Hyperglucagonaemia in cirrhosis. Relationship to hepatocellular damage.

Plasma glucagon and growth hormone concentrations were measured fasting and after oral glucose in 19 patients with portal vein block with extensive portal-systemic shunting but minimal liver cell damage, 11 cirrhotic patients and 12 matched control subjects. Portal vein block patients and controls had similar fasting glucose and glucagon levels (glucose 3.8 +/- 0.

Immune function in patients with extrahepatic portal venous obstruction and the effect of splenectomy.

Abnormalities of cell-mediated immunity-anergy to delayed hypersensitivity skin testing, diminished T-lymphocyte concentrations and mitogen responsiveness, and the presence of serum inhibitors--have been shown to be present in patients with portal venous obstruction and normal hepatic function. In contrast, tests of humoral immunity--antibody titiers to viral and bacterial antigens and immunoglobulin concentrations--were normal. These abnormalities in cell-mediated immunity are probably the result of the development of portal hypertension, portosystemic shunting, and congestive splenomegaly.

Triethylene tetramine dihydrochloride toxicity in primary biliary cirrhosis.

Triethylene tetramine dihydrochloride (trien) is a copper chelating agent used as the alternative drug of choice in the treatment of Wilson's disease. Because of its apparent safety, we have used the drug in 4 patients with primary biliary cirrhosis in whom penicillamine had to be withdrawn because of serious side effects. Trien is an effective cupruretic drug in primary biliary cirrhosis, but its use is limited by the occurrence of side effects that occurred in all 4 patients.

Primary biliary cirrhosis is a dry gland syndrome with features of chronic graft-versus-host disease.

Primary biliary cirrhosis (PBC) is part of a disease complex characterised by dry eyes, dry mouth, and both biliary and pancreatic hyposecretion: it is a "dry gland" syndrome resulting from damage to ductular epithelium. Additional extraglandular features include scleroderma-like skin lesions, pigmentation, Raynaud phenomenon and severe abnormalities of both humoral and cellular immunity. Identical ductular and extraductal features, including abnormalities of the immune system, are seen in chronic graft-versus-host disease after bone-marrow transplantation.

HLA-B8, immunoglobulins, and antibody responses in alcohol-related liver disease.

Ninety-two British, caucasian, alcoholic patients with liver disese were grouped on the basis of hepatic histology into fatty change, hepatitis with or without cirrhosis, and cirrhosis alone. Men with alcoholic hepatitis with or without cirrhosis showed an increased incidence of the histocompatibility antigen HLA-B8 (P less than 0.02).

Complement metabolism in chronic liver disease: catabolism of C1q in chronic active liver disease and primary biliary cirrhosis.

The fractional catabolic rate of C1q was increased markedly in primary biliary cirrhosis, and in HBsAg-positive chronic liver disease. In 3 out of 4 patients with HBSAg-negative chronic active liver disease C1q catabolism was normal. The rate of synthesis of the protein was increased in primary biliary cirrhosis, but it was normal in patients with chronic active liver disease.

A non-transferrin-bound serum iron in idiopathic hemochromatosis.

The nature of iron in the serum of patients with idiopathic hemochromatosis has been studied utilizing an isotope labeling method and results have been compared with those from normal individuals and patients with other forms of liver disease. Between 2 and 4% of a tracer dose of 59Fe added to normal serum was retained by DEAE Sephadex and has been designated non-transferrin-bound. Alcoholic liver disease, chronic active hepatitis, and iron deficiency have no effect on this fraction.

Hair copper in primary biliary cirrhosis.

Rats fed on a copper-enriched diet develop increased liver copper concentrations, which correlate well with hair copper content. It has been suggested that in man, hair copper analysis may be a useful noninvasive method for predicting liver copper concentrations. We have tested this hypothesis in 11 patients with primary biliary cirrhosis, a disease complicated by the accumulation of copper in the liver.

Chronic hepatitis.

Chronic persistent and chronic active hepatitis are defined and described as diseases of multiple aetiologies. The two major varieties, e g chronic active hepatitis, 'lupoid' and secondary to hepatitis B infection are described and contrasted.

Successful use of bromocriptine in the treatment of chronic hepatic encephalopathy.

Six patients with cirrhosis and severe chronic hepatic encephalopathy were treated with bromocriptine. All showed significant overall improvement clinically and in 3, the electroencephalogram became normal. The cerebral blood flow increased significantly from 32.

Treatment of chronic hepatitis.

Chronic persistent hepatitis is a benign condition and special treatment is not necessary. Chronic active hepatitis is usually treated with prednisolone. Hepatitis B positive patient's respond less well than those who are negative.

Focal nodular hyperplasia of the liver.

Focal nodular hyperplasia of the liver (FNH) in a fit young Iranian girl of 19 months presented with asymptomatic hepatomegaly. Liver scan and ultrasound examinations demonstrated a space-occupying lesion involving both hepatic lobes. Arteriography revealed a vascular pattern suggestive of liver cell carcinoma with dilated arterial branches and tumour blush on the capillary phase.

Pancreatic hypofunction in extrahepatic portal venous obstruction.

