Diagnosis of cirrhosis and hepatitis by quantitative hepatic and other reticuloendothelial clearance rates.

Although methods for measuring colloid clearance rates have been described, they are not commonly used. Rather, most clinicians rely on the relative radiocolloid accummulation in the liver and spleen as estimated by visual inspection of liver scans. This method lacks objectivity, however, and only indirectly reflects the rate of radiocolloid clearance. We have developed a noninvasive kinetic technique for measuring radiocolloid clearance by the liver, spleen, and other reticuloendothelial tissues. The clerance-rate constants obtained by this technique appear to differentiate among cirrhosis, fatty metamorphosis, hepatitis, and normal function. In normal subjects, the mean clearance-rate constants for the liver, spleen, and extrahepatosplenic reticuloendothelial system were 16.0, 1.4, and 3.4 ml/min per 100 ml of plasma, respectively. The mean hepatic clearance-rate constant was normal in hepatitis (16.8 ml/min per 100 ml), reduced in cirrhosis (5.7), and slightly reduced in fatty metamorphosis (10.4). Both the hepatic-to-splenic and the hepatic-to-extrahepatosplenic ratios of clearance-rate constants were reduced in cirrhosis and slightly reduced in fatty metamorphosis and hepatitis. Interestingly, the splenic clearance-rate constants were normal in these three diseases.

Observer variability in upper gastrointestinal endoscopy.

An analysis of the observer variation between 4 endoscopists was made assessing the frequency of visual interpretative discrepancies in the areas of the esophagus, stomach and duodenum. The observer variation in relation to the experience of the endoscopist was compared. The trial was carried out in 104 patients. Two observers were staff members with a minimum of 5 years experience in endoscopy. The other two were fellows with one year experience in endoscopy. The procedure was carried out by one endoscopist while the other observed the procedure through the teaching attachment. The findings were immediately recorded on a protocol. Discrepancies observed were classified in two categories: "Major" and "Minor" discrepancies. Results were evaluated in subgroups according to the different endoscopist's training (staff vs fellow, staff vs staff, fellow vs fellow). An analysis of the lesions where discrepancies occurred was made. The minor discrepancies per case was 2.18 +/- 1.32. Major discrepancies were reduced to 1.19 +/- 1.08. There was a significantly decreased incidence of minor and major discrepancies in the comparison of the staff vs staff as opposed to cases performed by fellow vs fellow (p less than 0.01 and p less than 0.005). The diagnoses where discrepancies occurred most often in order of decreasing frequency included. Esophagitis, hiatal hernia, gastritis, gastric ulcer, erosions and duodenal mucosal lesions.

A reappraisal of percutaneous liver biopsy in clinical practice.

The diagnostic yield of 101 consecutive percutaneous liver biopsies was assessed. Adequate tissue was obtained in most specimens. Even in the presence of an adequate specimen, other procedures were often necessary to rule out other diagnostic possibilities not explained nor completely ruled out by percutaneous liver biopsy alone. With the current diagnostic procedures available to the clinician which have low morbidity and low mortality, the use of blind percutaneous liver biopsy as an initial diagnostic step in certain types of liver disease should be reassessed.

A controlled study of reverse transcriptase in serum and CSF of HIV-negative patients with ALS.

Reverse transcriptase has been detected in the serum of HIV-negative patients with amyotrophic lateral sclerosis (ALS). An ALS-like disorder in HIV-positive patients can remit with antiretroviral therapy. Using the product enhanced assay technique, we measured reverse transcriptase activity in the serum and CSF of 23 HIV-negative patients with ALS and 21 neurologic disease controls. Results for CSF were not significant, whereas reverse transcriptase was detected in 56% of ALS sera vs 19% of controls.

A pilot, double-blind, placebo-controlled trial of indinavir in patients with ALS.

There is some evidence of retroviral infection in ALS. A randomized, double-blind, placebo-controlled trial of indinavir in ALS was performed to assess safety and efficacy trends. Nephrolithiasis and gastrointestinal side effects were frequent with indinavir treatment. Group differences in the rate of decline were not significant between the groups for the ALS Functional Rating Scale (p = 0.36) or for the secondary variables. The toxicity and negative efficacy trends discourage further indinavir trials in ALS.

Hydrolysis of lithocholate sulfate by Pseudomonas aeruginosa.

Pseudomonas aeruginosa was found to be able to hydrolyze bile sulfate. This property was observed when lithocholate sulfate was substituted for the sulfur source in the culture medium. The addition of MgSO4 to the medium inhibited the hydrolysis of the bile sulfate.