Bone Disease in Primary Biliary Cirrhosis: Increased Bone Resorption and Turnover in the Absence of Osteoporosis or Osteomalacia

Jennifer A. Cuthbert, Charles Y. C. Pak, Joseph E. Zerwekh, Kenneth D. Glass, Burton Combes – 1 January 1984 – The role of vitamin D in hepatic osteodystrophy was examined. Eleven unselected patients with primary biliary cirrhosis (PBC) were assessed for disorders of mineral and vitamin D metabolism. Six were not receiving supplementary vitamin D, and five were being treated with oral vitamin D (50,000 IU daily). Serum levels of 25‐hydroxyvitamin D were normal in all patients receiving oral therapy and in 4 of 6 untreated patients.

Epidemiology and Clinical Course of Liver Diseases: Identification of Candidates for Hepatic Transplantation

John M. Vierling – 1 January 1984 – Among a variety of liver diseases that have been treated by hepatic transplantation, several were chosen for evaluation because of their frequency or high rate of fatality. Information regarding the incidence and prevalence in the United States, the natural history with conventional therapy, and prognostic indicators of a terminal phase is reviewed. Based on this information, specific candidates for hepatic transplantation are identified.

Some Immunological Considerations in Liver Transplantation

Paul S. Russell – 1 January 1984 – Immunological considerations of special interest in liver transplantation are examined. It is concluded that liver transplants between human beings generate typical rejection reactions although they may, overall, be somewhat more mild than those encountered in transplanted kidneys and hearts. This is the case in some animals for reasons which are not yet clear. There is evidence that the transplanted liver can suffer immune attack better than other organs. Whether graft‐vs.–host activity is of clinical importance is uncertain.

Extrahepatic Biliary Atresia

Daniel Alagille – 1 January 1984 – Extrahepatic biliary atresia is defined as partial or total absence of permeable bile duct between porta hepatis and the duodenum. The incidence varies from 1:8,000 to 1:10,000. Cholestasis is total and permanent. 131I Rose Bengal test and needle liver biopsy allow correct identification of 95% of cases before surgery Before the surgical procedure described by Kasai in 1959, all patients died between 1 and 2 years of age. Through the use of different types of Kasai's procedures by experienced groups, 30 to 35% of patients are successfully operated on.

Skills and Resources Needed for Liver Transplantation

Ruud A. F. Krom, Chris H. Gips – 1 January 1984 – Trained specialists in hepatology, liver and biliary surgery, anesthesiology and pathology must form the core of a team for liver transplantation. The hospital must be a center for organ transplantation to provide the essential infrastructure to manage specific aspects of transplantation. A well‐organized blood bank is essential to cope with acute requests for large amounts of donor blood.

Chronic Hepatitis and Cirrhosis

Sheila Sherlock – 1 January 1984 – Chronic hepatitis is defined as diffuse chronic liver disease existing for at least 6 months. Cirrhosis is a sequel. It is of multiple etiology. Liver biopsy is essential for diagnosis and prognosis. Hepatitis B‐related chronic hepatitis is slowly progressive. Corticosteroid therapy is disappointing. Current antiviral therapy converts the hepatitis B e antigen‐positive patient to anti‐HBe in about 50%. Non‐A, non‐B virus hepatitis‐related chronic hepatitis suffers from lack of a diagnostic marker. No current therapy is of proven benefit.

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