Pancreatic function was studied in 29 patients with extrahepatic portal venous obstruction, and 30 age-matched controls. The aetiology of the portal venous obstruction was known in 20 out of 29 patients. No patient had a history of pancreatitis.

Computed tomography for determining liver iron content in primary haemochromatosis.

Dual-energy computed tomography (CT) was used to estimate hepatic iron concentration in eight patients with primary haemochromatosis with varying degrees of iron overload. The values corresponded closely with these derived from chemical analysis of liver tissue obtained by biopsy (correlation coefficient 0.993).

Benign recurrent intrahepatic cholestasis: studies of bilirubin kinetics, bile acids, and cholangiography.

Three patients with benign recurrent intrahepatic cholestasis are described. They had had between five and 16 attacks of cholestasis. Between attacks the liver function tests, including serum bile acids, were normal.

Percutaneous transhepatic portography in the assessment of portal hypertension. Clinical correlations and comparison of radiographic techniques.

Sixty-four transhepatic portograms performed before transhepatic obliteration of varices in patients with variceal hemorrhage have been reviewed. Sixty-two patients had coronary gastroesophageal vessels feeding gastric and esophageal varices and other major collateral circulation was seen in 25 patients. There was no relationship between the presence of major collateral circulation and the height of portal pressure or the severity of hemorrhage from gastroesophageal varices.

Bile duct carcinoma: a late complication of congenital hepatic fibrosis. Case report and review of literature.

Bile duct carcinoma is reported in a 50-year old man as a rare late presentation of congenital hepatic fibrosis (CHF). A survey of the world literature suggests that carcinoma occurs with increased frequency in congenital biliary dilatation. It appears to be a particular risk in patients with prolonged survival but is rare in CHF, where portal hypertension and renal insufficiency make the long-term prognosis poor.

An epidemic of type B viral hepatitis: its course and outcome.

Between June and August, 1977 there was a small epidemic of type B viral hepatitis in a market town in South-East England during which 4 people developed acute hepatitis. Their close friends and contacts were all negative for hepatitis B surface antigen (HBsAg) at this time. One year later, in July 1978, 3 of the original 4 patients were available for follow-up.

Late results of the Royal Free Hospital prospective controlled trial of prednisolone therapy in hepatitis B surface antigen negative chronic active hepatitis.

A long-term follow-up of at least 10 years or until death of 44 patients taking part in a controlled prospective trial of prednisolone therapy in hepatitis B antigen negative chronic active hepatitis (lupoid hepatitis) has been performed at the Royal Free Hospital, London. Patients presenting between 1963 and 1967 were randomly allocated into control and treatment groups. Ten year life table survival curves showed a significantly improved survival in the treatment group where 63% of patients were alive at 10 years compared with only 27% in the control group (log rank test, P = 0.

Levamisole therapy for HBsAg-positive chronic liver disease.

Eight subjects with HBsAg-positive chronic liver disease received levamisole therapy continuously for 6 to 8 weeks. Depressed T-lymphocyte concentrations, found in all patients before therapy, transiently returned towards normal. All of the three patients who had normal delayed hypersensitivity responses before treatment showed an acute hepatitic reaction manifested by elevation of serum aspartate transaminase (AsT) and HBsAg levels, with transient cell-mediated immunity to HBsAg.

Viral antibody titres in HBs antigen-positive and -negative chronic active hepatitis.

A comparative study of antibody titres to nine common viruses has been carried out in hepatitis B surface (HBs) antigen-positive and -negative chronic active liver disease. The results show that increased titres of antibody to morbilli virus by complement fixation and to rubella by haemagglutination inhibition are found in HBs antigen-negative but not in HBs antigen-positive chronic active liver disease. There was a significant association of increased morbilli but not of rubella virus antibody titres with the presence of high-titre nuclear antibodies (ANA) but no association with smooth-muscle antibody or the presence of HLA-B8.

Non-surgical treatment of biliary obstruction.

Bileduct catheterisation percutaneously through the liver can be used in patients with obstructive jaundice as an adjunct or as an alternative to surgery. Preoperative drainage allows adequate treatment of severe cholangitis and reduces jaundice. Palliative drainage, whether internal or external, can be used instead of surgery.

Monomeric (7S) IgM in chronic liver disease.

Monomeric (7S) IgM was detected by polyacrylamide/agarose gell immunodiffusion and Sephadex G200 gel filtration in 33% of sera from patients with primary biliary cirrhosis (PBC) and 5% of patients with HBsAg-negative chronic active liver disease (CALD). It was not found in the sera of patients with extrahepatic cholestasis, alcoholic liver disease (ALD), HBsAg-positive CALD and normal control subjects. In the PBC group the presence of 7S IgM was associated with significantly higher IgM concentrations and Clq binding activity (P less than 0.

The aetiology, presentation and natural history of extra-hepatic portal venous obstruction.

Extra-hepatic obstruction of the portal vein is a well known cause of hypertension in childhood and 55 out of the 97 patients (57 per cent) seen with this condition presented before they were 15 years old. However, nearly half our cases (43 per cent) presented in adult life. Haematemesis was the commonest mode of presentation in both the adult and childhood group although splenomegaly was common, especially in the children.