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PubMed1977

Peritoneoscopy as a diagnostic supplement to liver function tests and liver scan in patients with carcinoma.

Liver function tests, liver scintigraphy and peritoneoscopy were carried out in 240 patients with carcinoma. Hepatic invasion was demonstrated by peritoneoscopy essentially when both of the other tests were positive. However, in one-third of the patients, peritoneoscopy revealed the presence of other pathologic changes which could account for the positivity of either of the other diagnostic procedures. The status of the liver, with regard to presence or absence of metastases, could be microscopically documented in 59 patients. False-negative findings of liver chemistry tests, liver scan and peritoneoscopy were seen in 27, 42 and 36 per cent, respectively, of the patients while the rate of false-positive results was 15, 10 and 3 per cent, respectively. The rate of false-negative peritoneoscopy examinations in the absence of simultaneous positivey of the two other investigations was insignificant. These data indicate that liver chemistry tests, liver scan and peritoneoscopy play a major and complementary role in the screening of patients with carcinoma.

Biopsy↗
PubMed1975

Metabolic studies in eviscerated rats with functional livers.

A new technique is described for evisceration in the rat in which liver function is preserved. These animals lack all known sources of glucagon and insulin and are capable of active gluconeogenesis, urea formation and ketone body production by the liver. Measurements of blood levels of the metabolites of the caloric substrates showed that, unlike the classical eviscerate preparation, these animals maintain high blood glucose, urea and ketone body levels for up to 72 hr as contrasted with the profound decrease in these constituents in the absence of the liver. Survival time is also significantly extended from about 6 hr in rats lacking liver function to 72 hr or more when the liver is viable. This new surgical preparation is a valuable tool for studying the role of the liver in absence of the known gastroentero-pancreatic hormones. It would also be utilized as a model of "acute" diabetes.

Acute Disease↗
PubMedDate not supplied

[Endoscopic sclerotherapy of bleeding esophagogastric varices and functional liver status].

Endoscopic sclerotherapy of bleeding gastroesophageal varices was carried out in 52 patients within a sclerosis program for acute hemorrhage. According to Child's classification, 18 (34.6%) were A, 12 (23.1%) B and 22 (42.3%) C. The hemorrhagic focus was endoscopically proven in oesophageal varices in 45 (86.5%) and in 7 (13.5%) in gastric varices. The sclerotherapy was performed by both intra and extravascular injections of 3% ethanolamine according to treatment for emergency bleeding. The procedure was repeated on the 7th day or when necessary for recurrent hemorrhage. Hemostasis was achieved in 94.4% Child's class A, 75.0% Child's class B and 54.5% Child's class C, all of them with bleeding oesophageal varices. All patients with severe gastric hemorrhage (2 Child's class A, 2 Child's class B and 3 Child's class C) needed surgical treatment for uncontrolled bleeding. Liver failure and bleeding were the leading causes of death in 15 (68.1%) Child's class C and 2 (16.6%) Child's class B. There was no death in Child's class A. The conclusion was drawn that the results of endoscopic sclerotherapy of bleeding oesophageal varices was effective and clearly related to liver function. The endoscopic sclerotherapy, however, was not able to control severe hemorrhage from gastric varices and this was not related to liver function.

Brazil↗
PubMed1991

Correlation between the level of serum growth hormone; somatomedin-C; anthropometric measurements and the liver functions in chronic liver diseases.

Twenty patients with bilharzial periportal fibrosis (group I); 20 patients with post hepatitic cirrhosis (group II) and 20 normal controls were chosen to study the correlation between the serum level of human growth hormone (GH) and Somatomedin-C (Sm-C); and the anthropometric measurements; liver function tests and various haematological parameters. Group I showed no statistically significant difference in the mean values of serum GH before and after insulin induced hypoglycemia. The basal serum level of Sm-C showed a statistically significant decrease and highly significant decrease after insulin test. A statistically significant positive correlation was evident between the individual values of serum level of GH and Sm-C and the anthropometric measurements, haematological values and liver function tests (r = 0.41). The mean serum level of GH in group 2, showed statistically significant increase before and after insulin test. The mean serum level of Sm-C showed a statistically significant decrease before and after insulin test. A statistically significant negative correlation was found between the individual values of the serum level of GH and Sm-C and the anthropometric measurements, haematological values and liver function tests (r = 0.16).

Adult↗
PubMed1984

The relationship between cognitive function and liver function in alcoholism.

Thirty alcoholic patients were investigated for evidence of impaired hepatic function and deficits in cognitive functioning, to see if there was any significant relationship between these two complications of alcoholism. Forty-seven per cent had abnormal gamma-glutamyl transpeptidase levels, and 63 per cent had abnormal results on the Category test. Only one significant correlation coefficient was found, between one parameter of hepatic function and one of cognitive function. Possible explanations for this (negative) correlation are discussed, and the value of further study is suggested.

Adult↗
PubMed1992

[The effect of acute cellular rejection on liver function following orthoptic liver transplantation. Quantitative functional studies with the 14C-aminopyrine breath test].

To test the effect of acute cellular rejection on liver function as represented by cytochrome-P-450 enzyme activity, the 14C-aminopyrine breath test (ABT) was performed prospectively in 46 patients (31 men, 15 women; mean age 48 [15-66] years) who had undergone a total of 50 orthotopic liver transplantations. Routine biochemical tests were performed daily until the 30th postoperative day, while the ABT was done daily on days 1-10 and three times weekly on days 11-30, and liver puncture biopsies were obtained once weekly or more often if there was clinical suspicion of rejection. Histologically confirmed cellular rejection occurred within the stated period of observation in eight patients (five women, three men; median age 45 [18-59] years). Results of routine laboratory tests (transaminases, bilirubin, thromboplastin time), as well as bile-flow and body temperature, did not vary uniformly. On the other hand, results of ABT at the time of rejection showed a decrease in all patients by an average of 65% (P < 0.01). Changes in the ABT preceded those in other tests by 1-2 days in four patients, being the only measurable functional abnormality in one. All rejection episodes responded to glucocorticoid pulse-treatment (three times 1 g methyl-prednisolone). Using ABT results as criterion, liver function became normal after the glucocorticoid injection within 4-11 days. These data indicate that the ABT is suitable in the routine monitoring of transplant function, thus facilitating early diagnosis and controlled treatment of acute cellular rejection.

Acute Disease↗
PubMed1996

Caffeine clearance by two point analysis: a measure of liver function in chronic liver disease.

This study attempted to compare the pharmacokinetic parameters of caffeine in patients with chronic liver disease and in normal subjects and to define the two sampling times which are suitable for determining caffeine clearance in these patients. Ten decompensated and eight compensated cirrhotic patients, and nine patients with chronic hepatitis were given a 3.5 mg/kg single oral dose of caffeine, followed by measurement of serum caffeine concentrations at 0, 30, 60, 90 minutes and 3, 5, 10, 24 and 36 hours using the HPLC technique. Caffeine clearance and its elimination rate constant in the decompensated cirrhotic patients were significantly lower than those in the compensated cirrhotic patients and much lower than in normal subjects (p > 0.01). Caffeine clearance in chronic hepatitis patients was also significantly lower than in normal subjects. The volumes of distribution of caffeine in compensated and decompensated cirrhotic patients and normal subjects were significantly different. There was also a significant difference between normal subjects and the chronic hepatitis group. Serum caffeine clearance showed a good correlation with Child Pugh's score at r = -0.788. Two sampling times within 10 to 24 hours after oral dose of caffeine served as the best sampling points for determination of caffeine clearance by the simple equation; Cl = kel approximately Vd (Vd is a fixed value in each group). It was clearly shown that caffeine clearance, calculated by two point analysis, would be a simple and useful method for measuring liver function in chronic liver disease.

Adult↗
PubMed2000

The clinical importance of conventional and quantitative liver function tests in liver transplantation.

The advantages and disadvantages of using monoethylglycinexylidide (MEGX), the major metabolite of lidocaine, as a probe of hepatic function in liver transplantation are reviewed. A 'real time' test of liver function should give a measure of current hepatocellular capacity rather than reflect past damage. The hepatic metabolism of lidocaine to MEGX is the basis of a flow-dependent dynamic test of liver function. In pre-transplantation patients, data from this MEGX test support its role in assessing the risk of morbidity and mortality. In assessing the liver transplant donor, there are differences concerning its apparent usefulness and these must be resolved. In the liver transplant recipient, this MEGX test is also useful for measuring real-time hepatic metabolizing activity, and low MEGX values reflect the clinical condition of the patient. At present, however, this test has several limitations. Therefore, a comprehensive evaluation, not only by the MEGX test but also by a combination of other conventional liver function tests (biochemical parameters, etc.), or with histological evaluation, is thought to be desirable for deciding whether a liver transplantation should be carried out or not.

Chlorzoxazone↗
PubMed1984

Abnormalities of liver function and the predictive value of liver function tests in infection and outcome of acutely ill elderly patients.

In a prospective study of 79 acute admissions of elderly patients to a Geriatric Unit, elevated alkaline phosphatase levels were commonly associated with the presence of extrahepatic bacterial infections. The changes were attributed to alkaline phosphatase liver isoenzymes. There was no significant change in aspartate transaminase levels or in bilirubin levels in infection. Such frequent abnormalities of alkaline phosphatase disproportionate to bilirubin and aspartate transaminase are not described in younger patients with infection. These findings may reflect age-related changes in liver function. In the same series, both bilirubin and albumin were predictors of outcome.

Aged↗
PubMed1997

Value of an extended monoethylglycinexylidide formation test and other dynamic liver function tests in liver transplant donors.

Measuring monoethylglycinexylidide (MEGX) formation after intravenous administration of lidocaine in potential organ donors (MEGX test) has been advocated as a useful test to select donor livers for transplantation, but some groups have demonstrated a low test efficacy. We, therefore, investigated the value of an extended MEGX formation test and the value of other dynamic liver function tests, in selecting suitable human donor livers. In 51 human multi-organ donors, we measured elimination of galactose, indocyanine green, and lidocaine, as well as formation of MEGX, at 15, 30, and 60 min after administration of the test substances. In the early postoperative period, the function of the transplanted liver was then classified as good or poor, as defined by a prothrombin time above or below 65% by day 4 and fibrinogen concentration above or below 300 mg/dl by day 7. Donor characteristics and preservation modalities were very similar between the two groups. Galactose, indocyanine green, and lidocaine metabolism failed to predict good or poor graft function in the early postoperative period. MEGX serum concentrations, however, were significantly higher in the group of donors whose organs functioned well in the recipients, as compared with donors whose organs functioned poorly in the recipients. This was true for MEGX concentrations at 15 min (117+/-9 vs. 90+/-9 ng/ml; P=0.03), 30 min (108+/-8 vs. 86+/-8 ng/ml; P=0.04), and 60 min (100+/-6 vs. 73+/-5 ng/ml; P=0.006). Extending the MEGX formation test from 15 to 60 min improved test efficacy. Maximal MEGX concentration in 9 or up to 12 consecutive blood samples, drawn between 3 and 120 min after lidocaine infusion, was also significantly higher in donors whose organs functioned well, than in donors whose organs functioned poorly (129+/-10 vs. 101+/-10 ng/ml; P=0.03). Although the groups with good and poor organ function differed significantly with respect to their MEGX serum concentrations, and although efficacy of the MEGX test was improved by extending the test from 15 to 60 min, the overlap in individual MEGX serum concentrations was still so wide that it is virtually impossible to predict early graft function only on the basis of the MEGX test in the donor. Therefore, the MEGX test, although of potential scientific interest, does not predict early graft function with an accuracy necessary for clinical use.

Adult↗