Search

Albumin appears to reduce the risk of kidney failure and death in patients with liver cirrhosis and spontaneous bacterial peritonitis. Albumin is a plasma protein used to expand the blood volume. Researchers compared 126 patients with the liver disease and the abdominal infection treated with antibiotics and albumin, or antibiotics alone. The infection resolved in almost every patient. Kidney failure developed in 10% of the patients who received albumin and 33% of the patients given only antibiotics. Death was nearly twice as common among patients given only antibiotics, compared to those given antibiotics and albumin.

US and Spanish emergency room admissions for injury and noninjury problems were compared on the predictive value of breath-analyzer readings, drinking prior to the event, feeling drunk at the time of the event, drinking patterns, alcohol-related problems and demographic characteristics. Results showed that quantity and frequency of drinking, time and place of injury and feeling drunk at the time of the event were predictive of alcohol-related injuries in California. On the other hand, drinking patterns were less predictive of alcohol-related injury in Spain.

The accumulation of fluid in the abdominal cavity can be a debilitating consequence of liver cirrhosis. Although not common among cirrhosis patients, this condition, called ascites, may involve the accumulation of four or five gallons of ascites fluid. In many hospitals, this condition is treated with a peritoneovenous shunt, which provides a pathway for this excess fluid to return to the blood, and, ultimately, be removed by the kidneys. Recently, however, several studies have shown that paracentesis is a safe, rapid, and effective method for relieving ascites. Paracentesis is the direct removal of the fluid; it is generally accompanied by the infusion of additional albumin, a blood protein, into the patient's blood. A study was conducted to compare peritoneovenous shunting and paracentesis and determine which is most suitable for the treatment of this condition. A total of 89 patients with ascites were randomly assigned to receive one or the other treatment. Nine of 41 patients receiving paracentesis developed complications as did 15 of the 48 patients undergoing the shunt procedure. Three patients in the paracentesis group and six in the shunt group died during the initial hospitalization. The differences in complications and in deaths were not statistically significant. The ascites fluid was successfully removed in all 41 paracentesis patients and in 44 of the 48 shunt patients. There were no differences between the two groups in the value of the initial treatment. However, it was found that the patients who underwent paracentesis were more likely to be rehospitalized and require rehospitalization sooner than those who received a shunt. Overall, however, the need for hospitalization and patient survival were not significantly different between the two groups. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hepatocellular carcinoma (HCC), the most common type of liver cancer, can be difficult to diagnose since its symptoms are often similar to those of liver cirrhosis (a chronic, degenerative liver disease), with which it is often associated. Thus, a method of identifying patients with HCC at an early stage is needed. It is possible that the presence of severe diarrhea is an indicator of this disorder. To determine whether this is the case, 23 consecutive cirrhosis patients known to have HCC, and the same number of control subjects (cirrhosis patients without HCC), were questioned regarding the appearance of diarrhea during the three months before hospital admission. Diarrhea was defined as the occurrence of three or more loose stools per day, over a period of at least three consecutive days. Tumor size and differentiation (extent of malignant change) among the HCC patients were also evaluated. Results showed that 11 of the HCC patients (47.8 percent) had at least one episode of diarrhea, while only two control patients (8.7 percent) reported diarrhea. Eight HCC patients had either chronic or repeated episodes of diarrhea. HCC patients with diarrhea had higher alkaline phosphatase and bilirubin levels (substances in the blood that reflect liver functioning) than those without diarrhea, as well as poorer overall liver function. However, they were not different with respect to tumor size or differentiation. Thus, it appears that diarrhea is frequently associated with HCC in patients with liver cirrhosis, and that clinicians should be alert to the appearance of loose stools in their patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Altered leukocyte/cytokine response to inflammation has been observed in human and experimental portal hypertension. The aim of this study was to characterize leukocyte adhesion in portal hypertensive (PPVL) rats stimulated with endotoxin. Leukocyte rolling, adhesion, and migration assessed by intravital microscopy were impaired in mesenteric venules after lipo-polysaccharide administration (150 [micro]g/kg) in PPVL vs. sham-operated rats. Analysis of leukocyte L-selectin expression and soluble L-selectin showed that this defective adhesion was related to increased L-selectin shedding. In vitro experiments using isolated leukocytes treated with phorbol 12-myristate 13-acetate showed that monocytes and neutrophils but not lymphocytes were hyperreactive to cell activation, as measured by CD11b overexpression and increased L-selectin shedding in PPVL rats. However, neutrophil emigration in liver sinusoids and in the lung 3 h after endotoxin injection were similar in both groups of animals. Thus the alterations in leukocyte activation and adhesion molecule expression observed in this study may contribute to a better understanding of the higher susceptibility and severity of bacterial infections in cirrhotic patients with portal hypertension. portal hypertension; sepsis; L-selectin; cirrhosis; adhesion molecules

Hepatocellular carcinoma (HCC, liver cancer) is a prevalent form of liver disease, particularly in the Far East and Central Africa, which is fatal if not treated. Early detection is critical to the implementation of a successful therapeutic program. Currently, ultrasound and blood chemistry (alpha-fetoprotein levels) are used to diagnose HCC. Fine-needle aspiration biopsy (FNAB), a technique in which tiny amounts of liver tissue are removed with a very long, thin needle, is easy, harmless, and has been shown to be very sensitive (between 70 and 100 percent accurate) in the diagnosis of other types of tumors. FNAB was performed on 72 patients seen over the course of a year for suspected liver disorders, and the biopsy specimens were microscopically evaluated. Final diagnosis of HCC was made with standard diagnostic tools, as well as surgical exploration and autopsy results. Fifty-eight of these patients were ultimately diagnosed with HCC; the remainder had a variety of unrelated liver ailments, including benign tumors and nodular and fatty infiltration of the liver. Only 69 percent of the FNAB procedures allowed diagnosis of HCC. Using this method, 97 percent of the patients with positive results were confirmed to have HCC; only 40 percent of those patients with negative results actually did not have HCC. These findings indicate that FNAB is a useful diagnostic technique for patients with HCC, but the large proportion of tests yielding false negative results demonstrate that the diagnostic accuracy of the procedure must be improved. (Consumer Summary produced by Reliance Medical Information, Inc.)