[Left-side venous anastomosis as a method correcting blood outflow from the kidney].

Case histories and surgical protocols of 50 patients who were treated for chronic hepatitis by creating left-side renoportal venous anastomosis (RPVA) were analysed retrospectively. Early after surgery 75% patients had microhematuria, proteinuria to 0.033-0.066 g/l, leucocyturia. At discharge from the hospital these abnormalities were not registered in the majority of the patients. Three months after operation these indices were at the preoperative level. Significant shifts in parameters of urine were associated with an anomalous condition of the left renal vein (annular, retroaortal), its compression, portal hypertension and creation of RPVA without legation of the splenic vein. In a cositive compression test RPVA was created without arrest of arterial inflow for 45 min. This can be a criterion of feasibility of left renal vein ligature if left-side RPVA cannot be performed for preservation of the left kidney. Validity of left-side RPVA use for correction of blood outflow from the left kidney is proven by functional improvement and normal side of the kidneys in long-term postoperative follow-up.

A monoclonal antibody-based enzyme-linked immunosorbent assay of glycolithocholic acid sulfate in human urine for liver function test.

Urinary levels of sulfated metabolites of lithocholic acid (LCA) are expected to be a useful index of liver function. Thus, a sensitive, specific, and feasible enzyme-linked immunosorbent assay (ELISA) of these sulfated LCA metabolites (LCA-Suls) should be established. A newly generated monoclonal antibody specific to glycolithocholic acid sulfate (glycine-amidated LCA-Sul (GLCA-Sul)) was immobilized on microtiter plates via a second antibody. A urine specimen and an alkaline phosphatase-labeled antigen were added to the plate, which was then incubated at room temperature for 3h. After this competitive reaction, bound enzyme activity was measured colorimetrically using p-nitrophenyl phosphate as a substrate. The detection limit for GLCA-Sul was 0.4 pg/assay. Nonamidated LCA-Sul and taurine-conjugated LCA-Sul showed 40 and 11% cross-reactivities, respectively, while 3-sulfates of cholic acid (CA; 0.02%), chenodeoxycholic acid (CDCA; 0.63%), and deoxycholic acid (DCA; 2.2%) exhibited very low cross-reactivities. Applicability of the ELISA system to clinical samples was well validated by parallelism, recovery test, and intra/inter-assay variance. Enzymatic deconjugation with bile acids sulfatase resulted in dramatically decreased urinary levels, supporting the specificity of the ELISA toward GLCA-Sul. The mean GLCA-Sul levels in early morning urine from healthy volunteers were 314 ng/mg Ucre (males: n=16) and 507 ng/mg Ucre (females: n=9). Patients with liver diseases, including chronic hepatitis (CH) and liver cirrhosis (LC) exhibited significantly higher values (mean 5222 ng/mg Ucre: n=21). The present 'monoclonal ELISA' is predicted to be useful as a novel noninvasive diagnostic tool for liver function and hepatobiliary diseases.

Serum and urinary neopterin levels in patients with chronic active hepatitis B treated with interferon.

Serum and urinary neopterin levels and serum 2',5'-oligoadenylate synthetase and DNA polymerase activities were measured in 14 patients with HBeAg-positive chronic hepatitis B treated with interferon. Treatment with interferon brought about a threefold increase over basal levels in serum and urinary neopterin levels one week after the start of treatment. Both neopterin levels remained significantly elevated during treatment but rapidly returned to basal levels after the completion of treatment. Serum and urinary neopterin levels changed with a pattern similar to that of serum 2',5'-oligoadenylate synthetase activity and with a mirror image to serum DNA polymerase activity. It is indicated that measurement of serum and urinary neopterin can be used as a marker for cell-mediated immunity during interferon therapy for chronic hepatitis B, but can not be used to predict the short-term clinical effects of interferon treatment as in the case of serum 2',5'-oligoadenylate synthetase.

[Bacteriuria in patients with primary biliary cirrhosis]. / Bacteriuria en pacientes con cirrosis biliar primaria.

BACKGROUND: Controversies exist about the association between significant bacteriuria and primary biliary cirrhosis. There is evidence suggesting that infections by Gram negative bacteria may be implicated in the pathogenesis of this liver disease. AIM: To compare the incidence of bacteriuria in patients with primary biliary cirrhosis and those with autoimmune chronic hepatitis. PATIENTS AND METHODS: Twenty women with primary biliary cirrhosis and twenty three female patients with autoimmune chronic hepatitis were prospectively studied by routine bacteriological cultures of midstream urine specimens. Samples were obtained at three months intervals or when patients complained of symptoms suggesting urinary tract infection. Significant bacteriuria was defined as the growth of > 10(5) organisms/ml in pure culture. RESULTS: During 8 +/- 1 months of follow up. 60 urine samples from patients with primary biliary cirrhosis and 73 from autoimmune hepatitis cases were tested. Twenty one samples of patients with primary biliary cirrhosis (35%) were positive for significant bacteriuria compared with 7 from women with autoimmune hepatitis (9%); p < 0.01. In the follow up, ten patients with primary biliary cirrhosis (50%) and six with autoimmune hepatitis (26%) developed at least one episode of significant bacteriuria. CONCLUSION: These results suggest that female patients with primary biliary cirrhosis are in higher risk of significant bacteriuria than women with autoimmune hepatitis. Prospective studies evaluating the effects of long-term antibiotic therapy on cholestasis parameters in primary biliary cirrhosis are deserved.

[N-acetyl-beta-D-glucosaminidase and diurnal excretion of hydroxyproline in chronic viral hepatitis]. / N-acetyl-beta-glukozaminidaza i dobowe wydalanie hydroksyproliny w przewleklych wirusowych zapaleniach watroby.

In 37 patients with chronic active hepatitis, in 14 with chronic persistent hepatitis and in 11 with normal histological pattern of the liver the serum activity of N-acetyl-beta-glucosaminidase and the 24-hour excretion of hydroxyproline with urine were determined. The 24-hour excretion of hydroxyproline was similar in all groups of patients, while the activity hepatitis and higher than in those of chronic persistent hepatitis (36.9 +/- 12.9 i.u. per 100 ml versus 22.4 +/- 8.2 i.u. per 100 ml, p less than 0.05). In patients with high serum NAGL activity cirrhosis developed significantly more frequently.

Detección de aflatoxina en la orina en enfermedades hepáticas en la infancia / Aflatoxin detection in urine in liver diseases in childhood

Durante la última década una serie de investigaciones epidemiológicas y de laboratorio han demostrado una fuerte asociación entre el virus de la hepatitis B, la exposición a aflatoxina en la dieta y el incremento de la incidencia del carcinoma hepatocelular. En el instituto de oncología se desarrolló y validó el método inmunoenzimático para la detección de aflatoxina en orina. Se estudiaron 54 niños con un rango de edad (4-16) de la consulta de gastroenterologia, 30 con diagnóstico de hepatitis crónica activa (HCA) AgsHB+ resultando positivos el 56

Elevated formation of nitrate and N-nitrosodimethylamine in woodchucks (Marmota monax) associated with chronic woodchuck hepatitis virus infection.

Nitrate balance and N-nitrosodimethylamine (NDMA) excretion were studied in woodchucks chronically infected with woodchuck hepatitis virus (WHV). Twenty-four-h urinary recovery of a bolus dose of [15N]nitrate was 54 +/- 12% in woodchucks. WHV-infected animals formed 3-fold more nitrate endogenously than did control animals (P less than 0.01). Treatment of WHV-infected animals with Escherichia coli lipopolysaccharide increased nitrate excretion 15-fold, while uninfected animals increased nitrate excretion 4-fold. The endogenous formation of NDMA was higher in WHV-infected woodchucks than in uninfected controls. After administration of L-[15N2]arginine, [15N]nitrate, and [15N]NDMA were detected in urine indicating that arginine is a precursor of biosynthesized nitrate and the hepatocarcinogen NDMA. NDMA probably results from the formation of nitrosating agents during the oxidation of arginine to oxides of nitrogen and citrulline. Woodchucks chronically infected with WHV develop hepatocellular carcinomas with high frequency. Our observations suggest an additional mechanism that may be involved in the pathogenesis of hepatocellular carcinoma associated with chronic WHV infection.

[Aflatoxin detection in urine in liver diseases in childhood]. / Detección de aflatoxina en la orina en enfermedades hepáticas en la infancia.

During the last decade, a number of epidemiological and laboratory investigations have shown a close association among hepatitis B, dietary exposure to aflatoxin, and an increased incidence of hepatocellular carcinoma. An immunoenzymatic method for aflatoxin detection in urine was developed and assessed at the National Institute of Oncology. Fifty four children (age range 4-16 years) from the pediatric service at the National Institute of Gastroenterology were studied. Thirty patients had a diagnosis of chronic active hepatitis (CHA 17 of which 56%) were found aflatoxin- positive, 20 where HbsAg-positive carriers of which 7 of 35% were positive to aflatoxin, and 4 patients suffered from metabolic diseases from which 1 (25%) was found aflatoxin- positive. Controls and patients were matched by age, with 7.5% of aflatoxin-positive patients. Our results confirm the link between hepatitis B and aflatoxin in this type of patients compared to controls. The immunoenzymatic system proved to be specific for aflatoxin detection with a sensitivity of 100 picograms/milliliter.

Increased urinary excretion of bile alcohol glucuronides in patients with primary biliary cirrhosis.

The bile alcohol glucuronides in urine of 12 patients with primary biliary cirrhosis (PBC), 10 patients with chronic active hepatitis (CAH), and 6 healthy volunteers were analyzed by capillary gas-liquid chromatography-mass spectrometry. In all subjects studied, the major urinary bile alcohol was found to be 27-nor-5 beta-cholestane-3 alpha,7 alpha,12 alpha,24,25-pentol (C26 pentol). In PBC patients, the excretion of C26 pentol (main isomer) was significantly increased above values observed in healthy volunteers (mean +/- SD = 5.2 +/- 3.5 mumol/24 h, range 1.0-13.4; versus 0.6 +/- 0.3, range 0.4-1.0). In addition, PBC patients excreted increased amounts of other bile alcohols such as isomers of C26 pentol, pentahydroxylated C27 bile alcohols (5 beta-cholestane-3 alpha,7 alpha,12 alpha,24,25-pentol) and 5 beta-cholestane-3 alpha,7 alpha,12 alpha,25,26-pentol) and a hexahydroxylated C26 bile alcohol (27-nor-5 beta-cholestane-3 alpha,7 alpha,12 alpha,24,25,26-hexol). In CAH patients, the excretion of the C26 pentol main isomer ranged from 0.3 to 2.0 mumol/24 h (mean +/- SD = 0.7 +/- 0.5) and did not significantly differ from that in healthy volunteers. Moreover, the bile alcohol profile was comparable to those found in healthy volunteers and PBC patients. These findings show that total urinary bile alcohol glucuronide excretion is significantly increased in primary biliary cirrhosis. A PBC-specific urinary bile alcohol profile, however, does not exist.

Urinary hydroxyproline and hydroxylysine excretions in relation to hepatic hydroxyproline content in chronic liver disease.

In patients with or without various chronic liver diseases, the total urinary excretion of hydroxyproline and hydroxylysine and the hepatic content of hydroxyproline were examined. In 7 patients without liver disease, the urinary excretion of hydroxyproline and hydroxylysine were 10.3 +/- 1.5 and 1.31 +/- 0.21 mmol/mol creatinine, respectively, and the hepatic content of hydroxyproline was 4.9 +/- 0.6 mumol/g of wet liver. In 33 patients with liver disease, the urinary excretion of hydroxyproline and hydroxylysine and the hepatic content of hydroxyproline were increased in proportion to the severity of liver disease. The hepatic content of hydroxyproline showed a significant correlation with the urinary excretion of hydroxyproline and hydroxylysine (r = +0.406 and r = +0.531, respectively). These results suggest that the study of urinary hydroxyproline and hydroxylysine excretion may yield useful information on the metabolism of hepatic collagen in chronic liver disease. Moreover, urinary hydroxylysine excretion seemed to be a better index of hepatic collagen metabolism than urinary hydroxyproline excretion; perhaps urinary hydroxylysine excretion is not much affected by dietary collagen intake.

Potential of urinary neopterin excretion in differentiating chronic non-A, non-B hepatitis from fatty liver.

Urinary neopterin excretion was measured in 26 patients with histologically proven chronic non-A, non-B hepatitis (16 chronic persistent hepatitis, 10 chronic active hepatitis) and in 16 patients with steatosis. The potential of neopterin levels to discriminate between the two patient groups was compared with that of standard laboratory variables. Neopterin levels and triglycerides were shown to be the best variables for discriminating between the hepatitis and fatty liver patients, neopterin being the more specific of the two. Neopterin excretion in chronic persistent hepatitis was not statistically different from that in chronic active hepatitis. In the absence of specific tests, increased neopterin excretion seems to be a useful marker for diagnosing chronic non-A, non-B hepatitis and particularly in differentiating it from fatty liver.

Urinary prostaglandins and renal function in chronic liver diseases.

Changes in urinary PGE2 and PGF2 alpha excretion in chronic liver diseases were observed in relation to renal hemodynamics and sodium balance. After equilibration on a 110-170-meq sodium diet, daily urine collections were analyzed for PGE2 and PGF2 alpha by a new extraction and radioimmunoassay method. PGE2 was significantly greater in cirrhotics than in healthy subjects and in chronic hepatitis. The value was greater in cirrhotics with ascites than in those without ascites (p less than 0.05). PGF2 alpha did not differ among the groups. In cirrhotics PGE2 was correlated negatively with creatinine clearance (Ccr)(r = -0.76, p less than 0.001). After administration of 200 mg indomethacin, a significant fall in Ccr was seen only in cirrhotics with ascites. The percentage fall in PGE2 after indomethacin correlated with that in Ccr (r = 0.89, p less than 0.05) and with that in urinary sodium excretion (r = 0.68, p less than 0.02). These results suggest that PGE2 is essential in the maintenance of renal function in liver cirrhosis with ascites.