[Diagnosis of treated and untreated chronic-aggressive hepatitis]

A total of 121 patients with chronic active hepatitis (CAH) of two Zurich hospitals were controlled over a mean time of 5 years and 4 months. All patients of one hospital were consequently treated with corticosteroids and azathioprine, whereas those of the other hospital were not treated unless a severe deterioration occurred. In this case treatment was as short as possible. Results indicate that long - time treatment of CAH results in better prognosis than does no or short - time treatment. Death rate per observed patient - year was 0.079 in the no - therapy group, 0.035 in the short - therapy group and 0.025 in the long - time therapy group.

[Effects of the environment on the liver and gastrointestinal tract]

The liver has a central role in the detoxication and elimination of toxic substances which enter the body as lipid-soluble compounds. Their transformation into polar watersoluble metabolites, termed biotransformation, is bound to the membranes of the smooth endoplasmatic reticulum. The oxidating enzyme in biotransformation can be induced by certain toxins and drugs. The chronic induction of enzymes by DDT and the consequences of this process of adaptation, particularly in regard to the metabolism of calcium is discussed. The protective effect of biotransformation and induction of enzymes against carcinogens, especially aflatoxin, are briefly reviewed. As examples of the chronic influence of vasotoxic substances, mention is mode of the veno-occlusive disease caused by the alkaloid phlorrhizidin found in plants, and the vinyl-chloride disease occurring in workers handling PVC. The first leads to portal hypertension of the post-sinusoidal type, while the second leads to pre- or intrasinusoidal portal hypertension and, after years of exposure, to hemangioendotheliosarcoma of the liver. The same tumor has been observed after arsenic intoxication. Arsenic may also lead to non-cirrhotic portal hypertension. The present opinions about environmentally induced gastrointestinal diseases are widely hypothetical. The high frequency of gastric carcinoma in Japan. and the varying occurrence of carcinoma of the colon in the civilized world in comparison with the rural population of tropical regions, is emphasized. The explanation for these facts is probably to be sought in differences of nutrition.

Gastrointestinal involvement in systemic mastocytosis

Four consecutive patients with systemic mastocytosis were studied. One patient had a malabsorption syndrome with only minor histological changes of the intestinal mucosa. Another patient with ulcer diathesis had a gastric secretory pattern resembling Zollinger-Ellison syndrome. Serum gastrin and histamine levels were consistently normal in all patients. Endoscopy of stomach and colon disclosed urticaria-like papulae either spontaneously or after topical provocation in all patients. No increase of mast cells was found in multiple mucosal biopsies. A markedly increased gastric tissue content of histamine was found, however, in the three patients studied. The findings suggest that urticaria-like lesions associated with a high tissue content of histamine may be more important that hyperhistaminaemia in causing the various gastrointestinal symptoms.

[The diagnosis of liver metastases and primary hepatomas by means of scintigraphy, laparoscopy and laparotomy]

To evaluate the presence or absence of hepatic metastases or primary hepatoma 106 patients were examined by liver scintigram as well as laparoscopy or laparotomy. A definite diagnosis was established in all patients by histology, autopsy or observation of clinical course for at least one year. Only scintigrams resulted in false positive diagnosis (in 5%). False negative diagnoses were obtained in 29% of laparoscopies and in 36% of scintigrams when evaluated routinely with knowledge of the clinical findings and laboratory examinations. Analysis of the same scintigrams by an experienced examiner without knowledge of the clinical findings lowered the proportion of false negative scintigrams to 12%. In 5 patients with liver metastases or hepatoma coexisting in liver cirrhosis or advanced chronic liver congestion, both methods of examination gave false negative results.

[Pleural effusion: a symptom of acute and chronic hepatitis]

3 cases of acute and 2 of chronic aggressive hepatitis associated with pleural effusion are presented. Pleural effusion in this setting is a rarity and always occurs in the early phase of acute hepatitis or during exacerbations of chronic aggressive hepatitis. It disappears with normalization of liver function tests. The exudate is rich in protein (3-4 g %) and contains lymphocytes as well as erythrocytes. In 2 cases Australia-antigen (HBs) could be documented. An immunological mechanism is suggested.

[Changes in the blood picture in liver diseases]

The occurrence of hematologic changes has been studied in 256 patients with various liver diseases. Macrocytosis on smears and by MCV was found in 50% of acute and in over 70% of chronic liver diseases. MCV increased from 98 +/- 8 mu3 (acute hepatitis) up to 108 +/- 12 mu3 in alcoholic cirrhosis. Anemia, which occurred rarely in hepatitis but in 67% of cirrhosis, was always macrocytic, not correlating with reticulocyte counts. Target cells were found in 20% of acute hepatitis and 41% of cirrhosis. In patients with chronic liver disease target cells were associated with macrocytosis and increased bilirubin. Thrombocytopenia was found in 11% of acute, in 53% of chronic inflammatory and in over 60% of cirrhotic liver disease.

[Clinical aspects of carcinoma of the liver (author's transl)]

The incidence of epi-cirrhotic liver carcinoma is apparently on the increase. Between 1969 and 1973 there were 84 cases of primary liver carcinoma and 467 of cirrhosis among 10211 autopsies. In 74 (16%) the carcinoma had developed in a cirrhotic liver. Clincally the diagnosis of carcinoma had been made in only 14 cases. The mean survival time after the diagnosis was seven weeks, after onset of the terminal symptoms 13 weeks. Typical clinical features were decompensated, hypertrophic, often coarsely granular, liver cirrhosis. The best diagnostic method was apparently laproscopy and determination of alpha 1-fetoprotein and cholestatic enzymes.

Endometriosis of the lung: case report

The first case of a clinically and histologically verified miliary form of endometriosis of the lung is reported here. The cardinal symptom was a menstrually synchronised hemoptysis, which by treatment with high doses of progestins disappeared. After operative castration a complete remittence with normal chest X ray was attained. Pathogenesis and frequency were briefly described. The 11 previously published cases served as a basis. Taking into account experimental and clinical experience, we propound the opinion the endometriosis of the lung occurs via hematological spread as a result of uterine operations or pregnancy. The conditions under which endometrium survives in the lung remain uncertain. Large doses of gestagen drugs are to be recommended as therapy and should be this prove unsuccessful operative castration.

[Pancreatic carcinoma in chronic pancreatitis]

Chronic pancreatitis and carcinoma of the pancreas are being diagnosed with increasing frequency throughout the world. When both occur together, the question of their causal relationship arises. Secondary chronic pancreatitis following carcinoma of the pancreas is relatively frequent and can be proven histologically in at least 10% of pancreatic cancers. How often primary chronic pancreatitis develops into carcinoma is controversial. So far, there are only a few prospective clinical studies of chronic pancreatitis which cover this problem. We have followed 146 cases of chronic pancreatitis for an average of 8.7 years. Two thirds of our patients show pancreatic calcifications. Our series includes a family with congenital pancreatic insufficiency. So far only one adenocarcinoma of the head of the pancreas has been diagnosed in a 58-year-old male. Another 57-year-old male patient died from a solid metastatic carcinoma, probably of pancreatic origin. Therefore, the incidence of pancreatic cancer in our series is 0.7 and 1.4% respectively. However, 8 more patients suffering from extrapancreatic malignancies have turned up during the follow-up period: 2 cancers of the tongue, 2 colonic carcinomas, 2 bladder papillomas, and 1 bronchial and 1 gastric carcinoma. Our studies indicate that carcinoma of the pancreas probably does not occur more frequently in chronic non-hereditary pancreatitis than in the average population. A review of the literature suggests that there may be a higher incidence of carcinoma in families with hereditary chronic pancreatitis. The frequency of extrapancreatic cancer in our patients is remarkable. As pancreatic carcinoma is rare in chronic pancreatitis there is no reason for early aggressive surgery, e.g. pancreatectomy, in these patients.

HL-A phenotyping in an Indonesian population

The frequencies of 30 HL-A antigens were studied in an Indonesian population of 95 individuals from the city of Jakarta. The antigens HL-A9, or more precisely W24, and HL-A11 (first series) and W15 (second series) occurred with high frequencies, whereas HL-A8, W14 and W22 were completely absent. These results are consistent with previous reports of HL-A typing in South East Asian populations.

An automatic device for the isolated rabbit heart preparation for testing cardioactive drugs

An automatic device for the isolated rabbit heart is described. Test solutions are perfused from reservoirs via valves, the sequence and time of opening of which is controlled by a programmable unit. The perfusate was pushed through the heart at a constant flow-rate, with pressure measurement serving as an indicator of preparation stability. The system worked well giving reproducible results without tedious, repetitive manual work. The results obtained with caffeine were in line with those reported in the literature, there being a dose-dependent increase in rate and force of contraction.

Attraction between centric heterochromatin of human chromosomes

An analysis of the pattern of association of acrocentric chromosomes with nonacrocentric chromosomes in human lymphocyte metaphases was performed. This pattern in nonrandom with respect to chromosome length and intrachromosomal distribution. There is a general preference for the centric regions, most pronounced at the proximal segments of the long arms of chromosomes 1, 9, and 16, which is interpreted to reflect heterochromatin attraction during interphase. Comparison of the association patterns of homologous chromosome 1's differing with regard to the size of their heterochromatic regions corroborates this interpretation. The possible significance of heterochromatin attraction for the formation of spontaneous and induced chromosome anomalies is discused.

Biochemical and cytogenetic studies on the nucleolus organizing regions (NOR) of man. II. A family with the 15/21 translocation

The amount of ribosomal DNA (rDNA) was determined quantitatively by RNA-DNA hybridization in the genomes of a mother and her daughter, both with the karyotype 45,XX,t(15q21q). The saturation values found were 0.030% (mother), 0.023% (daughter), and 0.022% for the husband and father of the daughter. A detailed cytogenetic analysis of the short arms of the acrocentric chromosomes of these probands allowed the biochemical results to be interpreted in terms of the size of the individual set of nucleolus organizing regions (NORs) present in each proband. The correlation existing between the biochemical and the cytogenetic findings shows that the amount of rDNA in the human genome is not primarily a function of the number of acrocentric chromosomes, but depends on the individual combination of variant NORs occurring in the human genome.