Biomedical subjects
Publications and source records attributed to R R Schade.
In multiple myeloma, diffuse infiltration of the liver by myeloma cells can result in hepatic dysfunction and enzyme elevation. Discrete plasmacytomas are unusual and seldom disturb hepatobiliary function. We report a patient who developed jaundice due to extrahepatic biliary obstruction caused by an abdominal plasmacytoma.
Mixed rat pituitary cells harvested from pituitaries obtained from adult male rats were maintained in tissue culture for periods up to 240 hr. Viability determined by trypan blue exclusion at the end of each experiment was greater than 90%. Basal secretory rats of luteinizing hormone (LH) into the culture medium were determined before and after the addition of ethanol (30 mg/100 ml) to the incubation medium. Ethanol-reduced (p less than .01) LH secretion of treated cultures were compared to control cultures. Based upon this preliminary in vitro study with rat tissue and on prior studies performed in man and animals, we suggest that ethanol inhibits LH secretion at the pituitary level.
In order to determine the nature of T lymphocytes accumulating in hepatic tissues of patients with alcoholic liver disease, we phenotyped these cells in situ, using monoclonal antibodies to lymphocyte surface antigens and the avidin-biotin-peroxidase complex (ABC) technique. In portal areas of cirrhotic livers, a significant increase (p less than 0.001) in T lymphocytes was observed as compared to livers showing only fatty changes and normal liver tissues. The T cells accumulating in cirrhotic livers comprised T helper-inducer (T4) and T suppressor-cytotoxic (T8) subsets with the T4/T8 ratio of 1.4 +/- 0.5 (SD, n = 14). In contrast, the T lymphocytes in the cellular projections which extended into the parenchyma consisted mostly of suppressor-cytotoxic cells. The relative enrichment in T8+ lymphocytes among the cells invading the parenchyma suggests that they may be important in the mediation of a cytotoxic injury of hepatocytes in advanced alcoholic liver disease and in regulating an immunologic challenge possibly initiated in response to alcoholic hyaline.
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Disulfiram is used commonly as reinforcement in the treatment of chronic alcoholism. Although the drug is generally considered safe, there are reports of side effects including psychosis and hepatitis. We report a case of fatal fulminant hepatitis caused by the use of disulfiram in a man with previously normal hepatocellular function.
The gastric emptying of 99mTc-sulfur colloid, ingested in a nutrient liquid test meal, was followed by gamma camera for normals, diabetics, and diabetics receiving intravenous metoclopramide. Gastric emptying patterns of 99mTc by these groups present as normal, slow, and rapid on simple graphic inspection. Half times of indicator emptying were computed from inspection and from least-squares linear regressions of log(base e) residue versus time for the total postpeak curve and for the remainder of the 15-min postpeak curve. In addition, the percent of 99mTc residue leaving at, and the area under, the residue curve until 6, 12, 24, and 60 min postpeak and the indicator mean transit time (MTT) were computed. Standard half-time determinations revealed no significant differences among the three groups, despite obvious visual differences among them. In contrast, the mean transit time of the rapid group was significantly less than that of the slow (P less than 0.01) and normal (P less than 0.05) groups. However, no statistical difference was noted between the slow and the normal emptiers (P greater than 0.1) using the MTT measure. The percent of particles leaving the stomach and the area under the residue curves demonstrated significant differences among the three groups, reflecting the obvious visual perceptions gained from simple curve inspection. Because the percent of indicator particles leaving the stomach region at a given time reflects a single time, it was concluded that the residue area represents the most reliable, objective, and quantifiable parameter for testing of significant differences.
In one year, we have performed esophageal varix sclerosis upon 20 patients with portal hypertension and bleeding esophageal varices who were not candidates for portosystemic shunting. The flexible fiberoptic endoscope permits sclerosis of both gastric and esophageal varices and is less prone to serious complications than the rigid instrument. Repeated injections are necessary to control hemorrhage. Five of nine acute episodes were successfully controlled. Fifteen patients survived initial hospitalization and entered a chronic injection protocol. Sclerosis has controlled recurrent variceal bleeding in 13 of this group. We now use injection sclerosis as the primary form of therapy for patients who have bled from esophageal varices. Portosystemic shunting is reserved for those instances of sclerotherapy failures.
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A patient with coexistent hemochromatosis and alpha-1-antitrypsin deficiency which led to cirrhosis and death despite adequate therapy for hemochromatosis is reported. Evaluation of the family revealed first degree relatives with iron overload and others with alpha-1-antitrypsin deficiency but none with both conditions. The role of family studies in the early recognition and possible prevention of overt clinical disease in individuals with either of these two genetic diseases is discussed.
The prevalence of impotence is increased in males who chronically abuse alcohol. Further, impotence may occur in the absence of liver disease in such men. In contrast, no data is available concerning the prevalence of impotence in nonalcoholic men with advanced liver disease. To investigate the relationship between alcohol and impotence in cirrhotic men, a self-administered questionnaire was completed by male alcoholic cirrhotics admitted to the medical service as well as by nonalcoholic cirrhotic liver transplant candidates admitted to the medical and surgical services of Presbyterian-University Hospital. Each participant was asked whether or not he had experienced impotence and if so, to report the frequency and duration of his impotence. The frequency of impotence was recorded on a weighted scale with four gradations: 4 = always; 3 = usually; 2 = sometimes; 1 = seldom. In addition, measures of hepatic injury and function as well as measures of the functional integrity of the hypothalamic-pituitary-gonadal axis for each subject evaluated were obtained. Fourteen of the 20 alcoholics with cirrhosis and 10 of the 40 nonalcoholic liver transplant candidates with cirrhosis reported a history of impotence. The association between impotence and alcohol abuse was significant. The impotence index developed by multiplying the frequency by the duration of impotency for each individual demonstrated a more severe degree of impotence in the alcoholics as compared to the nonalcoholics (p less than 0.01). The alcoholics also had lower plasma levels of testosterone and greater plasma levels of gonadotropins as compared to the nonalcoholics.(ABSTRACT TRUNCATED AT 250 WORDS)
Liver transplantation has been developed to the point of a service operation, the exploitation of which depends upon the establishment of multiple regional centers. The increased use of this procedure will permit the delivery of optimum health care to victims of endstage liver disease.
The incidence of prospective organ donors in the United States and the techniques which are to used to guarantee their optimal use after identification are analyzed. Attitudes of the public and health professionals toward organ donation are discussed. The organization of the Pittsburgh Organ Procurement Agency and its relationship to other such agencies is described. Finally, the presently used techniques of liver salvaging and preservation are outlined.
The methods used to screen prospective candidates for orthotopic liver transplantation are described. Both the indication and the contraindications for the procedure are discussed. The timing of the procedure during the course of an individual candidate's liver disease is also discussed. Additionally, the institutional requirements of a liver transplant center are identified. Finally, the problems experienced by a liver transplant patient and his physician during the postoperative period are identified and discussed.
The thyroid hormones T4, T3, rT3 and TSH were assayed in 134 adult patients evaluated and accepted as potential liver transplant candidates at the University of Pittsburgh from March, 1981 to December, 1983. The subsequent course of these patients was evaluated with respect to the levels of these hormones obtained at the time of acceptance for transplantation. T4 levels were increased significantly while their T3 levels were reduced (both p less than 0.01) in those who survived and were discharged home as compared to either those who died waiting to be transplanted or died following the procedure. As a result, the ratio of T3/T4 was reduced markedly (p less than 0.01) in those who were transplanted and survived as compared to those not transplanted or dying following transplantation. Importantly, the rT3 levels clearly separated (p less than 0.01) those who would die prior to transplantation from those who would survive to be transplanted. Finally, the ratio rT3/T3 even more clearly separates those who will die prior to transplantation (p less than 0.01) from the other two groups. These data suggest that thyroid hormone levels, particularly rT3 levels, might be useful in setting priorities for which patients referred for a transplantation evaluation should be accepted into the program and in determining who among accepted patients should be operated upon in preference to others also accepted and waiting to be transplanted.
Portal-systemic encephalopathy, which occurs as a consequence of cirrhosis of the liver, is associated with a variety of neuropsychiatric symptoms. Problems related to the differential diagnosis and medical management of portal-systemic encephalopathy, as compared to other more usual psychiatric disorders, are discussed. Also addressed are issues of particular concern to psychiatry, such as the use of pharmacotherapeutics and the rehabilitation of alcoholism, which are commonly seen in individuals with portal-systemic encephalopathy and liver disease, as well as in the general psychiatric patient population.
Individuals with chronic renal failure (CRF) may have a variety of gastrointestinal (GI) problems, including dyspepsia, acid peptic disease, and bacterial overgrowth. We investigated gastrointestinal function in 11 uremic patients, seven of whom were on dialysis three times a week and four who were not on dialysis. Ten normal subjects were studied as controls. The nutritional status of the patients did not differ from that of the control subjects. Seven patients demonstrated abnormal GI endoscopic findings, although none was severe; they also had prolonged oral-cecal transit times but had no evidence of bacterial overgrowth, and all had normal numbers of lymphocyte subpopulations within the intestinal mucosa. The patients had significantly reduced activities of mucosal sucrase and maltase but not of lactase. In spite of the reductions in these enzymatic activities, carbohydrate malabsorption was not evident in the CRF group, probably because of the vast reserve of the small intestine. No differences were noted between the groups in the activities of several intestinal peptidases. From these data, we concluded that GI function is essentially normal in patients with CRF and postulate that this normality, which is in contrast to previous findings, is related to recent advances in the clinical management of uremic patients.