摘要:

AbstractWe have previously reported the results of a controlled trial showing that continuous oral administration of propranolol reduced the risk of recurrent gastrointestinal bleeding in patients with cirrhosis; only part of our patients had been followed for 1 year. This controlled trial was continued for an additional year; accordingly, all of our patients have now been followed for at least 2 years. The purpose of the present study is to determine whether prolonged administration enhances the efficacy of this therapy.Seventy‐four patients with cirrhosis, admitted for an episode of gastrointestinal bleeding, were included in this study; ascites, jaundice and encephalopathy were absent or mild and transient. The patients were randomly assigned to two groups; one group of 38 patients received propranolol twice daily at doses that reduced the resting heart rate by 25%, the other group of 36 patients received a placebo twice daily. The cumulative percentages of patients free of recurrent gastrointestinal bleeding 1 and 2 years after inclusion were 87 and 79% in the propranolol group, and 42 and 32% in the placebo group; both differences were highly significant (p<0.0001). Furthermore, the cumulative percentages of surviving patients 1 and 2 years after inclusion were 94 and 90% in the propranolol group, and 84 and 57% in the placebo group; the difference between the two groups was not significant at 1 year, but was statistically significant at 2 years (p<0.02). We conclude that, in patients with cirrhosis in good condition, propranolol reduced the risk of recurrent gastrointestinal bleeding and the mortality rate during the 2‐year period of continuous oral administration of the d

ISSN:0270-9139    

DOI:10.1002/hep.1840040301

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractPermeability of the blood brain barrier in relation to the development of hepatic encephalopathy was investigated in two animal models of acute hepatic failure, in one of which there was the potential for recovery (D‐galactosamine‐induced hepatitis). In both this and the hepatic devascularization model, there was an approximate 3‐fold increase in the passive permeability of the blood brain barrier to inulin and sucrose. Transport of amino acids was also significantly affected, with approximate 30% increases in the brain uptake of phenylalanine, tyrosine and arginine and a 65% increase in uptake of leucine. These changes are attributed to the action of circulating toxic substances, some of which increase blood brain barrier permeability in normal an

ISSN:0270-9139    

DOI:10.1002/hep.1840040302

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe presence of serological markers of hepatitis B virus (HBV) infection and of hepatocellular HBV DNA were investigated in 19 HBsAg‐negative patients with clinically and histologically significant chronic liver disease. Four cases negative for antibodies to HBsAg (anti‐HBs), to the core antigen (anti‐HBc), and to the e antigen (anti‐HBe) were classified as non‐A, non‐B hepatitis. The remainder, positive for one or more of the three antibodies, were classified as hepatitis B. Histologic diagnosis was chronic active hepatitis in five, chronic persistent hepatitis in 11, micron‐odular cirrhosis in two, and fatty liver in one patient. The DNA extracted from limited amounts of liver biopsies, without cleavage by restriction endonucleases, was analyzed by the Southern blot technique for the presence of episomal HBV DNA. Autoradiographs showed a single band of less than 4.0 kilobase (kb) corresponding to the monomeric form of HBV DNA in five patients, several bands of larger forms (4.0 to 18.0 kb) in three patients, both the monomeric and the larger forms in eight patients, and no HBV DNA in three patients. While HBV DNA was detected in the hepatocellular DNA of six patients who underwent splenectomy, hybridization was negative with the DNA extracted from their spleens. The episomal viral DNA larger than 4.0 kb may represent concatemeric forms or free oligomers which could not be distinguished from rearranged and/or integrated viral DNA in the limited analyses of the hepatocellular DNA hydrolyzed with HindIII or EcoRI. Our observations suggest the presence of HBV‐like agents in the liver of serologically HBsAg‐negative patients with chro

