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Biomedical subjects

C H Gips

Publications and source records attributed to C H Gips.

At least 55 records · Page 3Linked to original sources
PubMed1985

Liver disease and its effect on haemostasis during liver transplantation.

In a prospective study involving 25 consecutive adult orthotopic liver transplantation (OLT) patients, of whom 23 had cirrhosis, we have related pretransplantation recipient parameters to blood loss during transplantation. In phase 1 (explantation of diseased liver) blood loss was 0.1-7.2 1, in phase 3 (following restoration of the portal blood flow after implantation) 0.1-39.7 1, and total blood loss was 1.6-47.2, median 9.2 1. Five patients (20%) died from causes directly related to defective haemostasis during the operation. Pretransplantation cholinesterase, antithrombin III and albumin correlated most strongly with blood loss in phase 1; a history of ascites, antithrombin III and cholinesterase levels correlated with blood loss in phase 3, and a history of ascites, urinary sodium and antithrombin III with total blood loss. Cholestasis did not influence blood loss. Portal hypertension per se presumably played only a restricted role. A pretransplant 24-h urinary sodium excretion of 10 mmol or less and a serum sodium of 132 mmol/l or less were highly predictive of blood loss exceeding 10 1 during OLT. Urinary sodium determination under test conditions and serum sodium measurement should already be part of the assessment of potential OLT candidates by the referring hospital.

Adolescent↗
PubMed1985

Immune response to two different hepatitis B vaccines in haemodialysis patients: a 2-year follow-up.

Formalin-inactivated hepatitis B vaccine was given at 0, 1 and 6 months to 22 medical staff members and to 37 haemodialysis patients. After vaccination with 20 micrograms surface antigen (HBsAg), seroconversion occurred in 95% of the staff members. Following immunisation with a double dose, only 74% of the haemodialysis patients developed antibodies against HBsAg (anti-HBs). Anti-HBs levels were lower in the patient group and 6 responders (23%) became anti-HBs-negative within 2 years. 40 other haemodialysis patients were immunised at monthly intervals with either three doses of 3 micrograms or three doses of 27 micrograms heat-inactivated hepatitis B vaccine. Seroconversion was achieved in 60% of the patients in the 3-micrograms group and in 95% of the patients in the 27-micrograms group. Anti-HBs levels increased significantly when the high dose was used. Although the study design does not allow a definite conclusion, it appears that the immunogenicity per microgram HBsAg is higher for the heat-inactivated vaccine than for the formalin-inactivated vaccine. The findings further indicate that decreased immune response to hepatitis B vaccination in haemodialysis patients can be improved by increasing the dose of the vaccine. A booster injection should be considered in these patients within 2 years after the first vaccination.

Adult↗
PubMed1985

Composition of human hepatic bile.

To define reference values of human hepatic bile for sodium, potassium, chloride, calcium, iron, copper, urea, creatinine, phosphate, glucose, bilirubin, cholesterol, protein, bile salts, phospholipids, ammonia, pH, PCO2, bicarbonate and osmolarity, bile was obtained via a T-drain from 12 adult patients who underwent cholecystectomy. Bile of females had a higher cholesterol concentration than that of males. The saturation index, however, was not different in both groups.

Adult↗
PubMed1985

The effect of storage at different temperatures on cholinesterase activity in human serum.

The effect of storage on the catalytic concentration of cholinesterase and on the reference values of cholinesterase in human serum were studied. When serum was stored at room temperature (20 degrees C), at 4 degrees C and at - 20 degrees C (one year) there was no change in catalytic activity. Even after nine times freezing and thawing (over nine weeks) the catalytic activity was unaffected. The average reference value was significantly higher for males than for females (3.11 +/- 0.57 vs 2.50 +/- 0.43 kU/l).

Acetylthiocholine↗
PubMed1985

Choledochocholedochostomy, a relatively safe procedure in orthotopic liver transplantation.

The biliary anastomosis has been considered the Achilles heel of liver transplantation, and especially the choledochocholedochostomy has been reported to be ill-fated. However, based on previous experimental experiences we decided to use the choledochocholedochostomy as the biliary anastomosis of preference in orthotopic liver transplantation. A choledochocholedochostomy has been performed in 29 of the 31 patients who have undergone transplantation since 1979. Five complications (17%) were diagnosed, of which one proved to be fatal. Two complications were related to the handling of the T-tube and required simple laparotomy to solve the intraperitoneal bile leakage. The other three complications were major: in one patient the choledochocholedochostomy was stenosed, requiring a conversion into a hepaticojejunostomy, while in two patients the donor common bile duct became necrotic. One of these patients underwent successful retransplantation, while the other died of sepsis. In both patients the hepatic artery anastomosis proved to be thrombosed, while in all patients without biliary complications the hepatic artery anastomosis was patent angiographically or at autopsy. The total incidence of sepsis was 26%, but in only four patients (13%) was sepsis related to the choledochocholedochostomy. The relationship between the necrosis of the donor bile duct and the patency of the hepatic artery anastomosis emphasizes an impeccable surgical technique. The low incidence of biliary complications in our 31 patients characterizes the choledochocholedochostomy as a relatively safe biliary procedure in clinical liver transplantation.

Common Bile Duct↗
PubMed1984

Capillary gas chromatographic determination of cholestanol/cholesterol ratio in biological fluids. Its potential usefulness for the follow-up of some liver diseases and its lack of specificity in diagnosing CTX (cerebrotendinous xanthomatosis).

The concentration ratios of cholestanol/cholesterol in biological materials (serum, cerebrospinal fluid and tendon biopsy) were determined using a capillary gas chromatographic method. The method was validated by gas chromatography-mass spectrometry. The ratio was determined in several groups of patients: (a) patients with cerebrotendinous xanthomatosis (in serum, cerebrospinal fluid and tendon biopsy), before and during chenodeoxycholic acid therapy, (b) patients receiving cholestyramine therapy (in serum), (c) patients suffering from various liver diseases (in serum) and (d) one patient before and after liver transplantation (in serum). It can be concluded that the cholestanol/cholesterol concentration ratio is a potentially useful parameter for monitoring liver diseases but is not specific for establishing the diagnosis of cerebrotendinous xanthomatosis.

Brain Diseases, Metabolic↗
PubMed1984

Etretinate (Tigason) hepatitis in 2 patients.

A histologically confirmed, clinically inapparent and reversible hepatitis occurred in 2 patients (1 psoriasis, 1 basal cell nevus syndrome) within the first months after introduction of etretinate therapy. Causes of hepatitis other than etretinate were not found. Reintroduction of etretinate resulted in reactivation and/or persistence of the hepatitis in both patients. These data strongly suggest that the hepatitis in both patients was caused by etretinate. Later the basal cell nevus syndrome patient was given 13-cis-retinoic acid, which caused no liver test disturbances during a follow-up period of 6 months.

Aged↗
PubMed1984

Histopathology of serial graft biopsies from liver transplant recipients.

Serial graft biopsies (n = 78) from 12 liver transplant recipients (followed clinically up to 47 months) were studied with the use of histology, histochemistry, immunostaining, and electron microscopy. Planned-protocol needle biopsy specimens were taken from the graft before removal from the donor, 1 hour after transplantation, on the eighth day, and at yearly intervals. Nonprotocol biopsies were taken when deterioration of the clinical condition made a decision on changes in the regimen necessary. The protocol biopsies provided a baseline for graft condition and diagnostic histopathologic features. In these biopsies signs of hyperacute rejection, chronic rejection, or the recipient's previous liver disease were not observed. Mild acute rejection was regularly present on the eighth day, possibly due to a lag phase in the effect of immunosuppression. The syndromes in the nonprotocol biopsies included "pure" parenchymal cholestasis, reversible acute rejection resembling chronic active hepatitis, viral infection, and acute bacterial cholangitis. Each of these syndromes correlated with a separate histopathologic entity. Therefore, these entities proved to be of diagnostic value. It is concluded that a graft biopsy may substantially add to the pathogenetic interpretation, differential diagnosis, and management of major graft syndromes in orthotopic liver transplant recipients.

Acute Disease↗
PubMed1984

Choledochocholedochostomy is successful in orthotopic liver transplantation.

The viability of the extrahepatic bile ducts of liver grafts depends on their arterial blood supply, and consequently, on the patency of the arterial anastomosis. Thrombosis of the hepatic artery leads almost inevitably to necrosis of the extrahepatic bile ducts of the liver graft. An impeccable technique of arterial anastomosis is essential to avoid biliary complications resulting from ischemia. The low incidence of biliary complications (17%) in our 31 patients indicates that choledocho-choledochostomy is a relatively safe biliary procedure in clinical liver transplantation, especially when compared with other commonly used biliary anastomoses.

Adult↗
PubMed1984

Cellular and humoral immune reactions in chronic active liver disease. II. Lymphocyte subsets and viral antigens in liver biopsies of patients with acute and chronic hepatitis B.

The characteristics and distribution of the inflammatory infiltrate in liver biopsies of 25 patients with hepatitis B viral (HBV) infection were studied in relation to the distribution and expression of HBV antigens. Mononuclear subsets were characterized with monoclonal (OKT, OKM, Leu) antibodies to surface antigens. For the demonstration of viral antigens directly conjugated antibodies to surface (HBsAg), core (HBcAg) and 'e' (HBeAg) antigen were used. For the study of mutual relations all methods were performed on serial cut tissue sections. In chronic active hepatitis B (CAH-B, n = 12) OKT8+ lymphocytes of T cell origin were the only cell type present in areas with liver cell degeneration and T cell cytotoxicity appears to be the only immune mechanism. In chronic persistent hepatitis B (CPH-B, n = 7) the only conspicuous feature was the presence of many Leu 3+ lymphocytes of the helper/inducer population in the portal tracts. In acute hepatitis B (AHB, n = 6) OKT8+ cells of non-T origin (OKT1-,3-) and Leu 7+ cells of presumed natural killer (NK) potential predominated in the areas with liver cell necrosis, and non-T cell cytotoxicity appears to be the predominant immune mechanism. In none of these disease entities a positive spatial relation could be established between the cytotoxic cells and the demonstrable expression of HBV antigens in hepatocytes. It is concluded that differences in immunological reaction pattern may explain the different course in the three forms of HBV infection studied.

Acute Disease↗
PubMed1983

Determination of blood ammonia using the Ammonia Checker.

A new diffusion method employing bromocresol green for determination of blood ammonia (Ammonia CheckerR) using disposable reagent test-plates and a pocket-size colorimeter with direct read-out of results was compared with an enzymatic method. The values obtained with the Ammonia Checker were slightly lower than those with the enzymatic method. Instead of arterial blood, capillary blood may be used for ammonia determination, but thorough cleansing of the fingertip used is necessary because of the high ammonia content of sweat.

Ammonia↗
PubMed1982

Vascular problems in paroxysmal nocturnal haemoglobinuria. A report of two cases.

Two patients with paroxysmal nocturnal haemoglobinuria (PNH) are described who had severe vascular complications. The first patient developed extensive thrombosis of the abdominal veins leading to intractable ascites symptomatically treated with a peritoneo-venous shunt. The second patient had aneurysm of the abdominal aorta treated with a prosthetic graft. Although in both patients prosthetic grafts were implanted no signs of an increased activation of the P.N.H. cells were found and no thrombosis or severe haemolytic anaemia occurred. It is suggested that surgical intervention for vascular complications in PNH should not be delayed because of fear of activating the PNH.

Adult↗
PubMed1982

Determination of ammonia in saliva using indophenol, an ammonium electrode and an enzymatic method: a comparative investigation.

Three methods for determination of ammonia in saliva are reported. The indophenol method on diluted saliva has the best precision (coefficient of variation 0.8%) and the lowest reagent cost. The ammonium electrode method is the quickest, but it requires simultaneous determination of the potassium content of the specimen. The enzymatic method give the same result as the electrode method, but is more expensive. Deproteinisation proved not to be necessary. In one hour 10, 20 or 40 determinations can be performed with the enzymatic, indophenol- or the electrode method, respectively.

Ammonia↗
PubMed1982

Cellular and humoral immune reactions in chronic active liver disease. I. Lymphocyte subsets in liver biopsies of patients with untreated idiopathic autoimmune hepatitis, chronic active hepatitis B and primary biliary cirrhosis.

In liver biopsies of 37 patients with chronic active liver disease (CALD) the inflammatory infiltrate was studied with monoclonal antibodies to the surface antigens on helper/inducer (OKT4+), suppressor/cytotoxic (OKT8+), killer/natural killer (OKM1,2+) cells and common T cell antigens (OKT1+, OKT3+). Furthermore OKT11 antibody was applied, which defines the E rosette receptor. Special emphasis was given to areas with piece-meal necrosis (PMN). In areas with PMN in idiopathic autoimmune CALD (IA-CALD, n = 15) OKT8+ and OKM+ lymphocytes and IgG plasma cells were present, whereas in hepatitis B-CALD (HB-CALD, n = 12) almost exclusively OKT8+ cells were found. In PBC (n = 10) OKT4+ cells in central parts of portal tracts and OKT8+ cells in areas with PMN predominated. These findings indicate that in IA-CALD antibody-dependent cell-mediated cytotoxicity (ADCC), as well as T cell cytotoxicity may be responsible for liver cell damage, while in HB-CALD T cell cytotoxicity seems to be the only mechanism. In PBC liver cell damage also predominantly is the result of T cell cytotoxicity. In addition, helper T lymphocytes seem to play a role since these are found in central areas of the portal tracts.

Adolescent↗