The occurrence and significance of fibronectin in livers from chronic alcoholics. An immunohistochemical study of early alcoholic liver injury

The occurrence and distribution of fibronectin (FN) was assessed by an immunoperoxidase technique in liver biopsies from alcoholics without and with acinar zone 3 fibrosis of varying degrees. Increased amounts of FN was found diffusely in zone 3 areas with a perisinusoidal and pericellular localization. FN was closely correlating to the pattern of fibrosis but increased amounts of FN could also be seen in biopsies without fibrosis as visualized in Picro-Sirius stained sections. There was no topographical relationship to liver cells with fatty changes, Mallory bodies or to alcoholic hepatitis. It is made probable that FN is of significance in the development of early liver fibrosis in alcoholics and that FN may act as a chemotactic factor for collagen producing cells and as a skeleton for the new collagen formation.

Giant-cell arteritis. Histological, immunohistochemical and electronmicroscopic studies

Biopsies from the temporal artery of 32 patients suspected of giant-cell arteritis were evaluated retrospectively by light microscopy, histochemical, and immunohistochemical methods, as well as by transmission electron microscopy (TEM). At the clinical follow-up the 32 patients included four clinical groups: temporal arteritis (8 patients), polymyalgia rheumatica (10 patients), rheumatoid arthritis (4 patients), and a group of miscellaneous diseases unrelated to inflammatory rheumatic diseases (10 patients). There were a number of similarities between age-related alterations in the arteries and the changes in giant-cell arteritis. The most important differences were the inflammatory cellular infiltration of the media, the perifocal accumulation of fibronectin, and the occurrence of deposits of fibrin/fibrinogen and fibrin/fibrinogen degradation products. In addition, alpha-2 macroglobulin, lysozyme and factor VIII were also noted in giant-cell arteritis. The alterations in giant-cell arteritis show a number of similarities to the changes following experimental vascular injury of the rabbit aorta. The nature of the findings in human giant-cell arteritis, as well as the similarity to the experimental arteritis, indicate that giant-cell arteritis may reflect a non-specific reaction to injury, independent of the cause of the disease.

Lymph-node and thymus pathology in fatal drug addiction

Lymph-node sections from the porta hepatis, the lung hilus, the para-aortic and axillary regions and from the neck from totally 50 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen were studied together with tissue sections from 23 normal persons. In addition thymus sections from 30 drug addicts and 20 normal persons were investigated. Enlargement of lymph-nodes was found significantly more often in active drug addicts compared to normals except for the nodes on the neck. Birefringent material was seen in portal lymph-nodes in 42% of addicts, in para-aortic and lung hilus nodes in 18% each and in the axillary nodes in 12%. Signs of antigenstimulation evaluated by the number of germinal centre and plasma cells were found in about 60% or more in active drug addicts compared to about 30-40% in normals. There was not significant relation between the size of the lymph-nodes and the immunoactivity nor to the duration of the abuse. Examination of the thymus showed that the average weight in active drug addicts was 34 g, in normals 25 g. Histologically the tissue was in 48% of the active addicts composed of more than 80% lymphatic tissue compared to 15% of the normals. The results indicate that the enlargement and histological signs of activation in all the lymph-nodes investigated are caused by continuous antigenstimulation due to repeated injections of various antigens. The same may in part be applied to the thymus changes demonstrated.

Influence of ethanol on development of hyperplastic nodules in alcoholic men with micronodular cirrhosis

The type of cirrhosis was blindly evaluated in follow-up liver biopsies performed on 106 alcoholic men with micronodular cirrhosis. The median time interval from entry to follow-up liver biopsy was 31 mo (range, 3-44 mo). Patients were stratified into four groups according to their maximal registered ethanol consumption during follow-up. Thirty-six patients (34%) abstained from ethanol, 40 patients (38%) consumed a small amount of ethanol (less than 50 g/day), 19 patients (18%) consumed a moderate amount of ethanol (51-100 g/day), and 11 patients (10%) consumed an excessive amount of ethanol (greater than 100 g/day) during follow-up. Follow-up liver biopsy specimens demonstrated micronodular cirrhosis in 54 patients (51%), micronodular cirrhosis with development of hyperplastic nodules in 47 patients (44%), and nonclassifiable macronodular cirrhosis in 4 patients (4%); 1 patient showed portal fibrosis. The cumulative prevalence of patients developing hyperplastic nodules increased significantly (p = 0.014 for trend) with decreasing ethanol consumption, the prevalence being 57% in abstainers, 58% in those who consumed a small amount of ethanol, 32% in those who consumed a moderate amount, and 18% in those who consumed an excessive amount. In conclusion, alcoholic men with micronodular cirrhosis develop hyperplastic nodules during follow-up, the rate and prevalence of which is significantly related to the amount of ethanol consumed during follow-up. Ethanol consumption may inhibit hepatocellular proliferation in alcoholic men with micronodular cirrhosis.

No effect of long-term oral testosterone treatment on liver morphology in men with alcoholic cirrhosis

The effect of oral testosterone treatment (200 mg tid) on liver morphology was examined in a double-blind, placebo controlled study including men with alcoholic cirrhosis (n = 126). Liver biopsies obtained before randomization showed micronodular cirrhosis in 119 patients (94%), alcoholic hepatitis in 64 (51%), and fatty liver in 104 (83%). These and other morphological findings did not differ significantly in the patients randomized to testosterone (n = 76) and to placebo (n = 50) (skewed randomization 3:2). Follow-up liver specimens (biopsies or autopsies) obtained after a median treatment duration of 30 months demonstrated a significant (p less than 0.01) increase in the prevalence of macronodular cirrhosis (from 6 to 51%) and a significant (p less than 0.01) decrease in the prevalence of alcoholic hepatitis (to 21%) and of fatty liver (to 52%). Testosterone treatment did not significantly influence the prevalence of these changes. Further, testosterone treatment had no significant effect on the prevalence of other morphological changes, including vascular and malignant changes. However, in the testosterone-treated group one patient developed diffuse sinusoidal dilation and one patient showed Budd-Chiari's syndrome. The degree of fatty liver and of alcoholic hepatitis in follow-up liver specimens were significantly (p less than 0.002) higher among patients who consumed ethanol during follow-up than in patients who abstained (76 versus 22% and 30 versus 6%). In conclusion, this study does not establish any indication or any contraindication in terms of hepatic histopathology with the possible exception of hepatic venous thrombosis for the use of oral testosterone treatment in men with alcoholic cirrhosis.

The nature and the occurrence of birefringent material in different organs in fatal drug addiction

Insoluble birefringent tablet filler materials commonly found in tablets used in solution by drug addicts as intravenous injections were investigated microscopically. The following filler materials were investigated: talc, potato- and maize-starch, microcrystalline cellulose, magnesium stearate and siliciumoxid. The morphological characteristics of the different materials are described. Tissue sections (lung, liver, spleen, heart, bone-marrow, kidney, lymph-nodes and endocrine glands) from 33 consecutive fatality cases of intravenous drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen were studied with special reference to the occurrence and nature of birefringent material. Birefringent material was most often demonstrated in lung tissue (94%), followed by spleen (76%), liver (55%), lymph-nodes (portal: 39%) and bone-marrow (24%). The material was always localized intracellularly. Granulomatous reaction was only seen in the lungs. Except for one case, talc was the only foreign material seen in other organs than the lungs, undoubtedly due to its smaller size. The presence of insoluble foreign material in lung tissue of drug addicts indicates a habit of intravenous administration and the amount of the material indicates whether the addict usually injects tablets or only does so occasionally. The presence of birefringent material in the organs have only rarely any obvious clinical implications.

Lung and heart pathology in fatal drug addiction. A consecutive autopsy study

Lung and heart sections from 33 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen were studied together with tissue sections from 20 'normal' persons. In the drug addict cases focal bleedings in lung tissue were found in 94%, signs of earlier bleedings, haemosiderin containing histiocytes, were seen in 91%, and focal fibrosis in 46%. The bleeding episodes may be due to hypoxia in connection with heroin intake. In 94% of the drug addicts birefringent material in lung tissue was demonstrated, in 58% in granulomas and giant cells, in 27% in giant cells only and in 9% in isolated histiocytes. The material was localized in the wall of pulmonar arteries and/or in the interstitial tissue, undoubtedly depending on the duration of the abuse. In 18% angiothrombosis was seen, in all cases granulomas/giant cells were observed in the wall of the vessel concerned. The results indicate periodical intravenous injection of dissolved tablets in addition to heroin. Histological signs of pulmonary hypertension were not seen, possibly due to the fact that abuse of central stimulants is very rare in Denmark. Regarding heart alterations no significant differences were demonstrated between drug addicts and controls. The only note-worthy finding was focal infiltration of lymphocytes in the atrio-ventricular bundle in two drug addicts, the meaning of which is uncertain.

