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PubMed1990

Ovine white-liver disease (OWLD). Trace elements in liver.

Trace elements in liver were examined in vitamin B12 deficient lambs which developed ovine white-liver disease (OWLD), in cobalt/vitamin B12 supplemented lambs on the same pastures as well as clinically healthy, but sometimes subclinical B12 deficient lambs on other pastures (H). Liver Co was marginal to deficient in both OWLD lambs (S lambs) and H lambs. Supplementation with B12 or Co elevated liver Co. Liver copper was significantly lower in OWLD lambs than in the H lambs, and Co/B12 supplementation on pasture generally had no significant effect on the contents. Dosing lambs on OWLD pastures with copper oxide needles (SCuO), however, resulted in high/toxic liver Cu. Dosing with Co, Se and Cu glass boluses resulted in adequate liver Cu, except for 1 lamb with toxic amounts indicating dissolution and absorption of the bolus. OWLD lambs had significantly lower liver molybdenum than H lambs, and Co/B12 supplementation elevated values, while CuO treatment depressed them. Liver zinc, manganese and selenium are also reported.

Animals↗
PubMed1989

[Metabolic changes in liver tissue damage and the effect of nutrition on liver regeneration].

The present work reviews basic changes occurring in metabolism of carbohydrates, lipids and amino acids of an organism with liver injury and after resection of 70% of liver tissue. On the background of mentioned changes, the effect of individual energetic substrates and amino acids on the course of liver regeneration is discussed. Literature data and our proper results allow us to preclude that administration of only carbohydrates is impeding liver recovery. According to our observation, the liver regeneration after partial hepatectomy as well as the restoration of toxically damaged liver tissue may be favorably enhanced by infusion of lipid emulsion (Intralipid). The infusion of balanced amino acid solution (8% Nutramin) rather depresses the development of liver regeneration. Parenteral administration of amino acid solution enriched with branched chain amino acids (valine, leucine, isoleucine) has a favorable effect on the onset of liver regeneration after partial hepatectomy compared with glucose and of commercial amino acid solution (8% Nutramin). Probable mechanisms of inhibitory effect of glucose and favorable action of lipid emulsion infusions as well as branched chain amino acids on the initiation of liver regeneration are discussed.

Amino Acids↗
PubMed1989

[Classification of liver cirrhosis based on parenchymal echo patterns and its clinical usefulness for diagnosis of liver cirrhosis].

Owing to the recent advancement of ultrasonographic instruments, we can now easily detect variously sized hypoechoic nodules as well as coarse echo pattern in cirrhotic liver. Based on the size and distribution of such hypoechoic nodules, we classified echo patterns of liver parenchyma into four types as follows. Type 0: Homogeneous echo pattern. Type I: Coarse echo pattern with no distinct hypoechoic nodules. Type II: Echo pattern showing scattered hypoechoic nodules sized 3 approximately 5 mm. Type III: Echo pattern showing scattered hypoechoic nodules sized more than 5 mm. In the present study, all the 25 patients of normal liver showed type 0, 29 of 42 patients with chronic hepatitis showed type 0 and the remained 13 type I. In 65 patients with liver cirrhosis, 54 (83.1%) were classified as type I, II, or III. The grade of parenchymal echo pattern was significantly correlated with the severity of liver cirrhosis. In addition, the parenchymal patterns proved to be very useful in diagnosis of liver cirrhosis, presenting overall accuracy value of 81.8%. The value was the highest compared with those of other diagnostic factors on ultrasonograms. Immersion experiment with autopsied liver specimens evidenced that hypoechoic nodules on ultrasonogram represent regenerative nodules of cirrhotic liver. It was also revealed that the parenchymal echo patterns closely corresponded to gross or histologic findings of the liver.

Adult↗
PubMed1979

Radiocolloid imaging in primary liver cancer and amoebic liver abscess. Accuracy of differential diagnosis and extent of inter-observer variability.

