Biomedical subjects
Publications and source records attributed to H D Appelman.
The angiographic and pathologic features of two cases of primary carcinoid-like hepatic tumors are described. Neither patient had the carcinoid syndrome.
The contribution of hepatocytes of different acinar zones to bile salt transport and to the secretion of the BSNDF was studied in the rat. Changes in the removal of 14C-taurocholate from blood, in the biliary secretion of taurocholate, and in canalicular flow were determined after damage of the periportal (acinar zone 1) or centrilobular (acinar zone 3) areas by allyl alcohol or bromobenzene, respectively. The extent of cell necrosis was quantitated by light microscopy, and the quality of the intracellular damage was assessed by electron microscopy. After either periportal or centrilobular damage, surviving cells responded to an intravenous infusion of taurocholate by secreting bile salts into bile at a rate similar to controls. However, following the administration of 14C-taurocholate at high concentrations and as a single bolus, the rate of removal of this isotope from blood was slower than in controls. Both experiments suggested that periportal and centrilobular hepatocytes had the capability for bile salt transport. Consequently, since the concentration of bile salts in sinusoidal blood at each zone determines the relative contribution of hepatocytes to bile salt transport, periportal cells probably transport the largest amount of bile salts reaching the acinus. Canalicular bile flow, on the other hand, decreased following centrilobular cell damage, and this was associated with a high concentration of bile salts in bile. This suggested that at bile salt loads near physiological concentrations, the predominant contribution of centrilobular hepatocytes is to the secretion of the BSNDF.
Liver cell regeneration after selective zonal injury induced by bromobenzene (acinar zone III damage) and allyl alcohol (acinar zone I damage) was examined in the context of the simple liver acinus. The zonal distribution of necrosis and inflammation was assessed by light microscopy and the volume fraction of necrosis was quantitated at the times of maximal damage. The acinar distribution of hepatocytic [6-3H]thymidine incorporation was determined autoradiographically at 24, 36, 48, 60, 72, and 96 hr after the administration of the toxicants. The mitotic index for each acinar zone was calculated at the time of peak thymidine incorporation after each drug and then at 12-hr intervals for the next 24 hr. Autoradiographic data indicated that the relative contributions of acinar zones II and III to [6-3H]thymidine incorporation were greater after zone III damage (bromobenze), whereas the relative contribution of acinar zone I was greater after allyl alcohol (zone I) damage. This was observed despite the greater degree of damage seem after bromobenzene than after allyl alcohol (volume fractions of necrosis were 26.4 and 10.1%, respectively). Moreover, the acinar distribution of mitosis indicated an increased centrizonal mitosis after centrizonal damage, and an increased periportal mitosis after periportal damage. Thus, the contribution of each acinar zone to liver cell regeneration depends on the acinar location of damage.
Sarcomas of the gastric wall, other than lymphomas, are a heterogeneous group of stromal malignant neoplasms composed of round and spindle cells. Many are malignant forms of epithelioid leiomyoma. Small cell size, high cellular density, a high rate of mitotic activity, and cellular pleomorphism are helpful clues in distinguishing malignant from benign gastric stromal tumors. Sarcomas of the stomach are aggressive, rapidly growing neoplasms. Among 44 examples metastasis occurred in three-fourths of the patients, usually within the first year after diagnosis.
Ethanol (10 or 15% in the drinking water) was found to increase the amount of collagen in the livers of rats receiving a cirrhogenic diet. This effect of ethanol was most striking in the animals receiving 10% ethanol. Ethanol lowered the amount of labeled proline incorporated into hydroxyproline and, therefore, into collagen. The amount of labeled hydroxyproline remaining in the liver 7 days after injection was greater in the rats receiving 10% ethanol than in the pair-fed controls. A net increase in collagen deposition attributable to ethanol was associated with lowered rate of collagen synthesis. The main action of ethanol in increasing the rate of collagen deposition, therefore, must be inhibition of collagen breakdown.
During an eight-year period, 17 patients ranging in age from 7 months to 81 years were found to have arteriovenous malformations (AVMs) of the gastrointestinal tract complicated by major hemorrhage. After review of these cases, a clinical classification of AVMs was developed, based on angiographic characteristics, localization, age of the patient, and family history. Type 1 AVMs were solitary, localized lesions within the right side of the colon. They occurred in seven patients 55 years of age or older. None were palpable or visible at operation. Type 2 AVMs occurred in seven patients. They were larger and occasionally visible, most commonly in the small intestine, and probably of congenital origin. Symptoms all began before 50 years of age. Type 3 AVMs were punctate angiomas causing gastrointestinal hemorrhage. They occurred in three patients with the classical findings of hereditary hemorrhagic telangiectasia. The diagnosis of most AVMs can be determined preoperatively only by selective angiographic studies.
During the past decade, an increasing number of hepatic cell adenomas have been reported. Sppntaneous rupture, a life-threatening complication of this rare tumor, has been noted more frequently. Eight patients with hepatic cell adenomas have been treated at our center. Three patients first developed symptoms from hemoperitoneum. Palpable tumors were discovered in three asymptomatic patients during routine examinations. Two patients had upper abdominal pain from intrahepatic hemorrhage. All patients were young women using oral contraceptive agents. Emergent hepatic lobectomy was performed in the three patients with rupture. The other five patients underwent selective angiographic studies, prior to elective liver resections. All survived operation and have done well since. The increased incidence of hepatic cell adenomas may be related to the use of oral contraceptive agents.
Magnification hepatic wedge venography and manometry were evaluated in 40 patients with portal hypertension and in 6 normal individuals. Venography (alone or in combination with manometry) generally facilitated prediction of histology in cirrhosis, hepato-venular occlusive disease, periportal fibrosis, congenital hepatic fibrosis, and portal vein obstruction. The magnification wedge venograms demonstrated a number of histological features of cirrhosis that have not previously been described in vivo, including porto-hepatic vein shunts, micro- and macronodular regeneration, and obstructive changes which were more severe in hepatic than in portal veins.
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