Cholesterol nucleation-influencing activity in T-tube bile.

Nucleation-influencing activity was determined in T-tube bile samples derived from patients with obstructive jaundice. Since native T-tube bile samples do not nucleate, nucleation-influencing activity was determined by measuring the influence of T-tube bile on the nucleation time of model bile. In the assay, T-tube bile was mixed with model bile, and the nucleation time of this mixture was compared with the nucleation time of a model bile supplemented with the same amount of lipid as present in the bile sample. The results were expressed as ratio of the nucleation time of the mixture and the nucleation time of the control (NTm/NTc). There was a significant difference (p less than 0.01) between bile samples from patients with cholesterol gallstones and samples from patients with biliary obstruction due to other causes. More than 80% of the 33 samples from eight patients with stones were nucleation-promoting (NTm/NTc less than or equal to 0.6). Of the 40 bile samples from patients without stones, 7 were nucleation-promoting, 25 had no effect (NTm/NTc = 0.8 to 1.2) and 8 bile samples were nucleation-inhibiting (NTm/NTc greater than or equal to 1.4). There was no correlation between the lipid or protein content of a T-tube bile sample and its nucleation-influencing activity. The presence of both nucleation-promoting and nucleation-inhibiting activity in the same T-tube bile was demonstrated by chromatography on concanavalin A-Sepharose. More than 75% of the biliary protein did not bind to the column. This fraction showed nucleation-inhibiting activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Segmental auxiliary liver transplantation in dogs: a search for an ideal graft--illusion or reality?

Segmental auxiliary liver transplantation (SALT) has been carried out in 13 mongrel dogs to assess the possibility of a certain size of liver segment to accept without sequelae the total splanchnic and arterial blood normally diverted to the liver of the host. Prednisone (1 mg/daily) and azathioprine (2 mg/kg daily) were used as immunosuppression. Five dogs died during the first hours after the operation. Three because of technical failure and two of acute portal hypertension secondary to total portal and arterial blood diversion in dogs with liver segments of 195 +/- 49 g as a result of overloading of the graft. The remaining 8 dogs were divided into: 4 dogs into which a liver segment (195 +/- 49 g) was transplanted (group A) and 4 dogs in which a liver segment (385 +/- 85 g) was used (group B). Partial portal and total arterial blood diversion in group A dogs was not associated with portal hypertension but resulted in poor function of the graft and in poor survival. In contrast, the graft in group B dogs was able to cope with both total or partial portal blood and with a normal arterial blood diversion. Infection and graft rejection prohibited long-term survival (8-28 days). Data from this study support the view that the present technique of SALT with a graft corresponding to 300-400 g in mongrel dogs of about 30 kg is a potential alternative as temporary liver support in the diseased animal.

Simultaneous passive and active immunization against hepatitis B: noninterference of hepatitis B immune globulin with the anti-HBs response to reduced doses of heat-inactivated hepatitis B vaccine.

The effect of simultaneous administration of hepatitis B immune globulin on the antibody response to a low dose of heat-inactivated hepatitis B vaccine was investigated in 175 health care workers. Subjects were divided into four groups: Groups I and II received 3 monthly injections of a reduced dose (0.6 microgram) of a heat-inactivated hepatitis B vaccine (the usual dose being 3 micrograms) along with 500 IU of hepatitis B immune globulin simultaneously with the first injection of vaccine; Groups III and IV received the vaccine only. In addition, Groups I and III received a final booster injection with 0.6 microgram of the vaccine 8 months after the initial injection. Anti-HBs passively acquired from hepatitis B immune globulin did not interfere with the development of an active antibody response to the vaccine: the anti-HBs conversion rates were similar in persons treated with the combined regimen (89%) as in those who received the vaccine only (91%). At 3 and 5 months after the first injection, however, anti-HBs titers in the recipients of vaccine alone were slightly but statistically significantly higher than those of persons who received both hepatitis B immune globulin and vaccine; but at 8 months, this difference was no longer statistically significant. After a booster inoculation at 8 months, the geometric mean titer of anti-HBs increased 7- to 8-fold in antibody-positive vaccinees, regardless of whether hepatitis B immune globulin had been given earlier. Moreover, 6 of 13 nonresponders to the initial three vaccine injections developed anti-HBs after the booster inoculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic investigations in primary sclerosing cholangitis.

There is no consensus about the necessity and the possibility of therapy in primary sclerosing cholangitis. In some patients rapid deterioration of liver function may occur due to recurrent cholangitis and cholestasis. In one such patient, we obtained radiological evidence that the cholestasis was caused, not entirely by end-stage fibrotic scarring as interpreted upon surgical exploration, but, at least in part, by biliary stasis secondary to marked irregular narrowing of the extrahepatic bile ducts, together with precipitate formation. Moreover, the biliary ductular narrowing appeared to be partly reversible, indicating that edema and inflammation were responsible for part of the narrowing. These observations prompted us to evaluate topical lavage by nasobiliary drainage, first with saline, and then followed by corticosteroid solution in eight consecutive patients with recurrent cholangitis. Based upon clinical and biochemical evaluation, our preliminary results may be summarized as favorable. However, a large-scale multicenter controlled study will be required to prove the usefulness of this approach.

alpha 2-Plasmin inhibitor metabolism in patients with liver cirrhosis.

We describe the metabolism of purified human alpha 2-plasmin inhibitor in patients with liver cirrhosis to determine whether low plasma concentrations of alpha 2-plasmin inhibitor are the result of impaired synthesis or increased catabolism or both. A kinetic study was performed with 131I-alpha 2-plasmin inhibitor as a sensitive parameter of fibrinolysis in 14 patients with histologically proved liver cirrhosis compared with six healthy control subjects. Eight patients had macronodular cirrhosis (with positive hepatitis B surface antigen), and six had micronodular cirrhosis as a result of alcohol abuse. None of the patients had clinical signs of ascites, and in all the disease was stabilized. alpha 2-Plasmin inhibitor levels biologically and immunologically measured were decreased in all patients. Ten microCi 131I-alpha 2PI was injected intravenously, the disappearance of plasma radioactivity was measured, and turnover data were calculated according to the function x(t) = A1e-alpha 1t + A2e-alpha 2t + Be-beta t. Mean (+/- SD) turnover data in the control subjects were plasma radioactivity half-life 60.1 +/- 5.3 hours, fractional catabolic rate constant of the plasma pool 0.0318 +/- 0.0106 hr-1, and absolute catabolic (synthetic) rate constant 2.10 +/- 0.60 mg/kg/day. The alpha 1-phase was 1.26 +/- 0.23, and the transcapillary influx constant (k2,1) was 0.974 +/- 0.109 hr-1. In the patients, plasma radioactivity half-life was 58.7 +/- 12.09 hr, and fractional catabolic rate constant of the plasma pool 0.0283 +/- 0.0043 hr-1. The alpha 1-phase 4.74 +/- 6.48 and the transcapillary influx (k2,1) 3.08 +/- 3.9 hr-1 were both significantly increased compared with control values (p less than 0.05 and p less than 0.05, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Removal of bile acids from the blood by hemodialysis with a polyacrylonitril membrane: treatment of pruritus of cholestatic disease.

Hemodialysis with a polyacrylonitril membrane is evaluated as a possible method to alleviate pruritus accompanying severe prolonged cholestasis. To that extent results of a series of 30 dialysis sessions of a patient with advanced primary biliary cirrhosis are reported. Efficacy is measured with a pruritus score, kept by the patient herself, as well as with pre- and postdialysis plasma bile acid concentrations and bile acid concentrations in dialysates. Bile acid removal can then be calculated in three different ways: (a) From the decrease of the plasma bile acid concentration by dialysis a figure of 300 mumol bile acid removed is estimated. (b) Measurements of bile acid concentration in the dialysates results in a figure of 666 +/- (SD) 87 mumol bile acid removed. (c) From the mean pre- and postdialysis plasma bile acid concentrations together with an effective clearance rate of 8 ml/min for the bile acid mixture, calculated from ultrafiltration experiments, a removal of 589 +/- 100 mumol bile acid is calculated. These figures compare favorably with figures reported in the literature for the alternative techniques used, plasmapheresis and plasma perfusion over activated charcoal.

Follow-up of blood donors positive for hepatitis B surface antigen.

From 1973 to 1977 in Amsterdam the incidence of hepatitis B surface antigen (HBsAg) in blood donations from new donors was 0.224 and from known donors 0.034%. 65 donors, previously found positive for HBsAg, were re-examined. Persistence of HBsAg in new donors (28 of 31) occurred significantly (p less than 0.0005) more often than in known donors (15 of 34). All carriers were classified into HBeAg (21%) or anti-HBe (79%) by a sensitive Elisa technique. Abnormal liver function tests (LFTs) were observed in 30% of the carriers and were significantly (p less than 0.005) more often found in HBeAg than in anti-HBe-positive carriers. When the LFTs remained abnormal, in almost all (8 of 9) carriers moderate to severe histological liver disease was diagnosed.

Hepatic adenoma: imaging with different radionuclides.

A case of a benign hepatic-cell adenoma studies with dynamic radionuclide angiography and static imaging with different tracers is presented.

Alcoholic hepatic disease. Specificity of IgA deposits in liver.

The extent to which the immunofluorescent phenomenon of homogeneous deposition of IgA in the hepatic sinusoids (so-called continuous pattern) was specific for alcoholic hepatic disease was investigated. In 66 of 320 liver biopsy specimens a continuous IgA pattern was observed. Alcoholism was mentioned in the cases of 50 of the 66 patients (76%). The biopsy specimens in the remaining 254 cases continued scanty detectable IgA (discontinuous pattern) or none. In the latter group only eight patients (3%) had histories of alcoholism. A direct correlation between a continuous IgA pattern in the hepatic sinusoids and alcohol abuse is thus inferred (P less than 0.001). Additional findings of the concomitant occurrence of IgA in the perisinusoidal linings of the liver, the wall of superficial cutaneous capillaries, capillaries of the gut, and the glomerular mesangium in association with alcoholic hepatic disease further substantiates the concept of the existence of an IgA-associated disease.

[Adenoma of the liver and oral contraceptives]. / Leveradenoom en orale anticonceptiva

PIP: Heparomegaly was observed in a 26 year old woman who had used Lyndiol for 5 years. A large tumor which showed rich vascularization was found on each of the hepatic lobes. The case was diagnosed as liver cell adenoma caused by oral contraceptive use.^ieng

Fata eosinophilic enteritis.

A patient is reported with eosinophilic enteritis of the jejunum with fatal evolution. Surgical resection was considered impossible and medical treatment with corticosteroids, elemental diet, parenteral nutrition, and antimicrobials to combat the intestinal bacterial overgrowth failed to control the disease. The destructive and fatal nature of the reported eosinophilic enteritis raises the problem of classification of such disease entity, refractory to corticosteroid therapy.