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Biomedical subjects

S Sherlock

Publications and source records attributed to S Sherlock.

At least 199 records · Page 11Linked to original sources
PubMed1980

An epidemic of type B viral hepatitis: its course and outcome.

Between June and August, 1977 there was a small epidemic of type B viral hepatitis in a market town in South-East England during which 4 people developed acute hepatitis. Their close friends and contacts were all negative for hepatitis B surface antigen (HBsAg) at this time. One year later, in July 1978, 3 of the original 4 patients were available for follow-up. All were HBsAg negative but hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc) positive. Two had disturbed liver function tests and chronic persistent hepatitis on liver biopsy. Also at this time 2 of the original contacts were found to show evidence, from the serum markers, of previous infection by the type B virus. Both had abnormal liver function tests and showed chronic persistent or chronic active hepatitis on liver biopsy. A further subject was identified who had had an overt hepatitis 1 year previously and who also showed evidence of continuing liver disease. The origin of the epidemic and its spread through the group were identified. The varying modes of transmission, and the variation in clinical picture and sequelae are discussed. The importance of anti-HBc as a marker of hepatitis B virus infection is emphasised.

Adolescent↗
PubMed1980

Treatment of chronic hepatitis.

Chronic persistent hepatitis is a benign condition and special treatment is not necessary. Chronic active hepatitis is usually treated with prednisolone. Hepatitis B positive patient's respond less well than those who are negative. The management of the asymptomatic patient is discussed. In hepatitis B positive patients immuno-stimulation with transfer factor or levamasole has been tried but with little benefit. Antiviral chemotherapy with interferon is promising, but the drug is not generally available and is very costly. Adenine arabinoside (ArA) is more available and less expensive and may prove beneficial.

Azathioprine↗
PubMed1980

Hepatitis B surface antigen and alpha-fetoprotein secreting human primary liver cell cancer in athymic mice.

A human primary liver cancer cell line which retains the property of synthesizing hepatitis B surface antigen has been successfully transplanted into nude (athymic) mice. The morphology of the heterotransplanted tumor is similar to that of a well-differentiated human primary liver cell cancer. It produces hepatitis B surface antigen, but there is no evidence of hepatitis B virion production: Hepatitis B core antigen is not detected in the PLC tissue, and serum is negative for hepatitis B e antigen. The nude mouse exhibits a resistance to the transplantation of the human primary liver cancer cells which can be modified by sublethal total body irradiation, suggesting involvement of an immunologic rejection mechanism. The heterotransplanted primary liver cell cancer also produces alpha-fetoprotein, as did the original tumor in vivo, although this marker was not detected during in vitro cell culture. The serum level of alpha-fetoprotein rises exponentially, enabling quantitative evaluation of tumor growth. The human primary liver cell cancer in nude mice provides an in vivo model for determination of tumor response to chemotherapeutic agents.

Animals↗
PubMed1980

Bile duct carcinoma: a late complication of congenital hepatic fibrosis. Case report and review of literature.

Bile duct carcinoma is reported in a 50-year old man as a rare late presentation of congenital hepatic fibrosis (CHF). A survey of the world literature suggests that carcinoma occurs with increased frequency in congenital biliary dilatation. It appears to be a particular risk in patients with prolonged survival but is rare in CHF, where portal hypertension and renal insufficiency make the long-term prognosis poor. In this patient the absence of both gastroesophageal varices and renal disease may have permitted longevity with development of carcinoma. The finding of carcinoma arising in the bile ducts distal to the basic lesion of CHF suggests that active carcinogens may be present in the bile in CHF. The tumor in this patient was unusual in producing mucinous biliary obstruction and terminal hypercalcemia.

Adenocarcinoma, Mucinous↗
PubMed1980

Triethylene tetramine dihydrochloride toxicity in primary biliary cirrhosis.

