摘要:

ABSTRACT—The source of activation of T lymphocytes in primary biliary cirrhosis (PBC) is undefined. Hence, T‐cell‐mediated reactivity against a biliary tract antigenic protein from human bile was studied. The bile protein was fractionated by 30–50% saturated ammonium sulphate and gel‐chromatography, and analysed by SDS‐PAGE and Western immunoblotting using rabbit antisera to the bile protein. The antisera reacted specifically with human bile duct epithelium. Western blotting of bile proteins showed two major bands, the B1 and B2 antigens. B1 stained for sialoglycoprotein but not lipid, but B2 was negative for both. Cell‐mediated reactivity was tested by proliferation of peripheral lymphocytes against B1. Taking the upper limit of the normal range for stimulation indices (S.I.) as less than 1.89 (= mean + 2 SD), a mitogenic response was detected in 14 of 16 patients with PBC (S.I.: 11.7 to 2.3), and in 4 of 15 patients with chronic active hepatitis, but in none of 12 patients with drug‐induced intrahepatic cholestasis or obstructive jaundice. The B2 protein was non‐stimulatory. Lymphocyte proliferation to B1 in PBC was confined to T cell fractions of peripheral blood leucocytes. There was no cross‐antigenicity between B1 and the M2 antigens, according to Western blotting using the rabbit antisera and PBC sera with anti‐M2 reactivity. Thus, the B1 biliary protein is a possible source of T cell activation in PBC and hence could be an immunological co‐factor in the patho

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00537.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

ABSTRACT—Hepatitis C virus (HCV) has been proposed to be a cofactor in the pathogenesis of cirrhosis in patients with chronic alcoholism. The demonstration of a different liver histological pattern in anti‐HCV positive patients might provide additional evidence. We studied 164 patients with chronic alcoholism, and histologically proven cirrhosis. For all of them, serum samples were collected at the time of a liver biopsy and stored at –80°C. Testing for anti‐HCV antibodies was done using the Ortho Diagnostic Systems Anti‐HCV ELISA test. Only reproducible results were considered positive. A semi‐quantitative assessment of seven histological parameters was made independently on liver biopsy samples. In the study group, 29 patients (18%) had anti‐HCV antibodies. When compared with anti‐HCV negative patients, both groups had similar ALT and AST seric activities. Anti‐HCV positive patients had a greater score of mononuclear cells infiltrate (0.71±0.57 vs 0.41 ±0.52; p<0.05) and a lesser score of alcoholic hepatitis (0.19 ±0.57 vs 0.74 ±0.74; p<0.005). The scores for steatosis, perisinusoidal and perinodular fibrosis, and hepatocellular necrosis were similar in the two groups. In anti‐HCV positive patients, with a clearly positive recombinant immunobinding assay (RIBA, Chiron‐Ortho Diagnostic Systems), a greater score for hepatic necrosis and a lesser one for fibrosis were demonstrated. Among the seven patients with active cirrhosis, six were anti‐HCV positive. Therefore, HCV is likely to play a role in the pathogenesis of liver damage in a few patients with alcoholic cirrhosis, especially,

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00538.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

ABSTRACT—Infections are frequent in patients with liver cirrhosis, as their defenses against infectious agents are altered. But bacteremia occurring in cirrhotic patients has seldom been reported in the literature. From 1981 to 1986, we collected 197 cases with 228 episodes of bacteremia for this retrospective study. The incidence of bacteremia in cirrhotic patients was 8.8%; no significant difference was noted between cirrhotic patients with variant etiologies of HBV(+), HBV(–) and alcohol. But the incidence increased with the severity of the disease (1%, 4.8%, 17.1% in Child's A, B, C groups, respectively). Gram‐negative bacteria were the predominant microorganisms of bacteremia (75.6%). Among them,Escherichia coli, Klebsiella pneumoniaeandAeromonas hydrophiliawere the three most commonly detected microorganisms. Gram‐positive bacterias were detected in 21.2% of patients with bacteremia, with predominance of theStreptococcusgroup andStaphylococcus aureus.In about 26.3% of cases the infectious sources were the same by bacteria cultures as from blood. The most common sources were spontaneous bacterial peritonitis, urinary tract infection, pneumonia and biliary tree infection. In cirrhotic patients with and without bacteremia, the mortality rate increased significantly in the bacteremia group (54.8% vs 23.2%, P<0.05). By Child's classification, the mortality of patients with classes B and C increased significantly after onset of bacteremia. There was no significant difference in mortality between bacteremic patients in the HBV(+), HBV(–) and alcohol groups. In conclusion, bacteremia is a severe complication of liver cirrhosis and a sign of a poor

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00539.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

ABSTRACT—HEPAR is an expert system which can be used as a supportive tool in the diagnosis of disorders of the liver and biliary tract. When consulted for a particular patient, the system assesses the patient's disorder in two stages. In the first stage, data of medical history, physical examination and routine laboratory tests are used to determine whether the disorder is hepatocellular or biliary obstructive, and whether benign or malignant features are present. In the second stage, the system produces a differential diagnosis out of a set of 80 disease categories, using the conclusions of the first stage of the assessment and the results of a restricted number of supplementary investigations, i.e. serological tests and ultrasonography. The conclusions of the two stages are ordered by the amount of evidence computed by HEPAR. The system is not yet suitable for clinical use. The system has been evaluated using data of 181 patients selected from a population of 214 consecutively admitted patients with jaundice. The patients were classified by the system as having a hepatocellular or biliary obstructive, and a benign or malignant disorder in 96% and 100% of the cases, respectively. When comparing the conclusions with strongest evidence with the final clinical diagnoses, the patients were classified correctly in 86% and 83% of the classified cases, respectively. A differential diagnosis was produced in 87% of the patients. A correspondence between the diagnosis with strongest evidence and the final clinical diagnosis was found in 78% of the classified patient

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00540.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

ABSTRACT—Twenty‐four young, female, random‐bred rats weighing 250 g were partially hepatectomized and killed in groups of four animals at the following times: 1 h and 1, 2, 3, 7 and 14 days. One hour before killing, each rat was injected i.p. with 0.5 μCi [3H]‐thymidine, specific activity 5 Ci/mmol/g body weight. Livers were processed histologically and dipped into liquid emulsion for autoradiography. Twenty‐four hours after partial hepatectomy, hepatocyte and littoral labelling indices rose, reaching on the third day respective peak values of 3.7%, and 15.4%, whereupon they declined, remaining slightly above pre‐treatment level. Labelling indices served for cell production estimates. On day 3 the hepatocyte labelling index rose 26‐fold. At the same time hepatocytes doubled their ploidy, indicating that half of the observed L.I. increase was directed to DNA accumulation and not to cell division. The hepatocyte production rate therefore increased 13‐fold (or 1300%). The acinus diameter increased 15%, and cell density declined 5%, so that the acinus capacity to retain cells increased only 5%. Since the acinus did not enlarge proportionally to cell production, it is concluded that 95% of newly formed cells were eliminated. Partial hepatectomy thus triggers two processes: an acute process lasting about a week marked by massive and rapid cell turnover during which most newly formed cells are eliminated; and a second, more protracted process which serves for liver mass restoration. It is proposed that partial hepatectomy induces an acute shortage of a hitherto unknown metabolite that is produced by newly formed cells immediately a

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00541.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

ABSTRACT—Hepatitis B virus DNA (HBV‐DNA) in serum was studied in 67 anti‐HBe patients using dot‐blot hybridization, a modified technique and polymerase chain reaction (PCR). All patients had abnormal aminotransferase (ALT) levels. Serum HBV‐DNA was detected in 14/67 cases by dot‐blot and in 39/67 (DNA probe) and 45/67 (RNA probe) using the modified technique. The RNA probe was more sensitive than the DNA probe when they were compared, using serial dilutions of HBV‐DNA of known concentration (0.1 pg vs 1 pg, respectively). HBV‐DNA was found by PCR in 57/67 patients. Ten patients were negative to serum HBV‐DNA. The ALT level was significantly higher in patients with serum HBV‐DNA by dot‐blot as compared to those who had serum HBV‐DNA by the modified technique and PCR. With respect to the presence of anti‐HCV, 6/67 had anti‐HCV confirmed by RIBA test. These 6 patients had serum HBV‐DNA. The route of acquisition of HBV infection in anti‐HCV positive patients was by parenteral exposure in 67% of the cases and 15% in HCV negative (p<0.05). All patients were negative to nonorganic specific autoantibodies. In summary, most of the anti‐HBe patients (85%) had viral replication. HCV superinfection plays a minor role

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00542.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

ABSTRACT—The biological significance of antibody reactivities towards the preS2 gene encoded proteins of HBV is not yet well known. We investigated the pretreatment IgM anti‐preS2 (1–55)adreactivity in 22 Chinese and 11 Swedish patients with active HBV disease. Significantly enhanced IgM anti‐preS2 levels (titers>1/1000) were observed in 48% (16/33) of these patients. The OD405values for sera from patients with indolent HBsAg carriership were within the range of that obtained for “normal” control‐sera when tested at dilutions from 1/1000 to 1/128000. Five Chinese patients were treated with a short course of corticosteroids, followed by alpha‐interferon 2b (IFN‐α2b) treatment for 16 weeks. The IgM anti‐preS2 response was consecutively monitored during treatment. A beneficial effect on the outcome of the combined treatment was associated with rising titers of IgM anti‐preS2 during the prednisolone cycle. The IgM anti‐preS2 levels fell dramatically upon steroid withdrawal and were followed by a second peak response of IgM anti‐preS2 reactivity during the IFN‐α2b treatment. No sustained loss of HBV‐DNA or DNA polymerase with concomitant HBe/anti‐HBe seroconversion was observed in treated patients, who lacked detectable pretreatment levels

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00543.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Book reviewed in this article:Lebenthal, Emanuel,Textbook of gastroenterology and nutrition in infancy.Barkin, Jamie, O'Phelan, Cesar A. (eds.)Advanced therapeutic endoscopy.Berk JE, Haubrich WS. (eds).Gastrointestinal symptoms. Clinical interpretation.

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00544.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1991.tb00545.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY