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Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor worldwide and the third leading cause of cancer-related death. Despite the significant progress that has been achieved with local therapies, treatment remains limited by impaired liver function and high rate of recurrence. The purpose of the manuscript is to describe the current status of using living donor liver transplantation in patients with advanced HCC.

The study was aimed to investigate insulin resistance development in drug-susceptible newly diagnosed pulmonary tuberculosis patients. Those patients who developed insulin resistance during the 30 days of antitubercular therapy have expressed metabolic changes, that may be associated with impaired liver function due to the toxic effects of antitubercular drugs.

In the last few years, immunotherapy has become part of everyday clinical practice for the treatment of many solid tumors including metastatic non-small-cell lung cancer. These drugs, however, can yield a specific toxicity profile that consists of immune-related adverse events (irAEs). Hepatotoxicity is one of irAEs and occurs in about 1-3% of cases and may be manifested by the presence of increate levels of liver enzymes (aspartate aminotransferase, alanine aminotransferase) and/or biliary stasis evidence; in these cases, a differential diagnosis with other hepatic diseases must be considered. We present the case of a 73-year-old man who presented with an alteration in liver function during treatment with pembrolizumab (anti-programmed death 1 monoclonal antibody) for a stage IV nonsquamous non-small-cell lung cancer, which was initially mistaken for drug-induced irAEs hepatic toxicity.

Background and objectives Portal vein embolization (PVE) is a safe and effective procedure used to increase the safety of extensive hepatectomy for selected patients. However, it is unknown whether PVE is safe for patients with impaired liver functional reserve. Methods Patients who underwent PVE from April 2007 to September 2016 in our hospital were retrospectively assessed. According to indocyanine green retention rate at 15 min (ICG-R15), we divided patients into Group A (≤10%), Group B (10%-20%), and Group C (>20%). We described and compared the treatment course and the outcome among the three groups. Results A total of 106 patients were assessed and divided into groups A (n = 46), B (n = 49), and C (n = 11). The morbidity and mortality after PVE showed no significant differences among the three groups (A:B:C = 37%:53%:64%, p = .16; A:B:C = 0%:0%:0%, p = 1.00, respectively). The morbidity and mortality after successive hepatectomy also showed no significant differences among the three groups (A:B:C = 55%:71%:78%, p = .19; A:B:C = 0%:2%:0%, p = 1.00, respectively). Conclusion A patient with impaired liver functional reserve (ICG-R15 > 20%) can be a candidate for PVE and successive hepatectomy, as safely as a patient with normal and slightly impaired liver functional reserve (ICG-R15 ≤ 20%).

Background Several inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the prognostic value of the prognostic nutritional index (PNI) in HCC patients who underwent hepatectomy with special attention to preoperative liver functional reserve. Methods Preoperative demographic and tumor-related factors were analyzed in 189 patients with HCC undergoing initial hepatectomy from August 2005 to May 2016 to identify significant prognostic factors. Results Multivariate analysis for overall survival (OS) revealed that female sex (p = 0.005), tumor size (p Conclusions PNI was an independent prognostic factor for HCC patients who underwent hepatectomy. Patients with PNI lower than 37 were at high risk for early recurrence and poor patient survival, especially in the patients with preserved liver function of LHL ≥ 0.9.

Portal vein embolization (PVE) was developed for patients with insufficient future liver remnant volume and function and has gained relevant support worldwide before major hepatectomy. However, the efficacy of preoperative PVE for hepatocellular carcinoma (HCC) patients with impaired liver function remains uncertain. Ninety-seven HCC patients who were scheduled for PVE followed by hepatectomy were enrolled in this study. Their short- and long-term outcomes were investigated, according to the liver damage classification defined by the Liver Cancer Study Group of Japan. Of 97 patients who underwent preoperative PVE, 30 (32.4%) could not undergo subsequent hepatectomy. Dropout rate from treatment strategy was significantly higher in patients with liver damage B (n = 13, 61.5%) than in those with liver damage A (n = 84, 26.2%) (P = 0.014). Among the 67 patients who underwent planned hepatectomy after PVE, 53 were categorized to liver damage A, and 14 were categorized to liver damage B at the point of hepatectomy. Although major complication and mortality rates were comparable between the two groups, the cumulative overall survival (OS) and disease-free survival (DFS) after hepatectomy were markedly worse in patients with liver damage B than in those with liver damage A (5-year OS rate: 23.1% vs 74.6%, P = 0.014, 5-year DFS rate: 7.8% vs 33.5%, P = 0.054, respectively). The treatment strategy of PVE followed by hepatectomy might be a contraindication for HCC patients with impaired liver function categorized as liver damage B because of the higher dropout rate and poorer long-term outcomes after hepatectomy.

