[Evaluation of the aging change in cardiac autonomic nervous system by automated clinical measurement]

The object of this study was to establish normal values for age of clinical tests of autonomic nervous system activity based on an automatic measuring system. Ninety-seven subjects (50 M/47 F) aged 20 to 85 years (average 45 +/- 13 years) with a normal clinical examination and no medication were included in the study. The blood pressure (BP) and heart rate (HR) were measured continuously with the Finapres system. After a resting period, the BP and HR were measured continuously in 5 different situations: dorsal decubitus position for 7 minutes; on getting up actively in less than 3 seconds and for 9 minutes in the upright positions, during deep breathing at 6c/min and Valsalva manoeuvre during a handgrip test at 30% of maximal voluntary strength for 3 minutes. A specific programme (ISN-CNRS) initiated the calculations of the test and performed direct and crossed spectral analysis in the lying and standing positions. The average BP was 120 +/- 18/66 +/- 11 mmHg and HR was 67 +/- 9 b/min. A negative linear correlation was observed with age with respect to the 3 tests investigating vagal activity: 30/15 ratio, spontaneous variations of respiration and HR, ratio of HR at the end of Valsalva with r = -0.43, r = -0.60, r = -0.34 (p < 0.001). The other two tests: variation of systolic BP 1 min 30 after standing and variation of diastolic BP during the handgrip did not change with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphological aspects of early and late collagen degradation in granulation tissue

A sequential histologic, ultrastructural and immuno pathologic study was carried out in the Selye's inflammatory pouch model to observe extracellular matrix and cellular changes during granulation tissue formation. Besides changes involving different components of the connective tissue, it was observed that collagen resorption occurred under a biphasic process. At an early phase (3rd to 15th day), in which exudative inflammatory changes predominated, signs of collagen synthesis and degradation were seen simultaneously. Extracellular breakdown and internalization of collagen fragments within fibroblasts and myofibroblasts were observed. Later on (30th to 60th day), changes affecting collagen had a different ultrastructural appearance. Collagen fragmentation, focal "lytic" and "electron dense" changes occurred in the extracellular space specially at the periphery of fibroblasts, myofibroblasts and smooth muscle cells. Collagen degradation, thus seems to be a continuous process in granulation tissue, occurring with different morphologies at different times.

Cell populations in the lesion of human cutaneous leishmaniasis: a light microscopical, immunohistochemical and ultrastructural study

To characterize the in situ cellular immune response in localized cutaneous leishmaniasis (LCL), the authors studied frozen skin biopsies from 50 patients with LCL due to Leishmania braziliensis guyanensis. A panel of 31 monoclonal antibodies was used, which defined the number and distribution of inflammatory cell subsets. Skin inflammatory infiltrates were composed of T cells (with a local CD4/CD8 ratio of 1.05 +/- 0.7 vs 1.48 +/- 0.3 in peripheral blood), macrophages and a smaller number of B cells, natural killer cells and granulocytes. Most of the T cells expressed activation markers (interleukin-2 and transferrin receptors, HLA-DR+) and an increase in T-cell-receptor gamma delta expression was noted. Analysis of the CD4+ subpopulations with newly available reagents showed that helper T cells (CD4+CD45RO+) exceeded the suppressor/inducer subset (CD4+CD45RA+) by 1.4:1. There were no differences between local immune variables from patients with primary infection (45 patients) and those with recurrence (5). In 7 patients, biopsies were analysed before and 1 month after specific treatment, and did not show significant differences except for a small increase of dermal CD1a+ (Langerhans) cells/mm2. The observed pattern of cellular skin infiltration suggests an immune-mediated tissue injury including T-cell-mediated cytotoxicity and delayed hypersensitivity reactions in addition to direct parasitic action.

Matrix remodelling and fibroblast phenotype in early lesions of human cutaneous leishmaniasis

The connective matrix participates directly in early pathological events observed in the cutaneous lesion of leishmaniasis, due to Leishmania braziliensis guyanensis. A sample of 19 skin biopsies was examined by light and electron microscopy, in order to identify the matrix components (collagen isotypes I to IV, elastin and membrane associated proteins) of the dermal infiltrate, and the pattern of organization of the reparative connective matrix. An extensive remodelling process of apparently parasite-independent nature involves different fibroblast sub-populations. The original organization of this immune-mediated lesion offers a rare opportunity to study in situ the local inflammatory mediators inducing the activation of fibroblasts and macrophages.

Comparison of 1 or 3 MU of interferon alfa-2b and placebo in patients with chronic non-A, non-B hepatitis

Ninety patients with histologically documented chronic non-A, non-B hepatitis were randomly allocated to receive SC injections of placebo or of 1 or 3 MU of recombinant interferon alfa-2b three times weekly for 24 weeks. Complete normalization of alanine aminotransferase levels occurred posttreatment in 43.3% of patients receiving 3 MU, in 20% of those receiving 1 MU, and in 6.7% of untreated patients (P less than 0.0005 vs. those treated with 3 MU). Alanine aminotransferase normalization was sustained for 6 months after therapy in 13.3% of the patients treated with 3 MU and in 3.3% of those given 1 MU or placebo. The decline of alanine aminotransferase levels following interferon therapy showed independent, positive correlations with female sex (P less than 0.03) and younger age (P less than 0.05). The Knodell's fibrosis score was strongly positively correlated with age (P less than 0.0001). It is concluded that 3 MU of interferon is a more effective dose than 1 MU for controlling disease activity in non-A, non-B chronic hepatitis patients. Women and younger and noncirrhotic patients are more likely to respond.

Azathioprine induced liver disease: nodular regenerative hyperplasia of the liver and perivenous fibrosis in a patient treated for multiple sclerosis

Azathioprine hepatotoxicity has been described mainly in renal transplant recipients. Most reported cases are related to lesions of the venous system of the liver: peliosis hepatis, veno-occlusive disease of the liver, perisinusoidal fibrosis, and nodular regenerative hyperplasia of the liver. The most common clinical manifestation of these hepatic vascular lesions is portal hypertension. We present a case of nodular regenerative hyperplasia and perivenous fibrosis in a patient receiving azathioprine for multiple sclerosis. Histological abnormalities were similar to those described in renal transplant patients, and azathioprine was the only potential hepatotoxic agent present.

Expression of HLA antigens and T cell infiltrates in chronic viral hepatitis. A comparison of biopsy and fine-needle aspiration findings

To evaluate the expression of hepatocyte HLA Class I and II antigens and the infiltration of CD8-positive lymphocytes in patients with chronic hepatitis, cells obtained by the technique of fine-needle aspiration were compared with those obtained by percutaneous liver biopsy. In general, correlation between cytological and histological specimens of HLA Class I and Class II antigen expression and CD8 lymphocyte infiltration was excellent when comparing results of the core biopsy expressed semiquantitatively, and results from fine-needle aspiration quantitatively as percentage of cells stained. Although the major potential of multiple fine-needle aspiration sampling probably will be in the surveillance of patients who have received orthotopic liver transplants, the results of this study indicate that fine-needle aspiration can provide a useful technique for following antigen expression and inflammatory changes in studies in which frequent periodic samples may be necessary to monitor efficacy or toxicity of treatment regimens.

Elastin in human, baboon, and mouse liver: an immunohistochemical and immunoelectron microscopic study

Light microscope histochemistry and immunohistochemistry, and routine electron microscopy techniques were performed to analyse elastin distribution and structure in the human liver compared with that in baboon and mouse. In man and baboon, elastic fibers stained by iron hematoxylin or orcinolnew fuchsin seemed to be solitary and were few in number; in the mouse they were thinner but abundant, both in the portal tract and in hepatic veins. Orcein or resorcin-fuchsin stains, employed after oxidation of tissue sections, revealed a network comprising elastic, elaunin, and oxytalan fibers, which was also demonstrated by immunofluorescence with anti-elastin antibody in man and baboon. At the ultrastructural level, the elastic fibers of the human portal tract corresponded to discontinuous patches of amorphous material intermingled with few microfibrils. These contrasted with the thinner elastic fibers of baboon and mouse liver which had a core of amorphous material. In man and baboon, these fibers meshed into slender bundles of microfibrils often exhibiting small spots of amorphous material (elaunin fibers) and terminated as isolated microfibrils (oxytalan fibers). Immunoelectron microscopy of elastin carried out on baboon liver tissue labelled the amorphous material and also its microfibrillar component. Immunoperoxidase deposits were also associated with isolated bundles of microfibrils in the baboon portal stroma. Immunolabelling and elastic stains disclosed an important elastin portal network located around vascular, biliary structures and interspaced with collagen bundles. The structural polymorphism of elastin, assembling different relative amounts of amorphous material and microfibrils, might have a relationship with the required elasticity in a given species.

Elastin in alcoholic liver disease. An immunohistochemical and immunoelectron microscopic study

Increased elastic stained material has been described in fibrotic and cirrhotic liver processes. The aim of this work was to follow the development and distribution of elastic fibers from 48 chronic alcoholic patients. Patients were scored for fibrosis as 0, without fibrosis or minimal (n = 5); 1, incipient or early fibrosis (n = 9); 2, fibrosis or incomplete cirrhosis (n = 12); and 3, cirrhosis (n = 22). Elastica staining was performed by orcein, resorcin-fuchsin and iron hematoxylin and confirmed by immunofluorescence staining with an anti-human elastin antibody (Institut Pasteur). Electron microscopy of representative cases of each group and electron microscopy of immunolabelled elastin (n = 5) were also performed. In early alcoholic fibrosis, oxytalan fibers were pointed out in terminal hepatic veins and in Disse space. In fibrous portal extensions and cirrhotic internodular septa, oxytalan and elaunin fibers represented the major elastin components in association with the alcoholic liver fibroplasia. Immunostaining with anti-elastin Ab exhibits the same distribution as with histochemical methods in portal and septal zones. Electron microscopy confirmed abundant microfibrillar bundles between collagen fibers that mesh and are in continuity with elaunin fibers. Immunoelectron microscopy confirmed elastin deposits in the amorphous material and in association with the microfibrillar material in the portal and septal zones and disclosed elastin even in the thin strands of fibrotic tissue. In conclusion, elastogenesis, mainly represented by oxytalan and elaunin fibers, develops in alcoholic disease and takes part, with collagen deposits, in the fibrotic process.

Morphometry of terminal hepatic veins. 1. Comparative study in man and baboon

In the present study, hepatic venous distribution per unit of liver surface area on normal wedge biopsies from man (n = 11) and baboon (n = 8) were analysed and compared. Terminal hepatic veins (THV - man: n = 100; baboon: n = 200) morphometric size variables were obtained with a Leitz ASM 68K morphometric equipment. THV, defined as hepatic veins up to 150 microns in internal diameter (ID), in the centrolobular position and with sinusoidal openings, represented 84% and 74% of hepatic veins of man and baboon, respectively. Four or more THV were generally found on 8 mm2 of liver surface. Transversely sectioned THV selected by the ratio IDminimum/IDmaximum greater than 0.67, was found to be only 25% of the total THV. In baboon, THV merge with other terminal veins and the interlobular veins present sinusoidal inlets. The baboon THV wall surface (WS) and wall thickness (WT) values were higher than in man. Positive correlations between the number of mesenchymal cells (Mc) in the vein wall and wall surface of terminal hepatic veins (man: r = 0.79; baboon: r = 0.83) and between wall surface and internal surface (IS) (man: r = 0.80; baboon: r = 0.72) were found. Two ratios were selected as the most reliable parameters: (1) for the THV wall rim, wall surface/internal surface (WS/IS - man: 0.43 +/- 0.16; baboon: 0.63 +/- 0.23), regarding transversely sectioned THV; and (2) for the evaluation of wall cell density (WS/Mc-man: 550 +/- 231; baboon: 558 +/- 183 micron 2/cell) as they did not depend on THV caliber.

Morphometry of terminal hepatic veins. 2. Follow up in chronically alcohol-fed baboons

Alcohol induced perivenular fibrosis of terminal hepatic veins (THV) is claimed to be a precursor lesion leading to fibrosis development in man and baboon. The nature and significance of the THV lesions found in four baboons chronically fed with alcohol were studied in liver biopsies obtained during a three year period. The surface of THV wall and the number of mesenchymal cells were assessed with a semi-automatic image analyser. Histologically, THV were characterized as (a) phlebitic, in the presence of an inflammatory cell infiltrate involving the venous wall; (b) oedematous, when the connective tissue of the THV wall was disrupted or dissociated and (c) fibrotic, when perivenular scarring appeared as an increased rim. These lesions were present simultaneously and their intensity and distribution were independent of the duration of alcohol intoxication. Morphometric data obtained from these THV confirmed the thickening of the THV wall (WS/IS in: oedematous 1.05 +/- 0.36; phlebitic 1.65 +/- 1.04; fibrotic 1.47 +/- 0.36); and revealed an increased number of mesenchymal cells in fibrotic (439 microns 2/cell; p less than 0.01) and in phlebitic THV (510 microns 2/cell; p less than 0.05). A constant relationship was found between phlebitis and the presence of inflammatory infiltrate within the hepatic acini. Fibrotic THV was a less frequent finding and the lesion disappeared in the sequential biopsies of one of the baboons. In conclusion, THV lesions were heterogeneous and the collagen deposition in the THV wall was potentially reversible during the three year alcohol intoxication period, regardless the inflammatory reaction and, thus, did not indicate early irreversible hapatic fibrosis.

Immunohistochemical micromethods for the measurement of specific collagen types in human liver biopsies

Micromethods are needed for measuring the amount of collagen and other matricial proteins in human liver biopsies. Recently, a colorimetric method for the quantitative estimation of total collagen and protein has been developed. This method is sensitive, can be applied to fresh and fixed tissues and provides the absolute value of total collagen per section. Results are expressed as microgram of collagen per mg of proteins or per section. We now report two micromethods for the determination of specific collagen types in fresh frozen liver sections. The first method is a direct method utilizing the tissue section as an ELISA plate. Results are expressed as the amount of color reaction read at 450 nm per slide. After cleaving the antigen antibody complex with dilute acetic acid, the amount of total collagen can be measured by the colorimetric microchemical method and the amount of specific collagen type is expressed as the amount of color reaction per microgram of total collagen. The second method is an indirect method: the floating tissue section is incubated with an optimal amount of specific anti-collagen antibody and the residual amount of antibody present in the supernatant is measured in an ELISA plate coated with the specific collagen type. The amount of specific collagen type present in the tissue section is determined by comparing the optical deviation obtained with a standard curve prepared with known amounts of specific collagen, and values are expressed as microgram of collagen per tissue sections. As with the direct method, the amount of total collagen per section can be measured by the colorimetric method and then, the amount of specific collagen type can be expressed as microgram of specific collagen type per microgram of total collagen.

[Vidarabine treatment of chronic active hepatitis associated with hepatitis B virus multiplication. A randomized multicenter study]

A randomized controlled study of one course of vidarabin was carried out in 30 patients with HBs Ag, HBe Ag, DNAp, positive chronic active hepatitis: 15 patients were treated with vidarabin given intravenously (15 mg/kg/day for 7 days then 7.5 mg/kg/day for 14 days); the other 15 patients received a placebo for 21 days. During treatment, DNA polymerase activity fell dramatically in 13 treated patients and in no controls (p less than 0.001). Six months after inclusion, ALT normalization was observed in 40 p. 100 of the treated patients and 6 p. 100 of the controls (p less than 0.05), a decrease in inflammatory activity on liver biopsies was observed in 70 p. 100 of the treated patients and 20 p. 100 of the controls (p less than 0.05), a permanent lost of DNA polymerase and of HBe Ag occurred in 33 p. 100 and 13 p. 100 of the treated patients and 20 p. 100 and 7 p. 100 of the controls, respectively. In addition, a second course of vidarabin was administered to the 12 patients who were still HBe Ag positive 6 months after the first course. During the next 6 months, 8 patients lost DNA polymerase and 4 lost HBe Ag. Altogether, the final score of durable inhibition of HBV replication was 11/15 (73 p. 100) within one year. The above results demonstrate that one course of vidarabin can significantly improve ALT and liver inflammatory activity but the effect upon HBV replication is only transient. A second course does however increase efficacy on HBV replication without additional side effects.

Human extrahepatic biliary atresia: portal connective tissue activation related to ductular proliferation

Surgical bile flow restoration in extrahepatic biliary atresia (EHBA) does not prevent the development of ongoing hepatic fibrosis and cirrhosis. Portal connective matrix was studied on liver biopsies obtained from seven children submitted to portoenterostomy. Electron microscopy and immunohistochemical techniques (using specific antibodies directed against collagen isotypes and associated glycoproteins) were performed. The study of extracellular and cellular components of connective matrix demonstrated the existence of two distinct areas according to their situation with regard to ductular proliferation: loose connective matrix--mainly composed of fibronectin, type III collagen, type IV collagen and laminin--associated with microvessels and myofibroblasts proliferation characterized periportal zones adjacent to bile ductules; in areas distant from ductular proliferation, connective matrix appeared dense, composed of type I and type III collagen associated with fibroblasts. The connective matrix pattern observed in periductular areas can be compared to that described in cicatricial and hypertrophic processes where the myofibroblastic cell population is known to play an important role in fibrosis development. Although the connective matrix activation process remains unclear in EHBA, it may be suggested that activation of a connective tissue cellular clone might be responsible for this portal fibromatosis.

Therapeutic potential of acyclovir and of the interferons in HBV-related chronic active hepatitis due to HBV with or without HDV superinfection

Acyclovir only demonstrated activity in CAH patients with low HBV replication (DNA-p less than or equal to 80 cpm). In those, oral acyclovir 4 g/day for 4 months was able to permanently inhibit DNA-p in 5/5 cases without significant side-effects.

Therapeutic activity of vidarabine in symptomatic chronic active hepatitis related to HBV

The potential inhibitory effects of nucleoside analogues such as ARA-A and acyclovir on HBV-DNA-polymerase were first demonstrated in vitro and then confirmed in vivo in open dose finding studies. The therapeutic efficacy of both ARA-A and ARA-AMP which appeared the most potent drugs was then confirmed by various studies in symptomatic HBeAg-positive patients. These studies demonstrated a similar benefit of therapy with 38 and 40% of treated patients given ARA-A and ARA-AMP, respectively, who permanently cleared HBV replication after a single course, and 67-80% who did so after two courses. Significant improvement in transaminases and histologic activity was also documented (P less than 0.001). Myalgias were observed in 10 and 30% of the patients, respectively. Patients who failed to respond to nucleosides, and those coinfected with HDV, were treated with interferons. Out of 8 cases of HDV/CAH given 5 MU thrice weekly of fibroblast beta-interferon (UPSA) for 3 months, DNA-p activity fell transiently in all 6 initially elevated cases. A parallel decrease in anti-HD titers (P less than or equal to 0.05), inflammation (P less than or equal to 0.001) and necrosis (P less than or equal to 0.05) were observed. alpha-Recombinant interferon was given i.m. for 4 months (2-7 MU/m2 X 2/7 days) to 10 CAH with high DNA-p values. HBV replication was permanently inhibited in 4 cases and dramatically reduced in 3 additional patients. Three failed to respond. Careful monitoring of DNA-p values appeared to be the single most important factor in assessing activity.