Orthotopic liver transplantation in children

Between 1-1-1982 and 1-1-1988 52 children with an end-stage liver disease were evaluated to determine whether orthotopic liver transplantation (OLT) would be appropriate. 24 children were accepted as candidates in the long term. Twelve were not accepted as potential recipients. The parents of 3 decided not to accept OLT as treatment for their children. Two children died before a suitable donor liver was available, so that OLT was carried out in 11 children. Two of these children needed a second transplant. In 3 children only a part of a donor liver was transplanted. Shortage of donor livers of small size is partly alleviated by using a part of a larger liver. The underlying diseases of the transplanted children were cryptogenic cirrhosis (1x), biliary atresia with a hepatoportoenterostomy (8x) and cirrhosis following neonatal hepatitis (2x). Ten children with OLT are clinically and physically well. Postoperatively a primary graft dysfunction occurred in one child. He was retransplanted. The median waiting time for a donor liver was 5 months. The timing for OLT has to take this in account. In treating children with end-stage liver disease (partial) OLT should be considered.     

Systemic lupus erythematosus with rectal stenosis simulating tumour or diverticulosis. Case report

A case of systemic lupus erythematosus (SLE) with focal involvement of the rectum is reported. The lesion roentgenologically resembled a malignant tumour and was resected. Histologic examination disclosed only typical SLE changes in a very restricted area, with the remaining gastrointestinal tract unaffected. This appears to be the first report of focal colitis as a complication of SLE. The case points the importance of suspecting symptoms from any organ system in patients with connective tissue disorders to be manifestations of that underlying pathology.     

Synthesis and Properties of Haptens for the Development of Radioimmunoassays for Thioridazine,Mesoridazine, and Sulforidazine

For the separate development of radioimmunoassay procedures for thioridazine and its two major active metabolites, mesoridazine and sulforidazine, three haptens, respectively, 2-methylthio-, 2-methylsulfinyl-, and 2-methylsulfonyl-substituted 10-[2-[l-(2-carboxyethyl)-2-piperidinyl]ethyl]-10H-phenothiazine, were synthesized and characterized. Thioridazine hapten was coupled to bovine serum albumin, whereas the haptens for mesoridazine and sulforidazine were coupled to porcine thyroglobulin. The number of hapten residues per mole of carrier protein was determined in each case by an ultraviolet spectrophotometric method. Polyclonal antibodies to each hapten–protein conjugate were obtained in rabbits, and titers of the antisera were checked by evaluating their binding characteristics to the appropriate tritiated analyte. A hapten for the ring sulfoxide metabolite of thioridazine was also synthesized.     

Complex treatment and care of prostatic carcinoma patients

The authors' 5-year experience in the management and care of prostatic carcinoma are summarized. Their method differs essentially from earlier practice. They have found a new diagnostic and therapeutic method by introducing the TECO irradiation therapy, extensively using bone scintigraphy, by introducing cytostatics, extensively applying the prostate-specific acid phosphatase and by performing rectal biopsy of the prostate. They describe their own observations on the diagnostics and therapy of prostatic carcinoma. They stress that none of the therapies is the method of choice, the use of the various kinds of treatment are defined by strict indications. They state that care of prostatic cancer patients is highly important because only observation of the course of the disease may ensure the evaluation of treatment results and the indication of the adequate therapeutic method.     

Diabetic microangiopathy in subcutaneous fatty tissue

To evaluate diabetic microangiopathy in the subcutaneous fatty tissue objectively and to clarify the relation between pathogenesis of membranocystic lesion (MCL) and diabetic microangiopathy, specimens obtained from 23 diabetics and 23 nondiabetics were examined histologically. Ten of 23 diabetics and 7 of 23 non-diabetics were examined electron microscopically. Using electron micrographs measurements were made of the following areas; entire microvessel section, basal laminae, luminal space, endothelial cells, pericytes, and we scored the following findings: veil cells, cellular debris and vacuoles in the thickened basal laminae, abnormal densities of the endothelial cells. In diabetics, the area of luminal space was smaller and the area of basal laminae was larger than those of non-diabetics. Scored assessment of the veil cells, cellular debris and vacuoles in the thickened basal laminae were statistically significant in diabetics. Veil cells around the subcutaneous microvessels were less frequent and possessed fewer cytoplasmic processes than those around the dermal microvessels. Histologically, MCLs were frequently demonstrated in skin disorders resulting from diabetic microangiopathy, including 3 cases of pigmented pretibial patches, and 1 case of diabetic bulla. MCLs were more frequently demonstrated in diabetic cases with retinopathy, neuropathy, and nephropathy than those without complications. MCLs were detected only on the shins and the feet. MCLs were more frequently seen in cases with larger area of basal laminae than those with smaller area of basal laminae in morphometric measurement of electron micrographs. The present studies suggest that microangiopathy in the subcutaneous tissue is a pathological feature of diabetes mellitus and is a contributory factor to the formation of MCL.     

Circulating immune complex levels in patients with schistosomiasis and complications

Circulating immune complexes (CIC), adult schistosome antibody, and total immunoglobulin concentrations were estimated in sera from 35 chronic Schistosoma mansoni patients with different infection intensities and different pathological complications. High CIC levels were present in about one-third (10/35) of the sera. Most of the patients (9/10) with elevated CIC levels also had hepatomegaly or hepatosplenomegaly. This finding is significant in the pathogenesis of schistosomal liver fibrosis and may also apply to other liver diseases, especially cirrhosis. No correlation was found between infection intensity as judged by stool egg counts and CIC levels. A reverse relationship was observed between the level of anti-adult worm IgG and CIC levels. CIC levels were elevated within 7 and 28 days after treatment in most patients. Hypergammaglobulinaemia was detected in most sera.     

Effect of marginal zinc deficiency on the lymphatic absorption of [14C]cholesterol

The effect of zinc deficiency on intestinal absorption of cholesterol was investigated in adult male rats fed 3.6 ppm of dietary zinc (ZD) and compared with pair-fed (PF) and ad-libitum (CT) controls fed 30.6 ppm of zinc for 10 to 12 wk. The intestinal absorption of cholesterol was measured by collecting the mesenteric lymph at hourly intervals for 8 h after infusing a dose of [14C]cholesterol in a lipid emulsion through an indwelling duodenal catheter. Data on the hourly lymphatic output of [14C]cholesterol showed that the absorption of [14C]cholesterol plateaued at 4 h postdosing in all groups. The rate of the appearance of [14C]cholesterol in the mesenteric lymph significantly decreased in ZD rats at 5 h and thereafter. The cumulative absorption of [14C]cholesterol by ZD rats for the 8-h period was 4.4 +/- 1.0% of the dose, compared with 11.8 +/- 1.1% by PF and 10.7 +/- 1.4% by CT rats. There were no differences in percent distribution of esterified [14C]cholesterol among the three groups. Also, no significant change in mucosal cholesterol esterase activity was observed due to zinc deficiency. The present data and previous findings taken together suggest that the primary mechanism responsible for the impaired absorption of cholesterol may be associated with defective formation of chylomicrons in the intestinal mucosa.