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PubMed1998

Acute fatty liver of pregnancy.

Acute fatty liver is a rare but potentially fatal complication of the third trimester of pregnancy. Significant improvements in morbidity and mortality have been reported in the last several years. Despite accumulation of more data about the disease, the exact pathogenesis is unknown. Many women are initially misdiagnosed with other more common causes of liver dysfunction during pregnancy. It is possible that acute fatty liver is an atypical form of preeclampsia because 30% to 40% of women with acute fatty liver also have preeclampsia. Supportive care and expeditious delivery represent the only known treatment. More data are needed about acute fatty liver of pregnancy, but the rare nature of the disease and the likelihood that most cases are not reported in the literature limit the ability systematically to study causation, disease process, and treatment options. Because of the serious condition of most women who develop acute fatty liver of pregnancy, collaboration between critical care and perinatal care providers is essential for optimal maternal-fetal outcomes.

Acute Disease↗
PubMed1995

Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions.

The clinicopathological features of a previously unrecognised type of acute encephalopathy prevalent among Japanese children is described by reviewing the records of 13 consecutive patients treated and 28 previously reported cases. The hallmark of this encephalopathy, proposed to be a novel entity termed acute necrotising encephalopathy of childhood, is multiple, necrotic brain lesions showing a symmetric distribution. The encephalopathy was noted in previously healthy children after respiratory tract infections, with presenting symptoms of coma, convulsions, vomiting, hyperpyrexia, and hepatomegaly. Laboratory examinations disclosed liver dysfunction, uraemia, and hypoproteinaemia. The histological appearance of the liver was variable and non-specific. Cerebrospinal fluid contained an increased amount of protein. Computed tomography and MRI showed the presence of symmetrically distributed brain lesions of the thalamus, cerebral white matter, brainstem, and cerebellum. Necropsy examination confirmed extensive fresh necrosis of these regions with evidence of local breakdown of the blood-brain barrier. Based on the characteristic combination of clinical and pathological findings, acute necrotising encephalopathy of childhood can be distinguished from previously known encephalopathies, including Reye's syndrome.

Acute Disease↗
PubMed1995

Neuropsychological functioning in detoxified alcoholics between 18 and 35 years of age.

OBJECTIVE: The authors determined 1) cognitive functioning in detoxified alcoholics who had alcohol-related problems for a relatively brief time and 2) relationships between neuropsychological test scores and recent and chronic alcohol consumption patterns, childhood symptoms of hyperactivity/minimal brain dysfunction, and extent of familial alcoholism. METHOD: The subjects were 101 detoxified, drug-free alcoholics between 18 and 35 years of age who had consumed excessive amounts of alcohol (average of 114 g four to five times per week) for an average of 6 years. An average of 39 days after the last drink each alcoholic was given an extensive battery of neuropsychological tests assessing language skills, attention, motor skills, intelligence, memory, and cognitive functioning related to the frontal regions of the brain. RESULTS: Only four individuals evidenced mild cognitive dysfunction. Current psychiatric condition, anxiety and depressive states, and liver dysfunction were not related to cognition. Relationships of cognition of lifetime estimates of alcohol consumption (average of 189 kg) and number of days from last drink to testing were determined to be nonlinear and suggested that greater lifetime consumption predicted worse performance and that longer abstinence predicted better performance. Neither extent of familial alcoholism nor number of childhood signs and symptoms of hyperactivity/minimal brain dysfunction was predictive of cognition except that more antisocial behavior predicted poorer cognitive functioning. CONCLUSIONS: Cognition in young alcoholics, averaging 6 years of excessive alcohol consumption, was within normal limits, even though greater lifetime consumption predicted lower test scores and longer abstinence predicted higher scores.

Adolescent↗
PubMedDate not supplied

Dynamic tests to study liver function.

Two approaches have generally been used to assessing liver function: one is to measure the products of liver synthesis, the other is to monitor hepatic clearance function. The exogenous dyes that can be used to study liver function are sulphobromophthalein (BSF) and indocyanine green (ICG). One valuable way to measure hepatic function is to use non-toxic substances (stains, sugar, drugs) that are selectively metabolized by the liver and determine the rates of metabolism of these substances in vivo. The antipyrine clearance test is the most common and correlates well with the degree of liver damage. The caffeine clearance test is beneficial in severe liver lesions, but practically useless in the case of moderate liver damage. The galactose clearance test can be used early in the clinical course of jaundice to distinguish between hepatocellular disease and biliary obstruction. The MEGX test is useful as a real-time method for quantitatively assessing pre- and post-transplant liver function. In short, quantitative liver function tests are not suitable for use in screening for liver disease. They are more complex to perform and more expensive than conventional biochemical tests, but superior in monitoring the degree of liver dysfunction.

Humans↗
PubMed1990

[Selective resection of the distal bile duct in a high risk patient with polypoid cancer of the intrapancreatic bile duct].

An 81-year-old man who had suffered from hypertension for the preceding three years was admitted as an emergency to the department of neurology of our hospital with the chief complaint of dysarthria. He was diagnosed to have multiple lacunar cerebral infarcts by cranial CT, while the laboratory data showed liver dysfunction characteristic of cholestasis. Mild respiratory insufficiency and renal dysfunction were also found. Further radiological examinations on the liver and biliary tree (US, CT and ERC) were performed, and they revealed that the common bile duct was dilated due to two stone-like masses. He was referred to our department of surgery and underwent laparotomy. Intraoperative endoscopy disclosed intraductal papillomatous lesions. Because of the multiple complications of the patient, resection of the entire common bile duct including the gallbladder and the papilla of Vater without any resection of the pancreas was performed instead of pancreatoduodenectomy. The postoperative course was uneventful and he was discharged on the 31st POD. One year after operation, there is no sign of recurrence either clinically or radiologically. The potentially curative operation for cancer of the distal bile duct is pancreatoduodenectomy, but this is of so great a surgical stress that such a high risk case as described above might be unable to survive it. Even if he survived the perioperative period, he might have a poor quality of life due to postoperative complications. The macroscopic appearance of bile duct cancer is correlated to its invasive spread and prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1987

[Free methyltetrazolethiol concentrations in men subjected to intravenous administration of cephems with methyltetrazolethiol].

The disulfiram-like reaction due to cephems with methyltetrazolethiol (tetrazole) moiety was studied in biotransformation of these drugs. The serum tetrazole concentration was determined following intravenous administration of cefoperazone (CPZ) 1 g, latamoxef (LMOX) 1 g, or cefmetazole (CMZ) 2 g to patients suffering infections without liver dysfunction, and of CPZ 1 g to patients with liver cirrhosis. Tetrazole concentrations in normal patients were 0.5-2.0 micrograms/ml after 3 hours, and 0.14-0.26 micrograms/ml after 12 hours, and undetectable after 24 hours. On the other hand, the tetrazole concentration in cirrhotic patients was 0.143 +/- 0.07 micrograms/ml (mean +/- SD) even after 24 hours. Therefore, it is concluded that the disulfiram-like reaction due to cephems with tetrazole moiety closely related to the metabolism of these drugs in liver, and probably be caused by the inhibition of acetaldehyde dehydrogenase activity in liver by the free tetrazole group produced by the metabolism of these drugs in liver.

Aldehyde Oxidoreductases↗
PubMed1985

Conservative treatment of liver hematoma in the postpartum period. A report of two cases.

Two pregnant women at term had antenatal symptoms of impending preeclampsia (thrombocytopenia, liver dysfunction) and developed clinical signs of a leaking subcapsular liver hematoma in the immediate postpartum period. They were managed conservatively, with blood transfusions and ultrasonic computerized tomographic monitoring of the hematoma. Both did well, and their hospital stays were brief. These cases suggest that immediate celiotomy may not always be necessary for suspected liver hematoma associated with preeclampsia.

Adult↗
PubMed1993

Radiation hepatology of the rat: parenchymal and nonparenchymal cell injury.

Cellular changes that occur within the liver before and during liver fibrosis have been studied. At various times (0-90 days) after gamma irradiation (0-25 Gy) of the whole liver, hepatocytes and liver nonparenchymal cells were isolated by enzymatic dissociation of the liver and differential centrifugation. Differential cell counts were done to quantify the yield of hepatocytes and nonparenchymal cells. Hepatocyte function in vitro was assayed by the uptake of rose bengal and compared with the clearance of the dye in vivo. Intracellular alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were used to estimate the effect of radiation on the phenotypic expression of hepatocytes. Gene expression of transforming growth factor beta 1 (TGF-beta 1), a cytokine which has been found to play a role in hepatic fibrosis, was measured by 32P-cDNA:mRNA hybridization of poly(A+) mRNA isolated from purified populations of hepatocytes and nonparenchymal cells. Morphologically, hemorrhages were evident in perfused livers 28 days after 25 Gy whole-liver irradiation. This injury was preceded by a significant increase in liver nonparenchymal cells at 2 weeks, the earliest time after irradiation at which measurements were made. Significant increases in liver nonparenchymal cells occurred at doses greater than 10 Gy and persisted throughout the follow-up period after irradiation. The lowest dose studied (5 Gy) inhibited both normal growth of the liver and the associated increase in the number of hepatocytes. Doses greater than 10 Gy resulted in a dose-dependent decline in liver mass and hepatocytes. Viable hepatocytes isolated from irradiated dysfunctional livers, with respect to clearance of rose bengal, were functionally normal in vitro. A dose-dependent decline in the ALT and AST contents of liver cell suspensions and homogenates was observed but the relative decline in ALT was greater, resulting in lower ALT/AST ratios. This decline in the ALT/AST ratios occurred at doses (< 15 Gy) which caused no loss of hepatocytes, suggesting possible conversion of ALT-rich periportal hepatocytes to ALT-poor hepatocytes due to changes in the microenvironment and/or aging of the cell population. TGF-beta 1 mRNA was detected mainly in nonparenchymal cells, and radiation preferentially enhanced the TGF-beta 1 gene expression in these cells. These data suggest that radiation-induced alterations in liver nonparenchymal cell populations may be responsible for microvascular fibrosis, which results in a cascade of pathological events which lead to hepatocyte loss.

Alanine Transaminase↗
PubMed1985

Hepatic dysfunction and cardiovascular abnormalities. Occurrence in infants, children, and young adults.

In infants and children, the effect of heart failure and/or cyanotic heart disease on the liver has not been well documented, nor has there been any comparison between the degree of liver dysfunction and hemodynamic factors. Sixty-five patients with cardiovascular abnormalities were examined. Hepatic function, as indicated by laboratory data and histologic liver studies, was compared with the following categories of cardiovascular dysfunction: hypoxemia, systemic venous congestion, and low cardiac output. If any one of these factors was present, or any combination, abnormalities of liver function were usually noted. Patients with both hypoxemia and systemic venous congestion had marked hepatic dysfunction. Those with low cardiac output had the most severe abnormalities. Serial studies indicated that liver function correlated with cardiac status.

Adolescent↗
PubMed1996

Choledochoduodenostomy in the management of common duct stones or associated pathology--an obsolete method?

UNLABELLED: Choledochoduodenostomy (CDD) has been reported as a more effective treatment of CBD stones than T-tube drainage but it is regarded as a last resort or obsolete therapeutic method due to fears of higher mobidity, cholangitis, "sump" syndrome and liver dysfunction. We aimed to assess the aforementioned issues analyzing prospectively our experience from 1976 through Dec.92. METHODS: CDD was performed in 89 females and 36 males, aged 60 +/- 8.7 years, 26 during repeat surgery. Duct stones were the indication in 94, Sphincter of oddi (SO) dysfunction in 23 and obstructive pancreatitis nodule in 8. Peroperative liver biopsies were obtained in 44 patients. The "follow-up" schedule (> 2.5 years in 110) included clinical interview and LFT's on an yearly basis. Ultra sound (USG) was obtained every one or two years. ERC was done in 10 symptomatic patients and in 25 others for protocul purposes. Liver biopsies were taken four to nine years post surgery in 11 patients-five at relaparotomy for non-biliary causes and six percutaneously by fine needle. Ductal mucosa biopsy could safely be performed in one patient 10 years after surgery. The long-term results were classified as excellent, good, fair or poor. Poor meant the need for further invasive therapy (resurgery or EST). RESULTS: There were two operative deaths (1.6%). The long-term results (123 survivors) were considered excellent in 89, good in 22, fair in 9 and poor in three. Three patients died from unrelated causes and eight others ceased the "follow-up" evaluation three to five years post surgery. All of them were considered as having excellent or good results. A widely patient anastomosis of approximately 20 mms without mucosal inflammatory changes was documented in every patient assessed via ERC. food "debris" was detected within the distal duct of four patients yet it was easily flushed through the stoma. Normal tissue patterns were observed in all long-term liver biopsies. Likewise the ductal mucosa biopsy failed to reveal any acute or chronic inflammatory changes. CONCLUSIONS: 1) CDD is a highly effective short and long-term treatment of CBD lithiasis.2) It does not lead to bacterial or "chemical" cholangitis, to "sump" syndrome or to hepatic dysfunction, provided a wide anastomosis is accomplished.3) CDD should only be considered as obsolete after extensive, long-term, prospective, randomized assessment of laparoscopic or combined laparoendoscopic approaches have been shown to be as effective as or superior to CDD.

Choledochostomy↗
PubMed1993

Treatment of choledocholithiasis in patients with liver cirrhosis. Surgical treatment or endoscopic sphincterotomy?

OBJECTIVE: The clinical features of choledocholithiasis were analyzed in cirrhotic patients. The outcomes of surgical treatment and endoscopic sphincterotomy (EST) in this situation were compared and the risk factors predictive of an increased mortality rate were identified. SUMMARY BACKGROUND DATA: In cirrhotic patients, high risk for gallbladder stones in cholecystectomy has been established. Common bile duct stones can often exacerbate liver dysfunction and might be more difficult to treat. METHODS: Among 16 cirrhotic patients with choledocholithiasis, 9 underwent choledocholithotomy and T-tube placement (surgery group) and 7 underwent EST (EST group). Pretreatment clinical data were comparable between groups. RESULTS: Among 16 patients, 15 had biliary tract symptoms and 7 had cholangitis. The surgery group had excessive intraoperative hemorrhage (1576 mL) and a high morbidity rate (66.7%). The mortality rate was 44.4%: 0% in Child A or B classification patients and 80% in Child C patients. The common causes of death were liver failure, postoperative hemorrhage, and sepsis. The EST group had no complications related to procedures, but there was one death (14.3%) due to preexisting liver failure. Hepatic dysfunction, coagulopathy, and cholangitis were factors predictive of an increased mortality rate. CONCLUSIONS: Choledocholithiasis in cirrhotic patients should be treated by EST after liver function and general condition are improved by medical management, except in emergency cases.

Adult↗
PubMed1999

Correlation of serum cholylglycine level with hepatic dysfunction in children with sickle cell anemia.

Hepatic dysfunction occurs commonly in children with sickle cell disease (SCD). Although the etiology is multifactorial, cholestasis is a prominent feature. Serum cholylglycine (CG) has been found to be a very sensitive indicator of cholestasis. Our objective was to determine whether CG levels are elevated in children with SCD and whether they are predictive of hepatic dysfunction. Blood samples were obtained from 97 children with SCD. Liver function tests were done and serum CG concentrations were measured. Patients were followed up for 2 years. Thirty-eight percent of the patients had an elevated CG level. During the 2 years of follow-up, 16% of the children with a previously elevated CG level developed abnormal liver function test results or required a cholecystectomy as compared with 13% with a previously normal CG level (p = 0.92). We conclude that although CG level was elevated in 38% of the patients with SCD, it did not appear to predict liver dysfunction during the ensuring 2 years.

Anemia, Sickle Cell↗
PubMed2003

The molecular pathogenesis of hepatic encephalopathy.

Hepatic encephalopathy (HE) incorporates a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction with a potential for full reversibility. Distinct syndromes are identified in acute liver failure and cirrhosis. Rapid deterioration in consciousness level and increased intracranial pressure that may result in brain herniation and death are a feature of acute liver failure whereas manifestations of HE in cirrhosis include psychomotor dysfunction, impaired memory, increased reaction time, sensory abnormalities, poor concentration and in severe forms, coma. For over a 100 years ammonia has been considered central to its pathogenesis. In the brain, the astrocyte is the main site for ammonia detoxification, during the conversion of glutamate to glutamine. An increased ammonia level raises the amount of glutamine within astrocytes, causing an osmotic imbalance resulting in cell swelling and ultimately brain oedema. The present review focuses upon the molecular mechanisms involved in the pathogenesis of HE. Therapy of HE is directed primarily at reducing ammonia generation and increasing its detoxification.

Ammonia↗
PubMed1992

A case of tubulo-interstitial nephritis with exfoliative dermatitis and hepatitis due to phenobarbital hypersensitivity.

Severe exfoliative dermatitis and liver dysfunction developed in a 5-year-old girl 3 weeks after initiation of phenobarbital therapy. Liver function improved gradually after discontinuation of phenobarbital. During the convalescent stage an initially mild renal dysfunction was exacerbated by episodes of post-transfusion haemolysis. Liver biopsy revealed moderate parenchymal damage with subacute cellular infiltration. Renal biopsy demonstrated the cardinal findings of interstitial nephritis, excluding the possibility of acute tubular necrosis caused by haemolysis. Serial lymphocyte transformation studies and skin patch tests gave positive results for phenobarbital, supporting the view that these were unusual complications of phenobarbital hypersensitivity.

Chemical and Drug Induced Liver Injury↗
PubMed1991

Does ventricular dysfunction occur during liver transplantation?

In conclusion, we believe that ventricular dysfunction occurs infrequently during liver transplantation, except for the very short period of "cardioplegia" of the heart on reperfusion in some patients. There is no evidence that prolonged cardiac dysfunction is a common problem during liver transplantation. Understanding the physiologic changes that occur during liver transplantation should allow the anesthesiologist to correct many factors that might otherwise cause hemodynamic instability.

Heart Diseases↗
PubMed2005

Jejunectomy can reduce excessively elevated portal pressure after major hepatectomy in beagle dogs.

A number of factors can lead to the life-threatening liver dysfunction in the aftermath of an extended hepatectomy. Prominent among them is the high portal pressure induced by the concentrated flow of the entire stream of portal blood toward the small remnant liver. Twelve beagle dogs were randomly divided into group A (n=6, 70% hepatectomy) and group B (n=6, 70% hepatectomy after jejunectomy). Three dogs in each group were euthanized at 1 or 4 weeks after the operation and examined to evaluate hemodynamic changes, liver functions, and liver histology. One hour after the hepatectomy, the animals in group B exhibited a significantly lower portal pressure (P=0.002) and significantly higher hepatic arterial flow (P=0.004) than the animals in group A. As more time passed, the total hepatic flow and hepatic tissue flow both rose up to levels significantly higher than those in group A (P=0.037 and P=0.025, respectively). The alkaline phosphatase, total protein, albumin, and anti-thrombin III were all significantly better in group B than in group A on the 1st post-operative day. Liver specimens biopsied at 1 h after the hepatectomy showed significantly more swelling of the hepatocytes in group A than in group B. In addition, an immunohistochemical study using the TUNEL method for liver biopsy on the seventh post-operative day revealed numerous positive cells in group A but few in group B. Our results suggest that the portal pressure control by the enterectomy can forestall dysfunction of the remnant liver after extended hepatectomy, especially during the early post-operative period.

Animals↗
PubMed1989

[Anesthesia for a patient with HELLP syndrome].

A case of 30 year-old female with HELLP syndrome, who had undergone emergency caesarean section under general anesthesia, was reported. HELLP syndrome is characterized by hemolysis, liver dysfunction and thrombocytopenia, besides symptoms of severe toxemia of pregnancy. After an awake orotracheal intubation, anesthesia was maintained with nitrous oxide, oxygen and muscle relaxant. Blood pressure was controlled with intravenous administration of nitroglycerin. Though the eclampsia was recognized several times during and after the operation, the patient and her baby had no complication nor sequela on their discharge. The key in the anesthetic management of caesarean section in a patient with HELLP syndrome is to control hypertension and eclampsia, to consider the presence of liver and kidney dysfunctions, and to improve anemia and bleeding tendency.

Adult↗
PubMed2004

Cytomegalovirus infection after orthotopic liver transplantation is restricted by a pre-existing antiviral immune response of the recipient.

Infection of the liver by the human cytomegalovirus (HCMV) frequently occurs after orthotopic liver transplantation (OLT). However, the role of viral replication and the inflammatory reaction in the development of HCMV-associated liver dysfunction is unclear. To address this question in vivo, 84 liver biopsy specimens from 74 patients who received an orthotopic liver transplant were investigated by immunohistochemical detection of viral antigens and cell type specific marker proteins. The extent of viral replication was correlated with the HCMV antibody status of donor and recipient. HCMV immediate early antigens were found in 25 of 84 liver tissue sections investigated, hepatocytes being the predominant target cells. Bile duct epithelial cells, endothelial cells, mesenchymal cells and sinusoidal lining cells were also found susceptible to HCMV infection. The detection of viral capsid antigens, nuclear inclusions in infected cells and foci of infected cells were suggestive of permissive infection in these cells. In 25 HCMV-positive liver biopsy specimens, the median extent of HCMV infection was 0.33 (0.02-5.67) infected cells/mm(2) liver tissue. Primary infection of liver transplant recipients (D+/R-) was associated with a significantly higher extent of organ involvement as compared to reinfection or reactivation (D+/R+). In contrast, the extent of inflammatory infiltrates in areas of infected liver cells was higher in tissues of patients with pre-existing immunoreactivity (R+) compared to patients without pre-existing immunoreactivity (R-). In conclusion, these results favour the assumption that the immune response to HCMV is effective in restricting viral spread in the liver.

Antibodies, Viral↗