Fibrositis: evolution of an enigma.
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It is reported on results of a double blind study of colchicine therapy in fibrotic liver diseases over a period of three years. The study includes 74 probands; 37 of them had been treated after randomization for five days a week with 4 X 0,25 mg/d colchicine, 37 with placebo. 53 probands attained the 12th month of treatment, 43 of them 24th, 24 probands were in the study for 36 months. 3 diagnoses groups had been formed with regard to the histological grades of fibrosis: chronic hepatitis (without structural transformation); structural liver transformation/moderate liver cirrhosis; severe liver cirrhosis. In 38 cases the disease was caused by alcohol. 45 data had been studied (clinical results, paraclinical data concerning hepatological diagnostic and connective tissue metabolism and morphologic data). The biometric evaluation was carried out with the stage variant analysis by Friedman. Rebiopsies have been carried out in 40 probands after 1 year, in 4 probands after 2 years. 4 data (Serumalbumine, Gamma-GT, ALAT, KP) showed significant changes in the colchicine-group as well as in the placebo-group. In both therapy groups the morphologic supervisions of the fibrosis grades (rebiopsies) showed improvements, no changes, and deterioration about in the same frequency. In this study there was no effectiveness of colchicine on the course of fibrotic liver diseases to be stated. Concerning the contradictions in the recent literature and probable the insufficient colchicine dose, the authors recommend further studies on colchicine therapy in liver diseases with incipient i.e. reversible fibrosis.
Of 284 patients undergoing open mitral commissurotomy for mitral stenosis from January 1978 to December 1985, 81 patients had a densely scarred or partly calcified valve. In this study, we evaluated the postoperative results in these 81 patients. There were no operative or late deaths. Seventy-seven patients (95%) are in Functional Class I or II. Three patients required reoperation 3, 30, and 50 months after the initial procedure because of moderate or severe residual mitral regurgitation. After valvotomy there were four episodes of embolism. The actuarial rate of freedom from any complication (mortality, reoperation, congestive heart failure, and thromboembolic events) was 89.3% +/- 3.9% (mean +/- standard error of the mean) 8 years after operation. We conclude that for a follow-up period of 8 years, the stenotic mitral valve with anatomical deformities can be salvaged with satisfactory results. Therefore, we believe that this approach, at present, is a better alternative than prosthetic replacement with any type of valve presently available.
The role of polymorphonuclear leukocytes (PMNs) in fibrotic lung disease remains poorly defined, but PMN prominence may predict a poor response to therapy in some patients. The bleomycin injury to rats represents a model of PMN-prominent alveolitis leading to fibrosis. We examined a method of identifying the alveolitis during its PMN-prominent phase with indium 111-labeled homologous PMNs (In-PMNs). When pairs of injured and uninjured rats were compared, greater activity was consistently found persisting in the lung images of the injured rats, both several hours (early) and a day (late) after injection of In-PMNs. Differences could likewise be identified when lung activity was normalized to activity of the injectate, the spleen, and variably the liver, as determined from organ images. These differences in gamma camera images were supported by direct measurement of activity in organs obtained by killing the animals after scanning. When groups of animals were compared, lung/spleen ratios appeared to most consistently differentiate the group of normal animals from those with alveolitis. These methods may provide a noninvasive means of identifying PMN prominence in the lung, which occurs in some fibrotic processes.
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With a view to optimal treatment results, the reconstruction of the vestibule of the mouth by means of retroauricular full-thickness skin graft constitutes a precious contribution to the therapeutical possibilities. The imperfections of split-thickness skin transplantation are avoided by this method. The procedure is recommended for cases in which it is not possible to cover, after excision of an extended lobar fibrosis, the wound surface with a graft taken from the buccal mucous membrane.
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A 43-year-old patient with a two-year history of rheumatoid arthritis developed diffuse pulmonary fibrosis with increased lung elasticity. Pulmonary artery catheterization revealed pulmonary hypertension at rest. Treatment with steroids and immunosuppressive drugs prevented progression of the disease.