Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms.

We evaluated the relationship between the signs and symptoms of the clinical syndrome called veno-occlusive disease of the liver after bone marrow transplantation and the histological findings in 76 patients who later came to autopsy. Coded necropsy liver was scored for individual histological features that were correlated with prospectively assessed clinical features that the patients had exhibited during life. Patients were stratified into two groups: those with severe clinical veno-occlusive disease (n = 32) and those without. Clinically severe veno-occlusive disease was statistically correlated with several zone 3 acinar changes: occluded hepatic venules, the frequency of occluded hepatic venules x degree of occlusion, eccentric luminal narrowing/phlebosclerosis, zone 3 sinusoidal fibrosis and zone 3 hepatocyte necrosis (all p < or = 0.03). There was a significant relationship between the number of these histological abnormalities in zone 3 of the liver acinus and a clinical diagnosis of severe veno-occlusive disease (p = 0.003). The presence of ascites was significantly correlated with occluded venules, zone 3 sinusoidal fibrosis and zone 3 hepatocyte necrosis (p = 0.001). Maximum serum bilirubin in the first 20 days after transplant was significantly correlated with sinusoidal fibrosis, hepatocyte necrosis and eccentric luminal sclerosis/phlebosclerosis (p < 0.01) but not with venular occlusion. The clinical syndrome of liver toxicity (commonly called veno-occlusive disease) that results from cytoreductive therapy before bone marrow transplant is strongly correlated with a constellation of histological lesions involving structures in zone 3 of the liver acinus and the hepatic venules into which sinusoidal blood flows. This study suggests that there is no single diagnostic histological feature. The severity of clinical veno-occlusive disease appears to be proportional to the number of such histological changes and is not due solely to occlusion of small hepatic venules.

Automation of in situ hybridization.

The authors used automated DNA hybridization equipment, the Code-On (Instrumentation Laboratory, Lexington, MA), for more than 2 years to perform in situ hybridization in the clinical and research laboratory. For in situ hybridization for viral DNA in fixed, paraffin-embedded tissue, the Code-On produces results that are as sensitive as the manual method and with considerably greater ease. The procedure must be modified to fit the operating characteristics of the Code-On. The authors outline a procedure that emphasizes sensitivity, rather than speed. The automated procedure requires close technical attention, but the authors propose that it is considerably more efficient than the manual method. One technician can produce reliable results on as many as 60 slides a day. For in situ hybridization on cytogenetic preparations, the results are excellent, but the procedure is contorted and the probe use is increased. For these reasons the Code-On is not used for routine interphase cytogenetics. The Code-On is in routine use in the authors' pathology laboratory for performing in situ hybridization on formalin, B5, and Carnoy's fixed, paraffin-embedded specimens.

[Iotrolan-300 versus Iopamidol-300 in hysterosalpingography]. / Iotrolan-300 versus Iopamidol-300 in der Hysterosalpingographie.

From 9.1988 to 7.1989 we carried out on 50 patients at the Department of Gynaecology of the University of Freiburg a randomized double-blind study to compare the first dimeric, nonionic, hexaiodinated, water-soluble contrast agent (Iotrolan-300 corresponding to Isovist-300) with a nonionic, monomeric preparation (Iopamidol-300 corresponding to Solutrast-300) using the concentration of 300 mg I/ml. Both medicaments show a high contrast quality in the X-rays. Complications like hypersensitivity reactions resp. actual local irritations were not recorded. Iotrolan-300 was found to be the best tolerated of the two contrast media in respect of mildest intensity of pain.