Salmonella hepatitis.

Typhoid fever is often associated with abnormal liver biochemical tests, but severe hepatic involvement with a clinical feature of acute hepatitis is a rare complication. There have been more than 150 cases of salmonella hepatitis reported from both developed and developing countries. The documented incidence varies widely from less than 1% to 26% patients with enteric fever. The possible associated factors for development of salmonella hepatitis are virulence of the organisms, delayed treatment and poor general health of the patients. The pathogenesis of severe hepatic involvement in salmonella infection may be multifactorial and includes endotoxin, local inflammatory and/or host immune reactions. Clinical jaundice in salmonella hepatitis usually occurs within the first 2 weeks of the febrile illness. Hepatomegaly and moderate elevation of transaminase levels are common findings. Extreme hepatic dysfunction with hepatic encephalopathy is a rare coexisting complication in salmonella hepatitis. A positive culture for salmonella from blood or stool is essential to differentiate salmonella hepatitis from other causes of acute hepatitis. Hepatic pathology is characterized by the presence of typhoid nodules with marked hyperplasia of reticuloendothelial cells. The prognosis is usually good as salmonella hepatitis responds well to a specific antibiotic therapy and juandice resolves with clinical improvement. The clinical course can be severe with a mortality rate as high as 20%, particularly with delayed treatment or in patients with other complications of salmonella infection. As enteric fever is a common infection, the recognition of salmonella hepatitis is of clinical importance.

CT and US findings of a rare case of amoebic liver abscess rupturing into the pericardial cavity.

A rare case of amoebic liver abscess that ruptured into the pericardial cavity is reported. This is the first case in the world in which CT scan and ultrasonography were performed in conjunction with each other in demonstrating the fistulous tract. CT scan, ultrasonographic and echocardiographic findings were described in detail. Pericardectomy with surgical drainage and supportive measures led to complete recovery after 37 days of hospitalization.

Discrimination between normal and malignant hepatocytes in man by the monoclonal antibody RL23/36: comparison with the Ca1 and 791T/36 monoclonal antibodies.

The monoclonal antibody RL23/36 has been shown to discriminate normal from malignant hepatocytes in man. In frozen sections of liver tissue from 25 Thai patients without hepatocellular carcinomas, the antibody reacted strongly and preferentially with hepatocytes. Reactivity with 7 hepatocellular carcinomas was invariably abnormal, being totally absent in 5 and partially lost in 2. This discrimination was superior to that achieved with Ca1 and 791T/36 monoclonal antibodies. In 2 cases of hepatocellular carcinoma, binding of RL23/36 to associated apparently non-malignant hepatocytes was abnormal, being absent in one and partially lost in the other. These data show that RL23/36 detects an antigenic determinant which is lost during malignant transformation of human hepatocytes, sometimes before the development of frank malignancy.

Peritoneoscopic findings in 203 patients with Opisthorchis viverrini infection.

A study was conducted to determine the value of peritoneoscopy in the diagnosis of opisthorchiasis. Peritoneoscopic findings in 203 proven cases of Opisthorchis viverrini infection are presented. The authors found that cholangiocarcinoma is frequently encountered in patients presenting with prolonged jaundice and hepatomegaly as well as with the peritoneoscopic findings of dilated superficial intrahepatic bile ducts, a bile-stained liver surface and a markedly enlarged gallbladder.

Exocrine pancreatic function among diabetic patients in Thailand.

Pancreozymin-secretin-stimulated secretion was measured for volume, bicarbonate concentration and total amylase output in 16 noninsulin-dependent patients and 23 age-, sex-, and weight-matched similar control subjects. Another group of 17 insulin-dependent patients was studied using secretin stimulation and the secretory response compared to a similar group of 37 control subjects. Pancreozymin-secretin-stimulated pancreatic function was normal in noninsulin-dependent patients. Abnormal values for at least one parameter of secretion were found in 82% of insulin-dependent patients. Amylase output was low in 35% and bicarbonate concentration was low in 30%. Hypersecretion occurred in 35%. One patient had abnormal values for all three parameters and three patients had two abnormal values. Hypersecretory response to secretin stimulation is considered to be an early finding of pancreatic exocrine dysfunction among insulin-dependent patients. Progressive secretory failure occurs as the pathological process increases, and a decrease in total amylase output becomes the most significant abnormality.

Hepatitis B antigens and antibodies in serum from 41 cases of primary carcinoma of the liver. A study from Thailand.

Thirty-seven patients with hepatocellular carcinoma (HCC), one with cholangiocellular carcinoma (CCC), two with mixed HCC and CCC, and one with an anaplastic primary carcinoma of the liver, all from Bangkok, Thailand, were examined for the presence of hepatitis B virus infection markers in their blood. Of the patients with HCC, 70.6% had macronodular cirrhosis. Their serum was positive for hepatitis B surface antigen (HBsAg) in 64.9%, for hepatitis B core antibody (anti-HBc) in 97.3%, and for hepatitis B e antibody (anti-HBe) in 56.8% of the cases. The serum was positive for hepatitis B surface antibody (anti-HBs) in 53.9% of the HBsAg-negative and positive for hepatitis B e antigen (HBeAg) in 16.7% of the HBsAg-positive patients. The results of the study support the hypothesis of an etiological association between hepatitis B virus infection and HCC in Thailand.

Peritoneoscopy in the diagnosis of liver abscess. Experience with 108 cases during a 10-year period.

Among 4569 cases of peritoneoscopy performed in a period of 10 years (1972-1981), 108 patients with liver abscesses were encountered. The diagnosis of hepatic abscess was made on the basis of gross liver inspection and confirmed or disproved by needle puncture biopsy, histopathologic study, or surgery. Peritoneoscopy is a valuable procedure for the diagnosis of liver abscess. Liver aspiration under direct vision during peritoneoscopy yields more dependable material for the diagnosis of liver abscess than blind liver aspiration. Moreover, during peritoneoscopy one can choose more accurately the site for the insertion of the aspirating needle.

Paraganglioma of the common hepatic duct.

A case of paraganglioma arising in the common hepatic duct is reported. The patient presented with obstructive jaundice. At operation, a soft mass, 5 X 2 X 1.8 cm, was found firmly adherent to the intraluminal surface of the common hepatic duct. At cholecystectomy, exploration of the common hepatic duct was performed and the mass was partially removed. T-tube choledochostomy and operative cholangiography were performed. The final pathological report was paraganglioma of the common hepatic duct. The patient was clinically improved on discharge.

Plasma cobalamin and transcobalamin in patients with primary carcinoma of the liver. A study from Thailand.

Of 37 patients with histologically verified hepatocellular carcinoma (HCC) from Bangkok, Thailand, 34 had raised values of plasma cobalamin, and 1 presented with a markedly increased value of plasma transcobalamin I (TC I). One patient with clinical malignancy of the liver, not proven histologically to be HCC, had a raised plasma cobalamin value and a markedly increased value of TC I. From our own studies and from studies in the literature we find circumstantial evidence that TC I occasionally is produced by the malignant liver cells in HCC.