Prolonged bone marrow T1-relaxation in acute leukaemia. In vivo tissue characterization by magnetic resonance imaging

In vivo tissue characterization by measurement of T1- and T2-relaxation processes is one of the greatest potentials of magnetic resonance imaging (MRI). This may be especially useful in the evaluation of bone marrow disorders as the MRI-signal from bone marrow is not influenced by the overlying osseous tissue. Nine patients with acute leukaemia, one patient with myelodysplastic syndrome, and ten normal volunteers were included in the study. The T1- and T2-relaxation processes were measured in the lumbar spine bone marrow using a wholebody superconductive MR-scanner operating at 1.5 Tesla. In the patients MRI was done at the time of diagnosis and during follow-up of chemotherapy and related to bone marrow biopsies taken within three days of the MRI. At the time of diagnosis T1-relaxation time was increased two to three times in the patients (range 0.7-3.0 sec.) compared to the controls (range 0.38-0.60 sec.). No significant difference was seen in the T2-relaxation process. In relation to chemotherapy T1 decreased towards the normal range in the patients who obtained complete remission, whereas T1 remained prolonged in the patients who did not respond successfully to the treatment. The results indicate that MRI may be a non-invasive clinically useful tool in the evaluation of acute leukaemia especially as a follow-up control of chemotherapy.

Reflux oesophagitis in heavy drinkers. Effect of ranitidine and alginate/metoclopramide

Of 1,400 consecutive patients applying to an outpatient clinic for treatment of alcoholism, 477 complained of upper abdominal dyspepsia. After 2 weeks of abstinence, 78 had persisting complaints; of these, 72% had oesophagitis at endoscopy. The 53 patients with oesophagitis as the sole diagnosis were randomized to treatment with either ranitidine or a combination of alginate/antacid chewing tablets and metoclopramide for 6 weeks in a double-blind, double-dummy design. Twenty-five patients left the study during the observation time due to relapse of alcoholism, and were only observed until then. No significant differences were found between the treatment groups concerning the course of symptoms and endoscopic or histological improvement.

Alcoholic liver injury: defenestration in noncirrhotic livers--a scanning electron microscopic study

The fenestration of hepatic sinusoidal endothelial cells in 15 needle biopsies obtained from chronic alcoholics without cirrhosis was studied by scanning electron microscopy. As compared to nonalcoholics, a significant reduction in the number of fenestrae and porosity of the sinusoidal lining wall (fractional area of fenestrae) was observed in acinar Zone 3, both in biopsies with and without Zone 3 fibrosis as judged by light microscopy. A significant reduction of porosity as shown in this study may influence the blood hepatocytic exchange and contribute to the alcohol-induced liver injury.

Gastritis--a clinical entity?

Clinicians, endoscopists, and pathologists define gastritis in different ways. Pathoanatomical gastritis is very common and the prevalence increases with age. Patients submitted to routine endoscopy were interviewed before endoscopy and biopsies were taken from gastric antrum and body. No correlation could be found between upper abdominal dyspepsia, endoscopic signs suggesting gastritis, and histological gastritis. Gastritis does not seem to constitute a clinical entity within non-ulcer dyspepsia.

Variables predicting elevated portal pressure in alcoholic liver disease. Results of a multivariate analysis

In 46 alcoholic patients the association of wedged-to-free hepatic-vein pressure with other variables (clinical, histologic, hemodynamic, and liver function data) was studied by means of multiple regression analysis, taking the wedged-to-free hepatic-vein pressure as the dependent variable. Four variables showed significant independent association with the wedged-to-free hepatic-vein pressure: indocyanine green clearance (p = 0.031), degree of necrosis (p = 0.023), degree of hepatic architectural destruction (graded as: preserved architecture, nodules alternating with preserved architecture, totally destroyed architecture) (p = 2.3 X 10(-6) and sex (p = 0.0024), male sex being associated with higher wedged-to-free hepatic-vein pressure. The multiple coefficient of determination (R2) was 0.63; thus, 63% of the variation in the wedged-to-free hepatic-vein pressure was 'explained' by variation in these four variables.

