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Clinical/methodical Issue: Perfusion computed tomography (CT) has its main application in the clinical routine diagnosis of neuroradiological problems., Standard Radiological Methods: Polyphase multi-detector spiral computed tomography is primarily used in liver diagnostics., Methodical Innovations: The use of perfusion CT is also possible for the diagnostics and differentiation of diffuse hepatic diseases., Performance: The differentiation between cirrhosis and cirrhosis-like parenchymal changes is possible. It also helps to detect early stages of malignant tumors., Achievements: However, there are some negative aspects, particularly that of radiation exposure., Practical Recommendations: This paper summarizes the technical basics and possible applications of perfusion CT in cases of diffuse liver disease and weighs up the advantages and disadvantages of the examinations.

A precise staging of the degree of liver fibrosis is important for the estimation of prognosis, surveillance and treatment decision in patients with chronic liver diseases. At present, liver biopsy is still the reference standard for the assessment of liver fibrosis. However, it is an invasive method associated with patient discomfort and in rare cases with serious complications. In addition, the accuracy of liver biopsy is limited due to intra- and interobserver variability and sampling errors. Non-invasive markers and methods for the assessment of liver fibrosis have been intensively evaluated in many studies. The FibroScan (Echosens, France) uses the transient elastography principle for the measurement of liver stiffness. At present (January 2007), studies evaluating the FibroScan in a wide range of liver diseases have been published in 20 full papers and 76 abstracts. The present review gives an overview of the current literature. The best results are reported for the differentiation between cirrhosis and no cirrhosis. With the combination of FibroScan and non-invasive serum fibrosis markers, the accuracy for the diagnosis of significant fibrosis (Metavir F > or = 2) can be further improved. According to recent data the FibroScan can also be useful for the evaluation of treatment response in patients receiving antiviral treatment for chronic hepatitis C. In addition, several studies have shown, that the FibroScan can be applied to estimate the risk of complications associated with liver cirrhosis.

Cross-sectional imaging based on navigation and virtual reality planning tools are well-established in the surgical routine in orthopedic surgery and neurosurgery. In various procedures, they have achieved a significant clinical relevance and efficacy and have enhanced the discipline's resection capabilities. In abdominal surgery, however, these tools have gained little attraction so far. Even with the advantage of fast and high resolution cross-sectional liver and pancreas imaging, it remains unclear whether 3D planning and interactive planning tools might increase precision and safety of liver and pancreas surgery. The inability to simply transfer the methodology from orthopedic or neurosurgery is mainly a result of intraoperative organ movements and shifting and corresponding technical difficulties in the on-line applicability of presurgical cross sectional imaging data. For the interactive planning of liver surgery, three systems partly exist in daily routine: HepaVision2 (MeVis GmbH, Bremen), LiverLive (Navidez Ltd, Slovenia) and OrgaNicer (German Cancer Research Center, Heidelberg). All these systems have realized a half- or full-automatic liver-segmentation procedure to visualize liver segments, vessel trees, resected volumes or critical residual organ volumes, either for preoperative planning or intraoperative visualization. Acquisition of data is mainly based on computed tomography. Three-dimensional navigation for intraoperative surgical guidance with ultrasound is part of the clinical testing. There are only few reports about the transfer of the visualization of the pancreas, probably caused by the difficulties with the segmentation routine due to inflammation or organ-exceeding tumor growth. With this paper, we like to evaluate and demonstrate the present status of software planning tools and pathways for future pre- and intraoperative resection planning in liver and pancreas surgery.

The present paper tried to find relations between specific anamnesis of wild raptors and blood chemistry values at their day of presentation. 60 (88%) of 68 presented birds of prey showed changes in their blood values. In most birds an increase of GOT, GPT and AP was seen. Some birds showed increases of uric acid, urea and changes in the relation of Ca and P as well. A comparison between Eurasian buzzards with fractures and some without clinical signs showed a significant increase of uric acid, urea, potassium and inorganic phosphorus in the group of fractured birds. Changes of blood chemistry values after liver biopsy are investigated in the second part of the present study. Liver- and kidney values showed an increase after the biopsy. Kestrels (Falco tinnunculus) showed the maximum of the increase at the first day after biopsy while Eurasian buzzards (Buteo buteo) had the maximum at the third and Black kites (Milvus migrans) at the fifth day after biopsy.

This paper demonstrates the possibility of improving the spatial depth impression of colour-coded three-dimensional reconstructions by modulation of colour saturation. Patients were observed with spiral computed tomography (slice thickness 10 mm, table feed 10 mm/s, reconstruction of overlapping axial images at 2 mm increment). Interesting anatomical and pathological objects (vessels, organs, tumours, metastases) were segmented, colour-coded, and reconstructed three-dimensionally. Spatial depth impression of the coloured objects could be improved by modulating not only the brightness, but also the colour saturation.

The influence of thyroxine, estradiol and testosterone on the triacylglycerol (TG) secretion rate out of the liver into the blood as well as on concentrations of FFA, triglycerides, and glucose in serum was determined. All of these experiments were carried out under different nutritional conditions (non-fasting, and 10 or 16 h fasting, respectively). Accordingly the results after hormone application were compared with three groups of controls. Within these control groups increasing time of fasting caused exclusively an enhancement of FFA concentrations, while the TG secretion rate and other parameters were not influenced. Concerning all hormones effects on several lipid parameters have been observed. In particular, a decrease of FFA concentrations in comparison with controls after 16 h fasting was evident. In these cases, the TG secretion rate and TG concentration in serum were simultaneously lowered. Both alterations may be a consequence of a diminished mobilization of FFA in adipose tissue. Increases of FFA concentrations in serum after hormone application, compared with the corresponding controls, only occurred after administration of thyroxine and testosterone, while changes of the TG secretion rate and the TG concentration in serum were scarcely observed. Final remarks about the actual influence of hormones on the investigated parameters, especially TG secretion rate were drawn including results of a previous paper, where catecholamines, insulin, and prednisolone had been tested under the same conditions.

This paper deals with cellular-physiological changes in regard to adaptative problems in the pig. As an example for lysosomal catabolism, beta-glucuronidase activity in liver tissue of pigs with different constitution is presented. Male slaughter pigs (n = 120), equally distributed on the breeds Piétrain, German Large White and German Landrace, are used for the investigation. The results show significant variances between, as well as within the breeds. Partly high significant, positive correlations exist between beta-glucuronidase activity and survival rates. The importance of beta-glucuronidase activity and the lysosomes for adaptative constitution and development in the pig is discussed.

Reported in this paper are autopsy findings recorded from a boy who had died at the age of eight month. They included a spongy dystrophic tissue syndrome of the central nervous system associated with diffuse fatty degeneration of the liver. The case is considered to be in the category of glioneuronal dystrophy and is discussed under aspects of differential diagnosis.

Frequency-dependent attenuation of sound is considered a characteristic parameter of the interaction between sound and tissue and has been studied particularly in the liver via many different techniques. Due to the relatively wide scatter of the measured single values, especially in pathological liver samples, a clinically feasible application of the procedure has not yet been found. In the present paper, the suitability of the frequency-dependent coefficient of sound attenuation for tissue characterization with comparable experimental conditions in vitro was tested in a statistically representative collection of histologically defined tissue specimens of rat liver. Several statistical procedures were used (cluster analysis, discrimination analysis). Normal livers can be usually distinguished from pathological specimens by means of the frequency-dependent coefficient of sound attenuation with only slight scatter of the individual values. Although the latter differ on the average from normal specimens, they diverge considerably in respect of single values resulting in significant differences only in case of extensive tissue damage (cirrhosis). On the basis of tissue classifications in clinical and pathological use, only a rough tissue differentiation is possible. By using additional parameters of the interaction between sound and tissue, sonographic differentiation of pathologically changed tissue my be improved.

This paper reports on investigations of the formation of PGI2 and TXA2 using their stabile products 6-keto-PGF1 alpha and TXB2 (RIA) in liver biopsy specimens of 46 patients suffering from fatty liver (n = 19), chronic hepatitis B (n = 11), liver cirrhosis (n = 13), and miscellaneous diseases (n = 3). The measured formation rates in chronic liver disease were evaluated in comparison to a reference group (n = 19) consisting of minimal liver lesions. The 6-keto-PGF1 alpha formation correlating to the degree of the portal inflammation in the liver (morphometric evaluation). The same trend existed in relation to the intralobular inflammation. The results presented suggest in respect of analogous data in animal experiments that PGI2 is predominantly generated in mesenchymal cells of the liver and, presumably influences the course of liver diseases.

Copyright of Die Gastroenterologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A reaction of the RES with its organs (lymph nodes, spleen, bone marrow and Kupffer's cells) is not uncommon in rheumatoid arthritis. Although these manifestations are pronounced in Felty's syndrome, reviewing articles about Felty's do not mention liver manifestations. This paper summarises the publications about liver findings in Felty's syndrome. Hepatomegaly, abnormal bromsulfalein tests, raised alkaline phosphatase and transaminases have been stated in many case reports. Among 34 patients, the frequency of hepatomegaly was 68%, of abnormal bromsulfalein tests 27%, of alkaline phosphatase 23% and of transaminases 18%, respectively (52). Alkaline phosphatase and transaminases were raised in almost all of 12 patients (3). The histological correspondence is an infiltration with lymphocytes of sinusoids and portal fields, a portal fibrosis and occasionally a cirrhosis. These histological abnormalities, as well as enlarged lymph nodes and splenomegaly, have to be considered as organic manifestations of rheumatoid arthritis. If the nodular regenerative hyperplasia of the liver, which has been reported also after use of contraceptives, is a manifestation of Felty's syndrome, remains unresolved.

As a result of the ability to examine successive biopsy specimens, the process of progression of liver damage resulting from ethanol abuse is well appreciated. The ten most important tissue and cellular changes are described in the present paper. The staging system promulgated by the author since 1977 is reviewed: 1) Alcohol-induced liver damage without fibrosis, 2) Alcoholic hepatopathy with fibrosis, 3) Alcoholic hepatopathy with cirrhosis. Staging by this system provides clinically valuable prognostic information. Women with stage 1 changes have a two to threefold liklihood of advancing to stage 3 than do men with the same degree of initial damage.

On the basis of the authors personal experience of 155 liver resections, including 79 anatomical and 76 atypical ones, the paper presents various aspects of indications, choice of procedure and of various technical measures. The author demonstrates the indisputable advantages of anatomic liver resections over the atypic ones, since they permitted to increase the range of surgical aid to the liver patients.

The paper presents histophotometrical measurements of the histochemical SDH reaction with INT as redoxindicator in comparison with biochemical techniques of the determination of SDH activity (with K3[Fe(CN)6] and INT as indicators) and a histochemical method of elution (with INT as indicator). The measurements were performed on liver of mice. For each method absolute values of activity (10(-9) mol substrat/min-mg liver) are calculated as relative values of activity [%]. The standard deviation of the biochemical methods is approximate +/- 4%, of the histochemical methods +/- 8%. The smallest value of detection is 2.5-10(-14) mol formazan of histophotometrical measurement. The correspondence between the measurements of the relative values of activity by the described methods was secured by statistical tests. A statistically significant proportion of activities between periportal zone and central zone like 100:82 was determinated by histophotometrical measurement.

20 fertile women who were treated with mestranol as oestrogen and both gestagenes chlormadinonacetate and norethisteronacetate were investigated. Alkaline phosphatase, ASAT, ALAT, alpha-amylase, cholesterol, bilirubin, serumproteins, indocyanine green half time, paper electrophoresis of serumproteins, thymol and zinc sulfate turbidity tests were examined during the first therapy cycle. Elevation of ALAT activity (6,3 I U/l to 12,14 u/l) was found during treatment with mestranol/chlormadinonacetate. A depression of ALAT (up to 5,34 u/l) was observed under additional therapy with gestagene chlormadinonacetate. Statistical significance was noted only for ALAT and alpha 1 globuline under sequential therapy with mestranol/norethisteronacetate.

In recent literature numerous papers have been published concerning the accuracy of scintigraphic detection of liver metastases. Unfortunately however, the problem of false positive results is not particularly discussed in these papers. Because of the lack of information it was our aim to compare our own scintigraphic results with postmortem histopathological findings. Our investigations were carried out in 139 patients with various types of malignancy. Included in the investigations were 20 patients with primary liver tumor. The interval between scintigraphic examination and the histological verification ranged from 3 days to 1 year. In 62 of the patients with liver metastases, histopathology revealed liver metastases, while 77 patients showed no liver involvement. We arrived at the correct diagnosis "liver metastasis" in 50 out of 62 patients (80.6%). False negative scintigrams (19.4%) were found in most of the respective cases when diffuse malignant involvement such as leukemia and Hodgkin's disease was present, and also when the size of the metastases was less than 2 cm in diameter. Fifty six out of 77 patients (72.7%) without histopathological evidence of liver metastases revealed negative scintigrams. Twenty one (27.3%) false positive scintigrams were mostly due to (diffuse) nonmalignant disease e.g. fibrosis and cirrhosis. The overall accuracy of liver scintigraphy in our study was 76.2%. In 18 of 20 (90%) patients with focal liver disease correct diagnosis was established. 7 patients with benign liver tumors and 11 of 13 patients with hepatocellular carcinoma showed focal defects. Considering the fact that liver scintigraphy is a non-invasive procedure, it can be recommended as screening method. In connection with sonography and computer tomography liver scintigraphy can undoubtedly improve the diagnostic accuracy in detecting liver metastases and primary liver tumors.

Described in this paper is a technique for the determination of pyruvate carboxylase and phosphoenolpyruvate carboxykinase, two key enzymes of gluconeogenesis in swine liver. The technique is based on measurement of radioactively labelled carbon incorporated in the common metabolite, oxalacetate. The optimum measuring conditions to establish the enzymes in liver homogenate and supernatant are reported and compared with data given by other authors. The found parameters of kinetic properties were in good agreement with the findings obtained from purified enzymes from swine liver.

Adverse drug side effects of the antihypertensive substance dihydralazine have been increasingly observed in recent years. Damage is concentrated on the liver and is characterized by drug-induced hepatitis with confluent necrosis. Three cases (60 year old woman, 79 year old woman, 61 year old man) with lethal course after antihypertensive treatment, using dihydralazine are reported in this paper.

In the present paper measurements of DNA and protein content and lysosomal enzyme (beta-glucuronidase, beta-acetylglucosaminidase, cathepsin D) acitivities were performed in the rat liver following partial hepatectomy. The rats were divided into three age groups: 6 weeks, 10 months and 18 months. The regenerating liver of the 6 week and 10 month old animals disclosed significant higher concentrations of DNA than the controls. The 18 month old rats revealed no differences of the DNA content. In all age groups the protein content of the regenerating liver was significant diminished. There were age dependent differences of the activities of the three lysosomal enzymes. In comparison to the controls the beta-glucuronidase activity of the regenerating liver was significantly decreased in the 6 week and 18 month old animals, but significantly increased in the 10 month old rats. Refering to the protein content there were no differences of the activities of beta-acetylglucosaminidase and cathepsin D between the regenerating and control livers. Refering to the liver fresh weight the beta-acetylglucosaminidase activity of the regenerating liver was significant diminished in the 10 and 18 month old rats.

The paper describes the immunohistochemical demonstration of complement component C 4 in a case of pseudoglandular transformation of liver cells caused probably by viral hepatitis. C 4 could be found first of all in the lumen of dilated bile canaliculi (in position with "bile thrombi"), further in the cytoplasm of hepatocytes and Kupffer cells, on their plasma membranes, in the sinusoids, and in necrosis. Probably, these observations indicate a disturbance of the synthesis and catabolic mechanisms of complement and/or of immune complexes. The findings so far support the hypothesis that the pseudoglandular transformation of liver cells is the vain attempt of the liver to eliminate or sequestrate of own or foreign material, e.g. immune complexes.

