results show that the shunt fraction measured with ursodeoxycholic acid is well‐correlated with hemodynamic data. No overlap between Groups I to III is observed.It is concluded that the shunt fraction of nutrient portal blood can be measured with this noninvasive method. Minute amounts of ursodeoxycholic acid were used in order to be completely metabolized by the liver, even in spite of hepatocellular dysfunction. Therefore, this method should be valid in cirrhotic patients and be useful to decide the type of portosystemic shunt to propose for the decompression of gastroe

ISSN:0270-9139    

DOI:10.1002/hep.1840020404

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractAn amino acid mixture rich in branched‐chain amino acids and poor in aromatic amino acids was infused in six cirrhotics with altered plasma amino acid profile and normal mental state. The effect on muscle protein catabolism, as measured by urinary excretion of 3‐methylhistidine, was assessed during two consecutive 3‐day periods in which patients received the amino acid mixture alone or in a hypertonic dextrose solution. During a 3‐day basal period, cirrhotics showed increased rates of 3‐methylhistidine excretion as compared to six matched healthy subjects. Both treatments reduced urinary 3‐methylhistidine to normal. During treatment, branched‐chain amino acids failed to normalize, plasma aromatic amino acid concentrations and ammonia declined, and alanine increased. Branched‐chain amino acids are mainly oxidized in skeletal muscle with production of alanine. Reduced muscle protein catabolism following amino acid infusion is consistent with the physiological role of branched‐chain amino acids in suppressing protein breakdown and stimulating protein synthesis. Long‐term therapy with branched‐chain amino acid‐enriched mixtures may prove useful in advanced cirrhotics wit

ISSN:0270-9139    

DOI:10.1002/hep.1840020405

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractWe developed a simple and inexpensive method of perfusing small specimens of human liverin vitrothat maintains short‐term tissue viability as judged by protein transport function and morphological features. The technique allows investigation of liver function at the cellular level in normal specimens and those with hepatobiliary disease. Electron microscopy of specimens perfused with this system demonstrates the presence of an incomplete basement membrane within the space of Disse and shows that human microbodies contain crystalline‐like cores morphologically similar to those found in rat li

ISSN:0270-9139    

DOI:10.1002/hep.1840020406

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractThe role of bile acids in the biliary secretion of alkaline phosphatase was studied. Rats with external bile fistulae were drained for 4 hr. After 2 hr, bile acid secretion fell progressively. Alkaline phosphatase secretion also decreased progressively during the period of drainage, suggesting that secretion of the two components was related. Each rat was then given an i.v. infusion of the taurine conjugate of either cholate, chenodeoxycholate, or ursodeoxycholate. Alkaline phosphatase secretion increased in a dose‐dependent manner as bile acid secretion was varied over and beyond the physiologic range. Each bile acid affected alkaline phosphatase secretion differently: given at 0.5 /imoles per min per 100 gm, tauroursodeoxycholate caused a 3‐fold, taurocholate a 14‐fold, and taurochenodeoxycholate a 75‐fold increase in enzyme secretion. To determine if these findings might represent elution of canalicular enzyme by bile acids, isolated liver surface membranes were incubated with the bile acids. Like the findingsin vivo, taurochenodeoxycholate was strongest and tauroursodeoxycholate weakest in removing alkaline phosphatase from the membrane. Differential centrifugation of liver surface membranes after exposure to bile acids and ultracentrifugation of bile showed that more than half of the enzyme released by the action of bile acids did not sediment at 100,000gand, thus, could be considered soluble. These results document bile acid‐dependent secretion of alkaline phosphatase in rat bile and suggest that the process involves solubilization of both membrane fragments and free enzyme from membranes lining the bili

ISSN:0270-9139    

DOI:10.1002/hep.1840020407

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractTo investigate the possibility of an association between oral contraceptive steroids (CS) and hepatocellular carcinoma (HCC), we reviewed 128 cases of HCC in women collected between 1953 and 1980. There were 48 cases under the age of 40, and 13 of these (27%) had used CS. However, 62% of HCC associated with CS and 58% of HCC in women under 40 not using CS were classified histologically as “fibrolamellar” carcinoma. This subtype of HCC occurs predominantly in young people, both male and female. The apparent increase in HCC in young women can be explained by the presence of cases of fibrolamellar carcinoma in this age group, and the apparent association with CS is probably coinciden