Triethylene tetramine dihydrochloride (trien) is a copper chelating agent used as the alternative drug of choice in the treatment of Wilson's disease. Because of its apparent safety, we have used the drug in 4 patients with primary biliary cirrhosis in whom penicillamine had to be withdrawn because of serious side effects. Trien is an effective cupruretic drug in primary biliary cirrhosis, but its use is limited by the occurrence of side effects that occurred in all 4 patients. Three patients developed gastrointestinal side effects, and one of these patients developed a skin rash. The 4th patient developed acute rhabdomyolysis within 48 hr of receiving the first dose of the drug. One patient tolerated therapy for 20 wk, and, although her liver copper concentration did not show a marked fall, aspartate transaminase levels fell, and her IgM concentration fell to normal. Trien is an unsuitable copper chelating drug in primary biliary cirrhosis, although it remains the alternative drug of choice in Wilson's disease.

Adult↗
PubMed1980

Percutaneous transhepatic portography in the assessment of portal hypertension. Clinical correlations and comparison of radiographic techniques.

Sixty-four transhepatic portograms performed before transhepatic obliteration of varices in patients with variceal hemorrhage have been reviewed. Sixty-two patients had coronary gastroesophageal vessels feeding gastric and esophageal varices and other major collateral circulation was seen in 25 patients. There was no relationship between the presence of major collateral circulation and the height of portal pressure or the severity of hemorrhage from gastroesophageal varices. Failure to opacify the intrahepatic portal venous system was seen in 11 patients and was strongly associated with portal-systemic encephalopathy. In addition to transhepatic portography, 35 patients had a splenic portogram, and 27 patients had coeliac axis angiography. There was poor agreement between the findings of these three techniques. Transhepatic portography was markedly superior in demonstrating the portal-systemic collateral circulation. Because of the excellent anatomical definition obtained, transhepatic portography is a superior technique for visualizing the portal system. However, even this technique may occasionally fail to demonstrate gastroesophageal collateral circulation in patients with endoscopically documented variceal hemorrhage.

Adult↗
PubMed1980

Immune function in patients with extrahepatic portal venous obstruction and the effect of splenectomy.

Abnormalities of cell-mediated immunity-anergy to delayed hypersensitivity skin testing, diminished T-lymphocyte concentrations and mitogen responsiveness, and the presence of serum inhibitors--have been shown to be present in patients with portal venous obstruction and normal hepatic function. In contrast, tests of humoral immunity--antibody titiers to viral and bacterial antigens and immunoglobulin concentrations--were normal. These abnormalities in cell-mediated immunity are probably the result of the development of portal hypertension, portosystemic shunting, and congestive splenomegaly. These studies raise the possibility that qualitatively similar defects in patients with chronic liver disease and portal hypertension may, in part, be attributable to the same mechanisms.

Adolescent↗
PubMed1980

Successful use of bromocriptine in the treatment of chronic hepatic encephalopathy.

Six patients with cirrhosis and severe chronic hepatic encephalopathy were treated with bromocriptine. All showed significant overall improvement clinically and in 3, the electroencephalogram became normal. The cerebral blood flow increased significantly from 32.7 +/- 2.4 (mean +/- 1 SE) to 40.5 +/- 1.5 ml/100 g brain/min (P less than 0.05). Similarly, there were significant improvements in the cerebral oxygen consumption from 2.2 +/- 0.4 to 3.3 +/- 0.4 ml/100 g brain/min (P less than 0.02) and in cerebral glucose consumption from 2.1 +/- 0.6 to 6.6 +/- 1.6 mg/100 g brain/min (P less than 0.02). Cross-over to placebo produced overall deterioration, more marked in the patients who had received the active drug for the shorter time period. No serious side effects were seen; the drug was well tolerated in doses of up to 15 mg daily and is a useful treatment for chronic hepatic encephalopathy when the response to conventional therapy has been poor.

