Percutaneous Needle Biopsy Of Liver Research Articles

Percutaneous Liver Needle Biopsy Methods Can Be Safe and Effective in Patients with Viral Hepatitis

Percutaneous Liver Needle Biopsy Methods Can Be Safe and Effective in Patients with Viral Hepatitis

Clinicopathological correlation of liver biopsy- study of 50 cases

Background: The liver biopsy is considered by many experts to be the most specific diagnostic tool used to assess the nature and severity of liver diseases such as hepatitis C. Liver biopsies are important for many reasons, such as accurate diagnosis or ruling out any coexisting liver diseases, staging and grading the severity of liver disease, treatment decisions, patient and provider reassurance, and as a benchmark for gauging future progression. Methods: In this observational study, 50 patients were recruited from different Medicine units of Dhaka Medical College Hospital, Dhaka, from May, 2008 to June, 2009. After preliminary selection of patients, a specific protocol was followed which include patients’ particulars, clinical features and clinical diagnosis, biochemical parameters, radiological and other investigative procedures and finally percutaneous needle biopsy of liver was done. The objective of the study was to establish the correlation of clinical presentation of chronic parenchymal liver disease with histopathological findings and establish liver biopsy as a tool for diagnosis. SPSS version 16.0 was used to analyze the data. Quantitative data were presented in the form of tables and figures. Chi-square test and student t test was done to find out the statistical significance. Results: Histopathologically chronic liver disease (CLD) was found to be the commonest lesion (pd”0.05), which was 24 (48%) followed by hepatocellular carcinoma 13(26%) and secondary deposit 02(4%). Eleven cases consist of other findings including normal. CLD commonly presented with loss of appetite (82%), Jaundice (74%), Weight loss (68%), hepatic facies (54%).Hepatocellular carcinoma commonly presented with hepatomegaly (100%), jaundice (61.84%), weight loss (76.92%), and ascites (53.85%). Hepatomegaly was constant feature (100%) of all secondary metastasis. Among two cases of secondary carcinoma one (50%) was adenocarcinoma and another one (50%) was anaplastic type. Out of 29 cases of clinically diagnosed chronic liver disease 24 cases were confirmed histopathologically which was statistically significant (pd”0.05). Conclusion: For the establishment of diagnosis and treatment it is mandatory to have a good correlation between clinical features and histopathological finding. Histopathology could detect diseases which were not considered clinically and specific management could only be done depending on histopathology. Therefore, if there is no contraindication, for confirmation of diagnosis liver biopsy still remains the corner stone modality. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21520 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 120-124

Effects of pioglitazone on nonalcoholic steatohepatitis in a patient with anorexia nervosa: A case report

Diseases associated with metabolic syndromes are of major concern in developed countries. Nonalcoholic steatohepatitis (NASH) is one of the manifestations of metabolic syndrome in the liver. Previous studies have shown that NASH is also caused by malnutrition. In the present study, a case of malnutrition-associated NASH in a 66-year-old female with anorexia nervosa is reported. The patient had a body mass index (BMI) of only 11.1 kg/m2 and serum alanine aminotransferase levels of 1,495 IU/l. Steatohepatitis with fibrosis was confirmed by percutaneous liver needle biopsy. Total parenteral nutrition was conducted at first, followed by the administration of Stronger Neo-Minophagen C (a glycyrrhizin-containing preparation), ursodeoxycholic acid and prednisolone. The abnormal elevation of aminotransferase levels of the patient was prolonged and total bilirubin levels increased. Pioglitazone (15 mg/day), which has been identified to be effective for nonalcoholic steatohepatitis, was then administered. This resulted in marked reductions in aminotransferase and bilirubin levels within three months. Histological improvement of the liver was also confirmed by percutaneous liver needle biopsy after one year. The observations in the present case suggest that pioglitazone may be useful for the treatment of malnutrition-associated NASH.

A Doppler waveform index to characterize hepatic vein velocity pattern and evaluate hepatic fibrosis

To describe a Doppler waveform index representing the hepatic vein flow velocity pattern and to examine its relationship to the degree of hepatic fibrosis. Doppler waveforms were obtained in 66 patients scheduled for percutaneous liver needle biopsy and categorized as normal (with a retrograde flow phase) or abnormal (without retrograde flow). Waveforms were also characterized using a hepatic vein waveform index (HVWI): (maximum - minimum velocity)/(maximum velocity). Biopsy specimens were graded for fibrosis. There was a highly significant decrease in HVWI with increasing fibrosis score in the biopsy (p < 0.001, Jonckheere trend test). The biopsy showed cirrhosis in 14 of 29 patients (48%) with absent retrograde flow and 5 of 37 patients (14%) with a normal flow pattern. Using HVWI as the criterion, cirrhosis was present in 13 of 21 (62%) patients with HVWI < 0.75, in 6 of 31 (19%) patients with 0.75 < HVWI < 1.50, and in none of 14 (0%) patients with HVWI > 1.50. HVWI is inversely correlated to the degree of liver fibrosis and may be more efficient than the presence or absence of retrograde flow in diagnosing and grading hepatic fibrosis.

Inflammatory Pseudotumor of the Liver: Analysis of Seven Resected Cases

Objectives: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion which is commonly misdiagnosed as malignant tumor or liver abscess. Surgery is generally unnecessary because of its benign course. The purpose of this study is to determine non-surgical treatment options for IPT. Patients and Methods: Among 1262 patients who underwent liver resection for tumors from September 1989 to June 2004, seven patients had pathologically confirmed IPT of the liver. All the seven patients background characteristics, pathologic findings of the tumor, as well as early and late results were reviewed and analyzed. Results: The liver function tests were all within normal range with a normal serum α-fetoprotein (AFP) and carcinoembryonic antigen (CEA). Abdominal ultrasonography showed all tumors as hypoechoic lesions with unclear margin. Enhanced computed tomography (CT) scans showed a low-density area with marginal enhancement in six patients. One patient had liver cirrhosis. No complications occurred in any patient after surgery. All patients survived, with the longest survival time to date being 14 years. Conclusions: In patients with or without positive hepatitis seromarkers and normal tumor markers, if abdominal ultrasonography shows hypoechoic lesions with unclear margin and CT scan shows a low-density area with marginal enhancement, IPT of the liver could be suspected. If percutaneous liver needle biopsy confirms the diagnosis of IPT of the liver, surgery can be avoided.

PERSISTENT HIGH C2 LEVEL AS A RISK FACTOR FOR DEVELOPING CSA RELATED ADVERSE EFFECT IN STABLE LIVER TRANSPLANT PATIENTS

P509 Aims: A single blood concentration measurement 2 hours after cyclosporine administration (C2) has been shown to be a more sensitive indicator of drug exposure in de novo transplant recipients from the first week to 6 months after initiation of cyclosporine administration than trough concentrations (C0). To detect the risk factor according to C0 and C2 levels in stable liver transplantation, a prospective cohort study has been executed in our institute.. Methods: In 50 stable liver transplant recipients (0.5-13.5 years post-transplant), we determined C2 levels in addition to conventional C0 repeatedly up to 5 times and observed clinical outcome over a period of 10±5 months. The cyclosporine dosage was adjusted according to predetermined C0 target range (80-180 ng/ml) and clinical status. Besides regular physical examination and routine laboratory measurements, a separate questionnaire containing questions specifically on the adverse effects of cyclosporine was documented. Results: Totally 128 questionnaire and paired C0 and C2 values were obtained. Percutaneous liver needle biopsy has been performed in 13 patients during the study. No rejection episode has been observed. However, 94% patients (47/50) had at least one of CsA related adverse events, such as hypertension, elevation of serum creatinine or neurotoxic symptom. The C0 levels were 145±37 ng/ml whereas the corresponding C2 were 690±222 ng/ml. A C2 level above 750 ng/ml, determined at least twice in an interval of 3 months, was identified as a relevant risk factor for the presence of serious adverse effect, which was defined as the combination of hypertension, renal insufficiency and more than two neurological complaints (RR=4, p<0.01). Single elevated C2 value was not a statistically significant risk factor. Conclusions: In this study we prospectively analysed C2 values in stable liver recipients on maintenance immunosuppression based on C0 monitoring. C2 level exceeding 750 ng/ml over 6 months was found to be associated with sever adverse events from cyclosporine whereas C0 was failed to identified this population.

A CASE OF HEPATOCELLULAR CARCINOMA FOLLOWING THE OPERATION FOR SOLITARY TUBERCULOMA

Solitary tuberculoma of the liver is uncommon and this paper presents a hepatocellular carcinoma (HCC) case which occurred after the operation and antituberculous therapy for solitary tuberculoma of the liver. A 65-year-old man was admitted because of right hypochondralgia. Abdominal contrast computed tomography (CT) showed a mildy enhanced mass in the anterior inferior segment of the liver (S 5). Partial hepatectomy was performed with a suspected diagnosis of hepatoma. Pathohistologically the resected specimen was compatible with tuberculoma containing caseous necrosis and Langhans' giant cells. Antituberculosis drugs were prescribed for one year. Eighteen months after the operation, the enhanced tumor growing segmentally in the right posterior segment of the liver (S 7) was detected by the contrast CT scan. Angiography showed a hypervascularity in this tumor. These findings suggested HCC rather than a recurrence of the solitary tuberculoma, S 7 subsegmentectomy was performed. Microscopic examination revealed a travecular type HCC. A histogenetic relationship between tuberculosis of the liver and HCC was unknow. Abdominal contrast CT and angiography were useful for the definitive diagnosis. However, it is considered that a percutaneous liver needle biopsy should be tried for differential diagnosis of other hepatic tumors.

Unsuspected Exsanguination Four Days After Deep Percutaneous Liver Needle Biopsy

Unsuspected Exsanguination Four Days After Deep Percutaneous Liver Needle Biopsy