The blood hepatocytic barrier: a light microscopical, transmission- and scanning electron microscopic study

The normal blood hepatocytic barrier (BHB), comprised by the endothelial lining cells and the perisinusoidal space, was investigated, and it was concluded that the BHB is a complex structure in which each individual part serves several functions. Immunohistochemical staining for factor VIII showed endothelial lining cells to be positive. By TEM and SEM the endothelial cells were seen to be fenestrated without a basal lamina. They possess numerous endocytotic vesicles. The perisinusoidal space contains the lipocytes and a matrix composed of fibrils, and a microfilamentous to granular material. The nature of these matrix components was poorly analyzable by conventional methods. Lipocytes were visualized by LM in: sections stained with oil red 0 after fixation in Baker's formol-calcium and following post-fixation in dichromate, and toluidine-blue-stained Epon-embedded sections. TEM revealed numerous cytoplasmic processes rich in microfilaments encircling the sinusoids.

The sinusoidal lining cells in "normal" human liver. A scanning electron microscopic investigation

The scanning electron microscopic was used to study the fenestrations of human liver sinusoids. Thirteen biopsies, where light microscopy and transmission electron microscopy revealed normal sinusoidal architecture, were investigated. The number of fenestrae was calculated in acinar zone 3 and acinar zone 1 areas. The porosity, i.e. fenestrated area relative to total area of the sinusoidal lining wall, was estimated on micrographs by using a Texture Analysing System (TAS). A zonal gradient was found with median 23.5 fenestrae per micron 2 in zone 3, as compared to 19.2 fenestrae per micron 2 in the zone 1 area (p less than 0.005). Increasing porosity towards the terminal hepatic vein was found (9.1% in zone 3 vs. 7.6% in zone 1 (p less than 0.05)). This was due to an increased number of fenestrae measuring 100 nm or less in diameter in zone 3 areas. The number of fenestrae measuring more than 100 nm but less than 300 nm was unchanged along the sinusoids. Fenestrae larger than 300 nm were rare and randomly distributed. The results suggest a different permeability along the sinusoidal lining, which may influence the transport between blood and hepatocytes and thus be of importance to hepatocellular function.

Perfusion fixation of hepatic needle biopsies for scanning electron microscopy. A methodological study

Perfusion fixation is essential for the examination of the hepatic microvasculature by scanning electron microscopy. No detailed study has previously been done on the perfusion of human hepatic needle biopsies. The present paper demonstrates two modifications of a simple technique by which needle biopsies can be perfused. Perfusion was performed either manually (n = 33) or with a constant perfusion pressure of 10-15 mm H2O (n = 54). No significant difference in the ultrastructural preservation was observed in the two groups. Manual perfusion, however, when done gently, was superior in cleaning the sinusoids, and thus larger areas could be investigated by this method. Topographical orientation was possible, allowing the identification of terminal hepatic veins and portal tracts.

Early alcoholic liver injury. Activation of lipocytes in acinar zone 3 and correlation to degree of collagen formation in the Disse space

Acinar zone 3 areas in liver biopsy specimens from 23 alcoholics and 47 non-alcoholics were investigated by light microscopy and transmission electron microscopy to asses fibrosis in the perisinusoidal space and to evaluate the role of the lipocytes. Quantitative analysis by light microscopy on toluidine blue-stained sections showed a significant reduction in number of lipocytes--median values of 2.7 and 1.2 lipocytes per 100 hepatocytes in biopsies from chronic alcoholics showing no or varying degrees of zone 3 fibrosis, respectively, as compared to 3.6 lipocytes per 100 hepatocytes in non-alcoholic livers. By transmission electron microscopy, the reduction in number of lipocytes was related to a corresponding increase in number of cells rich in rough endoplasmic reticulum and microfilaments (activated lipocytes). The occurrence of activated cells was significantly correlated to fibrosis of the perisinusoidal space. Activation of lipocytes and collagenization of the perisinusoidal space appeared before light microscopic evidence of fibrosis and were topographically not related to Mallory bodies or alcoholic hepatitis.

