André Viallet

CATECHOLAMINE LEVELS IN PORTAL, HEPATIC, AND SYSTEMIC VENOUS BLOOI IN PORTAL HYPERTENSION

Abstract Combined hepatic and umbilico-portal venous catheterisation was used to sample blood in the vena cava, the hepatic vein, and the portal vein in eleven patients with hypertension and five patients without portal hypertension. Catecholamine levels were detremined by means of a fluorometric method. No difference in adrenaline and noradrenaline plasma levels was found in the two groups. Mean portal venous plasma levels of noradrenaline were higher than mean hepathic venous plasma levels, suggesting that the liver metabolises circulating noradrenaline. It is concluded that cate- cholamine plasma levels have no hearing on portal hypertension.

Hyperglobulinemia in alcoholic cirrhosis. Relationship with portal hypertension and intrahepatic portal-systemic shunting as assessed by Kupffer cell uptake.

The relative importance of portal hypertension and intrahepatic portal-systemic shunting in the pathogenesis of hyperglobulinemia is examined in 31 alcoholic cirrhotic patients and 6 patients with idiopathic portal hypertension. The degree of portal hypertension was evaluated by combined umbilicoportal and hepatic vein catheterization and the intrahepatic portal-systemic shunting was assessed by the Kupffer uptake of [125I]albumin microaggregates during a single passage through the liver. All patients had comparable severe portal hypertension and most had bled from ruptured varices; however, no demonstrable relationship could be found between portal hypertension and hyperglobulinemia. Elevated levels of serum gammaglobulins and immunoglobulins (mainly IgG) were observed only in cirrhotic patients, particularly those with markedly altered Kupffer cell uptake. It is concluded that intrahepatic portal systemic shunting as evaluated by the Kupffer cell uptake is more important than the collateral circulation secondary to portal hypertension in the pathogenesis of hyperglobulinemia in alcoholic cirrhotic patients.

Chronic carriers of hepatitis B antigen (HBsAg). Histological, biochemical, and immunological findings in 31 voluntary blood donors.

Among 289 HBsAg carriers detected by the Montreal Red Cross Blood Transfusion Service and seen by our group, 31 submitted voluntarily to liver biopsy. These 31 carriers have now been followed for 10–33 months (mean: 23) and all remained positive for HBsAg. 15 of these 31 subjects had lived in institutions during infancy or childhood and none were drug users. Histological examinations revealed 24 cases of chronic persistent hepatitis (CPH), 2 cases of chronic aggressive hepatitis, 2 with steatosis, and 3 with normall liver. On repeated determination, 16 of the 31 subjects had at least one elevated transaminase level. Transaminases levels could not be correlated with the histological diagnosis. 4 cases had positive antinuclear antibodies, all in the CPH group, a finding that could not be correlated with any clinical, biological, or histological findings. The search for other autoantibodies and the immunoglobulin determinations were totally unrewarding. Thus, it appears that chronic HBsAg carriers in Montreal voluntary blood donors often have chronic hepatitis, usually persistent, occasionally aggressive; liver biopsy still remains the most useful approach in the evaluation of these HBsAg carriers. The HBsAg-carrier state seems to be well tolerated, but further long-term studies are needed to understand the natural history of this condition.

The extrahepatic uptake of radioactive colloidal gold in cirrhotic patients as an index of liver function and portal hypertension.

In the present study, 21 cirrhotic patients underwent hepatic scintigraphy with radioactive colloidal gold. The extrahepatic uptake of this colloidal material was evaluated, using anterior and posterior scintigrams, by grading the spleen (0 to +++) and the vertebral bone marrow uptake (0 to ++). The summation of these two gradations was used as an index of extrahepatic uptake (198Au-EHU). The relative clearance of indocyanine green (K-ICG) was calculated in 19 cases. Combined portal and hepatic vein catheterization was performed, and free portal venous pressure (FPVP), free hepatic venous pressure (FHVP), and wedged hepatic venous pressure (WHVP) were recorded. The portohepatic gradient (FPVP-FHVP) was used to measure portal hypertension. A significant positive correlation was found between portohepatic gradient and198Au-EHU. A highly significant negative correlation was found between K-ICG and198Au-EHU and between the portohepatic gradient and K-ICG. The present study suggests that198Au-EHU cannot be useful as a single indirect evaluation of portal hypertension in individual cirrhotic patients. However, when both are recorded,198Au-EHU and K-ICG can be helpful in identifying cirrhotic patients with a significant degree of portal hypertension (a portohepatic gradient of 10 mmHg or more).

Mitochondrial antibodies in extrahepatic biliary obstruction

Sera from 732 patients were screened for mitochondrial antibodies by immunofluorescence. Such antibodies were not found in any of the 36 patients of this series with extrahepatic biliary obstruction, 14 of whom had obstruction lasting more than 3 months. Mitochondrial antibodies were found in all 5 patients with primary biliary cirrhosis, in 3 patients with chronic hepatitis, and in 1 patient with alcoholic cirrhosis. It is concluded that the presence of mitochondrial antibodies remains a useful diagnostic tool in the differential diagnosis between primary biliary cirrhosis and extrahepatic biliary obstruction.

Intravascular coagulation and ascitic-fluid infusion.

Excerpt To the editor: In their very informative paper in the May 1979 issue, Harmon and coworkers (1) have described their findings of disseminated intravascular coagulation in cirrhotic patients ...

The Advantages of Pre-Operative Umbilicoportal Catheterization and Venography in Extrahepatic Biliary Obstruction

Some 350 patients with extrahepatic biliary obstruction have been investigated and operated at the “Hopital Saint-Luc” of Montreal since 1964.