Investigation Of Liver Disease Research Articles

Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population-based cohort study.

Apart from a moderately increased risk of preterm birth and small for gestational age, there was no association between liver biopsy during pregnancy and adverse pregnancy outcome; potential excess risks should be weighed against the advantages of having a liver biopsy that may influence clinical management of the patient and indirectly fetal health. (Hepatology 2017).

The Clinical Profile of Subjects Included in the Swedish National Register on Individuals with Severe Alpha 1-Antitrypsin deficiency

The Swedish national register of severe alpha1-antitrypsin (AAT) deficiency was established in 1991. The main aims are to prospectively study the natural history of severe AAT deficiency, and to improve the knowledge of AAT deficiency. The inclusion criteria in the register are age ≥18 years, and the PiZ phenotype diagnosed by isoelectric focusing. The register is kept updated by means of repeated questionnaires providing data to allow analysis of the mode of identification, lung and liver function, smoking-habits, respiratory symptoms and diagnoses as reported by physicians.Until February 2014, a total of 1553 PiZZ individuals had been included in the register. The 1102 subjects still alive constituted about 20% of the adult PiZZ individuals in Sweden. Forty-three percent of the subjects had been identified during investigation of respiratory symptoms, 7% by an investigation of liver disease, 26% in an investigation of other pathological conditions, and 24% in a population or family screening. Forty five percent of the subjects had never smoked, 47% were ex-smokers, and 8% current smokers. Twenty-eight percent of the never-smokers, 72% of the ex-smokers, and 61% of the current smokers fulfilled the criteria for COPD with a FEV1/FVC ratio of <0.70.Among the 451 deceased, the most common cause of death was respiratory diseases (55%), followed by liver diseases (13%). We conclude that the detection rate of severe AAT deficiency is relatively high in Sweden. Large numbers of subjects are identified for other reasons than respiratory symptoms, and the majority of these have never smoked.

The role of hepatocyte-specific staining in liver pathology

The advantages of MRI in the investigation of liver disease are well documented. Recent developments, including fast scanning technique and new MRI contrast agents, enable improved detection and characterization of focal liver lesions. Therefore, a definitive diagnosis can be made avoiding invasive procedures, such as liver biopsy. In this article, a special emphasis is placed on the clinical use of combined perfusional and hepatocyte-selective MRI contrast agents, which allow us to obtain morphologic and vascular information, owing to the dynamic study, as well as functional information, owing to the hepatocyte-selective phase of enhancement. Different clinical scenarios are considered in order to highlight the proper use of the hepatocyte phase to noninvasively characterize and detect different focal liver lesions.

A Quick, Sensitive High-Performance Liquid Chromatography Assay for Monoethylglycinexylidide and Lignocaine in Serum/Plasma Using Solid-Phase Extraction

Recent advances in the investigation of liver disease and transplantation have seen the introduction of lignocaine as a probe of liver function. For this purpose, an assay that is sensitive and rapid is required for the major metabolite of lignocaine, monoethylglycinexylidide (MEGX). We have developed an accurate, low-cost high-performance liquid chromatography (HPLC) method using Bond-Elut phenyl (1 cc) cartridges for sample preparation. The total preparation time for five samples is less than 10 min and the run time is approximately 10 min/sample. Each cartridge can be used at least four times. Simultaneous measurement of another metabolite of lignocaine, glycinexylidide (GX), can be achieved by adjustment of the mobile phase and flow rate. The chromatogram is monitored with an UV detector at 210 nm. The inter- and intra-assay coefficients of variation for MEGX (10-250 micrograms/L) and lignocaine (100-2,000 micrograms/L) are less than 9.5 and less than 2%, respectively, with recoveries for MEGX, trimethoprim (internal standard), and lignocaine all greater than 85%. This method offers a rapid, sensitive assay that is clinically useful in the new role for lignocaine/MEGX in dynamic liver function testing.

Investigations of liver disease and drug toxicity

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False-positive result of hepatitis C enzyme-linked immunosorbent assay in children with autoimmune hepatitis

Hepatitis C virus has been identified as the major cause of parenterally transmitted non-A, non-B hepat i t i s /The current diagnostic test for hepatitis C is an enzyme-linked immunosorbent assay to detect antibodies against a nonstructural protein of HCV in serum. In addition to being positive in patients affected by hepatitis after transfusion of blood or blood-derived products, the HCV-ELISA result was recently found to be positive in several patients, adults and children, with autoimmune hepatitis; it was suggested that HCV might play a part in the origin of autoimmune hepatitis. 2 In children, however, positive HCV-ELISA results have been found mainly in sera tested before immunosuppressive treatment or during a relapse of the disease. 3 The question thus arises as to whether there is a causal relationship between HCV and autoimmune hepatitis or whether the HCV-ELISA positivity is nonspecific in such patients and thus could be misleading in the investigation of liver disease in children. Proper distinction between autoimmune hepatitis and hepatitis C is important because of the completely different treatment of the two diseases.

Bleeding time in patients with hepatic cirrhosis.

OBJECTIVE--To determine the frequency of an abnormal bleeding time in patients with cirrhosis and to relate this to known factors that affect primary haemostasis and to the severity of liver disease. DESIGN--Prospective clinical and laboratory study in patients admitted for complications or investigations of liver disease. SETTING--Royal Free Hospital hepatobiliary and liver transplantation unit. SUBJECTS--100 Consecutive inpatients aged 17-74 with various forms of cirrhosis, including alcoholic, biliary, autoimmune, viral, and cryptogenic. At least 10 days had elapsed since any episodes of bleeding, resolution of sepsis, or alcohol intake. No patient was taking any drug known to affect primary haemostasis. MAIN OUTCOME MEASURES--Bleeding time as measured with the Simplate double blade template device. A bleeding time longer than 10 minutes was considered abnormal. Other measures were platelet count, prothrombin time, partial thromboplastin time, packed cell volume, and blood urea, serum bilirubin, and serum albumin concentrations, all measured on each subject at the same time by standard laboratory methods. RESULTS--A weak but significant correlation existed between the bleeding time and the platelet count (rs = 0.483; p less than 0.001). There were significantly lower platelet counts, longer prothrombin times, and higher blood urea and serum bilirubin concentrations in the 42 patients with bleeding times of 10 minutes or more compared with the 58 patients with bleeding times less than 10 minutes. Multiple linear regression analysis showed that the bilirubin concentration as well as the platelet count was independently correlated with the bleeding time. The combination of a platelet count greater than 80 x 10(9)/l and a prothrombin time less than 17 seconds (usually taken as safe limits for performing routine liver biopsy) did not predict a normal bleeding time. Ten of 39 patients fulfilling these criteria had a prolonged bleeding time. CONCLUSIONS--Prolonged bleeding time is common in patients with cirrhosis, even in those with prothrombin times and platelet counts within "safe limits" for invasive procedures. The severity of liver disease as assessed by the bilirubin concentration plays an important part in determining the bleeding time in cirrhosis. The bleeding time should be measured when assessing patients for invasive procedures who have a raised bilirubin concentration or poor hepatic function, even if the platelet count and prothrombin time are considered adequate.

Glutathione S-transferases in alcoholic liver disease.

There is already evidence in alcoholic liver disease, mostly from studies of morphology and cytokeratin distribution, that hepatocytes can undergo a variety of phenotypic changes. This study reports findings of immunohistochemistry using antibodies against members of the glutathione S-transferase supergene family of detoxification enzymes. Hepatocytes in severe alcoholic liver disease coexpressed both alpha and pi class glutathione S-transferase. This coexpression has been previously described only in human fetal liver and in chemically-induced preneoplastic foci in rat liver. The use of function associated markers should provide additional information in the investigation of liver disease.

The Laboratory Investigation of Liver Disease

The Laboratory Investigation of Liver Disease

Laboratory Investigation of Liver Disease

Laboratory Investigation of Liver Disease

Ultrasonic diffraction analysis in the investigation of liver disease.

An ultrasonic analytical method has been developed which is capable of remote, in vivo differentiation between various types of soft tissue on the basis of differences in their gross histological structure. The method is analogous to that employed in X-ray crystallography and is referred to as ultrasonic diffraction analysis. A clinical trial of this method in the investigation of liver disease in 70 patients is reported, in which a total of 416 ultrasonic diffraction patterns associated with various liver conditions have been analysed and related to independent follow-up information. The existance of a malignant condition of the liver has been identified in 95% of the cases involving focal metastatic deposits and in all of the 11 cases studied where the livers had diffuse malignant involvement. Cirrhosis and secondary involvement of the liver due to Hodgkin's disease have also been shown to exhibit specific tissue signatures which enable them to be differentiated from other hepatic disorders.

Bromsulphthalein retention test and gamma-glutamyl transpeptidase activity in the investigation of liver disease

The usefulness of serum gamma-glutamyl transpeptidase activity (gammaGT) was studied in 39 patients on whom a bromsulphthalein retention test (BSP) was performed. In most patients, the potentially hazardous BSP test did not give any further evidence of hepatic disease over conventional hepatic function tests and the gammaGT.

POLYMYALGIA RHEUMATICA AND LIVER DISEASE

In a case of polymyalgia rheumatica with hepatic involvement, liver-function tests returned to normal after treatment with steroids. Liver biopsy revealed portal inflammation, liver-cell necrosis, and a granuloma. It seemed likely that these biopsy findings were associated with the polymyalgia rheumatica, rather than a second coincident liver disease, since other investigations of liver disease were negative. It is suggested that polymyalgia rheumatica may be another rare cause of liver granulomas.

Immunoglobulin deposition in liver of patients with active chronic hepatitis and antibody against smooth muscle.

Liver biopsies from 33 patients with miscellaneous liver diseases were studied by direct immunofluorescence. Three patients with active chronic hepatitis possessed a distinctive pattern of staining with anti-IgG conjugate. They were relatively young women and all three possessed the anti-smooth-muscle antibody. In addition, all three were untreated at the time of study. It is suggested that direct immunofluorescence on liver biopsies may help in the investigation of liver disease and that humoral immunity may participate in the pathogenesis of active chronic hepatitis.