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By Lucie M. Rice
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Professor Amy Noffsinger holds a glass microscope slide up to the light, turning it this way and that. On the slide, carefully arranged in a row, are what look like four or five thin purple worms, each measuring about a half-inch long.
"These are needle biopsies," says Noffsinger, peering at the slide.
Within the past couple of weeks, a clinician pushed a wide-bored needle deep into a patient's liver, using it to remove a core of diseased tissue. Then a pathologist like Noffsinger, the director of surgical pathology at University Hospital, mounted the biopsies on slides and stained them.
I meet Noffsinger in her office at about 5 p.m. Elsewhere, it's happy hour. While we squint at purple cells, people across the city are spilling onto sidewalks and making their way to crowded bars and restaurants for a couple of drinks.
"This is really bad looking," Noffsinger says. "The cells themselves are abnormal in appearance."
We're sitting at a teaching microscope with several eyepieces, so that two or three people can view a slide at the same time. Alison Koehler, an attending pathologist, is sitting with us.
"This person had a lot of fibrosis," Noffsinger says, using a joystick to move a pointer to a dark clump of cells. "One of the characteristics of alcoholic liver disease is that you get this fibrosis around individual cells."
Alcohol kills cells, which causes fibrosis -- or scar tissue. Left unchecked, fibrosis affects blood flow through the liver's blood vessels.
"That's where you get people who bleed into their gastrointestinal tract," says Koehler, with a pathologist's enthusiasm for people bleeding into parts of their bodies they shouldn't be bleeding into.
"You see these big clear, round globules?" Noffsinger asks, moving the pointer again to some large unstained areas amid the purple cells. "That's fat. The alcohol basically impairs the fat metabolism in the cell. The fatty change is the earliest change you see with alcoholism."
In fact, says Koehler, after one night of heavy drinking, most people will deposit fat in their liver that looks a lot like the deposits in the needle biopsies we're looking at.
A couple of minutes later we walk next door to another room. Pathologists in lab coats are bent over tissue samples, talking quietly into dictaphones. It's a relaxing atmosphere, provided you don't look at the discolored organs on the workbenches or listen to what the pathologists are actually saying or inhale too deeply the thick and potentially harmful formaldehyde fumes rising from the samples.
Noffsinger walks over to a Tupperware container filled with a couple of liters of dark fluid. Something about the way she picks it up gives the impression that its contents are heavy.
"This is fixed in formaldehyde," she says, lifting out what looks like an old joint of roast pork.
It is, in fact, a cirrhotic human liver, its surface blackened by congealed blood. Once upon a time, it developed fibrosis, its owner continued to drink, fibrosis became cirrhosis and its owner died.
"You can see with cirrhosis that the liver is very bumpy," Noffsinger says, prodding the liver with a gloved finger. "It's hard."
It's been sliced into half-inch wide sections, but not all the way through, so that it flops around. It reminds me a bit of an accordion.
"You can see all the white fibrous tissue," she says. "It's all these little white nodules."
"Eventually you just get a small, shrunken liver," Koehler says.
Alcohol is a versatile toxin. It affects more than just the liver. Even so, approximately 10-35 percent of heavy drinkers develop alcoholic hepatitis and 10-20 percent develop cirrhosis -- making it, according to the Centers for Disease Control and Prevention, the fourth biggest cause of death among adults aged 45-54.
The U.S. National Library of Medicine keeps an online database of scientific journals. It's a good barometer of the research studies involving alcoholism. When I started writing this article a month or so ago, the database contained 51,196 studies with the word "alcoholism" somewhere within them. When I finished it, more than 50 new articles on alcoholism had been added by researchers in Belgium, Chile, France, England, Germany, Japan, Poland, Spain, Turkey and the United States.
Almost 3,000 articles contain the word "beer," 271 include the term "hangover" and 23 contain the word "booze" -- including a 1985 study titled "Booze on the Telly," published, predictably enough, in the British Medical Journal.
Alcohol causes brain shrinkage, pancreatitis, gastritis and fetal alcohol syndrome; it's implicated in diabetes, impotence and cancer; and it's a factor in more than half of all homicides in the United States and, depending on the study you read, between one-third and one-half of all suicides.
Because alcohol abuse has so many negative effects -- more than we have space for here -- we can take this opportunity to look at some of the more colorful among them. For instance, there's Fournier's gangrene. Male CityBeat readers will think twice before performing their next keg-stand after seeing this flesh-eating disease in action. (For those so inclined there's a stomach-churning image here: http://emedicine.com/asp/image_search.asp?query=Fournier%20Gangrene.)
Fournier's gangrene -- localized to the rectum and genitals, accompanied by a fetid odor -- is more common in men than women and much more common in alcoholics than non-drinkers.
Male alcoholics stand a chance of developing breasts, too. Over time, alcohol stimulates the liver to remove testosterone, the hormone responsible for male characteristics, from the blood; at the same time, it reduces the ability of the liver to remove female hormones like estrogen, which all men produce in small amounts.
The result? Boobs. Don't believe me? Go to the appropriately named Web site www.embarrassingproblems. com for information on breast development in men. You can go there too, for information on extra nipples (one in 50 of us has them) and advice on constipation (never ever strain).
Pickled livers, rotting genitals, brain shrinkage, man boobs -- it's all getting a bit too much.
Meanwhile, back at the lab, Noffsinger carefully returns her cirrhotic liver to its container full of dark liquid and puts her needle biopsies back into a slide box. The sun is sinking slowly. Elsewhere across the city, happy hour is coming to an end. ©
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