Search PubMed⌕ Search

Biomedical subjects

S Sherlock

Publications and source records attributed to S Sherlock.

At least 55 records · Page 3Linked to original sources
PubMed1990

Hepatitis B: the disease.

Hepatitis B virus (HBV) is carried by approximately 300 million people in the world. The natural history of the disease in an individual patient depends on the method by which the infection was acquired, whether perinatal, in childhood, as a result of drug abuse, or in the course of health care work. Other important factors determining the course of the disease include an individual's sex and immunological status. Geographic factors also contribute. Changing lifestyles and the use of prophylactic hepatitis B vaccination affect the prevalence in various groups in the community. The clinical course of the disease, possible complications, and a recent classification system for chronic HBsAg carriers are discussed.

Chronic Disease↗
PubMed1990

Esophageal varices.

Bleeding from esophageal varices is related to the size and pressure of varices, endoscopic danger signs, and severity of liver failure. Prevention of bleeding with propranolol has given conflicting results in controlled trials, but is a safe treatment. Prophylactic sclerotherapy has been shown to reduce bleeding in European studies, but this has not been confirmed by studies in the United States. Acute variceal bleeding can usually be controlled by sclerotherapy, which may be supplemented by pharmacotherapy with vasopressin, nitroglycerin, or somatostatin. Recurrent bleeding is prevented initially by sclerotherapy, with surgery reserved for patients who have not responded to this treatment. Once bleeding has been controlled, the suitability and timing of hepatic transplantation must be considered.

Acute Disease↗
PubMed1990

Alcoholic hepatitis.

Alcoholic hepatitis is a serious consequence of alcohol misuse and the usual precursor of cirrhosis. Risk factors, histology, pathogenesis, clinical features, prognosis and treatment are discussed in this review.

Biopsy↗
PubMed1990

Immunological features of lung lavage cells from patients with primary biliary cirrhosis may reflect those seen in pulmonary sarcoidosis.

To investigate the basis of subclinical alveolitis in patients with primary biliary cirrhosis, 10 primary biliary cirrhosis patients were studied by bronchoalveolar lavage. Both bronchoalveolar lavage lymphoid and non-lymphoid cell populations were analysed using immunocytological methods to determine their proportions and phenotypic features in an attempt to gain information as to possible immune mechanisms active in the lung of these patients. Six of the 10 patients in our study showed evidence of an alveolitis (raised lymphocyte count: 27.6 (4.3)% of total count) on lavage. The results were compared with control groups of normal volunteers and patients with active pulmonary sarcoidosis. The six primary biliary cirrhosis patients with lymphocytosis had a raised CD4/CD8 T-cell ratio (4.13:1), similar to the sarcoid patients (5.60:1). A proportion of these T-lymphocytes expressed markers of activation (HLA-DR+ 7.5 (2.1)%); CD25 + 2.3 (0.9)%; CD7 + 5.8 (1.5)%. This increased T-cell activation was also seen in the sarcoid groups (HLA-DR+ 10.0 (1.9)%; CD25 + 3.0 (1.1)%; CD7 + 5.0 (0.2)%). This was not seen in the primary biliary cirrhosis patients without lymphocytosis and the normal volunteers. Within the non-lymphoid cell population, an increase in dendritic (RFD1+) cells was seen in primary biliary cirrhosis patients with lymphocytosis (31.2 (1.9)%) and sarcoid patients (46.3 (5.1)%) in contrast with the normal and primary biliary cirrhosis group without lymphocytosis. The primary biliary cirrhosis patients without lymphocytes had a relatively greater proportion of mature phagocytes (RFD7+). We postulate that these observations suggest the emergence in the lung of a granuloma producing mechanism similar to that occurring in the liver. By comparison, the alveolitis found in primary biliary cirrhosis is consistent with that observed in interstitial granulomatous lung disorders such as sarcoidosis.

Bronchoalveolar Lavage Fluid↗
PubMed1990

Portal hypertension in chronic hepatitis: relationship to morphological changes.

Various anatomical factors were examined which might provide passive resistance to portal venous flow and so cause portal hypertension. Methods included the measurement of portal pressure (WHVPG) in cirrhotic and non-cirrhotic patients, morphological assessment by semiquantitative grading of severity of disease, calculation of hepatocyte size indices, and assessment of volume density of hepatocytes, sinusoids, Disse's space and Disse's space collagen by electron microscopy. The wedged hepatic venous pressure gradient increased with progression of disease and portal hypertension was present before histologically detectable cirrhosis had developed. With increasing progression of disease towards cirrhosis, the relationship between individual and aggregated features and the WHVPG diminished and lost statistical significance. Hepatocyte size increased with progression of histological changes and correlated significantly with increase of WHVPG, both in non-alcoholic and alcoholic patients. Disse's space collagen was increased significantly in non-alcoholic chronic active hepatitis compared with patients with near-normal liver. No significant decrease of sinusoidal space was found. Multiple factors rather than any single feature influence the development of portal hypertension.

Chronic Disease↗
PubMed1989

Virus hepatitis B, A, non-A, non-B.

Hepatitis B vaccine is safe and effective. Its impact on the prevention of the disease, however, has been limited. In high risk areas, such as the Far East, mass vaccination of all babies is recommended. Even in low risk areas, such as Northern Europe and the United States, vaccination as part of a routine childhood immunisation programme might be effective so that protection is given before the adult becomes at risk of drug abuse or becoming a promiscuous homosexual or has joined the Health Care Service. A booster injection is probably necessary 5-7 years after primary vaccination. Hepatitis A still causes enormous epidemics. In Western Europe, large numbers of adults are at risk and the economic consequences are considerable. Vaccines which will replace serum immune globulin prophylaxis are under development. Epidemic non-A, non-B hepatitis is caused by a 27-34 nm virus, enterically transmitted. An antibody can be detected in the serum of sufferers from the epidemic but not the sporadic disease. Parenteral non-A, non-B hepatitis is associated with a viral genomic clone, isolated from infected chimpanzee liver and plasma. An antibody to it has been shown in serum of infectious blood donors and in haemophiliac patients previously exposed to blood products.

Child↗
PubMed1989

Wedged hepatic venous pressure recording and venography for the assessment of pre-cirrhotic and cirrhotic liver disease.

Wedged hepatic venous pressure recording and venography were investigated to assess histologic reflection of the stage of chronic liver disease. Forty-nine patients were studied. The four main groups and the means of the pressure gradients (WHVP - FHVP) with their 95% confidence limits were chronic active hepatitis (n = 12), 6 mm Hg (4.35-7.65); chronic hepatitis in transition to cirrhosis (n = 9), 10.3 mm Hg (6.6-14.1); and established cirrhosis (n = 8), 15.4 mm Hg (9.4-21.4); but only 3.4 mm Hg (2.2-4.6) in near-normal liver (n = 8). A pressure gradient of more than 5 mm Hg was always associated with significant liver disease on liver biopsy. In 25 patients venographies were assessed. Whereas patients with near-normal biopsy specimens had normal appearances, patients with more severe disease showed increasingly severe changes. The techniques applied should not replace liver biopsy. However, they provide relevant supplementary information, might have a place in follow-up studies to assess progression of disease, and occasionally reduce the need for liver biopsy.

Hepatic Veins↗
PubMed1988

Hepatocellular carcinoma: clinical, aetiological and pathological features in British patients.

