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OBJECTIVE: The prognostic impact of early stages of histologically confirmed alcoholic liver disease is uncertain. Our aim was to determine the risk of cirrhosis and premature death, and identify prognostic markers, in patients with biopsy-proven alcoholic steatohepatitis - and to compare prognosis in patients with alcoholic pure fatty liver and the general population.MATERIAL AND METHODS: Patients with biopsy-proven alcoholic fatty liver disease diagnosed during 1976-1987 were identified. Data were collected from medical records, the Danish National Patient Registry and the Registry of Causes of Death. All biopsies were re-examined and morphological findings assessed. A reference cohort matched for age and gender was created. Cox proportional hazard models adjusted for age and gender were used to analyse differences in mortality and cirrhosis development, as well as the prognostic impact of histological and biochemical parameters.RESULTS: Two hundred and twenty-five patients with fatty liver and 111 with steatohepatitis were followed for median 13 and 9.7 years, respectively. There was a significantly higher risk of developing cirrhosis amongst patients with steatohepatitis compared to both patients with fatty liver (p CONCLUSION: Presence of steatohepatitis indicates an increased risk of cirrhosis and premature death. However, none of the histological parameters defining steatohepatitis can independently identify patients at risk for premature death.

A 12-year-old Middle Eastern girl presented with abdominal pain, weight loss, and intermittent pain in both thighs. She was initially suspected of Crohn disease, but this diagnosis was excluded after extensive gastromedical evaluation. Plain x-rays of the femora were normal, whereas the initial Tc-99m methylene diphosphonate (MDP) bone scan showed several foci with increased activity in both femurs. MR scan showed excessive periostal inflammatory and mild intramedullary changes in both femurs. A percutaneous bone biopsy demonstrated changes consistent with chronic recurrent multifocal osteomyelitis (CRMO). The patient's symptoms disappeared spontaneously, but reappeared 1.5 years later, which led to a new MDP bone scan that showed normal findings.

Non-alcoholic fatty liver disease encompasses a spectrum of histological lesions ranging from steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. Simple steatosis is generally benign, while NASH can progress to severe liver disease. The aim of the present study was to quantify the number of patients with NASH and assess the prognosis associated with the condition in a large Danish referral centre for liver disease.Through the pathology archives at Hvidovre Hospital, 348 patients with steatohepatitis diagnosed during the 1976-1987-period were identified. Data were systematically collected by review of available medical records. These data were supplemented by data from the Danish National Hospital Registry and the Registry of Causes of Death.A total of 100 patients referred from other hospitals were excluded as their records were missing and 236 patients were excluded, mainly due to a history of alcohol abuse; this left 14 patients to constitute the study population. At the end of the follow-up period which had a median duration of 16.7 years, ten of the patients had died: four of cardiovascular disease, four of extra-hepatic neoplasm and two of unknown causes. There were no liver-related deaths and only one patient developed cirrhosis.In a specialised referral centre, only few patients were diagnosed with NASH 25-30 years ago and those who were identified had a low risk of progression to cirrhosis and premature death.The local research council and the foundation for the study of liver diseases at Hvidovre Hospital provided funding for this study.not relevant.

P1101 CYTOCHROME P4502E1 AS A DRIVING FORCE IN THE PROGRESSION OF ALCOHOLIC LIVER DISEASE H.K. Seitz, H. Qin, K. Glassen, R. Waldherr, C. Flechtenmacher, G. Millonig, T. Peccerella, F. Stickel, P. Schirmacher, T. Bruckner, S. Mueller. Alcohol Resarch Department, University of Heidelberg, Salem Medical Center, Department of Pathology, University of Heidelberg, Heidelberg, Germany; Hepatology, Clinic Beau Site, Bern, Switzerland; Biostatistics, University of Heidelberg, Heidelberg, Germany E-mail: helmut_karl.seitz@urz.uni-heidelberg.de

There are conflicting results respecting the segmental tubular origin of renal oncocytomas, a type of tumour said to be highly differentiated and benign, though metastases have been described. The aim of this study was, by applying different lectins on renal cell carcinomas (n = 50) and oncocytomas (n = 12), to search for patterns which could indicate a specific segmental origin of oncocytomas and perhaps elucidate the differentiation of this tumour. The following lectins were applied: jacalin, peanut agglutinin (PNA), wheat germ agglutinin (WGA), phytohemagglutinin E (PHA-E), concanavalin A (Con A), and Dolichos biflorus agglutinin (DBA). The results show that oncocytomas are positive when jacalin, a Lectin that stains distal tubules and collecting tubules, is used, supporting the view that the tumour derives from distal or collecting tubules. The staining of the oncocytomas is generally polarized as in normal kidney tubules underlining that the tumour is highly differentiated. Two oncocytomas with aggressive behaviour showed areas with a diffuse pattern suggesting lower differentiation.

Transitional cell tumours of the bladder in 12 men and 12 women were investigated for oestrogen receptors. All tumours and surrounding urothelium were found to be receptor-negative.