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PubMed1992

[The immunomodulating and hepatotropic effect of correcting hyperprolactinemia and hypophyseal gonadotropic dysfunction in liver cirrhosis patients].

Men suffering from liver cirrhosis were examined. They demonstrated a decrease in the blood content of gonadotropic hormones and testosterone and a rise of estradiol and prolactin. The changes indicated were more pronounced in decompensated liver cirrhosis and were associated with lipid peroxidation activation and a reduction of the count of T suppressor lymphocytes. As a result, the treatment of men suffering from decompensated liver cirrhosis and hyperprolactinemia by parlodel lowered blood prolactin and activity of lipid peroxidation. The use of chorionic gonadotropin for the treatment of men with decompensated liver cirrhosis and a low content of blood lutropin produces an immunomodulatory effect. Parlodel and chorionic gonadotropin favour a decrease of the cytolytic syndrome.

Adjuvants, Immunologic↗
PubMed1976

Utilization of the quantitative assay of lipoprotein X in the differential diagnosis of extraphepatic obstructive jaundice and intrahepatic diseases.

Quantitative determination of LP-X, abnormal serum low density lipoprotein, was performed on the sera of 620 patients with jaundice in two medical centers, one in Oklahoma City, Oklahoma, and the other in Birmingham, England. The results of serial assays over a period of 5 to 8 days after patient admission to hospital or after onset of jaundice, if this occurred in hospital, correlated best with the type and management of jaundice. In some cases of early cholestatic disease of extrahepatic origin LP-X may be absent, but after the observation period it was found that only 1 of 81 (98%) patients with obstruction of the extrahepatic bile duct system remained negative. Of the remainder, 74 (91%) had or developed levels of LP-X exceeding 300 mg per 100 ml. In addition, 43 (88%) of 49 subjects followed serially showed increases in LP-X concentration, with no change in 3 patients. Of 539 subjects with intrahepatic disease, 14 (26.5%) were LP-X positive and 27 (19.4%) of these had initial LP-X levels higher than 300 mg per 100 ml. During the follow-up period, 35 (74%) of 47 patients with intrahepatic disease showed a reduction of LP-X; of the remaining 12 patients 4 had mitochondrial antibody-positive primary biliary cirrhosis, and 6 had severe cholestasis associated with acute infectious hepatitis and high aspartate transaminase levels. Similar figures for alkaline phosphatase showed less consistent changes during the follow-up period. In this retrospective appraisal the trends and absolute levels of LP-X, in addition to the use of similarly followed levels of the routine liver function tests, allowed better differentiation of jaundice requiring surgical correction from that remediable by medical means exclusively than did the use of the routine liver function tests alone. In addition, LP-X is specific for liver dysfunction, whereas other routine liver function tests are not.

Alkaline Phosphatase↗
PubMed1987

Augmentation of hepatic uridine-diphosphate glucuronyl transferase activity by antituberculous drugs in hamsters in vivo.

Changes in uridine-diphosphate glucuronyl transferase activity (UDP-GT) in liver homogenates of hamsters treated with different doses of isoniazid (INH), rifampicin (RMP), para-aminosalicylic acid (PAS) and hydrocortisone for several periods of time were studied and expressed as mg of bilirubin conjugated per g of protein per h. INH, RMP, PAS and hydrocortisone induced UDP-GT activity to a statistically significant degree. The optimum dose for high induction was 20 mg for INH, RMP and hydrocortisone, and 200 mg for PAS per kg of body weight. The optimum time of treatment for high induction was 10 consecutive days of intraperitoneal administration for all drugs examined. Such data, particularly for INH and RMP, indicate why patients who receive these drugs show no clinical jaundice, although they develop an hepatitis-like disease with elevation of serum transaminase of hepatic origin. This could be the result of stimulation of the hepatic smooth endoplasmic reticulum which produces rapid conjugation and therefore excretion of bilirubin. Similarly, the antituberculous drugs may cause liver dysfunction by inducing other liver enzymes.

Aminosalicylic Acid↗
PubMed1995

[Separate perfusion of upper and lower body under mild hypothermia during operation on the thoracoabdominal aorta].

During last 7 years, we performed 24 operations on the thoracoabdominal aorta. There were 9 true and 15 dissecting aneurysms. There were two cases of ruptured aneurysm and thoracoabdominal replacement was performed as a last stage operation for total aortic replacement in 4 cases. Three cases with aortic dissection died within 30 days after surgery. Femoro-femoral bypass was used in 4 cases (1 case died of brain damage, paraplegia and MOF), left heart bypass in 5 cases and separate perfusion of upper and lower body (SPULB) under deep hypothermia in 7 cases (2 cases died of LOS and cerebrovascular accident occurred at 2 weeks after operation) and SPULB with mild hypothermia in 8 cases for circulatory support. There was one case of renal dysfunction and transient mild liver dysfunction occurred in 7 cases. There was no evidence on relationship between surgical outcome and methods of circulatory supports, but we recently prefer SPULB under mild hypothermia for thoracoabdominal surgery since intraoperative massive bleeding and cardiac arrest can be easily treated and major organs can be protected by introducing hypothermia in this perfusion technique.

Adult↗
PubMed1995

[Association of cirrhosis and hepatocellular carcinoma with porphyria cutanea tarda].

A common characteristic of patients with porphyria cutanea tarda (PCT) is liver dysfunction. The degree of liver damage is usually mild but liver cirrhosis is a common associated finding. Hepatic iron overload is a characteristic feature but the role of iron in the pathogenesis of the condition has not yet been clarified. Heavy alcohol consumption is a frequent precipitant of PCT. A strong association with markers of past hepatitis B virus infection was first demonstrated but a high prevalence of hepatitis C virus markers is now noted. Although the potential to give rise to hepatocellular carcinoma (HCC) in PCT patients with cirrhosis is well recognized, HCC itself has a risk of developing PCT. HCV or the cirrhotic change itself has been attributed as the risk factor for the occurrence of HCC.

Alcoholism↗
PubMed1995

[Paracetamol poisoning].

Administration of paracetamol (acetaminophen) has analgetic and antipyretic effect. After trauma paracetamol has an anti-inflammatory activity. It was presumed that paracetamol in therapeutic doses had fewer and more acceptable side-effects than other analgetic drugs such as acetylsalicylic acid and NSAID-drugs. However, in toxic concentrations, paracetamol is more life-threatening. The toxic effects of paracetamol most often occur in the liver and kidneys. Phosphate and lactate turn-over can also be impaired. Paracetamol poisoning can induce temporary liver dysfunction or even irreversible liver failure with liver transplantation as the only therapeutic possibility. Chronic alcoholics are especially at risk, as liver damage may occur following paracetamol even in recommended doses. When intoxication with paracetamol is presumed, administration of N-acetylcysteine is vital. N-acetylcysteine therapy should be initiated not later than 15 hours after paracetamol intake. Moreover, the antitoxic effect has been observed even when N-acetylcysteine therapy is initiated 24-36 hours after presumed paracetamol intake. Measures of preventing further absorbtion of paracetamol from the gastrointestinal tract should be taken. Activated charcoal should be given if less than two hours have passed since paracetamol intake. Between two and four hours following paracetamol intake gastric lavage should be performed. During the last 10 years the incidence of paracetamol self-poisoning has increased, but death following paracetamol poisoning is relatively constant at around nine per year in Denmark. It is suggested that the incidence of serious cases of paracetamol poisoning could be reduced by simple measures. Special attention should be paid to the risk-group of chronic alcoholics.

Acetaminophen↗
PubMed1994

Late graft dysfunction after liver transplantation for primary biliary cirrhosis: disease recurrence versus chronic graft rejection.

Possible recurrence of primary biliary cirrhosis (PBC) in the transplanted liver has been reported. We discuss a case of presumed PBC recurrence after liver transplantation. However, the patient's full documented 9-yr follow-up after liver transplantation confirmed the diagnosis of chronic liver graft rejection instead of recurrent disease. This case report underlines not only the difficult differential diagnosis between recurrent PBC and chronic rejection, but it also stresses that complete follow-up, including strict morphological follow-up, is necessary before definitive conclusions can be drawn.

Diagnosis, Differential↗
PubMed1994

Circulatory disturbance and renal dysfunction in liver disease and in obstructive jaundice.

The appearance of hepatorenal syndrome in a patient with acute or chronic liver disease is associated with a dismal outcome. Thus, management of HRS remains a formidable challenge to the aggressiveness and perseverance of the physician. The best treatment for HRS remains prevention based on avoidance of circulating volume contraction or the use of nephrotoxic drugs. Treatment for established HRS remains a frustrating experience with recovery being rare. A successful liver transplantation is currently the only definitive treatment that can reverse HRS. As this procedure is being performed with increasing frequency and encouraging results, a new window of hope has been opened for these patients.

Adult↗
PubMed1982

Serum bile acids during biphasic contraceptive treatment with ethinyl estradiol and norgestrel.

Twenty-nine women were treated with biphasic combined oral contraceptive pills containing ethinyl estradiol 0.05 mg and levonorgestrel 0.050-0.125 mg. Serum primary bile acids (cholic acid and chenodeoxycholic acid) and one secondary bile acid (deoxycholic acid) were measured by radioimmunoassay. The serum samples were collected before the treatment and at one, three and twelve months during the treatment. No significant changes were found in these bile acid levels during the treatment. The ratio of cholic/chenodeoxycholic acid did not change either. No pathological values were found in the conventional liver function tests although serum alanine aminotransferase activity was significantly increased after twelve months' treatment. It can therefore be concluded that the present contraceptive pill does not cause any liver dysfunction detectable by bile acid measurements of other "classical" liver function tests.

Adolescent↗
PubMed2005

The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection.

BACKGROUND AND AIMS: Major liver resection incurs a risk of postoperative liver dysfunction and infection and there is a lack of objective evidence relating residual liver volume to these complications. PATIENTS AND METHODS: Liver volumetry was performed on computer models derived from computed tomography (CT) angioportograms of 104 patients with normal synthetic liver function scheduled for liver resection. Relative residual liver volume (%RLV) was calculated as the relation of residual to total functional liver volume and related to postoperative hepatic dysfunction and infection. Receiver operator characteristic curve analysis was undertaken to determine the critical %RLV predicting severe hepatic dysfunction and infection. Univariate analysis and multivariate logistic regression analysis were performed to delineate perioperative predictors of severe hepatic dysfunction and infection. RESULTS: The incidence of severe hepatic dysfunction and infection following liver resection increased significantly with smaller %RLV. A critical %RLV of 26.6% was identified as associated with severe hepatic dysfunction (p<0.0001). Additionally, body mass index (BMI), operating time, and intraoperative blood loss were significant prognostic indicators for severe hepatic dysfunction. It was not possible to predict the individual risk of postoperative infection precisely by %RLV. However, in patients undergoing major liver resection, infection was significantly more common in those who developed postoperative severe hepatic dysfunction compared with those who did not (p=0.030). CONCLUSIONS: The likelihood of severe hepatic dysfunction following liver resection can be predicted by a small %RLV and a high BMI whereas postoperative infection is more related to liver dysfunction than precise residual liver volume. Understanding the relationship between liver volume and synthetic and immune function is the key to improving the safety of major liver resection.

Adult↗
PubMed1991

[Liver failure as part of multiple organ failure following polytrauma].

In the last few years there has been increasing evidence that adult respiratory distress syndrome is only part of a much more complex syndrome called multiorgan failure (MOF). Since renal and lung failure have become rare because of our increased understanding of the pathomechanisms involved and the treatment changes, liver dysfunction has been noted more often. In a clinical trial with 38 patients with severe trauma, we investigated liver function using ordinary parameters like the transaminases, bilirubin, etc. To define one group with MOF and one without we used the Goris MOF Score. In both groups glutamate dehydrogenase (GLDH) was increased initially up to 14 U/l, indicating hypoxia of the liver cells right after trauma. From day 6 on, a second increase up to 12 U/l of GLDH in the MOF group was evidence of liver cell dysfunction. The glutamine oxalacetic transaminase (GOT) level remained normal in both groups after an initial increase of up to 60 U/l in both groups. As 30% of serum GOT is released by muscle cells, the initial peak values could be due to direct muscle trauma, because an initial increase was noted even in the creatinine kinase. A decrease in clotting factor V down to 30% on day 8 in the MOF group indicated that the metabolic synthesis activity of the liver was lower. Bilirubin increased in the MOF group from day 5 on up to 240 mumol/l on the day 14. As this increase was not parallel to the gamma glutamyl transferase (Gamma BT) level, the reason for the bilirubin increase may be dysfunction of the liver cell membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Frozen section evaluation of donor livers before transplantation.

Frozen section examination was performed on 385 donor livers before transplantation. Exclusion criteria were applied to the donor livers examined to exclude potentially dysfunctional livers. The exclusion criteria included the following: severe macrovesicular steatosis, ischemic necrosis, prominent chronic portal inflammation, prominent periductular fibrosis, granulomatous inflammation, bridging fibrosis, and malignancy. Twenty-seven of the 385 donor livers examined were excluded before transplantation. The following histologic features were present in the excluded livers: severe steatosis (22), ischemic necrosis (2), portal inflammation (1), and periductular fibrosis (2). Steatosis was present in 51 of the 385 (13.25%) organs examined, including 22 of the donor organs excluded before transplantation. Twenty-nine livers with mild to moderate steatosis were implanted into size and blood type-matched recipients. Indicators of allograft function (prothrombin time and bilirubin) and damage (aspartate aminotransferase and alanine aminotransferase) were measured daily for the first 10 days after transplant. There was no statistically significant difference between the group of nonfat livers and donor livers containing mild steatosis. Statistically significant higher posttransplant serum alanine aminotransferase and prothrombin time levels were present in the patients with livers implanted with mild versus moderate steatosis. The 1-year survival rate for patients receiving fatty versus nonfatty donor livers was not statistically different (Kaplan-Meier, P = 0.592). No significant differences were found in the clinical and laboratory characteristics of donors whose organs were implanted compared with the clinical and laboratory characteristics of donors whose organs were excluded. The primary nonfunction rate after applying the exclusion criteria was 1.4%, which is a significant decrease compared with our primary nonfunction rate of 8.5% before using frozen section examination. Frozen section examination is useful in excluding donor organs which may become dysfunctional after transplantation.

Adenosine↗
PubMed1990

Pretreatment liver biopsy in 20 children with histiocytosis X: a clinicopathologic correlation.

Liver biopsies were done on 20 patients with histiocytosis X (HX) as part of pretreatment evaluation prior to entry on two Childrens Cancer Study Group protocols. Seventeen patients had hepatomegaly, and seven had one or more abnormal laboratory parameters using Lahey's criteria for liver dysfunction. Nineteen of 20 specimens showed various abnormalities of the portal triads. A single biopsy revealed normal liver. Among the changes were triaditis, bile duct proliferation, variable fibrosis with histiocytic infiltrates, and cirrhosis. One patient had typical granulomas of HX within the liver parenchyma in addition to portal triaditis. Patients with larger livers and dysfunction tended to show more marked histologic abnormalities in the portal triads. However, correlations among liver size, function, and pathology showed considerable overlap. Early death among these patients was more likely to be associated with progressive HX in other sites and/or infection. Death from cirrhosis and liver failure per se occurred in one patient 4 years after initial biopsy, but five other children had evidence of cirrhosis on biopsy or at autopsy. The majority of patients with triaditis initially did not have clinical evidence of progressive liver disease although four expired with other manifestations of HX or infection. Conversely, patients showing fibrohistiocytic changes or cirrhosis initially were likely to have continuing or progressive liver disease. Although the liver histology was not diagnostic of HX, the types of portal changes usually predicted the subsequent course of liver disease.

Biopsy, Needle↗