The diagnostic value of endoscopic retrograde cholangio-pancreaticography (ERCP) in patients with...

307 THE DIAGNOSTIC VALUE OF ENDOSCOPIC RETROGRADE QqOLANGIO-PANCREATICOGRAPHY (ERCP) IN PATIENTS WITH ~OLESTATIC SYNDP~ WITHOUT DIIATEDDUCTS.

S.H. Yap~ S.P. Strijk x, U.J.G.M. van Haelst xx Div. Of G.I. and liver disease, Dept. of Med., XDept. of diagnostic Radiology

and XXDept. of Pathology, St. Radboud Univ. Hospital, Nijmegen, The Netherlands

For the diagnosis of a cholestatic syndrome, clinical features and biochemical data are necessary. However, visualization of biliary tree is important for distinguishing between medical and surgical jaundice. For the diagnostic evaluation of cholestatic patients without evidence of dilated ducts on ultrasonogram, a percutaneous liver biopsy has beenusually re- con~nended as the procedure of choice. To determine the values of ERCP and liver biopsy in such patients, 59 patients (28 males, 31 females, 17-79 years) with cholestatic syndrome (alk. phosphatase >2 times of normal value, predominating over the increased levels of serum transaminases) were studied. Most of these patients were jaundiced or complained of itching. The, findings of these two methods of investigations were concordant in 38 patients, while a non-concordant finding was found in 11 patients (4 patients with normal ERCP and extrahepati¢ cholestasis on histology, 2 patients with normal histology and duct 5tenosis, 5 patients with hepatocellular abnormalities (steatosis, PBC, chr. hepatitis) and duct stenosis). The final clinical diagnosis was obtained in all but 13 patients. Conclusion: ERCP is an useful diagnostic aid in cholestasis also in patients with non-dilated ducts on ultrasonogram. A percutaneous liver biopsy is only indicated in such patients when the ERCP failed to demonstrate biliary abnormalities. In case of extrahepatic cholestasis diagnosed by a liver biopsy, ERCP is still necessary to facilitates the management of patien~ with biliary and/or pancreatic disease.

308 ACTIVATED T LYMPHOCYTES IN CHILDREN WITH CHRONIC ACTIVE HEPATITIS (CAH)

A.Yeo, L.Alvlggi,D.Vergani,G.Mieli-Vergani, A.P.Mowat

Depts of Child Health and Immunology*, King's College Hospital, London.

I a - a n t i g e n i s d e t e c t e d o n T - l y m p h o c y t e s w h e n t h e a r e a c t i v e l y i n v o l v e d i n i m m u n e - r e a c t i o n s , e . g . v i r a l d i s e a s e ( m o n o n u c l e o S i s ) a n d i m m u n e - m e d i a t e d d i s o r d e r s ( r h e u m a t o i d a r t h r i t i s , G r a v e ' s d i s e a s e , J u v e n i l e d i a b e t e s , S L E ) . To i n v e s t i g a t e w h e t h e r a c t i v a t i o n o f

T - l y m p h o c y t e s p l a y s a r o l e i n t h e i m m u n e - m e c h a n i s m s l e a d i n g t o CAH we h a v e d e t e r m i n e d n u m b e r s o f I a + r e T - c e l l s i n 11 s a m p l e s f r o m 9 c h i l d r e n w i t h CAH. C o n t r o l s w e r e 1 5 a g e - m a t c h e d h e a l t h y c h i l d r e n a n d 14 c h i l d r e n w i t h o t h e r c h r o n i c l i v e r d i s e a s e s . T - l y m p h o e y t e s w e r e p u r i f i e d b y E - r o s e t t i n g a n d I a + v e T - c e l l s w e r e d e t e c t e d b y d i r e c t i m m u n o f l u o r e s c e n c e w i t h a n t i - I a m o n o c l o n a l a n t i b o d y . N u m b e r s o f I a + v e T - c e l l s w e r e s i g n i f i c a n t l y h i g h e r i n p a t i e n t s w i t h u n c o n t r o l l e d CAH ( m e a n 8 . 2 SD 1 . 8 ) w h e n c o m p a r e d t o h e a l t h y c o n t r o l s ( 2 . 8 - 1 ; p < 0 . 0 1 , H a n k t e s t ) a n d t o o t h e r c h r o n i c l i v e r d i s e a s e s (3 .5+- 0 . 9 ; p ( O . O 1 , R a n k t e s t ) b u t w e r e n o r m a l i n 6 t r e a t e d p a t i e n t s w i t h i n a c t i v e d i s e a s e ( . 2 . 9 ~ 1 . 3 ) . Two p a t i e n t s w i t h h i g h n u m b e r s o f I a + v e T - c e l l s a t d i a g n o s i s s h o w e d n o r m a l v a l u e s w h e n r e t e s t e d d u r i n g i m m u n o - s u p p r e s s i v e t r e a t m e n t . I n c r e a s e d n u m b e r s o f I a + v e T - c e l l s i n CAH, b u t n o t i n o t h e r c h r o n i c l i v e r d i s e a s e s , a n d t h e i r r e t u r n t o n o r m a l d u r i n g e f f e c t i v e t r e a t m e n t , s u g g e s t t h e p a r t i c i p a t i o n o f a c t i v a t e d T - l y m p h o c y t e s i n t h e i m m u n e - m e c h a n i s m s l e a d i n g t o l i v e r d a m a g e i n CAN.

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