[Nursing of patients with liver cirrhosis. Liver cirrhosis and control of alcohol drinking--implementation of health instructions].
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Alcohol Drinking↗
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[Liver cirrhosis, liver neoplasms, and alcohol].
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Adult↗
Decision-making model for a non-invasive diagnosis of compensated liver cirrhosis.
Liver biopsy is used as a gold standard in the diagnosis of chronic liver disease. However, this procedure is not without risk to the patients. This study was aimed to evaluate whether clinical, ultrasonographic, and biochemical variables may discriminate between well-compensated liver cirrhosis and non-cirrhotic chronic liver disease. Logistic regression analysis was used to assess the independent predictive value of each variable. Moreover, the post-test probability of the diagnostic variables was converted into "weights" which positively correlated with the likelihood of diagnosis of liver cirrhosis. We applied a decisional rule based on the diagnostic "weight" of each variable to 412 patients, 278 with well-compensated liver cirrhosis and 134 with non-cirrhotic chronic liver disease, diagnosed by liver biopsy with/without laparoscopy. By adding the diagnostic "weights" of each variable, liver cirrhosis and non-cirrhotic chronic liver disease were correctly diagnosed in 67% and 75% of cases, respectively. This result was validated in a split sample of 100 patients (50 with compensated liver cirrhosis and 50 with non-cirrhotic chronic liver disease) randomly selected from the acquisition sample. Based on this data, diagnosis of well-compensated liver cirrhosis can be reached in over 67% of cases without using invasive procedures. However, a prospective study is needed to confirm the clinical reliability of this method.
Adult↗
[Differentiation alcoholic liver cirrhosis from viral liver cirrhosis].
Liver cirrhosis (LC) in habitual drinkers is divided into three categories: (1) alcoholic LC, (2) LC due to hepatitis C virus and alcohol, and (3) LC due to hepatitis C virus. In Japan, the frequency of LC related to hepatitis B virus in habitual drinkers is comparatively low. Although making a distinct differentiation is very difficult, it is possible to point out some characteristics which ars due to either alcohol or hepatitis C virus: (1) multiple spider angioma, acne rosacea, and palmar erythema are more frequently found in categories 1 and 2 than in 3, (2) levels of AST/ALT, gamma-GTP, TG, ALP, lactate, and UA are higher in category 1 than in 3, (3) enlargement of both lobes is observed in category 1, and (4) abnormality due to alcohol improves relatively soon after abstinence of alcohol.
Alanine Transaminase↗
Gene therapy for liver cirrhosis.
Liver cirrhosis is the irreversible end result of chronic liver disease and is characterized by fibrous scarring and hepatocellular regeneration. It is a major cause of morbidity and mortality worldwide and is induced by factors such as chronic hepatitis virus infection, drug abuse and alcohol abuse. The ideal strategy for the treatment of liver cirrhosis should include prevention of fibrogenesis, stimulation of hepatocyte mitosis and reorganization of the liver architecture. Hepatocyte growth factor (HGF) gene therapy has been investigated in a rat model of liver cirrhosis. In rats with lethal liver cirrhosis produced by dimethylnitrosamine, repeated transfection of the HGF gene into skeletal muscle induced a high plasma level of HGF and tyrosine phosphorylation of the c-Met/HGF receptor. Hepatocyte growth factor gene transduction inhibited fibrogenesis and hepatocyte apoptosis and also produced resolution of fibrosis in the cirrhotic liver. Hepatocyte growth factor gene therapy may have the potential to be useful for the treatment of patients with liver cirrhosis.
Animals↗
[Persectives on postgenome medicine: Gene therapy for liver cirrhosis].
