Liver Function Test Results Research Articles

Effect of zinc on liver cirrhosis with hyperammonemia: A preliminary randomized, placebo-controlled double-blind trial

ObjectiveTo our knowledge, no randomized study has shown whether zinc replacement therapy is effective for hyperammonemia in liver cirrhosis; therefore, we performed a double-blind, placebo-controlled trial to examine efficacy and safety of the zinc replacement therapy. MethodsPatients with liver cirrhosis and hyperammonemia (at or above the institutional reference value) and hypozincemia (≤65 μg/dL) were enrolled in the outpatient units of the participating institutions and were randomly divided to receive placebo (P group) or zinc acetate preparation at a dose of 3 capsules/d for a total zinc content of 150 mg/d (Z group) by the envelope method. Of the 18 enrolled patients, 6 dropped out; thus, the analyses included 12 patients (5 in the P group and 7 in the Z group). Variations in blood concentrations of zinc and ammonia as well as liver function test results were compared. ResultsBlood zinc levels significantly increased in the Z group (P = 0.0037; Friedman test) but not the P group. Blood ammonia levels significantly decreased in the Z group (P = 0.0114; Friedman test) but not the P group. The percent change in blood ammonia level also revealed significant reduction at the eighth week in the Z group (P = 0.0188: Mann-Whitney test). No serious adverse events attributable to the zinc preparation were noted. ConclusionAlthough this study is preliminary and includes a small sample, it is, to our knowledge, the first randomized controlled trial to show that zinc supplementation for 3 mo seems effective and safe for treating hyperammonemia in liver cirrhosis. Studies with a larger sample size are needed to confirm our findings.

Factors Associated with Diffusely Increased Splenic F-18 FDG Uptake in Patients with Cholangiocarcinoma.

ObjectivesAlthough diffuse splenic 18F-fluorodeoxyglucose (F-18 FDG) uptake exceeding hepatic activity, is considered abnormal, its clinical significance is rarely discussed in the literature. The aim of this study was to determine the contributing factors causing diffusely increased splenic FDG uptake in patients with cholangiocarcinoma.MethodsFrom January 2010 to March 2013, 140 patients (84 men, 56 women) were enrolled in this study. All patients had been diagnosed with cholangiocarcinoma and underwent F-18 FDG positron emission tomography/computed tomography (PET/CT) for the pretreatment staging work up. Clinical records were reviewed retrospectively. Various hematological parameters, C-reactive protein (CRP) level, CEA, CA19-9, pancreatic enzymes and liver function tests were conducted within 2 days after the F-18 FDG PET/CT study.ResultsDiffuse splenic uptake was observed in 23 patients (16.4%). Of those, 19 patients (82.6%) underwent endoscopic retrograde cholangiopancreastography (ERCP) 7 days before F-18 FDG PET/CT. The CRP level (p < 0.001) and white blood cell count (p = 0.023) were significantly higher in the group of patients with diffuse splenic FDG uptake. The hemoglobin (p < 0.001) and the hematocrit (p < 0.001) were significantly lower in patients with diffuse splenic FDG uptake. Pancreatic enzymes, liver function test results, and tumor markers were not significantly different between the patients who did or did not have diffusely increased splenic FDG uptake. The significant factors for diffuse splenic F-18 FDG uptake exceeding hepatic F-18 FDG uptake on multivariate analysis included: performing ERCP before F-18 FDG PET-CT (odds ratio [OR], 77.510; 95% CI, 7.624-132.105), and the presence of leukocytosis (OR, 12.436; 95% CI, 2.438-63.445) or anemia (OR, 1.211; 95% CI, 1.051-1.871).ConclusionIn conclusion, our study demonstrated that concurrent inflammation could be associated with diffusely increased splenic FDG uptake. We suggest that performing ERCP before F-18 FDG PET/CT could cause acute inflammation which may induce splenic FDG activity.

Analysis of the Hepatic Functional Reserve, Portal Hypertension, and Prognosis of Patients With Human Immunodeficiency Virus/Hepatitis C Virus Coinfection Through Contaminated Blood Products in Japan

BackgroundAs the survival of human immunodeficiency virus (HIV)-infected individuals has improved due to the widespread use of antiretroviral therapy, the mortality rate due to hepatitis C virus (HCV)-related liver disease has increased in HIV/HCV-coinfected patients. AimThe aims of this study were to establish the appropriate therapeutic strategy for HIV/HCV-coinfected patients by evaluating the liver function, including the hepatic functional reserve and portal hypertension, and to investigate the prognosis of HIV/HCV-coinfected patients in Japan. Patients and MethodsIn addition to regular liver function tests, the hepatic functional reserve of 41 patients with HIV/HCV coinfection was evaluated using the indocyanine green retention rate and liver galactosyl serum albumin-scintigraphy. The data for 146 patients with HIV/HCV coinfection through blood products were extracted from 4 major HIV centers in Japan. In addition to liver function tests, the platelet counts (PLT) were evaluated as a marker of portal hypertension. ResultsIn spite of the relatively preserved general liver function test results, approximately 40% of the HIV/HCV-coinfected patients had an impaired hepatic functional reserve. In addition, while the albumin and bilirubin levels were normal, the PLT was <150,000/μL in 17 patients. Compared with HCV mono-infected patients with a PLT <150,000/μL, the survival of HIV/HCV-coinfected patients was shorter (HCV, 5 years, 97%; 10 years, 86% and HIV/HCV, 5 years, 87%; 10 years, 73%; P < .05). ConclusionThese results must be taken into account to establish an optimal therapeutic strategy, including the appropriate timing of liver transplantation in HIV/HCV-coinfected patients in Japan.

Immunodeficiency and disseminated mycobacterial infection associated with homozygous nonsense mutation of IKKβ

A, Genealogical tree for the kindred. Arrow highlights index case. Asterisks denote family members who died within the first 2 months of life with febrile illnesses. B, Histology showing granuloma in skin by hematoxylin and eosin staining.

Abdominal Swelling in a Newborn With Trisomy 21

A newborn with trisomy 21 presents with abdominal swelling (Figure 1). Figure 1. Abdominal Swelling 19 days after birth ### Prenatal and Birth Histories The spontaneous vaginal delivery in the hospital had no complications. ### Physical Examination at Birth ### Later Findings

Treatment of ankylosing spondylitis with TNF inhibitors does not have adverse effect on results of liver function tests: a longitudinal study

To retrospectively investigate and compare the effects of tumor necrosis factor alpha inhibitors (TNFi) on hepatic enzymes in ankylosing spondylitis (AS) patients. A retrospective analysis of the records of 94 AS (66 male, 28 female) patients using TNFi was performed. Patients' clinical data, Bath Ankylosing Spondylitis Disease Activity (BASDAI) scores, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were all examined. Liver function test (LFTs) results of patients before the treatment and 3, 6 and 12 months after treatment with TNFi were investigated. Aspartate transaminase (AST) and alanine transaminase (ALT) levels were investigated as indicators of LFTs. The TNFi drugs used were infliximab (n = 28), adalimumab (n = 32) and etanercept (n = 34). Pre-treatment values of ESR, CRP and BASDAI scores were 28.3 ± 20.1 mm/h, 1.5 ± 1.2 ng/dL and 5.2 ± 0.8, respectively. Following TNFi use there was a statistically significant decrease in disease activity score (P = 0.001). There was a significant increase in LFT at the third month evaluation compared to the initial values, while the average value was within normal range (baseline AST 19.6 ± 10.8 U/L, ALT 19.1 ± 6.4 U/L, third month AST 31.3 ± 21.6 U/L, ALT 28.1 ± 18.1 U/L, P = 0.001). Drug group comparison analysis revealed a significant difference in the adalimumab group value at the end of the first year, but no other significant difference in the data for the other months (P > 0.05). No significant correlation was determined between initial disease activity scores and LFT. TNFi use-associated rises in hepatic enzymes were determined compared to pre-treatment but the mean values remained within normal limits. Considering the cases in the literature, in daily practice patients must be carefully monitored for liver function before treatment and at follow-up.

Visualization of liver uptake function using the uptake contrast-enhanced ratio in hepatobiliary phase imaging

PurposeTo visualize liver uptake function using the uptake contrast-enhanced ratio in hepatobiliary phase (uptake CERH) magnetic resonance imaging. Materials and methodsThirty-seven patients with hepatocellular carcinoma (HCC) and 23 with metastatic liver cancer were evaluated. Hepatobiliary phase images were acquired 20min after an intravenous bolus injection of gadoxetic acid disodium. We assumed that the contrast-enhanced ratio in the hepatobiliary phase (CERH) in the spleen was similar to the contrast-enhanced ratio in the extracellular matrix (CEREM). The Uptake CERH value was defined as the percentage signal gain between the precontrast and hepatobiliary phase images (without CEREM). The Uptake CERH value measured the tumor-free liver parenchyma. The association of the uptake CERH value with the biochemical liver function test results, and hepatocellular density in the liver parenchyma was assessed. Correlations were examined using Pearson correlation coefficient and the Mann–Whitney test. ResultsThe uptake CERH value was correlated with albumin, bilirubin, indocyanine green retention rate at 15min, prothrombin activity(%), platelet count, and cellular density in the liver parenchyma (p<0.01). ConclusionsUptake CERH images are useful for visualizing liver uptake function.

Paraclinical Evolutions Regarding Liver and Renal Abnormalities of Kawasaki Disease in the Southeast of Iran

Background: Kawasaki disease (KD) is a vasculitis affecting multi-organ systems including liver and kidneys. KD is diagnosed by some clinical criteria including sterile pyuria, microscopic hematuria, proteinuria due to renal involvement, liver abnormalities manifesting as abnormal liver function tests, gallbladder hydrops, and hypoalbuminemia. Objectives: The aim of the study was to determine the frequency of liver and renal abnormalities in patients with KD, hospitalized in Ali-Ebne-Abitaleb Hospital of Zahedan during 2006 - 2013. Materials and Methods: Paraclinical findings including serum and urine tests as well as gallbladder ultrasonography of 47 patients with KD hospitalized in Ali-Ebne-Abitaleb Hospital of Zahedan during 2006 - 2013 were reviewed retrospectively. Results: Liver abnormalities were found in 22 (46.8%) cases and impaired liver function tests were more common than other liver abnormalities in this cross-sectional study. The incidence of abnormal liver function tests in this study was about 42%. Gallbladder hydrops were found in 6 (12.7%) patients and 18 (38.3%) had renal involvement. Sterile pyuria was the most common urine abnormality with incidence of 36.2%. Microscopic hematuria and proteinuria were rarely found; in addition, serum urea nitrogen and creatinine had normal levels in all patients. Conclusions: The possibility of KD should be considered in any infants or children with abnormal results in liver or renal function tests. Paraclinical findings of liver and renal involvements of all patients were partly similar to the previous studies.

Protective effect of S-adenosylmethionine on hepatic ischemia-reperfusion injury during hepatectomy in HCC patients with chronic HBV infection

BackgroundAlthough hepatectomy is often performed with the Pringle maneuver, the problem of hepatic ischemia-reperfusion injury (HIRI) can also be serious. Thus, the present study was designed to investigate the protective effect of S-adenosylmethionine (SAMe) on HIRI, especially for patients with hepatocellular carcinoma (HCC) associated with chronic hepatitis B virus (HBV) infection and cirrhosis.MethodsEighty-one HCC patients with chronic HBV infection, undergoing partial hepatectomy with inflow occlusion, were divided into three groups. In the pretreatment group (PR group, n = 26), patients were given SAMe two hours before surgery. In the post-treatment group (PO group, n = 25), patients were given SAMe six hours after surgery. And in the control group (control group, n = 30), patients received partial hepatectomy without any SAMe. All pre-, intra- and postoperative blood samples were collected to measure the plasma levels of transaminases, bilirubin and cytokines. The results were compared among the three groups.ResultsThere were no statistically significant intergroup differences observed in age, gender, hepatic inflow occlusion time and the results of liver function tests. Preoperative administration of SAMe (PR group) significantly reduced the plasma levels of alanine transaminase (ALT), aspartate transferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) as compared to the other two groups. In the PO group, TBIL and DBIL were significantly lower than in the control group. Significant differences were also seen in IL-6 and TNF-α between the PR group and the other groups. In all groups, postoperative liver reserve function in the PR group as revealed by ICGR15 (Post ICGR15) was at its best before abdominal closure. Compared to the control group, the risk of complications and the hospital stay after surgery were significantly meliorated in the PR group. Additionally, patients with cirrhosis had a more acute rate of change in ALT and AST than non-cirrhotic patients.ConclusionsTaken together, our preliminary findings suggest that preoperative administration of SAMe is useful and safe for reducing the HIRI in partial hepatectomy, especially for HCC patients whose disease is associated with chronic HBV infection and cirrhosis.

Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases

The accurate discrimination between tumor and normal tissue is crucial for determining how much to resect and therefore for the clinical outcome of patients with brain tumors. In recent years, guidance with 5-aminolevulinic acid (5-ALA)-induced intraoperative fluorescence has proven to be a useful surgical adjunct for gross-total resection of high-grade gliomas. The clinical utility of 5-ALA in resection of brain tumors other than glioblastomas has not yet been established. The authors assessed the frequency of positive 5-ALA fluorescence in a cohort of patients with primary brain tumors and metastases. The authors conducted a single-center retrospective analysis of 531 patients with intracranial tumors treated by 5-ALA-guided resection or biopsy. They analyzed patient characteristics, preoperative and postoperative liver function test results, intraoperative tumor fluorescence, and histological data. They also screened discharge summaries for clinical adverse effects resulting from the administration of 5-ALA. Intraoperative qualitative 5-ALA fluorescence (none, mild, moderate, and strong) was documented by the surgeon and dichotomized into negative and positive fluorescence. A total of 458 cases qualified for final analysis. The highest percentage of 5-ALA-positive fluorescence in open resection was found in glioblastomas (96%, n = 99/103). Among other tumors, 5-ALA-positive fluorescence was detected in 88% (n = 21/32) of anaplastic gliomas (WHO Grade III), 40% (n = 8/19) of low-grade gliomas (WHO Grade II), no (n = 0/3) WHO Grade I gliomas, and 77% (n = 85/110) of meningiomas. Among metastases, the highest percentage of 5-ALA-positive fluorescence was detected in adenocarcinomas (48%, n = 13/27). Low rates or absence of positive fluorescence was found among pituitary adenomas (8%, n = 1/12) and schwannomas (0%, n = 0/7). Biopsies of high-grade primary brain tumors showed positive rates of fluorescence similar to those recorded for open resection. No clinical adverse effects associated with use of 5-ALA were observed. Only 1 patient had clinically silent transient elevation of liver enzymes. Study findings suggest that the administration of 5-ALA as a surgical adjunct for resection and biopsy of primary brain tumors and brain metastases is safe. In light of the high rate of positive fluorescence in high-grade gliomas other than glioblastomas, meningiomas, and a variety of metastatic cancers, 5-ALA seems to be a promising tool for enhancing intraoperative identification of neoplastic tissue and optimizing the extent of resection.

Are Unexpected Positive Dipstick Urine Bilirubin Results Clinically Significant? A Retrospective Review: Table 1

Urine-bilirubin measurement is common in urinalysis dipsticks, which are known to yield a high rate of false positive results. We evaluated the usefulness of this test after multiple physicians in our system reported that they do not act on positive dipstick urine bilirubin findings. We queried past records to determine how many samples with positive urine bilirubin results had associated abnormal results for liver function tests (LFTs) within 2 weeks before the positive urine bilirubin result. (LFTs included aspartate aminotransferase [AST], alanine transaminase [ALT], gamma-glutamyl transpeptidase [GGT], and total bilirubin.) We labeled positive results on these test as expected positives. We labeled the positive test results for samples from patients who had not had abnormal LFT results within 2 weeks before the current testing as unexpected positives. During a 20-month period, we performed 241,929 urine-bilirubin tests. Of these, 831 (0.3%) yielded positive results. Of these positives, 60% were from patients who had abnormal LFT results in the previous 2 weeks. The remaining 40% of positive results were deemed to be unexpected positives. Of these, 80% had had LFTs ordered within 2 weeks after the positive urine bilirubin results. A total of 85% of those LFTs yielded an abnormal result. In patients with an unexpected positive urine bilirubin test result, 85% had abnormal LFT results after their positive urine bilirubin result. However, these unexpected positives amounted to only 0.13% of all test results. Urine bilirubin does not appear to add significant information toward the diagnosis of most patients.

Ketamine-induced cholangiopathy

Hong Kong Med J ⎥ Volume 20 Number 1 ⎥ February 2014 ⎥ www.hkmj.org A 28-year-old woman presented to us in November 2010 because of deranged liver function test results; predominantly she had raised ductal enzyme levels (gamma-glutamyl transferase, 1088; reference range, 12-57 IU/mL); alkaline phosphatase (ALP) 579 (reference range, 46-127) IU/mL, alanine transaminase (ALT) 183 (reference range, 10-57) IU/mL with normal bilirubin levels. Upon further questioning, she had been a ketamine abuser for 5 years and was followed up by psychiatrists. She was completely asymptomatic and physical examination yielded nil abnormal. Her ALP level was excessive (154 IU/mL) and her ALT level was 48 IU/mL. Ultrasound of hepatobiliary system (HBS) showed a dilated common bile duct (CBD) of 1.1 cm in diameter with tapering over lower end. A gallstone was present in the gallbladder. Therefore, the endoscopic retrograde cholangiopancreatography (ERCP) was performed in November 2011, and showed a 5-cm stricture at the lower end of the CBD together with small bilateral segmental strictures in the intrahepatic ducts (Fig 1). Brush cytology of the stricture of CBD revealed no malignant cells. A plastic stent bypassing the CBD was inserted for drainage. Liver function test findings did not improve after stenting but repeated ultrasonography of the HBS showed that with the 5.7-mm stent in situ, the CBD was not dilated . A liver biopsy was therefore performed, and showed mild-to-moderate portal fibrosis with ductular proliferation (Fig 2) and periportal copper deposits were noted (Fig 3). These findings were consistent with chronic cholestasis at both the extrahepatic and intrahepatic level. There were no features suggestive of primary biliary cirrhosis, or primary sclerosing cholangitis. The colonoscopy was normal and showed no evidence of inflammatory bowel disease. The patient’s liver function improved

Liver function test profile of Nigerian children with sickle cell anaemia in steady state

Background and Objective: Several studies across the world have revealed that liver dysfunction is a common finding in children with sickle cell anaemia (SCA). The situation in hospitals in Nigeria is not known. The few studies carried out in Nigeria were on adult subjects. The overall objective of the study was to evaluate the liver function test (LFT) profile of children with SCA, aged 1-14 years, with a view to improve the routine investigation and management of this group of subjects. Materials and Methods: LFT profile of 60 SCA subjects and 60 age- and sex-matched apparently healthy subjects (controls) was evaluated in the present study in the departments of chemical pathology and paediatrics of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, northern region of Nigeria. Results: The results of serum LFTs of the SCA subjects and age- and sex-matched control subjects showed that the concentrations of serum total bilirubin (TB), conjugated bilirubin (CB), unconjugated bilirubin (UCB), alkaline phosphatase (ALP), and aspartate transaminase/alanine transaminase (AST/ALT) ratio were significantly higher (P 0.05). The results of serum LFTs also showed that there were no significant age differences (P > 0.05) in both SCA subjects and control subjects. There were no correlations between all the LFT analytes and the frequency of crisis (FOC) among SCA subjects (P > 0.05). Conclusion: It could be concluded from the findings of the present study that there are mild LFT abnormalities in children with SCA even in steady state, and that the extent of some of the abnormalities decreases with advancing age of the subjects.

Oral health and liver function in children and adolescents with cirrhosis of the liver.

IntroductionPeople with cirrhosis of the liver are predisposed to developing oral lesions. The occurrence and type of lesion depend on the degree of liver function impairment and its type, and on the severity and duration of systemic diseases. In children, the age at which the early symptoms of liver disease are experienced is also of great importance.AimTo assess the prevalence of oral pathological lesions in children and adolescents with cirrhosis of the liver, and their correlation with the degree of liver function impairment.Material and methodsClinical and laboratory results of liver function tests (Model of End-Stage Liver Disease/Score of Paediatric End-Stage Liver Disease, Child-Pugh score) were assessed in 35 patients with cirrhosis of the liver. The average age of the patients was 10.7 ±4.74 years. All patients also had their oral cavities examined (mucosa, gingiva – GI, hygiene – PLI, teeth – dmft/dmfs and DMFt/DMFs, DDE Index and Candida spp. presence) and this was then correlated to the degree of liver function impairment.ResultsAccording to the Child-Pugh scale, 16 patients were class A and 19 were class B/C. Jaundice during the first 3 years of life occurred in 9 patients. Mucosal lesions were found in 26 out of 35 patients (74%), including 10 out of 16 (63%) in Child-Pugh group A, and 16 out of 19 (84%) in group B/C (NS – non significant). Oral candidiasis occurred more often in class B/C than in class A (47.4% vs. 12.5%; p < 0.05). The GI index (Gingival Index) and PLI index (Dental Plaque Index) did not differ between the groups (A vs. B/C) but correlated in the whole group (R = 0.58) as well as in subgroups A (R = 0.65) and B/C (R = 0.59). Dmft/dmfs and DMFt/DMFs indexes did not differ between groups A and B/C, and neither did the DMFt/DMFs in patients with/without enamel defects.ConclusionsOral mucosal lesions are commonly found in children with cirrhosis of the liver. Advanced liver disease promotes oral candidiasis. Severity of gingivitis correlates with the presence of dental plaque.

Epithelioid hemangioendothelioma of the liver as a rare indication for liver transplantation.

To investigate the indications and outcomes of liver transplantation for hepatic epithelioid hemangioendothelioma (HEHE). Between 1989 and August 2013, in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1306 orthotopic liver transplantations (OLTx) were performed, including 72 retransplantations. Unresectable HEHE was an indication for OLTx in 10 patients (0.8% of primary OLTx), the mean age of the patients was 40.5 ± 13.3 years (range 23-65 years), and the male-to-female ratio was 2:8. Kaplan-Meier survival analysis in HEHE, hepatocellular carcinoma (HCC), and other OLTx recipients groups was performed. The differences in mortality were compared using the χ(2) test. A P-value < 0.05 indicated statistical significance. No concomitant liver disease was found in any patient. There was no neoadjuvant chemotherapy or radiotherapy. Liver function test results were normal in most of the patients. The levels of alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were normal. In immunohistochemical staining, the neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34, which are endothelial cell markers, and negative for cytokeratin 19, cytokeratin 7, and HepPar-1. Nine patients were alive without tumor recurrence. One patient died 2 mo after OLTx due to septic complications. No morbidity was observed. Maximum follow-up was 11.4 years, with a minimum of 1 mo. The cumulative survival rate at the end of follow-up in HEHE patients was 87.5% compared with 54.3% in the HCC group and 76.3% in the other OLTx recipients group (χ(2) test = 1.784, df = 2, P = 0.409). Unresectable HEHE, without extrahepatic metastases is an excellent indication for liver transplantation. Long-term survival is very good and much better than in HCC patients and the entire group of OLTx patients.

Liver involvement in systemic infection.

The liver is often involved in systemic infections, resulting in various types of abnormal liver function test results. In particular, hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis, and several mechanisms for this phenomenon have been proposed. In this review, we summarize how the liver is involved in various systemic infections that are not considered to be primarily hepatotropic. In most patients with systemic infections, treatment for the invading microbes is enough to normalize the liver function tests. However, some patients may show severe liver injury or fulminant hepatic failure, requiring intensive treatment of the liver.

Hepatitis E and Lymphocytic Leukemia in Man, Italy

Hepatitis E and Lymphocytic Leukemia in Man, Italy

Classical xanthinuria: a rare cause of pediatric urolithiasis.

Xanthine dehydrogenase catalyzes the oxidation of hypoxanthine to xanthine and xanthine to uric acid in the final two steps of the purine degradation process. Xanthine oxidase deficiency is an uncommon cause of pediatric urinary stone formation, and classical xanthinuria. A ten-month-old boy presented with a seven-month history of nausea, vomiting, discomfort during urination, gross hematuria and passage of stones. His renal and liver function test results and electrolytes were within normal limits, but serum and urine uric acid levels were undetectable. Ultrasonographic evaluation of the urinary tract revealed the presence of multiple bilateral renal stones. Renal stones were analyzed using an X-ray diffractometer, and were found to be composed of hypoxanthine-xanthine. High fluid intake, alkalinization and a low-purine diet were prescribed, and extracorporeal shock wave lithotripsy was performed. Recurrent renal stone formation was not observed during 18 months of follow-up. This case is reported to highlight the nature of this rare condition.

Acute hepatitis due to self-poisoning in an adolescent girl: Case report

Acute hepatitis due to self-poisoning in an adolescent girl: Case report

Multicenter randomized trial of postoperative corticosteroid therapy for biliary atresia

We aimed to evaluate early response to two different corticosteroids doses after Kasai portoenterostomy for biliary atresia (BA). A prospective, randomized trial was performed in infants from the nationwide BA registry with type 3 BA. Sixty-nine infants were randomized to receive either 4 mg/kg/day (group A, n = 35) or 2 mg/kg/day prednisolone (group B, n = 34). The corticosteroids were started on postoperative day 7, and the dose was tapered toward day 30. Results of liver function tests on days 31 and 60 were compared between the groups. Mean bilirubin, AST, ALT, and GGT levels did not significantly differ between the groups. However, the levels of total and direct bilirubin of infants <70 days old at surgery significantly differed between the groups. Four patients from group A and five from group B, dropped out of the study. Complications during the first month after PE were comparable between the groups. An initial 4 mg/kg/day dose did not significantly improve liver function, except that bilirubin levels were lower in the subgroup of infants <70 days old at surgery. There were no significant complications with either dose of corticosteroids.