Adult↗
PubMed1980

Complement metabolism in chronic liver disease: catabolism of C1q in chronic active liver disease and primary biliary cirrhosis.

The fractional catabolic rate of C1q was increased markedly in primary biliary cirrhosis, and in HBsAg-positive chronic liver disease. In 3 out of 4 patients with HBSAg-negative chronic active liver disease C1q catabolism was normal. The rate of synthesis of the protein was increased in primary biliary cirrhosis, but it was normal in patients with chronic active liver disease. The fractional catabolic rate and synthetic rate of albumin were normal in these subjects. These data provide further evidence for the activation of the classical pathway of complement in primary biliary cirrhosis and HBsAg-positive chronic active liver disease. In HBsAg-negative chronic active liver disease, the presence of C1q binding macromolecules was not associated with increased C1q catabolism.

Adult↗
PubMed1980

Chronic hepatitis.

Chronic persistent and chronic active hepatitis are defined and described as diseases of multiple aetiologies. The two major varieties, e g chronic active hepatitis, 'lupoid' and secondary to hepatitis B infection are described and contrasted.

Adolescent↗
PubMed1979

Non-surgical treatment of biliary obstruction.

Bileduct catheterisation percutaneously through the liver can be used in patients with obstructive jaundice as an adjunct or as an alternative to surgery. Preoperative drainage allows adequate treatment of severe cholangitis and reduces jaundice. Palliative drainage, whether internal or external, can be used instead of surgery. Drainage through the liver succeeded in 40 of 41 patients. Two complications followed the procedure and were treated conservatively. Bile drainage was established through an endoprosthesis into the duodenum in 7 patients and externally through a catheter in the remaining 33. The technique is described, and its use in patients with suppurative cholangitis and benign and malignant biliary strictures is illustrated.

Adenocarcinoma↗
PubMed1979

[Halothane hepatitis].

Explore the source record for details and available documents.

Chemical and Drug Induced Liver Injury↗
PubMed1979

Reduction of immune complexes and immunoglobulins induced by D-penicillamine in primary biliary cirrhosis.

Penicillamine has an effect on immune complexes and immunoglobulins both in vivo and in vitro. We therefore studied the effect of penicillamine on immune complexes and immunoglobulins in primary biliary cirrhosis. Twenty-eight patients were randomly allocated into a treatment group receiving 600 to 900 mg of penicillamine, or a control group, and followed for a maximum of 24 months. After 12 and 24 months, serum immune complexes had fallen significantly in treated patients as compared to controls (P less than 0.05, P less than 0.01). Treatment reduced IgA, IgG and IgM concentrations, with IgM being significantly different from controls at six, 12 and 24 months (P less than 0.01). Over 24 months, serum aspartate transaminase levels fell in treated patients but rose in controls (P less than 0.01). Bilirubin concentrations increased at a slower rate in treated patients. Penicillamine may favorably influence the course of primary biliary cirrhosis by its immunologic action in addition to its copper-chelating action.

Antigen-Antibody Complex↗
PubMed1979

Hepatic siderosis in alcoholics.

In a population of 157 (120 males, 37 females) predominantly British alcoholics with liver disease, the incidence of some degree of hepatic siderosis, as estimated by stainable parenchymal iron, was 57.3%. The incidence of significant siderosis (grades III and IV) was 7%, and was similar for both sexes. In the female alcoholics there was a significant correlation between age and the degree of siderosis (P less than 0.05)--four of the five females with significant siderosis being premenopausal. In the male alcoholics there was a significant inverse relationship between the grams of ethanol consumed per day and the degree of siderosis (P less than 0.05) and a significant correlation between the percentage saturation of iron-binding protein and the degree of siderosis (P less than 0.05). The mean daily iron intake from alcoholic beverages was 1.5 mg; there was no relationship between the amount of iron ingested in the alcohol and the degree of siderosis. In this population of alcoholics the incidence of significant siderosis in both sexes was low.

Adult↗
PubMed1979

Renal hemodynamics and the renin--angiotensin system in cirrhosis: relationship to sodium retention.

Renal hemodynamics and the renin-angiotensin-aldosterone system were investigated in 15 cirrhotic patients without renal failure on controlled sodium intake of 140-160 mEq/day and related to the degree of sodium retention as measured by urinary sodium excretion. Fourteen patients were free of clinical ascites when studied. The distribution of renal blood flow was measured by the noninvasive technique of computerized radioisotope renography. In 11 patients, outer cortical renal plasma flow, expressed as a percentage of total effective renal plasma flow, was directly proportional to sodium excretion (P less than or equal to 0.01). Three patients with severe sodium retention (UNa.V less than or equal to 10 mEq) had estimated outer cortical renal plasma flows of less than or equal to 274 ml/min/1.73 M2 as compared to eight cirrhotics with better (UNa.V greater than or equal to 50 mEq) sodium tolerance (mean = 438 ml/min/1.73 M2). A significant inverse correlation (P less than or equal to 0.01) existed between outer renal cortical blood flow and plasma renin activity. No significant relationship was observed between glomerular filtration rate, total effective renal plasma flow, plasma aldosterone concentration and sodium excretion. These results provide further evidence that a renal vascular abnormality exists in cirrhosis, and that diminished outer cortical renal perfusion is related to the elevated renin levels and sodium intolerance observed in cirrhotic patients.

Angiotensin II↗
PubMed1979

Hypertrophic hepatic osteoarthropathy. Clinical, roentgenologic, biochemical, hormonal and cardiorespiratory studies, and review of the literature.

Twenty patients with biopsy proved liver disease, and roentgenologic features of hypertrophic osteoarthropathy have been studied, and the literature has been reviewed. The syndrome is a rare association of many chronic liver diseases, including primary biliary cirrhosis, bile duct carcinoma, benign bile duct stricture, chronic active hepatitis, posthepatitic cirrhosis and alcoholic cirrhosis. Patients may be asymptomatic, although bone pain, arthralgia or arthritis may be presenting symptoms. Ninety per cent of the patients are clinical jaundiced at the time of diagnosis, and 95 per cent have digital clubbing. The distal tibia and fibula are the first bones to become involved, although wrist, foot bones, femurs, hand bones and humeri may be affected in order of frequency. There is no correlation between the presence of esophageal varices or surgical portacaval shunts and the extent of the syndrome, neither is there a correlation with the degree of liver function impairment. Serum calcium and phosphate levels are normal, as is urinary hydroxyproline and estrogen excretion. There was no evidence to implicate elevated levels of growth hormone or overdosage of vitamin A. Although the majority of patients tested had mild arterial hypoxemia, increased cardiac output and evidence of right to left shunting, these were also present in disease-matched control subjects without osteoarthropathy. For screening purposes, patients with chronic liver disease and clubbing should have roentgenologic studies of the lower tibias and fibulas, to select those patients suitable for a more extensive skeletal survey.

Adult↗
PubMed1979

Factors affecting plasma amino acid concentrations in control subjects.

Plasma amino acid concentrations were determined in groups of normal control subjects under fasting and postprandial conditions. Differences were observed that were found to be, to a considerable extent, sex-related. Fasting females had lower concentrations than fasting males of several amino acids, although postprandial differences in concentrations between the sexes were not significant. Under the dietary conditions normal for a British population, no significant diurnal variation of plasma amino acid concentrations was found. Reducing the dietary protein by 30% failed to affect plasma amino acid concentrations; however, increasing the dietary protein by 50% resulted in a significant increase in the plasma concentrations of several amino acids, and induced a significant degree of variation throughout the day in six, proline, half-cystine, methionine, valine, leucine, and isoleucine. The importance of these results with regard to the interpretation of population mean values and disease diagnosis is discussed.

Adolescent↗