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Biomedical subjects

R L Koretz

Publications and source records attributed to R L Koretz.

At least 91 records · Page 5Linked to original sources
PubMed1981

Clinical value of serum bile acid levels in chronic hepatitis.

A prospective study was undertaken to determine if individual serum bile acid (SBA) levels are clinically useful in differentiating patients with asymptomatic chronic active hepatitis (CAH) from patients with chronic persistent hepatitis (CPH). Fasting and postprandial SBA levels were obtained from 16 patients with CAH, 12 with CPH, and 18 control subjects. Levels of cholylglycine (CG) and total cholic acid conjugates (CCA) were determined by radioimmunoassay. Alanine aminotransferase (ALT) levels were also obtained from each subject. There were no significant differences in the mean fasting and 3-hr postprandial CG or CCA levels between the CPH group and the control subjects. The mean fasting and 3-hr CG and CCA levels were significantly higher for the CAH group than the CPH group (P less than 0.05 for each comparison). A combination of the 3-hr postprandial CG and CCA levels with the ALT levels resulted in a better separation of the two groups. All patients with CAH had either a 3-hr CCA level of 200 micrograms/dl, a 3-hr CG level of 170 microgram/dl, or an ALT level of 120 IU/liter. Using these values, only patients with CPH were misclassified as having CAH, and no control subject reached any of these levels. Although the differences obtained were statistically significant, the separation based on a combination of CG, CCA, or ALT levels may have been fortuitous. Nevertheless, these data suggest that postprandial serum bile acid levels may have clinical utility in identifying patients with asymptomatic chronic hepatitis who are likely to have CAH.

Adult↗
PubMed1981

Hypouricemia--a transient biochemical phenomenon of total parenteral nutrition.

A retrospective chart review of total parenteral nutrition identified several patients who developed hypouricemia. In order to study this phenomenon, seven patients were prospectively investigated during courses of total parenteral nutrition with serum and 24-h urine determinations of uric acid. In all seven patients, the serum uric acid level decreased, with the average fall being 3 mg/100 ml, then began to rise again. A uricosuric mechanism may have accounted for the reduced serum levels in one patient. The reduction in the serum uric acid in most patients is more likely related to a lowered rate of uric acid production.

Humans↗
PubMed1981

Multifocal eosinophilic granuloma involving the common bile duct: histologic and cholangiographic findings.

The multifocal eosinophilic granuloma syndrome (Hand-Schüller-Christian disease) is characterized histologically by focal accumulations of histiocytes and eosinophils. The clinical manifestations of this syndrome reflect the site and extent of these focal accumulations which are usually found in membranous bone, skin, and lung. Significant hepatobiliary disease due to this disorder has not been previously described. We are reporting an adult female with the multifocal eosinophilic granuloma syndrome who developed a mixed histiocytic and eosinophilic infiltration of the common bile duct which resulted in obstructive jaundice. Therapeutic attempts have failed to reverse this process, and the patient has shown progressive intrahepatic biliary tract destruction.

Adult↗
PubMed1980

Chronic active hepatitis. Who meets treatment criteria?

In order to ascertain the proportion of patients with biopsy-proven chronic active hepatitis who meet currently accepted criteria for immunosuppressive treatment, an analysis of 86 patients seen between 1973 and 1978 carrying this diagnosis was undertaken. Only 66 could be confirmed to have this lesion on blind histologic review. Nine of these 66 were on concomitant immunosuppressive therapy, four had inadequate documentation of chronicity, five consumed more than two ounces of alcohol daily, five had concurrent malignancy, two were prepubertal, and one had oxyphenisatin-induced disease. None of the remaining 40 patients met the biochemical criteria for disease activity. The disease was predominantly seen in asymptomatic middle-aged males and was of viral etiology. A small subgroup of elderly female patients was also identified whose disease was apparently nonviral. In conclusion, the vast majority of chronic active hepatitis seen at a large university center occurs in individuals for whom treatment guidelines have not been established.

Adult↗
PubMed1980

The long-term course of non-A, non-B post-transfusion hepatitis.

Patients with non-A, non-B post-transfusion hepatitis were followed from the onset of their disease until their blood tests normalized, until they died, or until the present time. Of 66 patients, 30 had a spontaneous resolution of their biochemical disease. Ten patients died or were begun on immunosuppressive therapy with transaminases still abnormal. The remaining 26 patients had abnormal transaminase levels when last seen. By actuarial analysis, only 54% of hepatitis patients are predicted to develop s spontaneous biochemical remission within 3 yr. No further resolutions have occurred after that time, Icteric and anicteric acute disease may be equally likely to progress to chronic disease. Initial and follow-up liver biopsy specimens have revealed both chronic persistent and chronic active hepatitis. Two patients showed histologic evidence of cirrhosis, and a third developed a hepatic coagulopathy and sphenomegaly. No other patient to date, however, has veveloped overt evidence of hepatocellular failure or portal hypertension. Thus, non-A, non-B post-transfusion hepatitis frequently results in biochemical evidence of chronic liver disease, and in a few patients cirrhosis may develop slowly and in a clinically inapparent fashion.

Alanine Transaminase↗
PubMed1979

Failure of endoscopic transmission of hepatitis B.

Emergency endoscopy was performed on two patients subsequently found to be hepatitis B surface antigen carriers. Before their carrier state was determined, nine other patients underwent endoscopy using the same instruments, which had been routinely cleaned between procedures. These patients were all notified within five days of the incident, given standard gamma globulin, and prospectively followed for the development of hepatitis. After one of the endoscopes was gas sterilized, the next three patients undergoing endoscopy were also followed. One of the hepatitis B surface antigen carriers was positive for antibody to e antigen; the other carrier had neither e antigen nor antibody. None of these individuals developed signs or symptoms of hepatitis, abnormal serum glutamic pyruvate transaminase elevations, or serologic evidence of hepatitis B exposure. From these data, and other recorded experiences, it appears that routine cleansing of endoscopy equipment is sufficient in preventing the transmission of hepatitis B.

Endoscopes↗
PubMed1979

Rapid development of cirrhosis secondary to squamous cell carcinoma of the common bile duct.

A 68-year-old male underwent cholecystectomy with a normal operative wedge liver biopsy. Five months later he presented with secondary biliary cirrhosis and signs of portal hypertension and hepatocellular failure. At autopsy, a squamous cell carcinoma of the bile duct was found. This case represents an unusually rapid development of cirrhosis secondary to extrahepatic biliary obstruction with documentation of normal liver histology five months prior to his last admission.

Aged↗
PubMed1978

Cimetidine versus intensive antacid therapy for duodenal ulcer: a multicenter trial.

In a randomized double blind multicenter trial, patients treated with cimetidine (800 or 1200 mg daily) or an intensive regimen of Al-Mg antacid (210 ml daily) had similar rates of duodenal ulcer healing and pain relief. After 4 weeks of treatment, the proportion of patients with ulcer healing by endoscopy were: cimetidine (1200 mg), 21 of 33 (64 percent); cimetidine (800 mg), 19 of 32 (59 percent); and antacids, 15 of 29 (52 percent). These proportions did not differ significantly. Eighty per cent of cimetidine-treated patients became asymptomatic by week 4, as did 63 percent of antacid-treated patients (P greater than 0.1). No untoward effects were observed during cimetidine treatment. Twenty-seven per cent of antacid-treated patients reported diarrhea.

Adult↗
PubMed1978

Hepatitis B surface antigen carriers--to biopsy or not to biopsy.

In order to assess the frequency of significant liver disease in hepatitis B surface antigen carriers with normal liver tests, 54 such individuals were identified and prospectively followed for 4 to 48 months with monthly liver tests. Upon testing, 4 were found to carry e antigen and 14 carried e antibody (anti-e). During follow-up, only 4 patients, none of whom were e antigen-positive, developed persisting abnormalities in liver tests. Of the 23 patients who underwent percutaneous liver biopsies, normal histologies were found in 2, nonspecific changes (ground glass hepatocytes, focal necrosis, fatty changes, etc.) in 18, and chronic persistent hepatitis (with or without other nonspecific changes) in 3. Chronic active hepatitis and/or cirrhosis, lesions which may carry more serious prognostic implications, were not seen in any biopsies. Two of the 4 e antigen-positive patients consented to biopsy, both of whom had chronic persistent hepatitis. All 6 patients with anti-e who underwent biopsy had ground glass hepatocytes, which were found in only about 50% of the remaining patients. It is concluded that hepatitis B surface antigen carriers should be followed with serial liver tests, and those whom tests remain normal should not be considered for liver biopsy.

Adult↗
PubMed1976

Post-transfusion hepatitis: the role of hepatitis B antibody.

Aliquots from units of blood previously transfused as part of a prospective post-transfusion hepatitis (PTH) study were rescreened for the presence of hepatitis B antibody (anti-HBS) to determine the effect of transfusion of such material. Anti-HBS was more commin in commercial blood. Infusion of anti-HBS was not associated with an increased or decreased risk of PTH, hepatitis B, or hepatitis B (HB) exposure. Receipt of anti-HBS did not modify the hepatitis which occurred. Receipt of large amounts of anti-HBS may be associated with an increased incidence of HB events. Preexisting anti-HBS was not only not protective against PTH, but more PTH (67% versus 40%) and hepatitis B (47% versus 12%) were seen in those patients with it.

Antibodies↗
PubMed1976

Post-transfusion chronic liver disease.

To document the sequelae of acute hepatitis among recipients of commercial and volunteer blood and to assess factors influencing the development of chronic hepatitis (CH), 47 patients with post-transfusion hepatitis were followed prospectively from the time they received their transfusions. Twenty-nine had prolongation of at least 2-fold serum glutamic pyruvic transaminase (T) elevations for more than 20 weeks, and were classified as CH. When the patients with CH were compared to those with only acute hepatitis (abnormal T for less that 20 weeks), no difference was found with respect to age, sex, number of units transfused, incubation period, presence or absence of symptoms, occurrence of jaundice, maximum T, receipt or development of hepatitis B surface antigen or antibody, underlying illness, or area of the hospital where the patient was treated. Liver biopsies in 15 of the 29 revealed chronic-active hepatitis in 9, chronic persistent hepatitis in 2, unresolved hepatitis in 4. Five of the 9 patients with chronic active hepatitis were without symptoms. None of these died or have developed cirrhosis. Because chronic liver disease frequently developed after acute post-transfusion hepatitis among multiply transfused hepatitis B surface antigen negative blood recipients, close follow-up, including liver biopsy, is warranted in such patients with prolonged transaminase elevations.

Acute Disease↗
PubMed1975

Prevention of post-transfusion hepatitis. Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion.

Aliquots from units of blood were screened by radioimmunoassay (RIA) and reverse passive hemagglutination (RPHA) shortly after transfusion. Recipients of positive units, as well as control subjects, were followed prospectively for evidence of either post-transfusion hepatitis (PTH) or exposure to hepatitis B (HB). There was a significant correlation between receipt of either an RPHA-positive or RIA-confirmed positive unit and the subsequent development of PTH or HB exposure. Recipients of all volunteer units had a lower incidence of PTH than did recipients of all commercial units. The frequency of PTH and HB exposure was not statistically different in groups receiving 1 to 5, 6 to 10, 11 to 20 and greater or less than 21 units of blood. The PTH seen in the study presented over a wide clinical spectrum, but it was usually anicteric and frequently asymptomatic.

Adult↗