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PubMed1975

Plasma immunoreactive insulin (IRI) and immunoreactive glucagon (IRG) after evisceration with and without a functional liver.

Fed male Wistar rats were eviscerated by two procedures. The first group of eviscerated rats were left with a nonfunctional liver in situ while the second group were eviscerated by a newer technic, developed in this laboratory, that preserves liver function. The animals were maintained on a regimen of saline and antibiotic treatment, and abdominal aortic blood was drawn at intervals up to seventy-two hours postoperatively from animals with a functional liver and up to six hours postoperatively in those with nonfunctional liver status. Blood concentrations of glucose, immunoreactive insulin, and immunoreactive glucagon were measured. Our results indicate that even with a functional liver, totally pancreatectomized eviscerated rats maintained normal amounts of plasma IRI and IRG for more than twenty-four hours. IRI and IRG were measurable even at forty-eight hours postoperatively. At the same time, these animals developed abnormally high blood glucose levels, which were sustained despite the presence of "normal" IRI in plasma. It had been suggested that the presence of measurable IRI and IRG in the classically prepared eviscerated animal was due to a deficit liver destruction of these substances. To the contrary, our data suggest that even with a functional liver, the eviscerated preparation maintains a circulating level of insulin and glucagon-like materials forty-eight hours after the known sources of such substances are removed. The physiologic meaning of immunoassay results following pancreatectomy are thus difficult to interpret.

Animals↗
PubMed1980

Functioning liver mass in uncomplicated and fulminant acute hepatitis.

The galactose elimination capacity and the plasma clearance of phenazone were investigated in 24 patients with uncomplicated acute hepatitis and in 8 patients who survived and in 26 who died of fulminant hepatitis. The galactose elimination capacity was 52% of the normal mean value on admission to the hospital in uncomplicated hepatitis, 47% in patients who survived fulminant hepatitis, and 22% in the fatal cases, while the plasma clearance of phenazone was 43%, 22%, and 10%, respectively. Both quantitative liver function tests showed rapid improvement in most cases of uncomplicated acute hepatitis and in the patients who survived fulminant hepatitis. They did not improve in the fatal cases of fulminant hepatitis, among whom the patients with the lowest initial values died first. Both the galactose elimination capacity and the plasma clearance of phenazone were significantly higher in survivors than in non-survivors of fulminant hepatitis. The results indicate that the loss of functioning liver cell mass is about 60-70% in the acute stage of uncomplicated hepatitis and 80-85% in patients who survive fulminant hepatitis, whereas patients who die of fulminant hepatitis have nearly total loss of functioning liver cell mass.

Acute Disease↗
PubMed1992

Pre- and post-transplant assessment of liver function in paediatric liver transplantation.

The pre-operative risk of paediatric liver transplantation candidates (n = 41) was assessed in a prospective study by means of clinical symptoms, conventional static and liver blood flow dependent dynamic liver function tests. Nine patients died during the 365-day waiting period. The data were subjected as covariates to a survival analysis in the Cox proportional hazards model. There was a significant relationship between the results of mono-ethylglycinexylidide (MEGX) formation and ICG test and the 365-day survival rate. In the stepwise analysis, none of the remaining parameters improved the predictive ability when added to the dynamic liver function test results. The assessment of post-transplantation liver function was studied in 27 patients during the first 28 postoperative-day period. In addition, liver function was studied in a cross-sectional study 1-7 years after successful liver transplantation in children with complete or partial rehabilitation. In the early postoperative period severe organ damage was indicated by both static and dynamic liver function tests. In the later course after transplantation no deterioration of liver function measured with MEGX formation was to be observed. These findings demonstrate the usefulness of dynamic liver function tests in the pre- and post-transplant assessment of liver function.

Child↗
PubMed1978

[Relationship of functional liver disorders in burn disease to the treatment methods].

The dynamics of liver function in 243 cases with deep burns was studied by means of a set of biochemical tests: determination of blood plasma proteins and protein fractions, residual nitrogen, bilirubin, sugar, lipides, activity of liver organospecific enzymes, sedimentation reactions and Quick-Pytel' test. The obtained findings showed disorders of all types of hepatic metabolism which was manifested through alterations of the indices of liver function tests. An intense transfusion therapy of burn shock and acute toxemia using the method of hemodilution, together with an early necrectomy and autodermoplasty were found to be effective means of preventing and treatment of liver functional disorders.

Acute Disease↗
PubMed1996

Expression of messenger RNA for liver functions following 70% and 90% hepatectomy.

AIMS/METHODS: The effect of moderate and severe reduction of the functional liver mass on gene expression for liver functions was studied in rats following 70% and 90% hepatectomy. At intervals up to 24 h after operation rats were killed and RNA was extracted from the remaining liver tissue. By slot-blot hybridization mRNA steady-state levels were determined for enzymes involved in metabolic 'liver-specific' functions, acute phase proteins, 'house-keeping', and growth-related proteins. Results were expressed as per cent of levels in a pool from fed control rats of the same gender and age. RESULTS: Among 'liver-specific' metabolic functions only expression of gluconeogenesis, represented by phosphoenol carboxykinase mRNA, was augmented initially, followed by a fall to very low values after 90% hepatectomy. The drug metabolizing system represented by CYP2B1/2 mRNA was reduced to half of the control values. Expression of urea synthesis, as reflected by carbamoylphosphate synthetase mRNA, showed a gradual decline after 90% hepatectomy, in contrast to rising levels of argininosuccinate lyase and arginase mRNA, possibly serving polyamine rather than urea synthesis. The mRNA level of the acute phase protein alpha 1-acid glycoprotein showed a smaller and later rise in 90% than in 70% hepatectomized rats, whereas that of alpha 2-macroglobulin only increased after 90% hepatectomy like the 'house-keeping' beta-actin mRNA. A rise in histone 3, which coincides with mitosis, was only seen after 70% hepatectomy, indicating that after 90% hepatectomy the response to growth-stimulating factors is weak or delayed, supported by a delayed rise in cyclin d and low levels of growth hormone receptor mRNA. CONCLUSIONS: It is concluded that attempts by gene regulation to adapt liver functions to a reduction of the liver mass depend on the amount of liver tissue lost. When the loss is nearly fatal, compensation for normal metabolic functions may be abandoned for efforts to regenerate, which, however, may be delayed or after all be too weak.

Actins↗
PubMed1980

Peritoneoscopic findings and liver function in chronic liver disease.

In 100 cases with chronic liver disease, peritoneoscopy and liver biopsy were performed, and the association between peritoneoscopic findings and liver function was studied. With respect to liver function, a series of tests which seem to indicate residual liver function were selected as follows; dye excretion, serum levels of albumin and cholinesterase, and subfractions of serum proteins. In evaluating the periotoneoscopic view, new criteria for the classification of liver surface findings are proposed. All cases were divided into 5 types in accordance with these criteria. Analysis of the correlation between peritoneoscopic findings and liver function showed that the degree of liver dysfunction was clearly indicated by liver surface alterations. As a result, the residual liver function may be determined quite well by using this classification.

Biopsy↗
PubMed1995

Prostacyclin, thromboxane, and oxygen free radicals and postoperative liver function in human liver transplantation.

The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and lipid peroxide levels at the portal and hepatic veins, and their relation to immediate postoperative liver function. Nineteen patients with liver cirrhosis undergoing orthotopic liver transplantation were prospectively studied. Blood samples were obtained within 5 min and 1 and 2 hr after reperfusion of the new liver, through a catheter placed at the portal vein in the recipient and another at the left hepatic vein in the donor liver. Plasma prostacyclin and thromboxane were analyzed by HPLC and RIA. The formation of lipid peroxides was determined and expressed in terms of thiobarbituric acid-reacting substances. Immediate postoperative liver function was evaluated using the transaminase levels within the first 48 hr and the early postoperative graft function score, as described previously. After reperfusion, only determinations at 5 min were related with liver function. Either prostacyclin (R = -0.61, P = 0.004) levels at the hepatic vein or prostacyclin production (subtraction between hepatic and portal vein levels) (R = -0.47, P = 0.04) correlated significantly with the early postoperative graft function score. Besides, there was a significant relationship between lipid peroxide production as measured by thiobarbituric acid-reacting substances and a worse early postoperative graft function score (R = 0.61, P = .005). These results suggest that prostacyclin released after liver grafting attenuates preservation and reperfusion damage of the liver, supporting the hypothesis that there is an imbalance of prostanoids within the microvasculature in patients with a compromised postoperative liver function. Our results agree with the involvement of some degree of lipid peroxidation products in the damage of hepatocytes during anoxia and reperfusion.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Early use of cyclic TPN prevents further deterioration of liver functions for the TPN patients with impaired liver function.

BACKGROUND/AIMS: Impaired liver function is frequently found in patients who need prolonged total parenteral nutrition. Cyclic total parenteral nutrition can minimize the adverse effects of long-term total parenteral nutrition, such as hepatic complication. The adequate timing to shift to use cyclic total parenteral nutrition for patients with impaired liver function may prevent further hepatic dysfunction. METHODOLOGY: A prospective study of 65 patients who need total parenteral nutrition and have impaired liver functions was performed. Cyclic total parenteral nutrition was used in different groups of patients, when their total bilirubin levels were just over 5 mg%, 10 mg%, or 20 mg% during the course of total parenteral nutrition. The patients of control groups received straight non-cyclic total parenteral nutrition. All the patients had stable vital signs without major stress, such as sepsis or acute bleeding. Ten patients (A2) in Group A were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 5 mg%; the other 10 patients (A1) continued the non-cyclic total parenteral nutrition. Eleven patients (B2) in Group B were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 10 mg%; the other 11 patients (B1) continued the non-cyclic total parenteral nutrition. Ten patients (C2) in Group C were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 20 mg%; the other 13 patients (C1) continued the non-cyclic total parenteral nutrition. The average energy intake among 3 groups had no difference. Their liver functions were examined each week for 2 weeks. RESULTS: The results showed that the patients with non-cyclic total parenteral nutrition had significant increase of direct-total bilirubin and alkaline phosphatase (P < 0.05) in Group A and significant decrease of albumin accompanied with increase of GOT, GPT, direct/total bilirubin (P < 0.05) in Group B. The patients either using cyclic or non-cyclic total parenteral nutrition showed significant decrease of albumin and increase of direct/total bilirubin (P < 0.05) in Group C. CONCLUSIONS: We conclude that the early use of cyclic total parenteral nutrition may prevent deterioration of liver function for the patients with jaundice and need prolonged total parenteral nutrition.

Adolescent↗
PubMed1998

Short-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on functional liver plasma flow in patients with advanced cirrhosis.

AIMS/BACKGROUND: TIPS, an effective procedure applied for the treatment of complications of portal hypertension, is potentially followed by worsening of the hyperdynamic circulation of cirrhosis and the impairment of liver function. The aim of the present study was to evaluate short-term changes of functional liver plasma flow after application of TIPS, using the hepatic (extrarenal) clearance of D-sorbitol (S-HCl). METHODS: Twenty-five cirrhotic patients submitted to TIPS for prevention of variceal rebleeding entered the study. At steady-state, during constant infusion of a solution of D-sorbitol (25 mg/min), appropriate blood and urine samples were collected in order to calculate S-HCI before and 120 min after TIPS opening. In addition, the hepatic extraction ratio of D-sorbitol was directly measured at the level of the right (Er), where TIPS was applied, and of the left (El) hepatic veins; meanwhile the portocaval gradient (PCG) was registered, before and after stent dilation. A comparison of values obtained before and after TIPS application was performed by Student's t-test for paired data. RESULTS: After application of TIPS, a substantial reduction was observed in PCG (12.1+/-4.2 vs 24.8+/-4.3 mmHg; p<0.001) and Er values (20.6+/-14.8 vs 57.5+/-22.3 %; p<0.001) but not El values (47.4+/-22.0 vs 53.4+/-21.4 %; p=0.178). S-HCl measured 120 min after TIPS opening was not statistically different from pre-TIPS values (389.2+/-212.1 vs 394.6+/-152.7 ml/min; p=0.892), although S-HCl variations in Child-Pugh class B patients were positively correlated with portal pressure variations (r=0.63, p=0.016). CONCLUSION: Our results demonstrate that in patients with advanced cirrhosis, TIPS procedure, while effective in reducing portal hypertension, does not lead to alterations in the functional liver plasma flow within the first 2 h.

Aged↗
PubMed2000

Assessment of liver function in chronic liver diseases and regional function of irradiated liver by means of 99mTc-galactosyl-human serum albumin liver scintigraphy and quantitative spectral analysis.

Scintigraphy with 99mTc-diethylenetriamine pentaacetic acid galactosyl human serum albumin (99mTc-GSA) was performed on 102 patients, then the hepatic extraction fraction (HEF), the rate constant for liver uptake of the tracer from the blood (K1) and the hepatic blood flow index (HBFI) were determined by spectral analysis. The HEF, K1 and HBFI values correlated moderately or closely with various indices of hepatic function, and the HEF and K1 values decreased according to the stage of liver dysfunction. The HEF and K1 values linearly and nonlinearly correlated with HH15 and LHL15, respectively. The HEF, K1 and HBFI values for the irradiated portion of 20 patients before and alter irradiation were compared. The HEF value in patients with a cirrhotic liver significantly (p < 0.002) decreased compared with that in patients with a normal liver at a dose of less than 40 Gy, whereas the HBFI value in patients with a normal liver significantly (p < 0.05) decreased compared with that in patients with a cirrhotic liver at a dose of 40 Gy or greater. This method appears to be a simple, non-invasive and useful tool with which to quantitatively evaluate liver function and it also helps clarify changes in regional function of the irradiated liver.

Aged↗