Liver cirrhosis is the irreversible end result of chronic liver disease, characterized by diffuse disorganization of the normal hepatic structure of regenerative nodules and fibrotic tissue. It is associated with prominent morbidity and mortality, and is induced by many factors. The ideal strategy for the treatment of liver cirrhosis should include prevention of fibrogenesis, stimulation of hepatocyte mitosis, and reorganization of the liver architecture. We have developed a novel gene therapy approach for rat liver cirrhosis by muscle-directed gene transfer of hepatocyte growth factor(HGF). HGF gene transduction inhibited fibrogenesis and hepatocyte apoptosis, and also produced resolution of fibrosis in the cirrhotic liver. Thus, HGF gene therapy may be potentially useful for the treatment of patients with liver cirrhosis, which is otherwise fatal and untreatable by conventional therapy.
Animals↗
A comparison of an open and laparoscopic appendectomy for patients with liver cirrhosis.
Liver cirrhosis is a critical factor contributing to morbidity and mortality in abdominal surgery, because patients with cirrhosis have a particularly high risk of developing bleeding, infection, and ascites. Laparoscopic appendectomy (LA) recently has gained a lot of attention around the world; however, comparisons between the benefits of LA and those of conventional open appendectomy (OA) for patients with liver cirrhosis have yet to be sufficiently compiled. In the present retrospective study, 40 patients with liver cirrhosis who were diagnosed with acute appendicitis before surgery underwent an appendectomy (OA in 25 patients and LA in 15 patients). This study focused on the operative time, amount of postoperative pain, use of analgesics, the restart of a normal diet, number of complications, length of hospital stay, and cost-effectiveness of the procedure in such patients. The amount of postoperative pain and the length of hospital stay were significantly smaller in the LA group. The mean values of the serum C-reactive protein on postoperative days 1, 3, and 7 were significantly less in the LA group. The number of wound infections and wound bleeding was also less in the LA group. The difference in the total cost of hospitalization was not significant. The cost of the operation was greater in the LA group than in the OA group, whereas the hospitalization cost in the LA group was less than that in the OA group. The results of this study suggest that LA may be superior to OA for the treatment of postoperative pain and postoperative complications for patients with liver cirrhosis. Long-term follow-up studies are still necessary, however, to determine any possible decrease in the number of late complications.
Aged↗
[Relation of laboratory parameters to complications of liver cirrhosis].
Liver cirrhosis is characterized with alterations in hepatocytic perfusion, decreasing in number of hepatocytes and with seriously impared synthetic function of liver (hypoalbuminemy, inversion of albumino-globulinic ratio, hypoprothrombinemia). In a group of patients, suffered of liver cirrhosis with complication, we attempted to establish relationships between some of the typical clinical values: body weight in function of ascites evacuation, protein, albumin and value of prothrombin time in function of different groups of activity of aminotransferase in sera (AspAT, AlaAT) of improved and dead patients. We found a positive correlation for different groups of aminotransferase activities and laboratory values typical for liver cirrhosis with complications.
Alanine Transaminase↗
[Induction of experimental splenomegaly with portal hypertension in rats with liver cirrhosis].
Liver cirrhosis was induced in rats by administering thioacetamide (TAA), and portal hypertension was maintained for at most 35 weeks to study the influence of portal hypertension on the weight of spleen and splenic tissues. TAA was intraperitoneally injected at dose of 200 mg/kg three times a week. The portal pressure was elevated and the weight of the spleen increased with the progression of hepatic fibrosis due to TAA. Liver cirrhosis was obviously observed after TAA was administered 60 times. The maximum ratio of the weight of the spleen to body weight in the group administered TAA was higher by 4.08 times than that in the control group. In all 49 rats used in the experiment there was a high correlation (r = 0.930, p less than 0.01) between the portal pressure and the ratio of spleen to body weight. Histological observation revealed that the red pulp tended to be enlarged, while the white pulp tended to be reduced, with increases in portal pressure and weight of the spleen. It also histologically revealed an increase in the splenic sinus-like structure, narrowing of the splenic cords, fibrosis due to reticular cell proliferation in the red pulp and fibrosis around the central artery in the white pulp. These histological changes in rats were similar to the histological findings of splenomegaly accompanying portal hypertension in humans. This suggests that the animal model prepared in the present experiment is useful as a model of splenomegaly due to portal hypertension.
Animals↗
[Study on improvement of liver cirrhosis and liver function in hepatolenticular degeneration patients treated with integrated Traditional and Western medicine].
OBJECTIVE: To observe the effects of sodium dimercaptosulphonate (DMPS) plus Gandou tablet, DMPS and calcium disodium ethylene diaminotetraacetate (EDTA) on improving liver cirrhosis and liver function of hepatolenticular degeneration (HLD) patients. METHODS: One hundred and forty-six HLD patients were divided into A, B, C three groups, and treated with DMPS plus Gandou tablet, DMPS and EDTA respectively, the therapeutic course was 8 weeks for three groups. The ultrasonography of liver, electrophoresis of serum protein and excretion of urinary copper were observed. RESULTS: The ultrasonography of liver was improved in all groups, the rate of improvement of group A was 54.0%, B was 44.0% and C was 39.1%. The amounts of serum albumin in A and B groups increased (P < 0.01, P < 0.05), and gamma-globulin decreased in all groups (P < 0.05). The excretion of urinary copper increased obviously in all groups (P < 0.01), and A, B groups increased more than that of C group (P < 0.05). CONCLUSIONS: The de-copper therapy could improve liver cirrhosis and liver function. The effect of DMPS plus Gandou tablet was better than that of DMPS and EDTA.
Adolescent↗
[Liver cirrhosis and liver cancer associated with viral hepatitis B and C in republic of Tatarstan].
Clinical and epidemiological data on 93 patients with liver cirrhosis, treated in the Gastroenterological Department of the Republican Clinical Hospital of the of the Republic of Tatarstan MoH in 1998-2000 were analyzed. The retrospective analysis of 856 cases of the liver cancer, diagnosed in the Republic of Tatarstan in 1996-2000, was made. In 20.4% of patients with liver cirrhosis and 16.2% of patients with liver cancer, registered in the Republic of Tatarstan, the serological markers of hepatitis B (HB) and hepatitis C (HC) were detected. The domination of HC markers was observed in the liver cirrhosis and that of HB markers in the cancer of the liver. The liver cirrhosis with HC markers was more often registered in the age group of 45-60 years and with HB markers at the age over 60 years, while the cancer of the liver was more often registered in persons aged 75 years and older. The necessity of introducing the official registration of the liver cirrhosis and cancer associated with chronic infection caused by hepatoviruses B and C is confirmed.
Adolescent↗
Evaluation of 13C-phenylalanine and 13C-tyrosine breath tests for the measurement of hepatocyte functional capacity in patients with liver cirrhosis.
Liver disease is associated with an abnormal elevation of the plasma concentrations of the aromatic amino acids phenylalanine and tyrosine. The liver is the main site of aromatic amino acid metabolism, particularly the hydroxylation of phenylalanine to tyrosine and further tyrosine degradation. In the present study, we have examined the usefulness of the L-[1-13C]phenylalanine breath test (13C-PheBT) and L-[13C]tyrosine breath test (13C-TyrBT) for the detection of hepatic damage in patients with liver cirrhosis. First, the time courses of 13CO2 excretion after the administration of L-[1-13C]phenylalanine and L-[1-13C]tyrosine were compared. The peak times (the time expressed in minutes at which 13CO2 excretion was maximal) were 20 min in both breath tests, but 13C-TyrBT gave a higher peak than 13C-PheBT. Next, the parameters of 13C-PheBT and 13C-TyrBT were compared with biochemical liver function test values. These parameters were well correlated with several liver blood test values conventionally regarded as measures of hepatocyte functional reserve. Therefore, 13C-PheBT and 13C-TyrBT may be useful to assess the degree and progression of hepatic dysfunction.
