M.C. Bateson

A comparative trial of liver biopsy needles.

A sheathed needle (Tru-Cut) was compared with a suction biopsy needle (Menghini) in a randomised prospective trial over 18 months to determine whether the former offered any special advantages in routine percutaneous liver biopsy. Seventy-seven consecutive biopsies were performed by a single operator. Although biopsy fragmentation was commoner with the suction needle, the length and volume of the largest core obtained was similar to results with the sheathed needle. Cytology provided useful additional information with the Menghini technique. The suction needle was repeatedly reusable and considerably cheaper than the sheathed needle, which may be used once only.

COMPARISON OF FIXED DOSES OF CHENODEOXYCHOLIC ACID FOR GALLSTONE DISSOLUTION

96 patients with gallstones have been treated for up to four years with chenodeoxycholic acid in daily doses of 500, 750, or 1000 mg. None of the patients started on 500 mg daily showed complete gallstone dissolution. 8 out of 41 patients on 750 mg daily had complete dissolution of their radiolucent gallbladder stones after six or more months, and a further 4 showed partial dissolution. 5 out of 28 patients on 1000 mg daily had complete dissolution of their radiolucent gallbladder stones after at least six months, and a further 9 showed partial gallstone dissolution. The mean duration of therapy was greater on 750 mg than on 1000 mg/day (1.27 vs. 0.58 years), and when results were analysed after the first six months therapy the total response-rate was significantly greater for the 1000 mg dose (12 out of 28) than for the 750 mg dose (9 out of 41). The individual response of radiolucent gallabladder stones to therapy could not be predicted from stone size, weight of patient, dosage/kg, orchange in biliary lipids. Treatment of radiolucent gallstones with chenodeoxycholic acid should start at 1000 mg daily.

Analysis of response to ursodeoxycholic acid for gallstone dissolution.

20 patients with radiolucent gallbladder stones were reviewed after 6 months treatment with ursodeoxycholic acid (UDCA) at a dose of either 500 or 1,000 mg daily. Successful treatment could not be predicted from the patients characteristics, nor from stone size or pre-treatment biliary lipid analysis. During treatment the bile in patients who responded to UDCA differed from bile in those who did not: mean cholesterol content was lower in responders (4.1 +/- 0.6 vs. 5.7 +/- 0.5 mol%, p less than 0.025) as was the lithogenic index (0.57 +/- 0.06 vs. 0.81 +/- 0.06, p less than 0.005) and the mean UDCA-corrected lithogenic index (0.79 +/- 0.10 vs. 1.04 +/- 0.07, p less than 0.05). However, the individual response could not be predicted from biliary lipid analysis during treatment.

JEJUNAL MORPHOLOGY IN MULTIPLE SCLEROSIS

In a prospective survey jejunal biopsy samples from 11 patients with multiple sclerosis on normal diets were compared with those from controls matched for age and sex. Quantitative histology, morphometry, and electron microscopy showed no difference between the two groups. Since there was no evidence that gluten sensitivity plays a role in the aetiology of multiple sclerosis, the wide adoption of gluten exclusion by patients seems unjustified.

Ursodeoxycholic acid for the dissolution of radiolucent gall bladder stones.

In a prospective dosage response study of 84 patients with radiolucent gall bladder stones treated with ursodeoxycholic acid (UDCA), a dose of 500 mg daily was as effective as 1,000 mg daily. Complete dissolution of stones was achieved in 9 of 31 patients (29%) treated for at least 6 months with the lower dose, and in 7 of 33 patients (21%) on the higher dose. 4 patients in each group continue on treatment having shown partial gall-stone dissolution. When the two dosage groups were considered together, small stones dissolved more readily than larger ones and, after allowance for stone size, success rates were equal in obese and non-obese patients. Treatment with UDCA was well tolerated and significant adverse effects were not encountered.

Serum bile acids in patients with hyperlipidaemia.

Individual serum bile acids were analysed by an improved gas liquid chromatography method in 12 patients with primary hyperlipidaemia. Total serum bile acid concentrations were raised in 10 subjects. Ursodeoxycholic acid was found in all 12 patients. It was present in significantly greater concentrations, accounted for a greater proportion of the total serum bile acids, and occurred more frequently than in patients with various forms of hepatobiliary disease. Patients with hyperlipidaemia had proportionately less deoxycholic acid than controls but more than patients with liver disease. There was proportionately less chenodeoxycholic acid in patients with hypercholesterolaemia, in whom the primary bile acid ratio was raised.

COMPARATIVE TRIAL OF LIVER-BIOPSY NEEDLES

A sheathed needle (Tru-Cut) was compared with a suction biopsy needle (Menghini) in a randomised prospective trial over 18 months to determine whether the former offered any special advantages in routine percutaneous liver biopsy. Seventy-seven consecutive biopsies were performed by a single operator. Although biopsy fragmentation was commoner with the suction needle, the length and volume of the largest core obtained was similar to results with the sheathed needle. Cytology provided useful additional information with the Menghini technique. The suction needle was repeatedly reusable and considerably cheaper than the sheathed needle, which may be used once only.

Extensive alimentary and genital ulceration, mesenteric cysts, malabsorption, T-lymphocyte depletion and subsequent anaplastic bladder carcinoma

The occurrence of several unusual disorders in a single patient prompted the question as to whether these may all have been part of a single syndrome, and the possible differential diagnosis is discussed in detail. The case was thought to be an instance of acquired T-lymphocyte depletion leading to the development of premature malignant disease.