Laennec's Cirrhosis Research Articles

Unilateral Nevoid Telangiectasia

A 52-year-old woman had Laennec's cirrhosis and unilateral telangiectases on recent onset. Her condition is thought to represent unilateral nevoid telangiectasia. This may be one form of generalized essential telangiectasia, or may result from metabolic abnormalities associated with Laennec's cirrhosis or altered hemodynamics of portal hypertension or both.

The effect of chronic administration of carbon tetrachloride and alpha-napthylisothiocyanate on tissue copper levels in the rat

Carbon tetrachloride (1 ml/kg body wt, subcutaneously, twice a week) was administered to 62 rats; the animals were sacrificed in groups at 24 hours or at 1, 2, 6, 12, and 18 weeks. The copper concentration was measured in 13 tissues. The hepatic copper concentration for animals sacrificed or dying spontaneously after 1- to 8-week treatment was significantly lower, and for those treated for longer periods significantly higher, than control values. The increase in copper concentration with time was associated with the development of cirrhotic changes. A significant elevation in spleen and bone concentration was noted in animals sacrificed at 12 and 18 weeks. Kidney showed an initial increase, but with prolonged administration of the agent there was a decreased copper concentration. Values for brain tended to be elevated. Other organs were unaffected. Alpha-napthylisothiocyanate was given to 18 young and 22 adult rats. The five survivors in each group were sacrificed at 2 and 7 weeks, respectively. There was an increase in both concentration and total content of copper in the liver at 7 weeks; the concentrations in the heart, lung, testis, and spleen were also significantly augmented. The values for the kidney were significantly diminished. The effect of these two hepatotoxins on intracellular distribution of copper was also studied. The percentage of copper in the nuclear fraction was found to increase whereas that of the supernatant fraction to decrease. This change in distribution was associated with elevated hepatic levels of the metal. The effect of other hepatotoxic agents on tissue copper levels is reviewed. The present findings are discussed in relation to Laennec's cirrhosis and biliary cirrhosis; an understanding of the alteration of copper deposition in these clinical conditions might evolve from further investigation of their experimental counterparts. Normal data on copper levels in the tissues of Sprague-Dawley rats are presented. Bone copper is found to decrease with age whereas that of kidney, tongue, and heart increases. The copper levels of adult tongue and diaphragm are four times the values for leg muscle.

Serum Copper and Zinc Levels in Various Pathologic Conditions

In order to explore their diagnostic significance, serum copper and zinc levels were measured in various pathologic conditions by means of atomic absorption spectrophotometry. Elevated copper levels were observed in most of the pathologic conditions studied, but the increases were significant in congestive cardiac failure, pneumonia, myoma of the uterus, rheumatic heart disease, bronchitis, cholelithiasis, asthma, pelvic inflammatory disease, cerebral arteriosclerosis, and arteriosclerotic heart disease. Zinc values in most diseases studied were normal or close to normal. However, decreased concentrations were found in alcoholism, Laennec's cirrhosis, bronchitis, and pneumonia. Although statistically significant elevations of copper and decreases of zinc have been found in various pathologic conditions, a large number of patients in each diagnostic category had values well within normal range. Owing to these inconsistencies it is obvious that these trace metal levels are of doubtful value for diagnostic purposes.

Zinc and collagen content of cirrhotic liver.

Liver samples obtained from 43 consecutive autopsies were analyzed for their content of zinc, hydroxyproline and nitrogen. Mean liver zinc was 2.36 and 1.27µg/mg nitrogen for histologically normal and cirrhotic samples, respectively. Hepatic zinc did not correlate with hepatic hydroxyproline. It is concluded that there is an absolute reduction in zinc content of cirrhotic liver and that this reduction bears no relationship to the amount of collagen present. If low levels of zinc in liver can be equated with zinc deficiency, patients with Laennec's cirrhosis are deficient in zinc.

Spontaneous rupture of a mesenteric varix in portal hypertension

In a patient with Laennec's cirrhosis and severe portal hypertension spontaneous rupture of a mesenteric varix resulted in hemoperitoneum and death. A review of the literature revealed one previous description of a similar situation.

