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PubMed1991

[Liver disorders in patients with Mycoplasma pneumoniae pneumonia].

Liver disorders were reviewed in 76 patients with mycoplasma pneumoniae pneumonia (MP) admitted to Kamo Hospital from 1979 to 1989. Liver dysfunction was detected in 16 patients (21%). Liver disorder were detected in 10% of MP from 1979 to 1980, but in 20% from 1984 to 1985, and in 36% from 1988 to 1989. By multiple regression analysis CRP was found to be the most significant factor among other factors such as prevalence, age, sex, history of smoking, history of drinking, and days after onset of fever.

Adult↗
PubMed1991

Ventricular dysfunction does occur during liver transplantation.

Ventricular dysfunction, then, does indeed occur during liver transplantation, particularly at the time of reperfusion. Pulmonary embolism contributes to right ventricular and right atrial encroachment on left-heart filling, and paradoxical embolism may occur. Pericardial effusions, tricuspid regurgitation, hypothermia, and the release of substances, particularly potassium from the donor liver, may further contribute to compromises in ventricular function. Proper monitoring and appropriate treatment, however, lead to successful operative outcomes in most cases.

Heart Arrest↗
PubMed1993

[Liver damage in lymphoma and its clinical significance].

The incidence of liver damage was evaluated in 125 patients with lymphoma. The result showed that liver dysfunction was seen in 44 cases and liver involvement in 30 cases. The liver damage due to the drug toxicity was not observed. HBV could cause severe clinical sequelae after chemotherapy in the lymphoma. Patients with liver damage had worse prognosis.

Adolescent↗
PubMed1996

[Long-term outcome of surgery for biliary atresia].

Between 1953 and 1995, 300 patients with biliary atresia underwent surgery at Tohoku University Hospital. Among them, 31 patients survived more than 20 years, while one of these patients died of hepatic failure at the age of 28 years. Of the 30 surviving patients (10 males and 20 females, age range; 20 to 41 years), 20 underwent hepatic portoenterostomy, 8 underwent hepaticoenterostomy and the remaining 2 underwent hepatic portocholecystostomy. None of these patients has undergone liver transplantation. Twenty-two patients have led near normal lives. This includes three married women, one of whom gave birth to 2 healthy babies. The remaining 8 patients have had experienced some troubles due to cholangitis, portal hypertension and intrahepatic gallstones. Two of them who have progressive liver dysfunction are being considered as candidates for liver transplantation. The quality of life of one patient has been severely affected by an unrelated (Turner's syndrome). While the majority of long-term survivors of biliary atresia have good quality of life, close long-term postoperative follow-up is required.

Adult↗
PubMed1998

[Clinical study on 6 cases of urosepsis associated with septic shock].

At Asama General Hospital, we experienced six cases of urosepsis with septic shock during a period of five years between 1989 and 1993. All six patients, whose average age was 74 years old, recovered. In four patients, the condition was caused by obstructive uropathy. The remaining two cases were caused by renal inflammatory disease, which was complicated by diabetes mellitus. One of them was renal abscess with renal papillary necrosis, and the other was emphysematous pyelonephritis. The patients, who exhibited symptoms such as gram-negative bacteremia, severe hypotension, tachycardia, decrease of urine volume and mental disturbance, were diagnosed with urosepsis with septic shock. In all cases, symptoms such as a high fever of over 39 degrees C, hypoxemia and thrombocytopenia were observed. Renal dysfunction was found in 67%, and both liver dysfunction and disseminated intravascular coagulation (DIC) were found in 50% of the cases. Since no patients suffered from adult respiratory distress syndrome, a high survival rate was apparent. Anti-shock therapy and anti-coagulation therapy were ineffective for the patients who had septic shock due to urinary tract obstruction. Urinary tract drainage was required to treat the latter patients. Nephrectomy could not be avoided in renal parenchymatous inflammatory disease. In the future, what might be essential in therapeutics against urosepsis with septic shock, particularly to avoid nephrectomy, are the treatments such as immunotherapy against endotoxins and their mediators, and hemoperfusion for the removal of endotoxins.

Aged↗
PubMed1997

Enhanced liver calpain protease activity is a risk factor for dysfunction of human liver allografts.

Our aim was to determine whether calpain protease activity is increased in liver tissue from allografts that have poor graft function postoperatively. Liver tissue was obtained from 36 patients at 1 hr after recirculation. The patients were divided into two groups: (1) 30 patients with good graft function; and (2) six patients with immediate poor graft function. Calpain protease activity was increased 1.6-fold in biopsy specimens from patients with immediate poor function as compared with those with excellent graft function. There was no difference between the two groups with regard to cold ischemic time for organ storage, donor age, recipient age, United Network for Organ Sharing status of the recipient, or fatty infiltration of the donor liver. In summary, enhanced calpain protease activity present in the liver 1 hr after reperfusion is a risk factor for graft dysfunction.

Adult↗
PubMed1999

Blockade of type beta transforming growth factor signaling prevents liver fibrosis and dysfunction in the rat.

We eliminated type beta transforming growth factor (TGF-beta) signaling by adenovirus-mediated local expression of a dominant-negative type II TGF-beta receptor (AdCATbeta-TR) in the liver of rats treated with dimethylnitrosamine, a model of persistent liver fibrosis. In rats that received a single application of AdCATbeta-TR via the portal vein, liver fibrosis as assessed by histology and hydroxyproline content was markedly attenuated. All AdCATbeta-TR-treated rats remained alive, and their serum levels of hyaluronic acid and transaminases remained at low levels, whereas all the AdCATbeta-TR-untreated rats died of liver dysfunction. The results demonstrate that TGF-beta does play a central role in liver fibrogenesis and indicate clearly in a persistent fibrosis model that prevention of fibrosis by anti-TGF-beta intervention could be therapeutically useful.

Adenoviridae↗
PubMed1998

Impact of ischemia-reperfusion injury on dimensional changes of hepatic microvessels.

Dimensional alteration of hepatic microvessels was demonstrated during reperfusion after normothermic hepatic ischemia. Using a specially designed cover glass, it was possible to relocate selected sites of observation and microvessels repeatedly throughout the whole reperfusion time. Twenty minutes of hepatic ischemia resulted in a decrease of sinusoidal diameter (mean +/- SEM; 10.0 +/- 0.3 microns at baseline, 8.2 +/- 0.2 microns after ischemia) and diameter of postsinusoidal venules (26.4 +/- 1.2 at baseline, 23.0 +/- 1.0 after ischemia). In the control group (no ischemia induced) no changes of these parameters were observed. Thus, the reduction of hepatic microvascular cross section was present during the early phase of reperfusion. Hepatic dysfunction was characterized by increased serum activity of liver enzymes and reduction of bile flow in the ischemia-exposed animals. It has been suggested that postischemic dimensional microvascular changes are involved in postischemic liver dysfunction.

Animals↗
PubMed1989

Role of the standard 'liver function tests' in current clinical practice.

A prerequisite of current therapy in liver disease is precise diagnosis. The rapid increase in the number of tests available--immunological, virological, histological and radiological--testifies to this, and reflects the inadequacy of the 'standard' liver function tests (LFTs). The LFTs are, however, in contrast to these more sophisticated tests, observer independent and despite their lack of specificity, several characteristic patterns of abnormality can be recognised which direct the physician to the most appropriate definitive investigation. The cheapness and non-invasive nature of the LFTs makes them particularly appropriate for monitoring the course of liver diseases once the diagnosis has been established and this, together with screening for hepatotoxicity of newly developed drugs, is now their main role. A second generation of liver function tests based on the capacity of the liver to eliminate various test compounds may come closer to offering a true estimate of liver function. More accurate methods of measuring the various bilirubin fractions, particularly bilirubin conjugates may also become available in the near future and provide more sensitive tests of liver dysfunction.

Humans↗
PubMed2005

Cystatin C, an easy and reliable marker for assessment of renal dysfunction in children with liver disease and after liver transplantation.

Renal dysfunction of variable severity is being increasingly recognized as a major complication of calcineurin inhibitors (CI), in some patients even necessitating renal transplantation. Close and effective monitoring of the renal function is indicated. Current methods for this monitoring are calculation of the glomerular filtration rate (GFR) based on creatinine or exogenous substances like 51Cr-EDTA. The first method is unreliable in children and the second is expensive and cumbersome. Cystatin C has been shown to be an accurate marker of glomerular filtration but has not been evaluated in a large cohort of pediatric patients before and after liver transplantation (LT). We evaluated the accuracy of cystatin C in 62 children (30 male) with LT, who had their 51Cr-EDTA measured on 40 occasions prior to LT and on 47 occasions after LT. The reciprocal of cystatin C correlated better with 51Cr-EDTA GFR (r = .78) than the reciprocal of creatinine (r = .40). Diagnostic accuracy in the identification of reduced GFR was assessed by ROC analysis. Cystatin C yielded the highest area under the ROC curve (AUC) in all groups assessed. From these data a cutoff level of cystatin C predicting 51Cr-EDTA GFR < 80 ml/min/1.73 m2 was calculated. A level of 1.06 mg/L was found to have a sensitivity of 91% and a specificity of 81%. Applying this cutoff level in our patient group would have avoided 51Cr-EDTA GFR estimation in 43 of the 87 estimations. In conclusion, the use of this simple test could be recommended as screening of renal dysfunction in children with liver disease and after LT.

Biomarkers↗
PubMed1991

Thyroid gland size and function in patients with cirrhosis of the liver.

Thyroid dysfunction has long been reported in patients with liver disease, but limited information is available on thyroid gland size in cirrhosis. Most studies were carried out on small, selected series of patients, and no study has measured thyroid volume in relation to the etiology of liver disease. Thyroid volume was measured at ultrasound in 118 consecutive patients with cirrhosis of different etiology and 48 healthy subjects matched for age and sex. No subjects had evidence of overt thyroid disease. The mean volume was increased by 17% (from 16.0 [SD 5.2] ml in controls to 18.8 [7.6] in cirrhosis; P less than 0.025), and thyroid enlargement (antero-posterior diameter greater than 20 mm) was present in 38% of cases, in the presence of hormone values indicative of low-T3 syndrome. No significant differences in thyroid gland size were observed in relation to the extent of liver dysfunction or to the etiology of liver disease. The prevalence of thyroid nodules was similar in controls and in patients with cirrhosis. In only 8% of cases were laboratory values indicative of hypothyroidism, with low free triiodothyronine and raised thyroid-stimulating hormone levels; in these patients thyroid volume was decreased on average by 26%. This was mainly the case with patients with primary biliary and alcoholic cirrhosis. The largest mean thyroid volume was observed in patients with HBsAg + ve postnecrotic cirrhosis, whose thyroid volume was increased on average by 37%, and 53% of subjects had thyroid enlargement. This finding raises the question of a possible direct involvement of the thyroid in hepatitis B virus infection.

Female↗
PubMed2003

Use of radiolabelled iododeoxyuridine as adjuvant treatment for experimental tumours of the liver.

BACKGROUND: The aim of the study was to determine whether hepatic regeneration stimulates growth of tumour residing within the liver, and whether a difference in the rate of DNA synthesis in liver and tumour may be used to target cancer using the radiolabelled thymidine analogue 5-iodo-2'-deoxyuridine (IUdR). METHODS: Partial hepatectomy was performed on Buffalo rats bearing solitary nodules of syngeneic Morris hepatoma. Liver and tumour DNA synthesis was measured by incorporation of radioactive IUdR. [(125)I]IUdR was tested as an adjuvant therapy after hepatectomy in Buffalo rats bearing diffuse microscopic Morris hepatomas to simulate the clinical situation. RESULTS: Liver regeneration enhanced liver and tumour DNA synthesis as measured by incorporation of radioactive IUdR. Liver DNA synthesis returned to baseline by 7 days, whereas tumour DNA synthesis remained above baseline level. Hepatectomy enhanced the growth of microscopic liver tumours. [(125)I]IUdR (250 micro Ci or 1 mCi/kg) administered 4 days after hepatectomy significantly reduced tumour growth without signs of systemic toxicity or liver dysfunction. CONCLUSION: The local environment of the regenerating liver stimulates tumour growth. The thymidine analogue [(125)I]IUdR may be used preferentially to target tumour DNA synthesis in the regenerating liver, and may prove useful as an adjuvant therapy for hepatic tumours after surgical resection.

Animals↗
PubMed2002

Allopurinol plus pentoxifilline in hepatic ischaemia/reperfusion injury.

OBJECTIVES: Ischaemia/reperfusion injury of the liver is the major cause of liver dysfunction and cellular death in transplantation and in liver resection with hepatic pedicle clamping. Many agents are used to prevent this phenomenon, which occurs following interaction of different mediators during both ischaemia and reperfusion. In this study, we aimed to assess the effects of allopurinol, a xanthine oxidase inhibitor, and pentoxifilline, on liver ischaemia/reperfusion injury when used together and to compare these with the effects of using these agents singly. METHODS: Thirty-two rats were divided into four groups consisting of eight rats: Group C, control; Group P, pentoxifilline; Group A, allopurinol; and Group PA, pentoxifilline + allopurinol. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were measured before hepatic pedicle clamping, on the 45th minute of ischaemia and 15 and 45 minutes after reperfusion. Group P rats were injected with 50 mg/kg pentoxifilline, Group A rats 50 mg/kg allopurinol and Group PA rats were injected with both agents 15 minutes before hepatic pedicle clamping. RESULTS: Ischaemia/reperfusion injury was produced by hepatic pedicle clamping, as demonstrated by AST, ALT and LDH increase. Injury prevention occurred in Groups P, A and PA. No significantly different (better) prevention was provided by giving allopurinol plus pentoxifilline to the rats. Furthermore, no difference was observed between the allopurinol and pentoxifilline injected groups in terms of preventing ischaemia/reperfusion injury. CONCLUSIONS: Pretreatment with allopurinol or pentoxifilline resulted in significantly lower hepatic enzyme elevation than that in controls in the rat liver ischaemia/reperfusion model. Using both agents does not provide better protection than using either agent alone.

Allopurinol↗
PubMed1998

Percutaneous thrombolysis and stent placement for the treatment of portal vein thrombosis after liver transplantation: long-term follow-up.

BACKGROUND: The durable use of percutaneous minimally invasive techniques for the treatment of portal venous thrombosis after liver transplant has not been widely described. This report illustrates two cases in which percutaneous thrombolysis, angioplasty, and endovascular stent placement were successfully used to treat portal vein thrombosis in patients with recent liver transplants. METHODS: Liver dysfunction was initially manifested by the elevation of liver enzymes or the development of marked ascites and confirmed in both cases by sonography and angiography. The occluded portal vein was accessed by either a transjugular transhepatic puncture or direct transhepatic catheterization. Intraportal thrombolytic infusion, angioplasty, and stent placement were accomplished without complication. RESULTS: At the most recent follow-up, portal vein patency had been maintained for 2.5 and 4.5 years. CONCLUSIONS: These results demonstrate the technical feasibility and long-term patency of angioplasty and endovascular stent placement for the treatment of portal vein thrombosis in liver transplant recipients.

Adult↗
PubMed2006

Amiodarone-sirolimus/tacrolimus interaction in a pediatric heart transplant patient.

A two year-old female who had underwent ABO-incompatible heart transplantation at four months of age was admitted with unexplained anemia and renal dysfunction. The patient also had evidence of moderate liver dysfunction. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil and prednisolone. Tacrolimus was held on day 2 for five days because of an elevated trough blood concentration. The patient required one fourth of her maintenance dose to keep trough concentrations within the target range. Nadolol and amiodarone were prescribed on day 7 to control ventricular arrhythmias. Sirolimus was prescribed on day 11. A precautionary (non-steady-state) sirolimus trough concentration was grossly elevated. Sirolimus was held and tacrolimus was discontinued. Sirolimus blood concentrations remained above the target range for fourteen days despite successive dose manipulations. The patient succumbed from complications of ECMO on day 42. Amiodarone and cyclosporine interactions in the solid organ transplant population have been previously described. To our knowledge, there are no cases of amiodarone and sirolimus or tacrolimus interactions reported in English literature. Both tacrolimus and sirolimus are metabolized through the same enzyme system as cyclosporine, and the chance of a similar interaction occurring is high. Sirolimus is also a substrate of p-glycoprotein and thus may be significantly affected by amiodarone. We have described a potential interaction with sirolimus, tacrolimus and amiodarone. If amiodarone is deemed the most appropriate choice for the patient, clinicians should consider prospectively decreasing sirolimus and tacrolimus doses. Blood concentrations should also be monitored more frequently in order to minimize prolonged periods of supratherapeutic concentrations and related toxicities.

Amiodarone↗
PubMed2003

Zinc supplementation attenuates thioacetamide-induced liver injury and hyperglycemia in mice.

Zinc supplementation has been shown to improve not only liver dysfunction but also glucose intolerance in subjects with liver cirrhosis. In this study, we investigated the effects of zinc supplementation on the changes in circulating levels of tumor necrosis factor-alpha and total antioxidant capacity in mice with thioacetamide-induced liver injury. The protective effect of concurrent zinc administration for thioacetamide-induced hepatotoxicity was also examined. The results showed that zinc treatment significantly attenuated thioacetamide-induced liver injury and hyperglycemia. Furthermore, thioacetamide-induced hepatotoxicity was markedly weakened by the simultaneous zinc administration. These effects might be attributed to reduced tumor necrosis factor-alpha production and elevated total antioxidant capacity induced by the mineral. Our data suggest that zinc supplementation might be beneficial for the subjects with a high susceptibility to liver injury.

Animals↗
PubMed2003

Hepatotoxic profile of catechol-O-methyltransferase inhibitors in Parkinson's disease.

Entacapone and tolcapone are selective catechol-O-methyltransferase (COMT) inhibitors developed recently as adjuncts to levodopa for the treatment of Parkinson's disease (PD). They extend the duration of action of levodopa. As a result, they increase 'on' time, decrease 'off' time and improve motor scores in patients with motor fluctuations. Both benefits and main side effects are related to increased dopaminergic activity. This paper reviews the use of those COMT inhibitors in PD with particular focus on the issue of hepatotoxicity. Neither tolcapone nor entacapone caused hepatotoxicity in preclinical studies. However, in 1998, four patients who were using tolcapone presented with serious liver dysfunction; three of them died due to acute liver failure. Tolcapone is now known to have the potential to cause hepatotoxicity in clinical use and experimental studies. It is now recommended that tolcapone be administered only in patients with motor fluctuations who are no longer satisfactorily treated with other medications for PD. Routine liver monitoring is now mandatory with this agent. Entacapone has been described as a well-tolerated and safe drug in recent experimental studies, human clinical trials and postmarketing surveillance. It can be offered to any patient with motor fluctuations and routine liver monitoring is not required.

Antiparkinson Agents↗
PubMed2000

[Manifestation of primary biliary cirrhosis and Basedow's disease caused by exposure to carbon monoxide in a patient with HTLV-1 associated myelopathy].

A 55-year-old woman with HTLV-1 associated myelopathy (HAM) was discovered in a rentan kotatsu (Japanese foot warmer with a frame and a coverlet by burning briquet) with conscious disorder and admitted to an emergency hospital. Her conscious disturbance waned the 3rd day after admission with gradual improvement of communication and food intake. However, on the 18th day after admission, her orientation was poor again and she was unable to take food for herself and keep sitting. She was diagnosed as suffering from an interval form of acute carbon monoxide (CMO) poisoning and transferred to our hospital for the purpose of hyperbaric oxygen therapy on the 20th day after exposure to CMO. In the course of treatment she recovered but showed jaundice, pruritus, liver dysfunction and elevation of antimitochondrial antibody. She received liver biopsy and was found to have primary biliary cirrhosis (PBC). On the 150th day, she manifested perspiration and hypertension. The clinical and immunological feature revealed her Basedow's disease. The relationship between HAM and PBC due to the autoimmune process has been predicted by investigators. The implication of autoimmune disease and HLA haplotype is a main focus of attention. Our case supports their hypothesis, and suggested that the complication occurred with immunological and genetic correlation. Anti-HTLV-1 antibody was positive at a titer of 1:8192 before exposure to CMO. On transferring to us, it was negative and revealed excessive positive at a titer of 1:20,480 on the 80th day. Immunoglobulin analysis was normal on admission and increased during hospitalization. It was reported that prenatal exposure to relatively mild concentrations of CMO in rats reduces splenic macrophage phagocytosis and killing ability as well as macrophage respiratory burst. These data suggested that PBC and Basedow's disease were manifested by exposure to carbon monoxide.

Acute Disease↗