摘要:

AbstractAntipyrine elimination halflife (APt1/2) was studied in 18 patients with obstructive jaundice along with routine liver function tests 24–48 h before the expected time of percutaneous transhepatic biliary drainage (PTBD). To see if it is possible to predict the outcome of PTBD, various predrainage parameters were correlated with the postdrainage bilirubin clearance after 1 week of drainage. Predrainage APt1/2correlated best with bilirubin clearance (r= 0.775,P<0.01) compared with predrainage serum bilirubin, alkaline phosphatase and serum proteins/albumin. Eight patients had APt1/2<15 h, while 10 had APt1/215 h. Patients with APt1/215 h. If PTBD can be restricted to those with APt1/2<15 h, the advantages of preliminary PTBD can be achieved with minimum complications. Thus, estimation of APt1/2may aid in the selection of patients with obstructive jaundice who are likely to benefit by preliminary biliary decompressio

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01619.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractTen patients with clinical features of chronic hepatitis showed on liver biopsy histologic evidence of chronic hepatitis plus predominantly moderate to severe fatty change. No patient had a history of excess alcohol intake, or prolonged intake of hepatotoxic drugs and steroids, and were not obese or malnourished. These cases differ from the reported cases of non‐alcoholic steatohepatitis resembling alcoholic hepatitis as they occurred in relatively young healthy adults, predominantly males, who were not diabetic or obese. Mallory's hyalin in liver was absent in all cases. Ingestion of toxic substances was possible but no history was obtained to account for it. While these could be unusual cases of chronic non‐A, non‐B hepatitis, this can be only speculation until a serologic test for non‐A, non‐B hepatitis becomes available. Follow‐up of eight patients for 1–3 years with liver biopsy showed that they had a relatively benign course with no evidence of progression

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01620.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractCapsules (8 times 30 mm) of technetium‐99m pertechnetate were designed for measurement of portal blood flow. Most of the radionuclide entered the superior mesenteric vein. The capsule was taken orally and monitored with a collimator for scintigraphy until it reached the small intestine, when a magnetic field completed an electrical circuit in a sensor, burning a thread, releasing a spring, and discharging the preparation.A study in crab‐eating monkeys(Macaca fascicularis)showed that the radionuclide in the small intestine circulated through the superior mesenteric vein to the portal vein and liver. Portal scintigraphy through the small intestine could be analysed in the same way as per‐rectal portal scintigraphy, in which blood flow mostly from the inferior mesenteric vein is evaluated.A study of four volunteers showed that, after the radionuclide was released, it circulated through the superior mesenteric vein to the portal vein and liver. Use of a capsule enclosing a radioisotope was possible, and the procedure seemed to be safe.The use of the per‐small intestine method plus the per‐rectal method should give more accurate results than either method used alone, because the haemodynamics of both the superior and inferior mesenteric vein would be

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01621.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to develop the technique of intra‐operative portal angioscopy using a portal angioscope, and to demonstrate its potential use in the therapy for patients with hepatocellular carcinoma (HCC) bearing a portal thrombus. Portal angioscopes, Olympus BF3C10 and CHFP10 of a diameter of 3.5 mm and 4.8 mm, respectively, were used during operation in five dogs, two patients with hepatic metastasis from colon cancer and three patients with HCC having a portal tumour thrombus. The portal vein and hepatic artery were ligated simultaneously, and the angioscope was immediately introduced under direct vision through a small portal venotomy. Blood in the portal vein was almost fully diverted by infusion of heparinized saline through a channel of the angioscope at a rate of 3 mL/min in dogs and 5 mL/min in patients with hepatic metastasis. Rates of 6 mL/min and 10 mL/min in dogs and patients, respectively, were adequate to clear completely the portal vein of blood. In patients with HCC, portal tumour thrombectomy was performed with a Fogarty balloon catheter by suctioning thrombi through a channel of the fibrescope after visual study of the portal thrombus.Observation and treatment of portal thrombus by angioscopy may become an important part of surgical treatment of HCC with portal invasion, but further technical improvement is desirable before this technique becomes a routine procedur