ISSN:0270-9139    

DOI:10.1002/hep.1840040303

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe etiology of fulminant viral hepatitis was determined in 65 consecutive cases among 1,814 (3.58%) adults with acute viral hepatitis who were admitted to the Infectious Diseases Hospital of Athens from May, 1981 to August, 1983. Radioimmunoassays were used to detect hepatitis B virus, hepatitis A virus and δ‐agent markers. Enzyme immunoassay was used to detect anti‐HBc IgM. Hepatitis B virus was responsible for 48 (73.9%), non‐A, non‐B for 16 (24.6%) and hepatitis A virus for one case (1.5%). The use of anti‐HBc IgM identified 10 cases of fulminant type B hepatitis among HBsAg negative, anti‐HBc and anti‐HBs positive patients. Fulminant non‐A, non‐B hepatitis was superimposed on 10 asymptomatic HBsAg carriers; δ‐agent co‐infection was diagnosed in two fulminant type B hepatitis cases. These data show that hepatitis B virus is the major cause of fulminant hepatitis in Greece. HBsAg carriers are at high risk for fulminant non‐A, non‐B hepatitis. α‐agent does not seem to be as important a

ISSN:0270-9139    

DOI:10.1002/hep.1840040304

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractHigh yields of viable human hepatocytes were obtained by enzymatic perfusion of the left hepatic lobe of kidney donors and cultured alone or with an epithelial cell line derived from rat liver. In conventional cultures, human hepatocytes did not survive more than 2 to 3 weeks and by Day 8 decreased their ability to secrete albumin. When co‐cultured, they survived for more than 2 months and secreted high levels of albumin even in a serum‐free medium. This long‐term survival appeared to correlate with production of an extracellular material which is rich in Type III collagen.In vitrophenotypic alterations of parenchymal cells were reversed by addition of rat liver cells and were characterized by recovery of cuboidal morphology, increased albumin secretion and a shift from Type I to Type III collagen deposition. Rat liver epithelial cells could not be replaced by nonhepatic epithelial cells. These observations suggest that when adult human hepatocytes are maintained in a culture which closely resembles theirin vivoenvironment, they are capable of continuing to actively express specific cell func

ISSN:0270-9139    

DOI:10.1002/hep.1840040305

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe effects of chronic alcohol consumption on the ultrastructure of endothelial fenestrations in liver sinusoids were studied by scanning electron microscopy in surgical liver biopsies of 16 baboons pair‐fed with nutritionally adequate diets containing alcohol or isocaloric carbohydrate for up to 112 months. Alcohol consumption for 4 to 24 months resulted in a decreased number of fenestrations (1.4 per μm2of the endothelial surface vs. 3.3 in pair‐fed controls; p<0.01) and an increase in their geometric mean diameter (115.6 vs. 82.3 nm in controls; p<0.001). After 61 to 112 months of alcohol feeding, the number of fenestrations was 1.9 (vs. 4.6 in controls; p<0.005) and the fenestration diameter was 91.8 nm (vs. 76.7 nm in controls; p<0.01). The fractional areas occupied by the fenestrations on the endothelial surface of the sinusoids in baboons fed alcohol for 4 to 24 and 61 to 112 months were calculated to be 84 and 58% of their respective controls. The alterations in the sinusoidal endothelium revealed in this study are most likely associated with a disturbance in the exchanges between the sinusoidal blood stream and the liver parenchyma and may thereby contribute to alcohol‐induced liver

ISSN:0270-9139    

DOI:10.1002/hep.1840040306

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractPrimary cultures and cell lines were established from suspensions of purified fat‐storing cells isolated from the rat liver. When seeded at a suitable density, fat‐storing cells in primary culture reached confluency in 3 to 4 days and could be transferred and established as cell lines for at least two passages. The typical morphological characteristics of fat‐storing cellsin vivowere retained in the cells during primary culture. Vitamin A fluorescence was still associated with lipid droplets of cells in culture up to and including the second passage. Investigation of the cytoskeletal structure by indirect immunofluorescence showed the presence of vimentin, actin and tubulin in the cells; noa‐prekeratin was present. The presence of vimentin suggested a fibroblastic or possible myogenic origin for fat‐storing cells. The presence of connective tissue components in fat‐storing cells in culture was demonstrated by indirect immunofluorescence. Collagen Types I and IV and laminin were present intracellular in small granules in fat‐storing cells in primary culture and in the first passage. Cells in the fourth passage contained only collagen Type 1. Fibronectin was only aligned extracellularly along the cell membrane, which did not exclude an extracellular source. Rat liver fat‐storing cells in culture show a high proliferating capacity. Cell multiplication during prolonged culture was associated with phenotypic transition to a more fibroblastic appearance and gradual disappearance of vitamin A. These results indicate that fat‐storing cells may be among the cell types involved in pathological changes observed during development

ISSN:0270-9139    

DOI:10.1002/hep.1840040307

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe liver ultrastructural findings in two girls with partial carbamyl phosphate synthetase I (CPS) deficiency and their heterozygote parents and two siblings with ornithine transcarbamylase (OTC) deficiency are described. Liver ultrastructure in the four patients with inherited deficiences of urea cycle enzymes showed minimal alterations with essentially normal mitochondria when biopsy was performed during periods of good control of their hyperammonemia. Mitochondrial ultrastructure was also essentially normal in the heterozygotes for carbamyl phosphate synthetase I deficiency. These findings are in contrast to the marked alterations in mitochondrial ultrastructure found in the study of two cases of Reye's syndrome in which severe depression of ornithine transcarbamylase and carbamyl phosphate synthetase I activities was noted.

ISSN:0270-9139    

DOI:10.1002/hep.1840040308

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractSix liver biopsies from previously healthy adult patients with cytomegalovirus (CMV) mononucleosis were studied by routine light microscopy and by the immunoperoxidase technique for CMV antigen. Light microscopical findings consisting of a mononuclear portal and sinusoidal infiltrate, increased hepatocellular mitotic activity and minimal hepatocellular necrosis were consistently found. Less common features were granuloma formation and bile duct epithelial damage. Typical CMV nuclear inclusions and CMV antigen were identified in only one case, a patient with marked leukopenia secondary to CMV who had received corticosteroid therapy. The other five cases contained no inclusions and CMV antigen could not be identified by immunoperoxidase staining. This data suggests that, as with hepatitis B, viral antigen is not identifiable in acute CMV hepatitis in the immunocompetent host, perhaps due to active destruction of infected cells. The immunoperoxidase technique for CMV appears to be of little value in the diagnosis of acute CMV hepatitis.

ISSN:0270-9139    

DOI:10.1002/hep.1840040309

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractFocal hepatocellular hyperplasia and focal mixed (hepatocytes and sinusoidal cells) hyperplasia are early histological alterations indicative of vinyl monomer exposure. To evaluate their uses in screening chemical workers, 93 liver biopsy specimens from 78 persons were examined in double‐blind duplicative fashion. Forty‐eight specimens were from exposed chemical workers, 35 of them having liver biopsy(ies) for hepatic test abnormalities and 13 for nonliver‐related reasons. A comparison group consisted of 30 nonchemical workers who had undergone liver biopsy for nonliver related reasons. Twenty‐three of the exposed workers (48%) had hepatic lesions consistent with exposure: 17 (35%) of these had focal hepatocytic hyperplasia, while 6 (13%) had focal mixed hyperplasia or more advanced lesions. Only five of the comparison group had like findings: four (13%) had focal hepatocytic hyperplasia; one had focal mixed hyperplasia and sinusoidal dilatation. This individual had persistent hepatic test abnormalities with the focal mixed hyperplasia and a sinusoidal dilatation, and on subsequent biopsy, angiosarcoma (and a history of using hair spray containing vinyl chloride propellant). Ten individuals had 25 multiple biopsies also read double‐blindly; 10 had two or more readings of the same biopsy. Duplicate 21 of 23 (91%) and multiple 27 of 28 (96%) biopsy interpretations in the same individual were identical. Only 6% of either duplicate and/or multiple readings disagreed. Both focal hepatocellular and mixed hyperplasia were always associated with abnormalities in hepatic test results of which indocyanine green clearance was the most sensitive and γ‐glutamyl transpeptidase the least specific. Focal hepatocellular hyperplasia is a more common finding and occurs earlier than the focal mixed hyperplasia among vinyl monomer exposed workers. Follow‐up for 5 to 7 years yielded no biochemical or histological evidence of spontaneous progression of this lesion in a work environment where vinyl chloride levels were 10 ppm with time‐weighted averages of 1 to 2 ppm. Focal mixed hyperplasia is, as noted, a later and less frequent finding among vinyl monomer‐exposed workers. Some individuals with this lesion develop hepatic angiosarcoma independent of subsequent vinyl monomer exposure. In screening for chemical liver injury, indocyanine green clearance supplementary to routine tests is recommended with confirmati

ISSN:0270-9139    

DOI:10.1002/hep.1840040310

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY