Presence of alcoholic steatohepatitis, but no selective histological feature, indicates an increased risk of cirrhosis and premature death

OBJECTIVE

The prognostic impact of early stages of histologically confirmed alcoholic liver disease is uncertain. Our aim was to determine the risk of cirrhosis and premature death, and identify prognostic markers, in patients with biopsy-proven alcoholic steatohepatitis - and to compare prognosis in patients with alcoholic pure fatty liver and the general population.

MATERIAL AND METHODS

Patients with biopsy-proven alcoholic fatty liver disease diagnosed during 1976-1987 were identified. Data were collected from medical records, the Danish National Patient Registry and the Registry of Causes of Death. All biopsies were re-examined and morphological findings assessed. A reference cohort matched for age and gender was created. Cox proportional hazard models adjusted for age and gender were used to analyse differences in mortality and cirrhosis development, as well as the prognostic impact of histological and biochemical parameters.

RESULTS

Two hundred and twenty-five patients with fatty liver and 111 with steatohepatitis were followed for median 13 and 9.7 years, respectively. There was a significantly higher risk of developing cirrhosis amongst patients with steatohepatitis compared to both patients with fatty liver (p < 0.001) and the reference cohort (p < 0.001). Mortality was significantly higher in patients with steatohepatitis compared to patients with fatty liver (p = 0.046) and the general population (p < 0.001). No histological or biochemical parameters with prognostic significance for mortality were identified.

CONCLUSION

Presence of steatohepatitis indicates an increased risk of cirrhosis and premature death. However, none of the histological parameters defining steatohepatitis can independently identify patients at risk for premature death.

Low incidence of non-alcoholic steatohepatitis in a Danish liver unit

INTRODUCTION

Non-alcoholic fatty liver disease encompasses a spectrum of histological lesions ranging from steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. Simple steatosis is generally benign, while NASH can progress to severe liver disease. The aim of the present study was to quantify the number of patients with NASH and assess the prognosis associated with the condition in a large Danish referral centre for liver disease.

MATERIAL AND METHODS

Through the pathology archives at Hvidovre Hospital, 348 patients with steatohepatitis diagnosed during the 1976-1987-period were identified. Data were systematically collected by review of available medical records. These data were supplemented by data from the Danish National Hospital Registry and the Registry of Causes of Death.

RESULTS

A total of 100 patients referred from other hospitals were excluded as their records were missing and 236 patients were excluded, mainly due to a history of alcohol abuse; this left 14 patients to constitute the study population. At the end of the follow-up period which had a median duration of 16.7 years, ten of the patients had died: four of cardiovascular disease, four of extra-hepatic neoplasm and two of unknown causes. There were no liver-related deaths and only one patient developed cirrhosis.

CONCLUSION

In a specialised referral centre, only few patients were diagnosed with NASH 25-30 years ago and those who were identified had a low risk of progression to cirrhosis and premature death.

FUNDING

The local research council and the foundation for the study of liver diseases at Hvidovre Hospital provided funding for this study.

TRIAL REGISTRATION

not relevant.

Subcutaneous lesions and bacteraemia due to Stenotrophomonas maltophilia in three leukaemic patients with neutropenia

Subcutaneous lesions were seen in three of 13 neutropenia patients who had Stenotrophomonas (Xanthomonas) maltophilia bacteraemia. The characteristic clinical presentation resembled leukaemic infiltrates, and were different from deep ulcers or subcutaneous nodules caused by Pseudomonas aeruginosa. The three patients had acute leukaemia and were treated with intensive combination chemotherapy. All had previously been treated with broad-spectrum antibiotics, and each patient recovered after proper combination antibiotic treatment given according to sensitivity testing.

Trichinella infection and clinical disease

Trichinellosis is caused by ingestion of insufficiently cooked meat contaminated with infective larvae of Trichinella species. The clinical course is highly variable, ranging from no apparent infection to severe and even fatal disease. We report two illustrative cases of trichinellosis. Returning to Denmark a few days after having eaten roasted pork in the Republic of Serbia, a female patient suffered from severe vomiting, epigastric pain, diarrhoea, and later myalgia, arthralgia, generalized oedema, and prostration. A biopsy showed heavy infestation with Trichinella spiralis, 2000 larvae/g of muscle. Life-threatening cardiopulmonary, renal and central nervous system complications developed. The patient recovered after several months. Her husband, who also ate the pork, did not have clinical symptoms, but an increased eosinophil count and a single larva in a muscle biopsy confirmed infection. The epidemiology, clinical manifestations, diagnosis, treatment and prevention of trichinellosis are reviewed.

Morphometric studies on treated and untreated heterotransplanted malignant tumours

Short-term therapy effects on heterotransplanted tumours are important to know in order to study the action of anticancer treatment. They are, however, difficult to assess due to interference from such factors as edema, vascular swelling and necrosis. Non-invasive methods such as NMR can be of some use, but the applicability is limited since background noise from the host animal organism may confound measurements. We studied a series of Cisplatine-treated bladder carcinomas heterotransplanted to nude mice and their untreated controls in order to illustrate short-term chemotherapy effect. We applied simple unbiased morphometric methods on formalin-fixed and paraffin-embedded material in order to obtain an unbiased estimate of the volume of the whole tumour and the volume of vital tumour tissue on day 1 and day 3 after treatment, at which time no gross changes in tumour size were evident. Furthermore, we estimated the number of tumour cells in the tumours. The estimate was based on measurement of the mean nuclear volume and the nuclear volume fraction in combination with the measured volume of vital tissue in the tumour. The pronounced therapy effects seen in this experimental system may be of potential interest in monitoring effects at the clinic.

Oestrogen receptor investigations in bladder tumours

Transitional cell tumours of the bladder in 12 men and 12 women were investigated for oestrogen receptors. All tumours and surrounding urothelium were found to be receptor-negative.

Interferon alpha-2b treatment of symptomatic chronic vulvodynia associated with koilocytosis

In an open study with identical criteria for diagnosis, 16 female patients with typical symptoms of chronic vulvodynia associated with acetowhitening of the vestibular epithelium and koilocytosis in biopsy specimens received recombinant interferon alpha-2b 5 MIU intralesionally 3 times weekly for 3 weeks or subcutaneously 3 times weekly for 8 weeks. Three months after end of therapy, clinical symptoms had disappeared in 7 (70%) of the 10 patients treated intralesionally, compared with only one (16%) of the 6 patients treated subcutaneously. In addition, the last 3 (30%) patients in the first group had a partial response to therapy. The acetowhitening persisted in all patients. The koilocytosis remained unchanged in 13 (81%) of the 16 patients. Our results indicate that recombinant interferon alpha-2b administered intralesionally seems to be efficacious in reducing clinical symptoms in vulvodynia with suspected human papillomavirus infection but does not eliminate the infection. Subcutaneous administration had neither symptomatic nor antiviral effect. A placebo-controlled study is needed, but with our present knowledge we recommend intralesionally administered interferon as a symptomatic treatment of vulvodynia.

In vivo 31P magnetic resonance spectroscopy and 1H magnetic resonance imaging of human bladder carcinoma on nude mice: effects of tumour growth and treatment with cis-dichloro-diamine platinum

In vivo 31P NMR spectroscopy and 1H NMR imaging were used to examine the bladder T24B carcinoma in nude mice during untreated growth and in response to chemotherapy by Cis-dichloro-diammine-platinum (CDDP) at a dose of 8 mg/kg i.p. Untreated growth was associated with an increase of inorganic phosphate and phosphomonoesters and a decrease of phosphocreatine. Fast growing tumours and early stage of regrowth after treatment presented a higher phosphocreatine/beta NTP ratio. Following CDDP treatment, 31P metabolite ratios and pH were significantly altered compared with age-matched controls, as early as 6 hours after treatment. Although necrotic area was clearly visible in MRI, no treatment effect could be detected on the images of treated tumours.

Comparative studies between nude and scid mice on the growth and metastatic behavior of xenografted human tumors

The growth and metastatic behavior of three human tumor cell lines and a human colon carcinoma previously passaged in vivo were compared between nude mice and scid mice after xenotransplantation. The three human tumor lines included a bladder carcinoma (T24B), a melanoma (RPMI 7931) and a lacZ gene-transduced breast cancer (MDA-MB-435 BAG). The lacZ gene codes for beta-galactosidase, which can be stained blue with chromogenic substrate X-gal, thus allowing the highly sensitive detection and quantitative examination of human cancer metastasis in host mice. Adult (7-14 weeks) NMRI nude and C.B-17 SCID mice were inoculated with 0.5-5 x 10(6) tumor cells s.c. Comparable take rate, latent period and growth rate of implanted tumors were observed in nude and scid mice for each of the cell lines tested. At the time of autopsy, which varied from 6 to 11 weeks after inoculation, a significantly higher incidence of spontaneous lung metastasis was discovered in scid mice (96%) than in age-matched nude mice (27%, total P less than 0.001). In vitro assays for NK cell-mediated cytotoxicity revealed no significant differences between the two strains of mice. Our results suggest that nude and scid mice are equally suitable for propagating human tumors. However, the metastatic capacity of human tumor cells appears to be better expressed in scid mice. Scid mice may therefore provide an advantageous model for the study of human tumor metastasis.