Liver Coma Research Articles

Changes of Plasma Blood Ammonia Levels of Chinese Healthy People and the Establishment of Reference Intervals

Blood ammonia detection is used for the diagnosis or differential diagnosis of various hepatitis virus infections, severe liver cirrhosis, and hepatic encephalopathy. It is also one of the important indexes reflecting liver coma, Reyes syndrome, and other diseases. However, blood ammonia changes rapidly with time. If samples are not sent and detected in time, the results will be wrong, resulting in clinical misdiagnosis and life danger to patients. The purpose of this paper is to explore the change of blood ammonia with time and establish its reference interval. For this study, 228 healthy patients (111 males and 117 females) were selected who underwent physical examination at the Health Management Center of the Second Xiangya Hospital of Central South University from April to May 2021. The blood ammonia detection kit (colorimetric method) produced by Roche Diagnostics GmbH of Germany was used for detection on the Roche cobas c702 automatic biochemical analyzer. After eliminating outliers from the obtained test results, they were grouped according to gender and age, and SPSS 26.0 software was employed to statistically analyze the blood ammonia test results. The differences in blood ammonia levels at each detection time were statistically significant (p < 0.05). The differences in blood ammonia levels between male and female subjects at 1 hour, 2 hours, and 3 hours were statistically significant (p < 0.05), but all ages saw no statistically significant difference in blood ammonia levels between segments (p > 0.05). The blood ammonia levels of each detection time and different genders showed a normal distribution. Therefore, it is necessary to take the 95% (X ± 1.96S) results of both sides as the reference interval according to the detection time and gender, and establish the reference intervals. The 1-hour blood ammonia reference interval for healthy men in Changsha is 15.8 - 47.5 μmol/L, for healthy women it is 12.4 - 39.6 μmol/L; the 2-hour blood ammonia reference interval for healthy men is 22.3 - 56.5 μmol/L, and for healthy women it is 19.1 - 48.0 μmol/L; the reference interval of 3-hours blood ammonia for healthy men is 27.9 - 65.7 μmol/L, and for healthy women it is 24.6 - 56.7 μmol/L. There are differences in blood ammonia levels between men and women at different detection times in Changsha. A reference interval suitable for blood ammonia in healthy individuals in the region should be established according to the detection time and gender, so as to provide better relevant evidence for clinical diagnosis.

Resurgence of Global Opportunistic Multidrug-resistant Stenotrophomonas maltophilia.

Context:Stenotrophomonas maltophilia is a known nosocomial pathogen which is intrinsically resistant to multiple antibiotics. In India, S. maltophilia infection has only few case reports.Aim:To determine the incidence of S. maltophilia infection from clinical isolates based on the specimen type, antibiotic susceptibility pattern, and impact on outcome.Settings and Design:One-year retrospective study was done at a tertiary liver care center.Methods:Patients with S. maltophilia isolation in clinical samples were selected. Serial levels of serum procalcitonin and total leukocyte count were recorded. Environmental surveillance was done from the wards of S. maltophilia isolation as part of routine practice.Statistical Analysis:Continuous data were compared using Kruskal–Wallis test/Mann–Whitney test. The categorical data were compared by Chi-square/Fisher's exact test, wherever necessary. Besides this, an appropriate analysis like survival was carried out at the time of data analysis.Results:One hundred isolates were obtained from eighty patients of six wards. The greatest number (44/100, 44%) were from the Liver Coma Intensive Care Unit and the lowest (3/100) from the day care. Isolation from the respiratory samples was 1.32% and bloodstream infection 0.6%. Of 100 isolates, 12 (12%) were resistant to both trimethoprim–sulfamethoxazole and levofloxacin.Conclusion:S. maltophilia was effectively isolated from the hospital environment, with two of hand impression and three of water samples’ positive. Patients with respiratory infection had most S. maltophilia isolates. Antibiotic susceptibility revealed more resistance than reported in this region.

Benefits of percutaneous ethanol injection in the treatment of advanced hepatocellular carcinoma.

e15119 Background: Hepatocellular carcinoma (HCC) is a devastating disease in which survival measured in months from time of diagnosis. Incidence is highest in Asia and Africa with high prevalences of hepatitis B and hepatitis C being strong predisposing factors. HCC is screened and diagnosed early in developed countries but this is not obtainable in our practice where patients present late, with severe abdominal pain and mass and therapeutic options are limited. Percutaneous ethanol injection (PEI) introduced twenty years ago for palliation of inoperable hepatocellular carcinoma is an option we are just exploring. This study was aimed at evaluating the benefits of percutaneous ethanol injection in the management of advanced hepatocellular carcinoma. Methods: With IRB clearance, informed consent was obtained from consecutive patients diagnosed with HCC. Patients with jaundice, signs of liver failure and coma were excluded from this study. They were randomized to Ethanol treatment in form of absolute alcohol manufactured by Riedel-de Haen, Germany “Group one” or routine pain control management (DF118) “Group two”. Baseline investigations and pain score using Visual Analogue Scale (VAS) was obtained for both groups. PEI was administered via ultrasound guided intra-tumour injection of 10- 50mls of ethanol at each sitting. Investigation and pain score were obtained weekly for four weeks then monthly at follow up. Data obtained from August 2010 to July 2012 was analyzed using Epi Info. Results: “Group one” 32 patients had (PEI), “Group two” 32 (DF118) out of an initial 82; 18 patients were excluded. Mean age was 40.4+/- 14.2 yrs, range of 18 to 60 yrs. Group one had 28 (87.5%) males and 4 (12.5%) females; Group two 29 (90.6%) males and 3 (9.4%) female. All patients had Right hypochondrial pain and mass. Pre intervention pain score ranged from 6-9 for both groups while post intervention pain score a week after was 1 -2 for group 1, and group 2 required regular analgesics to control their pain. Mean survival durations were 8 months and 2.5 months for groups 1 and 2, respectively. Conclusions: We conclude that percutaneous ethanol injection significantly reduces the pain of advanced hepatocellular carcinoma.

Sorafenib-induced liver failure: a case report and review of the literature.

In patients with hepatocellular carcinoma characterized by vascular invasion and/or extrahepatic disease, Sorafenib is considered treatment of choice. Although mild liver test abnormalities were reported in less than 1% of the patients in the two large randomized, controlled phase III trials, four cases of severe acute Sorafenib-induced hepatitis have been described. One of these four cases died from liver failure. In this paper, a patient with HCC with lung metastases developed high fever and a severe hepatitis that rapidly evolved into liver coma and death, two weeks after the initiation of Sorafenib. Biochemical parameters pointed to a hepatocellular type of injury. Clinical and biochemical presentations were compatible with a drug-induced hypersensitivity syndrome such as it has mainly been described for aromatic anticonvulsants, sulphonamides, and allopurinol. We hypothesize that an underlying cytochrome P450 dysfunction with the presence of reactive drug metabolites might lead to this potentially fatal Sorafenib-induced severe liver dysfunction.

Relative Risk of Liver Failure in Dairy Cows with Left Abomasal Displacement

Dairy cows with left abomasal displacement (LDA) are in substantial negative energy balance and mobilize considerable amounts of non-esterified fatty acids. Thus, fatty liver is a common hepatic disorder in LDA cows. Results of a previous study showed that approximately 4-5% of LDA cows referred to our clinic for surgical correction of abomasal displacement died or were sacrified due to liver coma. We found not only cows with severe fatty liver but also cows with moderate or even mild fatty liver affected by liver failure. Characteristically, cows with liver failure showed typical clinical signs of a hepatic encephalopathy (general depression, ataxia, recumbency or coma) and a low plasma amino acid ratio (Val+Leu+Ile/Phe+Tyr), low plasma cholesterol concentrations and high plasma levels of ammonia, total bilirubin and hepatic enzymes.&#x0D; Thus, aim of the study was to calculate the risk of liver failure of dairy cows with LDA related to the hepatic triglyceride content.

Primary biliary cirrhosis: survival of a cohort followed for 10 years.

To study the natural course of primary biliary cirrhosis (PBC) in order to be able to design accurate clinical pharmacological studies and evaluate the need for liver transplantation. A cohort of 86 patients with PBC living in northern Sweden was followed for a 10-year period during 1983-93. No patients received therapy with ursodeoxy cholic acid or other drugs during the follow-up period. At start all patients were investigated personally by the authors. At follow-up medical notes were scrutinized and special questionnaires to the current responsible physician were applied. Endpoints were the time of dropout, liver transplantation, death or end of the study period. At follow-up data were available for 84 patients (97%). During the study period 34 patients died, of whom 28 were symptomatic; 15 deaths had no direct connection to PBC. Nineteen deaths were related to PBC of whom two were asymptomatic, the most common cause being end-stage liver disease with liver coma. During the study period in all eight patients were subjected to liver transplantation. The survival rate of the 32 asymptomatic PBC patients at the start of the study was the same as a sex- and age-matched standard background population. Those patients with symptomatic PBC from the beginning of study had a survival rate at 10 years of 50%, and the most ominous sign was a bilirubin greater than 35 micromol L(-1) . Liver transplantation was performed in almost 10% in this cohort until 1993. Since then, the indications and referral practice for liver transplantation has changed and is now higher.

Hemoperfusion through polymer-coated adsorbents for metabolic disorders in liver disease

The experimental and clinical use of perfusion of blood or plasma through polymer-coated adsorbents in several liver diseases is described. Altogether, 148 clinical perfusions were performed. The best results were obtained in severe cholestasis, liver coma and two types of hepatic porphyrias.

Branched chain amino acids—What are they good for?

From the above consideration it is apparent that the BCAA fulfill unique physiological functions in normal man. Thus, the BCAA constitute a principal source of nitrogen repletion in muscle tissue after the ingestion of a protein meal. In addition, the BCAA and leucine in particular have been implicated in the regulation of synthesis as well as breakdown of muscle protein. However, much remains to be learned regarding the physiological significance of the BCAA in normal and pathological states. Theoretical considerations and several preliminary studies have suggested a therapeutic role of the BCAA in certain clinical disorders although, in the case of liver coma, the present evidence does not support such a role, The possible clinical usefulness of BCAA after trauma and infection still remain to be clarified and the papers by Freund et al , Hartig et al , and Schmitz et al in this issue of Clinical Nutrition are welcome contributions to this important and rapidly developing area of research.

Effect of jejunoileal bypass on plasma and brain amino acids in the rat.

Liver failure and coma are serious complications of jejunoileal bypass (JIB) in man. Rats underwent either a 90-95% JIB or a sham operation. Six weeks later all animals were sacrificed, and plasma and brain amino acids were determined. In the plasma of rats with JIB compared with sham operation, the concentrations of valine, leucine, isoleucine, lysine, tryptophan, and tyrosine were significantly lower, while in the brain, phenylalanine, tyrosine, histidine, and glutamine were significantly higher. These changes in the brain are similar to those resulting from portalsystemic shunting in the rat.

Sclerotherapy of bleeding oesophageal varices by means of endoscopy.

From 1.1.1969 up to 1.11.1977, 640 patients with hemorrhage from gastro-oesopheal varices were managed by sclerotherapy of the oesophageal wall. In 90% this method succeeded in stopping hemorrhage or preventing a new bleeding during the next four months. Only 43 patients of the total number were treated because of impending hemorrhage under precise indications. After two or three sessions of sclerotherapy the interval of control can be extended up to one years without new danger of hemorrhage. Overall mortality was 14.5%; main causes of death were liver coma, uncontrollable hemorrhage, mediastinitis and pyothorax.--If liver function improves, a porto-systemic-shunt is performed whenever possible.--416 = 65% of the patients are still alive; 50% longer than one year up to eight years. Thus sclerotherapy seems to be the method of choice in uncurable massive hemorrhage from varicosities from the oesophagus. It is indicated in patients with decompensated liver function, and whenever a shunt procedure is anatomically or clinically impossible or not advisable, too.

Quantitative Estimation of Coagulation Factors in Liver Disease. The Diagnostic and Prognostic Value of Factor XIII, Factor V and Plasminogen

20 coagulation parameters were investigated in 144 patients with different liver diseases. The groups of acute hepatitis, chronic active hepatitis and liver cirrhosis were compared and the prognostic value of the coagulation analyses investigated. It is clear that the determination of the factor V activity is a good and easy test for detection of actual liver function. Repeated controls over several weeks revealed with a statistical significance (p less than 0.0005) that all patients with a factor XIII below 35% and a plasminogen below 19% will die in liver coma, if they have not died beforehand from acute gastrointestinal haemorrhage, acute infection or cardiac arrest. Plasminogen is also lower in the group of non-survivors but the values of the two groups are overlapping and of no prognostic help in a single case. The possible causes of the diminution of factor XIII activity are discussed.

Prognosis of cirrhosis of the liver (15-year follow-up from time of first manifestation (author's transl)

114 patients with cryptogenic or "hepatitic" cirrhosis of the liver (toxic or biliary causes excluded) were followed for a period of 15 years. The time of first manifestation of the disease was known because all patients had been in hospital or under serial outpatient observation, with clinical and biopsy studies every six months for chronic hepatitis. In addition, diagnosis of the liver cirrhosis was confirmed by laparoscopy and histomorphology, which further confirmed the exact timing of first manifestation. In 37 patients (32.5%) the disease healed out completely by way of reactionless fibrosis after, in some of them, a long period of observation, while in 47 (41.2%) the active disease continued, and 30 (26.3%) died in liver coma or bleeding from varices or surgical shunt procedures or from carcinoma of the liver. Prognosis of cirrhosis of the liver is thus much better than previously thought.

Evaluation of Corticosteroid and Exchange-Transfusion Treatment of Acute Yellow-Phosphorus Intoxication

To evaluate steroid therapy in patients acutely intoxicated with yellow phosphorus, 49 patients were sequentially assigned to one of three groups. Group A did not receive steroids at any time, Group B received steroids from the time of admission, and steroids were used in Group C only when liver coma developed. Two out of four patients in coma recovered in Group A, none out of five in Group B, and four out of seven in Group C. Thus, steroids did not appear to prevent onset of coma in this type of liver injury and did not increase survival after development of coma. In another group of 44 patients similarly intoxicated, deep hepatic encephalopathy developed in 15. Five of these were given exchange transfusions, with two deaths and three survivals. Of the 10 not given exchange transfusions, seven died, and three survived.

EFFECTIVENESS OF IODINOL IN COMBINATION WITH SUCCINIC ACID AT RISK OF DEVELOPING FATTY HEPATOSIS IN COWS

In this report, we present the results of injecting an iodometabolic composition based on the well-known veterinary drug yodinol in combination with succinic acid during the predicted periods of risk of developing fatty hepatosis in lactating cows. The results of the post-slaughter examination indicate that fatty liver degeneration is detected in about 80% of culled cows. The main cause of fatty liver degeneration in lactating cows is the intensive involvement of the body's own fat reserves in the energy metabolism. With the intensive involvement of fats in the energy processes, some of them do not have time to be metabolized and are deposited in the liver cells, which leads to a liver coma and the death of cows. Theoretical basis for the application of iodotyrosines composition for the prevention of fatty liver was the experimental research of scientists of Institute of Biophysics on the assessment of the effectiveness of succinates activation energy metabolism. They found that succinic acid and its succinate salts increase the detoxification and metabolic activity of the liver tenfold. Exogenously administered succinic acid, even in absolutely low dosages, nevertheless provides an atypically high metabolic effect, in particular, to increase the oxygen consumption of liver cells by 60 times. According to the results of clinical trials, it was found that the injectable use of this composition provided a pronounced correction of pathobiochemical processes in high-yielding cows under conditions of intensive involvement of their own body lipids in energy processes. This had a positive impact on the health and safety of the cows.

Peritonealdialyse bei einem Fall von Leberkoma im Kindesalter

Discription of a case of liver coma in a 5 year old patient who was suffering from transfusion hepatitis. She was treated by peritoneal dialysis over a period af 6 days under continous control of body water, serum electrolytes and of the acid base balance. During this treatment the patient improved dramatically. Two months later the child was clinically without pathological findings. The liverfunction tests had returned to normal values.

PORTACAVAL SHUNTS

The patient with cirrhosis of the liver and bleeding esophageal varices presents a number of serious problems. Diagnosis may occasionally be difficult and the treatment hazardous whether by balloon tamponade or transesophageal ligation. If the patient survives the acute bleeding episode, a period of intensive treatment is necessary to attain a maximum return toward normal liver function. Having accomplished this, an operation of considerable magnitude, frequently under prolonged anesthesia, must be performed. The postoperative period is endangered, in addition to the usual complications, by those untoward events peculiar to this disease, such as liver failure, coma, ammonia intoxication, and hemorrhage. Therefore, any treatment or technique which will enhance the possibility of recovery assumes a degree of importance. This discussion concerns the utilization of hypothermia during anesthesia for portacaval shunt. The Rationale of Hypothermia Linton (1958), one of the pioneers in shunt surgery, has described on several occasions his preference for

Hepatic artery catheterization for liver perfusion.

The increasing interest in perfusion and infusion techniques for the application of chemotherapeutic agents in the treatment of cancer has revived interest in the treatment of metastatic cancer of the liver. Previous studies indicate that metastatic deposits within the liver derive approximately 80% of their nutrition from the arterial supply. In the early part of the last decade, single doses of chemotherapeutic agents such as mechlorethamine (nitrogen mustard) were introduced directly into the hepatic artery. After a few experiences, it became obvious that the large doses of a toxic chemical could not be tolerated by the normal liver cells in a liver already impaired by metastatic disease. Laparotomy was necessary to instill the drug directly into the hepatic artery. The trauma of laparotomy and the concomitant anesthesia, plus the toxicity of the chemical, made liver coma a frequent sequela. In spite of this, with the singledose technique, an occasional case

Pathogenesis and treatment of hepatic failure.

IN a review of hepatic coma published this journal eleven years ago1 the statement was made that, in spite of a long-continued search for a metabolic toxin liver coma, none has been demonstr...

Pathogenesis and treatment of hepatic failure.

IN a review of hepatic coma published in this journal eleven years ago1 the statement was made that, "in spite of a long-continued search for a metabolic toxin in liver coma, none has been demonstrated." Within a few years a continuing flood of papers on the biochemical and clinical effects of ammonia in hepatic coma was started by the observations that impending coma could be produced by ammonia-releasing substances such as cation-exchange resins, urea and dietary protein.2 3 4 5 It was fitting that this rediscovery of ammonia toxicity in liver disease was made at the same time in France,6 for it was . . .

The effect of liver disease on serum vitamin B12 concentrations.

Abstract 1.1. Serum vitamin B 12 concentrations were determined in 36 patients with liver disease; 11 patients had alcoholic cirrhosis, 10 patients had postnecrotic cirrhosis, 6 patients had acute viral hepatitis, 5 patients had biliary cirrhosis, and 4 patients were studied during liver coma. 2.2. All of the patients had total serum vitamin B 12 levels markedly elevated over the normal control values with the exception of those with biliary cirrhosis. 3.3. Patients with acute inflammation and necrosis had relatively high levels of free vitamin B 12 while those with chronic liver disease had elevated bound vitamin B 12 . 4.4. Twenty-four-hour urine collections were assayed for vitamin B 12 content in 14 patients with liver disease and in 10 normal controls. All of the patients with liver disease excreted comparatively large amounts of vitamin B 12 . 5.5. In vitro incubation studies and in vivo tolerance tests were done in both normal subjects and patients with liver disease in an effort to study the binding capacity of the serum. In most of the cases the serum binding capacity appeared to be saturated when studied by either of these techniques. 6.6. The possible significance of these results is discussed.