Lymphocyte subset alterations in patients with alcoholic hepatitis

Twenty-three patients with alcoholic hepatitis (AH) were entered into a study to evaluate the relationship between alcoholic hepatitis, malnutrition, and immune status. In order to quantify these variables, objective parameters of nutritional status and lymphocyte phenotype and function were used. On admission to hospital, the mean number of CD4 helper/inducer cells, CD8 suppressor/cytotoxic cells, and CD3 lymphocytes were significantly reduced compared to age matched, non-hospitalized laboratory controls. In order to ascertain whether this abnormality was reversible, 12 patients, who were willing to remain in the hospital for 30 days, were treated for this entire period with oral nutritional supplementation using a commercially available preparation high in calories, protein, and branch chain amino acids. After 30 days of this therapy and abstinence, the number of CD4 cells increased from a mean (+/- SD) of 658 +/- 428 to 815 +/- 599/mm3. There was no difference in results of the lymphocyte transformation test comparing pre- and post-therapy values using either fetal calf or autologous serum. For all groups tested, cells cultured in autologous serum exhibited a significantly decreased response to mitogen compared to cells cultured in fetal calf serum. Both the total nutritional and the protein depletion (kwashiorkor) scores improved significantly during the 30 days of nutritional supplementation (p less than 0.0009 and p less than 0.0004, respectively). Therefore, we have observed an alteration in the numbers of helper lymphocytes in patients admitted with AH. This abnormality was modifiable by abstinence and nutritional supplementation over a brief period of hospitalization.     

Probable myeloblastic leukemoid reaction with disseminated sarcoidosis.

A 55-year-old woman had progressive weakness, weight loss, night sweats, fever, right-sided facial weakness, and hepatomegaly. Reticulonodular infiltrates were seen on chest x-ray film and a central filling defect was noted on liver scan. Study of the peripheral blood was noted on liver scan. Study of the peripheral blood revealed pancytopenia and myeloblasts. The bone marrow was not markedly hypercellular but contained noncaseating granulomas and myeloblasts. The patient's condition deteriorated and she died on the 22nd hospital day. Autopsy disclosed disseminated sarcoidosis but no evidence of leukemic infiltrates. Although concomitant "smoldering" acute leukemia cannot be ruled out, the findings in this patient can be best explained on the basis of a myeloblastic leukemoid reaction accompanying sarcoidosis.     

Urea-cycle enzymes in normal liver and in patients with alcoholic hepatitis

Abstract. Urea-cycle enzymes and ornithine-ketoacid-transaminase have been measured in biopsy specimens of liver from healthy subjects and from patients suffering from alcoholic hepatitis. Both groups of subjects received a hospital diet of about 100 g of protein daily. Extraction of enzymes from biopsy specimens was performed by a standardized technique.—The DNA content of liver did not vary significantly between the groups, whereas protein content was significantly lower in patients with alcoholics hepatitis than in controls (p < 0.05). Of the enzymes tested, the activities of carbamyl-phosphate synthetase and arginase were significantly decreased (p < 0.05 and p < 0.005 respectively) in patients with alcoholic hepatitis. Activities of arginosuccinate lyase, ornithine-ketoacid-transaminase and ornithine-carbamylphosphate transaminase remained unchanged in both groups.—These results demonstrate that alterations in arginase and carbamylphosphate synthetase-activities in the liver of patients with alcoholic hepatitis precede the histological manifestation of liver cirrhosis, which is associated with a significant decrease in some urea cycle enzymes [3, 15, 16]. Therefore the determination of arginase and carbamylphosphate synthetase in needle-biopsies of human liver represent sensitive parameters of liver cell necrosis during the course of alcoholic hepatitis.     

Maternal ritodrine hydrochloride therapy associated with transient leukemoid reaction in the infant

We have described a preterm infant who had a transient self-limited leukemoid reaction apparently due to maternal ritodrine therapy.     

Associated reaction and spasticity among patients with stroke

OBJECTIVES: The objectives were to investigate the relationship between associated reaction (AR) and clinical spasticity in the paretic arm. DESIGN: The participants were ten patients with hemiparetic stroke, mean age of 65.2 yrs, and duration of stroke of 13.3 mos. The AR of the hemiparetic arm was analyzed with surface EMG, and AR ratio was calculated on the basis of comparison of the surface amplitude of the affected side to that of the nonaffected side. Simultaneously, we measured M-, H-, and T-wave amplitudes and calculated H/M and T/M in the paretic arm. The AR ratio, H/M, and T/M were compared with spasticity as assessed with the modified Ashworth scale (MAS). We repeated the same measurements after median nerve block to examine its effects on the parameters. RESULTS: The AR ratio correlated significantly with MAS (P < 0.01), whereas H/M and T/M did not. Median nerve block did not alter these relationships. CONCLUSION: AR, which could be elicited easily in patients with spastic hemiparesis, correlated strongly with spasticity, both before and after the median nerve block. However, the so-called monosynaptic reflex (H- and T reflexes) did not correlate significantly with spasticity. These results indicate that AR and spasticity partially share common pathways.     

Alcoholic hepatitis with and without alcoholic hyaline.

Sixteen cases of alcoholic hepatitis with alcoholic hyaline (Group I) and 13 cases without alcoholic hyaline (Group II) have been collected since 1970. These were most frequently found in the fifth decade in both groups. One female was found in Group I. Cases of about two-thirds of both groups were comsumers of 110 g or more of alcohol per day. No significant differences except fever and erythrocyte sedimentation rate were found in clinical and laboratory changes between both groups. Fatty change in liver biopsy specimens were more frequently seen in Group I than in Group II. The wedged hepatic venous pressure was markedly elevated in alcoholic hepatitis with cirrhosis and moderately elevated in alcoholic hepatitis without cirrhosis. Wedged hepatic venography showed the main portal trunk and extrahepatic collaterals, namely, reversal of the portal flow or such tendency in 2 out of 5 patients of Group I.     

Role of hepatitis B virus infection in alcoholic patients

Summary The aim of this study was to determine the incidence of HBV markers in patients with alcoholic liver disease and to compare the results with those of patients with non-alcoholic liver disease and control subjects. We tried to determine whether the association between alcohol intake and HBV infection increases the risk of developing severe liver disease. The results showed an increased incidence of HBsAg in alcoholic patients when compared with controls as well as an increased incidence of severe chronic liver disease in HBV-positive groups when compared with HBV-negative groups. We conclude that HBV infection is an important additional risk factor for the development of severe liver disease in alcoholic patients.