W. Burnett

THE NATURE OF PIECEMEAL NECROSIS IN CHRONIC ACTIVE HEPATITIS

On the basis of histological studies, it is proposed that the type of liver-cell death in piecemeal necrosis is apoptosis. The characteristic inconspicuousness of apoptosis explains why the mode of hepatocyte elimination in piecemeal necrosis has hitherto remained obscure. Cell-mediated immune attack induces apoptosis, not classical necrosis, and the occurrence of apoptosis in piecemeal necrosis links the observed morphological changes in chronic active hepatitis with the other evidence for an autoimmune pathogenesis. It is significant that apoptosis does not evoke inflammation or fibroplasia. In attempting to elucidate the cause of the fibrosis that accompanies progression to cirrhosis in chronic hepatitis, it may thus be more relevant to study the effect on fibroblasts of substances liberated during lymphocyte-hepatocyte interactions than the death of the hepatocytes.

Black pigment or polybilirubinate gallstones. Composition and formation

Black pigment, extracted from gallstones from patients, has been characterized as polybilirubinate. A similar material with the same physical properties was synthesized from bilirubin. The properties of black pigment are described. A mechanism for black pigment formation is postulated, and the possible relationship of this pigment to the formation of gallstones is discussed.

Acute occlusion of the portal vein in the calf

Complete occlusion of the portal vein for 2 hours has been studied, in the calf, in an attempt to produce survival with appropriate resuscitation. Systemic blood pressure fell immediately on occlusion and the portal blood became markedly acidotic with a rise in packed cell volume and plasma potassium. Circulating blood volume decreased by 50 per cent despite major transfusion. When the occlusion was released, blood pressure returned to normal levels for several hours. However a hemorrhagic enteropathy developed in the small intestine. Large quantities of serosanguineous fluid collected in the intestinal wall and lumen and in the peritoneal cavity. Marked hemo-concentration developed and the animal did not respond to further resuscitation. All animals grew E. coli on portal blood culture after occlusion. It is concluded that sequestration of fluid in the portal circulation is the main cause of death following portal occlusion, but that a rise in plasma potassium, coliform bacteremia, and progressive acid-base disturbances may well be contributory factors.

Transition-metal ions in human gallstones

Black pigment of polybilirubinate is found in most types of human gallstones. It behaves as a cationic exchange resin and adsorbs transition-metal ions from the bile in the gallbladder. It is suggested that the role of transition-type metals is minimal and the ions occur only as a result of the cationic exchange properties of the pigment.

The Management of Acute Cholecystitis

A detailed analysis is presented of 200 consecutive patients suffering from acute cholecystitis who presented at the Surgical Professorial Unit at the Royal Brisbane Hospital between the years 1961 and 1969. Conservative management was initiated and maintained whenever this was considered to be reasonable and safe. Immediate surgery, however, was considered imperative in 22 of the 200 patients, and early surgery was carried out in a further 29, by reason of failure of conservative management in 25, and uncertainty of diagnosis in four. The overall mortality rate in the series of 200 was 0.5%.

A trial of 5-fluorouracil and Corynebacterium parvum in advanced colorectal carcinoma.

SummaryThis study has confirmed that patients who have advanced colorectal carcinoma have impaired responsiveness to delayed-hypersensitivity skin testing, and also have elevated levels of serum IgM. Serial observations of delayed-hypersensitivity skin tests, total lymphocyte counts, T-lymphocyte counts, B-lymphocyte counts, and serum immunoglobulin levels failed to reveal any consistent pattern of responses in patients treatment with either chemotherapy alone or chemoimmunotherapy. In 33 patients chosen at random to receive either 5-FU alone or 5-FU in combination with intramuscularly administeredC. parvum, there was no evidence of objective response or influence on survival. Intramuscularly administeredC. parvum, in the dose and schedule used, produced no evident immunologic or therapeutic effect.

Melphalan and 5-fluorouracil in advanced gastrointestinal carcinoma: a preliminary report

Summary A preliminary analysis of a phase II trial of melphalan and 5-fluorouracil (5-FU) in advanced gastrointestinal carcinoma has shown 2 objective responses in 9 evaluable patients with colorectal carcinoma. Drug toxicity was at least equal to 5-FU alone. When other series are also considered, the response rate to this combination appears to be less than to 5-FU alone.