Prognosis of human liver transplantation.

The results of publications on liver transplantation were diverse since several years, without model prognosis. The impossibility was due to the international system of measurement. We resorted to vector functions for calculating the ratios of biological values. We studied 2 samples with the same total number (35 patients) in the same conditions. We proposed 2 vector functions of transplants: (alpha)v1 weight/age donor and recipient in proportion to obtain a medium coefficient; (gamma)v2 ratio of biliary volume/700 mL (minimum secretion); beta was the coefficient of ratio ALT/AST (transaminases). After evaluation of 560 observations and mathematical control about 3000 numbers, we compared the samples with 10 parameters without significant difference between variances, means, other values; with consented errors alpha= beta = 0.05; gamma < 10(-7); means of relative errors = +/- 0.03 negligible. The results were verified by diverse tests (standard deviation of differences, chi2-test, relative risk, odds ratio, comparisons of distributions, parent population, equations of normality, partial correlations, partial regression coefficients, multiple regression, coefficient beta. Final results : quantitative prognosis by grading ; right responders to immunosuppressive treatment without complications, RR1 fast response (scores 3.5 ; 4) ; RR2 slow response (scores 2 ; 2.5 ; 3). Partial responders: very slow response (score 2; 2.5; 3) with transitory complications. Those patients were in recovery (81.5c/o). Wrong responders (score 2), 4 deaths (5.55c/o) by ARS; score 2.5, 1 death (1.5 5c/o) by ARS. We subtracted beta from these scores to differentiate them. Non-responders (score 1.5), 2 deaths (35c/o) by ARS.

Immunohistochemical hepatocytes nuclear test for the evaluation of responses to treatment of the chronic hepatitis C by interferon alpha.

The results of the microscopic examinations on 23 paired liver biopsies of patients affected by the chronic hepatitis C, were realized successively before and after treatment by interferon alpha during six months. They showed a particular interest in the use of the antibody Anticore. The other antibody Anti C100-3-clone Tordji 32, was partially associated with the Anticore to improve its total number of positive responses by interchanging the loss of 3 wrong positive numbers (-) of the same patients from the Anticore, against earnings of 3 wrong negative numbers (+) for the same patients from the Anti C100-3-clone 32. This operation led to 70% of sensitivity. The results were submitted to mathematical verification and allowed to look for the maximum of the predictive probabilities. As for the other antibody Anti C100-3-Tordji-clone 22, it only used as a witness for some positive values. Moreover, this work brought a practical implementation to solve the problem concerning the indeterminate responses. Elsewhere, it appeared plausible for the Anticore to advance beyond its value, if the improvement of its conditions of realization were requiring. That hope was reasonable since it was yielded from the results of the predictive equations of the likelihood ratios by the logistic regression method which built two mathematical models to comparison for confirmation.

The use of ferricyanide for the electron microscopic demonstration of dehydrogenases in human steroidogenic cells.

The ultrastructural localization of 3 beta hydroxysteroid ferricyanide reductase, glucose-6-phosphate ferricyanide reductase and nicotinamide adenine dinucleotide and reduced form-ferricyanide reductase was investigated in some human steroidogenic tissues (corpus luteum of pregnancy, fetal adrenal gland and testis, adult testis and placenta) using ferricyanide as an electron acceptor. Copper ferrocyanide deposits were readily observed in the mitochondria, in the smooth endoplasmic reticulum profiles and in the cytoplasm. The sites of the various dehydrogenase activities could be visualized by using appropriate incubating media. The precise localization of various reactions in different electron transfer chains was determined by using different ferricyanide concentrations and intermediate electron-carriers such as menadione or exogenous nicotinamide adenine dinucleotide and reduced form-diaphorase. The use of respiratory chain inhibitors such as rotenone or antimycine A confirmed these data.

Image analysis for histochemical study of glucose-6-phosphatase inactivation by diethyl pyrocarbonate in normal human liver.

Glucose-6-phosphatase (G6Pase) is a multicomponent system that catalyzes G6P hydrolysis. To determine the specificity of the histochemical reaction of G6Pase, we investigated the inhibitory effect of diethyl pyrocarbonate (DEPC), a specific and very effective inhibitor of the phosphohydrolase component of the G6Pase system, in normal human liver. The inactivation of the histochemical enzymatic activity by DEPC was monitored by determining the mean brightness of the microscopic image and the histogram of light intensity distributions. The results obtained indicate that the histogram is more sensitive than the mean brightness to variations of enzymatic activities, and that the percent of pixels brighter than a convenient level is directly proportional to DEPC concentration. This study indicates that DEPC can be used as an efficient inhibitor of the histochemical reaction of G6Pase.

A quantitative immunocytochemical study of Na+,K+-ATPase in rat hepatocytes after STZ-induced diabetes and dietary fish oil supplementation.

Because diabetes causes alterations in hepatic membrane fatty acid content, these changes may affect the Na+,K+-ATPase. In this study we documented the effects of streptozotocin (STZ)-induced diabetes on hepatic Na+,K+-ATPase catalytic alpha1-subunit and evaluated whether these changes could be normalized by fish oil supplementation. Two groups of diabetic rats received fish oil or olive oil supplementation. Both groups had a respective control group. We studied the localization of catalytic alpha1-subunit on bile canalicular and basolateral membranes using immunocytochemical methods and confocal laser scanning microscopy, and the Na+, K+-ATPase activity, membrane fluidity, and fatty acid composition on isolated hepatic membranes. A decrease in the alpha1-subunit was observed with diabetes in the bile canalicular membranes, without changes in basolateral membranes. This decrease was partially prevented by dietary fish oil. Diabetes induces significant changes as documented by enzymatic Na+,K+-ATPase activity, membrane fluidity, and fatty acid content, whereas little change in these parameters was observed after a fish oil diet. In conclusion, STZ-induced diabetes appears to modify bile canalicular membrane integrity and dietary fish oil partly prevents the diabetes-induced alterations.

Ultrastructural and enzyme histochemical study of ovarian hilar cells in women and their relationships with sympathetic nerves.

The ultrastructure of normal ovarian hilar cells, both during the reproductive era and after the menopause, shows evidence of steroid hormone synthesis. In this respect these cells are very similar to Leydig cells in that they contain mitochondria with a dense matrix, a highly developed smooth endoplasmic reticulum, Reinke crystals, and microcystalline inclusions. The latter are much more numerous than in the normal testis. Their enzymatic activities are quite similar to those of Leydig cells. Ovarian hilar cells seem to originate from progressive metamorphosis of fibroblastic cells under the induction of sympathetic nervous structures. Their relations with hilar nerves are of three types: simple direct membrane contact without a Schwann cell sheath, intimate intracytoplasmic relationships, and specialized contacts, which are comparable to a synapse.

Kaposi's sarcoma: presence of herpes-type virus particles in a tumor specimen.

Three Kaposi's sarcoma biopsy specimens obtained from three African patients with typical nodular cutaneous tumors were investigated morphologically for cellular modifications suggestive of a viral origin. In one case a Kaposi's sarcoma cell of the endothelial type contained a few intranuclear herpes-type viral inclusions. The present findings complement previous reports of herpes-type viral particles in Kaposi's sarcoma cultured cell lines and suggest that, at least under certain conditions, Kaposi's sarcoma cells enter a virus-producing phase.

Progressive ophthalmoplegia associated with asymptomatic primary biliary cirrhosis. Histologic, histochemical, cytochemical, and ultrastructural studies of muscle and liver biopsy specimens.

The authors report a case of progressive ophthalmoplegia associated with asymptomatic primary biliary cirrhosis diagnosed by the finding of antimitochondrial antibodies and liver biopsy. Electron microscopic findings showed mitochondrial abnormalities, especially intramitochondrial paracrystalline inclusions, not only in skeletal muscle but also in hepatocytes. Enzymatic digestion revealed the acidic protein nature of the intramitochondrial paracrystalline inclusions of the hepatocyte. To the authors' best knowledge, the association of progressive ophthalmoplegia and primary biliary cirrhosis has not yet been reported in the literature. Despite the mitochondrial abnormalities in both skeletal muscle and liver and the presence of serum antimitochondrial antibodies, no apparent connection between these two diseases was found.

Immunohistochemical detection of C-100 hepatitis C virus antigen in formaldehyde-fixed paraffin-embedded liver tissue. Correlation with serum, tissue and in situ RT-PCR results.

We localized HCV C-100 protein in liver biopsies of 15 patients with chronic hepatitis C using immunohistochemistry. The results were compared to serum, tissue extract analysis of HCV RNA and in situ RT-PCR described in a previous study. HCV was detected in 80% of the sera tested, in 40% of the tissue extracts and in 80% and 60% of the tissue sections tested by immunohistochemistry and in situ RT-PCR respectively. Compared to the serum positive cases, 83% and 67% of the cases were respectively positive with immunohistochemistry and in situ RT-PCR and 41% were positive with tissue extract detection. Compared to the tissue extract positive cases, 25% and 50% of the cases were respectively positive with immunohistochemistry and in situ RT-PCR. Finally, 75% of the cases positive by immunohistochemistry were also positive by in situ RT-PCR. These results underline the complementarity of the different methods for the precise diagnosis of hepatitis C.

[Association of sarcoidosis and primary biliary cirrhosis. Clinical and anatomopathologic study of a case followed for over 10 years]. / Association de sarcoïdose et de cirrhose biliaire primitive. Etude clinique et anatomopathologique d'un cas suivi pendant 10 ans.

A new case of primary biliary cirrhosis associated with sarcoidosis is reported in a 38 year-old woman. The diagnosis of sarcoidosis was based on the occurrence of cutaneous nodules, mediastinal lymph node enlargement, pulmonary reticular infiltrate, parotitis and diffuse arthritic pain, all disappearing after steroid therapy. Hepatic biopsy showed epithelioid-cell granuloma without necrosis. The diagnosis of primary biliary cirrhosis was made 6 years later as based on intrahepatic cholestasis associated with high titer of antimitochondrial antibodies and chronic destructive cholangitis. This association (5 other cases have already been reported) raises the problem of a possible link between the two diseases which could represent different patterns of a single immunological disorder.

[Kaposi's sarcoma. A vascular neoplasm of presumably viral origin. Histologic and ultrastructural characteristics]. / Le sarcome de Kaposi. Un néoplasme vasculaire présumé d'origine virale. Caractères histologiques et ultrastructuraux.

Kaposi's sarcoma is a multiform mesenchymal neoplasm of uncertain histogenesis but of possible viral origin. Several anatomo-clinical forms have been described the cutaneous nodular lesion being the most common and at highest frequency in equatorial Africa. Eighteen of such typical lesions were reported; their morphology was uniform and associated: 1) spindle cells, 2) an excess of vascular spaces composed of intratumoral intercellular slits and of intra and peritumoral well structured vessels, 3) a lymphoplasmocytic inflammatory infiltration. The lesions of the other and less common forms of Kaposi's sarcoma associated the same histological features in variable combination. At one end of the histological spectrum the lesions are essentially composed of irregular capillaries with few spindle cells, at the other end the tumor is a highly cellular neoplasm with few or no angiogenic features. The vascular structure of the typical lesions appeared clearly at the ultrastructural level. Most tumor cells were of endothelial type and formed cylinders with virtual or large central lumina, reminiscing of vascular sprouts. Pericyte-like cells were also present. In one the three ultrastructurally investigated cases, a tumor cell of the endothelial type contained intranuclear herpes virus like inclusions, group to which belongs the cytomegalovirus (CMV), a possible promoter of Kaposi's sarcoma.

[Immunohistochemical characterization of a median raphe cyst of the penis]. / Caractérisations immunohistochimiques d'un kyste du raphé médian de la verge.

Cysts and canals found on the ventral surface of the penis have been ascribed to minor dysembryoplasia of the male genitalia. These lesions occur almost exclusively on the ventral surface of the penis along the median raphe and can extend from the urethral meatus to the anus. They are lined by stratified urothelium or squamous epithelium and they do not communicate with the urethra. Most cases are noted in early adulthood, they are usually asymptomatic but may become infected. Surgical removal is the adapted treatment. In this report we describe a case in which the urothelial origin of the cyst was documented by immunohistochemistry for cytokeratin 13.

[Ultrastructural study of the liver in Niemann-Pick disease type C]. / Etude ultrastructurale du foie dans la maladie de Niemann-Pick de type C.

The authors report an electron microscopic study of the liver in a case of Niemann-Pick disease type C. The diagnosis was supported by clinical data, moderate increase of phospholipids, total cholesterol, leukocytes and liver sphingomyelin and sphingomyelinase activity. Intrasinusoidal liver foamy histiocytes were filled with lamellar and multivesicular inclusions similar to those observed in sphingomyelinase deficient patients. Hepatocytes contained a few non-specific lamellar inclusions occasionally associated with triglycerides and cholesterol crystals. These results are discussed with reference to the recent biochemical findings supporting the evidence of excessive accumulation of unesterified cholesterol in Niemann-Pick disease type C.

[Prolonged survival in peritoneal mesotheliomas. Apropos of a case]. / Survie prolongée des mésothéliomes péritonéaux. A propos d'une observation.

A case of peritoneal mesothelioma discovered during laparotomy for ascites is reported. A long-term survival of 5 years was observed with combined treatment: surgery and chemotherapy. Peritoneal mesothelioma is a rare neoplasm often related to asbestos exposure and its prognosis is poor. No laboratory test other than histologic examination is specific for the diagnosis. Combined treatment with radiotherapy and chemotherapy seems to improve the survival rate.

[Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects]. / Les appendicites aiguës au Centre National Hospitalier Universitaire de Bangui, Centrafrique: aspects épidémiologiques, cliniques, paracliniques et thérapeutiques.

We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic. We compared our findings with those for other African countries and for industrialized countries. From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis. We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery). The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis. The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3%. The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants. These cases of appendicitis were diagnosed essentially on clinical grounds. Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients. Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix. Most of the patients consulted late, a mean of four days after the onset of symptoms. The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery. The mean duration of hospital stay after surgery was 7.6 days. No early postoperative complications were noted. However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5%. These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock. The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%). However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%). Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available. Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis. Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle. The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries. This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses.

[Place of the splanchnic nerves in the pathogenesis of shock due to retroperitoneal hematoma (author's transl)]. / Place des nerfs splanchniques dans la pathogénie du choc par hématome rétro-péritonéal. Etude expérimentale.

The clinical picture of retroperitoneal hematoma includes usually a state of shock. The author's experiment implies that the splanchnic nerves are directly involved in the pathogenesis of this fall in blood pressure. Simple therapeutic implications result from this.