摘要:

ABSTRACT—Surgical bile flow restoration in extrahepatic biliary atresia (EHBA) does not prevent the development of ongoing hepatic fibrosis and cirrhosis. Portal connective matrix was studied on liver biopsies obtained from seven children submitted to portoenterostomy. Electron microscopy and immunohistochemical techniques (using specific antibodies directed against collagen isotypes and associated glycoproteins) were performed. The study of extracellular and cellular components of connective mat ix demonstrated the existence of two distinct areas according to their situation with regard to ductular proliferation: loose connective matrix – mainly composed of finectin, type III collagen, type IV collagen and laminin – associated with microvessels and myofibroblasts proliferation characterized periportal zones adjacent to bile ductules; in areas distant from ductular proliferation, connective matrix appeared dense, composed of type I and type III collagen associated with fibroblasts. The connective matrix pattern observed in periductular areas can be compared to that described in cicatricial and hypertrophic processes where the myofibroblastic cell population is known to play an important role in fibrosis development. Although the connective matrix activation process remains unclear in EHBA, it may be suggested that activation of a connective tissue cellular clone might be responsible for this portal fibroma

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00288.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—In experimental liver failure (pigs with totally devascularized liver) the effect of different types of extracorporeal hepatic assistance was evaluated. Group I (N = 6) were untreated controls, Group II (N = 6), simple cross‐circulation, Group III (N = 6), cross‐circulation with inflow in the donor directly into the portal vein and Group IV (N = 4), cross‐perfusion with isolated perfused liver. The cross‐circulation was started 20 h after devascularization. There was no change in survival time. Bilirubin was decreased by a factor of 2 and the prothrombin index increased by a factor of 2 after initiation of the cross‐circulation due to the dilution. In contrast to this, ammonia was unchanged. During the perfusion no significant changes were found. In Group V (N = 4), extended cross‐perfusion with isolated perfused liver for 20 h, starting just after exclusion of liver function in the recipient and with a new liver in the perfusion system every 6th hour, the survival time was significantly increased. Furthermore, changes in the biochemical variables were prevented. It is concluded that with a supply of quantitatively sufficient hepatic assistance it is possible to extend the survival time in experimental

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00289.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—The effect of hepatic assistance on cerebral metabolism was evaluated in a series using cross‐circulation, anticipating increased efficiency of hepatic support. The experimental model for liver failure was pigs with totally devascularized liver. Cross‐circulation with a normal sibling pig, cross‐circulation with inflow in the donor directly into the portal vein and cross‐perfusion with isolated perfused liver starting 20 h after elimination of liver function in the recipient and lasting for 3 h did not increase survival. Before cross‐circulation in these three groups, the cerebral flow and oxygen uptake were decreased; during the cross‐circulation a significant but temporary increase was found. In experiments with early and prolonged perfusion with isolated perfused liver no changes in cerebral flow, oxygen or glucose uptake were found, and these variables were still normal 6 h after termination of the perfusion. The survival time was significantly increased. In the control group a significant rise in blood and CSF ammonia was found with a mean CSF/blood ratio of 0.92. After cross‐circulation, the CSF/blood ratio was 0.52 and 0.62, respectively, indicating a proportionally greater elimination of ammonia from the cerebrospinal fluid than from the blood. Cross‐circulation did not significantly change the α‐ketoglutarate, glutamate or glutamine CSF concentrations. After prolonged cross‐perfusion, the ammonia blood/CSF ratio was 0.24. It is concluded that by extended extracorporeal hepatic assistance it is possible to increase survival and to prevent changes in cerebral metabolism and ammonia accumulating in t

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00290.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—IgM antibody to hepatitis B core antigen (IgM anti‐HBc) may indicate an active immune response to persistent infection with hepatitis B virus (HBV). We studied 186 Greek HBsAg carriers for IgM anti‐HBc and attempted to correlate it with other HBV and hepatitis delta virus (HDV) markers. Overall, IgM anti‐HBc was detected more frequently than HBV DNA in this population (50% vs 34, p<0.001); this was also true for the 149 of the 186 HBsAg carriers with antibody to hepatitis B e antigen (anti‐HBe) (48% vs 22%, p<0.001). The opposite was found in the carriers positive for hepatitis B e antigen (HBeAg): HBV DNA was observed in 93% and IgM anti‐HBc in 64% of the cases (p<0.05). The detection of these markers was independent of sex. Serum alanine aminotransferase (ALT) levels were significantly more elevated in patients with positive tests for IgM anti‐HBc and HBV DNA than in patients positive only for HBV DNA (p<0.001) irrespective of their HBeAg or anti‐HBe status. Moreover, the detection of elevated ALT was independent of the intensity of the HBV DNA hybridization signal. Antibodies to hepatitis delta antigen (HDAg) were only found in 4 (2.4%) of 167