Elevated levels of γE (IgE) in conditions other than classical allergy

A micro-Ouchterlony technique for determining the approximate concentration of γE in sera with levels in excess of 0.8 μg per milliliter is reported. The test is relatively simple to perform and effectively detects those subjects with elevated γE levels but not those with levels in the normal range. Levels of γE were found to be elevated in 12 of 19 subjects with extrinsic asthma, 2 of 3 with eczema, 3 of 7 with seasonal rhinitis, and 7 of 16 with severe food sensitivity. In addition to these classical atopic diseases, a significant proportion of other selected disorders were found to be associated with elevated γE levels. These included 2 of 6 subjects with pulmonary hemosiderosis, 3 of 4 with hypersensitivity pulmonary aspergillosis, 5 of 5 with visceral larva migrans syndrome, 5 of 16 with celiac disease, 9 of 18 with Laennec's cirrhosis, and 4 of 14 subjects with multiple myeloma having no “M” peak. Most of the subjects with liver disease or myeloma had no history suggesting atopic symptoms. The findings are discussed in the context of current knowledge about γE.

The pattern of serum triglyceride fatty acids in Laennec's cirrhosis.

The pattern of fatty acids in fasting serum triglycerides has been examined in 15 patients with Laennec's cirrhosis. Levels of triglycerides over 170 mg/100 ml were found in 9 of the 15. In each cirrhotic patient, regardless of the triglyceride level, a relative decrease in linoleic acid was found. The data suggest a relative deficiency of this dietary derived fatty acid which may play a role in abnormalities of serum and hepatic triglycerides found in alcoholic cirrhotics.

A Rational Approach to the Treatment of Ascites in Laennec's Cirrhosis

A Rational Approach to the Treatment of Ascites in Laennec's Cirrhosis

SEPARATION OF HUMAN SERUM-ALKALINE-PHOSPHATASE ISOENZYMES BY POLYACRYLAMIDE GEL ELECTROPHORESIS

Electrophoresis on polyacrylamide gel slabs was found to separate human serum-alkaline-phosphatase into four distinct isoenzymes. The first was found primarily in the sera of patients with liver disorders and migrated just ahead of a more diffuse isoenzyme that was present in serum from patients with bone disorders. A third isoenzyme, identical with that of intestinal origin, was readily distinguishable from these two and was found in only two sera, both from patients with Laennec's cirrhosis. A fourth isoenzyme remained at the origin during electrophoresis, was present most often in patients with liver disease, but was of unknown origin and significance. With electrophoresis on polyacrylamide gel slabs, the presence of liver or bone disorders was predicted in more than 90% of one hundred and eleven patients with elevated serum-alkaline-phosphatase.

Separate Autoimmune Mechanisms for 7s and 19s Globulins in Laennec's Cirrhosis

Isolated 19s (IgM) and 7s (IgG and IgA) from three cirrhotic patients, normal human sera, and 19s from two patients with Waldenstrom's macroglobulinemia were conjugated with fluorescein isothiocyanate and incubated with liver, kidney, and thyroid and adrenal glands from normal humans as well as from patients with alcoholic cirrhosis and other liver diseases. Neither 19s nor 7s globulins of normal subjects, nor 19s of patients with macroglobulinemia were bound to any of the tissues. The 19s from all three cirrhotic patients was bound to the nuclei of cirrhotic or noncirrhotic livers as well as to the nuclei of adrenal, thyroid, and pancreatic cells. The 7s from all three cirrhotic patients was bound to necrotic liver tissue, but not to normal liver tissue or other human organs. These preliminary results suggest a secondary antibody response to antigenically altered constituents of hepatic cells.

Separate autoimmune mechanisms for 7s and 19s globulins in Laennec's cirrhosis

Separate autoimmune mechanisms for 7s and 19s globulins in Laennec's cirrhosis

Production of nutritional cirrhosis in Macacca mulatta monkeys.

Hepatic cirrhosis remains a major medical challenge both in regard to its pathogenesis and its treatment. The natural course of Laennec's cirrhosis, particularly its early development, does not lend itself to detailed clinical investigation, even if its victims were not so characteristically uncooperative. On the other hand, attempts to produce cirrhosis in experimental animals have either employed methods which produce a pathologic lesion significantly different from that encountered clinically (eg, carbon tetrachloride), or involved species whose livers exhibit important anatomical and physiological differences from man, or which are too small for detailed hemodynamic studies of portal hypertension and its modification by surgical shunting procedures. The production of nutritional cirrhosis in subhuman primates offers an opportunity to overcome some of these difficulties; preliminary reports by Wilgram¹and Gaisford and Zuidema²of the production of an early "Laennec" type of cirrhosis in monkeys by a low protein, choline deficient diet

Studies of Malabsorption Occurring in Patients with Laennec's Cirrhosis

The review of autopsy protocols and histological sections of 154 patients with Laennec's cirrhosis revealed an incidence of pancreatic lesions of 28%. A prospective study of the small bowel absorptive function of 20 alcoholic cirrhotics revealed steatorrhea in 10 of them (50%). No other parameter of small bowel absorption showed significant abnormality. Radiological studies of the intestine, Schilling tests, and small bowel biopsies were within normal limits. The D-xylose test was normal in the 20 patients as judged by normal blood levels; decreased 5-hr urinary excretion was only found in those patients with ascites or decreased renal function. Normal bacterial population was found in the duodenum of 19 of these patients. The steatorrhea found in the 10 patients could be ascribed to neomycin administration in 3 of them and to severe pancreatic insufficiency in another 4. The remaining 3 patients had maximal bicarbonate concentrations below normal levels and, therefore, probable pancreatic insufficiency. The results reveal that the steatorrhea found in these patients with Laennec's cirrhosis was secondary to either neomycin administration or pancreatic insufficiency, rather than to the cirrhotic process per se. These results indicate that small bowel absorptive function is normal in cirrhosis and that the steatorrhea commonly found in association with this disease is secondary to a variety of other disorders.

Plasma and urinary amino acids in Laennec's cirrhosis.

Plasma amino acid concentrations and urinary excretion of free amino acids were measured in 7 patients with severe hepatic decompensation (precoma) in Laennec's cirrhosis. Upon maximal improvement these patients served as their own controls. Contrary to earlier reports, the changes were found to be unspectacular. Plasma concentrations of amino acids proved to be remarkably stable. Decreased plasma concentrations of valine, leucine, and isoleucine pointed to a component of steatonecrosis, which was found in liver biopsy specimens and laboratory parameters. The urinary excretion of threonine, serine, asparagine/glutamine, alanine, ethanolamine, and histidine was increased significantly during hepatic decompensation when compared to the excretion values of the same patients at maximal compensation; but even here the changes were within the normal range. General aminoaciduria was observed in 3 cirrhotic patients who had undergone surgical portacaval shunts. It is possible that these changes are a sequence of the surgical procedure.

False-positive liver scan.

Letters and Comments1 November 1968FALSE-POSITIVE LIVER SCANDANIEL H. GREGORY, M.D.DANIEL H. GREGORY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-69-5-1075_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor: I should like to endorse the position set forth in the recent presentation by Klion and Rudavsky, "False-Positive Liver Scans in Patients with Alcoholic Liver Disease" (Ann. Intern. Med. 69: 283, 1968). It has also been our experience that hepatic scintillation scanning in the presence of cirrhosis is of little clinical value and, indeed, often quite misleading.The most striking example of a false-positive liver scan that we have recently encountered was in a patient with hypersplenism secondary to Laennec's cirrhosis. A liver scan was performed with sulfur colloid labeled with 1 mc of tc99. All of... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1968Volume 69, Issue 5Page: 1075-1075KeywordsCirrhosisLiverLiver diseases Issue Published: 1 November 1968 PDF downloadLoading ...

Portal decompressive surgery. Comparative evaluation of patients with Laennec's cirrhosis and other causes.

THE PORTAL-systemic shunt represents the definitive treatment for bleeding esophagogastric varices secondary to portal hypertension. The effectiveness of this procedure as a method of obviating future bleeding episodes is generally accepted. However, several questions remain unresolved. The ultimate effect of correcting the portal hypertension on life expectancy of cirrhotic patients has not been satisfactorily determined in controlled series. 1,2 Similarly, there have been no well-controlled studies for emergency shunts. 3 It is felt that part of the disparity in statistics is related to differences in the patient population of reported results. Therefore, the results of elective and emergency portal-systemic decompressive procedures for bleeding varices in patients with Laennec's cirrhosis and in patients in whom other disorders caused the portal hypertension have been compared. Materials and Methods The present study evaluates the cases of 57 patients who underwent 61 major portal-systemic decompressive procedures at Strong Memorial Hospital between January 1953 and

Bacterial endocarditis and cirrhosis of the liver.

A patient presenting with a rapidly decompensating Laennec's cirrhosis and an obscure fever was found to have acute bacterial endocarditis at autopsy. Previous reports describing the association of cirrhosis and bacterial endocarditis are briefly reviewed, and the insidious nature of this complication is emphasized.

Indirect reacting hyperbilirubinemia in cirrhosis: its relation to red cell survival.

The clinical, biochemical, and hematologic findings in 16 patients with Laennec's cirrhosis and predominantly indirect hyperbilirubinemia are presented. Three patients had previously undergone a portacaval shunt. The mean51Cr-labeled red-cell halflife obtained in 12 of the cirrhotics with indirect hyperbilirubinemia was 17.9 days, compared to a mean of 23.6 days in the control group of 12 cirrhotics with direct hyperbilirubinemia. This difference was statistically significant (p<0.01).

Cirrhosis of the liver.

Essentially three main types of cirrhosis are recognized: (1) micronodular, (2) macronodular, and (3) mixed. Primary biliary cirrhosis is a micronodular type of cirrhosis based on chronic biliary obstruction and cardiac cirrhosis is a fine cirrhosis also. No close relationship exists between the cause of cirrhosis and the configuration of the regeneration nodules. Alcoholic cirrhosis is often micronodular; however, regeneration nodules may be large in alcoholics with heavy intermittent drinking habits. Alcoholic cirrhosis, also known as Laennec's Cirrhosis, is a disease that is common where there is a high incidence of alcoholism. The disease is more common in males than in females. The liver is often enlarged and even micronodular type of cirrhosis may be present. The liver often looks greasy and this feature is well demonstrated in histological preparations, which show fatty change in the liver cells. Fatty infiltration is indicative of recent drinking and when drinking stops, the fat disappears. Liver cell damage is variable; however, following a bout of hard drinking, it can be severe with areas of liver cell necrosis and polymorph infiltration.

Hepatic vein visualization by intravenous carbon dioxide injection.

The vascular outflow tract of the liver, the hepatic veins, may be narrowed or obstructed in a variety of clinical settings. Primary or metastatic tumor in the liver, idiopathic thrombosis (Budd-Chiari syndrome) (1), and Jamaican veno-occlusive disease (2) are the major causes of hepatic vein obstruction. In most cases the manifestations of hepatic vein occlusion are not sufficiently distinct from other diseases of the liver to allow a precise clinical diagnosis. Radiologic visualization of the hepatic veins, therefore, would be of value to the clinician as well as to the clinical investigator. The hepatic veins have been visualized by direct catheterization with injection of opaque contrast material (3) and by carbon dioxide (CO2) injection into the veins of the left upper extremity (4, 5). There has been no systematic study of the hepatic veins by either technic. Because of the relative ease and safety of CO2 injection as compared with hepatic vein catheterization, the former method would be preferred. It is the purpose of this study to examine the hepatic veins after intravenous CO2 injection to assess: (1) the frequency of hepatic vein visualization; (2) the diameter of the hepatic veins in health and disease; and (3) the clinical usefulness of hepatic vein visualization. Materials Three groups of patients were examined. These consisted of 22 patients with cardiac disease who were evaluated for pericardial effusion (Group A); 25 with hepatic disease (Group B), Laennec's (nutritional) cirrhosis in most cases; and 23 who were being treated for other disorders (Group C). The diagnosis of hepatic disease was based on the clinical picture and characteristic alterations of the liver function tests. In most patients a liver biopsy was obtained for confirmation. Obvious ascites was present in 9 patients of Group B. Methods A preliminary anteroposterior radiograph was made of each patient in both the left and right lateral decubitus positions. These films were used to detect pleural effusions and to establish proper radiographic technic. An intravenous infusion was started in the left upper extremity as the patient lay in the left lateral decubitus position, and 100 cc of CO2 was rapidly injected into the intravenous tubing. Radiographs were made immediately following the CO2 injection and approximately five seconds later. Most of the cardiac patients and 8 of the patients with hepatic disease were examined with the table in a horizontal position. In the remainder of the patients the foot of the table was elevated, placing the patient in approximately a 15° headdown tilt. Since this position facilitated the passage of CO2 into the inferior vena cava and also improved visualization of the right atrium, it is now used routinely in all of our CO2 studies. The radiographs were reviewed by one of us (V. A. V.) without knowledge of the clinical data. A study was considered to be satisfactory when gas could be clearly visualized in the right atrium.