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The interrelationship of the liver function tests and the 5-year survival rates were studied in 62 patients with prostatic carcinoma who were treated with antiandrogens. Abnormally high bilirubin, and glutamic oxaloacetic and pyruvic transaminase serum levels were a significant index with regard to the 5-year survival rates.
The pharmacokinetics of ciprofloxacin after a single 500 mg oral dose was studied in one group of healthy volunteers and in patients affected by liver cirrhosis and classified into three groups according to Child-Turcotte criteria. The serum concentrations were determined by an agar well diffusion assay 0.5, 1, 3, 6, 12 and 24 h after the administration of the drug. No significant differences were noticed in Cmax, Tmax, T1/2 and AUCtot in the group A and B of patients and in the control group. Class C patients showed on the other hand a Cmax 15-25% higher than in other groups (2.74 mcg/ml), a T1/2 1.12-1.42 hours longer than in other groups and a consequent much higher AUCtot (17.70 mcg/h/ml). The concomitant administration of diuretics of anti-H2 drugs was also evaluated as possible factors affecting the ciprofloxacin pharmacokinetics, but no significant differences were noticed. A mild or moderate impairment of the liver function did not affect the pharmacokinetics of ciprofloxacin, but the severe impairment of the liver function could affect its Cmax and serum half-life, so that further studies with multiple doses will be needed to evaluate if any dosage adjustment would be required in these patients.
A prospective study of 181 patients suspected of having liver disease was carried out to determine the relative efficiencies of serum bilirubin (total and direct), alkaline phosphatase (AP), gamma glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) with respect to diagnosis. Liver biopsies, liver scans, abdominal ultrasound, and clinical parameters were also tabulated and used independently to evaluate the patient's hepatic status and to determine the final diagnoses in each case. From the results of these tests for the 60 patients who were diagnosed as having liver disease, and the 87 patients who were felt to be free of liver disease, predictive values of the above tests were established. Data from this study suggests that while direct bilirubin is the most specific test, GGT is the most sensitive and has the fewest false negatives in the diagnosis of liver disease.
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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.
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Hypertransaminasaemia and impaired liver function in a patient with oligosymptomatic celiac disease. We describe the case of a 45-year-old man who was referred for evaluation of elevated aminotransferases. One year before referral the patient developed an ischemic stroke followed by a subdural hematoma three months later. In our outpatient clinic the patient presented with a malabsorption syndrome including diminished vitamin-K-dependent clotting factors. Serologic testing was positive for IgA antigliadin antibodies and IgA antiendomysial antibodies. Celiac disease was confirmed by an upper endoscopy examination and biopsies obtained from the distal duodenum. Histological examination showed villous atrophy, crypt hyperplasia and an increase in intraepithelial lymphocyte count consistent with celiac disease. After initiation of a gluten-free diet the malabsorption syndrome as well as liver dysfunction improved. Serum aminotransferase levels normalized within 6 months. The clinical course demonstrates involvement of the liver in patients with celiac disease.
BACKGROUND: We have previously reported that by means of a breath test with intravenously administered L-[1-13C] phenylalanine (13Cphe), hepatopathy could be quantitatively evaluated by measuring expiratory 13CO2 levels in a short period. It is known that phenylalanine hydroxylase activity (PAHA) plays an important role in phenylalanine metabolism. We examined the relationship between changes in PAHA and the results of the 13Cphe breath test during hepatic regeneration in a rat model of 70% hepatectomy, to assess their usefulness for evaluating hepatic regeneration. METHODS: Male Wistar rats (Shizvoka Laboratory Animal Center, Hamamatsu, Japan) weighing 230 to 290 g were subjected to 70% hepatectomy under anesthesia with sodium pentobarbital. One, 2, 3, 5, 7, and 14 days postoperatively, 30 mg/kg 13Cphe was intravenously injected into the femoral vein, and the increase in exhaled 13CO2 (Delta 13CO2) was measured for 15 minutes. Simple laparotomy was performed in control rats. After the breath test, the regenerated liver was removed and weighed. The amount of DNA, amount of hepatic tissue total protein (TP), and PAHA were determined. RESULTS: The r between liver weight/body weight and PAHA, between DNA and PAHA, and between TP and PAHA were 0.832, 0.720, and 0.758, respectively. Breath test graphs revealed that liver weight/body weight, DNA, and TP showed the best correlations with the peak value of Delta 13CO2 (liver weight/body weight percentage, r = 0.801; DNA, r = 0.660; TP, r = 0.706), and r between PAHA and peak value was 0.638. CONCLUSIONS: These results suggest that measurement of PAHA in regenerated liver is an effective method for following up liver function after hepatic resection. Moreover, the 13Cphe breath test may also be useful to evaluate liver function after partial hepatectomy.
D-Penicillamine (DPA) was introduced to treat neonatal hyperbilirubinemia in 1973 and to prevent retinopathy of prematurity in 1980. In this study we investigated the renal and liver functions of neonates treated with DPA and the in vitro effect of the drug on superoxide anion generation and beta-glucuronidase release as well as phagocytic and intracellular killing activation of human peripheral blood granulocytes. Our data concerning the renal and liver functions before and after 3 to 4 days DPA treatment reveal that the drug does not produce any pathological change during short-term administration in the neonatal period. Furthermore, it was found that superoxide anion generation was slightly increased, and beta-glucuronidase release markedly increased by preincubation with DPA at concentrations of 0.5-5 mM. The rise was directly proportional to the concentration in the examined range. On the other hand, none of the examined DPA concentrations influenced the phagocytic or killing activity of neutrophils.
Two hundred and forty-three patients aged under 75 years with acute calculous cholecystitis treated by early surgery were studied with a view to investigating the frequency of choledocholithiasis and the predictive value of routine liver function tests (bilirubin, alkaline phosphatase, alanine aminotransferase). 7% had stones in the common duct, but 33% had hyperbilirubinaemia. In less than 10% of the latter could be hyperbilirubinaemia be attributed to common bile duct stones. It was concluded that the frequency of common bile duct stones in acute cholecystitis was low, and that patients often had signs of impaired liver function which was of no help in diagnosing the presence of stones in the common duct.
Weight loss in obese subjects ingesting very-low-energy (VLE; < 2510 kJ/d), low-fat (< or = 1 g/d) formula diets is associated with liver-function-test abnormalities and gallstone formation. It is unknown whether these abnormalities develop during treatment with diets higher in energy and fat. We prospectively studied liver-function tests and gallstone formation in 73 obese patients ingesting approximately 3500 kJ and 15-25 g fat daily for 10 wk. Two of 53 patients completing the protocol developed ultrasonographic gallstones during weight loss, a rate substantially lower than that observed with VLE diets. Trend analysis demonstrated significant increases in AST and ALT activities, but changes were less than those observed with VLE diets. Patients who developed gallstones had a significantly greater weight loss rate and larger increases in AST and ALT than did nonstone-forming patients. These results suggest that the risk of developing hepatobiliary abnormalities with dieting is lowered when subjects ingest greater amounts of energy and fat than that administered in earlier VLE-diet studies. Our results also highlight potential risk factors and markers of new gallstone formation.