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At least 91 records · Page 5Linked to original sources

PubMed1997

Hepatitis G virus in patients with cryptogenic liver disease undergoing liver transplantation.

To examine the prevalence of hepatitis G virus (HGV) in end-stage liver disease of unknown cause and the role of HGV infection in posttransplantation hepatitis, we studied 46 patients undergoing liver transplantation (mean age, 50 years; M:F, 18:28) with cryptogenic cirrhosis. HGV RNA was detected by polymerase chain reaction (PCR) and was quantified by a branched DNA (bDNA) assay. The prevalence of HGV RNA was determined in samples collected before and after liver transplantation and was found to be 22% and 67%, respectively. We evaluated the prevalence of posttransplantation hepatitis in 25 patients, 16 of whom were HGV-positive and 9 were HGV-negative. The proportion of patients with hepatitis was not significantly different in the two groups (38% in HGV-positive and 22% in HGV-negative patients). The median histological scores were significantly higher in liver biopsies from patients with HGV infection than in those without HGV infection (2 [range, 0-14] and 1 [range, 0-3]; P = .01), but the histological scores were low overall. The duration of follow-up was similar in the two groups. HGV RNA levels were not correlated with the severity of liver disease based on histological score (r = -.08). Graft survival and patient survival were not significantly different. We concluded that liver disease was frequent (32%) after transplantation in patients with a pretransplantation diagnosis of cryptogenic cirrhosis, although the disease was generally mild. Although HGV RNA was demonstrable in the majority (67%) of patients after transplantation, there was no relationship between the presence of HGV RNA and the presence of posttransplantation liver disease. The finding of posttransplantation hepatitis in the absence of known viruses (A-G), suggests that other, as-yet-unidentified viruses may be important.

Adult↗

PubMed1989

[Pulmonary complications and acid-base disorders in liver diseases].

Liver diseases are frequently associated with pulmonary complications and acid-base disorders, alterations which are frequently overlooked and thus undiagnosed in these patients. Among the respiratory abnormalities, mention should be made of the numerous functional and anatomic alterations responsible for arterial desaturation, the frequent chronic hyperventilation and the rare plexiform pulmonary hypertension. Acid-base disorders, especially respiratory alkalosis and metabolic alkalosis, are common. These conditions have a number of therapeutic implications since some of them play an important role in the pathophysiology of hepatic encephalopathy. The complications and their specific diagnostic features are reviewed and some therapeutic proposals are made.

Acid-Base Imbalance↗

PubMed1986

[Hepatic GOT and GPT activities in patients with various liver diseases--especially alcoholic liver disease].

GOT and GPT activities were measured in percutaneous needle biopsy specimens of human liver tissue from 98 cases including normal subjects and patients with various liver diseases. Hepatic GOT activity was markedly decreased in liver tissue of patients with nonalcoholic liver cirrhosis. Hepatic GPT activity was markedly decreased in liver tissue of patients with alcoholic liver cirrhosis. The GOT/GPT ratio in liver tissue was increased in patients with alcoholic liver cirrhosis (5.32 +/- 2.03) and alcoholic liver disease (4.78 +/- 2.43). The increased SGOT/SGPT ratio in patients with alcoholic liver disease is due to primarily to the increased LGOT/LGPT ratio.

Alanine Transaminase↗

PubMed1995

Diagnosis of chronic liver disease from liver scintiscans by fuzzy reasoning.

UNLABELLED: We investigated the possibility that fuzzy reasoning might be used to standardize diagnosis of liver disease based on scintigraphic results and compared the results with those obtained when scintiscans were scored conventionally. METHODS: Seventy-five patients with chronic liver disease (11 patients had chronic persistent hepatitis, 26 had chronic aggressive hepatitis and 38 had cirrhosis) and 25 controls were studied. Another 75 patients with hepatitis or cirrhosis were examined to test the effectiveness of the membership functions. Liver scintiscans were taken 20 min after the intravenous injection of 111 MBq of 99mTc-phytate. Fuzzy reasoning was used to evaluate the following five items: the ratio of the sizes of the left and right lobes, splenomegaly, radioactivity in the bone marrow, deformity of the liver and distribution of radioactivity in the liver. The degree of conformity to each of the three liver diseases being investigated was substituted into the membership function for the conclusion. The center of gravity for each patient's results was calculated. Conventional scoring was made with three levels for each of the five items examined by fuzzy reasoning. RESULTS: Distinctions between chronic persistent hepatitis and chronic aggressive hepatitis were difficult to assess with fuzzy reasoning and conventional scoring. The diagnostic accuracy was 95% for patients with cirrhosis and 88% for patients with chronic hepatitis with fuzzy reasoning. With conventional scoring the accuracy was 86% for patients with cirrhosis and 75% for patients with chronic hepatitis. When fuzzy reasoning was used to examine the other 75 patients with chronic liver diseases, the accuracy was 93% for patients with cirrhosis and 86% for patients with chronic hepatitis. CONCLUSION: The method is simple and can be used routinely in clinical settings.

Adult↗

PubMed1987

Bentiromide test is not affected in patients with small bowel disease or liver disease.

The bentiromide test reliably detects exocrine pancreatic insufficiency. The synthetic peptide attached to p-aminobenzoic acid (PABA) is cleaved by chymotrypsin, PABA is absorbed in the small intestine, partially conjugated in the liver, and excreted in the urine. It has been claimed that the bentiromide test is abnormal not only in patients with pancreatic insufficiency but also in patients with small bowel or liver disease because of impaired PABA absorption or conjugation, respectively. This study prospectively evaluates the bentiromide test in 12 patients with small bowel disease and 18 patients with biopsy-proven liver disease. One of 30 patients had an abnormal bentiromide test. Cumulative 6-h urinary arylamine excretion and plasma PABA concentration, 2 h after administration, were in the same range as healthy controls. We conclude that the bentiromide test is not affected by small bowel or liver disease. An abnormal test is virtually diagnostic for exocrine pancreatic insufficiency.

4-Aminobenzoic Acid↗

PubMed2003

TNF-alpha and growth hormone resistance in patients with chronic liver disease.

Liver cirrhosis is characterized by a severe impairment of the growth hormone/insulin-like growth factor-1 (GH-IGF-1) axis, that is, acquired GH resistance. The condition of the GH-IGF-1 axis in the phase of chronic liver disease (CLD) preceding cirrhosis, however, remains uncertain. The origin of GH resistance during CLD is multifactorial, and to date, the liver functional mass is considered to play a major role. Although proinflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and IL-1beta, were found to be elevated in patients with CLD and were shown to induce a state of GH resistance in other disease models, their involvement in the pathogenesis of GH resistance during CLD has never been investigated. We characterized the GH-IGF-1 axis by analyzing the individual components of the axis (GH, IGF-1, IGF-binding protein-3 [IGFBP-3], acid-labile subunit [ALS]) and the corresponding ratios (GH/IGF-1, GH/IGFBP-3, and GH/ALS) and verified the links with circulating proinflammatory cytokines (TNF-alpha, IL-1beta, and IL-6), in 34 patients with CLD and 12 healthy controls. Evolution of CLD from chronic hepatitis (CH, n = 17) to cirrhosis (CIR, n = 17) was associated with a progressive increase of GH resistance indices (e.g., GH/IGF-1 ratio: controls 0.5 +/- 0.9, CH 15.9 +/- 31.2, p < 0.01 vs. controls; CIR 188.4 +/- 282.7 mU/nmol, p < 0.001 vs. CH and controls), indicating its onset also in the early stages of CLD. The progressive increase in GH resistance indices matched the increase of circulatory TNF-alpha (e.g., TNF-alpha vs. GH/IGF-1, r = 0.54, p < 0.001). A similar trend was found for IL-6 without reaching statistical significance (r = 0.23, p = 0.13). We found undetectable levels of IL-1beta in our sample of patients and controls. We conclude that proinflammatory cytokines play an important role in the pathogenesis of GH resistance in CLD, but TNF-alpha is a major factor. In addition, GH resistance is present in CLD from the early stages. These results could begin new therapeutic lines of attack in the management of CLD.

Adult↗

PubMed1985

Pulmonary aspects of chronic liver disease and liver transplantation.

A vast spectrum of pulmonary pathologic conditions occurs in association with chronic liver diseases, and clinically important manifestations, such as arterial hypoxemia, can result. Both pulmonary vascular and parenchymal abnormalities can contribute to the dysfunction, as evidenced by results of pulmonary function tests and gas exchange studies. The clinical implications of identifying such pulmonary problems range from alleviation of symptoms, especially dyspnea, to comprehensive assessment of patients before and after liver transplantation. Physicians should be aware of these potential pulmonary disorders that can complicate liver disease and liver transplantation so that management of affected patients can be improved.

Chronic Disease↗

PubMed1997

GB virus-C/hepatitis G virus infection in an area endemic for viral hepatitis, chronic liver disease, and liver cancer.