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01622.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractLiver biopsies from 52 patients with chronic hepatitis B were investigated for the presence and distribution of HBcAg and the results were compared with the status of hepatitis B virus deoxyribonucleic acid (HBV‐DNA). The patients consisted of 37 men and 15 women, aged 16–55 years (mean = 34 years). Serum alanine aminotransferase (ALT) was elevated in 50 patients (range: 18–969 U/L; mean = 290 U/L). Serological testing showed HBsAg in all, HBeAg in 45 (87%), and HBV‐DNA in 28 (54%). Liver biopsies demonstrated HBcAg in 35 (67%) patients. HBcAg was not only present in 31 of 45 (69%) patients who were seropositive for HBeAg, but also in four of seven (57%) with antibody to HBeAg (anti‐HBe). In 28 of 35 (80%) patients with HBcAg in the liver, serum HBV‐DNA was detected. However, no serum HBV‐DNA was detected in 17 patients who had no detectable HBcAg in the liver. The distribution of HBcAg in the liver was rather cytoplasmic and nuclear than nuclear alone. Among 33 patients with cytoplasmic HBcAg in the liver, 15 (45%) had an evidence of acute exacerbation of hepatitis with marked ALT elevation (range: 168–894 U/L; mean = 385 U/L) and nine patients showed severe chronic active hepatitis and confluent necrosis, histologically. These results indicate that the presence of HBcAg in the liver correlates with the amount of circulating hepatitis B virus as quantified by serum level of HBV‐DNA. The predominant cytoplasmic HBcAg in the liver may suggest the possibility of multiple episodes of acute exacerbation and more severe ongoing hepatitis during th

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01623.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn patients with chronic active hepatitis (CAH), the absence of the conventional serum auto‐antibodies (antinuclear, smooth muscle and liver‐kidney microsomal) is often taken as evidence against an auto‐immune aetiology and as indicative that the disease is unlikely to respond to immunosuppressive therapy. We report 12 British patients (11 female) who presented with histologically florid CAH (11 with cirrhosis or fibrosis and seven with ascites) but without significant titres of these antibodies or any other demonstrable aetiological feature (cryptogenic CAH), who have been followed up for a median of 5.25 years (range: 0.75–16 years). Ten had hypergammaglobulinaemia and/or specific elevations of serum IgG concentrations at presentation and five of 10 patients tested were found to have the HLA allotypes B8 and DR3. Remission was initially induced with prednisolone with or without azathioprine in all patients. Six patients subsequently relapsed on one or more occasions, either spontaneously while on maintenance therapy or during attempts to withdraw corticosteroids, and required increases or reintroduction of immunosuppressive therapy to regain disease control. Retrospective analysis of pretreatment samples from 11 of the patients revealed that all had been seropositive at presentation for auto‐antibodies against the liver membrane lipoprotein preparation known as liver‐specific membrane lipo‐protein (LSP) and/or against the hepatic asialoglycoprotein receptor (ASGP‐R), titres of which subsequently fluctuated in direct relation to response to treatment. The findings suggest that in this group of patients (i) the absence of conventional auto‐antibodies does not exclude the likelihood of a response to immunosuppressive therapy, (ii) auto‐immune mechanisms underlie the disease, and (iii) screening for anti‐LSP and anti‐ASGP‐R may be useful for discriminating them from patients with chronic non

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01624.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractWe studied 563 consecutive adults with acute hepatitis B hospitalized from May 1981 to May 1983 and their habitual heterosexual partners. Radio‐immunoassays for the detection of serological markers of hepatitis A virus (HAV) and hepatitis B virus (HBV) and enzyme‐immunoassay for the detection of IgM antibody to hepatitis B core antigen (IgM anti‐HBc) were used. Of the 563 patients, 503 (89.7%) were hepatitis B surface antigen (HBsAg) positive and 60 (10.7%) were HBsAg negative on admission. Absence of HBsAg on admission was observed significantly more frequently in patients infected possibly by the heterosexual route than in the remaining patients (23.3% versus 6.6%;P<0.001). This finding was independent of sex. These data show that the route of HBV infection rather than the sex appears to have a more important role in the rapid clearance of