Background: Impaired liver function in LC (Liver Cirrhosis) can cause Zinc deficiency (Zn). One of the causes of Zn deficiency in LC is decreased albumin synthesis, whereas albumin is required as the main Zn binding protein in plasma. However, some studies of the severity of LC with Zn serum levels still provide controversial results. Objective: To determine the association between the degree of LC severity and Zn serum level. Methods: The subjects of this study were LC patients in Gastroentero-Hepatology Unit and In ternal medicine wards in of Dr. Soetomo General Hospital Surabaya for three months. Diagnosis of LC was based on clinical examination according to Soehardjno- S oebandiri criteria and other findings (ultrasound or endoscopy). The degree of LC severity was determined based on the CTP score (Child-Turcotte-Pugh). Serum Zn concentration was measured by atomic absorption spectrophotometry method. The research design used the cross-sectional method. The statistical test used was Spearman correlation. Results: Forty-three patients fulfilled the study criteria. The subjects consisted of 27 males (62.8%) and 16 females (37.2%) with the mean age of 53.81 ± 8.67 years. Based on the CTP scores, we obtained CTP A of 4 patients (9.3%), CTP B of 19 patients (44.2%) and CTP C of 20 patients (46.5%). The mean of Zn serum level in CTP A, CT P B, and CT P C score was 58.3 ± 19.6 μg/dl, 43.4 ± 14.5 μg/dl and 31.6 ± 10 μg/dl respectively. The result of the statistical test showed a significant correlation between LC severity and Zn serum level (p

Background The present study aimed to assess the clinical features of patients who received lenvatinib treatment for unresectable hepatocellular carcinoma (HCC). Methods The clinical characteristics, adverse events, and radiological responses were evaluated for 51 consecutive patients. Results Of the study subjects, 37 patients had Child–Pugh class A (CPA) liver function, and 14 patients had Child–Pugh class B (CPB) liver function. The overall response rates in the CPA and CPB groups were 42.9% and 25.0%, respectively, and disease control rates were 82.9% and 83.3%, respectively, without significant difference (p = 0.2621 and 0.9697). There was no significant difference between CPA and CPB groups regarding the incidence of adverse events, except for hepatic coma. No significant difference was observed in the relative dose intensity between the CPA and CPB groups, for the first month, 1–2 months, or 2–3 months (p = 0.2368, 0.9368, and 0.9293). Conclusion The comparable outcomes between the CPA and CPB groups suggest the acceptability of lenvatinib treatment in patients with impaired liver function, at least in the acute phase. With careful follow-up, the dose can be relatively intensified, even in patients with impaired liver function and this may contribute to offering comparable treatment.

Vitamin D plays an important role in the pathogenesis of chronic hepatitis B (CHB) through regulating immune response. This study aimed to determine the relationship between vitamin D levels and impaired liver function in CHB patients. This was an observational analytical study conducted from March to October 2019. We included 36 CHB patients aged 38.31±12.98 years and consisted of 16 men and 20 women. Vitamin D levels were measured by enzyme-linked immune assay (ELISA) method while albumin and bilirubin levels were examined by colorimetric assay. Vitamin D levels were in normal limits in 80.6% and insufficiency/deficiency in 19.4% of CHB patients. ALBI ratio scores were good in 75% and moderate-poor in 25% of subjects. Furthermore, there was no significant association between vitamin D levels and the ALBI ratio. In conclusion, this study shows that there is no relationship between plasma vitamin D levels and impaired liver function in CHB patients.

In this study an android-based application was produced that can provide dietary information and knowledge to patients with diabetes mellitus, heart, maag, kidney, and impaired heart function deisease, that for healthy living does not have to be expensive. The habit of consuming liquor, consuming fast food, and rarely doing physical activities is the cause. Diet is the first initial method recommended by doctors to patients. Eating patterns with the right menu, exercise and adequate and regular rest can help the patient’s recovery. Based on 50 questionnaires distributed and returned by patients, 42 of the total 50 patients who went on a diet within 1 month routinely felt a very good recovery in their bodies.

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus and impaired liver function. The objective of the study was to evaluate maternal liver elasticity by acoustic radiation force impulse (ARFI) elastosonography in ICP and to compare it with that in healthy pregnant women. This descriptive, case–control study consisted of 33 women with healthy pregnancies and 22 women with ICP in the third trimester of gestation. Maternal liver elasticity measurements were performed by ARFI elastosonography. The maternal characteristics and perinatal outcomes of the participants were also collected. All maternal liver ARFI elastosonography scores were elevated in women with ICP compared to healthy controls (p = 0.015, p = 0.011, and p = 0.004, respectively). There was a significant positive correlation between maternal liver enzymes and ARFI elastosonography scores (r = 0.404, p = 0.002 and r = 0.389, p = 0.003, respectively). The optimal cut-off point of maternal liver ARFI-mean elastography score to identify the risk of ICP was >1.23 m/s, and the sensitivity and specificity were 68.2 and 69.7%, respectively [area under curve (AUC) 0.731, 95% confidence interval (CI) 0.594–0.869). The current study found that maternal liver stiffness measured by ARFI elastosonography was increased in pregnancies complicated with ICP.

Background: It has been reported that anatomical resection of the liver may be preferred for primary hepatocellular carcinoma (HCC), and is at least recommended for systematic removal of a segment confined by tumor-bearing portal tributaries. However, nonanatomical resection (NAR) is often selected because of the patient's background, impairment of liver function, and tumor factors. The aims of the present study were to retrospectively compare the recurrence-free survival (RFS) rates for cases of partial resection (PR) and for small anatomical resection (SAR), which is regarded as NAR for primary HCC with impaired liver function. Patients and Methods: So-called NAR was performed for a primary and solitary (≤ 5cm) HCC in 47 patients; the patients were classified into PR (n=25) and SAR (n=22) groups. Clinicopathological factors, survival data, and recurrence patterns were compared between groups. Results: There were no significant differences in the preoperative characteristics between the two groups. Operative time was significantly longer in the SAR group than in the PR group. There was no significant difference in the postoperative morbidity and tumor pathological characteristics between the two groups. The RFS of the SAR group was significantly better than those of the PR group. Although there was no significant difference in the pattern of recurrence between the two groups, the rate of intrahepatic recurrence in the same segment as the initial tumor tended to be higher in the PR group than in the SAR group. Multivariate analysis revealed that only the PR operative procedure was significant independent risk factor for poorer RFS. Conclusion: Compared with PR, SAR effectively improves the rate of RFS after surgery for a primary and solitary HCC with impaired liver function.

Hepatobiliary scintigraphy (HBS) is an emerging tool in the assessment of hepatic function. This nuclear imaging technique can be used to calculate both global and regional liver function. It has proven to be the most reliable way of assessing the distribution of liver function, especially in patients with impaired liver function due to, for example, cirrhosis or after chemotherapy. There are two types of tracers: Technetium-99m with a type of iminodiacetic acid and Technetium-99m galactosyl human serum albumin. The main indication for HBS is the assessment of the future liver remnant function in patients scheduled to undergo hemihepatectomy; to predict the risk of posthepatectomy liver failure. Another upcoming indication is the use of HBS in patients undergoing radioembolization.

Background and Aim The outcomes of sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and impaired liver function remain unresolved. Although Child–Pugh (CP) classification is widely used for patient categorization, heterogeneity within a given CP class makes outcomes less predictable. The aim was to investigate the prognostic significance of CP score elements on the outcome of sorafenib in patients with advanced HCC and impaired liver function. Methods Of 1385 consecutive patients with advanced HCC in our center between January 2007 and December 2010, we reviewed the medical records of 325 patients who received sorafenib monotherapy. Results Median duration of sorafenib was 2.0 months (range 0.4–24.2) and median follow-up was 4.9 months (range 0.5–43.4). Disease control rates were significantly higher in CP class A (CPA) than in CP class B (CPB) patients. Median overall survival (OS) was 5.8 months. Subgroups with different CP scores showed significantly different OS (months): CPA5, 8.4; CPA6, 5.1; CPB7, 3.5; CPB8–9, 2.6 (P

Background Preoperative neoadjuvant therapy for colorectal liver metastases (CRLM) is increasing in use and can lead to chemotherapy-induced damage to sinusoidal integrity, namely sinusoidal obstruction syndrome (SOS). SOS has been associated with an increased need for intraoperative blood transfusions, increased length of hospitalization post-surgery, decreased tumor response, and a shorter overall survival after resection due to liver insufficiency. It is critical for clinicians and pathologists to be aware of this type of liver injury, and for pathologists to include the status of the background, non-neoplastic liver parenchyma in their pathology reports. In this study, expression of CD34 by sinusoidal endothelial cells (SECs), increased expression of smooth muscle actin (SMA) by hepatic stellate cells (HSCs), and aberrant expression of glutamine synthetase (GS) by noncentrizonal hepatocytes were semiquantitatively evaluated in liver resection or biopsy specimens from patients with CRLM to determine their diagnostic value for assessing chemotherapy-induced sinusoidal injury (CSI). Methods The expression of each marker was compared among 22 patients with CRLM with histologically evident SOS (SOS+) and 8 patients with CRLM who had not undergone chemotherapy. Each case was given a histologic grade using the sinusoidal obstruction syndrome index score (SOS-I) to assess the likelihood of SOS. Cases were also given an immunohistochemical grade using the total CSI score calculated as the sum of CD34, SMA, and GS scores. Results Abnormal staining patterns for CD34 and SMA were significantly more frequent and extensive in SOS+ cases than in the controls (81.8% vs. 25%, P

Sorafenib, a receptor tyrosine kinase-inhibitor with anti-proliferative and anti-angiogenic activity, is currently the only approved systemic treatment for patients with hepatocellular carcinoma. It inhibits downstream signaling of VEGFR-2, PDGFR, c-Kit receptors and BRAF. Over the last four years comprehensive experience with sorafenib in this indication has been accumulated. In this review we discuss the current data on the use of sorafenib in patients with advanced HCC including special patient populations such as patients with impaired liver function, patients after transplantation, and others. The most frequent side-effects and practical tips on how to manage them are discussed in detail. In addition, we summarize the current experimental data on the use of sorafenib in combination treatment, e. g., together with transarterial chemoembolisation or other targeted agents.

To identify patients with hemophilia who have a high risk of postoperative hemorrhagic complications.Prospective trial included 69 patients aged 18-71 years (median 29) with congenital hemophilia A and B. They underwent elective and emergency treatment for abdominal and thoracic pathology at the National Medical Research Center for Hematology in 2011-2016. Patients with mild and inhibitory forms of hemophilia were compared with those with severe and moderate forms of hemophilia. There were 50 (73%) patients with severe and moderate forms of hemophilia, 8 (11%) with inhibitory and 11 (16%) patients with mild form. Emergency operations were performed in 18 cases, elective - in 51.Inhibitory form of hemophilia is associated with 1.5 times higher (95% CI, 1.1-3.0) risk of hemorrhagic postoperative complications and death and 3,5 times higher (95% CI 1.7-5.9) risk of redo surgery compared with severe and moderate forms (p0.05). Risk of hemorrhagic postoperative complications is also higher in patients with mild form of hemophilia compared with severe and moderate forms (1/6 vs. 1/50; p=0.05).The risk of postoperative hemorrhagic complications is significantly higher in inhibitory and mild hemophilia compared with severe and moderate forms and associated with hemostatic therapy defects and inadequate assessment of hemostatic disorders. Long-standing haemorrhagic syndrome should be followed by blood clotting system analysis including evaluation of procoagulant activity, presence of inhibitor, and thromboelastography. Decreased levels of albumin (by 2.9-8.6% in our trial) and cholesterol (by 6.5-54.8%) reflects impaired liver function and is sign of unfavorable prognosis. This finding should be considered for surgery and therapy of hemorrhagic manifestations.Цель исследования - определить больных гемофилией, требующих особого внимания при выполнении хирургического вмешательства из-за высокого риска послеоперационных геморрагических осложнений. Материал и методы. В проспективное сравнительное исследование включили 69 больных врожденной гемофилией А и В в возрасте от 18 лет до 71 года, медиана 29 лет, прооперированных в плановом и экстренном порядке по поводу патологии брюшной полости и грудной клетки в Национальном медицинском исследовательском центре гематологии за период с 2011 по 2016 г. Группы больных легкой (n=11; 16%) и ингибиторной (n=8; 11%) формами гемофилии сравнили с группой больных тяжелой и среднетяжелой формами гемофилии (n=50; 73%). Результаты. Установлено, что риск геморрагического послеоперационного осложнения и летального исхода для больного ингибиторной формой гемофилии по сравнению с больными тяжелой и среднетяжелой формами в 1,5 раза выше (95% ДИ 1,1-3), а риск повторной операции - в 3,5 раза выше (95% ДИ 1,7-5,9) (р0,05). При легкой форме гемофилии по сравнению с тяжелой и среднетяжелой формами риск геморрагического послеоперационного осложнения также выше (1/6 против 1/50; р=0,05). Заключение. Риск послеоперационных геморрагических осложнений при ингибиторной и легкой формах гемофилии статистически значимо выше, чем при тяжелой и среднетяжелой формах, и связан с дефектами гемостатической терапии при ингибиторной форме и неадекватной оценкой состояния гемостаза при легкой форме. При наличии у пациента длительного геморрагического синдрома необходимо проведение анализа показателей системы свертывания крови, включающего оценку прокоагулянтной активности факторов свертывания, наличия ингибитора и тромбоэластографию. Сочетание снижения в крови уровней альбумина (в нашем исследовании на 2,9-8,6%) и холестерина (на 6,5-54,8%) отражает исходное тяжелое нарушение белково-синтетической функции печени, является признаком неблагоприятного прогноза при осуществлении гемостаза у больных гемофилией и должно учитываться при выполнении хирургического вмешательства и терапии геморрагических проявлений.

Acute hyperammonaemia is a medical emergency. Most cases are resulted from severely impaired liver function but some cases of non-hepatic causes do occur. In patients with unexplained altered conscious state, immediate measurement of plasma ammonia level is a simple but important step in early diagnosis of hyperammonaemia and prompt reduction of ammonia level to minimise permanent brain damage. We reported a case of recurrent hyperammonaemia and cerebral dysfunction due to urinary tract infection with urinary retention in a patient without underlying liver disease.

Malignant Liver Tumors – Early Detection and Local Treatment Hepatocellular carcinoma (HCC) is one of the five most common malignancies world-wide. In the Western world, it is predominantly found in patients with cirrhosis. The prognosis of untreated HCC is poor. In patients with overt symptoms of HCC, mean survival does not exceed 3–6 months. Surgical resection and orthotopic liver transplantation are the current options for curative treatment. Unfortunately, most lesions are not amenable to surgical treatment because of tumor size and location, impaired liver function, and co-morbidity. Therefore, early diagnosis of HCC is crucial, especially in populations at high risk. If a surgical option does no longer exist, local ablative therapies such as transarterial chemoembolization, percutaneous ethanol injection and radiofrequency ablation are alternatives. Until now, systemic drug treatment failed to prove its effectiveness or, much like octreotide and thymostimulin, is still in the phase of clinical testing.

We have already reported the safety and efficacy of laparotomic microwave coagulation therapy (LMCT) for the patients of hepatocellular carcinoma (HCC) with impaired liver function. The aim of this study is to evaluate less invasiveness of laparoscopic assisted microwave assisted microwave coagulation therapy (LAMCT) compared with LMCT.Method : 18 patients of HCC with poor hepatic reserve underwent since April, 2001. 7 patients received LAMCT (LA group) and 11 patient received LMCT (L group). Clinical data ware analyzed before and after surgery in 18 patients.Results : Operative time, blood loss during surgery, and hospitalization were significant less in the LA group than those in the L group. No significant differences between the groups were recognized after surgery in regard to changes in the time course of levels of liver function (AST, ALT, Total bilirubin, Prothrombin time, and Albumin). The changes in the time course of levels of WBC and CRP, as postoperative inflammatory indicators, in the LA group were significantly lower than those in the L group (pLAMCT might be useful treatment mordality for the patient of HCC with poor liver function, whose tumor number is not multiple and tumor size is 3cm or less, and further more, tumor location is not adjacent to Glissonn's sheath.

La ictericia es un problema muy frecuente en las unidades de recién nacidos. En este documento se presenta el caso de un neonato que cursó con hiperbilirrubinemia, inicialmente con predominio de la bilirrubina indirecta y posteriormente con anemia, hepatomegalia, aumento de la bilirrubina directa, alteración de la función hepática, disfunción tubular renal, cataratas y lesiones en la sustancia blanca del SNC. Se descartaron diversas causas de hiperbilirrubinemia directa en el neonato. Se encontró positiva una prueba de azúcares reductores en orina que resultó ser galactosa en la cromatografía en capa fina. Se documentó marcada reducción de la actividad enzimática de galactosa uridil transferasa, con lo cual se confirmó el diagnóstico de galactosemia. Se suspendió la alimentación con leche materna, se inició leche de soya con resolución del cuadro clínico.

Amiodarone is a class III antiarrhythmic drug used in dogs with dilated cardiomyopathy and ventricular tachyarrhythmias. Hepatopathy is one of the more commonly reported adverse effects of amiodarone use in people. We describe 4 dogs that developed hepatopathy associated with amiodarone administration; 2 dogs also developed neutropenia. Three dogs had clinical signs of anorexia and lethargy; 1 did not show signs until impaired liver function had developed. Clinical signs or biochemical abnormalities developed 1.5-8 months after amiodarone treatment was started. Clinical signs resolved within 2 weeks of discontinuing amiodarone, but biochemical abnormalities did not resolve for 6-8 weeks. The delay between onset of liver disease and overt clinical signs suggests that serial evaluation of liver enzyme activities following amiodarone use in does is important.

Background: Primary liver tumors or liver metastases may be either irresectable, or only resectable at high risk because of their local relation to important vascular structures (hilum of liver, venous confluens, V. cava).

We successfully saved a patient's life who developed severe hyperbilirubinemia after choledochotomy by treating according to hepatic failure and by closing an external fistula. A 53-year-old man was pointed out having gallstone when he was treated for hepatitis type C on an ambulant basis. HCV antibody was positive. On and after 4th hospital day, an increase in direct type dominant T-Bilirubin and increased and diluted exudate from a T-tube were observed. According to the treatment for postoperative hepatic failure. G.I. treatment was started, the T-tube was clamped, and eventually T-Bilirubin gradually decreased. We sometimes experience that a large quantity of diluted bile juice is exuded from an external fistula in cases of impaired liver function or cirrhosis, but we are not able to find courage to perform the internal fistulization at present. It is thought that internal fistulization of external biliary fistula with make bile acid increase, an increase in endotoxin inhibit, the hepatic blood flow increase, and the relief of obstructive jaundice stimulate. When a case of hyperbillirubinemia exuding a large quantity of diluted bile juice from an enternal fistula is encountered, we can expect to accelerate the relief of obstructive jaundice by clamping of the T-tube. This procedure appears to be worth to try before plasma exchange.

