摘要:

ABSTRACT—We studied 35 cirrhotic patients with tense ascites assigned at random into two groups: Group I consisted of 17 patients treated by total therapeutic paracentesis (TTP) (6–15 1) plus i.v. albumin (5 g/l of fluid) and Group II consisted of 18 patients treated by TTP (5.5–15.5 1) without albumin. On 19 patients we performed a sequential assessment of cardiac output (CO), plasma renin activity (PRA) and plasma aldosterone (PA). Both groups were similar in age, sex, and etiology of cirrhosis. CO, PRA and PA values were expressed as mean changes occurring in relation to their respective baseline values. CO changes after TTP (1/min): Group I: 2.5 after 6 h and 2.2 after 12 h; Group II: 2.2 after 6 h and –0.4 after 12 h, (p<0.05 comparing values after 12 h between the two groups). PRA changes after TTP (ng/dl/h): Group I: –7.4 after 1 h, –7.8 after 6 h and –3.2 after 24 h; Group II: –2.4 after 1 h, –0.8 after 6 h and 3.9 after 24 h (p<0.05 comparing values between both groups after 6 and 24 h). PA changes after TTP (ng/dl): Group I: –50.5 after 1 h, –36.7 after 6 h and –34.6 after 24 h; Group II: –18.2 after 1 h, –2.2 after 6 h and 20 after 24 h, (p<0.05 comparing values between both groups after 1 and 6 h). Complications were minimal in both groups. In conclusion, there was an increase of CO and a decrease of PRA and PA in all patients early after TTP. However, after 6 h there was a decrease of CO and an increase of PRA and PA, suggesting hypovolemia, only in patients without albumin. The frequency of complications after 24 h was similar in both groups. Since we do not exclude the possibility of complications over a longer period of time, we recommend the use of plasma expanders until their impact on morbidity and mortality in the long term is well established. The best time to infuse them is ab

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00637.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—Twenty hepatic infarction cases selected from 5420 consecutive autopsy cases were investigated to clarify the pathogenetic aspects of this disease. Additional postmortem angiological studies of 24 normal human livers obtained at autopsy were also further performed to analyse the effects of blocking vascular structures on lesion development. Seventeen of the 20 cases (85%) were clinically associated with systemic circulatory insufficiency, especially hepato‐ and/or renal failure. Histopathologically, there was a significantly closer relationship between the location of infarcted regions and portal vein thrombosis than with either hepatic vein thrombosis or hepatic arterial damage. The borders between infarcted regions and surviving hepatic parenchyma were located around central veins, corresponding with the microcirculatory periphery of the portal venous system. Postmortem angiographic studies revealed that hepatic lobuli mainly consist of portal vein branches. Moreover, postmortem embolization studies of six normal livers using glass beads and bariumgelatin injection showed that physical occlusion of portal vein branches produced defects in broad areas of the hepatic parenchyma. Therefore, it is suggested that the development of hepatic infarction principally depends on disturbances of the portal venous system. In addition, systemic circulatory insufficiency, which reduces the intrahepatic blood flow, probably contributes greatly to the development of hepatic infarct

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00638.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—A two‐stage study was carried out to characterize the bile and plasma lipid composition in normolipidemic non‐obese patients with and without cholesterol gallstones. The first stage involved 11 patients with cholesterol gallstones admitted for elective cholecystectomy and a control group of 16 patients without cholesterol gallstones undergoing elective laparotomy. Bile samples were obtained intraoperatively by aspiration from the gallbladder. The bile of all the gallstone patients was supersaturated with cholesterol and its nucleation time was much shorter than that of bile in the control group (2.5 days vs 22.5 days, respectively, P<0.001). The biliary fatty acid profile of phosphatidylcholine (PC) and free fatty acids (FFA) of gallstone patients was similar to that of the control group. C‐22 fatty acids were found in a higher concentration in the FFA than in the PC fatty acids (P<0.05) in both groups of patients. Plasma triglyceride levels in the gallstone patients were significantly higher than those in the control group and the biliary cholesterol level correlated with that of plasma triglycerides. In the second stage of the study, plasma lipid profiles were obtained in two additional groups of patients, 20 patients with and 24 patients without cholesterol gallstones, for an in‐depth characterization of the differences in plasma lipid profiles. The gallstone patients were found to have not only significantly higher concentrations of plasma triglycerides but increased cholesterol and phospholipid level as well. These differences were essentially due to a higher lipid content of the plasma VLDL fraction, similar to the pattern of patients with type IV hyperlipopr

