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PubMed1998

A case with subcapsular hematoma of the liver following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is a safe and less traumatic procedure for benign cholecystic disease. However there have been some complications peculiar to LC. Here we report a case with postoperative subcapsular hematoma of the liver after LC. A 78-year-old woman was admitted with acute cholecystitis due to cholecystolithiasis. She underwent LC and liver dysfunction was noted after the operation. Ultrasonography (US) and computed tomography (CT) showed subcapsular hematoma of the liver. It was supposed that it had happened to occur during the operation, but we could not make the cause clear. The patient was improved with only conservative therapy and discharged. It is important to handle the forceps carefully close to the liver in the laparoscopic surgery in order to prevent this complication. We report a case with subcapsular hematoma of the liver following LC with a review of the literature.

Aged↗
PubMed1993

Cranial metastasis of hepatocellular carcinoma in a female--case report.

A 78-year-old female presented with swelling and severe pain in the left forehead secondary to a simple head injury received 1 month previously. On admission, neurological examination was normal. Plain skull x-ray films and computed tomography showed an osteolytic and well-defined mass in the left frontal bone. Bone scintigraphy showed high-uptake areas in the right lower ribs and fifth lumbar vertebra. Blood tests showed slight liver dysfunction and a high alpha-fetoprotein level. Abdominal computed tomography showed a huge mass within the liver. Left common carotid angiography disclosed the enlargement of several feeding arteries arising from the external carotid artery with tumor staining. The bone tumor was removed for histological diagnosis and to reduce the localized pain. The histological diagnosis was a cranial metastasis from hepatocellular carcinoma. She died of ruptured varicose veins of the esophagus approximately 8 months after surgery. Surgery for cranial metastasis from hepatic cancer is only indicated when localized pain or hemorrhage threaten the quality of life.

Adult↗
PubMed2004

[Case of NK/T-cell lymphoma of the larynx with hemophagocytic syndrome].

We report the case of a 67-year-old man with NK/T cell lymphoma of the larynx accompanied by hemophagocytic syndrome (HPS) who reported throat paresthesia and was referred for evaluation of a laryngeal tumor extending from the left false vocal cord to the arytenoids. Two separate biopsies from the larynx yielded a histological diagnosis of NK/T-cell lymphoma, nasal and nasal type. Since he showed pancytopenia and remittent fever soon after admission, bone marrow was examined and showed severe hemophagocytosis, leading to a diagnosis of HPS. He died of circulatory and respiratory distresses due to HPS about one month after admission. HPS develops with symptoms of fever, cytopenia, and liver dysfunction, and is characterized by systemic proliferation of benign hemophagocytic histiocytosis in the bone marrow, lymph nodes, liver, and spleen. To the best of our knowledge, this is only the second case of NK/T-cell lymphoma of the larynx with hemophagocytic syndrome to be reported in the Japanese literature.

Aged↗
PubMed2001

Hepatoprotection by Elephantopus scaber Linn. in CCl4-induced liver injury.

The efficacy of the medicinal plant Elephantopus scaber Linn. (Asteraceae), to prevent carbon teterachloride (CCI4)-induced chronic liver dysfunction in the rats was examined by determining different biochemical markers in serum and tissues. In serum, liver function marker enzymes like aspartate aminotrasferase (AST), alanine aminotrasferase (ALT), alkaline phosphatase (ALP) and also protein were evaluated. The concentrations of total lipid, cholesterol and phospholipids were studied in serum and the different tissues. The concentration of serum triglycerides was also studied. The biochemical changes induced by CCI4 in different tissues particularly in the liver tissue improved following treatment with E. scaber Linn. The results suggest the hepatoprotective effect of this medicinal plant.

Alanine Transaminase↗
PubMed1990

[A case of hepatocellular carcinoma in an elderly patient that improved upon combination therapy of Lentinan and Tegafur].

The case was an 83-year-old man whose chief complaint was right-hypochondralgia and high fever. His laboratory findings at the first visit revealed liver dysfunction and an elevation of AFP level. Abdominal ultra-sonography revealed a giant tumor in his liver. Because of his advanced age and the large size of his tumor, he was given 2 mg Lentinan a week and 750 mg Tegafur every day. After 3 months his serum AFP level decreased to normal range, and on computed tomography his tumor disappeared completely 6 months after the beginning of this therapy. We recommend the combination therapy of Lentinan and Tegafur for patients with a high risk for usual therapies like this case for their quality of life.

Aged↗
PubMed1978

[Diffuse polymorphous inclusions in a patient treated with perhexiline maleate (author's transl)].

Case report of polyneuritis and liver dysfunction induced by perhexiline maleate in a 64 years old male patient. The ultrastructural study of nerve, liver, muscle and skin biopsies shows polymorphous, membrane bound, often multilamellar, lysosome-like inclusions, the content of which is probably complex lipids. The histochemical study of liver reveals a lipid storage, consisting mainly of triglycerides and of smaller amount of phospholipids and free fatty acids, the pattern of which is abnormal. The biochemical study of nerve tissue shows a decrease of phospholipids levels and some qualitative disturbances in gangliosides. These changes, some of which are similar to those reported in amphiphilic drug intoxications, are prevalent in high lipid metabolism cells such as hepatic and Schwann cells.

Biopsy↗
PubMed1995

Chronic cholestasis in patients after allogeneic bone marrow transplantation: several diseases are often associated.

From 1984 to 1991, 514 patients were treated by BMT in 1 center. 254 patients survived more than 3 months and, in 38 patients, 47 liver biopsies were performed for chronic liver dysfunction characterized by cholestasis. The aim of the present study was to evaluate the possible causes of liver disease at the time of biopsy. One clinician analyzed clinical data and was able to propose up to 3 diagnoses including GVHD, viral hepatitis, drug-related hepatitis, chronic veno-occlusive disease (VOD) or other. Two pathologists reviewed histologic sections and were also able to propose up to 3 diagnoses. Clinically, 1, 2 or 3 diagnoses were proposed in 30, 60 and 10% of cases, respectively. Pathologically, 1, 2 or 3 diagnoses were proposed in 13, 62 and 25%, respectively. Histologic changes of GVHD were present in 40 of 47 biopsies and concordance between the clinician and the pathologists on the presence of GVHD lesions was found in 77% of biopsies. Viral hepatitis was proposed 22 times by the clinician and 19 times by pathologists. Viral hepatitis, usually hepatitis C, was associated with GVHD in 16 cases. Diagnoses of chronic VOD and drug-related hepatitis were proposed less often. In summary, more than 1 diagnosis was suggested for many of the patients studied, GVHD being the most frequent. The simultaneous presence of GVHD, viral diseases, chronic VOD and drug-induced diseases could explain the high incidence of cholestasis in the long-term post-BMT.

Adolescent↗
PubMed1994

[Selectivity of glomerular proteinuria and liver function in gestosis].

Proteinuria in preeclamptic women was qualitatively differentiated and in cases of pure glomerular proteinuria three groups according to the low-, medium- or high selectivity of glomerular proteinuria were formed. In these patients the incidence of liver dysfunction and severe proteinuria together with an increase in mean arterial blood pressure was investigated. The aim of this study was to find out if there is any connection between glomerular proteinuria of different selectivity and disturbed liver function. In patients with EPH-gestosis a pure glomerular proteinuria in SDS-PAA-disc electrophoresis of the urine was found. Together with the increase in glomerular selectivity an increase in quantitative urinary protein loss was found. In patients with high selective glomerular proteinuria the extent of proteinuria was about three times higher than in patients with low selectivity. In all patients a moderate elevation of the liver enzymes was found. In all patients disturbed liver function returned to normal within a few days after delivery. We conclude from these data that glomerular functional lesions pregnancy in patients with preexisting glomerulopathies or pregnancy induced renal dysfunction are accompanied in a high rate by moderate disorders of liver function.

Alanine Transaminase↗
PubMed1995

Reversible hepatic dysfunction in association with cyclophosphamide therapy.

A 5.5-year-old child with nephrotic syndrome was treated with cyclophosphamide. After 9 weeks of therapy she developed jaundice and abnormal liver function tests. No infective aetiology was found and the abnormal liver function tests resolved within 5 weeks of discontinuing cyclophosphamide. Cyclophosphamide has rarely been reported to cause liver dysfunction, but not in children treated for nephrotic syndrome, and paediatricians should therefore be aware of its potential for inducing reversible hepatic dysfunction.

Child, Preschool↗
PubMed1989

Preclinical toxicity and pharmacology of liposome-entrapped cis-bis-neodecanoato-trans-R,R-1,2-diaminocyclohexane platinum(II).

Liposome-entrapped cis-bis-neodecanoate-trans-R,R-1,2-diaminocylohexane platinum(II) (L-NDDP) is a new lipophilic cisplatin derivative formulated in a liposomal carrier currently in phase I clinical trials. The preclinical toxicity and pharmacology of L-NDDP were studied in mice and dogs. At the LD50 dose (i.v. bolus) in mice (60.5 mg/kg or 181.5 mg/m2), a tenfold decrease in the granulocyte and platelet counts was observed in the absence of renal toxic effects. In dogs, the maximum tolerated dose (MTD) of L-NDDP given i.v. over a period of 45-60 min was 150 mg/m2. This dose produced significant vomiting (6-18 episodes), minimal renal dysfunction, a maximal decrease in granulocyte and platelet counts of from 30% to 70%, and acute and transient elevation of liver enzymes. Higher doses (225 and 300 mg/m2) resulted in severe gastrointestinal (GI) toxicity in one animal and the death of two others within 48 h. Autopsy results showed multifocal hemorrhages in the lungs, GI tract, kidney, and liver. Three dogs were treated monthly with the MTD up to a cumulative dose of 637.5-712.5 mg/m2 with excellent tolerance. No cumulative myelosuppression or liver dysfunction was observed, whereas a slight increase in the creatinine baseline level was detected in all three animals. Autopsy results at the end of the study showed mild changes limited to the liver, kidney, and GI tract. Pharmacologic studies showed that the drug was cleared, fitting a two-compartment model with a mean t1/2 alpha of 7.1 min and a t1/2 beta of 87.8 h. These studies show that L-NDDP can safely be given at therapeutic doses to animals and that the dose-limiting toxic effects consists of myelosuppression in mice and a multiorgan hemorrhagic syndrome related to vascular injury in dogs.

Animals↗
PubMed1990

Use of hepatic vein catheterization in the evaluation of patients with anasarca.

In patients with anasarca, the relative importance of cardiac, pulmonary and/or hepatic dysfunction is often difficult to determine. Conventional use of the Swan-Ganz catheter helps to separate the contributions of right and left heart disease, but it is seldom used to evaluate liver dysfunction. This report describes passage of a Swan-Ganz catheter into the hepatic vein prior to pulmonary artery placement in 11 patients. Hepatic vein catheterization permitted wedged hepatic venography using contrast media and measurement of the wedged and free hepatic venous pressures. All 11 patients had pulmonary hypertension; three had cor pulmonale only, and the others had combinations of left and right heart failure. In addition, six patients had either a cirrhotic pattern on venography, or portal hypertension. Only three of these six patients had previous clinical evidence of liver disease. This study does not prove that identification of hepatic dysfunction by this method improves the outcome in such patients. However, this low risk modification of standard pulmonary artery catheterization provides additional information which is clinically useful in searching for and avoiding complications of cirrhosis, as well as offering a clearer understanding of pathophysiology in acute multisystem disease.

Ascites↗
PubMed1980

Tissue lipids in hyperammonemic encephalopathies of childhood.

Cholesterol, triglyceride, free fatty acid, and phospholipid concentrations were measured in 33 brain, liver, and adipose tissue samples obtained from 17 children who died of an acute encephalopathy associated with liver dysfunction and hyperammonemia (hyperammonemic encephalopathy). Eleven patients had Reye's syndrome, three had acute "toxic" encephalopathy (without fatty liver), two had glycogen storage disease type 1, and one had congenital hyperammonemia type 2. Hepatic triglyceride concentrations were markedly increased in Reye's syndrome, but varied from normal to increased concentrations in other hyperammonemic encephalopathies. In contrast, the acute encephalopathy could not be differentiated on the basis of clinical, laboratory, or pathologic features and the brain lipid profiles were remarkably similar among all patients studied.

Adipose Tissue↗
PubMed1990

Early diagnosis of cytomegalovirus hepatitis in liver transplant recipients: role of immunostaining, DNA hybridization and culture of hepatic tissue.

Immunostaining techniques that use a monoclonal antibody against an early cytomegalovirus antigen or a polyclonal antibody, in situ DNA hybridization and inoculation of cell cultures for the detection of cytomegalovirus from liver biopsy specimens were studied in 20 liver transplant patients with cytomegalovirus hepatitis, as defined by histological criteria. A total of 108 liver biopsy specimens from 20 patients with a diagnosis of cytomegalovirus hepatitis (obtained per protocol at 7, 21, 90, and 180 days or whenever liver dysfunction occurred), which had previously been examined histologically and in cell culture, were again studied by recutting the liver tissue for histological examination, DNA hybridization and immunostaining with monoclonal or polyclonal antibodies to cytomegalovirus. In 5 of 20 patients, the diagnosis of cytomegalovirus hepatitis could have been made earlier (mean = 9.6 days) by immunostaining with a monoclonal antibody. Of 47 biopsy specimens with cytomegalovirus inclusion bodies, the sensitivity and specificity of the diagnostic procedures were immunostaining with monoclonal antibody (84% and 90%) and polyclonal antibody (72% and 97%), in situ DNA hybridization (72% and 100%) and cell culture detection (52% and 95%), respectively. Immunostaining with a monoclonal antibody against an early CMV antigen frequently detected cytomegalovirus infection in the liver allograft earlier than identification of typical histological inclusion bodies. DNA in situ hybridization was less sensitive than other techniques but highly specific; cytomegalovirus cell culture lacked sensitivity compared with the other procedures.

Adult↗
PubMed2006

Changes in liver and plasma acetylcholinesterase in rats with cirrhosis induced by bile duct ligation.

Classical studies of cholinesterase activity during liver dysfunction have focused on butyrylcholinesterase (BuChE), whereas acetylcholinesterase (AChE) has not received much attention. In the current study, liver and plasma AChE levels were investigated in rats with cirrhosis induced after 3 weeks of bile duct ligation (BDL). BDL rats showed a pronounced decrease in liver AChE levels (approximately 50%) compared with sham-operated (non-ligated, NL) controls; whereas liver BuChE appeared unaffected. A selective loss of tetrameric (G4) AChE was detected in BDL rats, an effect also observed in rats with carbon tetrachloride-induced cirrhosis. In accordance, SDS-PAGE analysis showed that the major 55-kd immunoreactive AChE band was decreased in BDL as compared with NL. A 65-kd band, attributed in part to inactive AChE, was increased as became the most abundant AChE subunit in BDL liver. The overall decrease in AChE activity in BDL liver was not accompanied by a reduction of AChE transcripts. The loss of G4 was also reflected by changes observed in AChE glycosylation pattern attributable to different liver AChE forms being differentially glycosylated. BDL affects AChE levels in both hepatocytes and Kupffer cells; however, altered AChE expression was mainly reflected in an alteration in hepatocyte AChE pattern. Plasma from BDL rats had approximately 45% lower AChE activity than controls, displaying decreased G4 levels and altered lectin-binding patterns. In conclusion, the liver is an important source of serum AChE; altered AChE levels may be a useful biomarker for liver cirrhosis.

Acetylcholinesterase↗
PubMed1985

Clinical and metabolic studies on Werner's syndrome: with special reference to disorders of lipid and liver function.

In a clinical study of patients with Werner's syndrome, it became apparent that careful observation of numbers of patients could result in the addition of new or modified signs and symptoms to those already known. In addition of flat feet and hyperreflexibility, it was observed that the irregular disarrangement of the teeth and thin, sparse and colour-faded hair were frequently occurrences in patients with Werner's syndrome. In the laboratory survey, disorders of lipid metabolism and liver function were detected in 3 out of 24 cases of Werner's syndrome. It was concluded that the disturbances of lipid metabolism result in part from moderate liver dysfunction.

Adult↗
PubMed2000

Laparoscopic cholecystectomy and the Peter Pan syndrome.

We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.

Biliary Fistula↗
PubMed1991

Hepatocellular oxidant stress following intestinal ischemia-reperfusion injury.

Reperfusion of ischemic intestine results in acute liver dysfunction characterized by hepatocellular enzyme release into plasma, reduction in bile flow rate, and neutrophil sequestration within the liver. The pathophysiology underlying this acute hepatic injury is unknown. This study was undertaken to determine whether oxidants are associated with the hepatic injury and to determine the relative value of several indirect methods of assessing oxidant exposure in vivo. Rats were subjected to a standardized intestinal ischemia-reperfusion injury. Hepatic tissue was assayed for lipid peroxidation products and oxidized and reduced glutathione. There was no change in hepatic tissue total glutathione following intestinal ischemia-reperfusion injury. Oxidized glutathione (GSSG) increased significantly following 30 and 60 min of reperfusion. There was no increase in any of the products of lipid peroxidation associated with this injury. An increase in GSSG within hepatic tissue during intestinal reperfusion suggests exposure of hepatocytes to an oxidant stress. The lack of a significant increase in products of lipid peroxidation suggests that the oxidant stress is of insufficient magnitude to result in irreversible injury to hepatocyte cell membranes. These data also suggest that the measurement of tissue GSSG may be a more sensitive indicator of oxidant stress than measurement of products of lipid peroxidation.

Animals↗
PubMed2004

Predicting factor of quality of life in long-term jaundice-free survivors after the Kasai operation.

BACKGROUND/PURPOSE: The aim of this study was to determine simple predictors for quality of life (QOL) in long-term jaundice-free survivors after the Kasai operation. METHODS: Kasai's original portoenterostomy was performed on 55 patients with biliary atresia. Among them, records were reviewed retrospectively of 35 long-term (at least 5 years) and jaundice-free (clearance in bilirubin level less than 1.0 mg/dL after Kasai operation) survivors. The patients were divided into 2 groups based on QOL, and the differences in clinical and laboratory data were analyzed statistically. RESULTS: The ages at Kasai operation, histologic, fibrosis grade of liver biopsy specimen at operation, the first onset and frequency of postoperative cholangitis, and postoperative clearance speed of jaundice after Kasai operation were not significantly different between the 2 groups. The aspartate aminotransferase (AST) level at 1 year was significantly correlated with the serum concentration of hyaluronic acid and an independent predictor for QOL in long-term jaundice-free survivors of the Kasai operation. CONCLUSIONS: The serum AST level at 1 year was a simple, strong predicting factor of QOL and liver dysfunction in long-term jaundice-free survivors after Kasai operation and may prove useful in planning liver transplantation.

Aspartate Aminotransferases↗