A patient with a progressive liver disease whose job involved substantial exposure to 1,1,1-trichloroethane (TCE) was seen. A comprehensive work-up ruled out nonoccupational etiologies for his liver condition. Neither the patient's history nor his liver histology suggested alcoholic cirrhosis. Removal of the patient from exposure to TCE led to significant improvement of his impaired liver function over a 3-month period. We conclude that this was a case of occupational liver disease induced by chronic exposure to TCE. This report joins other reports concerning hepatotoxicity of TCE which is considered the least toxic among the halogenated hydrocarbon solvents.

Hepatocellular adenomas are rare benign liver neoplasms that commonly occur in women with a history of oral contraceptives intake for more than 2 years. Hepatic adenomatosis is characterized by the presence of multiple adenomas, arbitrarily > than 10, involving both lobes of the liver, without any history of steroid therapy or glycogen storage disease. Although the adenomas in liver adenomatosis are histologically similar to other adenomas, liver adenomatosis appears to be a separate clinical entity. Adenomas in hepatic adenomatosis may be of the inflammatory, hepatocyte nuclear factor 1alpha-mutated, or beta-catenin-mutated subtype, and accordingly show variable imaging appearances. Hepatic adenomatosis carries the risk of impaired liver function, hemorrhage and malignant degeneration. We report a case with the inflammatory subtype of hepatic adenomatosis in a 39-year-old woman with liver steatosis. The magnetic resonance imaging features using extracellular gadolinium chelates and hepatocytetargeted contrast agents are described.

Background : There is evidence that cognitive functions are affected by some liver diseases such as cholestasis. Bile duct ligation induces cholestasis as a result of impaired liver function and cognition. This research investigates the effect of cholestasis progression on memory function in bile duct ligation rats. Materials and Methods: Male Wistar rats were randomly divided into five groups, which include: control group for BDL-7, control group for BDL-21, sham group (underwent laparotomy without bile duct ligation), BDL-7 group (7 days after bile duct ligation), and BDL-21 group (21 days after bile duct ligation). Step-through passive avoidance test was employed to examine memory function. In all groups, short-term (7 days after foot shock) and long-term memories (21 days after foot shock) were assessed. Results: Our results showed that liver function significantly decreased with cholestasis progression (P < 0.01). Also our findings indicated BDL-21 significantly impaired acquisition time (P < 0.05). Memory retrieval impaired 7 (P < 0.05) and 21 days (P < 0.001) after foot shock in BDL-7 and BDL-21 groups, respectively. Conclusion: Based on these findings, liver function altered in cholestasis and memory (short-term and long-term memory) impaired with cholestasis progression in bile duct ligation rats. Further studies are needed to better insight the nature of progression of brain damage in cholestatic disease.

e14527 Background: 70-90% of patients with HCC suffer from liver cirrhosis. A high proportion present with impaired liver function which is critical for the selection of treatment. Locoregional the...

Purpose: Though major hepatic resections including hemihepatectomy, trisectionectomy, and central bisectionectomy are most commonly employed for small (＜5 ㎝) hepatocellular carcinoma (HCC), limited hepatic resection is indicated in some HCC patients with impaired liver function, poor physical condition, or tumors peripherally located. We compared the clinicopathological features and long-term survival between the patients who underwent major resection and limited resection. Methods: From January 1998 to May 2007, 223 patients who underwent hepatic resection for small HCC were enrolled. 123 patients underwent limited resection and 100 patients underwent major resection. Clinocopathologic features, overall, and disease-free survival were compared between both groups. Results: The limited resection group had lower mean serum albumin levels (3.86±0.41 vs. 4.11±3.61, P＜0.0001) and higher mean ICG R15 (12.66±0.87 vs. 7.51±4.33, P＜0.0001). Patients with esophageal varix and liver cirrhosis were more common in the limited resection group (34.1% and 73.1% versus 9% and 45% respectively). Morbidity and mortality were not different in both groups. Overall 1-, 3-, 5-year survivals in both limited resection and major resection groups were 89.4%, 77.3%, 43.8% and 87.8%, 76.5%, 62.1% respectively (P=0.161) and 1-, 3-, 5-year disease free survivals were 80.2%, 50.2%, 38.6% and 79.9%, 63.2%, 50.4% respectively (P=0.10). Conclusion: Despite indifference of overall and disease-free 5-year survival rates between limited and major resection groups, careful follow up is essential to detect late recurrence in the limited resection group, since limited resection tends to have more frequent recurrence, especially 2 years after surgery.

A study designed to correlate clinical and pharmacologic observations was undertaken in 96 patients treated with adriamycin. The basic dosage schedule was 60 mg/m2 I.V. q 3 weeks. Pharmacokinetic studies showed a prolonged plasma half-life, low urinary excretion, and undetectable levels in CSF. Patients with significantly impaired liver function had marked elevation and prolongation of plasma drug levels associated with severe toxicity unless dosage was reduced by 50-7596. Of the 82 evaluable patients, 10/25 with sarcomas, 9/31 with carcinomas, and 15/26 with hematologic malignancies have achieved complete or partial remission. An additional 22/48 have improved. Six patients with solid tumors had progressive CNS disease while responding systemically. Adriamycin can he used with relative safety and high efficacy in a dosage schedule that resulted from pharmacologic studies. Dosage reduction in patients with liver disease is essential to avoid life-threatening toxicity.

Hepatic angiography was performed in a double-blind two-group study in 60 patients using iohexol 350 mg I/ml and ***metrizoate 350 mg I/ml. A slight increase in serum values of hepatic enzymes was found when metrizoate was used, particularly in patients with impaired liver function. Iohexol gave considerably less pain and sensation of heat than did metrizoate. A non-expected significant increase of creatine kinase was recorded when iohexol was used. The reason for this is not yet known.

To determine the effect of impaired liver function on conversion of prednisone to prednisolone, and to investigate the relationship of this to responses to treatment with prednisone, we measured serum prednisone and prednisolone by radioimmunoassay after 10 mg of prednisone was given by vein to 10 healthy volunteers, 6 untreated patients with severe chronic active liver disease (CALD), 10 patients with prednisoneinduced remission of CALD, and 3 patients with CALD deteriorating despite treatment with prednisone. Prednisone disappearance was comparable in all groups and substantial values for serum prednisolone appeared in all groups within 0.3 hr. Minor differences between the groups included lower than normal serum prednisolone in severe CALD and treatment failure; a higher percentage of nonprotein bound prednisolone in such patients; and an association between earlier treatment with prednisone and an increased disappearance rate of prednisolone. We conclude that no major defect of prednisone metabolism occurs in CALD and that failure of this condition to respond to therapy with prednisone is caused by other factors.

Fourteen patients with liver cirrhosis received oral prednisone or prednisolone (0.3 mg per kg) randomised on two consecutive days. Serum prednisone and prednisolone were measured over the following four hours. Mean serum prednisolone concentration after oral prednisone decreased with impaired liver function estimated by galactose elimination capacity (r = 0.64, P less than 0.03). Mean serum prednisolone concentration after oral prednisone in the seven patients with severely impaired liver function was only 53% (P less than 0.05) of that observed in the seven patients with slightly impaired liver function. Conversely, mean serum prednisone concentration after oral prednisone in the patients with severely impaired liver function was 74% higher (P = 0.05) than in patients with slightly impaired liver function. Mean serum prednisolone after oral prednisolone was independent of liver function. As only prednisolone exerts glucocorticoid activity, our results indicate that prednisolone should be preferred to prednisone in the treatment of patients with impaired liver function.

SUMMARY Using the multiple indicator dilution approach, events occurring in the microvascular bed can be characterized and are compatible with the two kinds of anatomical alterations in cirrhotic livers: capillarization and intrahepatic shunts. The combination of these two kinds of alteration contributes to the progressive limitation of the blood-liver exchange. The decreased ability of the liver to clear endogenous and exogenous substrates in cirrhosis is generally thought to result from a reduction of liver cell mass and/or function. Our data suggest that abnormalities in the hepatic uptake of these substrates may also contribute to the impaired liver function in cirrhosis. Capillarization of the hepatic sinusoid is of particular importance in the overall process of elimination while intrahepatic shunts, when present, further exacerbate the functional effects of capillarization.

Fifty-one offender drink drivers with impaired liver function tests, were extracted from a total population of drivers attending a driver assessment clinic (DAC) in 1982. A clinical profile is presented of these drink drivers who could be considered at risk for the development of alcohol related cirrhosis of the liver.

In a consecutive series of patients with acute cholecystitis, hepatic function was studied with the sulfobromophthalein test. In more than 75 per cent of the patients, pathological retention values were found. Liver function impairment occurred more frequently in male than in female patients. In patients with impaired liver function the effect of conservative treatment was compared with that of early operation. The patients were randomly assigned to either treatment and the sulfobromophthalein test was repeated at regular intervals until normal values were found. Comparison of both treatment groups led to the conclusion that normalization of liver function, as measured with the sulfobromophthalein test, takes place more slowly in patients receiving conservative therapy. In the controversy between early operation and conservative treatment for patients with acute cholecystitis this result is considered an argument in favor of early operation.

The influence of amino acids in the physiologic process of clot retraction and evidence pointing to impaired liver function in essential thrombocytopenic purpura have been presented. Methionine is more effective than cystine in controlling spontaneous bleeding and in restoring clot retraction in the acute form of essential thrombocytopenic purpura. The beneficial effects of the oral administration of methionine with regard to control of spontaneous bleeding and restoration of clot retraction have been definitely established and are of inestimable value in the management of both the acute and chronic stages of the disease. The use of methionine in this disease lends comforting support to the surgeon, preparatory to splenectomy.

Summary In 20 cases of infectious mononucleosis without jaundice 16 were found to have definitely impaired liver function as determined by the cephalincholesterol flocculation and the bromsulfalein excretion tests. Of the remaining 4 cases, 2 had possible, and 2 had no evidence of liver involvement but liver function tests were too infrequent to exclude liver disease. Including this series, abnormal liver function now has been recorded in 115 of 123 cases of infectious mononucleosis without jaundice. The liver dysfunction has been attributed to an acute hepatitis.

1. 1. The isoiodeikon liver function test, as an index of postoperative morbidity in operations on the biliary tract, has been observed in a group of 75 cases of cholecystectomy. 2. 2. No constant relation has been discovered between the findings of this test and the postoperative course in the cases observed. 3. 3. The test corresponds roughly to the icterus index findings and to the observed condition of the liver at operation, particularly where the variations from normal are marked. 4. 4. It is suggested that postoperative deaths from liver storm in some cases, where the various tests do not suggest greatly impaired liver function, may be due to other factors; possibly to surgical trauma.

Clinical and roentgenological evidence of a rather high incidence of gall bladder disease in pernicious anemia is presented. Intravenous cholecystography performed on 58 patients, revealed gall bladder dysfunction in 13 (22.5%). The roentgenologic impression was supported by clinical criteria in 10 of these 13 patients. Although 31% of the patients studied showed delayed absorption from the blood stream of the dye, phenol-tetraiod-phthalein sodium, the presence of impaired liver function was not confirmed by clinical findings or by the subsequent course of the patients’ illnesses. There was an apparent association between delayed absorption of the dye and reactions, characterized by chills and fever, following its injection. Persistence of gastro-intestinal symptoms in persons suffering with pernicious anemia, after remission has been induced, strongly suggests the presence of gall bladder disease. In pernicious anemia chronic disease of the gall bladder may modify seriously the expected response to anti-anemic therapy.

Hepatic dysfunction is a multisystem disorder, for the liver is an organ whose proper functioning is vital for the function of the whole body. The functional reserve capacity of the liver is enormous. If only 10% of normal liver tissue is left after a major partial hepatic resection in humans, this is sufficient to sustain life, in addition to which full regeneration of the liver mass occurs after four months [1]. However despite this massive functional reserve, surgery performed on patients with severe liver disease is associated with a high mortality [see chapter 10.1].

Summary The occurrence of jaundice in four patients in a group of 50 with pulmonary tuberculosis treated with 600 mg rifampicin and 300 mg isoniazid daily is reported. In one case, resumption of treatment after jaundice had disappeared provoked its re-appearance: an ethambutol-isoniazid regimen was then substituted, and progress was subsequently uneventful. In two cases, after jaundice had disappeared and liver function tests had returned to normal the rifampicin-isoniazid regimen was reinstituted: serum transaminase levels became elevated but eventually returned to normal. In the remaining case rifampicin-isoniazid treatment was continued despite the occurrence of jaundice: jaundice subsequently disappeared and liver function tests became normal. The daily dose of rifampicin varied from 7·6 mg per kg to 14 mg per kg bodyweight. Although none of these patients was seriously ill, evidence of hepato-toxicity should be looked for in patients treated with rifampicin, and especially in those who may initially have impaired liver function.

A patient undergoing partial hepatectomy subsequent to trauma was maintained post-operatively on a specifically tailored total parenteral nutrition regimen. This, despite obviously impaired liver function, allowed adequate nutrition without the expected adverse metabolic sequelae associated with hepatic resection and nitrogen loading. The patient also demonstrated, in the absence of normal hepatic tissue, an ameliorated metabolic response to trauma.

SummaryPlasma urokinase antigen levels were studied in 78 patients suffering from liver diseases. Blood was drawn before any specific medication was initiated. Impairment of liver function was comparable in all patients. In both groups of cirrhotic liver disease (alcoholic and non-alcoholic), normal levels of plasma urokinase antigen were found as compared to age-matched control groups. In both groups of patients with hepatomas (with or without a history of liver cirrhosis), however, significantly increased plasma urokinase antigen levels could be determined. These data indicate that an increase in plasma urokinase antigen might rather relate to malignant growth in liver disease than to impaired liver function.

Biliscopin® has been reported to be well tolerated and effective as an IV cholegraphic agent (Taenzer & Volkhardt, 1979; Doran et al, 1979, 1980a). This has been confirmed by pharmacokinetic investigations in man (Doran et al, 1980b; Doran & Bell, 1980) and even in patients with impaired liver function (Doran et al, 1978). These studies were performed almost exclusively at a dose level of 5 g iodine or even higher. On the other hand, it should be easier to judge the efficiency of a cholegraphic agent at a lower dosage.