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00639.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—It was our aim to evaluate whether the baseline activity of 2–5 oligoadenylate synthetase (2–5 OAS) in serum and changes induced by the treatment with interferon are relevant factors in remission of chronic hepatitis C. Seventeen out of 30 adult patients with chronic hepatitis C were randomized to receive recombinant alpha‐2b interferon at the dosage of 3 MU three times weekly. By the end of the third month, nine patients had normalized transaminase levels and continued to receive 3 MU of interferon for an additional 3 months, whereas in eight non‐responders the dosage was increased to 6 MU for the same period of time. A single patient responded to the increased dosage. Baseline 2–5 OAS serum activity was significantly higher in patients with chronic hepatitis when compared with normal controls. Follow‐up on the 13 untreated cases showed that 2–5 OAS elevation was stable and unrelated to concomitant infections. Comparison of responders and non‐responders showed that the latter had higher baseline 2–5 OAS activity, tended to have an earlier and higher peak in the enzyme during the first 4 weeks of treatment, and maintained higher levels during the first 3 months of therapy. The increased dosage of interferon in this group led to an additional, although temporary, increase in 2–5 OAS. Our data suggest that HCV infection by itself induces elevated 2–5 OAS levels. The paradoxical increase in non‐responders indicates that monitoring of the enzyme in serum does not predict the response to interferon. The role of the 2–5 OAS pathway in inducing the antiviral state in HCV infection should be furthe

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00640.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—The cyclin A gene was first identified at a site of hepatitis B virus DNA integration in a primary liver cancer (PLC). It has now been mapped to 4q27, in the proximity of a chromosomal locus (4q32) which is frequently rearranged and deleted in PLC. We took advantage of the TaqI polymorphism recently described in the cyclin A gene to search for allelic loss in this gene by means of PCR. Tumorous and non‐tumorous tissue from 50 patients with PLC was analyzed: 27 samples (54%) were homozygous for the A1 type allele (i.e. the allele bearing the TaqI restriction site), three (6%) were homozygous for the A2 type allele (without the TaqI site) and 20 (40%) were heterozygous. Comparison of tumorous and non‐tumorous patterns showed that only one (5%) tumorous tissue out of 20 heterozygous patients was homozygous, indicating the loss of an allele at this locus. We conclude that allelic loss in the cyclin A gene is a rare event in patients with PLC, and that PCR is rapid and reliable for the detection of allelic loss in the cyclin A gene when only small amounts of DNA are avai

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00641.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—Rats which were taurine‐deprived through ß‐alanine administration and untreated rats were used to elucidate the mechanism of hepatoprotective effects of ursodeoxycholate (UDC). Animals were infused with taurochenodeoxycholate (TCDC, 0.4 μmol · min‐1· 100 g‐1) alone or in combination with tauroursodeoxycholate (TUDC), or with UDC (both 0.6 μmol · min‐1 · 100 g‐1) for 2 h. Ursodeoxycholate as well as TUDC prevented severe cholestasis and liver damage induced by TCDC infusion in both untreated and taurine‐deprived rat groups. In untreated rats, however, UDC was less effective in hepatoprotection than TUDC as indicated by sequential changes in biliary LDH output during the period of 30 to 120 min (P<0.05). In rats receiving UDC and TCDC, total biliary output of LDH for 2 h was significantly higher in taurine‐deprived rats than that in the control (73.40±10.10 vs 41.14±12.56:P<0.05), suggesting that the difference became greater upon taurine deprivation. In contrast, in rats receiving TUDC and TCDC, the protective effect was comparable for the taurine‐deprived and untreated rats. When the animals were infused with UDC and TCDC, taurine‐deprived rats exhibited a biliary excretion rate for TUDC half that of control rats (P<0.05). Furthermore, a highly significant correlation was observed between the biliary excretion rate of TUDC and biliary output of LDH (r= –0.886,P<0.0001). These results suggest that UDC conjugates, especially TUDC, and not UDC may play a major role in the prevention of cholestasis and liver cel

