Hepatic collagen proline hydroxylase activity in primary biliary cirrhosis

The enzyme collagen proline hydroxylase has been measured in liver biopsies from fourteen patients with primary biliary cirrhosis. The activity was elevated in ten of the patients, but not to the degree previously found in patients with active cirrhosis. There was no correlation between the enzyme activity and the liver copper concentration, which was elevated in all except one of those measured. This suggests that excessive collagen synthesis in PBC is not directly related to the high liver copper concentrations.

Transfer factor in the attempted treatment of patients with HBsAg-positive chronic liver disease

Six patients with hepatitis B surface antigen-positive (HBsAg-pos) chronic liver disease have been treated with transfer factor (TF) prepared from leucocytes of normal blood donors with no history of hepatitis, and with TF from subjects recently recovered from type B hepatitis. In three patients there were transient elevations of aspartate transaminase (AsT) after 'specific' TF, representing damage or destruction of hepatocytes, and in two of these patients there was coincidental complement consumption, suggesting that TF had stimulated production of antibody. In one other patient there was an increase in E-rosetting lymphocyte (ERL) concentration representing a change in T-lymphocyte reactivity. One of the two patients who had no measured response to TF had a primary liver cell carcinoma and was receiving prednisolone therapy. TF prepared from subjects who have recently recovered from type B hepatitis may have temporarily altered the immunological status of patients with HBsAg-pos chronic liver disease, but it did not have a beneficial therapeutic effect.

A controlled trial of D-penicillamine therapy in primary biliary cirrhosis

D-penicillamine, 900 mg daily, was used in a randomised controlled trial for treatment of patients with primary biliary cirrhosis. 19 patients received D-penicillamine and 13 received placebo. The two groups were similar in age, duration of illness, liver function tests, and liver histology. Before entry into the trial liver-copper concentration was raised in 25 of the 27 patients in whom it was measured. After three months patients taking D-penicillamine showed a significant reduction in serum-aspartate-transaminase concentrations compared with the placebo group, and this reduction seemed to be sustained. In the 4 patients on D-penicillamine for a year, a second liver biopsy showed that mean liver-copper concentration fell from 310 +/- 128 (S.E.M.) to 84 +/- 36 microng/g dry liver, compared with a reduction from 511 +/- 169 to 454 +/- 128 in the 7 patients in the placebo group in whom serial liver-copper measurements were available. Liver histology demonstrated a comparative improvement in cholestasis in patients on penicillamine, but the degree of inflammation, necrosis, and the histological stage of disease remained similar in both groups. In 5 of the 19 patients in the D-penicillamine group the drug was discontinued because of side-effects. D-penicillamine seems to be a promising treatment for patients with primary biliary cirrhosis. It may produce its effect by reducing liver-copper concentration.

Percutaneous transhepatic cholangiography using the "Chiba" needle--80 cases

Using the Chiba needle for percutaneous transhepatic cholangiography, bile ducts have been visualized radiographically in 80% of 80 patients with cholestatic jaundice. The success rate was 94.4% in the 54 patients with dilated bile ducts due to an extrahepatic bilary obstruction, and 50% of the 20 patients with undilated ducts. Four patients developed ascending cholangitis with septicaemia on the same day as the procedure, and early surgery after visualization of obstructed bile ducts is recommended. The technique was successful in three of five patients with sclerosing cholangitis. Percutaneous cholangiography using the Chiba needle is a convenient method of opacifying the biliary system in patients with severe large bile duct obstruction.

Peripheral blood lymphocyte populations in chronic liver disease

Mature T lymphocyte concentrations are reduced, null cell concentrations are increased, and Fc receptor bearing (B and K) lymphocyte concentrations are normal, in the peripheral blood of patients with chronic hepatocellular or cholestatic liver disease. Some null cells can be stimulated by either thymosin or levamisole to form rosettes with sheep erythrocytes. These changes are present in viral, alcohol associated and 'autoimmune' liver disease and are therefore probably secondary phenomena relating to liver damage.

Double-stranded DNA-binding capacity of serum in acute and chronic liver disease

Serum antibodies to double-stranded 'native' DNA have been measured in acute and chronic liver diseases using the Farr technique. Elevated levels of DNA binding were found in all groups of patients, with the highest levels in acute viral hepatitis and lowest in primary biliary cirrhosis. All patients with hepatitis B surface antigen-positive chronic active hepatitis had elevated levels, hence persistent elevation of DNA binding after acute type B hepatitis might be an unfavourable prognostic marker indicating progression to chronic active hepatitis, DNA antibody levels will not offer diagnostic help in liver diseases, or help to follow the response of patients with 'lupoid' hepatitis to corticosteroid therapy. Production of DNA antibody may be a response to release of DNA from damaged hepatocytes.

