226 THE PLACE OF PERCUTANEOUS LIVER BIOPSIES IN THE EARLY PREOPERATIVE DIFFERENTIAL DIAGNOSIS OF EXTRAHEPATIC BILIARY ATRESIA

J.Deutsch, H.Becker Departments of Paediatrics and Anatomical Pathology, University of Graz, Austria

A prospective study was undertaken to reduce the incidence of invasive procedures in the early preoperative differential diagnosis of extrahepatic biliary atresia to a necessary minimum without reducing the diagnostic accuracy. 60 infants with direct hyperbilirubinaemia were evaluated: 50 infants were below the age of I month, 7 were between I and 2 months old, and 3 were up to 3 I/2 months old. Diagnoses were confirmed by serial sections of the porta hepatis, by the clinical course, or by postmortem examinations. The diagnostic work-up consisted of clinical data, of a search for the cause of liver disease, and of quantitative estimations of lipoprotein-X before and after cholestyramine, of cholescintigraphy with IDA-derivatives, and of percutaneous liver biopsies. Results: 21 infants had acholic stools, 5 of them had extrahepatic biliary atresia. 55 infants had intrahepatic diseases. The efficiency of the preoperative diagnostic work-up reached 98,3%. The incidence of percutaneous liver biopsies was reduced to 47,6% in infants with acholic stools, and 17,9% in infants with normal stools; this amounted to an average of 29,3% of infants who had percutaneous liver biopsies. The efficiency of liver biopsies was 88,2%. Further reductions of invasive procedures in the early preoperative differential diagnosis of extrahepatic biliary atresia may be possible by an improvement of imaging techniques.

227 MECHANI~4S OF DEFECTIVE LYMPHOCYTE ACTIVATION IN ALCOHOLIC LIVER CIRRHOSIS

J. DEVIERE*, E. DUPONT**, C. DENYS**, M. ADLER*, M. CREMER*, J. WYBRAN**. Departments of Gastroenteroly* and Inm~/nology**. U.L.B., Hdpital Erasme, 808, route de Lennik - B-1070 Brussels.

Mechanisms of depression of cellular in~nunity in alcoholic liver disease are still poorly understood. Several assays studying multiple pathways of T lymphocyte activation including lectin multiple pathways of T lym[zhocyte activation including lectin Con A and OKT3 Mo Ab assessing the T3-Ti T-cell receptor, phorbol myristate acetate (PMA) activating cell through protein kinase C (PKC) and A 23187 ionophore inducing CA2 + influx into the cytoplasm, and IL2 production have been studied in patients with severe alcoholic cirrhosis (AC, N=I0), alcoholic hepatitis (AH, N=4) and steatosis (AS, N=6). A striking feature was observed in all patients with cirrhosis in which a dramatic and significant depression of all proliferative assays (p 0.001) was found, contrasting with fully preserved capacity to produce IL2 (1.79 + 0.29 units versus 1.33 + 0.27 in healthy controls). ~his profound deficiency was found exclusively in AC patients.

In AS and AH, no significant variation of proliferative assays was found. It is concluded that A.C. is associated with defective lymphocyte activation affecting several pathways of T-cell activation including the T3-Ti receptor, PKC and Ca related mechanisms, without involvement of the capacity of IL2 production. Mechanisms of this striking dissociation are under current evaluation. Functional activity (CPM x 103)

Con A 50 Con A 10 OKT3 PMA A23187 Controls 405 + 38 277 + 25 242 + 15 262 + 23 92 + 31 Cirrhosis 197 + 21 92 ~ 15 142 ~ 17 79 ~ 17 4 ~ 1

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