Laparoscopic Findings in Senescent Patients with Primary Biliary Cirrhosis

Abstract: Fifty -two patients with primary biliary cirrhosis (PBC), 10 of whom were 65 years or older at the time of diagnosis, were investigated by laparo-scopy. Laparoscopic findings in these 10 patients were evaluated and compared with those in younger patients. The 10 cases were composed of nine females and one male, and two had been diagnosed as having symptomatic PBC with skin itching, while the remaining eight had asymptomatic PBC. Two, seven and one case were in Scheuer's stage I, II and III, respectively, and eight had chronic non-suppurative destructive cholangitis (CNSDC) on liver biopsy specimens. The majority of senescent PBC patients had typical findings of the early stage of PBC on the liver surface; mild undulations in nine and reddish patches in eight. The laparoscopic findings in senescent PBC were relatively mild.     

Increased serum levels of soluble interleukin 2 receptor in patients with drug-induced allergic hepatitis.

Soluble interleukin 2 receptor (sIL2R) level in the serum of 10 patients with drug-induced allergic hepatitis (DIAH) were quantified with a solid-phase enzyme immunoassay using two monoclonal antibodies against the receptor. The sIL2R levels in patients with DIAH were significantly higher than in 15 normal subjects (p less than 0.01). The high sIL2R levels observed during the florid stage of DIAH returned to normal during convalescence (p less than 0.05). SIL2R from the serum of DIAH patients was found to bind to a recombinant IL2 affinity column. It seems likely that sIL2R inhibits the hyper-immune reaction that occurs in drug allergies due to bind IL2. But, we have no data that sIL2R inhibits actually the biological activity of IL2.     

Tc-99m PMT hepatobiliary scintigraphy in the differential diagnosis of extrahepatic metastases and hepatocellular carcinoma

PURPOSE: The authors evaluated the utility of hepatobiliary scintigraphy for tissue characterization of extrahepatic metastases from hepatocellular carcinoma (HCC) using Tc-99m N-pyrydoxyl-5-methyltriptophane (Tc-99m PMT). METHODS: We examined 13 patients with HCC (29 extrahepatic metastases and 3 benign bone lesions) and 5 patients with other cancers (15 extrahepatic metastases). Thirty minutes to 6 hours after intravenous administration of Tc-99m PMT, planar (all 47 lesions) and SPECT (42 lesions) images were obtained. Accumulation of Tc-99m PMT in the lesion was evaluated visually by comparing bone scintigraphy, computed tomography, magnetic resonance imaging, or all of these. RESULTS: Findings were positive in 12 of 13 patients with HCC and extrahepatic metastases (16 of 29 on planar imaging and 21 of 26 on SPECT). Findings in all three benign bone lesions and 15 metastatic lesions from non-HCC primary lesions were negative (0 of 18 on planar imaging, 0 of 16 on SPECT). There were no false-positive findings in these lesions. Lesion-by-lesion sensitivity, specificity, accuracy, and positive and negative predictive values were 55%, 100%, 72%, 100%, and 58% by planar imaging and 81%, 100%, 88%, 100%, and 76% by SPECT, respectively. CONCLUSIONS: Because of the high specificity and reasonable sensitivity, Tc-99m PMT appears to be useful for the differential diagnosis of extrahepatic metastases from HCC. SPECT improves the detectability of small or faint accumulation in metastases from HCC.     

A case of malignant thymoma mimicking thyroid carcinoma: a pitfall in fine-needle aspiration

A case of malignant thymoma presenting as an anterior neck mass is reported. The tumor extended from the thyroid gland to the superior mediastinum. It did not accumulate Tc-99m pertechnetate, but continued to accumulate Tl-201 at the late phase. A fine-needle aspiration cytology from the tumor showed tight clusters of epithelial cells with crowded ovoid nuclei. The tumor was initially diagnosed as thyroid carcinoma, clinically and cytologically. A thymoma with a dominant epithelial component has to be considered in the differential diagnosis of a suspected papillary carcinoma of the thyroid.     

Serial observation of lymphocyte subpopulations and interleukin 2 production of T cells from patients with acute viral hepatitis and chronic active hepatitis

T cell subpopulations and interleukin 2 (IL-2) production of T cells in peripheral blood from patients with acute viral hepatitis (AVH) and chronic active hepatitis (CAH) were studied to elucidate the change of T cells functions during the exacerbation of viral hepatitis. The ratio of the number of CD4-positive cells to CD8-positive cells (CD:CD8 ratio) was increased in many patients with AVH. During exacerbation of CAH, the CD4:CD8 ratio was higher than that during remission (p less than 0.01), due to a decrease in the number of CD8-positive cells. IL2 production of T cells in AVH and CAH with bridging necrosis was higher than that of T cells in normal controls (p less than 0.01, p less than 0.05, respectively). T cells from patients with CAH produced more IL2 during exacerbation than during remission (p less than 0.01). IL2 production of T cells and the CD4:CD8 ratio (p less than 0.005, p less than 0.01). The change in T cell subpopulations in AVH and during exacerbation of CAH was found to induce an immunological condition, in which T cells easily produce IL2, which induces a proliferation of cytotoxic T cells.     

