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PubMed1999

[99mTc-GSA dynamic SPECT for regional hepatic functional reserve estimation: assessment of clinical value for hepatic resection].

We assessed the clinical value of three-dimensional functional mapping method employing GSA dynamic SPECT for the estimation of residual hepatic functional reserve before hepatic resection. Seventy-two consecutive patients of liver tumor were recruited in this study. Thirty-seven underwent segmentectomy or lobectomy and 35 did subsegmentectomy. GSA studies were carried out in all 72 patients before operation. Postoperative studies were performed in 70 patients about 1 month after operation, and 2 patients died of postoperative hepatic failure early after operation. In the preoperative study, liver functional images were divided into 4 segments according to liver anatomy and segmental GSA clearance was analyzed. The sum of GSA clearance of the segments immune from resection were calculated as predicted residual GSA clearance. Two patients who showed poor predicted residual hepatic GSA clearance died of postoperative hepatic failure within two months after operation (extended right lobectomy). There were good correlations between pre- and postoperative total liver clearance in patients underwent subsegmentectomy (r = 0.900, p < 0.0001, n = 35), and between predicted residual clearance and postoperative total clearance in patients underwent segmentectomy or lobectomy (r = 0.799, p < 0.0001, n = 35). After hepatic resection, there seemed to be discrepancies between hepatic volume expansion and functional restoration in some patients. Mean GSA clearance (clearance per unit volume) apparently decreased after operation in patients whose residual volume ratio (preoperative predicted residual liver volume/preoperative total liver volume) were less than 50% (p < 0.01, n = 12). These results suggested that three-dimensional functional mapping method employing GSA dynamic SPECT can provide quantitative information of postoperative hepatic function and reserve before hepatic resection. Changes of mean GSA clearance after hepatic resection suggested that hepatic function per unit volume changes in the process of hepatic regeneration.

Chronic Disease↗
PubMed2001

The influence of enteral nutrition on gut barrier in the post-operative patients with damaged hepatic function.

The safety, rationality and the practicality of enteral nutrition (EN) support in the postoperative patients with damaged hepatic function were investigated and the protective effect of EN on the gut barrier and the clinical implication studied. Seventy-six adult patients whose hepatic function were in Child B or C grade were randomly assigned in EN group (30 cases), total parenteral nutrition (TPN) group (26 cases) and control group (CON, 20 cases). The patients received different nutritional support. The signs of nutritional condition and hepatic function were messured at 1 day before, 5 days and 10 days after the surgical operation respectively. The changes in the urine lactulose (L) and mannitol (M) contents and L/M ratio were observed by using pulsed electrochemical detection (HPLC-PED) to acquire the different effects among the different nutritional support performance. The results showed that the patients in the EN group and TPN group had no worse hepatic function damage after operation. The patients in the EN group reached the positive nitrogen balance earlier, had a less weight loss than in the TPN group with the difference being significant (P < 0.05). There was no obvious change in L/M ratio in the postoperative patients in the EN group (P > 0.05), but there was significant difference in L/M between TPN group and CON group (P < 0.05). It was concluded that EN was a rational, safe, effective and practical nutrition support method in the patients with damaged hepatic function patients after surgical operation and EN can effectively protect the structure and function of gut barrier from sever infection.

Child↗
PubMed1998

Alterations in hepatic function during laparoscopic surgery. An experimental clinical study.

