摘要:

AbstractThere is controversy about clinical management of individuals who persistently have hepatitis C virus antibodies (HCVAb) but who have no symptoms or signs of liver disease. Liver biopsy samples were taken from 15 individuals, all of whom had normal alanine aminotransferase (ALT) levels, to determine the prevalence of liver disease and whether HCVAb and HCV‐RNA correlate with histological findings. Eleven patients with hepatitis C viremia had histological evidence of chronic hepatitis on biopsy. On the other hand, four HCV‐RNA‐negative individuals had almost normal liver histology. These findings indicate that serum HCV‐RNA is a sensitive and specific marker of liver disease in HCVAb‐positive subjects, independent of ALT levels. Furthermore, these results suggest that there are very few histologically healthy carriers of HCV among HCV‐RNA‐positiv

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01537.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractAt the end of extracorporeal shockwave lithotripsy (ESWL) gallstone fragments are dispersed throughout the gall‐bladder. In this state they should be expelled more easily than when later sedimented to the gall‐bladder fundus. Thus, a randomized study was performed to evaluate the clinical benefit of induced gall‐bladder contraction after ESWL. One hundred and five patients with radiolucent gallstones (1–3 stones, diameter ≤ 30 mm) were randomized to received either saline or an infusion of 0.2 μg/kg ceruletide. Stone clearance rates and incidence of biliary symptoms were recorded. Clearance rates at 6 weeks and 3 months after ESWL were significantly (P≤ 0.025) improved by the ceruletide infusion. This effect, resulting in shortened bile acid therapy, was limited to patients with small solitary stones and dependent on a good initial fragmentation. Major side effects attributable to ceruletide were not observed. These results suggest that induced gall‐bladder contraction can be successfully applied as an adjuvant treatment in a subgroup of patients with small solit

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01538.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSerological surveys of desert or rural Australian Aboriginal settlements report up to 85% positivity for hepatitis B virus (HBV) markers. We report the results of two cross‐sectional HBV surveys carried out 5 years apart in the bi‐racial town of Condobolin, New South Wales (population 3086; 14% Aborigines).In 1983–84, none of the 310 non‐Aborigines tested were hepatitis B surface antigen (HBsAg) positive but 7.2% were positive for hepatitis B core antibody (anti‐HBc). Among Aboriginal subjects, 57.6% had detectable HBV markers and 16.9% were HBsAg positive. In 1987–88, no non‐Aborigines were HBsAg positive and only 1% (of 422 individuals) had anti‐core antibodies. In contrast, 36% of Aboriginal subjects had HBV markers and 6% were HBsAg positive. No significant difference in detectable HBV markers was found among 98 Aborigines who were included in both surveys. Migration was the main factor influencing the HBV prevalence between the two surveys. Clustering of HBsAg carriers occurred within households and the likely mode of infection was intrafamilial horizontal childhood transmission.There was a significant association between HBV markers and tattooing in Aborigines (P≤ 0.02). Overall, HBV markers were less frequent in this population than in other desert or rural Aboriginal populations surveyed. The prevalence of HBV infection in non‐Aboriginal households was not significantly different from that in the Australian C

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01539.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe haemodynamic effects of nipradilol, a new non‐selective β‐adrenoreceptor blocker with vasodilating actions like nitroglycerin, were examined in rats with portal hypertension due to portal vein stenosis. Portal hypertensive rats were divided into five groups receiving infusion of placebo, 3 mg of propranolol, 300, 600 and 1200 μg of nipradilol. At its highest dose, nipradilol achieved a reduction of 34.4 ± 4.4% in heart rate which was similar to that in the propranolol group (36.5 ± 2.4%). Also for other systemic haemodynamic parameters, the nipradilol 1200 μg group exhibited changes not significantly different from those in the propranolol group; mean arterial pressure (‐ 13vs‐ 14%), cardiac index (‐ 37vs‐ 31%) and systemic vascular resistance (+ 29vs+ 32%). In contrast to the similar changes in the systemic circulation, a 1200 μg dose of nipradilol lowered portal pressure significantly more than propranolol (‐ 4.3 ± 0.6vs‐ 2.9 ± 0.2 mmHg,P≤ 0.05). Nipradilol then reduced portal blood flow by 22% (P≤ 0.05) without a significant change in portocollateral resistance. On the other hand, propranolol not only caused a reduction in portal blood flow of 30% (P≤ 0.01), but also an increase in portocollateral resistance of 21% (P≤ 0.05). The results suggest that nipradilol may ensure a more effective control of portal hypertension than propranolol, presumably via its venodilatory ac

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01540.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractProliferating cell nuclear antigen (PCNA), also known as cyclin, is an auxiliary protein of DNA polymerase‐δ and is found only in the nuclei of proliferating cells in the late G1and S phases. The proliferation of hepatocellular carcinoma (HCC) by immunohistochemical staining for PCNA using paraffin sections of 20 surgically resected HCC specimens was analysed. The mean percentage of PCNA‐positive nuclei in the HCC tissue was 10.3% in grade I of Edmondson and Steiner's classification, 25.5% in grade II, 28.4% in grade III and 41.5% in grade IV. In early HCC, we observed only a few PCNA‐positive tumour cells. However, PCNA‐positive nuclei were numerous in the tumour thrombi found in portal vein branches, in regions of extracapsular tumour growth, and in the inner nodules of tumours with a nodule‐in‐nodule formation. Proliferating cell nuclear antigen positivity was correlated with an increase of the nucleocytoplasmic ratio of tumour cells as determined by image analysis. Our findings showed that PCNA positivity was correlated with the histological grade and invasiveness of HCC, suggesting that this antigen may be used as an indicator to predict tumour invasion in patie

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01541.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractPre‐operative evaluation of the quantity of functional remnant hepatic parenchyma after hepatectomy was carried out to predict the optimal amount of hepatic resection using the trimethadione (TMO) tolerance test. This test is an estimate based on serum diamethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) 4 h after oral administration of TMO, and computed tomography (CT) scans of the liver in patients with hepatocellular carcinoma (HCC). The percentage of remnant hepatic parenchyma was calculated pre‐operatively from the remaining non‐cancerous portion and the whole hepatic parenchyma, excluding the HCC portion, using the CT scans. Presumptive remnant DMO/TMO ratio was calculated by multiplying the percentage of remnant hepatic parenchyma and pre‐operative serum DMO/TMO ratio in 45 patients with HCC undergoing resection. The presumptive remnant DMO/TMO ratios were 0.31 ± 0.10 (mean ±s.d.) in 42 patients who survived hepatectomy and 0.13 ± 0.02 (below 0.15) in the three patients who died from postoperative hepatic failure. Of these surviving patients, two patients who had the presumptive remnant DMO/TMO ratios under 0.15 developed postoperative severe complications. Thus, hepatectomy may not be indicated in patients where presumptive remnant DMO/TMO ratio is 0.15 and lower.These findings suggest that pre‐operative measurement of presumptive remnant DMO/TMO ratio, when obtained with the CT of the liver and TMO tolerance test, is useful for prediction of the quantity of functional remnant hepatic parenchyma after hepatectomy in patients with chronic l

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01542.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractTo investigate the effect of hepatitis delta virus (HDV) superinfection on the long‐term outcome of Japanese subjects with chronic hepatitis B virus (HBV) infection, we examined the presence of antibodies to hepatitis delta antigen (anti‐HD) in serial serum samples collected from 1127 subjects with chronic HBV infection. The subjects were followed for at least 36 months (mean: 121.3 months) between 1973 and 1991. Among 69 cases where anti‐HD was detected, eight (12%) developed liver cirrhosis (LC) and six (9%) developed hepatocellular carcinoma (HCC). However, among 1058 cases without anti‐HD, there were 43 patients (4%) who developed LC and 29 (3%) who developed HCC. The prevalence of LC and HCC was significantly higher among the cases with anti‐HD than those without anti‐HD. The proportion of LC and HCC per 1000 person years was 10.46 and 7.84, respectively among cases with anti‐HD, and 4.05 and 2.73 among those without anti‐HD, respectively. The overall relative risk of LC and HCC was 2.58 and 2.87, respectively; 95% confidence interval (CI): LC, 1.14–5.13; HCC, 1.03–6.23. These results indicate that in the Kure district in Japan, where HDV infection of persons infected with HBV is about 6%, such superinfection increases the

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01543.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSerum levels of the tissue inhibitor of metalloproteinases‐1 (TIMP‐1) were measured in 268 patients with liver diseases by means of a one‐step sandwich enzyme immunoassay. In the cases of acute hepatitis, chronic active hepatitis (CAH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC), the levels of TIMP‐1 were higher than those of the control group. Tissue inhibitor of metalloproteinases‐1 levels correlated with type III procollagen peptide and with type IV collagen, indicating TIMP‐1 as a useful marker for hepatic fibrosis. Levels of TIMP‐1 also correlated with aspartate aminotransserase and alanine aminotransferase levels and showed the highest levels in acute hepatitis. Thus, TIMP‐1 might also reflect hepatic inflammation. Serum levels of α‐fetoprotein and TIMP‐1 had a significant positive correlation in patients with HCC. A cut‐off level of TIMP‐1 between LC and HCC was set at 440 ng/mL, having a low sensitivity and a high specificity. These results suggest the usefulness of TIMP‐1 as a tumour marker in cases of HCC where α‐fetopr

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01544.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractHepatitis C virus (HCV) antibodies were measured in 28 patients with auto‐immune hepatitis type 1 using six different assay kits, three for C100–3 antibody and three for second generation HCV antibody, and two confirmatory tests to determine the prevalence of HCV infection in auto‐immune hepatitis. These patients were confirmed to have human leucocyte antigen DR 4 or 2 which is susceptible to auto‐immune hepatitis in Japanese. Of the 28 patients, four (14.3%) were positive for HCV antibody in all assays and reacted positively in at least one of the two confirmatory tests, indicating a true positive finding. Eight were positive for HCV antibody only by the Ortho ELISA kit and were negative in both confirmatory tests. The cut‐off level for these results was low and became negative soon after the patients received corticosteroid treatment. Thus, these eight patients are presumed to be false‐positive reactors. Hepatitis C virus RNA was detected in the serum of two of the four patients with HCV antibody and in none of 24 patients without HCV antibody. No significant difference was observed between the patients with and without HCV antibody in terms of clinical background, liver function tests and auto‐antibodies. Our results showed that the prevalence of a past or present HCV infection in patients with auto‐immune hepatitis in Japan is low; thus, auto‐immune hepatitis is thought to be distinct from hepatitis type C. However, it is also suggested that HCV infection can potentially trigger auto

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01545.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractHigh serum concentrations of growth hormone (GH) were found in five patients with chronic liver diseases, including auto‐immune chronic active hepatitis (two cases), Budd‐Chiari syndrome, primary biliary cirrhosis and hepatitis B virus associated cirrhosis. Mean levels of GH were 27.8 units (normal up to 5). In three patients elevated prolactin levels were also found (mean 37.3 units for two females, normal up to 20), and 36 units in one male (normal up to 9). No other endocrine disorders were found.Although the association of raised GH levels in patients with alcoholic cirrhosis is well known, its occurrence in patients with non‐alcoholic chronic liver disease is not fully established. We describe the effect of the disease course, and steroid treatment on GH levels in one patient with auto‐immune chronic active hepatitis, and propose possible mechanisms for this el

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1993.tb01546.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY