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Episodic confusion and tremor associated with extrahepatic portacaval shunting in cirrhotic liver disease.

In an elderly male patient with alcohol-related liver disease, who developed episodic confusion and tremor, we found a large extrahepatic portacaval shunt. He had no clinical or laboratory evidence of liver dysfunction except for an elevated serum ammonia level that increased further in response to an ammonium chloride challenge test. Extrahepatic portacaval shunting causing episodic confusion and tremor may occur with alcoholic liver disease without overt liver failure and may require abdominal angiography or a transhepatic portogram to demonstrate the shunt.

Aged↗

[Study on suppressed uptake by the liver in 67Ga scintigraphy].

During the past 3 years, we have performed 1525 studies of 67Ga scintigraphy and 38 cases of these showed suppressed liver uptake; 19 cases after chemotherapy, 13 cases with liver dysfunction and 6 cases with competitive blockade. Many cases in chemotherapy used cyclophosphamide and vincristine, and were performed 67Ga scan within 1 week after chemotherapy. In cases showed suppressed uptake by liver after chemotherapy, serum Fe was markedly increased and UIBC was markedly decreased (p less than 0.01). This suggested that serum Fe influenced suppressed uptake by liver more than carrier-protein, disturbed hepatic cells, and receptors.

Adult↗

Liver involvement in the syndrome of mixed cryoglobulinemia.

A study of liver abnormalities in 36 patients with mixed cryoglobulinemia in the absence of underlying infectious, connective tissue, or lymphoproliferative disorders revealed clinical or biochemical evidence of liver dysfunction in 84%. Hepatomegaly was detected in 77%, splenomegaly in 54%, and abnormalities in bilirubin, alkaline phosphatase, or serum glutamic oxalacetic transaminase in 77%. Only four of the patients had overt liver disease. Of 15 biopsies from 12 patients, there was normal tissue structure in two, minimal nonspecific changes in one, portal fibrosis in three, chronic persistent hepatitis in one, chronic active hepatitis in two, chronic active hepatitis with cirrhosis in four, and postnecrotic cirrhosis in two. These findings, together with the previously reported high incidence of serologic evidence of hepatitis B virus (HBV) infection, support the view that the syndrome of purpura, arthritis, and nephritis is often a consequence of immune-complex vasculitis secondary to HBV infection.

Biopsy↗

[Seroepidemiological survey of TT virus (TTV) infection in an endemic area for hepatitis C virus].

Seroepidemiological survey of TT virus (TTV) infection was performed in the inhabitants living in an endemic area for hepatitis C virus (HCV) in Gifu prefecture, Japan. In this area, 482 of 1062 inhabitants (45.4%) were seropositive for HCV relative antibodies. TTV-DNA was detected in the sera from 12 of 88 inhabitants (13.6%). The positive rate of TTV-DNA had no relation to sex or age. The TTV DNA-positive rate of the inhabitants with HCV infection was 21.4% higher than that of the inhabitants without HCV infection 10.0%. In the present survey, the rate of liver dysfunction of TTV DNA-negative inhabitants was not different from that of TTV DNA-positive inhabitants. Such results seem to suggest that TTV infection is not related to the liver disease in the area.

Biomarkers↗

[An autopsy case of malignant lymphoma who showed hearing loss and cavernous sinus syndrome in the first stage and hemophagocytic syndrome].

A 48-year-old man was admitted to our hospital due to multiple cranial neuropathy such as vertigo, hearing loss of the left ear, visual loss of the left eye, left ptosis and total ophthalmoplegia of the left eye. Brain MRI revealed no abnormalities. After 10 days, he suddenly showed hemophagocytic syndrome with high fever, liver dysfunction, jaundice and pancytopenia. In spite of the treatment, he died of multiple organ failure after 26 days. At autopsy, malignant lymphoma cells of T cell origin directly invaded into the liver, spleen, intraperitoneal lymph nodes and other organs. Reports that direct invasion of lymphoma cells could be detected at the cranial nerves in the cavernous sinus are very rare.

Cavernous Sinus↗

Long-term survival of intrahepatic cholangiocarcinoma with hilar lymph node metastasis and portal vein involvement.

We report the case of a very rare 6-year disease-free survivor of intrahepatic cholangiocarcinoma with hilar lymph node metastasis and portal vein involvement. A 76-year-old female with liver dysfunction was referred to our institution. Contrast-enhanced computed tomography showed a 5-cm low-density tumor with irregular marginal enhancement in the left and caudate lobes of the liver. Cholangiography revealed complete obstruction of the left hepatic bile duct. Angiography showed obstruction of the left branch of the portal vein. Metastasis to the hilar lymph nodes was disclosed at surgery. The patient underwent left hepatectomy with caudate lobectomy, resection of the extrahepatic bile duct, and lymphadenectomy. The total vascular exclusion of the liver was used for hepatectomy and reconstruction of the portal vein. Microscopically, the tumor was a poorly differentiated adenocarcinoma with many infiltrating lymphocytes, and extensive necrosis was present within the tumor. The experience gained in the present case suggests that aggressive surgery may be a potential approach to provide a hope of long-term survival for patients with intrahepatic cholangiocarcinoma despite the presence of regional lymph node metastasis and vascular invasion.

Aged↗

Liver regeneration attenuates increased voluntary alcohol intake evoked by the liver damage.

Liver dysfunction induced in Wistar rats either surgically (by construction of portocaval anastomosis) or chemically (by chronic administration of thioacetamide) led to increased voluntary alcohol intake. Alcohol preference could be attenuated by liver regeneration that was triggered by a two-thirds hepatectomy done on cirrhotic rats. The brain serotonin system was activated in portocaval anastomosis rats and unchanged in thioacetamide-treated rats, thus suggesting that serotonin is not likely to be implicated in the mechanism(s) underlying development of alcohol preference in these rats. Also, tetrahydro-beta-carboline could possibly be excluded from consideration. Neither change in the brain concentration or distribution of tetrahydrobetacarboline after long-term treatment with thioacetamide could be found.

Alcohol Drinking↗

[Liver functional disorders in traumatic stress].

The study conducts the analysis of liver dysfunctions in traumatic stress. The severe craniocerebral injuries, the skeletal bone injuries and the prolonged crush syndrome cause dystrophic changes of hepatocytes. The biochemical data testify the cytolytic syndrome and the liver insufficiency in patients with the traumatic disease. The hepatocytes metabolism disturbances and morphologically expressed dystrophy prove the development of the "traumatic hepatosis".

Animals↗

AI-driven diagnostic and prognostic models for metabolic dysfunction-associated steatotic liver disease: insights from clinical, imaging, and multi-omics studies-a scoping review.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease around the world, affecting 33.6% of the adult population (95% CI: 28.1%-39.5%; I 2 = 99.9%), or roughly one in three. The extent of the liver damage is variable, from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH), cirrhosis and hepatocellular carcinoma (HCC). Early diagnosis is essential to prevent serious liver damage. Traditional diagnostic techniques such as liver biopsy, imaging, and biomarker testing are all invasive, costly, reduced sensitive to early-stage disease, and they also have variability among observers. Modern diagnostic and prognostic approaches based on the principles of Artificial Intelligence (AI) and specifically on machine learning (ML) and deep learning (DL) have enabled multimodal approaches integrating clinical, imaging and molecular data. This scoping review conducted per PRISMA-ScR guidelines, synthesizes findings from 73 studies (search window 2020-2026) across three dimensions: clinical data driven models, imaging-based classifiers (ultrasound, CT and MRI), and multi-omics (genomics, transcriptomics and proteomics) techniques. Moreover, emergence of models such as U-Net and LiverNet 2.x, classification models like DeepLiverNet and BiLSTM models, as well as transformer frameworks and the identification of biomarkers models are also described. This study also investigates challenges such as data heterogeneity, data interpretability, fairness and real-world clinical application. Finally, important areas of research opportunities and future directions are highlighted to present a developing clinically applicable, explainable and ethical AI solutions to manage MASLD.

MASLD↗

The effects of oestrogens and progesterone on oestrogen receptors in female rat liver.

The administration of oestradiol-17 beta or ethynyloestradiol as well as the synthetic progestogen norethisterone acetate resulted in translocation of the oestrogen receptor. Progesterone and the synthetic progestogen (+)-norgestrel were ineffective. The increases in nuclear oestrogen receptor content 1 h after injection of each steroid were similar but different subsequently. The increase with oestradiol-17 beta extended for 3--6 h and for at least 9 h with ethynyloestradiol. With norethisterone acetate, nuclear content was still increased after 24 h. Oestrogen injection resulted in cytosol receptor depletion and a 'deficit' in receptor content extending for 6 h, whereas norethisterone acetate-induced translocation was quantitative. With injections of norethisterone acetate + ethynyloestradiol the increase at 1 h and retention of the nuclear receptors were similar to that with norethisterone acetate alone. In contrast, the depletion of cytosol receptor and its restoration were similar to that seen with ethynyloestradiol alone, suggesting that norethisterone acetate did not interfere with the oestrogen receptor replenishment. Specific binding in vitro of [3H]oestradiol-17 beta in liver cytosols was inhibited by (+)-norgestrel and norethisterone acetate, but not progesterone, at concentrations of 10--100 microM. Nuclear receptors present after norethisterone acetate injection bound oestrogen with high affinity (Kd = 1.52 nM), similar to receptors of oestrogen-injected animals. In the uterus, differential retention of nuclear receptors in response to oestrogens is associated with different cellular responses. The differences in the response of the receptor system in liver to the various steroids suggests that the corresponding tissue responses may also be dissimilar. These results are discussed in relation to the problems of liver dysfunction in oral-contraceptive users.

Animals↗

Thyroid function tests in chronic liver disease: evidence for multiple abnormalities despite clinical euthyroidism.

To further evaluate thyroid function in patients with liver disease, we have measured total and free T3 and T4, thyroxine binding globulin, basal and thyrotropin releasing hormone-stimulated thyrotropin and thyroglobulin antibodies in 33 patients with liver cirrhosis, in 22 with chronic hepatitis and in 30 healthy controls. All the patients but one were clinically euthyroid. T3, FT3, T3/thyroxine binding globulin and T4/thyroxine binding globulin ratios and thyrotropin after thyrotropin releasing hormone were significantly reduced, while FT4, thyroxine binding globulin and thyrotropin were significantly increased in liver cirrhosis. In chronic hepatitis group, FT3 and T3/thyroxine binding globulin ratio were significantly lower and thyroxine binding globulin and FT4 were higher than in healthy controls. The between patients comparison revealed a significantly lower T3, FT3, T3/thyroxine binding globulin and T4/thyroxine binding globulin ratios and delta thyrotropin in cirrhotics. Thyroglobulin antibodies were present at high titre only in two patients one of whom having evidence of Hashimoto's thyroiditis with subclinical hypothyroidism. The correlation coefficient between T4/thyroxine binding globulin ratio and FT4 were lower in patients than in controls. Furthermore an abnormal thyrotropin response to thyrotropin releasing hormone was shown in 10 cirrhotics and in four patients with chronic hepatitis. Serum T3 significantly correlated with serum bilirubin, albumin, and prothrombin time in both groups of patients. The present data confirm the existence of several abnormalities of thyroid function tests in patients with chronic liver disease, although showing that euthyroidism is almost always maintained, probably as a result of low-normal FT3 and high-normal FT4. Furthermore, T3 serum levels appear to parallel the severity of liver dysfunction.

Adult↗

Liver function and the diagnostic significance of conjugated cholic acid and chenodeoxycholic acid in serum of African patients with sickle cell disease.

Concentrations of two primary bile acids (cholic acid and chenodeoxycholic acid) were determined by radioimmunoassay in the serum of 15 African homozygous sickle cell patients, ages ranging from 4 to 22 years. The mean serum levels of the two primary bile acids studied were significantly elevated when compared with the normal mean values. About 67% of the patients had pathological elevation of both primary bile acids, thereby indicating some hepatobiliary damage. Serum conjugated cholic acid correlated significantly with serum chenodeoxycholic acid in the sickle cell disease (r = 0.91, p less than 0.001). The results suggest that radioimmunoassays of serum conjugated cholic acid and chenodeoxycholic acid in sickle cell disease may also serve as useful biochemical assays in predicting liver dysfunction in sickle cell disease.

Adolescent↗

[Liver diseases in pregnancy].

An analysis is made of the hepatopathies characteristic of pregnancy according to the latest research and from experience of the Pathology Department of the Hospital Central of San Luis Potosí. Such entities are the fatty liver, the hyperemesis gravidarum, the preeclampsia and eclampsia and the cholestasis of pregnancy. It is estimated that the eclamptic state is capable of showing clinical, structural and laboratory manifestations which vary absolutely and which bring us to consider as dependent upon the fatty liver, the HELLP syndrome and some cases of cholestasis. Also, cholestasis of pregnancy, determined genetically, must be distinguished from that which is associated with eclampsia or determined by drugs or other causes. Similarly, hyperemesis gravidarum may be primary, although rarely so, or be due to neurological causes; it is also capable of causing slight liver dysfunction. Finally, the above-mentioned ailments are correlated within the classic physiopathological grid of jaundice.

Cholestasis↗

An autopsy case with Good's syndrome and dermatomyositis.

A 31-year-old male patient complaining of repeated respiratory infections was revealed to be in an immunodeficient state in both humoral and cellular immunity and accompanied by dermatomyositis which was proved by both clinical and histological findings. Persistent diarrhea followed by colonic bleeding due to multiple ulcers and a severe liver dysfunction seemed to bring him to his death. The autopsy revealed the presence of thymoma of spindle cell type, depleted cells in the systemic lymphatic systems and inflammatory lesions in the muscle, liver, lung, kidney and gastrointestinal tract. This is the first report of Good's syndrome accompanied by dermatomyositis.

Adult↗

Glycochenodeoxycholate (GCDC) inhibits cytokine induced iNOS expression in rat hepatocytes.

BACKGROUND: Although the accumulation of hydrophobic bile acid (e.g., glycine conjugated chenodeoxycholic acid, GCDC) is considered to be an important factor contributing to cholestatic liver dysfunction, its pathogenesis is poorly understood. The purpose of this study was to examine the effect of the bile salt GCDC on the regulation of iNOS expression, a key immune modulator during liver inflammation. MATERIALS AND METHODS: GCDC significantly decreased cytokine-stimulated iNOS promoter activity, and both iNOS mRNA and protein expression. GCDC decreased iNOS promoter activity by preventing IkappaB degradation and inhibiting NF-kappaB DNA-binding activity. To explore the role of iNOS in bile salt induced apoptosis, we also examined the effect of NO on caspase-3 activity. RESULTS: GCDC strongly induced caspase-3 activity, and this increase was abrogated by both exogenous NO exposure and endogenous NO synthesis. Furthermore, adenoviral iNOS (AdiNOS) pre-treatment decreased acute cholestatic-induced liver injury in a rat bile duct ligation model. CONCLUSIONS: These findings indicate a novel signaling pathway where potentially toxic bile salts down-regulate hepatic iNOS expression. This blockade of the iNOS mediated antiapoptotic phenotype may have important implications in certain liver disorders.

Adenoviridae↗

Human leukocyte antigen-G, a new parameter in the follow-up of liver transplantation.

Human leukocyte antigen-G (HLA-G) displays immunotolerogenic properties toward effector cells in graft rejection through inhibition of natural killer (NK) and cytotoxic T lymphocyte (CTL)-mediated cytolysis and CD4+ T-cell alloproliferation. CD4(+)CD25(+)high regulatory T (Treg) cells are pivotal for the maintenance of self-tolerance of pathogenic alloresponses after solid organ or bone marrow transplantation in murine model systems. The aim of this study was to investigate whether there was an association between soluble and membrane-bound HLA-G levels on Treg cells and liver graft prognosis. For this purpose, we studied 37 liver transplant patients and 13 healthy blood donors. To investigate the expression of HLA-G on the surface of peripheral mononuclear (PMNL) cells, we have used monoclonal antibodies in flow cytometry to estimate CD4, CD25, CD45, and HLA-G content. HLA-G serum levels were determined by ELISA. We observed a correlation between sHLA-G serum levels and liver function tests. After a month of HLA-G decrease in serum levels, liver function tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), direct bilirubin (DB), total bilirubin (TB), and alkaline phosphatase (ALP) were above normal levels, suggesting liver dysfunction or rejection. Considering these results, we concluded that the increased sHLA-G in serum and on cell surfaces may afford preliminary data on the prognosis and response to treatment in liver transplant patients.

Blood Donors↗

Pediatric hepatic imaging.

Common indications for liver imaging in children include trauma, suspected mass, pre-liver transplantation, monitoring after liver transplantation, jaundice, or liver dysfunction. This article highlights areas where the pathology or imaging approach in children differs from that seen in adults. Topics covered include imaging of a suspected hepatic mass, neonatal jaundice, and segmented liver transplantation.

Child↗

The liver in heart failure.

Severe congestive heart failure is associated with two distinct forms of liver dysfunction: jaundice that is related to passive congestion and acute hepatocellular necrosis that is caused by impaired perfusion. Cardiac cirrhosis (fibrosis) may result from prolonged recurrent congestive heart failure. Ischemic hepatitis (shock liver) usually manifests as asymptomatic elevation of the serum aminotransferase levels after an episode of hypotension, although the clinical presentation may mimic that of acute viral hepatitis. In most cases, ischemic hepatitis is of little clinical consequence and is self-limited. Acute liver failure may occur in patients with preexisting cirrhosis, severe chronic heart failure, or sustained hepatic ischemia.

Animals↗