Strong correlation by ultrasonography of hepatomegaly and the presence of co-infection in HIV/HCV cirrhotic patients

OBJECTIVES: Progression of hepatic fibrosis is accelerated in patients co-infected with human immunodeficiency virus and hepatitis C virus compared to hepatitis C virus mono-infected patients. This study aimed to compare ultrasound features and selected clinical and biochemical variables between patients with human immunodeficiency virus/hepatitis C virus co-infection (n = 16) versus hepatitis C virus mono-infection (n = 16). METHODS: Each patient underwent abdominal ultrasound, and a specific evaluation was performed in order to detect findings consistent with chronic liver disease. Characterization of spleen size, liver structural pattern, diameter of the portal, spleen, and mesenteric veins was based on classical ultrasound parameters. Propensity score was used for control of selection bias and performed using binary logistic regression to generate a score for each patient. The Fisher and Mann-Whitney tests were used to evaluate categorical variables and continuous variables, respectively. RESULTS: On univariate analysis right hepatic lobe size was larger in human immunodeficiency virus/hepatitis C virus patients (157.06 ± 17.56 mm) compared to hepatitis C virus mono-infected patients (134.94 ± 16.95 mm) (p = 0.0011). The left hepatic lobe was also significantly larger in human immunodeficiency virus/hepatitis C virus patients Cirrhosis (115.88 ±22.69 mm) versus hepatitis C virus mono-infected patients (95.06 ±24.18 mm) (p= 0.0177). Also, there was a strong correlation between hepatomegaly and co-infection (p=0.005). CONCLUSION: Human immunodeficiency virus infection was the primary variable influencing liver enlargement in this population. Hepatomegaly on ultrasound was more common among cirrhotic human immunodeficiency virus/hepatitis C virus co-infected patients than among cirrhotic hepatitis C virus mono-infected patients. This aspect is very important in the management of human immunodeficiency virus/hepatitis C virus co-infected patients, because screening for hepatocellular carcinoma is necessary in this population.

Physical and ultrasonographic estimation of liver size in healthy Thai children under two years old.

Background: Liver size can be physically evaluated by means of percussion, but measurement remains only gross-estimation. Ultrasonography is a non-invasive and accurate method for measurement of liver size. However, there are few ultrasonic data available for assessment of liver span in Thai children under two years old. Objective: Determine liver sizes in healthy Thai children aged zero to two years and compare physical and ultrasonographic estimations. Subject and method: Two hundred eighty one children (148 boys and 133 girls) were enrolled in this study. The age, weight, and height were assessed, and the body surface area was calculated. The liver size or liver span was estimated by percussion and compared to ultrasonography. Result: The liver span (mean?SD) was 5.4?1.0 cm, 5.1?1.1 cm by physical and ultrasonographic examination, respectively. The measurement of liver span by physical examination had high reliability. The liver span correlated with body surface area rather than height, age, and weight. Conclusion: Physical examination of liver span provided reliable data in Thai children under two years old.

Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia / Sonographic determination of liver size in healthy newborns, infants and children under 7 years of age

OBJETIVO: Determinar o tamanho do fígado de crianças normais, entre 0 e 7 anos de idade, por ultrassonografia, correlacionando os valores obtidos com: idade, sexo, estatura, peso corporal e índice de massa corpórea. MATERIAIS E MÉTODOS: Foram examinadas 584 crianças saudáveis, subdivididas em 11 grupos etários, sendo medidos o diâmetro crânio-caudal do lobo esquerdo, na linha médio-esternal, e o diâmetro crânio-caudal da superfície posterior do lobo direito, na linha hemiclavicular. Na análise estatística foram aplicados: a) coeficiente de correlação de Pearson (estudo de correlação); b) teste t de Student não-pareado (comparação das medidas entre os sexos); c) modelos de regressão não linear (nomogramas). RESULTADOS: O tamanho hepático apresentou aumento progressivo, do nascimento aos 7 anos de idade, proporcionalmente menor que o crescimento corporal, correlacionado com idade, estatura e peso corporal (r > 0,70), não havendo correlação com índice de massa corpórea (r < 0,11). Não se observou diferença consistente das medidas hepáticas em relação ao sexo. CONCLUSÃO: Valores do tamanho do fígado de crianças normais (entre 0 e 7 anos) foram determinados mediante aplicação de técnica padronizada, verificando-se forte correlação com a idade e indicadores antropométricos. Nomogramas demonstram as variações normais do tamanho hepático na população estudada, com crescimento diferenciado para cada lobo.

OBJECTIVE: The present study was aimed at sonographically determining the liver size in healthy newborns, infants and children under 7 years of age, correlating results with age, sex, height, body weight and body mass index. MATERIALS AND METHODS: A total of 584 healthy children subdivided into 11 age groups were evaluated with measurements of the left lobe craniocaudal diameter at the midsternal line, and the craniocaudal diameter of the right lobe posterior surface at the midclavicular line. The following tests were utilized for statistical analysis: a) Pearson's correlation coefficient (correlation study); b) non-paired Student's t-test (comparison of measures between sexes); c) nonlinear regression models (nomograms). RESULTS: The liver size presented a progressive growth from the birth up to the age of 7, proportionally lower than the body growth, in correlation with age, height and body weight (r > 0.70). Correlation with the body mass index was not observed (r < 0.11). There was no significant difference in liver size between male and female individuals. CONCLUSION: Liver size was sonographically determined in healthy children under the age of 7 by means of a standardized method, demonstrating a strong correlation with age and anthropometric indicators. Nomograms demonstrate the typical variations of the liver size in the population evaluated with a different growth pattern for each hepatic lobe.

CT Square Index of Hepatic Segment: The Significance in Cirrhotic Patients

PURPOSE: To determine changes in the square index of the liver segments of liver cirrhosis(LC) patients, as seen on CT, and the value of this indicator during follow-up. MATERIALS AND METHODS: Twenty-three patients with LC were included in this study. Abdominal CT scans were performed twice in each patient and the mean follow-up period was 15 (6-36) months. We measured the square index of the right lobe, the caudate lobe, and the medial and lateral segment of the left lobe of the liver, as seen on initial and follow-up CT images, and compared the results. The square index was obtained by deter-mining the product of the transverse and longitudinal diameters. According to the Child-Pugh classification, the condition was classified as either progressive or non-progressive, and the square index was compared between the two groups. RESULTS: The square index of the left lobe medial segment showed a significant decrease in both the progression group(n=13) and non-progression group(n=10), while that of the right lobe was significantly lower only in the progression group. There was no significant change in the square index of the caudate lobe or the lateral segment of the left lobe. CONCLUSION: For predicting the progression of LC, the square index of the medial segment of the left lobe is a more sensitive index than the Child-Pugh classification. For ascertaining the progression of the condition, the square index of the right lobe is a valuable deferminant.

Postprandial Hepatic Volume Change: Spiral CT Evaluation in Case of Liver Cirrhosis

PURPOSE: To investigate the usefulness of evaluating liver cirrhosis through the measurement of liver volume. MATERIALS AND METHODS: In a control group(20 normal subjects) and 20 cirrhotic patients, variations in liver volume before and after a meal were obtained. A case-control study was conducted between the two groups. RESULTS: In the control group, the range of increased liver volume after the meal was 67-186ml. Mean increased liver volume was 119.3ml, the range of percentage increase was 6-12% and the mean percentage increase was 9.89%. In cirrhotic patients, the range of increased liver volume after the meal was 1-20ml. Mean increased liver volume was 6.9ml, the range of percentage increase was 0-1.9% and the mean percentage increase was 0.65%. Compared with the control group, cirrhotic patients showed a much smaller increase in liver volume (p<0.01). CONCLUSION: Difference in variation of liver volume between a control group and cirrhotic patients before and after a meal can be used for the evaluation of liver cirrhosis.

Change of Hepatic Volume after Selective Bile Duct Ligation: An Experimental Study in the Rabbit

PURPOSE: To evaluate the role of bile duct obstuction in the development of atrophy of the liver, using ananimal model. MATERIALS AND METHODS: Seven rabbits were divided into two groups : group 1(n=5), in which therewas selective bile duct ligation, and group 2(n=2), which underwent a sham operation. Each group was evaluated using CT for changes in hepatic volume after selective bile duct ligation or a sham operation. In group I, the diameter of dilated bile duct was measured 2, 4, 8, 12 and 16 weeks after bile duct ligation, while gross andhistologic change were evaluated in all cases. RESULTS: In group 1, bile duct dilatation was seen on CT two weeks after selective bile duct ligation, and did not change significantly during follow-up. In four of five cases, CT revealed no evidence of significant atrophy of the involved segment. Pathologic specimens, however, revealed dilatation of the bile duct, periductal fibrosis, infiltration of chronic inflammatory cells, and periportalfibrosis. One of five cases showed segmental liver atrophy after selective bile duct ligation. In addion to the above pathologic findings, there was obstruction of the portal vein by foreign body reaction. In group 2, no evidence of dilated bile duct or liver atrophy was revealed by CT or pathologic specimen after a sham operation. CONCLUSION: During long-term follow-up of 16 weeks, obstruction of the bile duct did not play a major role in the development of lobar atrophy in the rabbit.