Higher AST Levels Research Articles

Anatomical versus Non-anatomical Resection for Hepatocellular Carcinoma with Microscope Vascular Invasion: A Propensity Score Matching Analysis.

Background: The benefits of anatomical resection (AR) and non-anatomical resection (NAR) on hepatocellular carcinoma (HCC) patients with microscope vascular invasion (MVI) remain unknown. We aimed to investigate the prognostic outcomes of AR and NAR for HCC patients with MVI.Study Design: A total of 362 consecutive HCC patients diagnosed with MVI after hepatic resection between February 2005 and December 2013 were included in this study. The patient outcomes were compared, and a 1:2 propensity score matching (PSM) analysis was applied to eliminate selection bias.Results: Before PSM, compared to the NAR group, the AR group contained more patients that exceeded the Milan criteria, with larger, unilobar tumors and higher AST levels. After PSM, 100 patients were classified into the propensity-matched AR group (PS-AR), while 170 were classified into the propensity-matched NAR group (PS-NAR). Baseline data, including liver function and tumor burden measurements, were similar in the matched groups. The respective 1-, 3- and 5-year overall survival (OS) rates were 78.9%, 56.9%, and 51.5% in the PS-AR group and 76.2%, 53.0%, and 42.4% in the PS-NAR group (P = 0.301). The 1-, 3- and 5-year disease-free survival (DFS) rates were 51.1%, 44.7% and 42.0% in the PS-AR group and 44.9%, 34.3% and 26.4% in the PS-NAR group, respectively (P = 0.039). Multivariate analysis identified AR (P=0.025) as an independent favorable prognostic factor for DFS in HCC patients with MVI.Conclusions: Anatomical resection was superior to non-anatomical resection for improving DFS in hepatocellular carcinoma patients with microscope vascular invasion.

Impact of Soymilk on Productive and Biochemical performances as well as Economic indices of Two Commercial Broiler Breeds

A study was conducted to determine the effect of soymilk in the drinking water of broilers on their growth performance, carcass traits, blood parameters, kidney and liver functions and economic indices. A total number of 40 one day old chicks from two different breeds (20 Cobb 500 and 20 Avian 48) were randomly assigned to four equal groups, control without treatment and the other with soymilk for each breed. The obtained results revealed that there was no significant difference between the two breeds in the studied parameters except Cobb 500 breed had higher AST level than Avian 48. Regarding to the effect of treatment and the interactions, treated groups from both breeds had improved growth performance traits including final body weight, weight gain, feed conversion ratio and carcass traits, while decreased feed consumption. Also supplementation of soy milk elevated blood proteins, and reduced blood lipid profile. Kidney and liver function parameters significantly increased by supplementation of soymilk in treated groups except in creatinine level not significantly affected. Finally, considering the obtained results, it was observed that using soymilk for broilers resulted in a significant decrease in production costs and increase profitability. In conclusion, our results suggest that the inclusion soymilk in drinking water of broilers in 17-20, 27-30 and 37-40 days of age could have positive effects on the productivity and lipid profile, as well as on the profitability.

A case of irregular high spots on contrast-enhanced ultrasound image of high level of AST and ALT due to anti-PD-1 antibody

A case of irregular high spots on contrast-enhanced ultrasound image of high level of AST and ALT due to anti-PD-1 antibody

Clinical disparity of elevated serum alanine aminotransferase (ALT) levels among the working population of Taipei, Taiwan

Purpose: To explore sex variations in the prevalence and factors of high serum alanine aminotransferase (ALT) level among the working population in Taipei, Taiwan.Methods: This study included 8,351 healthy adults (5,247 men and 3,104 women) who admitted to a teaching hospital voluntarily for a physical examination in 2009. The definitions of occupations include computer and mathematical occupations, architecture and engineering occupations, community and social service occupations, sales and related occupations, office and administrative support occupations, and production occupations. The age distribution of $\leq$ 29 yrs, 30-39 yrs, 40-49 yrs, and $\geq$ 50 yrs were 22.5\%, 36.8\%, 23.5\%, and 17.2\%, respectively. Fasting blood samples were drawn using venipuncture and participants were interviewed with a structured questionnaire.Results: The overall prevalence of high serum ALT level ($\geq $ 40 U/L) was 17.1\%. After stratified the data according to age into four age groups ($\leq$ 29yrs, 30-39 yrs, 40-49 yrs, and $\geq$ 50 yrs) , the men participants revealed a higher prevalence of high serum ALT levels for all age groups than the women participants. Bases on multiple logistic regression models, for the men, the significant factors were associated with high serum ALT level and included age (OR = 0.96, 95\% CI: 0.95-097), BMI [no matter whether overweight (OR = 2.45, 95\% CI: 1.99-3.02) or obese (OR = 4.02, 95\% CI: 3.22-5.03)], hypercholesterolemia (yes vs. no, OR = 1.25, 95\% CI: 1.05-1.48), hypertriglyceridemia (OR = 1.25, 95\% CI: 1.04-1.50), high FPG levels (OR = 1.48, 95\% CI: 1.05-2.09), high AST levels (OR = 26.71, 95\% CI: 19.00-37.54), hyperuricemia (OR = 1.48, 95\% CI: 1.25-1.76), high ALP levels (OR = 1.20, 95\% CI: 1.00-1.45), and high glutamic acid transaminase levels (OR = 4.31, 95\% CI: 3.61-5.14). For the women subjects, the statistically significant factors that were associated with high serum ALT level included BMI [no matter whether overweight (OR = 3.53, 95\% CI: 1.87-6.67) or obese (OR = 4.32, 95\% CI: 2.26-8.23)], high AST levels (yes vs. no, OR = 38.49, 95\% CI: 21.45-49.28), high BUN levels (yes vs. no, OR = 1.66, 95\% CI: 1.03-2.29), and high glutamic acid transaminase levels (yes vs. no, OR = 9.87, 95\% CI: 5.79-16.83).Conclusion: In conclusion, the clinical problem of elevated serum ALT level is important in the working population. Many subjects are asymptomatic and the diagnosis of high serum ALT level should be considered with sex, age, hyperuricemia, high AST levels, high ALP levels, high glutamic acid transaminase levels, and metabolic risk factors in mind.

Aminotransferase levels, body mass index, and the risk of diabetes: a prospective cohort study

PurposeTo investigate whether the relationship between body mass index (BMI) and incident diabetes is modified by different alanine or aspartate aminotransferases (ALT or AST) levels. MethodsWe carried out an analysis of 6484 participants aged 40 years or older using data from the Korean Genome Epidemiology Study. The serum aminotransferase levels were stratified into low and high groups according to the median values and classified into three groups: both low, either high, and both high. To assess the association between BMI and incident diabetes according to the serum aminotransferase levels, multiple logistic regression models were used. ResultsIn participants with high levels of both ALT and AST, compared with the first BMI quartile, the adjusted odds ratios for incident diabetes of the second, third, and fourth BMI quartiles were 1.72 (95% confidence interval, 0.84–3.55), 2.19 (1.11–4.33), and 3.08 (1.60–5.90), respectively (P trend < .001). In participants with either high ALT or AST, the adjusted odds ratios were 3.58 (1.23–10.41), 2.65 (0.90–7.76), and 5.28 (1.86–15.02), respectively (P trend = .005). However, in participants with both low ALT and AST levels, high BMI was not independently associated with the risk of incident diabetes. ConclusionsThere was a strong association between BMI and incident diabetes among individuals with high aminotransferase levels, whereas no association was observed among those with low aminotransferase levels.

CORRELATION AMONG THREE NON-INVASIVE METHODS (APRI, FIB-4 AND TRANSIENT ELASTOGRAPHY) TO EVALUATE LIVER FUNCTION AND STIFFNESS IN PATIENTS WITH VIRAL HEPATITIS C OR SCHISTOSOMIASIS MANSONI

Both chronic viral hepatitis and schistosomiasis are potentially serious causes of liver fibrosis.Several studies suggest, however, that hepatic fibrosis may be reversible, which highlights the importance, not only of early diagnosis, but, above all, observing this while monitoring the disease. This study aimed to evaluate the correlation between three non-invasive methods for classification of hepatic fibrosis in patients with viral hepatitis or schistosomiasis. The sample consisted of 45 patients with chronic hepatitis with HCV and 17 with schistosomiasis.Medical records were analyzed for data collection related to sex, body mass index (BMI) and laboratory testing for biochemical markers. The evaluation was carried out by means of the following hepatic diagnostic methods: APRI, FIB-4 and Transient Elastography (Fibroscan), and the subsequent correlation analysis by Spearman test (r). There was a predominance of males among patients with HCV (64.4%). HCV patients also presented the highest average age (54.8 years) and high levels of AST and ALT. Positive correlation was noted between APRI and FIB-4 results in patients of both groups; positive correlation between APRI and Transient Elastography in patients with HCV; and positive correlation between FIB-4 and Elastography in patients with HCV or schistosomiasis. Our data suggest that the non-invasive methods for diagnosis and monitoring of hepatic fibrosis present a high degree of acceptance, especially in patients with HCV.

P-264 - HGCSG1401: A retrospective cohort study evaluating the safety and efficacy of regorafenib in patients with metastatic colorectal cancer: Analysis of risk factors for liver dysfunction

Introduction: Regorafenib (REG) prolongs overall survival (OS) and progression-free survival (PFS) for patients (pts) with metastatic colorectal cancer (mCRC) in RCTs. However, there is a problem with REG-induced severe liver dysfunction (≥Grade 3) which occurs in 5-11% of treated Japanese pts. Therefore, we analyzed the incidence, therapeutic efficacy, and potential risk factors for REG-induced severe liver dysfunction in a community-based retrospective study (HGCSG1401) of pts treated with REG. Methods: 173 pts treated with REG were retrospectively registered from 22 centers in Japan. Survival analyses were performed with Kaplan-Meier method. Log-rank test and Cox-proportional hazard model were used to compare Grade 0-2 and 3-5. To identify risk factors for REG-induced severe liver dysfunction, a multivariate analysis was performed using the logistic regression analysis with backward elimination for variables with p < 0.10 in univariate analysis. Results: In 173 eligible pts, 24 (13.9%) experienced REG-induced severe liver dysfunction. The median PFS of Grade 0-2 and 3-5 were 2.2 and 1.6 months, respectively. The median OS of Grade 0-2 and 3-5 were 6.9 and 3.4 months, respectively. In the analysis of PFS and OS, there were significant difference between Grade 0-2 and 3-5 (PFS: HR 1.578, p = 0.045, OS: HR 1.799, p = 0.010). Univariate analyses showed that high AST, LDH, ALP, and GGT level at baseline were associated with REG-induced severe liver dysfunction. In multivariate analyses, high baseline AST level (≥ 50 U/L) was significantly associated with increased risk of REG-induced severe liver dysfunction (odds ratio=3.458, p = 0.032). Conclusion: Compared with previous reports, this analysis showed the slightly higher incidence of REG-induced severe liver dysfunction (13.9%). In multivariate analysis, it was inferred that high AST level (≥ 50 U/L) at baseline might be an independent risk factor. REG-induced severe liver dysfunction population significantly showed shorter OS than mild liver dysfunction. It is presumed that this patient population could not receive TAS-102 as post regorafenib therapy. Since this is an exploratory analysis, we consider it necessary to verify in large data set.

The effects of glucose and fructose on body weight and some biochemical parameters in rats

Objective: Dietary fructose from added sugar as high fructose corn syrup may causes major risks in obesity, hyperlipidemia, cardiovascular diseases, hyperuricemia and fatty liver. The aim of this study was to investigate and compare the effects of high fructose and high glucose intake on body weight and some biochemical parameters in rats. Subject and methods: The study was conducted on adult, 32 Wistar albino male rats (300-350 g weeks) which fed with standard laboratory chow. In each group, 8 rats was selected randomly and which was be composed four groups. The rats in each group, in addition to standard meal, different amount of glucose and fructose containing solutions (10% and 30% glucose-fed group, 10% and 30% fructose-fed group) was given by oral gavage for 6 weeks. At baseline and after 6 weeks total cholesterol, VLDL-cholesterol, triglycerides, uric acid, AST and ALT as biochemical parameters and liver histopathological examination of rats were determined. Body weight of the rats was evaluated every week. Results:The 30% fructose group caused higher AST levels according to 10% glucose group, 30% glucose group and 10% fructose group. At the end of 6 weeks, the mean body weight in the fructose-fed groups was higher than the glucose-fed groups (p>0.05). No statistically significant difference between rat groups’ portal inflammation rates were found and the moderate and severe ballooning were observed in 30% fructose rats (p<0.05). Conclusions: As a result, dietary fructose from added sugar as high fructose corn syrup may causes major metabolic disorders.

Protective effect of the total flavonoids from Apocynum venetum L. on carbon tetrachloride-induced hepatotoxicity in vitro and in vivo

Apocynum venetum L., belonging to the family Apocynaceae, is a popular medicinal plant, which is commonly used in the treatment of hypertension, neurasthenia, and hepatitis in China. In the present study, the total flavonoids (TFs) were prepared from the leaves of A. venetum, and its protective effects on carbon tetrachloride (CCl4)-induced hepatotoxicity in a cultured HepG2 cell line and in mice were investigated. Cell exposed to 0.4% CCl4 (v/v) for 6h led to a significant decrease in cell viability, increased LDH leakage, and intracellular reactive oxygen species (ROS). CCl4 also induced cell marked apoptosis, which was accompanied by the loss of mitochondrial membrane potential (MMP). Pretreatment with TFs at concentrations of 25, 50, and 100μg/mL effectively relieved CCl4-induced cellular damage in a dose-dependent manner. In vivo, TFs (100, 200, and 400mg/kg BW) were administered via gavage daily for 14days before CCl4 treatment. The high serum ALT and AST levels induced by CCl4 were dose-dependently suppressed by pretreatment of TFs (200 and 400mg/kg BW). Histological analysis also supported the results obtained from serum assays. Furthermore, TFs could prevent CCl4-caused oxidative damage by decreasing the MDA formation and increasing antioxidant enzymes (CAT, SOD, GSH-Px) activities in liver tissues. In summary, both in vitro and in vivo data suggest that TFs, prepared from A. venetum, showed a remarkable hepatoprotective and antioxidant activity against CCl4-induced liver damage.

Potential role of liver enzyme levels as predictive markers of glucose metabolism disorders in a Tunisian population.

The relationship between liver enzymes and T2D risk is inconclusive. We aimed to evaluate the association between liver markers and risk of carbohydrate metabolism disorders, as well as their discriminatory power, for T2D prediction. This cross-sectional study enrolled 216 participants classified as normoglycemic, prediabetic, newly diagnosed diabetics, and diagnosed diabetics. All participants underwent anthropometric and biochemical measurements. The relationship between hepatic enzymes and glucose metabolism markers was evaluated by analyses of covariance. The associations between liver enzymes and incident carbohydrate metabolism disorders were analyzed through logistic regression and their discriminatory capacity to predict T2D by ROC analysis. High AP, ALT, γGT, and AST levels were independently related to decreased insulin sensitivity. Interestingly, a higher AP level was significantly associated with an increased risk of prediabetes (p = 0.017), newly diagnosed diabetes (p = 0.004), and T2D (p = 0.007). An elevated γGT level was an independent risk factor for T2D (p = 0.032) and undiagnosed T2D (p = 0.010) in prediabetic and normoglycemic subjects, respectively. In ROC analysis, AP was a powerful predictor of incident diabetes and significantly improved T2D prediction. Liver enzymes within the normal range, specifically AP levels, are associated with increased risk of carbohydrate metabolism disorders and significantly improved T2D prediction.

Relation between change in treatment for central diabetes insipidus and body weight loss

Patients with central diabetes insipidus (CDI) are known to lose weight because their polydipsia interferes with their nutritional intake. We retrospectively examined weight changes in CDI patients when they switched from nasal to oral desmopressin. Twenty-three patients with CDI were included. Weight change was defined as an increase or decrease of more than 3 kg or 3% body weight. As factors contributing to the weight change, we studied the patients' clinical characteristics and quality of life (QOL) scores as determined by our original questionnaire. Five patients showed a weight loss of 5.9 kg (2.4-9.0 kg), and two patients showed weight gain, while 16 out of 23 patients were weight neutral. When the patients with weight gain and weight neutral were analyzed together, the mean weight change was +0.3 kg (-0.5 to +1.1 kg). All the patients who lost weight had a Body Mass Index ≥22 kg/m2 (38% vs. 0%, P=0.027) and higher frequencies of abnormally high serum levels of AST (40% vs. 0%, P=0.005). The sum of the QOL scores was similar between the two groups, but higher in patients who lost weight after switching to oral desmopressin (43.3±2.7) than in those who did not (38.2±5.0, P=0.01). Switching the treatment from nasal to oral desmopressin may cause weight loss in patients with CDI who seemed to have polydipsia-associated weight gain.

Wisp2 disruption represses Cxcr4 expression and inhibits BMSCs homing to injured liver.

Liver regeneration/repair is a compensatory regrowth following acute liver failure, and bone marrow-derived mesenchyme stem cell (BMSC) transplantation is an effective therapy that promotes liver regeneration/repair. Wnt1 inducible signaling pathway protein 2 (Wisp2) is highly expressed in BMSCs, however, its function remains unclear. In this work, we used clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein -9 nuclease (CRISPR/Cas9) genome editing technology to knockdown Wisp2 in BMSCs, and these modified cells were then transplanted into rats which were induced by the 2-AAF/PH. By linking the expression of Cas9 to green fluorescent protein (GFP), we tracked BMSCs in the rats. Disruption of Wisp2 inhibited the homing of BMSCs to injured liver and aggravated liver damage as indicated by remarkably high levels of ALT and AST. Moreover, the key factor in BMSC transplantation, C-X-C chemokine receptor type 4 (Cxcr4), was down-regulated in the Wisp2 depleted BMSCs and had a lower expression in the livers of the corresponding rats. By tracing the GFP marker, more BMSCs were observed to differentiate into CD31 positive endothelial cells in the functional Wisp2 cells but less in the Wisp2 gene disrupted cells. In summary, Wisp2 promotes the homing of BMSCs through Cxcr4 related signaling during liver repair in rats.

NLRP3 inflammasome induced liver graft injury through activation of telomere-independent RAP1/KC axis.

Acute-phase inflammation plays a critical role in liver graft injury. Inflammasomes, multi-molecular complexes in the cytoplasm, are responsible for initiating inflammation. Here, we aimed to explore the role of inflammasomes in liver graft injury and further to investigate the regulatory mechanism. In a clinical liver transplant cohort, we found that intragraft expression of nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasomes was significantly up-regulated post-transplantation. Importantly, overexpression of NLRP3 was strongly associated with poor liver function characterized by high levels of ALT, AST, and urea, as well as neutrophil infiltration after transplantation. The significant correlation between NLRP3 and IL-1β mRNA levels led us to focus on one of the associated upstream regulators, telomere-independent repressor activator protein 1 (RAP1), which was further proved to be co-localized with NLRP3 in neutrophils. In the liver of a mouse model (hepatic ischaemia/reperfusion and hepatectomy model) and isolated neutrophils from RAP1-/- mice, the expression levels of NLRP3 and keratinocyte chemoattractant (KC) were significantly down-regulated in contrast to those in wild types. The levels of ALT and AST, as well as the neutrophil infiltration, were also decreased by RAP1 deficiency. In our clinical validation, intragraft KC expression was associated with NLRP3 and co-localized with RAP1 in neutrophils. Furthermore, NLRP3 inflammasomes were up-regulated by recombinant KC in the isolated neutrophils and liver of the mouse model. Our data demonstrated that NLRP3 inflammasomes, activated by the RAP1/KC axis, played a critical role in initiating inflammation during the early stage of liver graft injury. Targeting RAP1/KC/NLRP3 inflammasomes may offer a new therapeutic strategy against liver graft injury. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Clinical spectrum and therapeutic management of systemic lupus erythematosus-associated macrophage activation syndrome: A study of 103 episodes in 89 adult patients.

Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory syndrome that can occur during systemic lupus erythematosus (SLE). Data on MAS in adult SLE patients are very limited. The aim of this study is to describe the clinical characteristics, laboratory findings, treatments, and outcomes of a large series of SLE-associated MAS. We conducted a retrospective study that included 103 episodes of MAS in 89 adult patients with SLE. 103 episodes in 89 adult patients were analyzed. Median age at first MAS episode was 32 (18-80) years. MAS was inaugural in 41 patients (46%).Thirteen patients relapsed. Patients had the following features: fever (100% episodes), increased serum levels of AST (94.7%), LDH (92.3%), CRP (84.5%), ferritin (96%), procalcitonin (41/49 cases). Complications included myocarditis (n=22), acute lung injury (n=15) and seizures (n=11). In 33 episodes, patients required hospitalization in an ICU and 5 died. Thrombocytopenia and high CRP levels were associated independently with an increased risk for ICU admission. High dose steroids alone as first line therapy induced remission in 37/57 cases (65%). Additional medications as first or second line therapies included IV immunoglobulins (n=22), cyclophosphamide (n=23), etoposide (n=11), rituximab (n=3). Etoposide and cyclophosphamide-based regimens had the best efficacy. MAS is a severe complication and is often inaugural. High fever and high levels of AST, LDH, CRP, ferritin and PCT should be considered as red flags for early diagnosis. High dose steroids lead to remission in two third of cases. Cyclophosphamide or etoposide should be considered for uncontrolled/severe forms.

Caspase-Cleaved Cytokeratin 18 Fragment M30 as a Potential Biomarker of Macrovascular Invasion in Hepatocellular Carcinoma.

Extremely poor prognosis in hepatocellular carcinoma (HCC) patients with progressing disease was denoted by vascular invasion. Cytokeratin 18 (CK18) has been shown to be overexpressed in hepatocellular carcinoma so it is a valuable tumor marker; however, its role in vascular invasion is still unclear. This study aimed to predict CK18 as a predictive marker for macrovascular malignant invasion. The present study was conducted on three groups of patients: group I included 91 HCC patients without macrovascular invasion, group II included 34 HCC patients with radiological evidence of vascular invasion, and group III included 110 control individuals subdivided into IIIA as healthy blood donors and IIIB as post-HCV cirrhotic patients without HCC. ROC curve of M30 fragments of CK18 was constructed for discrimination between HCC with and without macrovascular invasion. Optimum cutoff value was 304.5ng/mL (AUC=0.997, P<0.001), sensitivity (100%) and specificity (98.8%). Regression analysis was conducted for prediction of macrovascular invasion within HCC patients. The following variables: higher levels of AST, M30, bilirubin, and AFP, lower levels of serum albumin, larger tumor size, child B score, and multiple lesions were associated with vascular invasion in univariate analysis. While in multivariate analysis, higher levels of AST and bilirubin and elevated levels of M30 and AFP serum were considered independent predictors for macrovascular invasion in HCC patients. The present study suggests that increased M30 fragments of CK18 levels may be useful as a possible marker of early tumor invasiveness.

Current approach to liver traumas

IntroductionLiver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates. Presentation of casePatients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003 and 2013. Patient demographics, hepatic panel, APTT (activated partial thromboplastin time), PT (prothrombin time), INR (international normalized ratio), fibrinogen, biochemistry panel were recorded. Hemodynamic instability was the most prominent factor for surgery decision, in the lead of current Advanced Trauma Life Support (ATLS) protocols. Operation records and imaging modalities revealed liver injuries according to the Organ Injury Scale of the American Association for the Surgery of Trauma.300 patients admitted to emergency department were included in our study (187 males and 113 females). Mean age was 47 years (range, 12–87). The overall mortality rate was 13% (40 out of 300). Major factor responsible for mortality rates and outcome was stability of cases on admission. 188 (% 63) patients were counted as stable, whereas 112 (% 37) cases were found unstable (blood pressure ≤ 90, after massive resuscitation). 192 patients were observed conservatively, whereas 108 cases received abdominal surgery. High levels of AST, ALT, LDH, INR, creatinine and low levels of fibrinogen and low platelet counts on admission were found to be associated with mortality and these cases also had Grade 4 and 5 injuries. Hemodynamic instability on admission and the type and grade of injury played major role in mortality rates). Packing was performed in 35 patients, with Grade 4 and 5 injuries. Mortality rate was %13 (40 out of 300). ConclusionA multidisciplinary approach to the management of hepatic injuries has evolved over the last few decades, but the basic principles of trauma continue to be observed. Diagnostic and therapeutic endeavors are chosen based mainly on the stability of the patient. Stable patients with reliable examinations and available resources can be managed nonoperatively. Unstable patients require surgery. Our current approach to liver traumas is non operative technique, if possible.

Kawasaki disease in Sicily: clinical description and markers of disease severity.

BackgroundKawasaki disease (KD) is an acute systemic vasculitis of small and middle size arteries; 15-25 % of untreated patients and 5 % of patients treated with intravenous immunoglobulin (IVIG) develop coronary artery lesions (CAL). Many studies tried to find the most effective treatment in the management of resistant KD and to select the risk factors for CAL.Our data are assessed on children from west Sicily, characterized by a genetic heterogeneity.MethodsWe studied the clinical data of 70 KD Sicilian children (36 males: 51 %; 34 females: 49 %), analysed retrospectively, including: demographic and laboratory parameters; echocardiographic findings at diagnosis, at 2, 6 and 8 weeks, and at 1 year after the onset of the illness.ResultsForty-seven had Typical KD, three Atypical KD and twenty Incomplete KD. Age at the disease onset ranged from 0.1 to 8.9 years. IVIG were administered 5 ± 2 days after the fever started. Defervescence occurred 39 ± 26 hours after the first IVIG infusion. Fifty-six patients (80 %) received 1 dose of IVIG (responders); 14 patients (20 %) had a resistant KD, with persistent fever after the first IVIG dose (non responders). Ten (14 %) non responders responded to the second dose, 4 (5 %) responded to three doses; one needed treatment with high doses of steroids and Infliximab.Cardiac involvement was documented in twenty-two cases (eighteen with transient dilatation/ectasia, fifteen with aneurysms). Pericardial effusion, documented in eleven, was associated with coronaritis and aneurysms, and was present earlier than coronary involvement in seven.Hypoalbuminemia, D-dimer pre-IVIG, gamma-GT pre-IVIG showed a statistically significant direct correlation with IVIG doses, highlighting the role of these parameters as predictor markers of refractory disease. The persistence of elevated CRP, AST, ALT levels, a persistent hyponatremia and hypoalbuminemia after IVIG therapy, also had a statistical significant correlation with IVIG doses.Non responders showed higher levels of D-dimer and gamma-GT pre-IVIG, persistent high levels of D-dimer, CRP, AST, ALT, hypoalbuminemia and hyponatremia after IVIG.ConclusionsThis is the first study on KD in Sicily. We suggest some laboratory parameters as predictive criteria for resistant KD. Patients who show early pericarditis need careful surveillance for coronary lesions.

Acute Sickle Cell Intrahepatic Cholestasis (SCIC) Successfully Treated with Exchange Blood Transfusion

Sickle cell disease (SCD) is a common blood disorder known to have hepatobiliary complications. Sickle cell intrahepatic cholestasis (SCIC) is a rare, but severe manifestation that is often fatal if not recognized and treated appropriately. We present a case of acute SCIC successfully treated with exchange blood transfusion (EBT). A 40 year-old African-American woman with SCD presented with two days of myalgias, right upper-quadrant abdominal pain, nausea, and vomiting. She was afebrile, tachycardic, but saturating well on room air. She was alert and oriented with tender hepatomegaly and an otherwise unremarkable exam. Labs revealed leukocytosis, hemolytic anemia with numerous sickle cells on a peripheral smear, acute kidney injury, severe lactic acidosis, and hypoglycemia. She had an albumin of 3.5 g/dL, AST 2901 U/L, ALT 1116 U/L, ALP 160 U/L, Tbili 20.6 mg/dL, Dbili 15 mg/dL, and INR 2.8. Ultrasound of the liver revealed patent vasculature without cholelithiasis or common bile duct dilation. Viral, autoimmune, and toxin work-up were negative. She was diagnosed with acute liver injury due to SCIC. An EBT with 6 units of packed red blood cells was initiated on hospital day 2 and her hemoglobin S remained < 30%. She improved with supportive care and was discharged on hospital day 14. SCIC was first described in 1953 with few cases reported to date, roughly 50% of which were fatal. It is due to widespread sickling within hepatic sinusoids leading to ischemic and hypoxic injury. This results in ballooning of hepatocytes with resultant intracanalicular cholestasis and bile plugs. It presents with tender hepatomegaly, fever, leukocytosis, nausea, vomiting and can progress to acute liver failure. A direct hyperbilirubinemia is the characteristic finding that is seen with high levels of AST and ALT, reported to be as high as 3070 U/L and 6,680 U/L respectively. Early reports of SCIC were often fatal due to fulminant liver failure and bleeding. Anecdotal evidence has shown that EBT significantly improves outcomes with case reports of SCIC reversal if given early in the disease course. It has been proposed to maintain HbS levels < 30% which was achieved in our patient. SCIC is a rare complication of a common disease with a high mortality. Gastroenterologists should be aware because early recognition and initiation of exchange blood transfusion can improve mortality.

The Evaluation of Liver Function and Surgical Influence by ICGR15 after Chemotherapy for Colorectal Liver Metastases.

Background; Approximately 60% of patients with colorectal cancer develop liver metastasis at some point after diagnosis. The aim of this study is to investigate whether the evaluation of ICGR15 preoperatively is a useful clinical indicator of hepatic injury following chemotherapy and to investigate the influence of multiple chemotherapies on liver function.Results; Mean ICGR15 values were higher in patients ≥65 years (P = 0.047) and in patients with ≥3 cycles (P = 0.022) and ≥6 cycles (P = 0.001) of systemic chemotherapy. ICGR15 values tended to be higher in patients with postoperative complications (P = 0.085). Patients receiving systemic chemotherapy for ≥6 cycles had higher levels of AST (P = 0.003), ALT (P = 0.015), and alkaline phosphatase (ALP) (P = 0.041). Patients receiving systemic chemotherapy for ≥3 cycles had higher levels of AST (P = 0.015) and ALP (P = 0.015).Conclusions; Because the pathological diagnosis is usually established only after operation, preoperative evaluation such as the identification of sinusoidal injury is difficult. Based on this study, higher ICGR15 values may provide an indication of surgical complications and be a predictor of liver dysfunction following frequent cycles of chemotherapy. Hepatectomy should be performed with the utmost care in such patients, and the number of cycles of preoperative chemotherapy should probably be as low as possible.

Septic Shock in Pyogenic Liver Abscess: Clinical Considerations

Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not. We reviewed the medical records including etiologies, underlying diseases, laboratory, radiologic and microbiologic findings, methods of treatment and treatment outcomes. The case fatality rate was 6.1%. In univariate analysis, the presence of general weakness, mental change, low platelet level, prolonged PT, high BUN level, high creatinine level, low albumin level, high AST level, high CRP level, abscess size >6 cm, the presence of gas-forming abscess, APACHE II score ≥ 20, and the presence of Klebsiella pneumoniae infection were significantly associated with septic shock. Multivariate analysis showed the presence of mental change (p=0.004), gas-form -ing abscess (p=0.012), and K. pneumoniae infection (p=0.027) were independent predictors for septic shock. The presence of mental change, gas-forming abscess, and K. pneumoniae infection were independent predictors for septic shock in patients with PLA.