BACKGROUND & AIMS: GB virus-C/hepatitis G virus (GBV-C/HGV) is a newly identified flavivirus, and little is known about its clinical significance. GBV-C/HGV was investigated in different populations, and its coinfection was investigated in patients with liver disease in Taiwan where hepatitis B and C are endemic. METHODS: Viral RNA was studied in 70 high-risk individuals, 20 patients with chronic non-B, non-C hepatitis, 13 with non-A-E fulminant hepatitis, 100 with asymptomatic hepatitis B surface antigen carriage, 120 with hepatitis B surface antigen-positive chronic liver disease and hepatocellular carcinoma, 100 patients with chronic hepatitis C, and 100 healthy adults. RESULTS: GBV-C/HGV infection was more frequent in high-risk groups (15%-30%) and hepatitis C virus carriers (10%) than in healthy adults (1%) and hepatitis B virus carriers (3.2%). Eighty-three percent of those infected had undergone blood transfusions previously. The prevalence in hepatitis B virus carriers increased with the severity of liver disease, being 1% in asymptomatic carriers and 10% in hepatocellular carcinoma. In chronic hepatitis C, clinical and virological data were comparable between those with and without coinfection. CONCLUSIONS: In Taiwan, GBV-C/HGV infection is common in high-risk groups, and its coinfection seems to not aggravate the course of chronic hepatitis B or C.

Adult↗

PubMed1985

[Liver diseases and pregnancy. II: Liver diseases without causal relation to pregnancy--general principles for treatment of patients with liver disease].

In addition to a previous paper [7] a survey is given of acute viral hepatitis, drug-induced liver-disease, chronic hepatitis, cirrhosis of the liver, hyperbilirubinemia, hepatic porphyria, and obstructive jaundice as hepatobiliary diseases independent of pregnancy. Finally, some questions of treatment of pregnant women suffering from liver disease are stressed.

Chemical and Drug Induced Liver Injury↗

PubMed1991

[Autonomic nervous activity in patients with chronic liver disease especially liver cirrhosis].

Fifty three patients with liver cirrhosis and other chronic liver disease were divided into three different groups according to severity (group I: non-cirrhotic group, group II: compensated cirrhotic group, group III: decompensated cirrhotic group) and were studied with regard to their autonomic nervous and general nervous activity. To estimate the patients' autonomic nervous activity, they were examined on the following items: 1) their subjective symptoms, 2) orthostatic dysregulation, 3) coefficient of variation in R-R interval in ECG (CVR-R) at rest, 4) minimum heart rate (MHR) at night, CVR-R at MHR at night, disparity in MHR between day and night (all three of these items measured using the Holter ECG), 5) serum adrenalin, noradrenaline, cyclic AMP, and cyclic GMP. Meanwhile, general nervous activity was evaluated by measuring the reaction time to sound and light stimuli and by performing a number connection test. Cardiac function was also measured using radionuclide angiography to study its relationship to autonomic nervous disturbance in patients with chronic liver disease. The results of autonomic nervous function tests, especially CVR-R at rest, MHR at night, CVR-R at MHR at night and the disparity in MHR between day and night, indicated a marked lowering of autonomic nervous function in group III. In the serological examination, serum noradrenaline. and cyclic GMP levels were significantly higher in groups II and III. The evaluation of general nervous function showed that the reaction time to sound and light stimuli was significantly slower in group III than in group I. The cardiac function test revealed no statistically significant differences between the groups. In conclusion, autonomic nervous disturbance in patients with chronic liver disease seems to increase gradually as the disease progresses and to emerge as a distinct clinical symptom chiefly at the decompensated stage of liver cirrhosis.

Adult↗

PubMed2006

Nonalcoholic fatty liver disease and liver transplantation.

Nonalcoholic fatty liver disease affects a substantial proportion of the general population worldwide. This high prevalence of nonalcoholic fatty liver disease has important consequences in the donor selection process for liver transplantation, and in the posttransplant period given the high recurrence rate of disease. This paper reviews the prevalence of nonalcoholic fatty liver disease, its progressive potential, and the implications of this liver condition in both the pre- and post-liver transplantation setting.

Disease Progression↗

PubMed1994

Haemostasis associated with liver disease and liver transplantation.

