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Biomedical subjects

G L Davis

Publications and source records attributed to G L Davis.

At least 109 records · Page 6Linked to original sources
PubMed1993

Renal splenic heterotopia, a rare mimic of renal neoplasia: case report of imaging and fine-needle aspiration biopsy.

Renal splenic heterotopia, a very rare benign occurrence of splenic tissue within the renal capsule, mimics organizing capsular hemorrhage, adenomyolipoma and renal cortical adenoma or carcinoma. It is found incidentally as a result of imaging asymptomatic kidneys for other reasons or may cause signs and symptoms due to mass effect and hypersplenism. When occurring in patients who had had splenectomy it has been classified as splenosis. When found in patients with intact spleens it is called splenorenal fusion and considered to be a developmental heterotopia. Renal splenic heterotopia can be diagnosed by 99mTc-sulfur colloid scan and confirmed with fine needle aspiration biopsy cell block preparations. Unnecessary nephrectomy can be avoided if splenic heterotopia is included in the differential diagnosis of renal lesions, particularly in splenectomized patients.

Aged↗
PubMed1993

Interleukin-1 differentially modulates chondrocyte expression of cyclooxygenase-2 and phospholipase A2.

Interleukin-1 beta (IL-1) increases the synthesis of prostaglandins as well as the expression of synovial fluid phospholipase A2 (PLA2) mRNA and activity by chondrocytes. In order to examine the potential involvement of cyclooxygenase in the induction of prostaglandins by IL-1, the effect of IL-1 on rabbit articular chondrocyte expression of cyclooxygenase enzymes was investigated. By Northern analyses, mRNA for cyclooxygenase-2 (COX-2) was found to be constitutively expressed, and its expression was increased in cultures treated for 24 h with IL-1 (100 ng/ml). Cyclooxygenase-1 mRNA was not detected in control or IL-1-treated cultures. IL-1 caused a concentration-dependent increase in steady-state levels of COX-2 message as assessed by slot-blot analyses. Half-maximal induction of the COX-2 message levels was estimated to require 1.2 ng/ml IL-1. In duplicate slot blots probed with a cDNA for synovial fluid PLA2, half-maximal induction of PLA2 mRNA was estimated to require 0.15 ng/ml IL-1, approximately 10-fold less IL-1 than required for COX-2. In addition, maximal increase in COX-2 message levels was only 3-fold as compared with a 13-fold induction of PLA2. No change in message levels for the intracellular protein, actin, was found between control and experimental cultures. Cycloheximide enhanced COX-2 transcript levels, but did not modulate IL-1 induction of COX-2. Actinomycin D did not inhibit IL-1 augmentation of COX-2 mRNA levels; whereas, induction of PLA2 mRNA levels was completely inhibited, implicating transcriptional mechanisms in the induction of PLA2 but not COX-2 mRNA. These data demonstrate that chondrocyte expression of COX-2 and synovial fluid PLA2 are differentially modulated by IL-1.

Animals↗
PubMed1993

Pathological diagnosis of chronic hepatitis C: a multicenter comparative study with chronic hepatitis B. The Hepatitis Interventional Therapy Group.

BACKGROUND: Hepatic histological responses described in hepatitis C virus (HCV) infection include bile duct damage, lymphoid follicles and/or aggregates in portal tracts, large- and small-droplet fat, Mallory body-like material in hepatocytes, liver cell dysplasia and multinucleation, and activation of sinusoidal inflammatory cells. The specificity of these lesions for HCV infection is uncertain. METHODS: In two multicenter trials of recombinant interferon alfa therapy for chronic hepatitis C and B, the frequency of these eight lesions in pretherapy and posttherapy liver biopsy specimens was examined to determine the set of features, if any, that distinguishes HCV from hepatitis B virus (HBV) infection. The lesions were scored in 317 HCV biopsy specimens and 299 HBV specimens. RESULTS: Stepwise logistic regression determined a set of three features more likely to be seen in HCV than in HBV infection: bile duct damage [odds ratio (OR), 4.7; 95% confidence interval (Cl), 1.8-12.3], lymphoid follicles and/or aggregates (OR, 2.4; 95% Cl, 1.2-4.7), and large-droplet fat (OR, 2.4; 95% Cl, 1.4-4.1). A fourth lesion, Mallory body-like material, was seen only in HCV biopsy specimens (OR, 71.6; 95% Cl, 4.4-996.1). CONCLUSIONS: These four histological lesions are useful pathological parameters in the diagnosis of liver disease caused by HCV.

Biopsy↗
PubMed1993

Fibrosing cholestatic hepatitis in a transplant recipient with hepatitis B virus precore mutant.

A patient with hepatitis B virus (HBV) precore mutant (seropositive for hepatitis B surface antigen [HBsAg], anti-hepatitis B e antigen [HBeAg], and HBV DNA) who underwent orthotopic liver transplantation for end-stage liver disease is described. Sequencing of the HBV precore region of the pretransplant serum sample confirmed the presence of the precore stop-codon mutant (G-->A mutation in codon 1896) only. The patient received HBV immunoglobulin prophylaxis for 6 months but HBV recurred thereafter with a mild hepatitic flare, and he remained seropositive for HBsAg, anti-HBe, and HBV DNA. The initial hepatitic illness resolved in 3 months. The patient remained well for another 16 months before presenting with fibrosing cholestatic hepatitis (FCH). During his entire initial hepatitic flare, quiescent period, and final FCH phase, he remained seropositive for HBsAg, anti-HBe, and HBV DNA. Moreover, sequencing of the serum HBV DNA in final FCH phase showed the presence of the identical HBV precore mutant. Immunohistochemical staining showed extensive expression of HBsAg/pre-S1, pre-S2, and hepatitis B core antigen, but HBeAg was scarcely detectable. This case illustrates that (1) recurrence of HBV precore mutant infection can occur in liver; (2) it can give rise to FCH; and (3) hepatic accumulation of HBeAg is not essential for the development of FCH.

Adult↗
PubMed1993

Hepatitis C virus infection in kidney transplant recipients.

To determine the prevalence and significance of hepatitis C virus infection in kidney transplant recipients, paired serum samples collected from 100 renal allograft recipients on admission for kidney transplantation and 1 yr after transplantation were tested for antibody to hepatitis C virus with second-generation enzyme immunoassay and recombinant immunoblot assay and for hepatitis C virus RNA with reverse transcription-polymerase chain reaction. Before kidney transplantation, hepatitis C virus antibody was detected with second-generation enzyme immunoassay in 18 patients (12 second-generation recombinant immunoblot assay-positive, 6 second-generation recombinant immunoblot assay-indeterminate). Nine of 12 second-generation recombinant immunoblot assay-positive and 2 of 6 second-generation recombinant immunoblot assay-indeterminate samples were hepatitis C virus RNA positive. In addition, 7 of 82 patients who had no detectable antibody on second-generation enzyme immunoassay or second-generation recombinant immunoblot assay were hepatitis C virus RNA positive. After kidney transplantation, hepatitis C virus antibody was detected in 19 patients (12 second-generation recombinant immunoblot assay-positive, 7 second-generation recombinant immunoblot assay-indeterminate, 14 seropositive for hepatitis C virus antibody). Eleven of 12 patients with second-generation recombinant immunoblot assay-positive results and 4 of 7 with second-generation recombinant immunoblot assay-indeterminate results were positive for hepatitis C virus RNA. Hepatitis C virus RNA was present in 28 patients 1 yr after kidney transplantation. Six patients appeared to have acquired active hepatitis C virus infection 1 yr after kidney transplantation (seroconverted to hepatitis C virus RNA positivity).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Significance of antibody to the host cellular gene derived epitope GOR in chronic hepatitis C virus infection.

The humoral response to the host cellular gene-derived epitope GOR (anti-GOR) was reported to be associated with chronic hepatitis C virus (HCV) infection. To determine the prevalence and clinical significance of anti-GOR, sera from 31 patients (M/F, 19/12, age 30-72) with chronic HCV infection (anti-HCV+ in 30, HCV-RNA+ by PCR in 31) were tested for anti-GOR by enzyme immunoassay. Results were correlated with clinical, biochemical and histological features, and the subsequent response to interferon-alpha therapy (a complete response was defined as normalization of serum ALT at the completion of therapy; a sustained response was defined as having normal serum liver biochemistry during the entire follow-up period). Anti-GOR was detected in 21 patients [67.7%, median optical density (OD) reading 2.634, range 0.865-3.000, cut-off value 0.300]. There was no correlation between the presence or the OD reading of anti-GOR and the clinical features (sex, age, mode of acquisition), biochemical tests (serum ALT, AST, alkaline phosphatase and albumin levels), autoimmune markers [serum globulin levels, anti-nuclear antibody (+ at < 1:80 in 6/31 patients)], and their subsequent response to interferon-alpha therapy (complete response in anti-GOR+ patients: 13/21, anti-GOR-: 5/10, p = NS; sustained response in anti-GOR+ patients: 5/21, anti-GOR-: 2/10, p = NS). There was also no correlation between anti-GOR and the histological features including Knodell score and its components including periportal inflammation, portal inflammation and fibrosis, the presence of lymphoid aggregates, macrovesicular and microvesicular fat, multinucleated hepatocytes, dysplasia, sinusoidal activity or bile duct lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Relationship of the polymerase chain reaction for cytomegalovirus to the development of hepatitis in liver transplant recipients.

In a pilot study, the polymerase chain reaction was found to be more sensitive than standard viral culture methods for the detection of cytomegalovirus, particularly from blood and tissues. We therefore applied this technique to 71 serially collected liver biopsies from 16 orthotopic liver transplant patients. All patients were CMV-seropositive (n = 15) or seroconverted (n = 1). Seven patients (9 biopsies) had histologically proved CMV hepatitis, and all these biopsies were CMV PCR-positive. Six of these 7 patients had a prior liver biopsy that was CMV PCR-positive, but culture and histology-negative, an average of 13.2 +/- 6.9 days before the histologically positive biopsy. The 7th patient was not biopsied prior to the diagnostic biopsy. Three patients had 7 liver biopsies that were CMV PCR-positive, but histologically negative for CMV hepatitis. Two of these three had CMV infection confirmed by viral culture of blood or liver biopsy. The remaining 6 patients had a total of 26 liver biopsies that were negative for CMV by PCR, culture, and histology. Among liver transplant patients, CMV PCR performed on liver biopsy specimens correctly identified all histologically proven cases of CMV hepatitis. CMV PCR positivity in liver tissue did not correlate with latent infection and preceded the development of CMV hepatitis or other meaningful CMV infection in 8 of 10 patients.

Biopsy↗
PubMed1993

Non-A, non-B hepatitis and elevated serum aminotransferases in renal transplant patients. Correlation with hepatitis C infection.

One hundred renal transplant recipients were studied for antibodies to hepatitis C virus (HCV), and to HCV RNA in serum by reverse transcription+nested polymerase chain reaction (RT-PCR). Presence of antibody to HCV confirmed by recombinant immunoblot assay II was considered evidence of HCV infection, and detection of HCV RNA by RT-PCR was considered evidence for active viremia. On pretransplant sera, 18 patients were RT-PCR positive and an additional 3 had antibody evidence of HCV infection. At 1-year follow-up, all of these patients were RT-PCR positive and an additional 7 patients became RT-PCR positive. Clinical diagnosis of non-A, non-B hepatitis underestimated the prevalence of HCV infection (5/28 cases, 18%). Serum alanine aminotransferase (ALT) elevations were neither sensitive nor specific. An isolated pretransplant ALT elevation predicted a 52% chance of being RT-PCR positive for HCV. An ALT elevation greater than 2 months after transplant predicted a 45% chance of HCV positivity; however, 18% of patients who never had any ALT abnormality were also HCV positive. Sixty-eight patients had an early postoperative rise in ALT, but there was no correlation with HCV status. After an average follow-up of over 4 years, 3/28 HCV-positive patients developed cirrhosis. HCV infection in the renal transplant population is common and underdiagnosed by clinical and biochemical parameters. HCV appears not to cause aggressive liver disease in the early posttransplant period, but longer follow-up is needed to define the natural history of HCV in the renal transplant population.

Adult↗
PubMed1993

Initial results with recombinant interferon alfa-2b in patients with chronic hepatitis C: the United States experience.

Early experience with recombinant interferon alfa-2b in chronic hepatitis C (HCV) has shown that normalisation of serum alanine aminotransferase activities and reduction in hepatic inflammation can be achieved in about 40% of patients. This occurs with loss of viral replication as measured by polymerase chain reaction for HCV-RNA. Further studies are needed to identify patients most likely to respond to treatment and to investigate the issues of non-response and relapse when treatment is stopped. Alternative interferon treatment regimens, as well as other drugs and combinations of agents, need to be investigated.

Chronic Disease↗
PubMed1993

Psychological adjustment of liver transplant candidates.

The psychological functioning of 20 adult liver transplant candidates was evaluated. Using standardized assessment instruments, we found few personality disturbances and normal levels of anger. However, clinically significant levels of depression and anxiety were reported for 28% and 37% of the sample, respectively. Moreover, patients whose coping strategies were characterized by avoiding the exigencies of their illness reported more depression, more anxiety, and increased psychopathology. Disease severity was also positively correlated with anxiety and avoidant coping strategies. Implications of these findings for the pre-transplant psychological evaluation are discussed.

Adaptation, Psychological↗
PubMed1992

Treatment of chronic hepatitis.

Chronic hepatitis is an etiologically diverse syndrome. The approach to treatment depends on the cause of the disease. The efficacy of immunosuppressive treatment of chronic autoimmune hepatitis has long been established, and most patients with this disease can be treated successfully with prednisone and azathioprine. Interferon therapy has revolutionized the treatment of chronic viral hepatitis. Although the response in chronic hepatitis delta is disappointing, hepatitis C is often controlled, and certain patients with chronic hepatitis B may actually be cured of the disease. Future studies will seek to optimize the therapeutic effects of interferon in these viral diseases. Certainly, studies with other antiviral agents and biologic response modifiers are forthcoming. We have entered a new era in the treatment of chronic liver disease. It is reasonable to hope and expect that progress will continue and that most forms of chronic viral hepatitis will become curable within the next several years.

Anti-Inflammatory Agents↗