Early alcoholic liver injury: changes of the Disse space in acinar zone 3

One hundred and twelve consecutive liver biopsies were studied by transmission electron microscopy. In 18 out of 23 biopsies from chronic alcoholics showing preserved architecture by light microscopy, basal laminas were found in acinar zone 3 applied to endothelial cells as well as to hepatocytes. Basal laminas occurred independently of Mallory bodies and lipogranulomas, and were observed even in cases where light microscopy showed no fibrosis in zone 3. In addition to basal laminas, deposition of collagen and defenestration of the endothelial cells were observed. Basal laminas were seen only rarely in biopsies from non-alcoholics. We suggest that basal lamina formation in acinar zone 3 is initiated by changes in the perisinusoidal space and that it may contribute to impaired liver cell function and possibly initiate liver cell necrosis.

Mortality of alcohol abusing men prospectively assessed in relation to history of abuse and degree of liver injury

A prospective evaluation of mortality in relation to a broad range of alcoholic abuse and biopsy-assessed stage of alcoholic liver injury was carried out by following 315 men admitted to hospital for various medical disorders. During 10-13 years, 184 patients (58%) died, which, according to national mortality statistics, corresponds to a mortality ratio of 3.07. 43% of the excess mortality could be attributed to liver disease. Our results indicate that the alcohol abuse, irrespective of its magnitude and duration, is associated with a rather constant excess mortality and that the occurrence and severity of hepatic injury ranging from normal liver to active cirrhosis is directly associated with a subsequent liver-disease-related excess mortality.

Correlation between liver morphology and haemodynamics in alcoholic liver disease

In 32 alcoholic patients the degree of hepatic architectural destruction was graded (preserved architecture, nodules alternating with preserved architecture, totally destroyed architecture) and related to portal pressure. A significant positive correlation was found between degree of architectural destruction and wedged-to-free hepatic vein pressure (W-FHVP) (p less than 0.001). The degree of necrosis, fatty change and inflammation showed no correlation with portal pressure, whereas a significant positive correlation was found between the occurrence of Mallory bodies and W-FHVP (p less than 0.01) and between degree of fibrosis and W-FHVP (p less than 0.001). In 22 of the patients, hepatic blood flow (HBF) was measured and in these patients hepatic resistance was calculated (W-FHVP/HBF). A significant positive correlation was found between fibrosis and hepatic resistance (p less than 0.01). Further, hepatic architectural destruction (p less than 0.01) was positively correlated to hepatic resistance. Necrosis, fatty change, occurrence of Mallory bodies or inflammation showed no significant correlation with hepatic resistance. Mean hepatocyte volume was calculated in 29 patients, but no correlation was found with haemodynamic variables. The present data substantiate the concept that established portal hypertension in alcoholic liver disease is mainly accomplished by a derangement in hepatic architecture, whereas parenchymal changes, including hepatocyte size, are of less importance.

Prospective evaluation of alcohol abuse and alcoholic liver injury in men as predictors of development of cirrhosis

258 alcohol-abusing men, free from cirrhosis on primary liver biopsy, were followed for 10-13 years during which cirrhosis developed in 38, corresponding to a rate of 2% per year. The likelihood of cirrhosis developing proved to be independent of duration of abuse and of daily consumption before the primary biopsy. This indicates that the effect of alcohol abuse is not cumulative over time, but rather establishes conditions for the development of cirrhosis. The rate of cirrhosis increased stepwise with degree of steatosis in the primary biopsy, and in those with alcoholic hepatitis was nine times higher than in those with no steatosis. This finding, together with the results on alcohol abuse, indicates that steatosis and alcoholic hepatitis, despite their reversibility, are causally associated with cirrhosis rather than epiphenomena of alcohol abuse. In the alcohol-abusing man, a liver biopsy provides more information than alcoholic history about the likelihood of future cirrhosis.

