ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00181.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—In a prospective double‐blind trial, polyunsaturated phosphatidyl choline therapy (3 g/day) was given in addition to normal maintenance immunosuppressive therapy to 15 patients with HBsAg negative chronic active hepatitis. Histological evidence of disease activity was significantly reduced in the phospholipid‐treated group. The results indicate that polyunsaturated phosphatidyl choline is of value as additional treatment in the management of patients with HBsAg negative chronic active hepatitis whose disease is inadequately controlled with conventional doses of immunosuppressive th

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00182.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—Morphometric investigations were carried out on liver biopsies of chronic aggressive (active) hepatitis (CAH), type IIa, chronic aggressive (active) hepatitis, type IIb, and on chronic nonsuppurative destructive cholangitis (CNDC) (primary biliary cirrhosis (PBC)) in the second and third stages. The goal of the histometric analysis was a comparison of the portal tracts before and after immunosuppressive therapy with azathioprine and corticosteroids as well as with azathioprine alone. The volume and surface measurements of the portal tracts and their components showed that for an evaluation of the effectivity of the immunosuppressive therapy on CAH, along with a division into HBsAg‐positive and ‐negative cases, a histologically determined degree of the severity of the inflammatory activity is extremely significant. The therapeutic effect is significant for all cases of CAH IIb, evident for HBsAg‐negative cases of CAH IIa and slight for HBsAg‐positive cases of CAH IIa. Immunosuppressive therapy of CNDC has no effect on the characteristic destruction process of the bile ducts and ductule prol

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00183.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—One hundred and forty‐eight patients with non‐alcoholic cirrhosis or chronic aggressive hepatitis entered a prospective, unblinded, randomized trial on the effect of azathioprine versus prednisone. For all 148 patients, there were no differences in survival related to the two drugs. In 99 patients the disease was classified as autoimmune, in 23 as posthepatitic, and in 26 as cryptogenic. No significant differences were seen in survival between these three groups of patients and no differences in survival related to the two drugs were registered within any of the groups. The autoimmune group included the patients with the biochemically most active disease, and a statistically significant reduction in activity was obtained with prednisone as well as azathioprine. Most remarkably, the frequencies of the autoantibodies were reduced parallel to the biochemical improvement in these patients. Immunosuppressive treatment was found to be rather ineffective in posthepatitic chronic liver disease of type B; however, no signs of activation of the hepatitis B virus were

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00184.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—A liver biopsy material comprising 477 biopsies from 477 patients included in a prospective, unblinded, randomized trial of treatment of cirrhosis with prednisone has been re‐evaluated using new and more restrictive histological criteria for the diagnosis of cirrhosis and chronic aggressive hepatitis (CAH). The material was divided according to the likelihood of cirrhosis being present: (A) cirrhosis (287 patients), (B) probably cirrhosis (101 patients) and (C) compatible with but not diagnostic for cirrhosis (89 patients). Each group was further divided according to the presence (I) or absence (II) of CAH. A total of 98 patients fulfilled the histological criteria for CAH. The effect of prednisone concerning survival was evaluated in each group. In the total group of patients with CAH a significant beneficial effect of prednisone was found (p=0.04). Among these patients the subgroup with cirrhosis in addition (group I A) also showed a significant effect of prednisone, while groups I B and I C only had a trend towards a beneficial effect (p=0.44 and p=0.36, respectively). In patients without CAH in the biopsy (Group II, A+B+C), no effect of prednisone was seen although a trend towards a harmful effect was found in patients with cirrhosis (Group II A). Control patients with CAH in all three subgroups had an insignificantly shorter survival than patients without CAH. All the CAH groups significantly more often included female patients with no history of alcoholism and a lower frequency of spider naevi. In addition, the CAH groups were more active as judged by biochemical and histological variables. It was further disclosed that the presence of large piecemeal necroses indicated a favourable effect of prednisone treatment, while alcoholism, ascites and male sex acted as indicators for an unfavourable treatment eff

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00185.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—A prospective, unblinded, randomized trial of treatment of cirrhosis and chronic aggressive hepatitis (CAH) with prednisone included 484 patients who were divided using both the clinical criteria: non‐alcoholic females without ascites, and the morphological criterion: presence of a liver biopsy showing CAH. A total of 164 patients (34%) satisfied the three clinical criteria and biopsies from 95 patients (20%) showed CAH. By a cross‐tabulation method between the two sets of criteria, four groups were formed. Evaluation of the treatment effect by means of relative death rate showed that the clinical criteria identified both a group of patients with a beneficial effect of prednisone (p<0.05) and a group with a harmful effect of the treatment (p<0.05). Patients with CAH also had a significant beneficial treatment effect, but patients without CAH showed only an insignificantly harmful effect of treatment. Patients fulfilling both sets of criteria had a beneficial effect of prednisone (p<0.05) and patients lacking both sets had a significantly harmful treatment effect. A significantly better survival was found in patients satisfying the clinical criteriawithoutCAH in the biopsy than in patientswithCAH and not fulfilling the clinical criteria (p=0.03). In both the groups of patients with disagreement between the two sets of criteria, a trend towards a beneficial effect of prednisone was found. It is concluded that the simple clinical criteria in comparison with the histological criteria identify a larger group of patients with a beneficial effect of trea

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00186.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—To clarify the importance of ethnic and geographic factors in chronic active hepatitis (CAH), HBV markers and autoantibodies (AMA, ANA, SMA), have been compared in 158 patients with biopsy‐proven CAH from New York City and in 92 patients with CAH from Milan. HBsAg‐positive CAH was more frequently observed in Milan (49%) than in New York City (27%). However, among HBsAg‐positive patients, HBcAg, HBeAg, and epidemiologic risk factors for acquisition of HBV infection were more frequently found in New York than in Italy. The prevalence of HBsAg‐negative, anti‐HBc‐positive CAH and cryptogenic CAH was similar in the two cities, while autoimmune CAH was more frequently observed in New York (20%) than in Milan (2%). In particular, the prevalence of autoimmune hepatitis was higher among Jewish patients than among patients of Anglo‐Saxon or Latin ethnic background in New York. Thus, environmental and/or ethnic factors may influence the prevalence of the four maj

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00187.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—Hepatitis B surface (HBs) and core (HBc) antigens (Ag) were studied in liver tissue in HBsAg seropositive patients with chronic liver disease complicated (n=32) and not complicated (n=36) by hepatocellular carcinoma. Both groups were matched by age, sex and underlying disease. There was no qualitative and quantitative difference in tissue HBsAg between the two groups. However, HBcAg was significantly less in quantity in hepatocytes of patients with hepatocellular carcinoma compared to chronic liver disease without cancer. Serum hepatitis B e antigen tested by radioimmunoassay was also less frequently positive in patients with hepatocellular carcinoma. These findings seem to suggest that hepatitis B virus replication becomes less active in the process of hepatocarcinogenesis. The relationship between intrahepatic hepatitis B antigens and liver cell dysplasia was also studied. In hepatocellular carcinoma, tissue hepatitis B antigens often coexisted in the same liver having liver cell dysplasia, but no such association was observed in chronic liver disease without cancer. However, no indication was obtained that the dysplastic cells harbor HBsAg more frequently than non‐dysplastic ce

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00188.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—The hepatotoxic effect of phalloidin, a mushroom poison, was examined in whole liver and in isolated liver cell plasma membranes. By electron microscopy, a thickening of the pericanalicular microfilamentous network was noted. Bile canalicular enriched plasma membrane fractions of livers from phalloidin‐treated animals contained increased amounts of microfilaments. Analysis of the peptides in these fractions, by sodium dodecyl sulfate polyacrylamide gel electrophoresis, indicated that although the actin peptide bands were prominent, a band apparently corresponding to myosin was drastically reduced. The morphological change was accompanied by a reduced bile flow and biliary excretion of bile acids, proteins and the exogenous organic anion dibromo‐sulphthalein. These changes may result from a modification of the microfilaments, suggesting a role of the microfilaments in the liver membrane structure and fun

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00189.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT—Clinical, biochemical and serological data obtained in 103 patients with primary biliary cirrhosis (PBC) were analysed with respect to the four defined morphological stages. Evaluation of the initial biopsies (99 needle biopsies/4 wedge biopsies) revealed that most patients were in stage I (focal bile duct destruction). Unequivocal distinction between stages I and II was possible in most cases, while considerable overlapping of criteria was observed in stages II to IV. Morphological cholestasis, a characteristic sign of stage IV was already found in 7% of PBC I cases. Four out of 12 autopsy specimens showed micronodular biliary cirrhosis (Hanot's type) and eight specimens had a macronodular type of biliary cirrhosis. No predominant clinical symptoms were found in patients with PBC I or II, but pruritus was observed in about 30%. Increased serum alkaline phosphatase (AP) and IgM levels as well as a positive antimitochondrial antibody (AMA) test were typical features of all stages in up to 80–90%, but patients with normal AP or IgM or negative AMA have been observed, especially in stages I and II. Five of 57 patients at stage I had increased bilirubin levels and in three patients IgM and IgG were simultaneously elevated in stage I. The natural course of PBC, as it is reflected in histological staging, was studied in 30 patients in whom biopsies were regularly taken over a period of 2–18 years. About 80% of PBC I‐cases lasted between 1 and 7 years before reaching stage II, while another 5–10 years were necessary for the development of stage III‐IV. Thus it appears that in the vast majority of patients PBC lasts about 10–15 years and in some instances even more than 20 years. The finding in stage I and II of normal AP indicates a benign course, while morphological and biochemical cholestasis seems to be associated with a rather progr

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1982.tb00190.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY