Hepatoportal arteriovenous fistula: morphologic features studied after orthotopic liver transplantation.

A 51-year-old woman underwent orthotopic liver transplantation because of a small-duct primary sclerosing cholangitis associated with chronic ulcerative colitis and a hepatoportal arteriovenous fistula. Arteriograms before liver transplantation and specimen arteriograms revealed a convolution of arteries in the right hepatic lobe which communicated with a massively dilated and partly thrombosed portal vein branch. The lesion was probably the result of a previous liver biopsy.

A novel method for the analysis of platelet-activating factor: direct derivatization of glycerophospholipids.

A novel, facile, and sensitive method for the quantitative and complete structure-proof analysis of platelet-activating factor (PAF) and other glycerophospholipids is described. 1-O-Alkyl/acyl-2-acyl-3-glycerophospholipids were treated with heptafluorobutyric anhydride in a one-step reaction to yield 1-O-alkyl/acyl-2-acyl-3-heptafluorobutyroyl-sn-glycerols as gas-liquid chromatography (GLC)-compatible derivatives. Furthermore, the components of the polar head group were also analyzed from the aqueous extract of the same reaction mixture as t-butyldimethylsilyl derivatives.

Classification and terminology of hepatic allograft rejection: whither bound?

The current classification of hepatic allograft rejection recognizes "acute rejection" and "chronic rejection." Although these terms convey duration, implicitly they have been defined on the basis of their morphologic manifestations. This usage causes contradictions in reports and publications because features of "chronic rejection" may occur acutely and vice versa.

Rapid shell vial culture and tissue histology compared with serology for the rapid diagnosis of cytomegalovirus infection in liver transplantation.

Sixty-six patients who had undergone 78 liver transplantations, with no detectable cytomegalovirus (CMV) infection before transplantation, were studied to assess the value of CMV serology compared with the rapid detection of the virus in shell vial cell cultures or histology for the diagnosis of (1) the first evidence of infection, (2) symptomatic disease, and (3) asymptomatic infection. Of 28 evaluable patients, shell vial cell culture assay and histologic findings provided the first evidence of CMV infection earlier in 22 (79%) or at the same time as the serologic response in 5 (18%). Serologic results yielded the first indication of CMV infection in only 1 of these 28 patients (3%).

Endotheliitis in hepatic allografts.

Endotheliitis (EN) is a feature of hepatic allograft rejection, characterized by the adherence of immunocytes to the endothelium of veins, often leading to endothelial damage, endophlebitis, and, sometimes, panphlebitis. We found EN at least once in 28 of 41 allografts (68%) that had survived 6 months or longer. In approximately half the affected cases, the condition recurred.

Acute hepatic failure: the emerging role of orthotopic liver transplantation.

From 1985 through 1987, we diagnosed acute hepatic failure in 13 patients. Spontaneous recovery occurred in three of these patients. Eight patients underwent liver transplantation, five of whom survived and three of whom died.

Effect of proctocolectomy for chronic ulcerative colitis on the natural history of primary sclerosing cholangitis.

The effect of proctocolectomy on the primary sclerosing cholangitis that frequently is associated with chronic ulcerative colitis in patients with both conditions is unknown. We have studied prospectively the progression of clinical, biochemical, cholangiographic, and hepatic histologic features in 45 patients with both primary sclerosing cholangitis and chronic ulcerative colitis to compare these variables in the 20 patients who had undergone proctocolectomy with the 25 who had not. The two groups were similar initially with regard to clinical, biochemical, cholangiographic, and hepatic histologic findings.

The nature of unexplained chronic aminotransferase elevations of a mild to moderate degree in asymptomatic patients.

To determine the nature of unexplained chronic serum aspartate aminotransferase elevations of a mild to moderate degree in asymptomatic patients, we performed systematic clinical, biochemical and histologic examinations in 47 individuals who had been screened for virus-, alcohol- or drug-related disease. Serum aspartate aminotransferase levels ranged from 3- to 8-fold normal (mean: 156 +/- 7 units per liter) for at least 6 months (mean: 30 +/- 6 months). Serum alanine aminotransferase levels were also increased but to a lesser degree in most patients.

Floxuridine-induced sclerosing cholangitis: an ischemic cholangiopathy?

A 43-year-old man underwent abdominoperineal resection of a rectal adenocarcinoma, and left hepatic lobectomy for a single metastasis. He then received hepatic artery infusions of floxuridine. The tumor did not recur, but sclerosing cholangitis and liver failure developed which necessitated orthotopic liver transplantation.

Surgical pathology of the syndrome of primary sclerosing cholangitis.

The diagnosis of primary sclerosing cholangitis (PSC) is based on the characteristic cholangiographic manifestations of the condition. Surgical biopsy specimens from extrahepatic bile ducts are not diagnostic. They should be obtained only if the presence of bile duct carcinoma must be ruled out.

Clinically unsuspected complications of arterial surgery shown by post-operative digital subtraction angiography.

Intravenous digital subtraction angiography was performed within 20 days of 678 vascular reconstructions as a routine post-operative evaluation. After 339 carotid endarterectomies, 34 patients showed a stenosis of greater than 30% and six occlusions were seen. In 157 patients after aortic aneurysm repair, we found five anastomotic aneurysms and seven stenoses of greater than 30%.

The first 100 liver transplantations at the Mayo Clinic.

Between March 1985 and June 1987, the first 100 liver transplantations at the Mayo Clinic were performed in 83 patients (primarily adults). The most frequent diagnoses were chronic active hepatitis (in 24 patients), primary sclerosing cholangitis (in 22), and primary biliary cirrhosis (in 20). The median operating time was 406 minutes, and the median usage of erythrocytes was 13.

Haemodynamics as a determinant of the pharmacokinetics of and the plasma catecholamine responses to isoprenaline.

The total body clearance and fractional extraction of isoprenaline (ISO) have been determined, and the relation between these parameters and cardiac output established. Whether desipramine, an inhibitor of neuronal uptake, altered the plasma catecholamine response to ISO was also investigated. Seven healthy subjects were given i.

Cloning and high level expression of a chimeric antibody with specificity for human carcinoembryonic antigen.

A mouse/human chimeric antibody has been constructed by using variable light and variable heavy regions from a murine hybridoma specific for human carcinoembryonic antigen (CEA) (CEM231.6.7).

Ultrasonic duplex scanning of the prevertebral segment of the vertebral artery in patients with cerebral atherosclerosis.

A routine duplex investigation of the prevertebral segment of the vertebral artery was carried out in 2814 consecutive patients who were suspected for extracranial cerebral atherosclerosis. Depending on local anatomical properties duplex scanning failed to make a decision about the state of the ostium of the vertebral artery in 24% of the cases. This occurred in approximately three quarters of the cases on the left side.

Prospective trial of penicillamine in primary sclerosing cholangitis.

We evaluated the therapeutic efficacy of penicillamine in primary sclerosing cholangitis. In a randomized, prospective, double-blind trial, 39 patients received penicillamine (250 mg t.i.

Idiopathic adulthood ductopenia. A cause of chronic cholestatic liver disease and biliary cirrhosis.

We describe three adult patients who had chronic cholestatic liver disease associated with unexplained loss of interlobular bile ducts; two of these patients eventually required orthotopic liver transplantation. We have named this condition 'idiopathic adulthood ductopenia' because (1) the etiology is unknown, (2) the age of the patients may be the only distinguishing feature between this newly described condition and neonatal or infantile nonsyndromatic paucity of intrahepatic bile ducts, and (3) morphologic demonstration of ductopenia is an indispensable finding. Our three patients, all males, had a negative drug history, absence of antimitochondrial antibodies, normal cholangiographic findings, and no evidence of inflammatory bowel disease.

Features reflective of early prognosis in corticosteroid-treated severe autoimmune chronic active hepatitis.

To identify features reflective of early prognosis in corticosteroid-treated severe autoimmune chronic active hepatitis, we compared the initial findings and immediate biochemical response of 5 patients who died soon after institution of corticosteroid therapy (mean survival, 2.5 +/- 0.7 mo) with those of 108 patients who survived for at least 6 mo after comparable therapy (mean survival, 94 +/- 6 mo).

Clinical and statistical analyses of new and evolving therapies for primary biliary cirrhosis.

Primary biliary cirrhosis is a chronic, progressive, cholestatic liver disease thought to be related to abnormalities in immune regulation. The disease is associated with granulomatous bile duct destruction, cholestasis, hepatic copper overloading and the development of hepatic fibrosis or cirrhosis or both. There have been numerous therapeutic trials evaluating immunosuppressive, antifibrotic and cupruretic agents.

Gallbladder disease in patients with primary sclerosing cholangitis.

We evaluated the gallbladders of 121 patients who had well-documented primary sclerosing cholangitis. Sonograms, cholangiograms, and CT scans were reviewed, and the findings were correlated with surgical or autopsy findings, when available. Pathologic examination of the gallbladder was available in 55 (45%) of the 121 patients; of these, 49 (89%) had abnormal gallbladders.

Frequency and significance of immunoglobulin M antibody to hepatitis B core antigen in corticosteroid-treated severe chronic active hepatitis B.

To assess the frequency and significance of immunoglobulin M (IgM) antibody to hepatitis B core antigen (anti-HBc) in corticosteroid-treated severe chronic active hepatitis B, we tested 96 serum samples from 16 patients who were seropositive for hepatitis B surface antigen (HBsAg) (group 1) and 8 HBsAg-negative, anti-HBc-positive patients (group 2) by enzyme-linked immunoassay. Samples obtained in the presence and absence of disease activity before, during, and after long-term corticosteroid therapy (mean duration, 42 +/- 7 months) were evaluated. Seropositivity for IgM antibody was demonstrated in 12 group 1 patients, including 9 tested before corticosteroid therapy; no group 2 patients were seropositive.

Benefits of carotid patching: a randomized study.

Advocates of carotid artery patching claim a reduced incidence of recurrent stenosis after endarterectomy. A prospective study was undertaken to determine its value with random selection between primary closure and saphenous vein patching. A consecutive series of 129 carotid endarterectomies was evaluated by duplex scanning at 3, 6, and 12 months after operation.