[Valine and branched-chain amino acids in the treatment of hepatic encephalopathy]. / Valin und verzweigtkettige Aminosäuren in der Behandlung der hepatischen Enzephalopathie.

We studied the effects of infusion of a liver adapted amino acid solution (Amino-Mel hepa: Group A) versus a liver adapted amino acid solution plus L-valine (Amino-Mel hepa + L-valine: Group B) in 30 patients with decompensated liver cirrhosis with coma. Each 15 patients were randomly allocated to the group A and B, respectively. Both regimens included the infusion of glucose and fat, further supplementation of vitamins and trace elements in addition to the amino acid solution. The results of this study show that in patients with advanced stage of hepatic coma a valine increased supply of branched chain amino acids neither influences the course of the disease nor the death rate. The prognosis of patients with this disease is mainly determined by liver function and accompanying complications.

Correlations between zinc, amino acids and ammonia in liver cirrhosis.

In view of the universal metabolic importance of zinc in the organism, it was the purpose of the present work to determine the concentrations of zinc in serum, of amino acids and ammonia in plasma of patients with liver cirrhosis, and investigate that correlations might exist between these substances. The study involved 18 patients with decompensated liver cirrhosis without coma and eleven with coma. The subjects with normal livers were used as controls. While confirming known data (reduced zinc levels, imbalance of plasma amino acids, hyperammonaemia in chronic liver diseases) the findings also revealed correlations between the above substances. A negative correlations existed between zinc and ammonia. Decreases in zinc serum levels were accompanied by increases in plasma ammonia concentrations in hepatic coma (p less than 0.05). Plasma levels of amino acids did not correlate with serum zinc concentrations.

[Determination of cellular and humoral parameters of fatty liver]. / Untersuchungen von zellulären und humoralen Parametern bei Patienten mit Fettleber.

Cellular and humoral immunological parameters were examined in mononuclear cells from peripheral blood of patients with alcoholic and nonalcoholic steatosis hepatis. The ratio of T4 and T8 positive lymphocytes and the number of monocytes of these patients were in the normal range. The percentage of NK-cells, B-lymphocytes and DR-antigen-positive cells was increased.

Clinical studies on zinc in chronic liver diseases.

Zinc is essential to numerous metabolic processes in the organism, multiform symptoms being found especially in deficiencies. In addition to nutritional factors, diseases such as cirrhosis of the liver. Crohn's disease and chronic renal diseases are relevant in this context. In the present work, serum zinc levels were investigated in 109 patients with various chronic liver diseases. The lowest serum zinc concentrations were seen in patients with decompensated hepatic cirrhosis with coma. Patients with decompensated alcoholic cirrhosis had lower zinc levels as subjects with nonalcoholic cirrhosis. None of the groups exhibited a significant change in serum zinc levels during the treatment period. Laboratory data (such as transaminases, thromboplastin time, alkaline phosphatase, total proteins) did not correlate with the serum zinc concentrations. The concentration of plasma ammonia, however, appeared to be inversely related to the serum zinc levels. Thus, patients with coma had maximum ammonia and minimum zinc levels.

[Value of ultrasound tomography in the diagnosis and follow-up of fatty liver]. / Untersuchungen zum Stellenwert der Ultraschalltomographie in der Diagnostik und Verlaufskontrolle der Leberverfettung.

In a prospective study 187 patients with diffuse fatty infiltration of the liver, estimated by ultrasound tomography, were investigated. In any case the history as well as the results of clinical investigation and the lab findings were known to the observer. Liver blind punctions were performed after a short time, on an average of 11 days. In 91.4% the sonographic diagnosis "fatty infiltration of the liver" could be confirmed by histological findings, while in the other cases the diagnosis was incorrect or incomplete respectively. Following sonographic criterions any results were graduated into three groups and compared with the percentage of fat infiltrated liver cells found by histological investigation. There was a high accuracy in patient with fatty liver: 90.9% could be established by ultrasound tomography. Only in those cases, in which the sonographic diagnosis "fatty infiltration" is not confirmed by case history, clinical and lab findings, the liver biopsy is to be performed.

[Initial clinical experience using an interdisciplinary management concept for pregnant patients with liver damage]. / Erste klinische Erfahrungen mit einem interdisziplinären Betreuungskonzept für Schwangere mit Leberschädigungen.

Among 6,404 deliveries in 49 cases (0.8%) a liver disease was diagnosed in the course of pregnancy. The onset of the disease happened exclusively in the last trimester of pregnancy. In 36 pregnant women a hyperbilirubinaemia of diagnostic value was stated. As an informing diagnostic procedure the only determination of the alanine-aminotransferase activity has been proved to be sufficient. In every fifth pregnant woman the liver disease was observed in connection with a preeclampsia. The preterm delivery rate was 16.3%. An intrauterine growth retardation was found in 22.4% of women with hepatopathy during pregnancy. In 5 out of 34 patients asked for a post partum control a manifestation of the liver disease, respectively a cholecystopathia, was present and follow-ups were necessary. An interdisciplinary concept of treatment is emphasized to treat these pregnant women in cooperation with the specialist of internal medicine. Methodically an additional sheet of documentation is used, which contains important data of patients history and all obstetrical, clinical and laboratory results accompanying the pregnant woman during pregnancy and post partum controls.

[T cell subpopulations in peripheral blood and liver tissue in acute HBsAg-negative hepatitis]. / T-Zell-Subpopulationen im peripheren Blut und Lebergewebe bei HBsAg-negativer akuter Hepatitis.

