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PubMed1980

Serum cholic and chenodeoxycholic acid conjugates and standard liver function tests in various morphological stages of alcoholic liver disease.

Fasting and postprandial serum concentrations of conjugates of cholic (CCA) and chenodeoxycholic (CCDA) acid measured by radioimmunoassay were compared with morphological changes in percutaneous liver biopsies from 49 patients with alcohol abuse. Sulfobromophthalein (BSP) and galactose elimination tests were also performed, and serum levels of aminotransferases (ASAT, ALAT), glutamyltransferase, alkaline phosphatase, and bilirubin were determined. Raised fasting serum concentrations of CCDA were found in 29 patients (59%), whereas elevated fasting serum levels of CCA were found in 19 patients (39%). The mean fasting and postprandial serum bile acid concentrations were significantly higher in patients with hepatofibrosis and cirrhosis than in those with only fatty changes. The extent of the postprandial rise, however, was variable and not significantly different among the various groups. The BSP elimination test was abnormal in 12 patients (25%) but gave normal results in 2 of the 3 patients with cirrhosis of the liver. The galactose elimination rates differed only between patients with normal liver biopsies and patients with cirrhosis of the liver. The serum enzyme levels were not significantly different between the various morphological groups. It is concluded that determinations of fasting serum bile acids, especially CCDA, give more reliable and sensitive information on the degree of liver damage in alcoholic liver disease than BSP and galactose elimination tests or serum enzyme assays.

Adult↗
PubMedDate not supplied

Liver function tests in patients receiving parenteral nutrition.

A 5-year prospective study was performed to monitor liver function tests (LFTs) in patients receiving total parenteral nutrition (TPN). A gradual and progressive rise was seen in the plasma concentration of bilirubin, aspartate transaminase, and alkaline phosphatase. The rate of rise was not increased in patients with LFT abnormalities before the start of TPN. Half of the patients had an episode of sepsis during TPN, but overall abnormal LFTs did not appear more common in these patients than in those without obvious sepsis. Patients with malignant disease, those requiring long-term TPN, and those requiring a nonstandard TPN regimen were more likely to develop raised LFTs.

Adult↗
PubMed1990

Liver function tests in non-parenteral cocaine users.

To investigate the effect of cocaine on standard liver function tests (LFT), we studied 46 cocaine users with no history of parenteral drug use or homosexuality. LFT were similar in 21 users of cocaine only (Group A) and 25 users of cocaine and alcohol (Group B). Only three patients, two of whom were hepatitis B carriers, had an alanine aminotransferase level more than five units above normal limits. Group B patients were significantly more likely to complain of headaches, irritability, and loss of memory. We conclude that (1) non-parenteral cocaine use is rarely associated with significant LFT abnormalities and (2) alcohol may potentiate some adverse effects of cocaine.

Adult↗
PubMed1980

Liver function tests and low-dose estrogen oral contraceptives.

Twenty healthy female volunteers were treated with 35 microgram ethinyl estradiol and 0.4 mg norethindrone for a two-month period of time. Liver function tests (serum SGOT, SGPT, LDH, alkaline phosphatase, total bilirubin, total protein, albumin and prothrombin times) were measured at baseline and control prior to treatment, and at one and two months of therapy. There was a 1.25% incidence of abnormalities in the 320 tests conducted during therapy. During the first month of therapy, there was a 1.9% incidence of abnormal tests. 0.625% incidence of abnormal tests was seen in the second month of treatment. A 5% incidence of abnormalities (single episodes in each parameter) was seen in SGPT, LDH, total bilirubin and prothrombin time levels during the two-month period. This was well below the 10-30% incidence of abnormalities reported with 50-100 microgram of estrogen-containing birth control pills in previous studies. There seems to be little effect on liver function tests with use of estrogen preparations containing 35 microgram ethinyl estradiol.

Adult↗
PubMedDate not supplied

Effects of occupational and nonoccupational factors on liver function tests in workers exposed to solvent mixtures.

A total of 368 workers from six paint-manufacturing factories participated in this study. The workers were classified according to type of exposure: direct, intermittent, and no exposure. The workers' liver-function tests were influenced greatly by gender, hepatitis B, alcohol consumption, and body mass index. Both the serum concentration and the odds of abnormality of total serum bile acids were elevated among the directly exposed group. The authors concluded that analysis of covariance should take into account occupational and nonoccupational factors on liver-function tests to avoid any errors. Total serum bile acids also indicated liver dysfunction from solvent exposure.

Adolescent↗
PubMed2005

Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis.

BACKGROUND: The role of liver function tests (LFTs) in evaluating common bile duct (CBD) stones in patients with cholelithiasis has been studied widely. However, it is not clear whether these predictive models are useful in inflammatory gallstone disease. METHODS: A review was undertaken of 385 consecutive patients admitted as an emergency for acute calculous gallbladder disease. The diagnosis of calculous cholecystitis was confirmed by ultrasonography or histological confirmation of acute or chronic inflammation of the gallbladder. Patients with obvious jaundice, defined as a bilirubin level above 80 micromol/l, and gallstone pancreatitis were excluded. RESULTS: Some 216 patients met the inclusion criteria, of whom 28 (13.0 per cent) were found to have CBD stones. LFT results were not significantly different in patients with chronic, acute or complicated acute cholecystitis. Using several cut-off levels, gamma-glutamyl transpeptidase (GGT) had the highest specificity, positive predictive value and negative predictive value, comparable to a scoring system that combined all LFTs. Bilirubin was the least specific and predictive. A cut-off point for GGT at 90 units/l produced a sensitivity of 86 per cent (24 of 28), specificity of 74.5 per cent (140 of 188), and positive and negative predictive values of 33 per cent (24 of 72) and 97.2 per cent (140 of 144) respectively. This represented a one in three chance of CBD stones when the GGT level was above 90 units/l and a one in 30 chance when the level was less than 90 units/l. CONCLUSION: Selection criteria based on GGT can be used in acute calculous cholecystitis to identify high-risk patients who would benefit most from further imaging to exclude choledocholithiasis.

Adolescent↗
PubMed1996

Evaluation of patients with abnormal uterine bleeding.

An accurate, efficient diagnosis of disorders responsible for abnormal uterine bleeding depends on a systematic consideration of all the possible causes. Careful history and physical and pelvic examinations provide the framework for evaluation. Many adjunctive diagnostic aids can be used to evaluate women with abnormal uterine bleeding. These tests include complete blood cell count, pregnancy test, hormone levels (estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, dehydroepiandrosterone sulfate), thyroid function tests, liver function tests, and coagulation profile. The need for these tests are individualized and based primarily on the patient's presentation. In women of reproductive age a complication of pregnancy should always be ruled out. Ectopic pregnancies can be life threatening. The prognosis in women with trophoblastic disease can be altered by a delay in establishing the correct diagnosis. Ultrasonographic studies, particularly transvaginal ultrasonography and hysteroscopy, have played an increasing role in the evaluation of patients with abnormal uterine bleeding over the past decade, especially for cases of intrauterine space-occupying lesions, including endometrial polyps, submucosal myomas, and retained placental fragments. Suspicion of reproductive tract malignancies is heightened in patients > 35 years old, those with a history of oligoovulation or anovulation suggestive of long-term unopposed estrogen exposure, those who are obese, and those who do not respond to first-line medical management. Diagnostic techniques available for the evaluation of these cases include endometrial biopsy, dilatation and curettage, transvaginal ultrasonography, and hysteroscopy. These procedures not only allow accurate diagnosis but may permit immediate therapeutic measures to be taken when organic causes are discovered. In summary, the key to the evaluation of abnormal uterine bleeding is a through history and physical and pelvic examinations governed by the differential diagnosis of excessive uterine bleeding and the selected use of adjunctive diagnostic tests and procedures only when absolutely necessary.

Diagnosis, Differential↗
PubMed1999

Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD)

The aim of our study was to assess the efficacy of extracorporeal photopheresis (ECP) in chronic graft-versus-host disease (GVHD). Eleven patients with chronic cutaneous GVHD were studied. Four had mucosal involvement and five had pulmonary involvement. All had failed to improve on first- and second-line therapy. Three patients received ECP alone; the remainder continued to receive steroids and/or immunosuppressive therapy. Patients received ECP twice monthly for 4 months and then once monthly for 3 months. They were evaluated by serial skin scores, mucosal and skin photography, pulmonary function tests, biochemical and haematological parameters. Nine patients showed objective evidence of cutaneous improvement with a mean reduction in skin score of 48% overall. In the 10th patient, skin scores and oral involvement improved on twice monthly ECP but deteriorated when reduced to once monthly. The final patient died from renal failure secondary to cyclosporin toxicity. Two out of five patients with lung involvement showed a mild improvement in pulmonary function tests. Liver function tests were abnormal in five patients; they improved in one and deteriorated in three. All patients receiving concomitant immunosuppressive/steroid therapy were able to reduce drug dosages by trial completion. Our results indicate that ECP can benefit patients with cutaneous and mucosal chronic GVHD who have failed on first- and second-line therapies. The effect on the systemic manifestations of GVHD is less consistent.

Adolescent↗
PubMed2004

HLA class II polymorphism in Egyptian children with lymphomas.

UNLABELLED: The major histocompatibility complex (MHC) is a set of closely-linked genes encoded on the short arm of chromosome 6. It is important for understanding human immunological diseases, transplantation and in host defense against infection. The membrane proteins are two types; class I MHC proteins and class II MHC proteins. Strong arguments supporting genetic linkage between susceptibility to lymphomas and human leukocyte antigens (HLA)-class II are reported and give a clue about susceptibility or protection from the disease. AIM: To evaluate the possible changes of HLA class II (DR, DQ) alleles in children with lymphoma. METHODS: Thirty cases were included in this limited study. Nineteen cases of non Hodgkin's lymphoma (NHL) and eleven patients with Hodgkin's lymphoma (HD). Their ages ranged from 1.5 to 15 years. The control group consisted of 121 unrelated healthy subjects for DRB1 alleles and 59 unrelated healthy subjects for DQB1 alleles (only 59 subjects were typed for both DRB1 and DQB1). All cases in the study were assessed by thorough history taking, physical examination and laboratory investigations that included complete blood count, renal function tests, liver function tests, serum uric acid and HLA typing. Patients and controls were typed for HLA class II DRB1 and DQB1 alleles using INNO-LIPA reverse hybridization line probe assay (Innogenetic, Belgium). RESULTS: HLA-DRB1 *0403 and *1301 and HLA-DQB1 *0501,* 0201 and *0301 were significantly increased in patients with NHL when compared with control; whereas HLA-DRB1 *1302 and HLA-DQB1 *0502 and *0602 were significantly decreased when compared with control. In patients with HD, HLA-DRB1 *0403 and *1202 and HLA-DQB1 *0604, *0201 and *0203 were significantly increased when compared with control. CONCLUSIONS: (1) The susceptibility to NHL is related to HLA-DRB1 *0403 and *1301 and HLA-DQB1 *0501,* 0201 and *0301. (2) The susceptibility to HD is related to HLA-DRB1 *0403 and *1202 and HLA-DQB1 *0604, *0201 and *0203. (3) HLA-DRB1 *1302 and HLA-DQB1 *0502 and *0602 may confer protection to NHL. (4) Different HLA alleles may have a role in patients with both groups of lymphoma and further study is needed to better define the possible prognostic value of different HLA associations in patients with lymphomas regarding increased risk in the presence of certain HLA alleles and the possibility for treatment modifications in the future based on the presence or absence of certain HLA alleles.

Child↗
PubMed1975

Benorylate: a report on 2 years' experience of its use in rheumatoid arthritis and other chronic rheumatic diseases.

52 outpatients with rheumatoid arthritis or osteoarthritis were given benorylate (as the 40% suspension) in doses of up to 8 g daily. Peroids of medication were varied but some patients were given the drug for nearly 2 years. Assessments of clinical progress were made at regular intervals by recording both subjective and objective measurements including duration of morning stiffness, grip strength, joint size. Laboratory investigations include renal function tests, liver function tests, blood picture and occult blood. No serious side effect, attributable to benorylate was reported and it was concluded that the drug is satisfactory for the long term treatment of rheumatic diseases.

Arthritis, Rheumatoid↗
PubMed2003

Management of febrile convulsion: scene in a regional hospital.

OBJECTIVE: To determine whether practice parameters are applied to the management of children with febrile convulsion. DESIGN: Retrospective study. SETTING: Paediatric department of a public hospital, Hong Kong. METHODS: Practice parameters of the American Academy of Pediatrics and audit measures recommended by the Joint Working Group of the Research Unit of the Royal College of Physicians and the British Paediatric Association were employed as standards. Records between January and April 2000 with the diagnostic coding of febrile convulsion, convulsion, status epilepticus, or meningitis/encephalitis/encephalopathy were reviewed. Areas assessed were appropriate documentation of hospital records and unit statistics (adverse outcomes, inappropriate investigations and treatment). RESULTS: Ninety-four consecutive records were evaluated. In the documentation of hospital notes, accurate description of seizure was observed in 92%, incorrect diagnosis or coding in 12%, and presence/absence of signs of meningitis and parental counselling documented in 64% and 85%, respectively. Regarding unit statistics, investigations performed included a complete blood count, blood glucose, serum calcium, serum electrolytes, renal function tests, liver function tests, chest X-ray, and urinalysis. The mean number of routine investigations was seven. The average length of stay was 2 days. There were no cases of delay in the diagnosis of central nervous system infection. Inappropriate investigations and treatment were as follows: electroencephalography 11%, computed tomography brain scan 2%, and maintenance anticonvulsants 2%. All patients were discharged home with panadol regardless of clinical state. CONCLUSIONS: The present study showed that the use of unnecessary investigations was common. Investigations, though resulting in significant expense, proved to be of little diagnostic value. Diagnostic procedures should be performed only when specifically called for by the patient's condition or medical history.

Child, Preschool↗