摘要:

AbstractHepatitis C virus RNA (HCV‐RNA) and serological markers of HCV infection were measured in 30 patients with chronic hepatitis C who had been treated with interferon (IFN). Patients were classified into four groups according to serum alanine aminotransferase (ALT) levels after treatment. These were: as complete responders (CR); partial responders (PR); transient responders (TR); and non‐responders (NR). In all 11 patients in the CR group, HCV‐RNA disappeared from serum for at least 24 months and anti‐c100‐3 decreased progressively during this time. In the PR group, four of five patients were positive for HCV‐RNA in spite of the improvement of ALT levels and decline of anti‐c100‐3. In the TR and NR groups, HCV‐RNA disappeared transiently or remained persistently positive. The results indicate that IFN‐mediated improvement of ALT and decrease of anti‐HCV (anti‐c100‐3) were not always related to the disappearance of HCV‐RNA from serum. On the other hand, sustained disappearance of HCV‐RNA from serum was demonstrated in the patients who did not have post‐treatment ALT relapse. This indicates that IFN can eradicate HCV from serum in some patients and provide a clinical r

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01167.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe biliary lesions that developed spontaneously in senescent female C57BL/6NCrj mice were investigated. Degeneration of the bile duct epithelium was observed in 12 of 13 mice (92%), destruction of bile duct epithelial cells was seen in six of 13 mice (46%) and chronic non‐suppurative destructive cholangitis was found in three of 13 mice (23%). The biliary lesions were characterized by prominent round cell infiltrates in the portal areas. Extra‐hepatic lesions such as sialoadenitis were observed in six mice (46%) and pancreatitis in seven (53%). IgM class antipyruvate dehydrogenase antibody was positive in one of three C57BL/6NCrj mice not given anti‐Lyt 2 antibody and in three of six C57BL/6NCrj mice injected with anti‐Lyt 2 antibody. These lesions were not observed in male C57BL/6NCrj mice, young female C57BL/6NCrj mice, or ICR mice. However, by transferring the splenic cells of senescent female C57BL/6NCrj mice to 6 week old females, the biliary lesions could be transferred at the rate of 6/9. The lymphocytes infiltrating in the bile ducts were CD8 positive lymphocytes. Moreover, in the ultrastructural immunocytochemical analysis of lymphocytes infiltrating bile duct epithelia, CD8 positive lymphocytes often formed broad contacts with the epithelial cells. The biliary lesions developing spontaneously in these mice are similar to those found in human primary biliary ci

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01168.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSomatostatin has been used to effectively control acute variceal haemorrhage, with conjectured mechanisms on portal hypertension. We, therefore, evaluated the effects of somatostatin on hepatic and systemic haemodynamics in 15 patients with hepatitis B‐related cirrhosis and portal hypertension. All patients received an intravenous, continuous infusion of somatostatin 250 μg/h, following a bolus injection of 250 μg. In systemic haemodynamics, the mean arterial pressure (MAP) increased (P<0.05), associated with a reflex bradycardia within 3 min following bolus injections, compared with basal values. The right atrial pressure, pulmonary capillary wedge pressure, inferior vena cava pressure, cardiac index, and systemic vascular resistance remained unaffected after drug infusion. In hepatic haemodynamics, the wedge hepatic vein pressure remained unchanged after drug administration. However, there was an increase in free hepatic vein pressure (FHVP;P<0.05), and a trend toward a decrease in the hepatic vein pressure gradient (HVPG;P= 0.063), within 3 min after bolus injection. Furthermore, the hepatic blood flow decreased significantly at 10 and 30 min after somatostatin infusion (P<0.05). The effective sinusoidal perfusion assessed by indocyanine green infusion also decreased progressively at 10 min (P= 0.057) and 30 min (P<0.05). We concluded that somatostatin, at the dose used in this study, caused a transient and bolus‐related vasoconstrictive effect, resulting in increases in MAP and FHVP, a decrease in heart rate, and a trend toward lower HVPG. In addition, somatostatin reduced the hepatic blood flow and effective sinusoidal perfusion which may be hazardous to cirrhotic patients during variceal haemor

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01169.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractIron overload, such as occurs in the genetic disease haemochromatosis, leads to synthesis of ferritin containing an increased proportion of L subunits. Inflammation also leads to clinically important increases in ferritin synthesis but the predominant subunit involved is unclear. Elevation of serum ferritin concentration during the acute phase response confounds its use as an indicator of body iron stores and identification of the major subunit involved may allow distinction of the ferritin associated with inflammation from that synthesized during iron overload. The present study examined H and L ferritin subunit mRNA levels in rats with: (i) longstanding iron overload, both parenteral and oral, in which changes should be maximal and stable; and (ii) inflammation of 24 and 48 h duration. A two‐fold increase in L mRNA level was found in both groups of iron loaded animals while H mRNA level was unchanged. This finding would account for the observed preponderance of L subunits in ferritin during iron overload. During the course of inflammation there was a progressive decrease in L mRNA level in the liver but not the spleen. H mRNA relative to total RNA level was unchanged in both liver and spleen. It is concluded that the differential regulation of the two ferritin subunits in response to different stimuli and in different tissues occurs at the level of alteration in mRNA concentratio

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01170.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBacterial pathogens gain access into the biliary system by descending via the portal venous circulation or ascending through the sphincter of Oddi in duodenal‐biliary reflux. Bacteria thrive as glycocalyx‐enclosed microcolonies, coalescing to form an adherent biofilm. The establishment of biofilm is a key event in the formation of biliary sludge and pigment gallstones, and the blockage of biliary stents. The biofilm mode of growth is very effective because it provides bacteria with a measure of protection from antibacterial agents and phagocytic leucocytes. Calcification of the matrix confers further protection for the micro‐organisms living inside the biofilm. To date, attempts to prevent blockage of biliary stent have employed physical methods by using large self‐expandable stents and stents without side hole. Incorporation of antibiotics within stents has not been successful presumably because bacteria once living in their biofilm are quite resistant to antimicrobial agents. Even the most toxic bile salts have no effect on the biofilm bacteria. Yet, hydrophobic bile salts reduce bacterial adhesion on biomaterial, suggesting that incorporation of such bile salts might prevent the formation of bacterial

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01171.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractAcute suppurative cholangitis is one of the common causes of acute abdomen in Taiwan. Emergency decompression is a life‐saving procedure if patients fail to respond to antibiotic treatment. From July 1988 to June 1991, 224 patients were encountered with concomitant bile duct stones and cholangitis; 40 were brought to the emergency service with shock or mental confusion or responded poorly to antibiotic treatment. The patients consisted of 20 males and 20 females aged 21–81 years (mean age 64 years); 55% had intrahepatic duct stones, 50% had positive blood culture, 38% had undergone previous biliary surgery, 25% had concomitant medical illnesses and 20% presented with mental confusion. Emergent endoscopic nasobiliary drainage (ENBD) was performed within 48 h of each patient's arrival in the emergency room. In 3 days all the patients exhibited significant improvement as defined by body temperature, vital signs, white blood cell count, serum bilirubin and alkaline phosphates levels. When their condition had stabilized, 21 patients underwent elective surgery. Six patients received ethylenediaminetetraacetic acid infusion through an ENBD tube. Two of the patients’ stones dissolved completely. Six patients received papillotomy with stone removal. The remaining patients refused further treatment. There was no hospital mortality. It is therefore concluded that ENBD offers an effective treatment for acute calculus suppurative cholangitis and it is a potential route of administration for the chemical dissolution of bile duct s

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01172.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractTo investigate the role of lymphocytes frequently observed in the parenchyma of alcoholic liver disease (ALD), lymphocytes infiltrating into the liver were stained immunohistochemically with monoclonal antibodies (MoAb) and were quantitatively assessed by a morphometric analysis in 17 patients with ALD and, for comparison in five patients with chronic active hepatitis B (B‐CAH). In patients with alcoholic hepatitis, the number of CD8+lymphocytes in the hepatic lobule was similar to that in patients with B‐CAH but was significantly greater than that in alcoholics with hepatic fibrosis (HF). The CD4/CD8 ratio in the hepatic lobule was low in both alcoholic hepatitis and B‐CAH compared with that of alcoholic patients with HF. When Mallory bodies (MB) and lymphocytes were simultaneously stained with a specific antibody against MB and MoAb, respectively, only CD3+and CD8+lymphocytes were found to have a close contact with MB. These results suggest that in alcoholic hepatitis, hepatocyte necrosis may be partly mediated by immunological mechanisms involving cytotoxic T cells infiltrating into the hepatic l

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01173.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe safety, effectiveness and capabilities of therapeutic upper fibreoptic endoscopy in children undergoing therapeutic endoscopic procedures (n= 443) was studied. Therapy for gastrointestinal bleeding formed the major group (injection sclerotherapy for varices,n= 197 procedures; thermocoagulation for haemorrhagic gastritis,n= 1; and photocoagulation for Dieulafoy's disease,n= 1). Sclerotherapy was 97% effective in controlling acute bleeding and 84% effective in obliterating varices with no serious complications or deaths. Oesophageal dilatations for surgical, caustic, congenital and peptic strictures and achalasia (n= 193) were performed with no oesophageal perforations or deaths. Foreign bodies were retrieved (n= 34) with no failures or complications. Percutaneous endoscopic gastrostomy was performed (n= 11) with one failure, proceeding to an unsuccessful surgical gastrostomy. Miscellaneous procedures included endoscopic transpyloric tube placement (n= 5) and endoscopic diathermy of pyloric web (n= 1). Therapeutic fibreoptic endoscopy is therefore concluded to be safe and effective in children, replacing rigid oesophagoscopy and some traditional surgical approaches.

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01174.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe role of infectious factors in the pathogenesis of acute pancreatitis and the protective effect of combined therapy with a new potent synthetic protease inhibitor, E3123, and a new potent synthetic cephalosporin, Shiomarin were examined in rat acute pancreatitis. Sodium taurocholate injection into the pancreatico‐biliary duct of rats caused severe pancreatitis with a high mortality rate, characterized by hyperamylasaemia, high amylase activity in ascitic fluid, hyperendotoxaemia and a high serum level of fibrin degradation products (FDP) and redistribution of cathepsin B from the lysosomal fraction to the zymogen fraction. Sodium taurocholate injection into the pancreatico‐biliary duct also caused the bacterial growth in the pancreas. In rats with E3123 infusion almost all parameters were improved, including mortality rate, serum and ascitic fluid amylase levels, plasma endotoxin and serum FDP levels, and distribution of lysosomal enzyme. But combination therapy with E3123 and Shiomarin was significantly more protective than E3123 therapy alone.These results indicate that infection plays an important role in the development of severe pancreatitis and that combination therapy with a new synthetic protease inhibitor and a new potent antibiotic may be useful in the treatment of severe pancreati

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01175.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractHomocystinuria is frequently associated with severe multisystem involvement such as dislocated lenses, skeletal deformities, mental retardation and premature vascular occlusions. Surprisingly, gastro‐intestinal involvement has not been described in this disorder. We present a 17 year old boy with homocystinuria due to cystathionine beta‐synthase deficiency, who developed severe gastrointestinal involvement, manifested by chronic diarrhoea and acute pancreatitis. The diarrhoea was successfully treated with betaine. Possible pathophysiological mechanisms and suggested treatment are descri

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01176.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY