摘要:

AbstratPeripheral blood mononuclear (PBM) cells from patients with halothane hepatitis are unusually susceptible to damage from phenytoin metabolites generated by anin vitrodrug metabolising system. In order to provide more information about the nature of this susceptibility factor, the effect of removing calcium ions (Ca2+) from the incubation medium of the test system was examined. Phenytoin metabolites were generated by incubating phenytoin with β‐naphthoflavone‐induced rat liver microsomes in the presence of 1,1,1‐trichloropropene oxide (TCPO), an epoxide hydrase inhibitor. When PBM cells from patients who had recovered from halothane hepatitis were incubated in this system and then maintained in Ca2+‐containing tissue culture medium (without α‐tocopherol) for 16 h, cell death, as measured by trypan blue exclusion, was greatly increased (53% and 78% at 0.06 mmol/1 and 0.12 mmol/1 phenytoin, respectively) compared with control incubations (TCPO omitted). Removal of Ca2+from the tissue culture medium effectively abolished reactive metabolite‐induced cell death. Resting cytosolic free Ca2+concentration in PBM cells was also measured using the quin‐2 fluorescence method and total Ca2+content was measured by atomic absorption spectrometry. Although variability appeared greater among patients, mean values for these parameters among 12 patients with halothane hepatitis did not differ from controls. It is concluded that enhanced permeability of PBM cells to extracellular Ca2+may be an important factor in the pathogenesis of drug metabolite‐induced cell death in patients susceptible to halothane hepatitis. Such permeability to Ca2+is not evident in resting cells and presumably results from an interaction between electrophilic metabolites and the pumps which regulate cell ca

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00800.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstratOne hundred and fifty‐seven patients with alcoholic liver disease were studied. Hepatitis B surface antigen (HBsAg) was positive in 20.4% of the patients. Those who were positive for the HBsAg presented at an earlier age, had a lower albumin level, a higher globulin level, a more prolonged prothrombin time, were more likely to have features of cirrhosis in the liver biopsy, and were probably more likely to suffer from hepatic encephalopathy in the follow‐up compared with those negative for HBsAg. The mortality of subjects was low both on admission and during follow‐up. It is concluded that chronic alcoholism and hepatitis B virus infection act synergistically in producing more severe liver damage and causing cirrhosis at a younger age compared with chronic alcoholism alone. One possible reason for the low mortality of the patients might have been their relatively good nutritional s

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00801.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstratDes‐γ‐carboxy prothrombin (DCP), a precursor of prothrombin, has been reported recently to be as good a marker, or even better, of hepatocellular carcinoma than α‐fetoprotein (α‐FP). The sensitivity, specificity and predictive values of the two markers have been compared in 98 southern African Blacks with hepatocellular carcinoma and in 120 Black controls with various diseases which might be mistaken clinically for this tumour: 32 with hepatic metastases, 33 with amoebic hepatic abscesses, and 55 with chronic hepatic parenchymal disease. DCP levels were measured using a chromogenic assay withDispholidus typusvenom and staphylocoagulase. The agreement between the two methods was excellent (r= 0.995). α‐FP concentrations were measured by radioimmunoassay. DCP levels were raised in 66 of 98 patients (67.3%) and α‐FP levels in 82 of 98 patients (83.7%) with hepatocellular carcinoma (P= 0.006). The specificity of DCP was also less than that of α‐FP, although the difference just failed to reach statistical significance (P= 0.085). The predictive values of both a positive and a negative test for DCP were significantly less than those for α‐FP (P= 0.047 and 0.048, respectively). When, in an attempt to eliminate false positive results, the diagnostic cut‐off level for DCP was increased from 1.5 to 5.0 mu/ml and that of α‐FP from 20 to 400 ng/ml, the differences between the two markers remained the same. If the two tests were used together, the number of false negative α‐FP results was reduced from 16.3% to 7.1% and the number of equivocal α‐FP results was reduced from 11.2% to 5.1%. It is concluded that DCP is less useful than α‐FP as a single marker of hepatocellular carcinoma in southern African Blacks. However, the two mar

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00802.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstratThe anti‐pre‐S antibody in the samples of sera from normal healthy persons and patients with different clinical types of liver diseases due to hepatitis B virus (HBV) infection was detected by a newly established enzyme‐linked immunosorbent assay technique. This test is a blocking assay where anti‐pre‐S antibody in the patient's serum blocks subsequent addition of horse radish peroxidase‐labelled polymerized human serum albumin (pHSA) to the pHSA‐receptor site of HBsAg molecules fixed on a solid surface. Anti‐pre‐S activity was not detected in any from 95 healthy persons who were negative for all HBV‐markers or from 105 healthy HBV carriers. In 12 sera from HBV vaccine recipients, anti‐pre‐S activity was noted in higher proportions compared with anti‐HBs, after both the second and third doses of vaccine. Anti‐pre‐S activity was detected in small proportions of HBsAg positive sera from acute viral hepatitis (4.2%) and chronic active hepatitis (10%). In subacute viral hepatitis patients, the anti‐pre‐S antibody was totally absent. However, anti‐pre‐S activity was recorded in high proportions of HBsAg‐positive sera from patients with cirrhosis of liver (57.2%) and fulminant hepatitis (41.6%). The anti‐pre‐S antibodies were assumed to be implicated in the clearance of HBV particles fro

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00803.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

ABSTRACTFifteen patients (eight males, seven females; age range: 23–76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1–10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall‐bladdersin situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile‐duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall‐bladdersin situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3–26 months (mean follow‐up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is pe

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00804.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstratThe numbers of immunoreactive gastrin and somatostatin cells in gastric and duodenal mucosal biopsy specimens from dyspeptic patients with duodenal ulcers and dyspeptic controls without ulcers were calculated using a morphometric method. The levels of gastrin and somatostatin in the tissue were also measured by the radioimmunoassay. The results showed no significant difference in the number of G cells and the level of gastrin in the tissue between the ulcer and non‐ulcer groups. However, the number of D cells and the level of somatostatin in the tissue in ulcer patients were remarkably reduced in comparison with those in non‐ulcer patients (P<0.01 andP<0.05, respectively). The G: D cells and gastrin: somatostatin ratios in ulcer patients were much higher than those in the non‐ulcer control group. It is considered that the reduction of D cells and the relative lack of somatostatin in duodenal ulcer patients might have a role in the mechanism of the duodenal ulcer

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00805.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstratThe hypothesis that suppression of transient lower oesophageal sphincter relaxation (TLOSR) in recumbent postures in the dog is dependent upon the sensing of a gastric pool of liquid in proximity to the lower oesophageal sphincter was examined. Constant gastric insufflation with air (80 ml/min) was used to evoke TLOSR in unsedated, fasting animals. Oesophageal motility was monitored with a perfused manometric sleeve catheter assembly. Gastro‐oesophageal flow was recognized manometrically and by oesophageal pH recording. TLOSR occurred significantly less frequently in three recumbent positions (right lateral, left lateral and supine) than when the dog stood on four legs, but was more likely to be associated with acid reflux when they occurred in recumbent positions. Aspiration of the gastric pool was found to have no effect on triggering of TLOSR although it reduced the frequency with which acid reflux was associated with TLOSR. It is concluded that the low rate of occurrence of TLOSR in recumbent positions is unlikely to be explained by the presence of a gastric pool of liquid in proximity to the lower oesophageal sphincte

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00806.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstratThere are several reports on oesophageal strictures caused by alkali ingestion, but information on oesophageal strictures due to acid ingestion is scarce. Endoscopic dilatation, which has been found to be quite safe and effective in the treatment of benign oesophageal strictures of other aetiology, has also not been evaluated adequately in the treatment of these strictures. Over a period of 2 years, of 47 patients treated at this centre of benign oesophageal strictures, 17 (36.2%) patients had strictures following ingestion of corrosive agents. Thirteen patients had ingested acids and only four gave a history of alkali ingestion. The age range of these 13 patients was 14–50 years (mean = 25.5 years, s.d. = 2.6). The amount of acid ingested varied from 10 to 100 ml (median = 50 ml). The interval between acid ingestion and presentation to hospital ranged from 1 to 60 months (median = 2 months). Ten patients had multiple strictures, and the most common site of involvement was the upper third followed by the lower third of the oesophagus. Only five‐of these 13 patients had evidence of gastric involvement in the form of antral stricture (four) and hour glass deformity (one). Strictures were dilated using Eder‐Puestow metal olives passed over a guide wire. The total number of sittings required to achieve adequate dilation in this group ranged from 1 to 30 (median = 14). Most patients were managed successfully with dilatation (good response 63.6%, satisfactory response 18.2%). On follow‐up, recurrence of dysphagia was seen in a high number of patients (66%), but this could be managed easily with repeat dilatation. It is concluded that, in contrast to reports from the West, acid ingestion is a common cause of oesophageal strictures in India. These strictures are usually tight and multiple. The patients not only require several sittings to achieve adequate dilatation, but they also have a high recurren

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00807.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Congenital biliary dilatation (CBD) or choledochal cyst has previously been considered a rarity; however, the number of cases reported in the literature has been increasing. It is generally accepted that there is a predominance in Japanese, as more than one‐third of the cases are from Japanese literatur

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00808.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

As its image sensor, the electronic endoscope incorporates the so‐called charge‐coupled device (CCD) at its tip. The device was developed by the high technology of microelectronics, and it has a quite new construction, different from fibre‐optics. Two years after the electronic endoscope was produced first by Welch‐Allyn from the USA, the first Japanese electronic endoscope model was developed in 1985, and now an upper gastrointestinal model, a duodenoscope model, and a colonoscope model are available commercially from four companies wo

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1989.tb00809.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY