Pharmacokinetics of trapidil in patients with chronic liver disease.

The pharmacokinetics of trapidil were studied in 15 patients with chronic liver disease (12 with hepatic cirrhosis, 2 with alcoholic fatty liver, 1 with liver fibrosis). Trapidil was administered intravenously as a 100-mg bolus. Serum samples were analyzed for trapidil by means of high-performance liquid chromatography.

[Palliative endoscopic treatment of malignant occlusive jaundice with a balloon expandable metal stent].

Balloon-expandable Strecker-stents were endoscopically inserted in 13 patients (8 females, 5 men; mean age 75.2 [55-99] years) suffering from malignant obstructive jaundice. The stent implantation was difficult in one patient because of trouble to retract the balloon carrying the stent.

[Endoscopic sclerosing of esophageal varices--technique, possibilities and limits of the method].

The paper intends to give a survey of the significance of endoscopic sclerotherapy in gastro-esophageal varices. The control of an acute bleeding can be achieved in a high percentage (70-95%). However, the hospital mortality has persisted in 30% depending on early rebleeding episodes and alterations in hepatic function.

[Portal hypertensive gastropathy--a rare cause of upper gastrointestinal hemorrhage].

There is evidence that the portal-hypertensive gastropathy is a clinical complication of portal hypertension and a distinct clinical entity being different from various types of gastritis. According to endoscopical findings one can differentiate 4 stages: I = superficial reddening on the surface of the gastric rugae, II = white reticular pattern separating areas of prominent pink oedematous mucosa (snake-skin or mosaic pattern), III = cherry red spots, IV = diffuse bleeding. These alterations occurring more prominently in the gastric fundus are caused by venous and capillary ectasia and by arteriovenous shunts.

Prophylactic endoscopic sclerotherapy of esophageal varices--a prospective randomized trial.

Sixty-three patients with degree III or IV esophageal varices and the so-called red color sign, but without previous bleeding were randomly assigned to either prophylactic sclerotherapy (PST) (n = 30) or to a control group (n = 33). In 58 cases the portal hypertension was caused by liver cirrhosis (40% alcoholics). The two groups were comparable with respect to demographic data and endoscopic appearance, causes and severity of liver damage.

[Prostacyclin and thromboxane synthesis in liver tissue in chronic liver diseases].

This paper reports on investigations of the formation of PGI2 and TXA2 using their stabile products 6-keto-PGF1 alpha and TXB2 (RIA) in liver biopsy specimens of 46 patients suffering from fatty liver (n = 19), chronic hepatitis B (n = 11), liver cirrhosis (n = 13), and miscellaneous diseases (n = 3). The measured formation rates in chronic liver disease were evaluated in comparison to a reference group (n = 19) consisting of minimal liver lesions. The 6-keto-PGF1 alpha formation correlating to the degree of the portal inflammation in the liver (morphometric evaluation).

[Therapy strategy in bleeding esophageal varices].

In the therapeutic regimen in the haemorrhage of the oesophageal varices the sclerotherapy part from measures for the combat against shock and prophylaxis of the liver coma occupies a central position both for control of haemorrhage and for avoiding recidivations of haemorrhages. Advantages of the method are the relatively good efficacy, the small rate of serious complications and a relatively good practicability. Furthermore, liver function, portal circulation and course of the in most cases underlying liver cirrhosis are not negatively influenced.

[Pedicled fibroma of the extrahepatic bile ducts].

It is reported on the very rare occurrence of a benign tumor in common hepatic bile duct of a 33-year-old woman, associated with obstructive jaundice. Clinical diagnosis and treatment are described, histological typing like fibroblastic tumor with neurogenic parts are discussed and a short review of the literature is given.

Immunoglobulin allotypes and immunoreactivity in chronic liver disease.

The immunoglobulin allotypes Gm (a; x; f) and Km 1 have been estimated in 194 patients with chronic liver disease, and compared with the frequency distribution of a representative reference group (Gm : n = 2171; Km : n = 2179). In relation to the Gm phenotypes we have investigated the cell-mediated immunoreactivity by the E rosette test, lymphocyte transformation test and migration inhibition test. Virus-induced chronic liver disease showed significantly higher prevalence of the phenotypes Gm a+x-f+ and Gm a+x+f+ as well as of the marker Km + 1 (p less than or equal to 5%; chi 2-test).

[Adenosine deaminase activity--an indicator of inflammation in liver disease].

Inflammatory liver diseases display higher levels in serum ADA activity compared to non-inflammatory ones. The most pronounced increases in activity are found in acute virus-induced hepatitis, in active liver cirrhoses, extremely high levels in some liver tumours. Due to correlative relations, the ADA is mainly attributed to the mesenchymal parameters by factor analysis.

Haptoglobin type and liver disease.

The haptoglobin phenotype has been estimated in patients suffering from chronic liver disease (n = 222) and acute hepatitis (n = 59) in comparison with the haptoglobin pattern of a normal population (n = 1726). The frequency of Hp 1-1 was significantly increased in non-alcoholic chronic liver disease (p = 5%; chi 2-test) in contrast to alcoholic disease. The highest incidence of Hp 1-1 occurred in cryptogenic cases (p = 1%).

[Genetic studies in etiologically different chronic liver diseases].

In 198 patients with chronic liver diseases of different etiology 16 genetic feature systems were investigated (blood groups, erythrocytic enzymes, immunoglobulin allotypes, proteins). In comparison to a representative normal population significant differences of the frequency of the distribution of phenotypes of various systems were found. In these cases is remarkable that association between genetic markers and hepatopathies were above all proved in their classification according to etiopathogenetic criteria.

[Rational procedures in the differential diagnosis of jaundice].

In jaundice after exclusions of prehepatic and functional hepatogenic hyperbilirubinaemias the sonography should pre-eminently be used as a riskless, economical and qualified investigation method, taking into consideration clinical and laboratory-chemical data. If sonographically the findings of an intrahepatic cholostatis are shown, in therapeutic relevance the histological clarification must follow. Only in unequivocal focal changes of the liver (perhaps thin needle puncture) further investigations are unnecessary.

[Changes in phagocytic performance of neutrophilic granulocytes in chronic liver diseases of various etiologies].

The phagocytic functions and the nitroblue-tetrazolium (NBT)-reduction of heat inactivated Saccharomyces cerevisiae blastospores by polymorphnuclear leukocytes in 92 patients with chronic liver diseases and 21 normal human subjects was investigated. The percentage of phagocytizing leukocytes and the number of phagocytized yeast particles/100 leukocytes was only significantly reduced in active alcoholic cirrhosis. A relationship between this findings and highly enhanced sIgA levels of this group is discussed.

[Gastroesophageal reflux--cause of hemorrhaging esophageal varices?].

The results of the examinations do not depend on the peptic theory of the haemorrhage of the oesophageal varices in patients with liver cirrhosis, since the relative frequency of reflux troubles and of gastrooesophageal reflux in patients with liver cirrhosis and haemorrhage of the oesophageal varices was not found greater than in patients with liver cirrhosis and oesophageal varices without haemorrhage as well as the combination of reflux oesophagitis and oesophageal varices was rarely to be observed in the endoscopic material.

[Experiences with endoscopic sclerosing of esophageal varices].

In this paper is reported on endoscopic sclerotherapy in 35 patients, which have been treated from March 1980 to March 1983. The efficacy of submucosal (paravascular) wall sclerosis wasn't sufficient. We achieved better results in the prevention of esophageal variceal bleeding with combined para- and intravascular injections of sclerosant.

Aldehyde dehydrogenase (E.C. 1.2.1.3) in chronic alcoholic liver diseases.

Acetaldehyde dehydrogenase (ALDH) activity in liver biopsy specimens was considerably reduced in alcoholic cirrhosis (n = 5), elevated in alcoholic fatty liver (n = 11)--probably due to enzyme induction--only slightly elevated in alcoholic hepatitis (n = 6), but unaffected in non-alcoholic liver diseases (n = 23) in comparison with specimens obtained from patients with minimal liver lesions. We will argue as a working hypothesis that alcoholics with induced ALDH activity will mainly develop fatty liver, whereas reduced hepatic ALDH appears to be a reason for elevated acetaldehyde levels followed by additional liver injury and progression at least for alcoholic cirrhosis.

Levamisole therapy in chronic hepatitis--results of a multicentric double blind trial.

The effectiveness of levamisole in the immunmodulatory treatment of chronic hepatitis was assessed in a multicentric double blind trial. Twenty patients received in the first week 50 mg, in the second 100 mg and thereafter 150 mg, levamisole on two days every week for 6 months, 20 others received a placebo. Five patients dropped out (non-compliance 1, pregnancy 1, adverse effects 3).

[Cell-mediated immune reactivity in skin tests in chronic liver diseases].

For the judgment of cell-mediated immune reactivity in patients with chronic liver diseases in comparison to healthy test persons tests of the skin were performed by means of the neoantigen DNCB and the recall antigens tuberculin and streptokinase. Depending on the degree of severity of the hepatopathies the intensity of reaction decreased in the DNCB-test. There were no relations to the etiopathogenetic factors of the liver diseases.

[Acetaldehyde-induced leukocyte migration inhibition in alcoholic liver diseases].

Acetaldehyde in non-toxic doses (15.6 micrograms per start) causes in the inhibition test of the migration of leucocytes an inhibition of the migration in 6/13 of the patients with alcoholic hepatitis, a stimulation of the migration in 6/11 of alcohol cirrhoses. Healthy (n = 16) persons, patients with alcoholic fatty degeneration of the liver (n = 3) as well as non-alcoholic liver diseases (chronic persisting hepatitis, n = 11; chronic active hepatitis, n = 8, cirrhosis, n = 7) did not show this cellular immune reagibility.

[Ultrasound determination of size and calcium content of gallstones].

In a prospective study, ultrasound examinations of the gallbladder as well as cholecystocholangiography were carried out in 77 patients with solitary stones and the ultrasound stone symptoms were compared with the x-ray findings. The ultrasound stone reflex as well as the wideness of the sonic-shadow correlated significantly with the size of the stones. The stone size can be approximately calculated from the wideness of the sonic shadow.