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Cognitive performance and liver function among recently abstinent alcohol abusers.

It has frequently been suggested that some of the enduring subtle cognitive impairments seen in sober alcohol-dependent persons may be a result of subclinical liver dysfunction. Cognitive performance and liver function among 85 recently abstinent alcohol-dependent persons were assessed by means of a neuropsychological examination and the GGT test of liver function. Unlike some previous studies, no relationships were found between the two areas of functioning. It is argued that lack of statistical power did not account for the failure to find an association between the two domains. The proposition that residual cognitive impairment in abstinent alcoholic persons is (partly) mediated by earlier liver dysfunction rests on slight empirical foundations and remains speculative.

Alcoholism↗

Liver function and splanchnic ischemia in critically ill patients.

STUDY OBJECTIVE: To investigate the concept that splanchnic ischemia leads to hepatic dysfunction in the critically ill. DESIGN: Prospective study and analysis of patient data. SETTING: A general ICU in an inner-city London teaching hospital. PATIENTS: Twenty-seven consecutive critically ill patients with evidence of inadequate tissue perfusion requiring pulmonary artery catheterization and mechanical ventilation. MEASUREMENTS: In all patients, we measured the hepatic metabolism of lidocaine (lignocaine) to monoethylglycinexylidide (MEGX) and the clearance of indocyanine green (both dynamic, flow-dependent tests of hepatic function) over the first 3 days following admission to the ICU. These were compared with results of standard liver function tests and related to tonometric assessment of gastric intramucosal pH (pHim) and outcome. RESULTS: There were no significant differences in bilirubin, aspartate aminotransferase, alkaline phosphatase, and prothrombin levels, or in indocyanine green clearance between survivors and nonsurvivors. On day 3, the median MEGX level was higher in survivors than in nonsurvivors (16 vs 2.4 ng/mL, p < 0.001), and the median MEGX level in nonsurvivors fell over the 3 days (20.6 to 2.4 ng/mL, p < 0.002). MEGX levels were significantly correlated with pHim (Spearman rank correlation coefficient [Rs] = 0.69, p < 0.001) as were the changes in the two measurements over the 3 days (Rs = 0.46, p < 0.02). The MEGX formation test and gastric pHim were the most discriminatory with regard to death and survival. CONCLUSIONS: Our findings suggest that critically ill patients develop significant hepatic dysfunction that is associated with a poor outcome. This is likely to be due to a mismatch between hepatic metabolic demand and blood flow, and the MEGX formation test appears to be an extremely effective means of assessing liver function and flow in this group of patients.

Critical Illness↗

[Clinical characteristics of factory workers with asymptomatic liver function test abnormalities found on serial health examination].

BACKGROUND/AIMS: The liver function tests (LFTs), such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltranspeptidase (gamma-GT), have been widely used as screening tests but their low positive predictive value can cause many false positive results. To evaluate the clinical usefulness of these tests, we analyzed the serial LFT results for factory workers, and we compared the risk factors for the groups that were divided according to the serial LFT results. METHODS: From June 2001 to October 2001, 1223 consecutive healthy workers in a single factory were enrolled in our study; a questionnaire, LFT and liver ultrasonography were done for all the subjects. The previous LFT results were collected from the Annual health examination survey. According to the abnormalities on the serial LFT, the participants were classified into three groups (abnormal-in-both, alternating or, normal-in-both) and the risk factors were compared among these groups using multiple logistic regression analysis. RESULTS: The prevalence of LFT abnormality on a single test was 16.8%, but on the serial LFT, only 5% of the study participants showed consistent abnormality. The risk factors for the abnormal-in-both group, compared with the alternating group, were liver ultrasonography abnormality such as a fatty liver (odds ratio, 2.2; P=0.026) and a heavy alcohol intake (more than 210 g/week) (odds ratio, 7.2; P=0.064). HBsAg was not a significant risk factor for any of the three groups. CONCLUSIONS: In factory workers having serial LFT abnormalities, alcoholic liver disease could be the principal cause of abnormal LFT. Even if the HBsAg were positive in patients with abnormal LFT, there is the possibility of another causes for LFT abnormalities such as alcoholic liver disease and non-alcoholic steatosis or steatohepatitis.

Adult↗

Synthesis of urea after stimulation with amino acids: relation to liver function.