BACKGROUND: Very few studies have been done on the consequences of pneumoperitoneum on hepatic function. At present, there is no consensus on the physiopathological hepatic implications of pneumoperitoneum. The purpose of this clinical study was to evaluate the effects of pneumoperitoneum on hepatic function in 52 patients treated with laparoscopic procedures. METHODS: Thirty-two laparoscopic cholecystectomies and 20 nonhepatobiliary laparoscopic procedures were performed in 52 patients (12 men and 40 women) with a mean age of 44 years (range, 15-74). All patients had normal values on preoperative liver function tests. The anesthesiologic protocol was uniform, with drugs at low hepatic metabolism. The 32 cholecystectomies were randomized into 22 performed with pneumoperitoneum at 14 mmHg and 10 performed at 10 mmHg. All nonhepatobiliary laparoscopic procedures were performed with a pneumoperitoneum of 14 mmHg. The postoperative serologic levels of AST, ALT, bilirubin, and prothrombin time were measured at 6, 24, 48, and 72 h. The serologic changes were related to the procedure, the duration, and the level of pneumoperitoneum. RESULTS: Mortality and morbidity were nil. All 52 patients had a postoperative increase in AST, ALT, bilirubin, and lengthening in prothrombin time. Slow return to normality occurred 48 or 72 h after operation. The increase of AST and ALT was statistically significant and correlated both to the level (10 versus 14 mmHg) and the duration of pneumoperitoneum. CONCLUSIONS: The duration and level of intraabdominal pressure are responsible for changes of hepatic function during laparoscopic procedures. Although no symptom appears in patients with normal hepatic function, patients with severe hepatic failure should probably not be subjected to prolonged laparoscopic procedures.

Adolescent↗
PubMed1997

Growth hormone prevents prednisolone-induced increase in functional hepatic nitrogen clearance in normal man.

BACKGROUND/AIMS: Glucocorticoid treatment increases urea excretion and leads to negative nitrogen balance. This effect is presumed mainly to reflect actions on tissue protein metabolism, but has been shown in rats to involve an hepatic element in the form of upregulation of the kinetics of ureagenesis. Likewise, the anabolic action of growth hormone administration has been shown to involve an hepatic element, just as growth hormone administration has been shown to prevent the protein catabolic side effects of prednisolone. Whether glucocorticoids increase the ability of the liver to convert amino-N to urea-N in man, and whether growth hormone counteracts any possible effect of glucocorticoid has not been studied. METHODS: We measured urea nitrogen synthesis rates and blood alpha-amino-N levels before, during, and after a 4-h constant i.v. infusion of alanine (2 mmol x kg BW(-1) x h(-1)). The urea nitrogen synthesis rate was estimated hourly as urinary excretion corrected for gut hydrolysis and accumulation in body water. The slope of the linear relationship between urea nitrogen synthesis rate and amino-N concentration represents the hepatic kinetics of conversion of amino- to urea-N, and is denoted the functional hepatic nitrogen clearance. Eight normal male subjects (aged 22-28 years; BMI 21.6-26.3 kg/m2) were randomly studied four times: i) after 4 days of s.c. saline injections, ii) after 4 days of s.c. growth hormone injections (0.1 IU x kg(-1) x day(-1)), iii) after 4 days of glucocorticoid administration (50 mg/d) and iv) after 4 days of growth hormone and glucocorticoid administration. All injections were given at 20 00 hours and 25 mg prednisolone was given morning and evening. RESULTS: Growth hormone decreased functional hepatic nitrogen clearance (l/h) by 21% (from 38.8+/-1.8 l/h (control) to 30.5+/-2.7 l/h (4 d growth hormone) (mean+/-SE) (ANOVA; p<0.05)). Glucocorticoid increased functional hepatic nitrogen clearance by 23% (47.7+/-3.3 l/h, p<0.05), while growth hormone plus glucocorticoid offset any effect on functional hepatic nitrogen clearance (36.2+/-3.3 l/h, p=0.83). CONCLUSIONS: Glucocorticoid administration leads to loss of nitrogen as urea, in part due to a specific hepatic mechanism, as shown by the increased functional hepatic nitrogen clearance. Growth hormone has the opposite effect, and also neutralises the glucocorticoid effect when given together with prednisolone. This adds to the understanding of the development and treatment possibilities of steroid catabolism.

Adult↗
PubMed2005

Effects of sildenafil citrate on hepatic function and regeneration in normal and alcohol-fed rats.

Sildenafil citrate is a potent inhibitor of specific phosphodiesterase-5, which mediates metabolism of intracellular second message -- cGMP. Sildenafil citrate has been widely used for erectile dysfunction in men. Moreover, it is known that men with liver diseases have higher rate of erectile dysfunction. Furthermore, it has been demonstrated that nitric oxide plays an important role in liver function and regeneration. The present study evaluates effects of sildenafil citrate on hepatic function and regeneration in normal and alcohol-fed rats. In normal rats sildenafil citrate has a trend to improve hepatic function after partial hepatectomy (PHx). Moreover, sildenafil citrate significantly reduces hepatic regenerative activity at the concentration of 5 mg/kg body weight. However, sildenafil had no effects on hepatic function and regeneration of alcohol-fed rats. In general, sildenafil citrate did not induce significant changes in hepatic function and regenerative activity after PHx in normal and alcohol-fed rats, except at concentration of 5 mg/kg sildenafil citrate significantly inhibit hepatic regeneration in normal rats.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1999

Preoperative assessment of residual hepatic functional reserve using 99mTc-DTPA-galactosyl-human serum albumin dynamic SPECT.

UNLABELLED: Preoperative assessment of residual hepatic functional reserve offers important strategic information for hepatic resection. To predict the postoperative residual liver function, we assessed the value of hepatic 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) clearance estimated by dynamic SPECT analysis. METHODS: We investigated 114 consecutive patients with liver disease, including 55 hepatectomy cases. One minute after injection of 185 MBq 99mTc-GSA, 15 serial dynamic SPECT images were obtained every minute. The initial five sets of SPECT images were analyzed by Patlak plot to estimate the sequential initial hepatic 99mTc-GSA clearance (mL/min) as an index of hepatic function. The sum of hepatic 99mTc-GSA clearance of the segments immune from resection was categorized as predicted residual 99mTC-GSA clearance. In the hepatectomy cases, scintigraphy was performed before and 37 +/- 10 d after the operation. RESULTS: Good correlation was observed between the total hepatic 99mTc-GSA clearance and conventional hepatic function tests: plasma retention rate of iodocyanine green (ICG) at 15 min (ICG R15), r = -0.600, P < 0.0001, n = 94; plasma disappearance rate of ICG (K ICG), r = 0.670, P < 0.0001, n = 83; cholinesterase, r = 0.539, P < 0.0001, n = 121; serum albumin, r = 0.421, P = 0.0001, n = 123; and hepaplastin test, r = 0.456, P < 0.0001, n = 120. There was good correlation between the predicted residual 99mTc-GSA clearance and the postoperative total hepatic 99mTc-GSA clearance in patients who underwent segmentectomy or lobectomy (r = 0.84, P < 0.0001, n = 28) and between the pre- and postoperative total hepatic 99mTc-GSA clearance in patients who underwent subsegmentectomy (r = 0.91, P < 0.0001, n = 25). Five patients who had postoperative complications due to hepatic insufficiency (2 patients died of postoperative hepatic failure within 2 mo after operation) showed significantly lower predicted residual 99mTc-GSA clearance compared with the patients without complications (90.3 +/- 37.2 versus 320.9 +/- 158.8 mL/min; P < 0.005). CONCLUSION: The total hepatic 99mTC-GSA clearance reflected hepatic function. In addition, preoperative predicted residual hepatic 99mTc-GSA clearance was a good indicator of postoperative hepatic function and early prognosis. 99mTc-GSA dynamic SPECT is assumed to be a useful method for determining the surgical strategy in patients with hepatic tumor and especially in patients with hepatic dysfunction.

Coloring Agents↗
PubMed1989

Effects of hypocapnia and hypercapnia on splanchnic circulation and hepatic function in the beagle.

The effects of mild hypocapnia (PaCO2 22 mm Hg) and hypercapnia (PaCO2 59 mm Hg) on the splanchnic circulation and hepatic function were studied in six pentobarbital anesthetized, laparotomized, mechanically ventilated beagles. Tidal volume and respiratory frequency were held constant throughout the measurements. Hepatic artery blood flow (HABF) and portal vein blood flow (PVBF) were measured by electromagnetic flowmeters. Hepatic function was assessed by indocyanine green (ICG) elimination kinetic analysis after intravenous injection of the dye. Hypocapnia caused a decrease in HABF without affecting the systemic circulation. Hypercapnia, on the other hand, caused a significant increase in cardiac output without changing mean arterial pressure. There was a significant increase in PVBF and total hepatic blood flow (THBF = PVBF + HABF). Despite the increases in PVBF and THBF, the half-life of ICG was significantly longer during hypercapnia (9.09 +/- 0.79 min) than during hypocapnia (7.16 +/- 0.37 min), and plasma ICG clearance was smaller during hypercapnia (4.79 +/- 0.44 ml.min-1) than during hypocapnia (5.44 +/- 0.33 ml.min-1) or normocapnia (5.27 +/- 0.50 ml.min-1), indicating the depressed hepatic function during hypercapnia. We conclude that mild hypocapnia decreases HABF without affecting hepatic function and that mild hypercapnia is associated with a depression of hepatic function in spite of the increases in PVBF and THBF.

Animals↗
PubMed2000

The effects of prolonged low-flow sevoflurane anesthesia on renal and hepatic function.

UNLABELLED: We assessed the effects of prolonged low-flow sevoflurane anesthesia on renal and hepatic functions by comparing high-flow sevoflurane with low-flow isoflurane anesthesia. Thirty patients scheduled for surgery of > or =10 h in duration randomly received either low-flow (1 L/min) sevoflurane anesthesia (n = 10), high-flow (6-10 L/min) sevoflurane anesthesia (n = 10), or low-flow (1 L/min) isoflurane anesthesia (n = 10). We measured the circuit concentrations of Compound A and serum fluoride. Renal function was assessed by blood urea nitrogen, serum creatinine, creatinine clearance, and urinary excretion of glucose, albumin, protein, and N:-acetyl-beta-D-glucosaminidase. The hepatic function was assessed by serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, alkaline phosphatase, and total bilirubin. Compound A exposure was 277 +/- 120 (135-478) ppm-h (mean +/- SD [range]) in the low-flow sevoflurane anesthesia. The maximum concentration of serum fluoride was 53.6 +/- 5.3 (43.4-59.3) micromol/L for the low-flow sevoflurane anesthesia, 47.1 +/- 21.2 (21.4-82.3) micromol/L for the high-flow sevoflurane anesthesia, and 7.4 +/- 3.2 (3.2-14.0) micromol/L for the low-flow isoflurane anesthesia. Blood urea nitrogen and serum creatinine were within the normal range, and creatinine clearance did not decrease throughout the study period in any group. Urinary excretion of glucose, albumin, protein, and N:-acetyl-beta-D-glucosaminidase increased after anesthesia in all groups, but no significant differences were seen among the three groups at any time point after anesthesia. Lactate dehydrogenase and alkaline phosphatase on postanesthesia Day 1 were higher in the high-flow sevoflurane group than in the low-flow sevoflurane group. However, there were no significant differences in any other hepatic function tests among the groups. We conclude that prolonged low-flow sevoflurane anesthesia has the same effect on renal and hepatic functions as high-flow sevoflurane and low-flow isoflurane anesthesia. IMPLICATIONS: During low-flow sevoflurane anesthesia, intake of Compound A reached 277 +/- 120 ppm-h, but the effect on the kidney and the liver was the same in high-flow sevoflurane and low-flow isoflurane anesthesia.

Acetylglucosaminidase↗
PubMed1987

Plasma amino acid clearance as an indicator of hepatic function and high-energy phosphate in hepatic ischemia.

A major function of the liver is to maintain normal levels of plasma amino acids. This function may depend in part on tissue levels of high-energy phosphate. Experiments were performed in adult mongrel dogs to assess the relationship between plasma amino acid clearance (PAAC) and tissue high-energy phosphate after 90 minutes of warm hepatic ischemia. In addition, when PAAC was assessed in the anhepatic dog, PAAC fell to low levels after hepatectomy. After 90 minutes of warm ischemia, both tissue adenosine triphosphate (ATP) and PAAC fell to low levels, with PAAC similar to those levels observed in anhepatic dogs. Recovery of ATP and PAAC progressed over a 48-hour period but did not reach control values. Mortality rate was 33% in a group of 12 animals at 48 hours after ischemia. At 24 hours after ischemia, total free plasma amino acid levels were significantly higher in those animals that were dying as compared with those that were surviving (4352 mumol/L versus 2850 mumol/L; p less than 0.05). There was a strong correlation between PAAC and ATP (r = 0.81). PAAC appears to be an indicator of hepatic functional recovery and tissue ATP levels after ischemia.

Adenine Nucleotides↗
PubMed1996

Effects of long-term growth hormone (GH) and triiodothyronine (T3) administration on functional hepatic nitrogen clearance in normal man.

BACKGROUND/AIMS: A decline in urea excretion is seen following long-term growth hormone administration, reflecting overall protein anabolism. Conversely, hyperthyroidism is characterized by increased urea synthesis and negative nitrogen metabolism. These seemingly opposite effects are presumed to reflect different actions on peripheral protein metabolism. The extent to which these hormonal systems have different direct effects on hepatic urea genesis has not been fully characterized. METHODS: We measured urea nitrogen synthesis rates and blood alanine levels concomitantly before, during, and after a 4-h constant intravenous infusion of alanine (2 mmol.kg bw-1.h-1). Urea nitrogen synthesis rate was estimated hourly as urinary excretion corrected for gut hydrolysis and accumulation in body water. The slope of the linear relationship between urea nitrogen synthesis rate and alanine concentration represents the liver function as to conversion of amino-N, and is denoted the functional hepatic nitrogen clearance. Eight normal male subjects (age 21-27 years; body mass index 22.4-27.0 kg/m2) were randomly studied four times: 1) after 10 days of subcutaneous saline injections, 2) after 10 days of subcutaneous growth hormone injections (0.1 IU/kg per day), 3) after 10 days of triiodothyronine administration (40 micrograms on even dates, 20 micrograms on uneven dates) and 4) after 10 days given 2)+3). All injections were given at 20 00 h. RESULTS: Growth hormone decreased functional hepatic nitrogen clearance (l/h) by 30% (from 33.8 +/- 3.2 l/h (control) to 23.8 +/- 1.5 l/h (10 days growth hormone) (mean +/- SE) (ANOVA; p < 0.01)). Triiodothyronine did not change functional hepatic nitrogen clearance (36.7 +/- 3.2 l/h), but triiodothyronine given together with growth hormone abolished the effect of growth hormone functional hepatic nitrogen clearance (38.8 +/- 4.8 l/h). CONCLUSIONS: The results show that long-term growth hormone administration acts on liver by decreasing functional hepatic nitrogen clearance, thereby retaining amino-N in the body. Triiodothyronine has no effect on functional hepatic nitrogen clearance, but given together with growth hormone, it abolishes the effect of growth hormone on functional hepatic nitrogen clearance. A possible mechanism is the known effect of thyroid hormones in reducing the bioavailability of insulin-like growth factor-I. Thus, the effects of growth hormone and triiodothyronine on amino-N homeostasis are interdependent and to some extent exerted via interplay in their regulation of liver function as to amino-N conversion.

Adult↗
PubMed2005

[Effects of levonorgestrel-releasing intrauterine system on serum lipids and hepatic function].

OBJECTIVE: To assess the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on serum lipids and hepatic function. METHODS: Blood samples of 35 cases receiving LNG-IUS were collected and determined for serum lipids and hepatic functions. RESULTS: Six months after insertions, HDL-C and ApoA were increased significantly, while LDL-C and ApoB decreased significantly. TG and TC levels were decreased at the 6th months and showed significant difference till the end of one year. TG/HDL-C and LDL-C/HDL-C ratios were increased and Apo A/ApoB ratio decreased significantly. The indices of hepatic function varied in the normal ranges, while Glb were decreased significantly after one year. CONCLUSION: LNG-IUS is an effective therapy without obvious adverse effect on lipid metabolism and hepatic function.

Adult↗
PubMed1995

[Preoperative evaluation of hepatic functional reserve for patients with primary liver carcinoma].

The retention rate of indocyanine green at 15 minutes (ICGR15) and routine hepatic function tests were performed preoperatively in 122 cases of patients with primary liver carcinomas in order to evaluate the hepatic functional reserve. These patients were divided into 3 groups according to the post-operative changes of hepatic function. 87, 24 and 11 cases showed good recovery (group good), mild liver dysfunction (group mild) and severe liver dysfunction (group severe) respectively, after operation. The differences of Pugh's points, ALT, ALP and gamma-GT between each two groups were not significant. But, the differences of ICGR15 were very significant. We also divided all cases into 3 groups according to the value of ICGR15. The incidence of liver dysfunction was 6.0% in group A (ICGR15 < 10.0%), 27.8% in group B (ICGBR15 = 10.0%-20.0%) and 76.5% in group C (ICGR15 > 20.0%), respectively. The difference of the incidences of liver dysfunction in these 3 groups was very significant. The higher the ICGR15, the more the incidence of liver dysfunction. These results demonstrated that ICGR15 is a good indicator to judge hepatic functional reserve for patients with primary liver carcinoma.

Adult↗
PubMed1992

[The utility of quantitative 99mTc-GSA liver scintigraphy in the evaluation of hepatic functional reserve: comparison with 99mTc-PMT and 99mTc-Sn colloid].

Using data from 17 patients with liver cirrhosis and 3 patients with fatty liver, we have compared the utility of 3 hepatic imaging agents in the evaluation of hepatic functional reserve. Evaluated here were 99mTc-galactosyl human serum albumin (GSA) which is a new ligand for hepatic binding protein, 99mTc-N-pyridoxyl-5-methyl tryptophan (PMT) of a hepatobiliary agent, and 99mTc-Sn colloid. In each patient, we performed these 3 imaging studies within a week and also examined hepatic function tests (indocyanine green test, hepaplastin test, choline-esterase, etc). In each imaging study, serial images and dynamic data were obtained after the injection of 99mTc-GSA (185 MBq/3 mg), 99mTc-PMT (185 MBq), or 99mTc-Sn colloid (185 MBq). Using the obtained dynamic data, we analyzed the liver kinetics of the 3 agents based on 1 compartment model with 3 parameters (hepatic clearance, hepatic excretion rate, non-specific volume of distribution). From fitting the liver and heart data to this model, three unknown parameters were determined. Patlak plot was also applied in order to estimate liver uptake rate. Both curve fitting and Patlak plot could determine appropriate parameters in every study. In 99mTc-GSA, a nonlinear 3 compartment model was also applied in order to estimate hepatic blood flow, liver receptor density, and affinity of receptor-GSA binding separately. Using the obtained parameters, we analyzed the correlations between the parameters and the results of hepatic function tests. In all of the parameters, those obtained from 99mTc-GSA imaging showed the most significant statistical correlation with the results of hepatic function tests. From the present results, 99mTc-GSA imaging was concluded to be the best for evaluation of hepatic functional reserve.

Adult↗
PubMed1988

Postischemic ATP levels predict hepatic function 24 hours following ischemia in the rat.

Hepatic function was assessed by the aminopyrine breath test (ABT) in male Sprague Dawley rats 24 h after partial hepatic ischemia. ABT decreased progressively to 26.3 (p less than 0.05) and 19.7% of dose (p less than 0.05) after 90 and 120 min of ischemia, respectively. ABT at 24 h after injury was correlated to the concentration of ATP in the ischemic lobes 1 h after the onset of reperfusion (r2 = 0.971) but not to ALT activity in plasma at 1 h (r2 = 0.391). We conclude that postischemic ATP levels are a better index of subsequent hepatic function than ALT.

Adenosine Triphosphate↗
PubMed1991

[Relation of hepatic protein synthesis and hepatic functional mass in obstructive jaundiced rats].

In obstructive jaundiced rat, the change of hepatic functional mass assessed by [14C]-aminopyrine breath test (ABT) and galactose tolerance test (GaTT) and hepatic protein synthesis measured by [14C]-leucine incorporation into hepatic protein fraction were investigated. Bile duct ligation (BDL) for 5 and 14 days was followed by choledocho-duodenal fistula as the relief of obstruction. Hepatic functional mass measured by ABT and GaTT revealed a remarkable decrease at 5 and 14 days after BDL without differences in grades. These depressed values returned to the preoperative ones in 10 to 20 days after the relief of obstruction. On the contrary, hepatic protein synthesis was reciprocally enhanced after BDL. After the relief of obstruction the enhancement of hepatic protein synthesis was prolonged and then returned to the normal level in 20 days. These data suggested that in obstructive jaundice hepatic protein synthesis was stimulated by several stress and continued to be enhanced even after the relief of obstruction. These enhancement of hepatic protein synthesis would induce to decrease hepatic functional mass.

Aminopyrine↗
PubMedDate not supplied

Drugs as indicators of hepatic function.

It is well recognized that liver disease may influence the disposition of many drugs. Conversely, it has been suggested that knowledge of the disposition of a model drug might provide an index of certain aspects of hepatic function. This review discusses the physiology of drug disposition and indicates how recent progress in understanding the determinants of drug disposition has provided useful indices of individual aspects of hepatic function. Topics which are discussed are the interpretation of pharmacokinetic parameters as indices of hepatic function, including half-life clearance, and intrinsic clearance. Utilizing the "intact hepatocyte hypothesis" as an operational model, an approach is described that uses the pharmacokinetic disposition of high and low intrinsic clearance drugs following p.o. and i.v. administration to provide quantitative estimates of hepatic function, flow to functioning hepatocytes, and the extent of portasystemic shunting through the liver. Thus, the theoretical basis for quantitation of certain aspects of hepatic function are available. It remains to be determined whether these indices will provide clinically useful measures to follow the natural history of hepatic disease.

Aminopyrine↗
PubMed1981

Distal splenorenal shunt. Hemodynamic advantage over total shunt and influence on clinical status, hepatic function and hypersplenism.

Clinical status, hepatic function and hypersplenism were investigated in 20 patients who underwent distal splenorenal shunt between January 1970 and June 1978. The operative morality rate was 5 percent, and encephalopathy of varying degrees affected 30 percent of the patients. There was no recurrence of bleeding, and the 3 to 5 year actuarial survival rate was 78 percent. Hypersplenism was significantly ameliorated in 17 patients (p less than 0.01). Serum glutamic improved and pyruvic transaminase significantly improved postoperatively and bilirubin significantly worsened, whereas other tests of liver function remained unchanged. Our results confirm the efficacy of this procedure in controlling recurrence of bleeding from esophageal varices. Moreover, severe hypersplenism is not an absolute contraindication to the shunt, which is preferable to total shunts since hepatopetal flow is preserved, thus avoiding early hepatic decompensation as demonstrated by the substantial stabilization of the liver function tests in the short run.

Adult↗
PubMed1993

[Usefulness of blood disappearance corrected hepatic uptake ratio (LHL/HH) as a hepatic functional index using 99mTc-galactosyl serum albumin].

The authors introduced blood disappearance corrected hepatic uptake ratio (LHL/HH) as an index of hepatic function using 185 MBq/3 mg of 99mTc-galactosyl serum albumin (GSA). Three ratio parameters, the hepatic uptake ratio (LHL15), blood disappearance ratio (HH15), and LHL15 divided by HH15 (LHL/HH) were evaluated with percent injected dose of 99mTc-GSA in blood at 15 min after injection (%ID15) and hepatic functional severity graded by Child-Turcotte criteria score. Seventy eight patients with chronic liver disease were studied. There was a poor linear correlation between the LHL15 and %ID15, because the LHL15 formed a plateau phase in the lower-value range for %ID15. In contrast, LHL/HH showed an excellent linear correlation with %ID15 in its whole range. In the comparison with the clinical functional severity, LHL/HH gave a more highly significant difference (p < 0.001) than LHL15 (p = 0.005) between the normal and mild dysfunction groups and gave a significant difference (p = 0.032) between the mild and moderate groups, in which HH15 showed no meaningful difference (p = 0.07). This index is obtained with no difficult procedures and can be regarded as a unified parameter for hepatic uptake and blood disappearance. It is hoped that LHL/HH will prove useful in the diagnosis of hepatic functional severity using 99mTc-GSA.

Adult↗