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00291.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—Recent studies have suggested that decreased excitatory neurotransmission in the brain may contribute to the overall neural inhibition which characterizes the syndrome of hepatic encephalopathy (HE), and that vasoactive intestinal polypeptide (VIP) and cholecystokinin (CCK) may promote neural excitation in the brain. To determine if brain levels of these neuropeptides are altered in HE, measurements were made of the concentrations of immunoreactive VIP (iVIP) and immunoreactive CCK (iCCK) in cerebral cortex, cerebellum and hypothalamus isolated from normal rabbits and rabbits with galactosamin‐induced hepatic coma. Hepatic coma was associated with reduced concentrations of iVIP, small molecular weight iCCK and large molecular weight iCCK in the cerebral cortex but not in the cerebellum or hypothalamus. These findings are compatible with decreased VIP‐ and CCK‐mediated neural excitation occurring in the syndrom

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00292.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—In a longitudinal study liver volume and liver function were measured in a series of 12 patients undergoing partial liver resection for focal hepatic lesions. Ultrasonography revealed that liver volume, reduced by about 50% by the resection, progressively increased, and 6 months after surgery it returned to nearly normal values. A variable reduction in routine liver function tests was observed, possibly reflecting the influence of the different reserve synthetic capacity of the liver and, in the early postoperative phase, plasma half‐life of liver products and blood loss or changes in plasma volume. The galactose elimination capacity was only marginally reduced in the early period (from a pre‐surgery value of 2.49 ± SE 0.21 mmol/min to 2.31 ± 0.14 after 7 days; p = ns) and reached a nadir at 14 days (1.97 ± 0.16; p<0.001). When expressed per unit of liver volume, the galactose elimination (22 ± 2 μmol/min per unit before resection) progressively decreased during the regeneration phase from 36 ± 4 at 14 days to 26 ± 3 at 6 months (P vs 14‐day:<0.01). At 6 months both galactose elimination and galactose elimination per unit of liver volume were no longer different from baseline values. Our data show that, following hepatic resection, both liver volume and liver function increase and progressively return to nearly normal values. In agreement with data obtained in animal studies, it appears that the metabolic activity of the remaining parenchyma is increased in the early postoperative phase, and it slows down in the course o

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00293.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—Forty‐six patients with liver biopsy‐documented chronic hepatitis B were followed for a mean period of 44 months. A total of 200 serum samples from these patients was analyzed for the presence of hepatitis B virus DNA (HBV‐DNA). The results were correlated to the HBeAg/anti‐HBe status and to the presence of anti‐delta as a marker for delta superinfection. In the initial serum samples HBV‐DNA was detected in the vast majority of the patients independent of the HBeAg/anti‐HBe results and whether the patients were superinfected by delta agent or not. During the complete follow‐up period, HBV‐DNA was detected in 88% of those patients who were positive for HBeAg, irrespective of the presence or absence of a simultaneous delta infection. When anti‐HBe positive, 79% of the patients with anti‐delta had detectable HBV‐DNA in their sera, while only 43% of those negative for anti‐delta were positive for HBV‐DNA. The results indicate a high prevalence of virus release into the blood of patients with chronic hepatitis B, especially among patients positive for HBeAg and among those anti‐HBe positive patients

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00294.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—In a retrospective study the average yearly incidence of bacteremia in cirrhosis patients was found to be 4.5%. This is about 5–7 times higher than in two general materials of all bacteremic patients from the same hospital. There was no difference between the distribution of bacterial strains in the 43 bacteremic cirrhosis patients and the two general materials of all bacteremic patie

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00295.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—Through in‐depth interviews, an inventory has been made of the experiences of 18 liver patients who have been considered for or undergone a liver transplant. Interviews were also held with the patients' relatives. Chronic patients especially seem to regard a transplant as their last chance, and all their hopes become based on it. The strict selection procedure is distressing, and being turned down causes negative feelings. As far as the operation itself is concerned, patients are inclined to create high success rates for themselves in relation to their survival chances and the expectations of quality of life. For some patients a transplant means a marked improvement in the various aspects of their functioning. Others are not so fortunate, but do not give up hope of improvement. From the relatives of the patients who had died post‐operatively, no negative feelings were encountered over the ‘failure’ of the

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00296.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT—In 67 patients (mean age 51 years, range 26–79), at diagnosis of primary haemochromatosis (PH), grade III or IV liver iron overload was present in all cases, cirrhosis in 85%, transferrin saturation>80% in 75%, serum ferritin>1000 μg/1 in 84%, and overt diabetes in 48%. Alcohol intake was>150 g/day in 11 patients; six were chronic hepatitis B surface antigen (HBsAg) carriers. HLA‐A3 and B7 antigens were present in 64% and 23% versus respectively 22% (p<0.01) and 9% (p<0.025) in controls. Iron overload was found in the stomach, duodenum, skin and bone marrow in 57, 43, 45 and 59% of the patients studied. Sixty‐three patients were followed for 1–260 months (median 24); 43 received regular iron‐depleting treatment and 20 did not because of liver failure, cancer or refusal. Cumulative survival was 79%, 67% and 61% at 1, 4 and 10 years, respectively. Ten patients died from hepatocellular carcinoma and two from extrahepatic cancer. The early high mortality rate was due to some cases of advanced disease or cancer. Cumulative survival in the regularly treated group was 95% at 1 year and 91% at 4 and 10 years, which was higher than in the unt

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1986.tb00297.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY