摘要:

Abstract:Angiographic visualization of the hepatic vascular bed by selective angiography can be profitably complemented with the evaluation of functional portal‐systemic shunting by D‐sorbitol bioavailability. Seventeen patients requiring diagnostic arterial catheterization were studied: most of them had biopsy‐proven liver cirrhosis. Patients were studied at rest and after overnight fasting on two subsequent days, in which a sterile pyrogen‐free solution (1.5%) of D‐sorbitol was administered by direct infusion (15 mg/min for 20 min) into the superior mesenteric artery and an antecubital vein, respectively. The fractional bioavailability (Fma) of Dsorbitol was calculated as the ratio between the net cumulative urinary outputs obtained after infusion through the catheter into the superior mesenteric artery and the systemic vein, respectively. A good correlation was found between the estimated fractional portal‐systemic shunting, which in the present study ranged between 1.4% and 96.7%, and a suitable index scoring the clinical evidence of collateral circulation. Since the hepatic removal of D‐sorbitol is not affected by sinusoidal capillarization and its hepatic extraction ratio is quite high and only slightly modified by reduction in the number or functional activity of hepatocytes, the measured Fma can be assumed as a parameter reflecting the entity of portal‐systemic shunting. The test is safe and inexpensive, and appears potentially useful in several situations in which portal‐systemic shunting is pathophysiol

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00760.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The present study aimed to analyze the pathology of chronic hepatitis C in relation to HCV serotype, and to speculate on possible differences in the pathogenesis of liver injury. Liver biopsies were investigated from 59 consecutive patients in whom hepatitis C virus genotypes were determined by a serological genotyping assay that detects antibodies directed to epitopes encoded by the NS4 region. A morphological study was performed in each case, semiquantitatively scoring necro‐inflammatory and fibrotic liver lesions. The prevalence of HCV serotypes was as follows: 26 of the 59 patients (44%) had type 1 infection, 11 (19%) had type 2 and 20 (35%) had type 3. A significant association between intravenous drug abuse and serotype 3 infection was observed. Patients with HCV type 2 proved significantly older than patients with infection types 1 or 3, and more frequently they showed a more active liver disease, but no differences were found in the quality and acinar topographic distribution of all the morphological lesions scored. In conclusion, in chronic hepatitis C a more active liver disease can be related to HCV serotype 2 but the spectrum of liver lesions is independent of HCV types. From a morphological point of view, a different pathogenesis of liver injury related to different HCV types is unlikel

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00761.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The presence of types of alkaline phosphatase (ALP) other than the tissue non‐specific type enzyme in rat liver and its increase by fat feeding are known. In order to examine expression of intestinal type ALP in liver, specific oligonucleotide primers corresponding to two types of mRNAs of rat intestinal ALP (RTIN‐1 and‐2) were designed and amplified by means of the reverse transcriptase‐polymerase chain reaction (RT‐PCR). It was found that RTIN‐1 mRNA was expressed only in the intestine but not in the liver, while RTIN‐2 mRNA was expressed both in the intestine and in the liver. By fat feeding, expression of RTIN‐1 mRNA increased in the intestine and that of RTIN‐2 mRNA increased both in the intestine and in the liver. Thus, it was concluded that rat liver expressed one of the intestinal type ALP (RTIN‐2) which was enha

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00762.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Circulating hyaluronan is mostly derived from lymph, fibroblast and Ito cells in the liver, and more than 90% of hyaluronan is degraded in hepatic sinusoidal endothelial cells. Thus, elevated serum hyaluronan is regarded as an indication of hepatic fibrosis with activated Ito cells and dysfunctional sinusoidal endothelial cells. We studied the distribution of hyaluronan in human liver sinusoids to determine the influences on elevated hyaluronan levels in sera. Histochemical examination was made using hyaluronan‐binding protein (HABP) and serial sections of liver tissue for staining of alpha‐smooth muscle actin (ASMA) (an indicator of activated Ito cells) and of ulex europaeus agglutinin I lectin (UEA‐1) (closely related to hepatic sinusoidal capillarization). Positive staining, indicating the presence of hyaluronan, was noted in fibrous regions around the portal tracts, areas of focal necrosis in the liver parenchyma, and walls of the sinusoids in chronic hepatitis. In this group, hyaluronan‐positive areas corresponded to positive ASMA staining and faint staining of UEA‐1. On the contrary, in liver cirrhosis, UEA‐1‐positive areas were essentially identical to hyaluronan‐positive areas and to ASMA‐negative areas in sinusoidal walls. Hyaluronan and ASMA could be detected in the same areas of sinusoidal walls in chronic hepatitis, but not in liver cirrhosis. Hyaluronan appears to be mainly related to the staining of activated Ito cells in chronic hepatitis. Therefore, we concluded that in chronic hepatitis, the production of hyaluronan was accelerated in Ito cells; however, degradation of hyaluronan by sinusoidal endothelial cells continued. On the contrary, in liver cirrhosis, hyaluronan production decreased in Ito cells, and a marked transformation of sinusoidal endothelial cells with hepatic sinusoidal capillarization indicated loss of the ability to degrade hyaluronan. These different mechanisms in chronic hepatitis and liver cirrhosis may operate in the sinusoidal walls and may cause the elevation of h

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00763.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Hepatocellular carcinoma (HCC) is one of the most common malignancies in certain parts of the world, particularly in Africa and Asia, but it is less commonly encountered in the United States. It is closely associated with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and almost always develops in a cirrhotic liver. In non‐cirrhotic livers, HCC is found in about 20% of asymptomatic carriers of HBV and rarely in patients taking androgenic‐anabolic or oral contraceptive (OC) steroids. We report four patients, who developed HCC after prolonged use of OC steroids. Whether OC steroids act as mutagen or co‐carcinogen in hepatocarcinogenesis is not clear. To exclude latent HCV and HBV infections which may occur in the absence of their serological markers, we employed polymerase chain reaction for the detection of HBV and HCV sequences in the tumor and non‐tumorous liver tissue. Viral sequences of HBV and HCV were undetectable in all four cases. These findings suggest OC use as the only known risk factor in these cases and, therefore, strengthen its possible role in hepatocar‐ci

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00764.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:To assess the hospital prevalence of asymptomatic primary biliary cirrhosis (PBC), routine determination of serum alkaline phosphatase (AP), liver function tests (albumin, bilirubin, prothrombin time) and serum liver biochemistry (aminotransferases, gamma‐glutamyltranspeptidase) were performed in 4468 consecutive in‐patients (2332 men, 2136 women; mean age 57 years, range 16–94 years) admitted to our medical department from April 1991 to May 1995. In patients with an increase of serum AP levels, antimitochondrial antibody (AMA) testing, ultrasonography or CT scan, HIDA biliary scintiscan, bone scintiscan and endoscopic retrograde cholangio‐pancreatography (ERCP) were performed to exclude any disorders other than PBC. Fourteen out of the 4468 patients (0.3%) showed an asymptomatic increase of AP levels (i.e., detected by chance at the entry and not earlier investigated). In 12 of 14 cases the increase of AP was not related to PBC. Asymptomatic PBC was found in 2 of 4468 patients (0.04%). When only the “risk group” (women over 40 years) is considered, the prevalence rate increases to 0.12% (2/1644 women). Our data, while not assessing the true prevalence of asymptomatic PBC in the general population, suggest that symptomless PBC is much more common than has been thus f

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00765.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Ethanol‐inducible cytochrome P4502E1 is the main pathway in the non‐alcohol dehydrogenase oxidation of ethanol. Its coding gene,CYP2E1, is polymorphic at theRsaI restriction site in the 5′‐flanking region. The mutant genotype c2c2 has a higher transcriptional activity than the genotypes c1c1 or c1c2. Heavy drinkers carrying the c2 allele might be at a higher risk of alcoholic cirrhosis since they might synthesize greater amounts of acetaldehyde, the compound believed responsible for hepatotoxicity of ethanol. With the aim of establishing if the c2 allele increases the risk of cirrhosis in heavy drinkers, we studied 58 (6 female) chronic heavy drinkers with liver cirrhosis and 137 healthy normal controls of the same ethnic (white Spaniards) origin. After extraction of DNA from white blood cells, alleles c1 and c2 ofCYP2E1were identified by restriction fragment length polymorphism (RFLP) with endonucleaseRsaI. Fifty‐six patients and 130 controls were classified as homozygous c1c1 and two and seven, respectively, as heterozygous c1c2. No homozygous c2c2 were detected. The c2 allele frequencies were 0.017 in patients and 0.026 in controls (non‐significant differences). We conclude that theRsaI RFLP polymorphism is probably not related to the risk of cirrhosis in Spanish hea

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00766.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:In hepatitis C, both susceptibility to infection and the course of disease may depend on differences in the immune response. As the major histocompatibility complex (MHC) plays a crucial role in antigen presentation, we investigated a possible relationship between susceptibility to hepatitis C virus (HCV) infection and human leucocyte antigen (HLA) alleles. Therefore, phenotype frequencies of HLA were compared in 186 anti‐HCV positive patients with end‐stage renal disease (ESRD) to 328 anti‐HCV negative patients with ESRD. HLA class I alleles were determined serologically and HLA class II alleles (DRB1, DQA1, DQB1) by the polymerase chain reaction sequence‐specific oligonucleotide (PCR‐SSO) technique. Additionally, in anti‐HCV positive patients we looked for a relationship between the activity of hepatitis C (indicated by elevation of transaminases or the presence of viremia) and HLA determinants. For the three criteria (antibody status, elevation of transaminases and viremia) a significant association to HLA alleles was not found in patients with ESRD. This suggests that neither susceptibility to HCV infection nor the biochemical activity of hepatitis and HCV‐RNA positivity seem to be strongly related to HLA status in Caucasian patients with end‐stag

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00767.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:To investigate the relationship between intrahepatic cytokine expression and interferon (IFN) response in chronic hepatitis C [CH(C)], interleukin (IL)‐1ß,‐2,‐4,‐6,‐8, interferon (IFN)‐γ, tumor necrosis factor (TNF)‐α and TNF‐ß mRNAs were investigated semiquantitatively by reverese transcription polymerase chain reaction using serial liver biopsies taken before and after IFN‐α treatment from 24 patients with CH(C), including 12 responders and 12 non‐responders. Before IFN treatment, IL‐2, TNF‐ß, IFN‐γ and IL‐8 mRNA were associated with severe hepatitis activity whereas IL‐4 mRNA was associated with weak hepatitis activity, regardless of IFN response. IL‐2, TNF‐ß and IFN‐γ mRNAs were significantly greater in IFN non‐responders. After IFN treatment a complete response to IFN was significantly associated with the disappearance of these pro‐inflammatory cytokines, whereas non‐responders retained the expression of cytokine mRNA as before IFN treatment. Our results indicated that IFN‐α treatment may modulate the intrahepatic cytokine network, and this may be one mechanism of IFN‐α that reduces hepatitis activity, aside from an anti‐viral effect. A difference in

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00768.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Book reviewed in this article:De Franchis, ed.Portal hypertension II: definitions, methodology and therapeutic strategies.Goodlad RA, Wright NA, eds.Cytokines and growth factors in gastroenterology

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00769.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY