Reduced liver function is the trigger for renal sodium retention following portal vein ligation in the rat

Sodium retention along with peripheral vasodilation are features of prehepatic portal hypertension. In several models of experimental liver damage, sodium retention occurs only when hepatic function, measured by the aminopyrine breath test (ABT-k), falls below a critical threshold. The relationship between renal sodium handling, ABT-k and systemic and renal haemodynamics in partial portal vein ligated (PVL) rats was examined to test the hypothesis that peripheral vasodilation was responsible for initiating sodium retention. Haemodynamic measurements were conducted early after surgery in portal hypertensive rats with and without sodium retention and in sham-operated controls. Compared with control, both PVL groups of rats had elevated portal pressure and lower peripheral vascular resistance (P<0.05). Sodium retaining-PVL rats had both lower ABT-k (0.95 ± 0.05 vs 1.38 ± 0.06 times 10^-2/min; P<0.05) and higher sodium balance (1.38 ± 0.09 vs 0.43 ± 0.09 mmol/day; P< 0.05) than non-sodium retaining PVL rats. No differences in plasma renin activity or noradrenaline concentrations were observed. In a separate group of rats, hydralazine-induced peripheral vasodilation did not induce sodium retention. These results suggest that the presence of peripheral vasodilation alone is not sufficient to trigger a sodium-retaining status. A factor, probably liver function-dependent, acting directly on renal tubules may be necessary for changes in renal sodium handling in this model.     

Antibodies to P450IID6, SLA, PDH-E2 and BCKD-E2 in Japanese patients with chronic hepatitis

Auto-antibodies specific to various antigens in chronic hepatitis (CH) have been detected but their specificities and implications were uncertain. The aims of the present study were to investigate the frequency and the significance of seropositivity of antibodies to P450IID6 or liver/kidney microsome 1 (LKM1), soluble liver antigen (SLA), pyruvate dehydrogenase (PDH) and branched-chain keto acid dehydrogenase (BCKD) in 188 Japanese patients with different forms of CH by western blot or enzyme immunoassay (EIA). Anti-LKM1 was also measured by indirect immunofluorescent test. Anti-P450IID6 was found in 6/188 (3.2%) CH patients including 5/104 (4.8%) with hepatitis C virus (C) infection and 1/12 (8.3%) CH-C patients with antibodies to nuclear and smooth muscle antigens and hypergammaglobulinaemia (> 2.5 g/dL). This patient was the only one diagnosed with autoimmune hepatitis (AIH). All CH patients with hepatitis B (B), hepatitis non-B non-C (NBNC) and AIH were seronegative for anti-LKM1. Antibodies to soluble liver antigen were found in two of 188 (1%) patients, one with AIH and one with CH-B. Anti-BCKD-E2 but not anti-PDH-E2 was found in four patients (2.5%), one with AIH, two with CH-C, and one with NBNC. There was no obvious difference in age, sex ratio and laboratory findings in patients with or without anti-SLA and anti-BCKD-E2. Antibodies to P450IID6, SLA, PDH-E2 and BCKD-E2 are uncommon in adult CH-C, CH-B, CH-NBNC and AIH patients in Japan. Some of these patients positive for auto-antibodies appear to have autoimmune features and might require a careful follow up. The heterogeneity of these antibodies in CH preclude further justification for subtyping of AIH by the presence of the distinct auto-antibodies.     

Basaloid-squamous cell carcinoma of the oral mucosa: Report of two cases and study of the proliferative activity

Two cases of basalold-squamous cell carcinoma (BSC) of the oral mucosa are described. The first case occurred at the floor of the mouth in a 58-year-old man, and the second case occurred at the mandibular gingiva in a 79-year-old woman. The laboratory data of the first case showed a positive response to hepatitis C virus antibody. in the first case, the tumor mass measured 4 times 4 cm in size, and was i-texl at the lingual side of the median mandible beside the sublingual gland. In the second case, the tumor mass measured 25 times 15 mm In size, and was located in the alveolar mucosa of the right mandible. Histologically, both tumors showed a neoplastic epithelium arranged in a solid pattern with evidence of peripheral palisading, central necrosis, and some squamous differentiation. The pro-ilferathfe activities of the BSC were compared with conventional squamous cell carcinomas (SCC) in the oral floor and gingiva, respectively, by employing a sensitive argy-rophillc nuclear organizer region (AgNOR) staining method. The number of AgNOR per nucleus of the BSC was higher than that of any other SCC cases. The results support the opinion that BSC of the oral mucosa has a worse prognosis than conventional SCC.     

Relationship Between Diastolic Mitral Regurgitation and PQ Intervals or Cardiac Function in Patients Implanted with DDD Pacemakers

Diastolic mitral regurgitation (MR) is known to be induced by prolonging atrioventricular (AV) delay in patients implanted with a DDD pacemaker. We studied the relationship between diastolic MR and PQ intervals on cardiac function in 50 patients (71.3 ± 11.3 years old: mean ± SD), who had been implanted with DDD pacemakers. In 19 patients, prior to pacemaker implantation, pulmonary capillary wedge pressure (PCWP) was measured using a Swan-Ganz catheter during AV sequential pacing with an AV delay of 0.165 seconds. Transmitrai blood flow was measured with pulsed Doppler echocardiography, while prolonging AV delay stepwise by 0.025 seconds from 0.065 seconds for about 5 minutes each. In nine patients, AV delay could not be prolonged enough due to occurrence of intrinsic AV conduction. In the other 41 patients, diastolic MR was induced by prolonging AV delay. The critical PQ intervals that induced diastolic MR ranged from 0.14 to 0.26 (0.23 ± 0.03) seconds. Four of five patients whose critical PQ intervals were 0.20 seconds or shorter had heart failure, while 36 patients whose critical PQ intervals were >0.20 seconds were free from signs and symptoms of heart failure. Their PCWPs were 2–27 (7.5 ± 5.1) mmHg. There was a significant negative correlation between the critical PQ intervals for the appearance of diastolic MR and PCWP during AV sequential pacing, which was performed prior to pacemaker implantation (r = -0.85, P < 0.001). It is suggested that the appearance of diastolic MR is determined mainly by PQ intervals and cardiac function. Measurement of the critical PQ intervals that induce diastolic MR may be useful in assessing cardiac function in patients implanted with DDD pacemakers.