By means of monoclonal antibodies against surface antigens of mononuclear cells we examined alterations of T-cell-subpopulations of peripheral blood and liver tissue in the course of acute HBsAg-negative hepatitis. Used methods for determination were the immunofluorescence for blood lymphocytes, respectively the peroxidase-anti-peroxidase-(PAP)-technique for round-cell-infiltrates of the liver based on paraffin fixed sections. The focus of attention was the relation of T4-(helper/inducer) to T8-(suppressor/cytotoxic) cells, the so-called immuno-regulatory quotient. With advancing improvement in the course of the disease we observed in peripheral blood a decrease of T4+/T8+ ratio from very high (3.6) to normal (1.9) values. By examination of the tissue round-cell-infiltrates we found a contrary behaviour to the peripheral blood with a low T4+/T8+ ratio in the liver, characteristic to more acute phases and due to an T8+-cell interchange between periphery and liver. This may be common for all virus diseases and without specificity for defined types of acute hepatitis. Beside this exists the possibility T4+/T8+ ratio has any prognostic value.

[Functional muscular abdominal distension--a case report]. / Die funktionelle muskuläre Bauchauftreibung--ein kasuistischer Beitrag.

The rare clinical picture of the functional muscular distension must be demarcated from organic changes which are connected with an increase of the abdominal volume such as intraabdominal tumours, accumulations of fluid or gatherings of gas or pregnancy. In this symptom a functional disturbance is concerned which appears in patients with vegetative lability or psychic peculiarities and by changes of tension of the musculature surrounding the abdominal space leads to the intermittent or chronic protrusion of the abdomen. By means of an anaesthesia the presence of a functional cause can be made evident: after injection of anaesthetics the protruding abdominal wall is subsiding. The knowledge of the picture of the disease saves long diagnostic ways which contribute to the fact to fix labile patients extremely to the observation of their abdomen and to favour the manifestation of a neurosis. The often unsatisfying therapeutic long-term effect is in contrast to the harmlessness of this symptom.

[Pathogenesis, clinical aspects and development of fatty liver]. / Untersuchungen zur Pathogenese, Klinik und Entwicklungstendenz der Fettleber.

Anamnestic, clinical, biochemical and bioptic examinations were performed in 127 patients with fatty infiltration of the liver of different degrees of severity. Anamnesis, clinical practice and laboratory findings can only throw the suspicion on the fatty infiltration of the liver. For the verification of the diagnosis and for the gradation first of all the liver biopsy is necessary. Alcohol clearly plays the most important part as a cause of the development of the fatty infiltration of the liver, followed by adiposity, diabetes and hyperlipoidaemia. Because of the great medical and social-economic importance fatty infiltration of the liver cannot longer be taken for a harmless disurbance.

[Behavior of plasma amino acids in alcohol-induced chronic liver diseases]. / Verhalten der Plasmaaminosäuren bei alkoholbedingten chronischen Lebererkrankungen.

In chronic liver diseases of alcoholic and non-alcoholic origin there are strikine differences of aspartate, glutamate and prolin. Where as plasma levels of aspartate and prolin are in most cases higher than in non-alcoholics, glutamate shows a contrary behaviour except in hepatic coma. The plasma ratio of alpha-amino-butyric acid to leucin allows no distinction of alcoholic from non-alcoholic liver lesion.

[Hepatological aspects of surgical interventions in the stomach]. / Hepatologische Aspekte operativer Eingriffe am Magen.

By means of quantitative-biochemical and histomorphological methods after vagotomies changes of the liver could be proved to a smaller extent than after resections of the stomach (Billroth II). Among the bionomic operation methods the supra-selective proximal vagotomy without pylorplastics is superior to other methods under the aspect of the change of the liver.

[Gastrectomy patients--a retrospective study]. / Magenoperierte Patienten--eine retrospektive Betrachtung.

Of 39 patients with resected stomach the endoscopic and radiological findings as well as the anamnestic and paraclinical data were analysed retrospectively and compared. In contrast to the patients with recidivation ulcer and stump gastritis the patients with a gastric stump carcinoma had an essentially higher average age and, in general, a considerably longer postoperative interval. The endoscopy, including biopsy, achieved a considerably greater diagnostic security in the various groups of disease than the X-ray examination. Symptoms, such as decrease of weight, gastric pains and vomiting, were most frequently found in patients with carcinoma.

[The effectivity of long-term treatment of porphyria cutanea tarda from a hepatological viewpoint]. / Untersuchungen zur Effektivität der Langzeitbehandlung der Porphyria cutanea tarda aus hepatologischer Sicht.

34 Patients with an ascertained porphyria cutanea tarda who underwent a long-term therapy a comprehensive internal and hepatological diagnosis was made. In these cases for the first time the estimation of the intrahepatic distribution of enzymes and its comparison with the serum enzymes were also performed. The liver histology allowed a division of our patients into three groups, in which cases the reactive hepatitides prevailed and a conspicuously large proportion of normal histological findings were present. The comparison of all data got with the literature made the conclusion possible that the phlebotomy therapy as well as the care in a special dispensary for years lead to very favourable results on liver and skin.

[Peptic ulcer and the liver]. / Peptisches Geschwür und Leber

The interorganic relations between liver and stomach are explained from the point of view of the primary diseases of each organ and the higher mechanism is also discussed. The at present well-known and partly hypothetic pathophysiological mechanisms are treated within the subject. On own combined histologo-biochemical examinations of the liver punctate is generally explained the too little regarded role of the peptic ulcer for the induction of so-called latent hepatopathies. In this respect in operations of the stomach the vagotomy as the method of choice serves the preference compared with resections of the stomach.