Radiocolloid liver scans from 58 patients with primary liver cancer and 56 patients with amoebic liver abscess were examined 'blind' and independently by three nuclear physicians and one registrar in training in order to evaluate the accuracy of the differential diagnosis between the two conditions and to assess the extent of inter-observer variability in the interpretation of these scans. Each of the observers incorrectly interpreted about 12% of scintiphotographs and at least one observer was wrong in 25% of the scans. The difference in diagnostic accuracy between individual observers was not statistically significant. Observers disagreed in 21,6% of the scans. The main reasons for misdiagnosis were failure to realize that excessive extrahepatic uptake of radiocolloid can occur with liver abscesses, and the indistinguishable appearance of the defect or defects in some cases of primary liver cancer and amoebic liver abscess. This margin of error and of inter-observer variability must be borne in mind when interpreting liver scans of patients thought to have either primary liver cancer of amoebic liver abscess.

Colloids↗
PubMed1980

Liver specific autoimmunity and chronic liver disease--an enigmatic relationship.

Refinements in techniques for identifying liver specific immune responses have currently aroused considerable interest in the role of such immunity in the pathogenesis of chronic hepatic disorders. Presence of antibodies against liver cell membrane was tested for in 242 samples of serum and in 86 liver biopsies from patients with liver diseases as well as from controls. Indirect immunofluorescence tests on isolated rabbit hepatocytes and on human liver cells from biopsies respectively were carried out. In the serum, antibody was detected in 16 per cent, several of these cases belonging to the category of recovering acute viral hepatitis and some to chronic hepatitis or to other liver disorders. Serum HBsAg status in these antibody carriers vary. Antibodies on liver cell membrane were detected in approximately 25 per cent cases of hepatitis. The distribution among different cases were like in case of serum positivity. The pathogenetic role of these antibodies in initiation or progression of disease appears doubtful. It is possible that presence of these antibodies merely represents an immune response following liver injury and may not be responsible in causing acute or chronic liver disease.

Adolescent↗
PubMed1978

Transient liver hypoxia after liver hilus dearterialization.

Dearterializaton of the liver causes changes which have been thought to be ischaemic in nature. Previous reports of direct measurements of liver tissue gas tensions have been confined only to the acute postoperative phase. In this study 15 dogs underwent a standardized and angiographically controlled liver hilus dearterialization with (6 dogs) or without (9 dogs) cholecystectomy. Six dogs underwent a sham operation and were used as controls. Liver respiratory gas tensions were measured with a Silastic tonometer intraoperatively during the first 90 minutes after dearterialization and on the first and seventh day postoperatively. Six dogs died, only one of these being in the dearterialization and cholecystectomy group. Liver pO2 decreased from the mean of 33.2 mmHg to a level of 15--20 mmHg in 20 minutes (p less than 0.05) during room air breathing. On the next day the liver pO2 values were normal. There was no difference in pO2-Values between the cholecystectomy and the noncholecystectomy groups. Liver pCO2 increased from the mean of 26.4 mmHg to 55--60 mmHg in the same time (p less than 0.05). However, on the first postoperative day normal values were seen only in the cholecystectomy group. 60% oxygen breathing prevented the changes in both liver pO2 and pCO2. No changes were noted in the liver gas tensions of the sham-operated dogs, not in the systemic arterial pO2 and pCO2 of the dearterialized animals. Thus a transient hypoxic state developed after this operation, which lasted for less than one day. This hypoxia may be prevented by 60% oxygen breathing postoperatively.

Animals↗
PubMed1995

[Is liver abscess still an indication for liver resection?].

AIM: The standard therapy for liver abscesses consists of percutaneous drainage. In certain cases a liver resection may be indicated. The indication for liver resection in six patients with liver abscess is analysed retrospectively. METHODS: Between 7.7.87-13.10.93 six patients (4 male, 2 fem.) in the age of 40-72 years (mean 59 yrs.) underwent liver resection for liver abscess at our institution. The patients suffered from symptoms of a progressive liver abscess formation: fever, hepatomegaly, loss of weight, jaundice and anorexia. Abscess localization was performed preoperatively by ultrasound and CT. Drainage attempts were unsuccessful in these patients, resections were carried out for suspicion of malignancy or during a laparotomy due to other reasons. RESULTS: Liver resections were left and right hemihepatectomy (1x each), left lateral resection (3x) and one wedge resection. Intraoperative blood transfusion requirements were not different from those of other indications for resection. Postoperative hospitalization lasted 12-33 days (mean 19 days). The postoperative course was uneventful, in one case a hematoma at the resection site required drainage. CONCLUSION: Resection for liver abscesses is indicated only in exceptional cases but allows for definite therapy.

Adult↗
PubMed1993

[Cost-effectiveness analysis of long-term liver transplantation; the liver transplantation program of Groningen 1979-1991].

A medical technology assessment of the liver transplantation programme of Groningen University Hospital, which was commissioned by the Dutch National Health Insurance Board, is discussed. The results of all 152 liver transplantations performed between 1979 and November 1990 were analysed. The main objective of the study was to evaluate the long-term effects of liver transplantation. Five years after transplantation 59% of the adult patients were still alive. The survival probability depended greatly on the primary liver disease. Mortality and morbidity occurred mainly within the first year after transplantation. Thereafter the prospects for the patients were excellent, with regard to both the probability of survival and the quality of life. The costs of liver transplantation could be calculated only for patients with primary biliary cirrhosis and other forms of biliary cirrhosis, not caused by hepatitis B infection or alcohol abuse. For these patients the costs of a liver transplantation were estimated at HFl. 263,000--(with a 10% margin), 10 years of follow-up included and corrected for the costs that would have been made for the treatment of the liver disease. For this population of patients a liver transplantation costs between Hfl. 64,000--and Hfl. 79,000--per life year gained, 10 years of follow-up included. Costs of cyclosporin still take up a major part of the costs. The need for liver transplantation in the Netherlands was estimated at between 35 and 126 transplantations per year, depending on indications, contraindications, referral policy and the percentage of retransplantations.

Adolescent↗
PubMed1996

Study of the liver changes occurring in preeclampsia and their possible pathogenetic connection with acute fatty liver of pregnancy.

OBJECTIVE: The objective of the present study was to investigate liver involvement in preeclampsia on the basis of clinical, laboratory, and histological data and to detect a possible connection with fatty liver of pregnancy by the determination of microvesicular fatty infiltration of the liver. METHODS: The authors studied the liver changes in 10 patients with preeclampsia, observing the clinical and laboratory alterations, the macroscopic liver surface features by laparoscopy, and the presence of microvesicular fatty infiltration by specific lipid staining of hepatic tissue collected by needle biopsy. RESULTS: Macroscopy of the liver surface disclosed some degree of subcapsular liver hemorrhage in all cases; however, the hemorrhage was not related to the clinical and histological severity of the disease. Microvesicular fat droplets were observed in all patients, and the intensity of the fat deposition was not related to pressor levels, laboratory alterations, or the evolution of preeclampsia. CONCLUSIONS: The presence of fatty liver infiltration in all patients studied supports the idea that preeclampsia and acute fatty liver of pregnancy could be components of the same pathologic spectrum, with a probable, but still unproved, pathogenetic connection. The deficiency of the long chain 3-hydroxyacyl-coenzyme A dehydrogenase activity may be the determining factor in the evolution of the disease.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed1995

alpha 1-antitrypsin phenotype PiMZ, a risk factor for liver cirrhosis but not for liver cancers in Thailand.

The risk of developing liver cirrhosis, hepatoma (HCC) and bile duct carcinoma (BDC) have been associated with homozygous alpha 1-antitrypsin (AT) deficiency especially linked to the Z allele. While the association between liver cancers and AT deficiency remains debatable, the risk of adult AT deficiency carriers to develop liver cirrhosis has not been assessed quantitatively. Liver cancers and liver diseases with subsequent liver cirrhosis are highly prevalent in tropical countries such as Thailand and heterozygous AT phenotypes are rather common in this country as well. The aim of this study was to assess the risk of developing liver cirrhosis, HCC and BDC by means of case-control studies with Thai patients and controls in connection with AT deficiency. For hepatitis, HCC and BDC to association with AT deficiency was detected. Carriers of PiMZ phenotype in Thailand have a high risk to develop liver cirrhosis (odds. ratio of 10.8, 95% confidence interval = 1.3-88.1). Patients with predisposing diseases should be screened for Pi phenotypes so that rigorous measures to combat the occurrence of liver cirrhosis can be implemented.

Adolescent↗
PubMed1996

Analysis of diffuse parenchymal liver disease by liver scintigrams: differential diagnosis using neuro and fuzzy.

In colloid liver scintigraphy, diagnosis of diffuse parenchymal liver disease such as chronic hepatitis or cirrhosis is evaluated by size and distortion of the liver, distribution of tracer in the liver, size and activities of tracer in the spleen, visualization of the bone marrow and so on. It is not difficult to read a scintigram which shows a typical pattern of normal, chronic hepatitis and cirrhosis; however in some cases it is difficult to distinguish normal or chronic hepatitis and chronic hepatitis or cirrhosis visually. Therefore, we tried to use fuzzy inferences to perform differential diagnosis in chronic hepatitis (CH), severe fibrosis (SF) and liver cirrhosis (LC). First, five features in colloid liver scintigrams were measured or evaluated visually. These features were liver size index (left lobe/right lobe), splenomegaly, the degree of visualization of the bone marrow, liver deformity, and distribution of tracer in the liver. Having fuzziness in these data, certain characteristics of these features were considered to be fuzzy sets and thus could be expressed in membership functions. Fuzzy inference was carried out using these data and fuzzy rules. Using fuzzy inference, differential diagnosis in LC could be performed up to 100%, but those of CH and SF could not be performed sufficiently. Using neural network CH, SF and LC could be diagnosed up to 63%, 80%, and 88%, respectively. But fuzzy inference had the merit to evaluate the degree of disturbance by the center of gravity of the resulting membership function. Therefore by combining neural network and fuzzy inference, CH, SF, and LC could be differentiated to the degree 77%, 80%, and 100%, respectively.

Chronic Disease↗
PubMed1998

Liver problems in pregnancy: part 2--managing pre-existing and pregnancy-induced liver disease.

In distinguishing normal from abnormal hepatic changes, the author described the expected changes in liver tests that occur during complicated pregnancy. This article reviews the forms of pre-existing liver disease that may affect or be affected by pregnancy, as well as liver diseases that tend to arise during pregnancy. Among the pre-existing liver diseases are autoimmune chronic active hepatitis, which may be activated by pregnancy and tends to be associated with an increased risk of still and premature births. Worsening of chronic hepatitis B and C has occasionally been observed. While some women with cirrhosis can sustain a normal pregnancy without any worsening of hepatic function, others develop liver failure; plus, women with cirrhosis are less fertile and have higher rates of both stillbirths and premature infants. Other liver disorders that may or may not be affected by pregnancy include Dubin-Johnson syndrome, Gilbert syndrome, benign recurrent intrahepatic cholestasis, Wilson's disease, hepatic adenomas, and focal nodular hyperplasia. Among the hepatic disorders that occur during pregnancy in normally healthy women and then resolve after delivery is intrahepatic cholestasis of pregnancy (also known as pruritus gravidarum, recurrent intrahepatic cholestasis of pregnancy, and obstetric hepatosis). Others include acute fatty liver of pregnancy and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), which may be part of the spectrum of disorders associated with pre-eclampsia/eclampsia. Pregnancy may also trigger the dissemination of herpes infection to the liver.

Cholestasis, Intrahepatic↗
PubMed1985

Detection and clinical significance of acetone-insoluble liver cell membrane antigen in sera of patients with chronic active liver diseases.

An enzyme-linked immunosorbent assay was developed to detect insoluble liver cell membrane antigen (LMAg) which gives rise to serum LMA (anti-LM) in HBsAg-negative patients. The optical density (OD) ratio of the average LMAg level of normal subjects was less than 1.2. In HBsAg-positive cases, high LMAg levels (OD ratio greater than 2.4) were noted in 8 of 8 patients with acute hepatitis (AH), 3 of 8 with chronic persistent hepatitis (CPH), 5 of 10 with moderate chronic aggressive hepatitis (CAH), 7 of 10 severe CAH and 4 of 8 with liver cirrhosis (LC). In HBsAg-negative cases, however, high LMAg levels were noted in only 6 of 8 patients with AH, 1 of 10 with CPH, 1 of 10 with moderate CAH, 1 of of 10 with severe CAH, 0 of 8 with LC, 0 of 8 with fatty liver and 5 of 10 with alcoholic hepatitis. In micro-immunodiffusion experiments, intensively absorbed rabbit anti-rat LM precipitated two organ-specific components of rat liver homogenate, one of which was identical to liver specific protein (LSP). In immunohistochemical demonstrations of LMAg and LSP, anti-LM, prepared from the serum of a HBsAg-negative CAH patient, bound to both human and rat acetone-fixed liver cell membranes, but not to those of human or rat kidneys. Absorbed rabbit anti-rat LM also bound to liver cell membranes, but absorbed anti-rat LSP lacked organ-specificity when assayed with the immunofluorescence technique using acetone-fixed liver sections. In conclusion, the appearance of serum LMAg was associated with high-SGPT patients and HBsAg-positive CAH patients.

Acetone↗
PubMed2006

Outcome of 1000 liver cancer patients evaluated at the UPMC Liver Cancer Center.

We evaluated 1000 consecutive patients with liver tumors at the University of Pittsburgh Medical Center (UPMC) Liver Cancer Center over the 4-year period from August 2000 to August 2004. Of the 1000 patients seen, 573 had primary liver cancer and 427 had metastatic cancer to the liver. The mean age of the patients evaluated was 62.2 years, and 61% were male. Treatment consisted of a liver surgical procedure (resection or radiofrequency ablation) in 369 cases (36.9%), hepatic intra-arterial regional therapy (transarterial chemoembolization or (90)yttrium microspheres) in 524 cases (52.4%), systemic chemotherapy in 35 cases (3.5%), and palliative care in 72 patients (7.2%). For treated patients, median survival was 884 days for those undergoing resection/radiofrequency ablation, compared to 295 days with regional therapy. These data indicate that over 90% of patients with liver cancer evaluated at a tertiary referral center can be offered some form of therapy. Survival rates are superior with a liver resection or ablation procedure, which is likely consistent with selection bias. Hepatocellular carcinoma was the most common tumor seen due to referral pattern and screening of hepatitis patients at a major liver transplant center. The most common reason for offering palliative care was hepatic insufficiency usually associated with cirrhosis.

Age Factors↗
PubMed1997

Auxiliary partial orthotopic liver transplantation for acute liver failure.

BACKGROUND/AIMS: Auxiliary partial orthotopic liver transplantation holds potential advantages over conventional orthotopic liver transplantation, but experience with the technique in acute liver failure is limited. METHODS: We describe our initial experience in seven patients (4 men, 3 women; mean age 28, range 14-35 years) with acute liver failure (paracetamol 3, non A-E 2, autoimmune 1, Ecstasy 1) who fulfilled criteria for emergency transplantation. Preoperatively, the median international normalised ratio was seven (range 3.4-15), with a creatinine of 123 microM (51-389 microM) and bilirubin 320 microM (61-572 microM). The reasons for performing an auxiliary transplant were the patients' young age and stable preoperative condition (n = 5), or a significant psychiatric history precluding conventional transplantation (n = 2). RESULTS: All patients received blood group-matched left (n = 2) or right (n = 5) auxiliary grafts. Median duration of surgery was 8.5 h (7.3-10 h), with blood loss of 8.3 litres (4.6-14.6 litres). Post-transplant, the international normalised ratio and aspartate aminotransferase fell progressively in all patients, with median values at day 7 of 1.4 (1.0-2.4) and 108 IU/1 (78-910 IU/1). Three patients died from sepsis within the first postoperative month. At 2 weeks, four of six patients had partial regeneration of the native liver, which became complete in two of the survivors by 1 year. CONCLUSIONS: Although patient selection remains poorly defined, auxiliary partial orthotopic liver transplantation in acute liver failure is technically feasible and, in some patients, allows native liver regeneration and eventual immunosuppression withdrawal.

Acute Disease↗
PubMed1975

Increased particulate and decreased soluble guanylate cyclase activity in regenerating liver, fetal liver, and hepatoma.

We determined the activities of soluble and particulate guanylate cyclase [GTP pyrophosphatelyase (cyclizing); ?EC 4.6.1.2] IN REGENERATING RAT LIVER, FETAL AND NEONATAL RAT LIVER, AND HEPATOMA. TIn these tissues we found increased particulate and decreased soluble enzyme activities compared to normal adult rat liver. The particulate activity increased 12 hr after partial hepatectomy, reached maximal activity at 48 hr, and then declined. The soluble enzyme activity decreased within 8 hr and continued to decline. The activity of homogenates did not change. Guanylate cyclase activity was increased in plasma membrane and microsome fractions from regenerating liver. The increase in particulate activity was prevented with cycloheximide. Decreased soluble and increased particulate enzyme activities were found in fetal liver. After birth the soluble activity increased and the particulate activity decreased. Seven to 14 days after birth the activities of soluble and particulate fractions were similar to those of adult rat liver. In hepatoma 3924A, the activity of particulate guanylate cyclase was 9-fold greater and that of the soluble enzyme was 50% that of normal liver. These studies suggest that guanylate cyclase activity and its subcellular distribution may be related to liver growth through some unknown mechanism.

Animals↗
PubMed1980

Enhanced drug-metabolizing capacity within liver adjacent to human and rat liver tumors.

Cytochrome P-450 content (nmol/g of liver) differed within regions of rat liver according to proximity to intrahepatically implanted Morris hepatoma 7795 or 5123D. Liver adjacent to tumor had higher microsomal cytochrome P-450 content, decreased DNA content (mg/g of liver), and unaltered cytochrome c reductase activity compared to histologically indistinguishable liver far-removed from the tumor. Liver either adjacent to or far-removed from tumor contained markedly more cytochrome P-450 and higher cytochrome c reductase activity but less DNA than transplanted Morris hepatomas 7795 and 5123D that were grown intrahepatically. Compared to intramuscular implants of these same tumors, intrahepatically implanted Morris hepatomas 7795 and 5123D had increased cytochrome P-450 content. Tumor-containing liver from two human subjects revealed regional changes in cytochrome P-450-mediated monooxygenases similar to those observed in rats. These results suggest that histomorphically nontumorous mammalian liver directly adjacent to intrahepatic tumors exhibits previously unsuspected biochemical alterations.

Aniline Hydroxylase↗
PubMed1974

Clinical application of cytochrome a(plus a3) assay of mitochondria from liver specimens: an aid in determining metabolic tolerance of liver remnant for hepatic resection.

Measurement of cytochrome a(+a(3)) contents in liver mitochondria was made on 52 biopsy specimens of patients with liver tumor. Patients having higher cytochrome a(+a(3)) contents in mitochondria from remaining liver than those of normal human liver mitochondria could survive well major liver resections whether or not associated with liver cirrhosis. However, patients with cytochrome a(+a(3)) contents less than 0.5 x 10(-10) moles per mg protein showed a high rate of postoperative complication (80%) and death (40%) in spite of minor operation. In routinely used liver function tests such as serum albumin, A/G ratio, SGOT, total bilirubin, prothrombin time, BSP and TTT, there were no significant differences between patients with cytochrome a(+a(3)) contents more than 0.5 x 10(-10) moles per mg protein and those less than 0.5. The results indicate that routine laboratory studies do not have much diagnostic value in estimation of a marked decrease of mitochondrial cytochrome a(+a(3)) contents. It is suggested that the measurements of cytochrome a(+a(3)) of the remnant liver should be done prior to a contemplated major resection.

Adolescent↗