[Fibrolamellar hepatoma]

Unlike hepatocellular hepatoma (HCC), the so-called fibrolamellar hepatoma (FLH) is found almost exclusively in the non-cirrhotic, non-infected liver. Patient characteristics and the course of the disease in FLH differ markedly from HCC. FLH represents only a small portion of hepatomas in general (approx. 2%), but accounts for over 40% of hepatomas in young adults. We present the case of a 38-year-old woman showing the typical histological findings of polygonal eosinophilic tumor cells and characteristic lamellar bundles of fibrous stroma, which led to the diagnosis of FLH. The approx. 140 cases of FLH published in the world literature are also presented and discussed. The usefulness of additional examinations (neurotensin, vitamin B12 binding capacity and copper stains) is mentioned. The difficulty in diagnosing FLH lies in its histological differentiation from focal nodular hyperplasia. When diagnosed early, however, FLH is characterized by good resectability with a chance of cure or at least a markedly better survival rate than HCC.

Absence of detectable serum interferon in acute and chronic viral hepatitis

Amounts of interferon were measured in sera from 59 patients with acute viral hepatitis and 49 patients with chronic hepatitis B and compared to those from patients with nonviral liver disease or influenza, and from healthy controls. In all patients with acute and chronic viral hepatitis, no serum interferon could be detected, confirming data from earlier studies of acute viral hepatitis in which no circulating interferon was found. Our results disprove the view that the amounts of serum interferon, detected at the time of the acute clinical illness, may be a determinant of outcome.

Preoperative cervical dilatation for first trimester induced abortion: comparison of two prostaglandin analogues

The present study compares two methods of local application of prostaglandins prior to surgical abortion in the first trimester. Fifty patients were treated with a vaginal tablet of Gemeprost (E1 analogue); 50 others by the intra-cervical application of PGF2 alpha gel. Gemeprost was found to be superior to the PGF2 alpha gel. Several hypotheses are formulated to explain this observation. The side effects of the two methods are compared and discussed.

Primary structure of tyrosinase from Streptomyces glaucescens

The complete amino acid sequence of Streptomyces glaucescens tyrosinase is reported. The molecule consists of 273 amino acids and has a Mr of 30 900 including two copper atoms. The primary structure was determined by a combination of amino acid and DNA sequence analysis. Peptide sequence information was derived from the cyanogen bromide, tryptic, and thermolytic fragments of apotyrosinase by automated Edman degradation and aminopeptidase M and carboxypeptidase C digestions. The nucleotide sequence of the tyrosinase gene cloned into the PvuII site of pBR322 was determined. The enzyme contains no apparent leader peptide despite the fact that it is secreted into the culture medium. As observed for a number of different Streptomyces genes, the tyrosinase gene shows a strong preference (97%) for codons ending in G or C. A comparison of the amino acid sequence of Streptomyces glaucescens tyrosinase with that of Neurospora crassa tyrosinase reveals an overall sequence homology of only 24.2%. However, the sequence homology is much higher in those regions thought to be involved in metal binding of the binuclear active site copper of this monooxygenase.

Management of obstructive carcinoma of the left colon. Comparative study of staged and primary resection

Of 82 patients who had obstructing cancer of the left colon, 22% had incurable disease and 36.5% had advanced cancer at presentation. All methods of treatment carried a high morbidity and mortality. The mean survival rate with palliative operations was 8.7 months. Twenty-four poor-risk patients treated with staged operations had a 25% operative mortality and a 20.8% five-year survival rate. Forty primary resections, with or without anastomosis, were followed by a 27.5% operative mortality and by more than a twofold five-year survival rate (47.5%) compared with that of staged resection. These results suggest that delay of cure may reduce the late survival rate and justify primary resection as the operation of choice in selected good-risk patients.

[Interferon production in acute virus hepatitis]

Serum interferon activity was measured in 40 patients with acute viral hepatitis A, B and non-A-non-B during the acute stage of the disease and correlated with the severity, the long-term outcome and the viral etiology of the disease. Patients with alcoholic hepatitis, patients with an influenza-like illness and healthy volunteers served as controls. 80% of all patients with virus hepatitis revealed no measureable or only borderline interferon activity in their serum. No correlation was found with severity and long-term outcome of the disease, but patients with virus hepatitis A showed a stronger interferon induction than patients with hepatitis B and non-A-non-B. Further investigations of the interferon system in patients with virus hepatitis might help to improve our understanding of the different forms of the disease. The data presently available, however, do not permit as yet to define the value of interferon in the treatment of severe forms of acute virus hepatitis.