Hepatic urea synthesis is the organism's main channel for the disposal of nitrogen and it may be an 'essential' liver function. In six control subjects and five patients with cirrhosis of the liver urea synthesis was studied during continuous infusion for six to 24 hours of about 3 mmol alpha-amino nitrogen/h X kg body weight. The urea synthesis rate was calculated in intervals of two hours as urinary excretion with correction for accumulation in the total body water and for hydrolysis of urea in the gut. The peripheral venous plasma alpha-amino nitrogen concentration increased from 3 to about 14 mmol/l and the urea nitrogen synthesis rate from 25 to about 215 mmol/h. In all cases the urea synthesis rate rose linearly with the alpha-amino concentration throughout the examined range. The slope of this linear relationship is an expression of the hepatic conversion of alpha-amino nitrogen to urea nitrogen ('functional hepatic nitrogen clearance'). The functional hepatic nitrogen clearance was 22.4 l/h in control subjects and 13.7 1/h (P < 0.025) in the patients with cirrhosis. It was correlated with quantitative measures of the liver function (the galactose elimination capacity, r = 0.84, and the clearance of antipyrine, 4 = 0.80). These observations, while confirming the abundant capacity of the urea synthesis system, imply that a given urea synthesis rate requires a higher alpha-amino level in patients with reduced liver function.

Adult↗

Nuclear medicine liver-function tests for pregnant women and children. 2. A new test method via urine using 15N-methacetin.

A simple, non-invasive, non-radioactive liver-function test is proposed. After an oral dose of 3 mg 15N-methacetin per kilogram body mass, the kinetics of 15N excretion via urine were characterized by the quotient of the amounts of 15N excreted in two successive urine samples (Q value). The stable nitrogen isotope 15N was found to be an excellent and easily detectable indicator of the sum of all methacetin metabolites present in urine. Alterations in the nature or ratio of methacetin metabolites due to liver diseases could not be found. From the investigation of 11 men, 3 pregnant women and 15 children, a clear difference was observed in Q values of healthy persons and patients suffering from liver-cell-activity diseases. The discriminating power of our new liver-function test is shown to be equivalent to that of the 14CO2 breath test.

Acetamides↗

[The effectiveness of endoscopic variceal ligation in patients with different grades of liver function].

OBJECTIVE: To evaluate the effectiveness of endoscopic variceal ligation (EVL) in patients with different grades of liver function. METHODS: MELD scores were determined for 156 patients before their EVL operations. After the EVL these patients were followed-up and their survival rates were analyzed. RESULTS: Fifty percent of the patients whose MELDs were less than or equal to 7 survived longer than 45 months after the EVL; in those with MELDs between 7 and 9, 50% of the patients survived 47.34 months; however, the figure for those whose MELD were more than 9 survived only 24.89 months. In the first two groups, 50% of the patient' survival duration was significantly longer than that of the third group. The difference was statistically significant. CONCLUSION: EVL becomes an effective clinical way to treat hemorrhage of esophagus varicose veins. The survival rate for this procedure is directly correlated with the liver function of the patient before the EVL.

Adult↗

[Study on decision support system for the interpretation of laboratory data by an artificial neural network--with a special reference to estimation for histological diagnosis of liver diseases with laboratory data on liver function].

An artificial neural network (ANN) was trained on laboratory data of liver function tests to estimate for histological diagnosis in patients with liver diseases such as chronic hepatitis, liver cirrhosis and fatty liver. ANN diagnosed accurately 95.3% of the cases for training and 50% of the test cases. Elimination of ZTT, GOT or A/G ratio from the data set for input reduced the ability of accurate diagnosis, whereas elimination of TBA raised this ability to 66.7%. On the other hand, accuracy of physician in diagnosing the test cases ranged from 20.8 to 62.5%. From our results it is expected that ANN may support a physician's decision on the interpretation of laboratory data.

Algorithms↗

Pre-operative time course changes in liver function tests in biliary atresia: its usefulness in the discrimination of biliary atresia in early infancy.

In order to investigate the possibility of early discrimination of extrahepatic biliary atresia from other cholestatic diseases, a series of results of liver function tests in infants with cholestatic diseases were reviewed. The results of routine liver function tests (LFT) recorded in patients' charts were reviewed within 12 weeks after birth in 47 infants with extrahepatic biliary atresia (BA), 10 infants with neonatal hepatitis (NH) and 130 age-matched control infants (CO) without cholestatic diseases. The mean of each test value for each week after birth was derived from the actual data examined in each infant. No differences were observed between BA and CO in the levels of aminotransferases within 2 weeks after birth. Total bilirubin and direct bilirubin levels were significantly different between BA and CO within 1 week after birth (16.1 +/- 3.2 mg/dL vs 11.1 +/- 4.5 mg/dL, 4.6 +/- 2.6 mg/dL vs 0.7 +/- 0.3 mg/dL, respectively). The direct bilirubin-total bilirubin ratio exceeded 25% within the first week in BA. The individual values of direct bilirubin (DB) exceeded 2 mg/dL within the first week in all infants with BA, while none of the individual values exceeded 1.6 mg/dL in CO. Gamma-glutamyl transpeptidase levels were significantly different between BA and CO at 4 weeks (432 +/- 272 IU/L vs 79 +/- 43 IU/L) and thereafter; and were significantly different between BA and NH at 6 weeks (314 +/- 232 IU/I vs 69 +/- 58 IU/L) and thereafter. These data suggest that the determination of direct bilirubin within 1 week after birth can detect extrahepatic biliary atresia patients from those with physiologic jaundice, and gamma-glutamyl transpeptidase levels may discriminate BA from NH at no later than 6 weeks of age.

Alanine Transaminase↗

Serum bile acids, gamma-glutamyltransferase and routine liver function tests in emetic and nonemetic pregnancies.

The etiology of nausea and vomiting in pregnancy is still unknown. One possibility is that ovarian and placental hormones may play some part. The liver is the major site of metabolic inactivation of steroid hormones. In this study, 102 healthy pregnant women, of whom 62 complained of nausea, were followed throughout pregnancy. Liver function tests were performed to ascertain whether emesis gravidarum is related to impaired hepatic function. In this series, all values were within the normal ranges. Serum levels of total bilirubin and gamma-glutamyl-transferase were significantly decreased and those of total serum bile acids significantly increased in emetic women compared to nonemetic subjects. Furthermore, the metabolic load on the liver seems to follow a biphasic course as there is an apparent minimum in liver function variables in the second trimester. It is concluded that a slow adaptation to the increased hormonal load on the liver might be responsible for the condition of emesis gravidarum.

Adult↗

Changes in lymphocyte single strand breakage and liver function of workers exposed to vinyl chloride monomer.

Vinyl chloride monomer (VCM) is a suspected human carcinogen. Its metabolite, chloroethylene epoxide, is able to alkylate the DNA molecule and to produce single strand breakage (SSB). A total of 244 workers from 4 polyvinyl chloride (PVC) manufacturing factories were recruited to assess the SSB of their peripheral lymphocyte DNA. The method of alkaline unwinding and hydroxyapatite chromatography was used to detect and calculate frequencies of SSB. In addition, hepatitis B and C markers and the liver function of the workers were also examined. The worker's cumulative exposures to VCM were retrospectively constructed from the current monitoring data and each worker's job history. Multiple linear regression models were constructed to predict the worker's level of SSB and liver functions based on various exposure indices and variables, such as age, sex, smoking, drinking, and hepatitis markers. The results showed that current smoking and drinking status, and the presence of VCM exposures on the previous day were 3 major determinants of the level of SSB. Among the liver function tests, only gamma-glutamyl transpeptidase (GGT) was associated with current VCM exposures. In contrast, aspartate aminotransferase (AST), alkaline phosphatase (ALP) and alanine aminotransferase (ALT) were mainly affected by the presence of hepatitis B surface antigen (HBsAg) or anti-hepatitis C virus (anti-HCV). We conclude that GGT should be considered to be included in the regular health screening of VCM workers, and that the SSB method may not be suitable for long-term monitoring of cumulative exposure because of the quick DNA repair mechanism in humans.

Adult↗

Abnormal liver function tests as biological markers for alcoholism in narcotic addicts.

Liver Function Test (LFT) abnormalities are frequently observed in narcotic addicts. However, the role of alcohol in producing such changes remains unclear. In order to evaluate the effects of alcohol in producing LFT elevations as well as the use of routine LFTs to serve as biochemical markers for alcoholism in narcotic addicts, 612 addicts participating in a randomized control trial of intervention in alcoholism were studied. Baseline parameters including LFTs and history of alcohol use were obtained on entry into the study and subsequently periodically during follow-up which varied from 6 months to 2 1/2 years (mean 13.5 months). On entry to the study, 104 of 612 (17%) of addicts were classified as alcoholics. Mean values of LFTs (SGOT, SGPT, Alkaline phosphatase, GGTP) in the alcoholic cohort were significantly increased compared to those among nonalcoholics (p less than 0.01 to less than 0.001 for individual tests). Mean values of LFTs did not significantly change during methadone maintenance in either group. Although a greater proportion of alcoholic addicts had elevated LFTs, the predictive values for each test (18 to 35%) were sufficiently low to prevent them from being used as biochemical markers of alcoholism. These findings suggest that although elevations in LFTs are frequently present in narcotic addicts and are significantly greater among addicts who are also alcoholic, most elevations are not specifically due to alcohol. Conventional LFTs are therefore of limited value in assessing alcoholism among narcotic addicts.

Alcoholism↗