摘要:

AbstractWe investigated whether bile concentration influenced cholesterol saturation index or nucleation time of cholesterol monohydrate crystals in a large number of gallbladder bile samples. Pigment stone patients never had cholesterol crystals in their fresh biles, and nucleation time was always longer than 20 days. Of the cholesterol stone patients 79% had cholesterol crystals in their fresh biles. Long nucleation times were generally found in cholesterol stone patients with dilute biles despite a high cholesterol saturation index. Nucleation time was usually short if bile was well concentrated depite a relatively low saturation index. Serialin vitrodilution of concentrated biles from cholesterol gallstone patients resulted in progressively prolonged nucleation times. Patients with solitary cholesterol stones had longer nucleation times than patients with multiple cholesterol stones. This study indicates that bile concentration is an important factor for nucleation time and cholesterol saturation index. Moreover, solitary and multiple cholesterol stones may have a different pathogenesis. (HEPATOLOGY 1990; 11: 1–6

ISSN:0270-9139    

DOI:10.1002/hep.1840110102

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractPrimary sclerosing cholangitis often occurs in association with inflammatory bowel disease, particularly ulcerative colitis but also Crohn's disease of the colon either with or without terminal ileal disease. Little data exist as to the effect of inflammatory bowel disease on the presenting symptoms, radiological features, response to liver transplantation, and potential risk of bile duct carcinoma in individuals with primary sclerosing cholangitis. In an effort to answer these questions, 66 patients with primary sclerosing cholangitis were studied. The definitive diagnosis of primary sclerosing cholangitis in each was accomplished using cholangiography, which in each case demonstrated characteristic beading, ectasia and stricturing of the intrahepatic and extrahepatic bile ducts.Inflammatory bowel disease was present in 47 (71.2%) patients. Thirty nine (59.1%) had ulcerative colitis; their mean age was 42.5 ± 11.6 yr (mean ±SD), and the male/female ratio was 2.9: 1. In addition, eight patients (12.1%) had Crohn's colitis; their mean age was 40.5 ± 6.5 yr, and the male/female ratio of this group was 1:1. Nineteen patients (28.8%) had primary sclerosing cholangitis without any inflammatory bowel disease; their mean age was 42.0 ± 12.1 yr, and the male/female ratio in this group was 0.72:1. Seventy‐two percent of the patients without inflammatory bowel disease had either jaundice, pruritus or fatigue at presentation compared with 41% of the patients with inflammatory bowel disease (p<0.05). In contrast, abnormal liver function tests were more common as the first manifestation of liver disease in the latter group (38% vs. 11%; p<0.05).Combined intrahepatic and extrahepatic bile duct involvement was found more frequently in patients with inflammatory bowel disease than in those without inflammatory bowel disease (81.5% vs. 46.2%, p<0.05). In contrast, involvement of the extrahepatic bile ducts alone was more frequent in patients without inflammatory bowel disease (38.4% vs. 7.4%, p<0.05). Thirty‐eight subjects (58%) underwent orthotopic liver transplantation. Two‐year survival after orthotopic liver transplantation for the groups with and without inflammatory bowel disease was 84% and 100%, respectively (NS).During this time, six patients with bile duct carcinoma were admitted. In four patients the diagnosis of bile duct carcinoma was established at time of referral and in two patients at liver transplantation. Five of these six patients had inflammatory bowel disease. The prevalence of bile duct carcinoma in patients with and without inflammatory bowel disease was similar (9.8% vs. 5%, respectively; NS). None of the transplanted patients have experienced a disease recurrence within a mean follow‐up period of 24.6 ± 11.8 mo.Based on these observations, it is concluded that primary sclerosing cholangits occurring in association with inflammatory bowel disease differs from primary sclerosing cholangitis occurring in the absence of inflammatory bowel disease differs from primary sclerosing cholangitis occurring in the absence of inflammatory bowel disease in terms of its location and gender distribution. (HEPATOLOGY 199

ISSN:0270-9139    

DOI:10.1002/hep.1840110103

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractAberrant hepatic expression of HLA molecules has been shown to be present in primary biliary cirrhosis and may play a determining role in the pathogenesis of the disease. We have studied the effect of the long‐term administration of ursodeoxycholic acid on hepatic HLA expression. Nine untreated patients with primary biliary cirrhosis, eight patients treated for at least a year with ursodeoxycholic acid and eight control subjects without hepatobiliary disease were compared. HLA expression was studied on liver biopsy sections using a direct immunofluorescence technique with specific monoclonal antibodies directed against class I or class II HLA molecules. Aberrant biliary HLA class II expression was not modified by chronic administration of ursodeoxycholic acid. In contrast, aberrant hepatocyte HLA class I expression was markedly reduced. Reduction in HLA class I expression may lead to decreased cytotoxic T cell‐dependent lobular necrosis, which is thought to contribute to the progression of primary biliary cirrhosis to advanced stages. These findings suggest that the beneficial effect of ursodeoxycholic acid treatment in primary biliary cirrhosis could result not only from a reduction in the intrahepatic accumulation of cytotoxic bile acids but also from a reduction in immunological injury.(HEPATOLOGY 1990; 11: 12

ISSN:0270-9139    

DOI:10.1002/hep.1840110104

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractMost of the sera from patients with primary biliary cirrhosis contains antimitochondrial antibodies, which react with four proteins of the mitochondrial inner membrane. We reported in a previous paper that when beef heart mitochondrial inner membrane proteins were digested by trypsin, a new reactive 36 kDa fragment with antimitochondrial antibody was obtained. This 36 kDa fragment derives from original 70 kDa protein because the monoclonal antibody specific to 70 kDa protein reacts with the 36 kDa band equivalent to 70 kDa band. The 36 kDa fragment was purified using an affinity column conjugated with an immunoglobulinrich fraction of primary biliary cirrhosis serum containing antimitochondrial antibody, preparative electrophoresis and high‐performance liquid chromatography using a reverse phase column. The final preparation showed a single band in sodium dodecyl sulfate polyacrylamide gel electrophoresis. Its amino acid composition is in good agreement with that of the subunit binding domain of the pyruvate dehydrogenase complex E2 from bovine hear

ISSN:0270-9139    

DOI:10.1002/hep.1840110105

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractThis study describes a murine model of autoimmune hepatitis: experimental autoimmune hepatitis. Experimental autoimmune hepatitis could be induced most effectively in male C57BL/6 mice by intraperitoneal immunization with the 100,000gsuperantant of syngeneic liver homogenate (S‐100) in complete Freund's adjuvant. BALB/C and C3H mice were less susceptible than C57BL/6 mice. Experimental autoimmune hepatitis could not be induced in Lewis rats. Intraperitoneal immunization was more effective than intramuscular or subcutaneous injections, and the amount of protein administered above a threshold was of little influence. A single intraperitoneal injection of S‐100 in complete Freund's adjuvant resulted in hepatitis of at least 6 mo duration. Histological changes were most marked 4 wk after disease induction. The histological findings were characterized mainly by perivascular inflammatory infiltrates and hepatocyte necroses. The histological changes were accompanied by biochemical evidence of liver cell death. Passive transfer of experimental autoimmune hepatitis with concanavalin. A–activated splenocytes was possible. Specific T‐cell reactivity against fractions of S‐100 could be demonstratedin vitro.Thus experimental autoimmune hepatitis is a murine model of autoimmune hepatitis probably mediated by autoreactive T cells. It will allow studies of the pathogenesis of autoimmune hepatitis. (HEPATOLOGY 1990; 1

ISSN:0270-9139    

DOI:10.1002/hep.1840110106

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractCirculating immune complexes were isolated by conglutinin affinity chromatography during the course of hepatitis A virus infection in a chimpanzee. Characterization of circulating immune complexes showed that most of the hepatitis A virus‐specific antibody was IgM, that IgG was present and that C3d and fibronectin were also present. Hepatitis A virus capsid polypeptides were identified in the circulating immune complexes and polypeptides in the molecular weight range of 63 to 67 kDa having immunological determinants common to both C3d and hepatitis A virus. Hepatitis A virus‐RNA was detected in these circulating immune complexes using the polymerase chain reaction for in vitro amplification of nucleic acid and suggests the circulating immune complexes contain intact vi

ISSN:0270-9139    

DOI:10.1002/hep.1840110107

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractSera from four patients with acute hepatitis B and 87 patients with chronic hepatitis B were examined quantitatively for pre‐S1 and pre‐S2 antigens by solid‐phase enzyme immunoassays. Pre‐S1 and pre‐S2 antigens were detected in HBsAg‐positive sera irrespective of the presence of viral replicative markers, and their titers correlated with those of HbsAg(r = 0.74, p<0.01; r = 0.74, p<0.01, respectively). Sera positive for HBeAg showed higher titers of pre‐S1 (p<0.01) and pre‐S2 (p<0.01) antigens than sera negative for HBeAg. The titers of pre‐S1 and pre‐S2 antigens also correlated with the levels of HBV‐associated DNA polymerase activity (r = 0.51, p<0.01; r = 0.59, p<0.01, respectively) and HBV‐DNA (r = 0.50, p<0.01; r = 0.46, p<0.01, respectively). However, the ratios between the titers of pre‐S antigens and HBsAg had no significant relationships with those viral replicative markers. These findings suggest that the expression of pre‐S antigens is intimately related to the expression of HBsAg and that they are not useful as markers of viral replication. The ratios between the titers of pre‐S antigens and HBsAg tended to be high in patients with chronic active hepatitis and high aminotransferase levels. This finding may have been due to the hepatic release of pre‐S antigens, overproduction of which may have so

ISSN:0270-9139    

DOI:10.1002/hep.1840110108

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractReplication of duck hepatitis B virus in extrahepatic tissue such as pancreas, kidney and spleen has been well documented. To assess whether there is more widespread extraheptic virus replication, we assayed brain, heart, lung, thymus, pancreas, kidney, spleen and intestine of 1‐ to‐wk‐old ducklings for the presence of duck hepatitis B virus DNA and mRNA by blotting inin situmethods. Replicative intermediates and single‐stranded duck hepatitis B virus DNA and RNA transcripts were detected in the brain, lung, heart, intestine, kidney, pancreas and spleen. In situ hybridization showed evidence of viral replication in the lung epithelium, germinal center of spleen, acinar cell of pancreas and tubular epithelium of kidney.These data suggest that extrahepatic duck hepatitis B virus replication is more widespread than previously thought. It is yet to be determined whether widespread extrahepatic replication is unique to duck hepatitis B virus infection or is a common feature of other mammalian hepatitis B‐like viruses. (HEPATOLOGY 1990; 1

ISSN:0270-9139    

DOI:10.1002/hep.1840110109

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractFifty consecutive patients admitted with acute liver failure, minimal grade II encephalopathy, were studied prospectively to determine to incidence, timing and cause of bacterial infection, the relationship to clinical criterial for infection; and the influence of early microbiological diagnosis on clinical outcome. There were 53 proven bacterial infections in 40 patients, whereas in 5 of the remaining 10 patients infection was suspected on clinical grounds in the absence of significant cultures. Seven patients (14%) had more than one bacterial infection, and four patients had simultaneous infections caused by different organism at each site. Fourteen infections (26.4%) were associated with backteremia, and in six of these no source was found. Twenty‐five infections (47.1%) arose from the respiratoory tract, 12 (22.6%) from the urinary tract and 2 (3.7%) from central venous due to gram‐positive bacteria;Staphylococcus aureusaccounted for 19 (35.8%) of all the infections.Thirty patients died (60%), 28 of whom had bacterial infection at some time; in 24 of these the infection was diagnosed less than 24 hr before death. All nine deaths that occurred more than 7 days after admission were directly attributable to microbial infection.Clinical features such as elevated temperature and elevated peripheral white blood cell count were poor indicators of bacterial infection because these were absent in 30.2% of cases.These data show that there is a high incidence of bacterial infection early in the course of acute liver failure and suggest that porphylactic antimicrobial therapy, although unproven, might be justified. (HEPATOLOGY 1990; 11: 49

ISSN:0270-9139    

DOI:10.1002/hep.1840110110

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY

摘要:

AbstractThis report describes a patient with marked hypoxemia caused by intrapulmonary shunt associated with primary biliary cirrhosis. Liver transplantation resulted in resolution of digital clubbing and reduction of intrapulmonary shunt as demonstrated by normalization of room air arterial blood gases, reduction in shunt fraction and normalization of the indocyanin‐enhanced echocardiogram and perfusion lung scan.This patient's course challenges the conventional notion that intrapulmonary shunting associated with chronic liver disease does not reverse after liver transplantation. (HEPATOLOGY 1990; 11: 54–

ISSN:0270-9139    

DOI:10.1002/hep.1840110111

出版商:W.B. Saunders    

年代:1990

数据来源: WILEY