Adult↗
Cimetidine prevents and partially reverses CCl4-induced liver cirrhosis.
Liver injury produced by CCl4 depends on its metabolism by the liver cytochrome P450 enzyme system to a highly reactive intermediate (CCl3.). Cimetidine impairs cytochrome P450 and stimulates regenerative processes acting on DNA synthesis. This work was performed to investigate whether cimetidine may prevent CCl4-induced liver cirrhosis. Male Wistar rats were used: animals in group 1 received CCl4 (0.04 g per 100 g, i.p.) three times a week for 8 weeks; group 2 was treated with CCl4 plus cimetidine (120 mg kg-1, p.o.) three times a week for 8 weeks; group 3 received CCl4 for 8 weeks and then cimetidine for 4 weeks. Alkaline phosphatase, gamma-glutamyl transpeptidase (gamma-GTP) and alanine aminotransferase (ALT) activities, as well as protein and bilirubin, were measured in serum; collagen and lipoperoxidation were quantified in liver. Intoxication with CCl4 increased (P < 0.05) serum activities of alkaline phosphatase, gamma-GTP and ALT, and bilirubin concentration; liver collagen and lipoperoxidation were also increased. Cimetidine treatment prevented or reverted the increases in the three enzyme activities and in bilirubin content and the fall in proteins. It is worth noting that cimetidine co-treatment completely prevented both the increase in collagen content and the lipid peroxidation. The protective effect of cimetidine can be attributed to a reduction in cytochrome P450. However, it could also stimulate regenerative processes.
Alanine Transaminase↗
Physico-chemical factors predisposing to pigment gallstone formation in liver cirrhosis.
Liver cirrhosis is associated with a high prevalence of pigmentary cholelithiasis. The major compound of pigment gallstones is unconjugated bilirubin (UCB) in the form of calcium bilirubinate salts or a black pigment polymer. Most of UCB in bile derives from enzymic or non-enzymic hydrolysis of mono- or diconjugated bilirubin. Changes in the relative ratios between these two bilirubin species have been associated with pigment gallstones. It has also been shown that UCB solubilization in bile depends on its interaction with bile salts. In order to clarify the factors predisposing cirrhotic patients to pigment stone formation, we measured UCB, monoconjugated bilirubin (MCB) and diconjugated bilirubin (DCB) in duodenal bile of 15 patients with cirrhosis, ten patients with chronic active hepatitis (CAH) and ten normal subjects, we also analyzed their relationships with lipids. In cirrhotic patients, the MCB concentration in bile was significantly (p less than 0.05) higher than in normal subjects and was correlated with the severity of the disease. Bile salts and lecithin concentrations were significantly lower in cirrhosis (p less than 0.005 vs. CAH or normals). Cirrhotic patients have a bile salts/UCB molar ratio which is one third that of CAH patients or normal subjects (p less than 0.01). No differences were found between CAH patients and controls in each of the parameters tested. In conclusion, we propose that the very low BS/UCB molar ratio and the very high biliary content in MCB represent two independent physico-chemical factors predisposing cirrhotic patients to pigmentary cholelithiasis.
Aged↗
[The disorder of vitamin D metabolism in patients with liver cirrhosis].
