Multifocal fatty infiltration of the liver; an aspecific presentation form of hepatitis C infection.

We present the case report of a 60 year old man with multiple focal echogenic lesions on ultrasound. While CT and MRI suggested the diagnosis of focal fatty infiltration of the liver, histology and serology showed a chronic hepatitis C infection. This is to our knowledge the first case of a patient with hepatitis C infection in whom focal steatosis could be seen on different imaging techniques.

Hepatitis C virus genotypes: epidemiological and clinical associations. Benelux Study Group on Treatment of Chronic Hepatitis C.

In a cohort of 292 chronic hepatitis C patients living in the Benelux countries the relationship between viral genotype and geographical origin, route of transmission, clinical characteristics and severity of liver disease was analyzed. HCV-RNA isolates could be classified by the Line Probe Assay (LiPA) as 1a, 1b, 2, 3, 4 or 5 in 286 (98%) cases. Patients of European origin were predominantly infected with HCV subtype 1b (164/254, 65%, CI 58-70%), as were patients of Asian origin (7/13, 54%). Patients originating from Surinam (South America) had predominantly type 2 (9/10, 90%), whereas Africans were mainly infected with type 4 (7/9, 77%). Blood transfusion was the mode of transmission in 142 (50%) patients, intravenous drug abuse (IVDA) in 40 (14%), occupational needle accident or tattoo in 11 (4%); no obvious source of infection was found in 93 (33%). In patients infected by blood transfusion, subtype 1b was predominant (70%, CI 61-77%), whereas subtypes la and 3 were predominant in those infected by IVDA (25% and 45%, respectively, p<0.001). Cirrhosis was observed in 68 (24%) patients; in multivariate analysis, factors independently related to cirrhosis were: the duration of infection, age and prior hepatitis B. No significant relationship was found between the severity of fibrosis or liver inflammation and the HCV (sub)types. In summary, in this large cohort of patients in the Benelux countries the hepatitis C virus (sub)type present was clearly related to the country of origin and the route of transmission, but not to the severity of liver disease.

Polyarteritis nodosa and the antiphospholipid syndrome.

We report a case of biopsy-proven polyarteritis nodosa (classic type in association with the antiphospholipid syndrome. Medium-sized arteriopathy was confirmed on visceral angiography. Elevated anticardiolipin antibodies were detected before initiating therapy with methylprednisolone and IV pulse cyclophosphamide. Rapid subsidence of symptoms correlated with a gradual normalisation of the erythrocyte sedimentation rate. After 6 months of therapy anticardiolipin antibodies were within normal limits. Only one similar case has been reported so far.

[General argyria caused by administration of tobacco-withdrawal tablets containing silver acetate]. / Veralgemeende argyrose door het gebruik van tabak-ontwenningstabletten met zilveracetaat.

In a 49-year-old man generalised argyria was diagnosed, a systemic dissemination and tissue deposition of silver in the body. The clinical picture was brought about by use of a silver acetate-containing lozenge as a deterrent to smoking. Argyria is characterised by a slate blue-gray discolouration of the skin, particularly in areas exposed to light. Generally, it causes patients a great deal of anguish and embarrassment. Present understanding is that it does not entail non-cutaneous, systemic effects. There is no effective treatment--the discolouration is permanent. Currently, prevention is the only possible measure. Efforts should be made to eliminate the uncontrolled use of silver-containing preparations.

Br, Rb, Zn, Fe, Se and K in blood of colorectal patients by INAA and PIXE.

A preliminary study was conducted on blood samples and blood fractions of 11 colorectal patients and 10 healthy subjects (controls) in Belgium, in order to determine the concentration of some vital trace elements. Two non destructive analytical methods were used for the determination: INAA and PIXE. The agreement between PIXE and INAA was within about +/- 10% for plasma, but for Rb, Se and Fe in whole blood and red cells a difference of +/- 20% was noted; part of the discrepancy may be due to self absorption problems in PIXE, and for Rb, spectral interferences also may have contributed. The precision of the INAA method for the elements studied was found to be +/- 3% for whole blood and red cells and +/- 5% for plasma; the accuracy for Br, Rb and Zn was better than +/- 10% and +/- 17% for Se. The ratios of the concentrations in whole blood to red cells and whole blood to plasma were not significantly different for normals and cancer cases and, therefore, in future studies analysis of whole blood only may be sufficient. The mean values for Br, Rb, Br/Rb ratio, K, Fe and Se were significantly lower for cancer cases than for healthy individuals, and this might be applicable as an additional parameter for differentiating normals from malignant cases.

Serum gastrin levels and colorectal neoplasia.

PURPOSE: Confirmation of an association between elevated serum gastrin concentrations and presence of colorectal tumors would have important implications with regard to screening procedures and therapeutic strategies. METHODS: We compared fasting serum gastrin concentrations of patients with colorectal cancer (n = 91; mean age, 66 (range, 35-87) years), colorectal polyps (n = 89; mean age, 61 (range, 38-86) years), or a normal colonoscopy (n = 101; mean age, 62 (range, 34-82) years) in the period between 1983 and 1992. RESULTS: Median serum gastrin concentrations were, respectively, 20, 20, and 21 pmol/liter (not significant). We were unable to find a relation with histology of the polyp, presence or severity of dysplasia, and extent of cancer. CONCLUSIONS: This large study fails to show any difference in serum gastrin concentrations among the three studied groups.

Neutron activation analysis for the determination of trace elements in biological materials.

Neutron activation analysis, in both its radiochemical and instrumental forms, is a precious technique for the determination of trace elements in biological materials. Probably its most important advantage is its relative freedom from errors resulting from contamination of the samples. Invaluable characteristics are also its excellent sensitivity, outstanding selectivity, and remarkable multielement capability. It is, however, necessary to warn against uncritical expectations. This is best illustrated by the seriously inconsistent results obtained in several laboratories. Because of the necessity to have access to a nuclear research reactor, the stringent safety rules to be observed, the rather high costs of the analyses, the relatively low sample throughput, and the sometimes long delay between the taking of a sample and the obtaining the final result, the use of neutron activation analysis remained restricted to a few--essentially research--laboratories. It found its main application in solving arduous problems and in paving the way for other analytical techniques better suited to routine applications.

Bismuth in human serum: reference interval and concentrations after intake of a therapeutic dose of colloidal bismuth subcitrate.

A sensitive method for the determination of the bismuth concentration in human serum is described. Analyses were carried out by inductively coupled plasma-mass spectrometry (ICP-MS), after a simple dilution of the samples with nitric acid. The detection limit of the applied method is 0.007 microgram/l whereas relative standard deviations varied from 5.7 to 13.6%. Determination of reference values in human serum of healthy adults gave a range from < 0.007 to 0.067 microgram/l (19 persons). Bismuth concentrations in serum were also measured before, during and after the intake of therapeutic doses of colloidal bismuth subcitrate (CBS). About 1.5-2 h after the intake of one tablet of CBS, the bismuth concentration in serum was found to have increased 51-1483 times (two apparently healthy volunteers and six hospitalized patients), showing that the serum bismuth concentrations can increase by several orders of magnitude during the intake of CBS. During the intake of four tablets of CBS per day by two apparently healthy volunteers, bismuth concentrations in serum after an overnight fast were found to be, respectively, 5.56 and 8.1 micrograms/l on day 15 and 4.28 and 13.6 micrograms/l on day 29. After stopping the therapy, the concentration of bismuth in serum slowly returned towards normal over a period of months.

Effect of solvent type on the determination of total iodine in milk powder and human serum by inductively coupled plasma mass spectrometry.

A method for the determination of the total iodine content in milk powder and human serum by inductively coupled plasma mass spectrometry is described. It is shown that the oxidation state of the analyte has a strong impact on the analytical performance. If iodine is present as iodide and nitric acid is used for acidification, the observed ion signal is not stable and samples spiked with iodide yield erroneous recoveries up to 750%. Hence, as the iodine in milk powder is present almost exclusively as iodide, destruction of the sample with nitric acid is not suitable. It was found that such an excessive spike recovery does not occur if ammonia solution instead of nitric acid is used as the diluent. The proposed sample preparation was tested by analysing three reference milk powders, namely Certified Reference Materials 150 and 151 Spiked Skim Milk Powder (from the Community Bureau of Reference) and Standard Reference Material 1549 Non-Fat Milk Powder (from the National Institute of Standards and Technology). Good agreement with the certified values was obtained, indicating that no significant errors are introduced. For human serum, samples treated with nitric acid or with ammonia solution gave results that were not significantly different from each other. Results are given for both a 'second-generation' biological reference material, Freeze-Dried Human Serum (University of Ghent), and for sera from healthy individuals.

[Liver and liver segment transplantation in adults and children. Experiences with the first 50 cases]. / Leber- und Lebersegmenttransplantation bei Erwachsenen und Kindern. Erfahrungen mit den ersten 50 Fällen.

The experience with 50 liver transplants performed in 42 patients within a 16 months period is reviewed. There were 15 transplantations in 12 children and 35 in 30 adults. The series was analysed regarding the source of transplant, i.e. living related (LR) n = 2 or cadaver (CAD) n = 48, graft size i.e. full size (FS) n = 34, reduced size (RED) n = 12 and split grafts (SG) n = 4. Regarding the preservation time or operating time there was no statistically significant difference between the groups. The overall function rate was 88%, 94% for FS and 73.4% for the remaining partial grafts (RED and SG). The difference was not significant (p = 0.062). Biliary leakage occurred in one (2%) reduced graft. Hepatic artery complications (kinking, intima dissection) were encountered in two (4%) patients receiving a FS. It is concluded that the use of partial liver grafts is a safe procedure to alleviate organ shortage while preservation time and operating time are not prolonged as compared to the transplantation of full size grafts.

Determination of tin in human blood serum by radiochemical neutron activation analysis.

A method was developed for the determination of tin in human serum by radiochemical neutron activation analysis, using the long-lived radioisotope Sn(T1/2 = 115.09 days). This radioisotope decays to a daughter isotope 113mIn, the most suitable nuclide for counting (T1/2 = 1.658 h, gamma-ray of 391.7 keV). Experience showed that, with the exception of the serum samples with the lowest tin levels, in the experimental conditions of the present study tin could mostly also be determined by using its radioisotope 117mSn(T1/2 = 13.61 days, gamma-ray of 158.5 keV). Samples were collected and prepared by using the procedure elaborated by the authors, which proved its effectiveness in preventing significant sample contamination on several occasions. Because samples had to be irradiated at 10(14) n.cm-2.s-1, dry ashing was necessary. After irradiation, tin was separated by solvent extraction of tin(IV) iodide from a sulfuric acid-ammonium iodide solution with toluene. The dry ashing and solvent extraction steps were exhaustively tested by means of radioactive tracer experiments whereas the accuracy and precision of the analytical method were thoroughly checked by analyzing biological reference materials (Bowen's kale powder, the NBS' bovine liver, the NBS' nonfat milk powder, and the "second-generation" biological reference material--freeze-dried human serum--for trace element determinations, developed by the authors).(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of strontium in human serum by inductively coupled plasma mass spectrometry and neutron activation analysis: A comparison.

Strontium has been determined in a human serum reference material by ICP-MS and by NAA. By ICP-MS, results for (88)Sr and (86)Sr in both 10- and 5-fold diluted serum were in good agreement. For (88)Sr the precision was better than 3% and the detection limit was 0.05 mug/l. under the conditions used. The results were 25.5 mug/l. in the liquid serum or 0.281 mug/g in the lyophilized reference material. In the NAA the (87m)Sr produced was radiochemically separated by extraction with oxine in chloroform. The precision was about 10% and the detection limit 0.02-0.05 mug/g.

Vanadium determination at the ultra-trace level in biological reference materials and serum by radiochemical neutron activation analysis.

In order to help resolve present inconsistencies of two orders of magnitude or more in reported levels of vanadium in human serum and blood, a totally postirradiation radiochemical neutron activation analysis (NAA) method was further developed and applied to some pertinent nanogram and subnanogram reference materials. In particular, the second generation human serum reference material of Versieck was found to contain a value of 0.67 +/- 0.05 ng/g dry wt., corresponding to 0.061 +/- 0.005 /4/ ng/mL original fresh serum. Results are also reported for some other appropriate CRMs. Additionally, a small-scale study in 10 normal subjects (5 m, 5 f) revealed levels similar to those in the serum reference material and in agreement with the lowest data reported in the literature. Discussion of pitfalls of vanadium determination and the use of reference materials is included.

Determination of trace elements in human serum by inductively coupled plasma-mass spectrometry. Comparison with nuclear analytical techniques.

The determination of trace and ultratrace elements in human serum by ICP-MS is described. The accuracy of the method is tested using a "second generation" human serum reference material. Elements determined include Fe, Co, Cu, Zn, Br, Rb, Sr, Mo, and Cs. The method is compared to nuclear analytical methods (NAA, PIXE). Perspectives for the future are also discussed.

Determination of mercury in human serum and packed blood cells by neutron activation analysis.

A method is described for the determination of mercury in human blood serum and packed blood cells employing neutron activation analysis. Great attention was devoted to the collection and manipulation of the samples. The accuracy and precision of the method were tested by analyzing biological reference materials and by comparing the concentrations measured in a number of serum samples to those obtained by another, independent technique (cold vapor atomic absorption spectrometry) in the same samples. The article reports the levels measured in blood serum and packed blood cells samples from 15 adult volunteers, as well as the figures determined in a "second-generation" biological reference material (freeze-dried human serum), prepared and conditioned at the University of Ghent.

Determination of iron, cobalt, copper, zinc, rubidium, molybdenum, and cesium in human serum by inductively coupled plasma mass spectrometry.

A method was developed for the determination of seven trace elements (Fe, Co, Cu, Zn, Rb, Mo, and Cs) in human serum by inductively coupled plasma mass spectrometry (ICP-MS). Sample preparation was kept as limited as possible. As the only sample pretreatment serum samples were diluted with nitric acid and indium was added as an internal standard. The results for iron, cobalt, copper, and zinc were corrected for interferences from polyatomic ions by using a blank solution containing the same concentration of sodium, sulfur, chlorine, and calcium as human serum. For copper and zinc the corrections are small, whereas for iron and cobalt they are important. No interferences occur for the considered isotopes of rubidium, molybdenum, and cesium. In order to test the accuracy and precision of the analytical technique, a "second-generation biological reference material (human serum)" was analyzed. The results obtained by ICP-MS for the seven elements considered showed good agreement with the certified values.

Accuracy of biological trace-element determinations.

Mounting evidence suggests that the accuracy of much of the published information on trace-element concentrations in biological matrices leaves much to be desired. Potential sources of error are: (a) inadequate sample collection and preparation (sampling errors); and (b) inaccuracies at the moment of the measurement (measurement errors). Probably much of what has been maintained on trace elements in human health and disease in the past will have to be revised in the future.

Evaluation of trace elements in human lung tissue. I. Concentration and distribution.

The lungs of eight individuals were investigated for 27 elements by neutron activation analysis and atomic absorption spectrometry. Thirteen segments of each lung pair were analyzed, together with hilar lymph nodes. The trace element distribution in the lungs and the inter-individual concentration differences reveal the existence of two groups of elements. A similar situation is observed in the lymph nodes. The elements Br, Cs, Cu, K, Na, Rb, Se and Zn are relatively homogeneously distributed over a lung pair and show little inter-individual concentration differences. On the other hand, Cd, Co, Cr, Pb, Sb, Sc and V are very inhomogeneosly distributed. The inhomogeneity and the concentrations increase with age. The existence of a concentration gradient within the lung and of relatively higher levels in the lymph nodes point to an enrichment in the lung tissue by inhaled atmospheric contaminants.