Search

We studied a selected group of 39 female patients suffering from primary biliary cirrhosis (PBC). This disease is characterized by typical lipoprotein alterations and elevated concentrations of serum cholesterol. Despite the increased concentration of atherogenic lipoproteins, enhanced atherogenesis is not characteristic of PBC. Serum total cholesterol, triglycerides, HDL2 and HDL3-cholesterol concentrations were measured by enzymatic methods or in combination with precipitation procedures. Apolipoproteins were determined by using immunonephelometric methods. ELISA sandwich method was used for lipoprotein(a) determinations. Apoprotein(a) phenotyping (isoforms) was performed by Western blotting with specific antibodies. The concentrations of serum lipids, lipoproteins and apoproteins (AI, AII and B) were found in the range of earlier investigations. The serum lipoprotein(a) concentration did not differ between the PBC patients and control subjects (10.0/0.1-54/, median 2.55 vs. 11.5/0-75/, median 5.2 mg/dl). In the advanced stages of PBC we found a higher number of patients with low lipoprotein concentration (lower than 1 mg/dl). In patients with shorter durations and milder histological alterations high HDL2 cholesterol subfractions has been detected (stage I = 0.42 +/- 0.18, stage II = 0.53 +/- 0.29 and stage III = 0.62 +/- 0.41 vs. stage IV = 0.26 +/- 0.15 mmol/l, P < 0.05). Despite the elevation of atherogenic lipoproteins, high HDL2-cholesterol and normal lipoprotein(a) concentrations may be one of the reasons why patients with advanced PBC are not placed at increased risk for atherosclerosis.

Author takes a review of the more than 30 year history of liver transplantation and of its more important miles. After the international consensus meetings (Washington in 1983 and Paris in 1993) the liver transplantation has become as a curative therapy in the progressive liver diseases intractable with other methods. Liver transplantation program in Hungary has been successfully introduced. Author underlines the role of multidisciplinary cooperation and the importance of support by health policy and society.

Unlabelled: Between 1983 and 1992 altogether 638 alcoholic cirrhotic patients had been treated because of acute esophageal variceal bleeding. In 96 cases the treatment were carried out in the following circumstances; volume and coagulation factor substituate, vasopressin or glypressin and nitroglycerin, urgent endoscopy and ballontamponade but in 47 cases an urgent sclerotherapy were also performed. The survival, cases of rebleeding,-from the first bleeding events-of the 49 nonsclerosed patients were compared to those of the 47 sclerosed one., Conclusions: 1. The endoscopic sclerotherapy proved to be life-saving procedure. 2. Within 30 days the nonsclerosed patients died twice as much number than the slcerosed patients. 3. The lengths of the survival period were found four and half times so long at the sclerosed patients than in nonsclerosed patients (535 versus 125 days). 4. The numbers of the rebleeding were not less at the sclerosed patients than the nonsclerosed subjects. 5. The lengths of the nonbleeding period was found triple so long at the sclerosed patients than in nonsclerosed patients. 6. The survival of the "Child C" patients at the sclerosed and nonsclerosed patients, too. The authors come to conclusion that by the fiberendoscopic sclerotherapy an increase in the survival time of the patients with acute esophageal variceal bleeding in alcoholic cirrhosis can be achieved.

The aim of the review is to evaluate the putative clinical interactions between alcohol metabolism and the administration of H2-receptor antagonists. Places of the first-pass metabolism of ethanol in the body have been investigated as well. According to the in vitro experimental results the H2-receptor antagonists can inhibit the ethanol metabolism which may have clinical relevance. When low doses of alcohol (below 0.3 g/kg) are given per os, the administration of H2-receptor antagonists results in an increase in the blood ethanol concentrations. Since that challenged increase never exceeds the level of 0.3/1000 blood alcohol concentration, it has hardly any clinical or medico-legal significance.

Data from the past few years have shown that as caffeine metabolizes solely in the liver, caffeine elimination can serve as a liver function test. We have collected data by monitoring 40 persons with liver diseases (11 chronic alcoholic hepatitis, 24 liver cirrhosis, 5 non-cirrhotic liver disease). Eight subjects served as controls. The patients with liver cirrhosis were classified according to the Child--Pugh scoring system. To determine caffeine elimination blood samples were collected before and at 3, 6, 9 and 12 hours after oral administration of 0.2 g caffeine. Fasting serum caffeine concentration and concentration 12 hours after administration, serum clearance, half life, peak concentration and volume of distribution have been compared. The respective values measured in patients with non-cirrhotic liver diseases did not differ significantly from the controls. The disappearance of caffeine was significantly decreased in cirrhotics. Our results demonstrated a good correlation between impairment of caffeine elimination and assessment of severity of liver disease by the Child--Pugh classification. Measuring serum levels in samples taken 12 hours after caffeine administration is a simple and useful method in the diagnosis of liver diseases at cirrhotic stage.

The authors describe the development and the application of polymerase chain reaction (PCR) in the detection of hepatitis C virus. Based on the sequence data available in the literature, a conservative motif at the 5' end of the virus genome has been selected for amplification. Using the flanking synthetic oligonucleotides the specificity of the highly sensitive RNA-PCR assay was proved by serologically positive and negative serum samples. HCV-RNA-PCR studies were applied to start interferon treatment in patients from National Institute of Rheumatology and Physiotherapy (Budapest) with anti-HCV positive serum samples and this method was used to evaluate the efficacy of interferon therapy, as well.

The authors summarize the recent findings obtained in the field of inflammatory cytokines with particular attention on interleukin-6 (IL-6). After a short review of the molecular biology and of the cellular effects of IL-6, the most important clinical relations of IL-6 in hepatic diseases, in non-specific inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and in certain autoimmune diseases are provided. The simultaneous discussion of molecular and clinical data contribute to the understanding of pathomechanisms.

Helicobacter pylori (H. pylori) is a Gram-negative, curved bacillus known since 1983. It is supposed to play role in the pathogenesis of certain gastroduodenic diseases, e.g. non-ulcer dyspepsia (NUD), chronic inflammation, ulcers, etc. Serum samples of 70 patients who were examined for stomach complaints with gastroscopy and those of 22 healthy persons were analysed. The purpose of the study was to evaluate anti-H. pylori IgG, IgM and IgA antibodies using ELISA method. Whether the antibodies can be detected or not, 8 possible variations exist, each of them denoting certain state of infection. These states are not always going parallel with the macroscopic pictures revealed by gastroscopy, but there are some obvious congruences. Results show that serologic examination cannot replace gastroscopy but on the other hand in follow-up tests and examinations as well as in understanding the aetiology of different gastroduodenal diseases it can play an important role.

Magnesium is the second most important intracellular cation after potassium in the human cell. Its pathologic and therapeutic role is well established in a large number of chronic conditions as vascular heart diseases, arrhythmias, hypertension, nephrolithiasis, diabetes mellitus, alcoholism, as well as in liver and pancreatic diseases. A broad spectrum of different clinical aspects and need of supplementation of magnesium is reviewed by the authors. Since suitable preparations are not available in the market the substitution of magnesium can cause difficulties in the practice.

Among the serum enzymes used for diagnostic purposes the alkaline phosphatase (AP) is one of the oldest and the most frequently applied laboratory tests. Increased activity found in the serum is a consequence of certain hepato-biliary disorders, different bone diseases, endocrine syndromes, kidney illnesses and malignant tumors as well. From the study of the pattern of the isoenzymes of the serum-AP information of practical importance may be gained by which many differential-diagnostic problems can be solved. For the clinical-chemical laboratories methods that use electrophoretic separation on different membranes or gels are recommended. Patterns characteristic for different diseases may well be differentiated from normal constellation. AP-isoenzymes help to reveal cholestases at early stages, some disorders of bone metabolism and malignant processes as well.

In the literature an increasingly large body of evidence has revealed disturbances of zinc metabolism and a consecutive zinc deficit in a broad spectrum of chronic diseases. The authors call attention to the therapeutic benefit of zinc substitution mainly in chronic hepatic diseases, pancreatitis and colitis, as well as in diabetes and in several cases of immunodeficiency with various complications. Since suitable preparations are not available on the market 'possibilities concerning zinc substitution are rather limited. There is a real need for completing our therapeutic arsenal with an up-to-date zinc preparate, possibly in combination with a magnesium compound.

Lactate dehydrogenase (LD) isoenzyme-1 levels (LD1) determined after immunoprecipitation of M-subunits, LD1 activity by electrophoresis, and the activities of alpha-hydroxybutyrate dehydrogenase (HBD), urea-stable LD, and heat-stable LD, by Association of Clinical Biochemists Proposed Methods, were examined for their ability to differentiate between serum samples from patients with cardiac or liver disease. Compared with total LD, all methods gave higher serum activity in patients with cardiac disease than in those with liver disease. Differentiation between patient groups was greatest for LD1 by immunoprecipitation, followed by heat-stable LD and LD1 by electrophoresis. HBD and urea-stable LD both gave less discrimination, with negligible difference between these two procedures. LD1 activity by immunoprecipitation correlated well with LD1 activity determined by isoenzyme electrophoresis with densitometric scanning. The advantages and disadvantages of the various procedures are considered.

A wide range of enzymes was investigated following endoscopic retrograde cholangio-pancreatographie ERCP/. Of the 12 enzymes studied highly significant increase of levels were seen in amylase /AML/ and lipase /LIP/ activities. Increase in the other 13 enzymes were slight and failed to persist for 40 hours. The incidence rate of a subclinical pancreatitis-like disorder is high, but typical acute pancreatitis is rare. Likely post-ERCP complications must not be disregarded, however, in selecting patients for ERCP.

After inducing experimental ileus in albino rats, the authors found changed lysosome enzyme activities in liver homogenizate. In the same kind "free" activity of acid phosphatase and acid ribonuclease is elevated by strangulation ileus. According to literature, these alterations result from changed permeability of lysosome membranes, resp. from rupture of lysosomes. Ileus by obstruction causes no significant changes of the "free" lysosomes activities in liver homogenizate. Increase of acid phosphatase and ribonuclease in blood serum by strangulation or obstruction is equally considerable in both kinds of ileus. The results of these experiments suggest the developing of hepatic damage under both kinds of experimental ileus, the extent of which can be assessed by determination of lysosome enzyme activities.

It has been shown in several studies that there is a statistically confirmed connection between cholesterol and Hb levels in the sense that hypocholesterolemia and anemia occur together particular frequently. This was demonstrated in an epidemiological cross-section study of 3958 patient data, and also that in a retrospective case control study of 159 anemias there was a concurrent hypocholesterolemia. It is postulated that a causal connection exists which is explained by the fact that cholesterol deficiency leads to rigidity of the erythrocytes.

In patients with intestinal obstruction, nine of the enzymes usually studied in liver diagnostics were determined before and after operation. Intestinal obstruction causes reversible changes in the liver and in hepatic metabolism; they normalize after relief of the obstruction.