Schemes of the lipid and the pyruvate metabolism serve to show that a great part of the enzymes which intervence in the metabolic pathways and are associated with the formation and the consumption of acetyl coenzyme A may be regulated by cyclic 3',5'-adenosine monophosphate (cAMP) in the sense of activation or inhibition. The cAMP increase in the liver, which has been demonstrated in the present study for a diet containing 25% of fat, opens the metabolic pathway to the formation of acetyl coenzyme A by means of fatty acid degradation and simultaneous inhibition of lipogenesis. The deficiency of insulin (which has been evidenced in previous paper) characterizes, together with the facts mentioned, a state like diabetes or the fasting state. Acetyl coenzyme A is mainly used for energy supply. The close negative correlation between cAMP and acetyl coenzyme A (which is shown in the present paper) permits to conclude that the extent and trend of the increase and decrease in the liver is subjected to intensive hormonal control in which cAMP in involved.

According to electron microscopic investigations, there is no uniform substratum and no uniform formal pathogenesis in the light microscopic appearance of globular hyalin bodies in the liver. This paper presents a survey on the different electron microscopic equivalents of the light microscopic findings of globular hyalin bodies in human liver biopsies. These electron microscopic equivalents, their occurrence, their different pathogenesis and, resulting from this, their different diagnostic and prognostic significance are described and demonstrated in detail.

Reactions in the connective tissue metabolism are of considerable importance in the pathophysiological process of diseases. It is from this aspect that new findings in chronic liver diseases are reported in the present paper. A report is given on cellular and extracellular pathological changes in connective tissue functions. Diagnostic and pharmacological methods undergoing continued development for controlling and influencing liver fibrosis are discussed.

The paper presents information about the fine structure of the sinusoids, the space of Dissé, the development of the bile canaliculi and some compartments of the hepatocytes in the liver of the carp. The sinusoids are covered completely by flat endothel cells. The plasma of these cells contains numerous vesicles. The endothelial cells possess plasmatic processes, which extend into the space of Dissé. The fine structure of the space of Dissé corresponds to that of mammals, the existence of fibrebundles included. The bile canaliculi don't develop intracellularly as described by other authors. They run intercellularly as in mammals, but they form diverticles which reach into the plasma sideways. The rough ER was found in two types. Outwardly the liver is limited by a layer of connective tissue existing in two different layers.

The paper analyses the findings of a CT study of 21 lesions of focal nodular hyperplasia in 17 patients. In addition to subjective valuatin of the dynamic studies, densitometric measurements on a time basis were carried out (gamma-fit curves) and a density profile was obtained. These tumour-like lesions show typical density changes with rapid enhancement in the arterial phase and rapid fall in density after one or two minutes. Various patterns of the hyperdense lesions (non-homogeneous, those resembling vessels or homogeneous lesions) may be of significance in differential diagnosis. Atypical density patterns were found particularly in foci projecting from the liver.

30 young healthy women were investigated during the first therapy cycle with ethinyl-estradiol-norethisterone acetate and ethinyl-estradiol-chlormadinone acetate as a sequential regime. The following laboratory data were achieved by each of the investigated group of young women: serum aminotransferase (GOT and GPT), serum alkaline phosphatase and alpha-amylase-activity in serum, serum proteins, serum cholesterol, serum bilirubin, serum ZST, serum TTT and the indocyaningreen-clearance of the liver. The serum protein pattern was determined by the paper electrophoretic method. A significant decrease of the aminotransferase GPT was viable during the sequential therapy with ethinyl-estradiol and norethisterone acetate. This viable decrease of the GPT was induced through the application of norethisterone acetate to estrogen. The alkaline phosphatase was significant lightly lower and the beta-globuline lightly elevated at the end of the therapy cycle. The sequential therapy with ethinyl-estradiol and chlormadinone acetate induced only a significant increase of the ZST in serum.

In the present paper, 66 Studies on exploratory laparotomy with splenectomy in Hodgkin's lymphoma from Western Europe and the USA are presented in tables. This statistical compilation on 7183 laparotomies shows that the spleen was involved in 39.9% (2685 out of 6900 cases investigated), the liver in only 7.7% (446 out of 5789) and the abdominal lymph nodes were involved in 30.3% (1389 out of 4578) of the cases. Altogether, laparotomy with splenectomy led to a change in staging in 33% of the patients (1892 out of 5745). In the period from 1970 to 1986, 123 patients with Hodgkin's lymphoma were laparotomized (and also splenectomied apart from one exception) at the Surgical Division, University of Göttingen. The patients comprised 52 cases in the context of primary staging and 71 cases in the context of secondary staging. In 43 cases (35.2%) the spleen was affected, in seven cases (5.7%) the liver was affected, and there was combination with spleen involvement in each case. Infiltration of abdominal lymph nodes was shown in 38.2% (26/68). Exploratory laparotomy led to a change in stage in 46 cases (37.1%) comprising 28 improvements and 18 deteriorations. Before laparotomy, 15 patients were in stage I, 29 in stage II, 44 in stage III and 21 in stage IV. After pathological staging, 14 were in stage I, 40 were in stage II, 47 were in stage II and 19 were in stage IV. Out of the 14 patients who could not be assigned to any stage before the operation, 11 could be definitively staged afterwards. In addition, lymphography was performed in 103 patients, liver and spleen scintigraphy in 51 patients, sonography in 30 patients and computer tomography in 22 patients. In the re-examination of the lymph node situation in the retroperitoneal space, lymphography attained a specificity of 48% and a sensitivity of 71.4% with a positive prediction precision of 35.7% and a negative prediction precision of 88.8%.

In the present paper is reported on the behavior of different serochemical parameters in heterologous perfusion of the liver of pigs. The perfusion of the animal livers was carried out with preserved human blood in 11 recirculation experiments (closed machine circulations). In addition to this an empty circulation with human blood without attachment to an animal liver was carried out, whereby otherwise the arrangement of the experiment was the same, in order to take into consideration the effects of the blood traumatisation in the interpretation of the results. The enzymes GOT and LAP proved as sensible indicators of the lesion of the liver cells occurring in the perfusion of the liver of the pigs. The behavior of the mitochondrial GDH as well as of the lysosomal enzymes SP and BETA-GC which scarcely increased during the recirculations in the perfusate blood, however, allows the conclusion that there did not appear a severe lesion of the liver cells (necrobiosis) during several hours of perfusion. A cholestasis did not develop during the perfusions, when one takes as basis the behavior of the enzymes AP, GGTP and AAP indicating cholestasis. Compared with GOT the enzyme GPT showed by far less elevations in the perfusate blood so that with increasing duration of the perfusion the De-Ritis-quotient significantly increased. Increased LDH-activities above all revealed the increasing during perfusion haemolysis and less reliably a lesion of the liver of the pig. The increase of ADA in the perfusate blood proved as nearly exclusively conditioned by haemolysis. Total protein, albumins, immunoglobulins, cholinesterase and thymol turbidity test remained unchanged in the course of the perfusions.

Unlabelled: Problemacy: In an earlier paper we have reported the influence of adrenalectomy on DNA-synthesis in rat liver and found that during the first 2 days the incorporation of H3 thymidine is elevated). (DESSER-WIEST 1974). Therefore we have examined the DNA-synthesis in regenerating live of rats with and without adrenals., Material and Methods: 300 g male rats were adrenalectomized and 14 days later 2/3 hepatectomized. One group of animals were bled and the concentration of corticosterone in serum was determined by a radioprotein-binding method (SPATH and JOZAN 1972). The other group of animals were injected with H3thymidine at 9 a.m. All animals were killed between 10:00 a.m. and 10:15 a.m. The incorporation of H3thymidine was determined by the method of BURTON (1969). In adrenalectomized animals, the onset of liver regeneration was found to be retarded for 18 hours, the maximum of DNA-synthesis was depressed., Results: The corticosterone concentration of the serum was 17,8 mug/100 ml serum in contro animals and was undetectable in animals during the first and second day after adrenalectomy, thereafter the steroid level increased. A third of the amount found in control animals was found 14 days after operation. Partial hepatectomy, caused an increase of the corticosterone level in serum of animals with and without adrenals. In castrated and adrenalectomized animals no corticosterone in serum was found. The importance of corticosterone for liver regeneration is discussed.

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