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00642.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—Severe coagulation defects, as reflected by platelet count and prothrombin time, have always been considered a contraindication to needle biopsy of the liver, but there are very limited data on the actual rate of bleeding in patients with such severe alterations and none whatsoever on the bleeding risk associated with newer, fine‐gauge needles that produce less trauma to the liver tissue. In addition, there has never been any evidence that platelet count and/or prothrombin time are the most sensitive indices of bleeding risk. This retrospective study of 85 patients, with platelet counts less than 50 000/mm3and/or prothrombin times less than 50% of controls, subjected to ultrasound‐guided fine‐needle liver punctures for diagnostic or therapeutic (percutaneous ethanol injection) purposes showed no bleeding episodes after any of the 229 punctures performed. No type of replacement therapy was administered to correct clotting defects prior to the procedure. Correct pathologic diagnoses were obtained in 81.2% of all patients. Ultrasound‐guided fine needle puncture appears to be safer than currently believed in patients with severe clotting defects and deserves further evaluation as an alternative to surgical procedures to diagnose and treat liver lesions, even when severe coagulation impairment i

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00643.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—Thirty‐nine of 61 prospectively followed patients who had had acute non‐A, non‐B hepatitis in 1978 were clinically reexamined in 1991 and tested for antibodies to hepatitis C virus (anti‐HCV) with a second generation ELISA and RIBA and for HCV RNA by PCR. Acute hepatitis C was diagnosed in stored sera from 1978 in 24 patients, who were found still to be anti‐HCV positive in 1991, and 16 of them were also HCV RNA positive. The majority of anti‐HCV positive patients with or without HCV RNA had elevated serum ALT levels 13 years after onset of their acute hepatitis C. After 13 years follow‐up, 1.6% of the patients had died of end‐stage liver disease, 8% of anti‐HCV positive patients had histologically confirmed liver cirrhosis, 79% of anti‐HCV positive patients were judged to have chronic infection, whereas 21% seemed to have recovered. To conclude, we found that a majority of our patients with acute symptomatic hepatitis C continued to be viraemic 13 years after onset of hepatitis C, and that all continued to be anti‐HCV positive by

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00644.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—Hepatocellular carcinoma samples obtained from 59 patients at surgical resection were examined for mutations of the third base at codon 249 of thep53gene, using the polymerase chain reaction and oligonucleotide hybridization techniques. This point mutation, which is frequently observed in HCC cases from Southern Africa and Quidong in China, was not recognized in either 60 hepatocellular carcinomas or 53 noncancerous liver tissue samples from Japan. Thirty‐four of 45 patients (75.6%) were positive for the hepatitis C virus, which was a higher rate than that for hepatitis B virus infection (9 of 55; 16.4%). The exposure to aflatoxin B1 was not considered to be remarkable. These results suggest that the point mutation of the third base at codon 249 is not common in Japanese patients, and it is suggested that numerous other factors affect the mutation of thep53gene and the development of hepatocellular carcin

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00645.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT—Lipocytes are the major site of hepatic vitamin A storage, and they have been demonstrated to lose their vitamin A content in the process of hepatic fibrosis. To investigate the relationship between hepatic vitamin A content and the degree of hepatic fibrosis, we measured levels of retinyl palmitate and retinol in the CCl4‐induced fibrotic liver using high‐performance liquid chromatography. We estimated hepatic collagen content using a spectrophotometric analysis with sirius red, and also by measuring hydroxyproline levels. Lipocytes were detected by an immunoperoxidase method with anti‐desmin antibody, and were counted morphometrically through a Texture Analyzing System. A significant negative correlation was observed between the level of retinyl palmitate and collagen content (r = –0.64) as well as the hydroxyproline level (r = –0.69) in the CCl4‐induced fibrotic liver. In the process of fibrosis, hepatic retinol levels were elevated in association with a decrease in retinyl palmitate. In particular in the early stage of fibrosis, lipocytes increased remarkably in number in fibrotic areas in spite of a decrease in total hepatic vitamin A. The present study suggests that an increase in hepatic retinol as well as a decrease in retinyl palmitate may facilitate the process of hepatic fibrosis produced

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1993.tb00646.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY