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Biomedical subjects

D R Triger

Publications and source records attributed to D R Triger.

At least 91 records · Page 5Linked to original sources
PubMed1980

Primary biliary cirrhosis: an epidemiological study.

A three-year study (1977-9) of primary biliary cirrhosis in the city of Sheffield disclosed 34 cases, a point prevalence of 54 per million population. Closer inspection showed an apparent clustering of cases, and the prevalence in relation to one water reservoir appeared to be more than ten times that of the other reservoirs. Nevertheless, analyses of the water showed no significant relevant differences between the reservoir serving areas with a high prevalence of cirrhosis and other reservoirs. Despite the inconclusive results of the water analyses, these findings do suggest that an environmental agent may be a cause of primary biliary cirrhosis and that further epidemiological studies may help to elucidate the cause.

Adult↗
PubMed1980

Liver disease complicating severe haemophilia in childhood.

Liver biopsies were performed in 5 boys aged between 2 and 9 years with severe classical haemophilia who had persistently abnormal liver function tests. Abnormal histology was present in all; 4 had chronic persistent hepatitis and the fifth chronic aggressive hepatitis with early cirrhosis. Evidence of previous hepatitis B infection was present in one patient, 3 had antibodies to hepatitis, A, and 2 had subnormal levels of alpha-1-antitrypsin. Haemobilia occurred as a late complication of biopsy in one. The significance of these findings in young boys is discussed, as is the role of exposure to factor VIII containing blood products. It is concluded that cryoprecipitate should be used in preference to large pool factor VIII concentrates in children with haemophilia.

Child↗
PubMed1979

Differences in intrahepatic portal-systemic shunting in alcoholic and nonalcoholic liver disease as assessed by liver scan, portal pressure, and E. coli antibodies.

The interrelationship among portal vein pressure, 99mTc sulfur colloid liver/spleen scan abnormality, and serum E. coli antibody titers has been examined in 33 patients with alcoholic liver disease (ALD) and compared with 24 patients with liver disease not related to alcohol (non-ALD). A correlation between portal vein pressure and liver scan abnormality is seen in both groups, but for a given degree of portal hypertension there is a much greater redistribution of sulfur colloid in the ALD group (P less than 0.01). E. coli antibody titers are significantly higher in the ALD patients compared with the non-ALD patients (P less than 0.02), and they show a positive correlation with scan abnormality but not with portal vein pressure. It is suggested that the differences in scan appearance and E. coli antibody titers in these two groups of liver disease patients may be related to differences in intrahepatic shunting.

Alcoholism↗
PubMed1978

Percutaneous liver biopsy and chronic liver disease in haemophiliacs.

Systematic screening of forty-seven haemophiliacs in Sheffield revealed abnormal liver-function tests in thirty-six (77%), with a tendency for these abnormalities to persist. To assess the importance of these abnormalities, percutaneous liver biopsy was carried out on eight symptom-free patients under factor-VIII cover. A wide spectrum of chronic liver disease was demonstrated, including chronic aggressive hepatitis and cirrhosis. The liver pathology bore no relation to clinical history or to biochemical findings. Hepatitis-B-virus markers were common, but evidence suggests that this is not the only factor contributing to the development of liver disease. The high incidence of chronic liver disease seems to be a recent development and is probably related to factor-concentrate replacement therapy.

Adult↗
PubMed1978

Acid hydrolases in monocytes from patients with inflammatory bowel disease, chronic liver disease, and rheumatoid arthritis.

A sensitive technique was used to estimate two acid hydrolases--N-acetyl-beta-glucosaminidase (N.A.G.) and beta-glucuronidase (B.G.)--produced by peripheral-blood monocytes. Enzyme levels were measured after in-vitro incubation of monocytes with or without stimulation by zymosan and endotoxin. Compared with controls, enzyme production and release in inflammatory bowel disease, chronic liver disease, and rheumatoid arthritis were markedly raised. It is suggested that various stimuli, including immunological ones, may be responsible for the release of such enzymes from monocytes and that such release may be a factor in the production of the chronic inflammation seen in these disorders.

Acetylglucosaminidase↗
PubMed1978

Portal and systemic bacteraemia and endotoxaemia in liver disease.

Using a percutaneous transhepatic technique, blood was obtained from the portal veins of 30 patients with various hepatic disorders and examined for the presence of bacteria and endotoxin. Simultaneous samples also were drawn from hepatic and peripheral veins. In three cases, portal vein cultures grew diphtheroids, which were of doubtful significance, while all hepatic and peripheral cultures were sterile. Endotoxin was detected in seven portal vein samples; in none of these patients were the hepatic or peripheral blood samples positive. In three cases, only peripheral blood samples were positive for endotoxin. It was concluded that portal bacteraemia occurs as infrequently in patients with liver disease as in those without. Portal endotoxaemia was detected in patients with all degrees of liver disease but, even in patients with moderately severe portal hypertension, the liver may remain an effective filter of endotoxin.

Corynebacterium↗
PubMed1978

DNA-binding antibodies and hepatitis B markers in acute and chronic liver disease.

A Farr technique has been used to assay antibodies to double-stranded DNA in the serum of patients with acute and chronic liver disease and carriers of HBsAg from the United Kingdom and Iraq. These antibodies were found in all groups from both countries. The highest levels were found in chronic active hepatitis and cirrhosis. In the Iraqi patients there was a strongly positive correlation between DNA-binding antibody levels and the presence of hepatitis B markers but not with disease activity. In the patients from the United Kingdom there was little correlation with disease activity and none with autoantibodies. Ninety-five per cent of asymptomatic carriers of HBsAG had elevated DNA-binding antibodies. It is suggested that hepatitis B-specific DNA might be one trigger to DNA antibody formation, though in liver disease a variety of factors are clearly operative.

Acute Disease↗
PubMed1978

Amoebic liver abscess in Wessex--a retrospective survey of 24 cases.

The clinical features and response to treatment of 24 patients with amoebic liver abscess in Wessex are presented. Two patients died before adequate treatment could be instituted, but 6 of the remaining 22 patients (27%) did not respond to single courses of conventional anti-amoebic therapy. Possible reasons for this high failure rate are discussed. It is concluded that although Metronidazole is a highly effective anti-amoebicide, there remains a place for other drugs such as Emetine. The importance of early diagnosis of Amoebic Liver Abscess is emphasised.

Adult↗
PubMed1977

Direct transhepatic measurement of portal vein pressure using a thin needle. Comparison with wedged hepatic vein pressure.

A technique for the direct measurement of portal vein pressure in fully conscious patients is described. This uses a percutaneous transhepatic approach with a thin Chiba needle and is shown to be simple and safe. The technique has been applied to 123 patients with a variety of liver disorders and the pressure measurements have been compared with those obtained by the indirect technique of wedge hepatic vein catheterization. Close agreement was found between portal vein pressure and wedged hepatic vein pressure in quiescent alcoholic liver disease and alcoholic hepatitis. In chronic active hepatitis, portal vein pressure tended to be higher than wedged hepatic vein pressure, indicating a presinusoidal component to the portal hypertension. This technique is shown to be useful in assessing idiopathic protal hypertension and in demonstrating hepatofugal flow.

Alcoholism↗
PubMed1976

Liver abnormalities and gallstones: a prospective combined clinical, histological and surgical study.

In a prospective study of 57 patients coming to elective cholecystectomy for gallstone disease, clinical, biochemical and immunological features have been correlated with the histological changes in core biopsies of the liver obtained at surgery. Only 13 liver biopsies were normal. Ten biopsies showed changes of acute duct obstruction, 16 showed minimal portal tract abnormalities and 10 showed moderate portal tract inflammation and scarring. Histological changes were more marked in male patients. Clinical and biochemical investigations were not useful in predicting histological appearance, apart from cases with jaundice at the time of operation where changes of acute duct obstruction were usually, but not invariably, seen. Atuo-antibodies were present in 50 per cent of cases tested and all persisted for at least 6 months after operation. They were commoner in patients with more marked histological changes. Operative cholangiography was of little use in predicting histological change. These findings suggest that the possibility of gallstones should be considered in the interpretation of any abnormal liver biopsy irrespective of clinical symptoms or biochemical investigations.

Adult↗
PubMed1976

Measles antibodies and autoantibodies in autoimmune disorders.

Measles CF antibodies have been examined in the sera of patients with a variety of clinical disorders associated with the production of autoantibodies. Previous reports of high-titre reactions in DLE and chronic active hepatitis have been confirmed, the titres in the latter disorder being particularly elevated. Mean antibody titres to measles in patients with rheumatoid arthritis were significantly lower than in matched controls, and an inverse correlation between measles antibody levels and serum globulin levels was found. Measles antibody titres in patients with myasthenia gravis and primary biliary cirrhosis did not differ significantly from those found in controls. However, subdivision of patients with rheumatoid arthritis, myasthenia gravis and primary biliary cirrhosis showed that the presence of anti-nuclear antibody (ANA) was associated with significantly increased measles antibody levels compared with the ANA-negative sera. The presence of gastric parietal cell antibody or thyroid microsomal antibody did not appear to be associated with increased measles antibody levels, whether or not they occurred in association with previous anaemia or thyroid disease. Possible explanations for these findings in terms of immune complex formation and immune hyper-reactivity are discussed.

Anemia, Pernicious↗
PubMed1976

Alpha-1-antitrypsin deficiency and liver in adults.

Thirteen adult patients (aged 16 to 73 years) form 12 families are described with liver disease and alpha- 1- antitrypsin deficiency. Long-term observation of several of these patients suggests that the liver disease may be only slowly progressive, but review of possible factors aggravating this has failed to reveal any obvious clues. Progression to death from hepatic failure was the commonest outcome, but one patient developed a malignant hepatoma and two others died because of intraperitoneal haemorrhage due to ruptured cirrhotic nodules--a complication not hitherto described in association with this condtion. Diagnosis of alpha-1-antitrypsin deficiency was based on serological, histological, immunopathological and genetic studies. The most useful screening test in liver disease was found to be the demonstration of PAS positive globules in liver biopsy material which is diagn by immunofluoresence or immunoperoxidase, the latter being a superior technique. Serum estimation of alpha-1 -antitrypsin deficiency was performed by immunoelectropharetic and immunodiffusion techniques, the former being preferred because it gave more consistent results. Both methods, however, were of limited value since wide variations in the serum values are commonly found in normal and abnormal states. Genotyping was carried out using starch gel electrophoresis and although of value in family studies, its value as a diagnositc aid is limited because of technical difficulties and also because alpha-1-antitrypsin accumulation in the liver may be found in both homozygous and heterozygous states. It is suggested that adult liver disease associated with abnormalities in alpha-1-antitrypsin may be more common than has hitherto been reported. This condition should be systematically sought in all cases of liver disease of uncertain aetiology.

Adolescent↗
PubMed1976

Bacterial, viral and auto antibodies in acute and chronic liver disease.

There have been numerous reports of elevated antibody titres to a variety of bacteria and viruses in the sera of patients with acute and chronic liver disease. The results are reviewed in the light of the immunological function of the liver, notably its ability to sequester exogenous antigens and the loss of this property following liver damage. Non-organ specific auto-antibodies are also commonly found in most forms of acute and chronic liver disease, the pattern varying from one disorder to another. A possible hypothesis linking these phenomena is put forward.

Acute Disease↗
PubMed1975

Quantitative liver imaging using 131-I Rose Bengal as an index of liver function and prognosis.

A technique for assessing quantitatively hepatic function by direct measurement of liver parenchymal cell uptake of 131I Rose Bengal using a scintillation camera with a digital store and retrieval system is described. Ninety-four studies were performed on 84 patients with a variety of hepatic disorders over a two-year period, the diagnosis in each case being established by liver biopsy or laparotomy. The results were compared with the clinical, biochemical and histological assessment of the patients. A good correlation was found between the half-time for hepatic uptake of 131I Rose Bengal and the histological changes, as well as with clinical prognosis measured in terms of clinical improvement or deterioration to death. The rate of liver uptake was found to be a better index than the clearance of radioisotope from the blood and was superior to conventional biochemical investigations in both icteric and anicteric patients. The test was not shown to be of clinical value in discriminating between intra- and extrahepatic causes of jaundice. It is suggested that this technique may provide a safe and sensitive method for assessing the severity of liver dysfunction and also for monitoring clinical progress, especially in situations where liver biopsy may be unreliable or hazardous.

Biopsy↗