Induction of IgE receptors on human lymphocytes

A mouse myeloma IgE protein was cross-linked with dimethylsuberimidate to induce polymerization and incubated with normal human peripheral blood T lymphocytes in tissue culture. After 24 hours at 37 degrees C approximately 30% of the cells formed rosettes with IgE sensitized red cells as compared with much lower levels in the controls. A variety of controls established that the cellular receptors involved in rosette formation were specific for IgE. Monomeric mouse IgE failed to induce a response.

[Importance of ultrasonography in the diagnosis of diffuse parenchymal disorders of the liver]

In a retrospective analysis, ultrasonographic findings were compared with the individual histological diagnosis in 49 patients with diffuse parenchymal liver disease and 5 healthy controls. Ultrasonography differentiates with great accuracy between normal liver tissue on the one hand and diffuse parenchymal liver disease such as cirrhosis and fatty liver on the other, but only poorly between cirrhosis and fatty liver. The combination of 4 single ultrasonographic criteria serves for diagnosis of liver cirrhosis with a very high degree of specificity but with low sensitivity. Among the various single criteria adopted, sound transmission is that for which interobserver variation is highest.

Cancer of the colon: a study of age-related incidence

Incidence of colorectal cancer in Israel was studied in 1035 patients who were divided by ethno-geography into a Euro-American group and an Afro-Asian group. The majority of patients were in the age groups over 50 years, with a markedly higher incidence rate of disease in the Euro-American group. In the younger age group the incidence rate of the disease was significantly higher in the Afro-Asian group. These findings, if verified by others, must lead to revision of our present concepts of epidemiology of colorectal cancer.

[Experiences with a new percutaneously effective antirheumatic preparation]

The new substance Etofenamat (Rheumon Gel) is effective percutaneously in the treatment of rheumatic diseases. The gel is shown to be an effective antiphlogistic and analgetic, especially in vertebragenic diseases. The results of treatment of 81 patients are summarized. In a total of 56 patients, use of Etofenamat led to an evident improvement, for example, freedom from pain. Treatment for up to 9 days, eliminated pain in 73 of the 81 patients. In 28 patients out of 38, the mobility of joints was favourably effected. No side effects were observed.

[Acute kidney failure as a complication of fasting therapy]

Acute urate nephropathy during starvation for weight reduction has been observed in 2 patients. Under these conditions ketoacidosis causes impaired renal uric acid excretion and hyperuricemia. Uricosuric agents or sudden intake of normal calorie diet induces massive uricosuria and kidney damage. Uricosuric agents should be avoided and steps taken to promote abundant diuresis, while allopurinol should be prescribed.

Facilitated purification of hypoxanthine phosphoribosyltransferase

Three major approaches to the complete purification of hypoxanthine phosphoribosyltransferase from human erythrocytes and rat brain are described. Preparative isoelectric focusing which has been used for the isolation of the human enzyme was not fully successful in the case of rat brain. Preparative polyacrylamide-gel electrophoresis in gel blocks yields enzyme samples of high purity as judged by analytical gel electrophoresis, but with a comparatively low specific enzyme activity. The most rapid and convenient method, a modification of the affinity chromatography on GMP agarose first described by Hughes[5] gives hypoxanthine phosphoribosyltransferase which is superior to the other preparations in its homogeneity and its specific activity. All three methods produce an identical enzyme protein detected by polyacrylamide electrophoresis on nondenaturing and sodium dodecylsulfate gels. Molecular data of hypoxanthine phosphoribosyltransferase derived from these studies are: Isoelectric points of 5.60; 5.85 and 5.90 for three isozyme peaks of the rat brain enzyme; and a molecular weight of 72000 for the native rat brain enzyme and of 25000-27000 for the subunit of human and rat enzyme. Guanylate kinase does not interfere with the purification of hypoxanthine phosphoribosyltransferase on GMP agarose and moreover is itself partially purified by this chromatography.