Pathologic analysis of liver transplantation for primary biliary cirrhosis

A retrospective histopathologic review of all pathologic specimens from 394 adult liver transplant patients was undertaken with clinical correlation to determine if primary biliary cirrhosis has affected the posttrans‐plant course compared to all other indications for liver transplantation and if recurrent primary biliary cirrhosis has occurred after liver transplantation. We also compared the histopathologic features seen in native livers with primary biliary cirrhosis to failed allografts with chronic rejection. One hundred six of the 394 adult patients transplanted during this time (1981 to July, 1986) fulfilled clinicopathologic criteria for a diagnosis of primary biliary cirrhosis. Neither the incidence nor any qualitative pathologic feature of histologically documented acute cellular rejection differentiated subjects transplanted for primary biliary cirrhosis vs. other diseases. No correlation between the titers of antimitochon‐drial antibody and the presence of posttransplant hepatic dysfunction based on liver enzyme profiles or the development of chronic rejection was seen in patients transplanted for primary biliary cirrhosis. Minor differences noted in the posttransplant course of primary biliary cirrhosis patients as compared to other conditions (higher incidence of chronic rejection as a cause of graft failure) was seen, but this did not significantly affect graft or patient survival. Recurrent primary biliary cirrhosis could not be diagnosed with certainty in any patient. A comparison of failed chronically rejected allografts vs. native hepatectomies obtained from patients with primary biliary cirrhosis revealed the presence of chronic obliterative vasculopathy, centrilobular cholestasis, and lack of granulomas, cirrhosis, cholan‐giolar proliferation, copper‐associated protein deposition and Mallory's hyalin in specimens with chronic rejection. In contrast, livers removed from patients with primary biliary cirrhosis demonstrated a mild vasculopathy, cirrhosis, granulomas, copper‐associated protein deposition, Mallory's hyalin and periportal cholestasis. Both conditions demonstrated a nonsuppurative destructive cholangitis with bile duct paucity. Copyright © 1988 American Association for the Study of Liver Disease

Methylated DNA recognition during the reversal of epigenetic silencing is regulated by cysteine and cerine residues in the Epstein-Barr Virus lytic switch protein

Epstein-Barr virus (EBV) causes infectious mononucleosis and is associated with various malignancies, including Burkitt's lymphoma and nasopharyngeal carcinoma. Like all herpesviruses, the EBV life cycle alternates between latency and lytic replication. During latency, the viral genome is largely silenced by host-driven methylation of CpG motifs and, in the switch to the lytic cycle, this epigenetic silencing is overturned. A key event is the activation of the viral BRLF1 gene by the immediate-early protein Zta. Zta is a bZIP transcription factor that preferentially binds to specific response elements (ZREs) in the BRLF1 promoter (Rp) when these elements are methylated. Zta's ability to trigger lytic cycle activation is severely compromised when a cysteine residue in its bZIP domain is mutated to serine (C189S), but the molecular basis for this effect is unknown. Here we show that the C189S mutant is defective for activating Rp in a Burkitt's lymphoma cell line. The mutant is compromised both in vitro and in vivo for binding two methylated ZREs in Rp (ZRE2 and ZRE3), although the effect is striking only for ZRE3. Molecular modeling of Zta bound to methylated ZRE3, together with biochemical data, indicate that C189 directly contacts one of the two methyl cytosines within a specific CpG motif. The motif's second methyl cytosine (on the complementary DNA strand) is predicted to contact S186, a residue known to regulate methyl-ZRE recognition. Our results suggest that C189 regulates the enhanced interaction of Zta with methylated DNA in overturning the epigenetic control of viral latency. As C189 is conserved in many bZIP proteins, the selectivity of Zta for methylated DNA may be a paradigm for a more general phenomenon

Isolation and primary cultures of human intrahepatic bile ductular epithelium

A technique for the isolation of human intrahepatic bile ductular epithelium, and the establishment of primary cultures using a serum- and growth-factor-supplemented medium combined with a connective tissue substrata is described. Initial cell isolates and monolayer cultures display phenotypic characteristics of biliary epithelial cells (low molecular weight prekeratin positive; albumin, alphafetoprotein, and Factor VIII-related antigen negative). Ultrastructural features of the cultured cells show cell polarization with surface microvilli, numerous interepithelial junctional complexes and cytoplasmic intermediate prekeratin filaments. © 1988 Tissue Culture Association, Inc

The anorexic body: a feminist and sociological perspective on anorexia nervosa

This thesis attempts a sociological and feminist analysis of anorexia nervosa. Anorexia is an illness which affects predominantly women, and its incidence is greatest among middle-class young women in Western countries. Its strong bias along class and gender lines suggests that such an approach to the illness could prove fruitful. The thesis argues that analysis of anorexia demands a clear understanding of the sociology of the body. The sociology of the body sees the body as constructed in social life: understandings of the body vary temporally and culturally, and reflect the categories of their culture. It is suggested that anorexia nervosa represents an attempted transformation of the concept of the feminine body in contemporary culture. Anorexic women aim to transcend appetite, and to allow no intrusions into the body, constructing an anorexic body which is closed, separate and inviolable. Since this transformation is individuated and privatised, however, it cannot ultimately succeed in overturning a system of social meanings. The thesis concludes that individual solutions to anorexia will not lead to the end of the illness as a social phenomenon in the lives of women. Only collective feminist action can reconstruct the degraded contemporary concept of woman. The argument is pursued firstly through a discussion of the initial use of the term `anorexia nervosa' in the late nineteenth century by Gull and Lasegue. The treatment of anorexia as a modern disease is discussed, and the claim that anorexia has always existed but has not been recognised is refuted. Psychiatric and feminist accounts of anorexia are then considered. The former see anorexia as a purely individual phenomenon, and the limitations of this position are discussed. Feminist analyses of anorexia, in seeing it as deeply intertwined with women's social position in a patriarchal culture, are argued to advance understanding of the illness, while still retaining individualist elements. The next section analyses the ways in which anorexic women themselves explain their illness. This leads on to a discussion of the notion of the body as concept. After a theoretical outline, several body-concepts are analysed and placed in their social and historical contexts. Contemporary understandings of the body as an individuated possession are then discussed, with particular focus on the concept of the feminine body as passive object. Objectification, discipline and chaos are argued to be the central meanings of the feminine body in contemporary culture. Analysis of the issues of abortion and rape seek to make this theoretical point clearer. A detailed analysis of anorexic practices looks at how these meanings are transformed in anorexia. It is suggested that anorexic women try to construct an inviolate anorexic body which is completely under their control through a complexly ritualised eating pattern. The precarious nature of this control points to the limitations of individual `solutions' to social problems

Canadian Association of Gastroenterology Practice Guideline for Informed Consent – Gastrointestinal Endoscopy

Informed consent has undergone a transformation from an ethical concept to a legal doctrine. It is based on the ethical principles of self-determination and autonomy. Over the past several years, courts have established physician liability based on the failure to obtain adequate informed consent. It is the duty of all gastrointestinal endoscopists to obtain legally adequate informed consent before performing any endoscopic procedure