[Gallbladder injury in blind liver biopsy].
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Biomedical subjects
Publications and source records attributed to G Menghini.
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With the purpose of facilitating liver biopsy during upper abdominal procedures, an adaptation of the percutaneous one-second needle biopsy technic is proposed. A simple device, consisting of a three-way deviator, allows the utilization of the standard needles for percutaneous biopsy. The entire procedure requires from 10 to 30 seonds. Large caliber needles from 1.6 to 2.0 mm are recommended. Complications are practically nonexistent.
In a group of 16 patients, receiving chenic acid (20 mg/kg/day) and phenobarbital (60 mg/day) for gallstone dissolution, three patients were observed to develop a marked increase in serum levels of SGOT-SGPT and alkaline phosphatase without associated symptoms. Liver biopsy in one patient showed cellular infiltration with neutrophils and eosinophils, suggestive of a hypersensitivity reaction. Enzyme levels returned to normal, following cessation of chenotherapy, and a second biopsy 3 months later was normal. In that patient a challenge with chenic acid, at 250 mg/day, was again followed by a marked elevation in levels of SGOT-SGPT and alkaline phosphatase. These patients are the first to show marked elevation in liver enzyme levels during chenotherapy; the mechanism and significance are unclear.
The one-second liver biopsy technic, published about 18 years ago, has undergone, in the course of the years, some minor modifications, suggested by the practical experience and by the critical evaluation of published and unpublished complications. Some instrumental innovations are described. A new design skin perforator and a penetration limiter are proposed. The clinical use of biopsy needles of different size is discussed. Moreover, the importance of some technical aspects of the practical execution of the biopsy, which are frequently neglected, is pointed out. Finally, the biopsy technic, in its up-to-date version is summarized and the opportunity of a further trial to confirm the validity of the innovations suggested is emphasized.
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Three cases of nuclear glycogenosis in the liver of diabetic patients have been studied by electron microscopy. In addition to the glycogen deposits described by others, an unusual intranuclear glycogen-filled body was found in all three cases. This body occurred alone or in close contact with the major glycogen deposit.
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