Polyvinyl pyrrolidone deposits in the liver

Association for the Study of Liver Diseases this series and in a much larger additional group of patients. Esophageal varices were found in ninety-five cases or 63.3 per cent of the whole group. Among fifty-nine patients with a history of gastrointestinal hemorrhage, varices were found in forty-seven cases, or 79.6 per cent. More surprising was the finding of forty-eight cases of esophageal varices in ninety-one of the patients, or 52.7 per cent, who had no history of hemorrhage. In the same patients x-ray diagnosis revealed only nineteen cases of the ninety-five diagnosed esophagoscopically. In this study, x-ray diagnosis of esophageal varices was quite unreliable in comparison to endoscopy. Comparison was also made with physical findings in the groups with and without esophageal varices. Hepatomegaly, splenomegaly and ascites were found in a comparable percentage of cases in both groups. Spider angiomas were found significantly more frequently in the group with varices, being present in 59.0 per cent of these cases as contrasted to 30 per cent of cirrhosis cases without esophageal varices. The finding of spider angiomas should suggest not only the presence of cirrhosis but also lead to a search for esophageal varices. EXPERIENCES WITH THE TEST FOR SERUM MucoPROTEIN

IN

ONE

HUNDRED

PATIENTS

WITH

Emanuel E. Mandel, ‘Thomas L. Gorsuch and Florence L. Jones. Communicable Disease Center, Public Health Service, U. S. Dept. of Health, Education and Welfare; Depts. of Medicine and Pathology, Emory Univ. School of Medicine, and Grady Memorial Hospital, Atlanta, Ga. HEPATOBILIARY

DISEASE.

Serum mucoprotein (M) was measured as mg. biuret peptide per 100 ml. following differential precipitation with perchloric and phosphotungstic acids. In seventy healthy individuals and hospital controls 90 per cent of values ranged from 40 to 90 mg. for males and 35 to 72 for females. Of thirty patients with viral hepatitis, M was subnormal in twenty-four, normal in four patients having low-grade jaundice and elevated in two cases complicated by pneumonia and mastitis, respectively. Normal or high levels were found in leptospiral (two cases) and amoebic (one) hepatitis. In a group of twenty-seven cases of cirrhosis sixteen had extrahepatic complications and normal or elevated M; seven (two posthepatitic) had subnormal and the rest, normal values. One cardiac cirrhosis was associated with a subnormal, hemochromatosis

905

with an elevated M, and six cases of hemolytic ,jaundice with either normal or elevated M. None of thirty-two patients with biliary obstruction had subnormal levels but more than onehalf, including both benign and malignant lesions: showed distinct elevations. A subnormal M appears to he indicative of hepatocellular disease, being more reliable than positive cephalin flocculation or thymol turbidity reactions. The diagnostic contribution of normal or elevated levels depends upon more judicious scrutiny. POLYVINYL PYRROLIDONE DEPOSITS IN THE LIVER.

Herbert Braunstein, E. A. Gall, Leon Sch$, Gordon M. Mindrum, David G. Freiman, William A. Altemeier and .Jerome Giuse$, Jr. Depts. of Internal Medicine and Pathology, Cincinnati General Hospital, Cincinnati, Ohio. Polyvinyl pyrrolidone is a high molecular weight polymer of N-vinyl pyrrolidone which was used extensively as a plasma expander in Germany during World War II and is currently being evaluated for similar use in this country. Although clinical studies have suggested that the compound is innocuous, there has been disagreement whether acute pathologic changes are produced by its administration, and there are relatively few reports concerning possible long-range pathologic effects. In this study twenty-two patients confined to a chronic disease hospital were utilized. None suffered from hepatic, hemopoietic or febrile disorders. Three weeks following a control needle liver biopsy exhibiting no or inconsequential pathologic changes, 1,000 cc. of 3.5 or 4.5 per cent polyvinyl pyrrolidone were administered intravenously. Subsequently, needle biopsy specimens were secured at intervals ranging from six weeks to thirteen months after infusion. The number of follow-up biopsies varied from one to four per patient, and one patient was autopsied following death from an infection unrelated to this study. Despite the failure of clinical and laboratory studies to demonstrate striking aberrations from normal, significant lesions were observed in the liver sections. In the early follow-up biopsy specimens, no recognizable changes from the controls could be detected. At periods of three to thirteen months following infusion, deposits of smudgy, basophilic material were detected in increasing frequency and quantity. These distended Kupffer cells filled sinusoids and

Association

for the Study of Liver Diseases

occasionally were present in portal areas. Usually little reaction appeared although in some a minor lymphocytic and histiocytic infiltrate was present in relation to the deposited substance. Occasionally, early fibroblastic activity, without evidence of permanent fibrosis, was detectable about larger deposits. In the autopsied case there were similar hepatic findings and smaller deposits in the spleen and bone marrow. The material in sections exhibited an affinity for Congo red dye and iodine, but was otherwise histochemically inert. The findings suggest that the deposited material is related to polyvinyl pyrrolidone. The latency of its accumulation suggests that it may represent that part of the polymer which is retained in the body following excretion of the portion of lower molecular weight. Further studies are in process in order to evaluate the possibility of long-range noxious sequelae. CHRONICIDIOPATHIC JAUNDICEWITH UNIDENTIFIEDPIGMENTIN LIVER CELLS: A NEW CLINICOPATHOLOGIC ENTITYWITH A REPORTOFTWELVE CASES.1. N. Dubin and Frank B. Johnson. Armed

Forces Inst. of Pathology,

Washington,

D. C.

The disease manifests itself as a form of chronic jaundice in young people. The commonest symptoms are abdominal pain and fatigue; jaundice, dark urine and slight enlargement of the liver are the only signs present. The jaundice fluctuates in intensity and is aggravated by intercurrent diseases. The prognosis is excellent. Both the direct and total serum bilirubin levels are elevated. The jaundice is neither hemolytic, obstructive nor inflammatory in origin. Except for the presence of an unidentified pigment in parenchymal cells, the liver is histologically normal on biopsy studies. The etiology of the disease is unknown; it probably consists of an inborn deficiency of the liver in excreting such substances as (1) bilirubin, (2) the pigment which accumulates in liver cells, (3) bromsulphthalein and (4) dyes used, in cholecystography. Clinically, the disease resembles Gilbert’s disease but there are important differences between these disorders which led us to believe it is a separate disease process. It differs from Gilbert’s disease in the following respects: (1) dark urine, present in our cases, is absent in Gilbert’s disease, (2) the serum bilirubin always gives an elevated direct Van den Bergh reaction,

in contrast to Gilbert’s disease in which the reaction is indirect, (3) liver function tests, such as bromsulphthalein excretion, cephalin flocculation and thymol turbidity often give abnormal results in our cases, (4) in our cases the gallbladder cannot be visualized on cblecystography while in Gilbert’s disease this procedure always gives normal results and (5) in our cases the liver is grossly and histologically discolored by the presence of a brown pigment in parenchymal cells, a finding absent in Gilbert’s disease. PRELIMINARYPRESENTATION OF THE POSSIBLE USE OF A PHOSPHATASE-CHOLESTEROL INDEX IN THEDIFFERENTIATION OFCHOLANGIOLITIC HEPATITIS.Hurry Shuy. Samuel S. Fels Research Inst.,

Temple Univ. School of Medicine Univ. Hospital, Philadelphia, Pa.

and Temple

The differentiation of cholangiolitic hepatitis from congenital biliary atresia and from other forms of extrahepatic biliary obstruction presents a serious problem. An enlarged liver, if present at the onset, is helpful in the adult but not in the infant. In some cases one or another of the flocculation tests may become persistently positive early. In many, however, neither of these findings appear and in these detailed liver function profiles are identical with those obtained in extrahepatic obstruction. In studying the inter-relationships of a large number of liver function data collected in the past two years, we have found a phosphatasecholesterol relationship that appears promising in this difficult diagnostic problem. All data are based on the Shinowara-Reinhart-Jones method for serum alkaline phosphatase and the index is calculated only when the total serum cholesterol is above 300 mg. per cent. The figure for the phosphatase-cholesterol index is represented by the units of phosphatase per hundred mg. of cholesterol. This index will be below 7.5 in cholangiolitic hepatitis and, incidentally, in the inspissated bile syndrome as well, and greater than 7.5 in congenital atresia and in extrahepatic biliary obstruction from other causes. Certain other details will be published in full. COMPARISON OF THE LIVERSOF MAN, DOG AND RAT. Leon Gershbein, Hans Elias and Hans Popper.

Dept. of Anatomy, Chicago Medical School and Hektoen Inst. for Medical Research, Chicago, Ill. Stimulated by the observations of Hartroft as to the “non-portal” character of the hepatic AMeRlCAN JO”RNI\L. UF MEDI<:,NE