We have examined the clinical, prognostic, aetiological and pathological features of 41 consecutive British patients with hepatocellular carcinoma (HCC). Presenting symptoms were often vague, and patients were generally in poor condition at diagnosis, 56% being of WHO grade 2 performance score or higher. Ascites (46%) and jaundice (35%) were often present at diagnosis, and the median duration of survival from diagnosis was only 6 weeks. Only initial performance grade (p less than 0.0001) and serum bilirubin concentration (p = 0.02) significantly affected prognosis. Serum alphafoetoprotein (AFP) was positive by counter-immune electrophoresis in only 34%, but increased to 68% when radioimmunoassay was used. Cirrhosis was present in 33 patients (80%) and was most often cryptogenic (12) or alcoholic (7) in origin. Serum HBsAg was detected in 5 patients (12%) and, of the remainder tested, 21% had serological evidence of past HBV exposure. None of 8 serum HBsAg-negative tumour specimens had detectable HBV-DNA integration into the tumour cell genome. Liver-cell dysplasia was noted in 56% of patients with liver biopsies predating the diagnosis of HCC, and in 78% of biopsies taken at the time of HCC diagnosis. The commonest histological pattern was trabecular (71%). Other forms were rare; the fibrolamellar pattern was only seen in 2 patients.

Adolescent↗
PubMed1988

Liver disease in women. Alcohol, autoimmunity, and gallstones.

Some liver diseases, such as autoimmune liver disease, affect women far more often than men. Others, such as alcohol-related disease, progress more rapidly in women than in men. An increased index of suspicion will lead to improved diagnosis and earlier treatment of women with liver disease.

Adult↗
PubMed1987

The syndrome of disappearing intrahepatic bile ducts.

Diseases with disappearing intrahepatic bile ducts may be developmental, immunological, infective, vascular, or chemical in origin. The immunological group includes primary biliary cirrhosis, graft-versus-host disease, and sarcoidosis. HLA class 2 antigens are displayed on the bileducts and recognition of biliary antigens by cytotoxic T-cells leads to destruction of interlobular ducts. Primary sclerosing cholangitis is associated with immunological features, but the hepatic histology is not that of immunological duct disease. The association with immunodeficiency syndromes, and the finding that secondary sclerosing cholangitis may occur in patients with the acquired immunodeficiency syndrome who are infected with cytomegalovirus, suggest that primary sclerosing cholangitis might be infective in origin. In bacterial cholangitis there is contiguity between the biliary system and the intestinal tract and usually, but not necessarily, partial biliary obstruction. Interference with the hepatic arterial supply to the bileducts leads to vascular cholangitis. Chemical cholangitis follows injection of scolicidal agents into the biliary tree. Diseases with disappearing bileducts have a long natural history and hepatocellular failure occurs late. In the late stages hepatic transplantation gives good results.

Bacterial Infections↗
PubMed1987

Hepatic reactions associated with ketoconazole in the United Kingdom.

Ketoconazole was introduced in the United Kingdom in 1981. By November 1984 the Committee on Safety of Medicines had received 82 reports of possible hepatotoxicity associated with the drug, including five deaths. An analysis of the 75 cases that had been adequately followed up suggested that 16, including three deaths, were probably related to treatment with the drug. Of the remainder, 48 were possibly related to treatment, five were unlikely to be so, and six were unclassifiable. The mean age of patients in the 16 probable cases was 57.9, with hepatotoxicity being more common in women. The average duration of treatment before the onset of jaundice was 61 days. None of these well validated cases occurred within the first 10 days after treatment. The results of serum liver function tests suggested hepatocellular injury in 10 (63%); the rest showed a mixed pattern. In contrast, the results of histological examination of the liver often showed evidence of cholestasis. The characteristics of the 48 patients in the possible cases were similar. Allergic manifestations such as rash and eosinophilia were rare. Hepatitis was usually reversible when treatment was stopped, with the results of liver function tests returning to normal after an average of 3.1 months. In two of the three deaths probably associated with ketoconazole treatment the drug had been continued after the onset of jaundice and other symptoms of hepatitis. Clinical and biochemical monitoring at regular intervals for evidence of hepatitis is advised during long term treatment with ketoconazole to prevent possible serious hepatic injury.

Adolescent↗