Spleen and portal lymphnode pathology in fatal drug addiction

Spleen and portal lymphnode sections from 86 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen in the year 1979 were studied together with tissue sections from 24 "normal" persons. In 70% of the drug addicts the spleen weight was more than 200 g, and in 71% portal lymphnode hyperplasia was found. Birefringent foreign material was found in spleen tissue of drug addicts in 72% and in portal lymphnode tissue in 44%. Signs of antigen stimulation in both spleen and portal lymphnode tissue evaluated by the number of germinal centre and plasma cells were found in more than 80% of the drug addicts compared with about 20% of the "normal" persons. The results were related to anamnestic information of duration of drug abuse, to the spleen weight, to the occurrence of birefringent material and to the liver changes. Examination of lysozyme and immunoglobulin containing cells using the indirect preoxidase technique was performed in a total of 72 cases of spleen tissue, 59 cases of portal lymphnode tissue from drug addicts, 24 cases of spleen tissue and 18 of portal lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG containing cells were found significantly more often among drug addicts than "normal" persons. The results indicate that the splenomegalia and the portal lymphnode hyperplasia often found in drug addicts are caused by continuous antigen stimulation due to repeated injections of various antigens.

Correlation between liver morphology and portal pressure in alcoholic liver disease

In 14 alcoholic patients, the degree of hepatic architectural destruction was graded (preserved architecture; nodules alternating with preserved architecture; totally destroyed architecture) and related to portal pressure. A positive correlation was found between the degree of architectural destruction and both wedged hepatic vein pressure (r = 0.72, p less than 0.01) and wedged-to-free hepatic vein pressure (r = 0.67, p less than 0.02). Degree of fatty change, fibrosis, inflammation, necrosis and occurrence of Mallory bodies showed no correlation with portal pressure. After morphometrical evaluation of liver biopsies, no significant correlation was found between mean hepatocyte volume or relative sinusoidal vascular volume and portal pressure. To test whether an increase in hepatocyte volume compresses the vascular structures and causes portal hypertension, the ratio of relative sinusoidal vascular volume to mean hepatocyte volume, which expresses the compression of the vascular structures exerted by enlargement of hepatocytes, was related to portal pressure. No significant correlation was found. Further, mean hepatocyte volume was not significantly correlated to relative sinusoidal vascular volume. The present findings are in accordance with the hypothesis that elevated hepatic vascular resistance and portal pressure in alcoholic liver disease are in part determined by the severity of the hepatic architectural destruction and subsequent distorsion and compression of the efferent vein system. Parenchymal changes, including changes in hepatocyte volume, seem to be of minor importance.

Plasma fibronectin concentrations in morbidly obese patients

Plasma fibronectin concentrations and liver morphology were investigated in 45 morbidly obese subjects (median overweight 88%) and in 42 normal weight controls, matched for sex and age. A significantly (P less than 0.01) raised plasma fibronectin concentration (median 464 mg/l, range 276-862 mg/l) was found in the obese subjects when compared with concentrations in the controls (median 348 mg/l, range 164-536 mg/l). Plasma fibronectin concentrations of the obese patients correlated significantly to their degree of overweight (r = 0.33, P less than 0.05) as well as to the degree of fatty change found in their liver biopsies (r = 0.33, P less than 0.05). Significantly (P less than 0.05) elevated plasma fibronectin concentrations even in obese subjects without hepatic fatty change indicate that liver fat accumulation is no prerequisite of the obesity-related elevation of plasma fibronectin. Raised plasma fibronectin concentration in obesity may more readily be explained by an increased fibronectin formation by lipocytes.

Occurrence and significance of Mallory bodies in morbidly obese patients. An immunohistochemical study

Liver biopsies from 61 consecutive patients with morbid obesity (less than 60% overweight) and from 48 patients with alcoholic liver disease were examined for the presence of Mallory bodies. For the detection both routine haematoxylin and eosin stained sections and sections exposed to an immunohistochemical technique were employed. The latter uses an antiserum which recognizes antigenic determinants in Mallory bodies. Using haematoxylin and eosin staining. Mallory bodies were not detected in any of the biopsies from the obese patients, but found to be present in 63% of the patients with alcoholic liver disease. Using the immunohistochemical technique, Mallory bodies were found in the liver of 2 obese patients (3%) and in 36 patients with alcoholic liver disease (75%). None of the Mallory body positive obese patients showed signs of diabetes mellitus, cholestasis or hypocholesterolemia, but both patients admitted previous excessive alcohol consumption. It is concluded that the immunohistochemical detection of Mallory bodies is more sensitive than routine staining. Further, Mallory bodies are rare findings in livers of obese patients and may be related to excessive alcohol consumption.