Liver cirrhosis (LC) is often associated with osteomalacia and osteoporosis. Since it has been shown that serum levels of 25 hydroxy vitamin D (25-OH-D) are reduced in LC, defective hepatic hydroxylation of vitamin D has been postulated to be responsible for the low serum 25-OH-D levels and skeletal demineralization. This study was designed, therefore, to determine serum 25-OH-D and 1 alpha, 25-(OH)2-D levels in patients with LC. Further, the response of serum 1 alpha, 25-(OH)2-D to a single oral dose of 1 alpha-OH-D3 (2 micrograms) was investigated. In 5 patients with severe decompensated LC and 3 patients with compensated LC, serum 25-OH-D and 1 alpha, 25-(OH)2-D levels were respectively measured by the modified method of Belsey and by that of Eisman. Serum 25-OH-D in patients with compensated and decompensated LC was significantly higher than that in normals. Serum levels of 1 alpha, 25-(OH)2-D in patients with decompensated LC were significantly lower than those in patients with compensated LC and normals. After a single oral administration of 1 alpha-OH-D3 at a dose of 2 micrograms, the 1 alpha, 25-(OH)2-D rose in each patient within 6h, reaching the maximum levels at 12h. The percent increase over the basal value in decompensated LC was similar to that in compensated LC.(ABSTRACT TRUNCATED AT 250 WORDS)
Dihydroxycholecalciferols↗
[Liver cirrhosis and liver cancer--types, clinical courses, and progress in their treatment].
There have been several controversies about classification of liver cirrhosis between Western countries and Japan. By the follow-up studies for 5 years on 478 cirrhotic patients diagnosed in Osaka area, relatively higher survival rates were found in cases without HBs-antigen and in heavy drinkers, whereas cases of cryptogenic type showed poor prognosis. The most marked progress in diagnostic procedures in this field seems to be several imaging techniques such as scintiphotography, U.S. echography and computed tomography. Analysis obtained by serial observations on imaging films would be valuable in differentiation between hepatoma and liver cirrhosis. Remarkable improvement has been shown in examinations on etiologic factors, degree of impairment of liver cell functions and precise evaluation of pathophysiological status of patients. Although it is our great regret that radical procedure to cure patients suffering from liver cirrhosis or hepatoma has not yet been known, several palliative treatments have become practical in recent years. For example, percutaneous transhepatic portal occlusion or injection of sclerosing agents for bleeding esophageal varices, parenteral feeding using adjusted amino acids pattern solution for impending coma and selective arterial embolization by sponges or coils infused with anticarcinogenic drugs for inoperable hepatoma have been used and effective to prolong survival period of these patients.
Ascites↗
[The effect of smoking and drinking habit on the process from liver cirrhosis to liver cancer].
A retrospective cohort study of liver cirrhosis cases was carried out. 270 cases of liver cirrhosis which were confirmed histologically from 1972 to 1981 at Juntendo University Hospital, were followed up until the end of 1988. The average observation period for these cases was 74 months or 6.2 years, and we found 141 death cases including 46 of primary liver cancer (PLC). The analysis of survival rate revealed that the smoking group had a slightly higher death rate of PLC than non-smokers, and the ex-smoker group had a much higher survival rate than the continuous smoking group. On the other hand, it was found that the alcohol-drinking group had a much lower death rate of PLC than the non-drinkers group, and that there was no difference of the survival rate among drinkers, non-drinkers and ex-drinkers.
Adult↗
[Comparison of laparoscopic and scintigraphic findings in chronic hep-titis, liver cirrhosis and liver tumours (author's transl)].
Results of laparoscopy and scintigraphy were compared and contrasted with ultimate clinical diagnosis in 94 patients with chronic hepatitis or liver cirrhosis and 38 with liver tumours. The findings agreed in 77 cases of chronic hepatitis and cirrhosis and 33 of liver tumour. In the remainder either laparoscopy or scintigraphy gave the wrong results. In one case each of cirrhosis and liver metluded that (1) laparoscopy and scintigraphy are methods complementing but not replacing other clinical tests; (2) if diffuse liver disease is suspected clinically the diagnosis can essentially be done only by laparoscopy and selective biopsy or blind liver biopsy but not scintigraphy; (o) if a circumscribed condition is suspected, scintigraphy is among the most important screening tests, but cannot replace laparoscopy, biopsy or angiography for confirming the diagnosis; (4) liver scan is an important method, of little stress to the patient, in following the progress of chronic hepatitis and liver cirrhosis, additional to clinical examination, enzyme tests, laparoscopy and histology.
Angiography↗