Clinical Characteristics of Portal Hemodynamics in Alcoholic Liver Cirrhosis

Background: Low incidence of reversal blood flow at the portal vein has been reported by measurement in larger and extrahepatic blood vessels but not in intrahepatic blood vessels in patients with liver cirrhosis. Moreover, there is little information regarding the incidence of reversal blood on the basis of the cause of liver cirrhosis. The aim of this study was to measure the reversal blood flow in the portal vein including intrahepatic branches in patients with alcoholic and viral cirrhosis.
Methods: The blood flow in the portal vein and existence of portosystemic shunt were studied in 52 and 27 patients with alcoholic and viral cirrhosis, respectively, by Doppler ultrasonography. The parameters of liver function test and the prevalence of ascites and esophageal varices were compared between patients with and without reversal blood flow.
Results: Reversal blood flow at the portal vein was found only in patients with only alcoholic cirrhosis (17 of 52 patients) but not in any patients with viral cirrhosis (0 of 27 patients; p < 0.05). The incidence of portosystemic ascites and red color of esophageal varices was also higher in patients with alcoholic cirrhosis with reversal blood flow in the portal vein compared with patients without reversal blood flow ( p < 0.05).
Conclusions: Reversal blood flow in the portal vein is a characteristic feature of alcoholic cirrhosis. The presence of reversal blood flow indicates severe liver diseases, and this feature may have prognostic importance for patients with alcoholic cirrhosis.     

Kinetic characteristics of K-activated para-nitrophenylphosphatase in isolated adult dog heart myocytes

K⁺-activated para-nitrophenylphosphatase (K⁺-pNPPase) was characterized kinetically in isolated adult dog heart myocytes. The results show that: (i) the K_m and V_max for K⁺ activation were increased by increasing concentrations of Mg²⁺ and para-nitrophenylphosphate (pNPP); the highest V_max/K_m value was obtained at 5 m Mg²⁺, 5 m pNPP and 10 m K⁺; (ii) the optimal molar ratio of Mg²⁺ to pNPP was 1 when the concentration of K⁺ was 10 m and that of pNPP was higher than 1.25 m ; (iii) when the molar ratio of Mg²⁺ to pNPP was kept at 1 and the K⁺ concentration was 10 m , increases in Mg²⁺ and pNPP concentrations increased the enzyme activity sigmoidally with a Hill coefficient of 1.7 and a S_0.5 value of 2.3 m ; (iv) Na⁺ at low concentrations (< 10 m ) activated, while Na⁺ at high concentrations (> 10 m ) inhibited K⁺-pNPPase activity when K⁺ concentrations were greater than 1 m ; (v) Ca²⁺ at low concentrations (0.1 to 0.2 m ) inhibited K⁺-pNPPase activity by competing with K⁺, while Ca²⁺ at high concentrations (0.5 to 1.0 m ) inhibited K⁺-pNPPase activity by mixed (both competitive and non-competitive) competition with K⁺; (vi) ouabain inhibited K⁺-pNPPase activity with a Hill coefficient of 0.59 and a S_0.5 value of 4.8 × 10⁻⁷ ; the inhibitory effect of ouabain (< 10⁻⁶ ) was decreased in the presence of Ca²⁺ (0.1–0.5 m ). These results demonstrate that isolated adult heart myocytes possess K⁺-pNPPase activity which can be used as a sensitive and specific probe for studies of the myocardial sodium pump ATPase enzyme system.     

In vitro effects of E coli endotoxin on K+-activated para-nitrophenylphosphatase activity and ouabain binding in dog hearts

The in vitro effect of E coli endotoxin on the activity of K+-activated paranitrophenylphosphatase (K+-PNPPase), an enzyme which represents the partial activity of (Na+ + K+)-ATPase enzyme system, was studied in isolated adult dog heart myocytes. The results were correlated with ouabain-binding studies. Endotoxin had an inhibitory effect on the Vmax for K+ activation as well as the Vmax for Mg++ and para-nitrophenylphosphate (PNPP) saturation. The inhibition was concentration-dependent and noncompetitive with K+, Mg++, and PNPP and furthermore, reversible. Endotoxin did not displace the bound 3H-ouabain from receptor sites nor did it affect the capacity of ouabain binding, indicating that the total enzyme concentration was not altered. From these findings, it is concluded that endotoxin in vitro affects the myocardial (Na+ + K+)-ATPase enzyme system by decreasing the turnover number of the enzyme molecule. The ability of endotoxin to modify myocyte membrane-associated enzyme activity may be responsible for altered heart metabolism and function in endotoxemia.