ISSN:0270-9139    

DOI:10.1002/hep.1840020408

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractDuring a 33‐month period, 295 patients with acute viral hepatitis were admitted to a state hospital for civil servants and their dependents in Sao Paulo, Brazil. Seventy‐nine per cent (232) were HBsAg negative. To define the contribution of non‐A, non‐B viral hepatitis to hepatitis morbidity in this population, further serological studies were performed in 147 confirmed HBsAg‐negative patients. One hundred and twelve (76%) were serologically classified as hepatitis A based on identification of IgM antibody to hepatitis A virus. Thirty patints (20%) without IgM antibody to hepatitis A virus, HBsAg, or anti‐HBc were categorized as the non‐A, non‐B hepatitis group. The remaining five patients had probable hepatitis B (IgM antibody to hepatitis A virus negative, HBsAg negative, anti‐HBs negative but anti‐HBc positive). These data suggest that all three etiological forms of viral hepatitis are endemic in Sao Paulo.Epidemiological, clinical, and laboratory features were compared in the hepatitis A and non‐A, non‐B hepatitis groups. Patients with non‐A, non‐B hepatitis were significantly older than patients with hepatitis A (mean age ± S.D.: 30 ± 22 years vs. 9 ± 9 years, p<0.001). Contact with hepatitis or jaundice was recognized in 26 (23%) of 112 hepatitis A patients and 3 (10%) of 30 non‐A, non‐B patients, a difference which was not statistically significant. Parenteral exposures were identified in 13 (43%) of 30 patients with non‐A, non‐B hepatitis and 23 (21%) of the 112 hepatitis A patients. Blood transfusion in the 2 months preceding onset of illness was reported in 5 (17%) of the 30 non‐A, non‐B patients and in none of the hepatitis A group (p1,000 HJ/per liter, and the mean duration of SGPT elevations for each group were not significantly different. Mean peak serum bilirubin levels were slightly higher in the non‐A, non‐B group than in the hepatitis A group (7.6 ± 8.0 mg per dl vs. 5.1 ± 2.7, p10 mg per dl were found in 27% of the non‐A, non‐B group and 5% of the hepatitis A group (p<0.001). Whether the higher bilirubin levels reflect an agent‐related phenomenon or

ISSN:0270-9139    

DOI:10.1002/hep.1840020409

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractA commercial radioimmunoassay was adapted to detect serum Dane particle‐associated HBeAg in patients whose sera contained the homologous antibody. HBeAg was released from Dane particles with guanidine HC1.Dane particles were separated from anti‐HBe by gel‐filtration (Sepharose 4B) and ultracentrifu‐gation of the eluate. Dane particle‐HBeAg was tested in 45 HBsAg carriers with anti‐HBe and was present in 8 (18%) carriers, all of whom had chronic liver disease. By contrast, HBeAg was not found in 10 carriers with normal liver histology. Serum or liver HBeAg was found in 6 of 8 patients with Dane particle‐HBeAg. None of the carriers without Dane particle‐HBeAg had other markers of hepatitis B virion synthesis.We conclude that Dane particle‐HBeAg provides a sensitive index of active hepatitis B virus replication, a guide to the presence of chronic hepatitis in HBsAg carriers with anti‐HBe, and a noninvasive method to follow infectio

ISSN:0270-9139    

DOI:10.1002/hep.1840020410

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY

摘要:

AbstractDifferent methods of expressing the results of the aminopyrine C02breath test (ABT) were compared to determine the method that would be most sensitive for evaluating liver function. The patient population included healthy controls (n = 22); patients with mild (4), moderate (9), and severe (7) alcoholic liver disease; and patients with chronic persistent hepatitis (7), chronic active hepatitis (18), chronic active hepatitis with bridging (18), and chronic active hepatitis with cirrhosis (17). The ABT was performed with 2 μCi [14C]aminopyrine or 2 mg per kg [13C]aminopyrine, and the results were expressed as the instantaneous labeled CO2excretion rates at 30, 60, 90, and 120 min after the dose, the maximum excretion rate, and the 120‐min cumulative excretion. The 30‐min parameter had the highest sensitivity toward moderate alcoholic hepatitis, severe alcoholic hepatitis, chronic active hepatitis with bridging, and chronic active hepatitis with cirrhosis (96%); however, when the ABT was repeated in six normal controls with 225 ml of orange juice, the 30‐min rate was significantly reduced (7.8 ± 1.3 vs. 5.6 ± 1.2% dose per hr), and the rate of false‐positive test results was increased (0 of 6 vs. 2 of 6) indicating that gastric delay influenced the 30‐min parameter. The 60‐min excretion rate, maximum rate, and 120‐min cumulative excretion were the next most sensitive expressions of the ABT, and were not altered by the small gastric load. Of these three expressions, the 60‐min parameter was the most convenient because it required fewer samples and a s

ISSN:0270-9139    

DOI:10.1002/hep.1840020411

出版商:W.B. Saunders    

年代:1982

数据来源: WILEY