The production and regulation of components of haemostasis is largely dependent on liver function. Liver disease is associated with alteration of the coagulant:anticoagulant and fibrinolytic:antifibrinolytic balance as well as quantitative and qualitative alterations of the cellular components of haemostasis. In this article we have reviewed the nature and frequency of disturbed haemostatic function in patients with acute and chronic liver disease and during liver transplantation. The risk of haemorrhage and thrombosis, and mechanisms leading to these complications are reviewed and treatment strategies utilising blood component therapy and pharmacological manipulation of the coagulant and fibrinolytic systems are proposed. Finally, areas for further study are suggested so that rational effective therapeutic strategies can be developed.

Acute Disease↗

PubMed1996

The case for liver transplantation in end-stage alcoholic liver disease.

Liver transplantation is now a routine procedure and is seen as a valid treatment option for end-stage liver disease. Alcoholism has been regarded as a relative or absolute contraindication to liver transplantation in many transplant units. Recent data document a success rate for transplantation in alcoholic patients that equals that in other patient groups. Issues relating to the ethical and scientific arguments surrounding this complex area of treatment are discussed. It is concluded that individual patients should be assessed in their own right for this treatment option. It is argued that patient groups should not be denied access to specific life-saving treatments.

Journal Article↗

PubMedDate not supplied

Oral changes associated with end-stage liver disease and liver transplantation: implications for dental management.

In children, chronic liver disease has a variety of causes; its effects include malnutrition, bleeding tendencies, osteopenia, and rachitic changes in the skeleton. Chronic liver disease in children may have many oral manifestations, such as green staining of the teeth and gingiva, as well as enamel hypoplasia. Dental management may be complicated by many factors, like bleeding tendencies and inability to metabolize routine anesthetics. Patients who undergo increasingly successful liver transplantation require life-long immunosuppressive therapy, which has side-effects. Results of this study of nine patients, seven females and two males, show that the effects of end-stage liver disease are permanently recorded on the teeth. Six were examined both before and after liver transplantation; the other three, only afterwards. This study confirms and extends the findings of three previous reports describing the oral manifestations of congenital biliary atresia in childhood.

Biliary Atresia↗

PubMed1993

Human leukocyte antigen class I-independent pathways may contribute to hepatitis B virus-induced liver disease after liver transplantation.

The proliferative response of peripheral blood lymphocytes to the HBcAg was compared with serological, molecular and immunohistochemical parameters of hepatitis B virus infection and with biochemical and histological parameters of liver disease in a patient who received a completely human leukocyte antigen class I-mismatched liver allograft for fulminant hepatitis. The proliferative response increased progressively after transplantation, as hepatitis B virus infection became reestablished in the hepatic allograft. Strikingly, the HBcAg-specific T cells suddenly disappeared from the peripheral blood immediately before the acute onset of a severe necroinflammatory liver disease in which more than 80% of the hepatocytes expressed HBcAg. These observations are compatible with the hypothesis that human leukocyte antigen class I-independent hepatitis B virus-specific T cells might play a previously unsuspected role in the pathogenesis of hepatitis B virus-induced liver disease.

Adult↗

PubMed1999

Quality of life before and after liver transplantation for cholestatic liver disease.

Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P <.01), 1.16 for function (P <.01), 2.37 for health satisfaction (P <.01), and 1.16 for overall QOL (P <.01). Patients' overall QOL before transplantation was significantly related to subjective and objective health status indicators and clinical factors such as ascites and renal dysfunction. QOL at 1-year follow-up, however, could not be adequately predicted by the pretransplantation subjective health status and clinical factors. Patients with end-stage cholestatic disease undergoing LT experience substantial improvement in all aspects of QOL addressed in this study. The patients' QOL 1 year after LT could not be predicted by pretransplantation variables used in this study.

Adult↗

PubMed1996

Prostaglandins in liver disease and liver transplantation.

This brief review summarizes the physiology and pharmacology of eicosanoids and describes how they have been tested for possible application in liver disease and transplantation. The objective is to trace the stepwise application from the laboratory to the bedside. Although many questions remain to be answered, the observations summarized in this article have opened up new and potentially rewarding prospects in application to liver disease.

Animals↗

PubMed2004

Liver transplantation in the era of model for end-stage liver disease.

Liver transplantation is challenged by organ shortage and prolonged waiting list time. The goal of the ideal organ allocation system is to transplant individuals least likely to survive without a liver transplantation, and maintain appropriate rates of postoperative survival. Currently, liver allocation in the United States is based on the model for end-stage liver disease (MELD). Studies have shown MELD to be objective and accurate in predicting short-term survival in patients with cirrhosis.

Health Care Rationing↗