J. De Groote

Arsenic and non-cirrhotic portal hypertension: A report of eight cases

It was discovered that eight patients with complications of non-cirrhotic portal hypertension had received an arsenical preparation for psoriasis as Fowlers solution some years age. Seven of them were admitted for bleeding oesophageal varices. Upon admission, splenomegaly and hypersplenism were present. Liver tests were normal and palmar skin keratosis and melanosis were noted. Liver biopsy of six patients showed features of incomplete septal cirrhosis. Malignant skin lesions were present in half of the patients. One patient died from lung carcinoma and another from an ovarium neoplasm. Chronic arsenic intake should be actively looked for in all patients with psoriasis and non-cirrhotic portal hypertension. They should be followed up for many years for development of malignant lesions in skin, lung and liver. Liver abnormalities present in the biopsies are often minor and may escape detection.

Histopathology of portal hypertension: a practical guideline

T Roskams, A Baptista, L Bianchi, A Burt, F Callea, H Denk, J De Groote, V Desmet, S Hubscher, K Ishak, R MacSween, B Portmann, H Poulson, P Scheuer, L Terracciano & H Thaler Department of Pathology, K.U. Leuven, Leuven, Belgium, Hospital de Santa Maria, Lisboa, Portugal, University of Basel, Basel, Switzerland, University of Newcastle, Newcastle, UK, Spedali Civili of Brescia, Brescia, Italy, University of Graz, Graz, Austria, Department of Hepatology, K.U. Leuven, Leuven, Belgium, Department of Pathology, University of Birmingham, Birmingham, UK, Armed Forces Institute of Pathology, Washington, DC, USA, Department of Pathology, Western Infirmary, University of Glasgow, Glasgow and Institute of Liver Studies, Kings College Hospital, London, UK, Frederics Berg, Denmark, Department of Pathology, Royal Free Hospital, London, UK, and Wien, Austria

Serum Xanthine Oxidase and Liver Disease

A recently-described assay for xanthine oxidase was used for the estimation of serum xanthine oxidase (SXO) in patients with a variety of liver disorders. SXO was markedly increased in acute viral hep

Thyroid hormones and the hepatic handling of bilirubin: II. Effects of hypothyroidism and hyperthyroidism on the apparent maximal biliary secretion of bilirubin in the Wistar rat

This study was undertaken in the Wistar R/A Pfd rat to investigate the effects of hypothyroidism and of hyperthyroidism on the maximal biliary excretion (Tm) of bilirubin and on the concentration and composition of bilirubin in liver and plasma at the end of a bilirubin load. Hypothyroidism caused a cholestatic condition with a 50% decrease in bile flow and in bilirubin Tm, and with an increased proportion of conjugated bilirubin in liver and plasma. This was associated with an increased ratio of bilirubin diconjugates to monoconjugates in bile, liver, and plasma, which can be ascribed to the increased hepatic conjugation activity towards bilirubin and/or to the prolonged retention of bile pigments in the hepatocytes with increased conversion of monoconjugates to diconjugates. Cholestasis induced by hypothyroidism was further characterized by a decreased biliary output of unconjugated bilirubin. The latter phenomenon might represent an indirect effect related to a decreased output of bilirubin monoconjugates with impaired hydrolysis to unconjugated bilirubin; it might also reflect the cholestatic condition with decreased excretion of the unesterified bile pigment as such. Hyperthyroidism resulted in a 1.3-1.4-fold increase in bile flow. The maximal bilirubin concentration in bile decreased 1.3-1.4-fold, so that the apparent maximal bilirubin excretion rate remained unchanged at 115 nmol.min-1.100 g-1, as observed in untreated rats. Hyperthyroidism lowered the bilirubin UDP-glucuronosyltransferase activity, produced a decreased ratio of bilirubin di- to monoconjugates in bile and plasma, and a decreased ratio of conjugated to total bile pigment concentration in liver and in plasma. Similar findings are present in the heterozygous Gunn rat strain and in patients with hepatic bilirubin UDP-glucuronosyltransferase deficiency. We therefore propose the hyperthyroid rat as an experimental animal model of Gilberts syndrome.

Hepatic echinococcosis ruptured into the biliary tract. Clinical, radiological and therapeutic features during five episodes of spontaneous biliary rupture in three patients with hepatic hydatidosis

Three patients are described with hepatic involvement by Echinococcus granulosus, complicated by spontaneous rupture into the biliary tract. Clinical features consisted of upper abdominal pain, jaundice, fever, anorexia, and vomiting. Hepatomegaly and marked epigastric tenderness were consistently observed. Laboratory findings included obstructive liver function tests, leucocytosis, eosinophilia, and hyperamylasemia. Abdominal computed tomography, showing the cystic wall, the presence of wall calcifications, daughter cysts and wall enhancement, provided a correct diagnosis of hepatic hydatidosis in all patients. Dilatation of the bile ducts with the presence of intraluminal material was clearly shown by sonography and endoscopic retrograde cholangiography. These abnormalities were most frequently found in the common bile duct and in the left hepatic duct. On sonography, the intraluminal material appeared as amorphous, sludge-like hydatid sand, and as daughter cysts. On ERCP, the intrabiliary parasitic material appeared as non-homogeneous, irregularly shaped and mobile filling defects. Other findings at ERCP were displacement and distortion of intrahepatic bile ducts by the hepatic cysts and a mild dilatation of the pancreatic duct. In one occasion, evacuation of a daughter cyst through the papilla was observed. The therapeutic value of mebendazole and endoscopic sphincterotomy in our patients is discussed.

Discriminative and Prognostic Signs in Acute Hepatic Coma, Treated by Exchange Transfusions

Discriminative and prognostic signs in 14 patients with acute hepatic coma, treated by exchange transfusion and permanent intensive care are described. Five patientssurvived and in none of them was th

Einteilung der chronischen Hepatitis

Die Untersuchung der Leber im Punktatzylinder hat eine Fülle diagnostischer Probleme mit sich gebracht. Besonders schwierig ist die Beurteilung der verschiedenen Verlaufsformen der Hepatitis. Mit diesem diagnostischen Problem werden die Pathologen täglich konfrontiert. Die „European Association for the Study of the Liver“ hat deshalb ein gemischtes Komitee aus Pathologen und Hepatologen bestimmt, um für den Begriff der chronischen Hepatitis eine brauchbare morphologische Definition festzulegen. In einer zweitägigen Arbeitstagung im Juli 1968 in Zürich wurde in gemeinsamer Aussprache, unter Vorlage entsprechender histologischer Schnitte, die nachstehende Einteilung und Definition der chronischen Hepatitis ausgearbeitet. Die Redaktion von Virchows Archiv Abt. A hält es für wünschenswert, daß diese Definition allen Pathologen zur Kenntnis gebracht wird, um auf diesem schwierigen Gebiet die einheitliche Beurteilung zu fördern.

Application of Photoacoustic and Photothermal Techniques for Heat Conduction Measurements in a Free-Standing Chemical Vapor-Deposited Diamond Film

Heat conduction in a free-standing chemical vapor-deposited polycristalline diamond film has been investigated by means of combined front and rear photoacoustic signal detection techniques and also by means of a “mirage” photothermal beam deflection technique. The results obtained with the different techniques are consistent with a value of α=(5.5±0.4)×10−4 m2 · s−1 for thermal diffusivity, resulting in a value ofκ=(9.8±0.7)×102 W·m−1·K−1 for thermal conductivity when literature values for the density and heat capacity for natural diamond are used.

Amoebic Liver Abscess. Report of 5 Cases

SummaryClinical and serological data of 5 patients with amoebic liver abscess are described. They were infected during a stay in Africa or Asia. Follow up shows that the cavities after successful medical therapy only decrease with a rate of 0.07–0.12 mm per day. It can thus take years before a large abscess disappears completely.

Pathogenesis of cholesterol stones in the gallbladder

SummaryThe secretion by the liver of bile saturated with cholesterol is the first stage in the development of cholesterol stones in the gallbladder. Biliary cholesterol is derived mainly from lipoprotein cholesterol, which is transported to the liver by chylomicron remnants, low-density and high-density lipoproteins. Oestrogens stimulate the uptake and catabolism of low-density lipoproteins in the liver.Newly synthetized cholesterol contributes less to biliary excretion. Insulin may increase gallstone formation by increasing the activity of the rate-limiting enzyme in the synthesis of cholesterol in the liver.Cholesterol is virtually insoluble in water and is held in solution in bile by its association with bile salts and phospholipids. An increased cholesterol secretion into bile can predispose to saturation and gallstone formation in obesity, on high-caloric diet, on weightreduction diet, in hypcrtriglyceridaemia, and by the effects of insulin, oestrogens and clofibrate therapy.Plasma low-density lipopr...