A randomized trial of percutaneous transhepatic cholangiography with the Chiba needle versus endoscopic retrograde cholangiography for bile duct visualization in jaundice

Sixty consecutive patients, who were deeply jaundiced or in whom intravenous cholangiography had failed, were randomized to retrograde endoscopic cholangiography or percutaneous transheptic cholangiograhy with the "skinny" Chiba needle technique. Twenty-eight patients were assigned to retrograde cholangiography, which succeeded in 17 (65%). Percutaneous cholangiography was successful in 16 (50%) of the remaining 32 patients. When patients in whom the first procedure was unsuccessful were reinvestigated by the alternative technique, retrograde cholangiograms were obtained in 13 (81%) of 16, and percutaneous cholangiograms in 8 (73%) of 11. Thus, one or the other technique was successful in 54 (90%) of 60 patients. When the results were analyzed separately for extrahepatic (29 patients) or intrahepatic (31 patients) cholestasis, percutaneous cholangiography was successful in 95% of patients with extrahepatic cholestasis but in only 25% with intrahepatic cholestasis. Endoscopic retrograde cholangiography successded in 63% of patients with extrahepatic and 76% with intrahepatic causes of cholestasis. Complications occurred only in patients with extrahepatic cholestasis. Cholangitis and septicemia occurred in 1 patient after retrograde cholangiography and in 2 after the percutaneous technique. An intraperitoneal bile leak occurred in one other patient after percutaneous cholangiography. Percutaneous cholangiography with the narrow needle is a simple, inexpensive, and reliable method for demonstrating the biliary system and is usually successful when an extrahepatic cause of cholestasis is present. The occurrence of serious complications in patients with extrahepatic cholestasis, despite prophylactic antibiotics, makes provision for early surgery mandatory after both techniques.

Potassium status of patients with cirrhosis

Whole body potassium measurements were performed on 55 cirrhotic patients in different stages of the disease. They included 34 with alcoholic cirrhosis, 10 with cryptogenic cirrhosis, eight with chronic active hepatitis, and three with haemochromatosis. Serial measurements were carried out in 21 patients. The findings of this study indicate that: (1) the aetiology of the cirrhosis is important in determining the potassium status of cirrhotics, most alcoholics being depleted; (2) ascites and decompensation are usually associated with potassium depletion but compensated cirrhotics may also be depleted even when not receiving diuretics; (3) the initial potassium status, whether a cirrhotic be decompensated or not, is difficult to alter in the short term (six months). Marked changes in potassium status can occur in alcoholic patients studied over longer periods.

Infectious mononucleosis with jaundice, anaemia, and encephalopathy

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Failure of D- and L-thyroxine to protect cholesterol and oil fed cockerels against coronary atherogenesis

In cockerels, L-thyroxine was significantly more active biologically than an equivalent dose of D-thyroxine, or even four times the dose, as demonstrated by the effects on body weights, organ weights and comb index.

In cockerels fed an atherogenic diet, the plasma cholesterol concentrations in all the thyroxine-treated groups were significantly lower than in the control groups.

No consistent effect of D-thyroxine on thoracic aorta atherosclerosis was observed. However, L-thyroxine had some protective action in the one experiment done.

Despite suppression of hypercholester-olemia, no protection against coronary atherosclerosis was seen with the administration of either L- or D-thyroxine. In fact, with an increase in dose of D-thyroxine to 4 mg, there developed actually an increase in the percentage of coronary vessels showing atherosclerosis.

These observations confirm once again the importance of avoiding reliance exclusively on blood cholesterol levels when judging the effects of hormones on atherogenesis.

Influence of various dietary fats on hypercholesterolemia and atherogenesis in cockerels

When cockerels were given a cholesterol supplemented, fat-free, semi-synthetic diet as the basic ration, all oils and solid fats were atherogenic and caused elevated serum cholesterol levels. The degree of hypercholesterolemia and atherogenesis was related to fatty acid composition of the fat fed. Margarines were less atherogenic and less hypercholesterolemic than oils. The additives used in the preparation of margarine have some influence on maintaining lower cholesterol levels, but do not appear to have any significant effects on atherogenesis. The structural isomers formed during margarine manufacture may be responsible through an alteration of lipid metabolism.

Benefit from testosterone and hydrocortisone on coronary atherogenesis in cockerels on a low protein atherogenic diet

In the presence of high fat and high cholesterol in the diet, growing cockerels showed more marked hypercholesterolemia and atherosclerosis when their protein intake was low. Testosterone counteracted both the increased hypercholesterolemic and the enhanced atherogenic effects of a low protein diet. Hydrocortisone markedly aggravated the hypercholesterolemia in these cockerels but offered significant protection against coronary atherogenesis when associated with a low protein intake. When the dietary protein level is adequate neither testosterone nor hydrocortisone lowered coronary atherogenesis, despite modification of plasma cholesterol levels. Protein level in the diet must be considered in evaluating hormonal atherogenic effects.