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01625.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn male rats, genetic obesity and experimental diabetes are associated with altered activities of several of the hepatic microsomal P‐450 isozymes concerned with steroid and xenobiotic oxidation. The present study examined the roles of insulin and ketonaemia in effecting these changes. In obese male Zucker rats, androstenedione 6β‐, 16α‐ and 16β‐hydroxylase activities (mediated by P450PCN‐E, P‐450UT‐Aand P450PB‐B, respectively) were significantly decreased to 21%, 20% and 43% of lean control. Obesity was also associated with a significant decrease in the activities ofN‐nitrosodimethylamine demethylase (P‐450j) and anilinep‐hydroxylase to about 70%. A similar decrease in total microsomal P‐450 was also observed. Androstenedione 7α‐hydroxylase activity (mediated by P‐450UT‐F) was unchanged in these animals.In streptozotocin‐induced diabetic male Wistar rats, androstenedione 7α‐ and 16β‐hydroxylase activities were significantly elevated to 230% and 270% of control, respectively. Significant increases in the rates ofN‐nitrosodimethylamine demethylase and anilinep‐hydroxylase were also noted in diabetic rat liver. In contrast, the activity of P‐450UT‐Awas reduced to 30% of control and P‐450PCN‐E‐specific 6β‐hydroxylation was unchanged. Control of the diabetic state with insulin treatment reversed all the changes in P‐450‐mediated activities. Significant correlations were found between serum concentrations of insulin and catalytic activities of P‐450PB‐B, (ρ= ‐0.46), P‐450UT‐F(ρ= ‐0.65) and P‐450j (ρ= ‐0.71). Positive correlations of the same magnitude were also found between these mixed function oxidase activities and β‐hydroxybutyrate.These studies provide further evidence that hormones and ketone bodies are involved, either directly or indirectly, in the alteration of hepatic P‐450‐mediated metabolism of sex steroids and foreign compounds. In p

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01626.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractDuring the 2 years of the study, 402 patients and an equal number of age‐ and sex‐matched controls were investigated for the presence of diarrhoeal pathogens. Pathogenic organisms were recovered from 277 (68.9%) patients and 97 (24.1%) controls. In the patient group, possible bacterial pathogens were found in 210 (52.2%) cases. EnteropathogenicEscherichia coli(EPEC) was the most frequently found potential pathogen, being recovered in 132 cases (32.8%) with serotypes 026, 086, 0111 and 0124 being the most frequently identified. Other bacterial pathogens identified were enterotoxigenicE. coli(ETEC) 57 (14.2%),Shigella13 (3.2%) andSalmonellaeight (2%). Rotavirus was identified in 33 (8.2%) cases. Mixed bacterial and viral infections were also seen in 26 (6.5%) cases.In the control group, enteric pathogens were recovered from 97 (24.1%) specimens. The most common bacterial pathogen found in this group was again EPEC (40, 9.9%), with serogroups 018, 044, 0111 and 0126 being the most frequent.Giardia lambliaandEntamoeba histolyticawere found in 31 (7.7%) and 10 (2.5%) controls, respectively. Rotavirus was found in 16 (4%) controls. The results of both centres where the study was performed (Karachi and Rawalpindi) were compa

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01627.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn order to understand whether the serum pepsinogen I (PGI) levels of non‐ulcer dyspepsia (NUD) patients differed from those of healthy controls and which kends of factors might influence these levels of the former, serum PGI levels were determined by radio‐immunoassay in 120 healthy controls and 361 NUD patients. The mean serum PGI level was significantly lower in NUD patients than in the controls (75.8 ± 38.2 ng/mL versus 95.9 ± 39.3 ng/mL;P<0.0001); in NUD patients, it was significantly higher in males than in females (79.6 ± 40.4 ng/mL versus 63.2 ± 26.4 ng/mL;P<0.001). However, corrected serum PGI levels according to the lean body mass disclosed no sex difference. Nevertheless, there was a weak correlation between the ages of patients and serum PGI levels (r= 0.403). The serum PGI levels in blood groups A, B, AB and O did not differ significantly. Smoking might be a decisive factor, for the mean serum PGI level was significantly higher among the smokers than among the non‐smokers (86.7 ± 44.6 ng/mL versus 70.6 ± 33.7 ng/mL;P<0.001). It is concluded that the mean serum PGI level of NUD patients, while affected by sex, age, smoker status and the body size, is lower than that of the healthy controls. Without endoscopy, assay of serum PGI level has no place in the diagnosis of dyspepsia because of the wide overlapping of serum PGI levels between NUD patients and patients with other common gast

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01628.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY