Significance of serum aminograms in diagnosis and prognosis of liver diseases.

The diagnosis, prognosis, and treatment of various liver diseases are still frequently equivocal despite the various liver function tests and invasive procedures presently available to the clinician. The introduction of the Beckman Amino Acid Analyzer Model 119 Cl, greatly facilitated the determination of the individual amino acids in serum and cerebrospinal fluid, and the data thus obtained seem to help in the differentiation of some of the commoner types of liver disease. These data indicate that changes in the concentration of some of the aromatic amino acids (AAA) and branched chain amino acids (BCAA) are helpful in the diagnosis, evaluation of the severity of the hepatic morphologic changes, and prognosis of the type of liver disease. Moreover, the ratio between the AAA and the BCAA seems to be indicative of certain liver diseases. We describe the alterations in the amino acid patterns which may help in the diagnosis, prognosis, and treatment of patients with certain types of liver disease.

Congestive heart failure as cause of fulminant hepatic failure.

In this patient with long-standing cardiomyopathy and congestive heart failure the syndrome of fulminant hepatic failure developed on two occasions; he recovered both times. There was no evidence of viral or toxic hepatitis as a cause of his liver failure. We conclude that in this case, aggravation of long-standing congestive heart failure may have led to severe hepatocellular necrosis with signs of encephalopathy not commonly observed.

Immunoglobulins in submassive hepatic necrosis.

The presence of submassive hepatic necrosis in acute liver injury of viral or toxic etiology in liver biopsy specimens is of great diagnostic and prognostic significance. Liver biopsy, however, cannot be performed in some of these patients due to an abnormal coagulation profile. Hence, other noninvasive methods for diagnosis of submassive hepatic necrosis would be helpful. We compared the serum immunoglobulin-G levels in 15 patients with typical acute viral hepatitis and 19 patients with severe acute viral hepatitis with submassive hepatic necrosis. The difference of the Ig-G levels in both groups was statistically significant. By using discriminant analysis we found that it was possible to make the correct diagnosis of submassive hepatic necrosis in 89.5% of patients with acute viral hepatitis when only Ig-G levels were utilized.

Myelography wiht perfluoroctylbromide. Comparison with Pantopaque.

The efficacy and toxicity of perfluoroctylbromide in myelography were studied in dogs. Perfluoroctylbromide moves freely in intrathecal space and provides satisfactory radiopacity for diagnosis of subarachnoid structures. The outstanding feature of this substance is its low toxicity. The dog tolerates 0.5-1.0 ml/kg intrathecally without toxic manifestation. Histological studies and CSF analyses show that it is much less irriating than Pantopaque. Because of the long retention of the perfluorocarbon removal may be necessary. Perfluoroctylbromide shows promise as a diagnostic contrast medium, particularly in cases where the currently available contrast media are not suitable.

Cholestasis associated with administration of L-amino acids and dextrose solutions.

Infants of very low birth weight who require prolonged assisted ventilation are unable to tolerate oral feedings. To provide and maintain nutrition in these infants, a modified form of parenteral nutrition (dextrose 10% and crystalline L-amino acids, 1.7-3.4 g%) is used in our nursery. Intrahepatic cholestasis was diagnosed at autopsy in four infants who received modified peripheral alimentation and in a fifth infant who received total parenteral alimentation (dextrose 20%, L-amino acids 3.8 g%) via a central venous catheter. These infants weighed less than 1,250 g at birth (range 943-1,247 g) and were appropriate for gestational age. They required assisted ventilation for over 2 weeks. Three infants did not receive any oral feedings. L-Amino acids were given for a mean of 36.8 +/- 10 days (range, 22-76 days). The diagnosis of cholestasis was suspected clinically in only one infant, in whom persistent elevation of direct bilirubin was detected at 4 weeks of age. Pathologic findings in four infants included the presence of bile casts in bile canaliculi and, in one case, in ductules and canaliculi. Liver architecture was well preserved. Inflammatory infiltrate in the portal tract was either absent or minimal, consisting of lymphocytes, and only in one of five cases a few eosinophils. Cholestasis may be regarded as a possible complication of parenteral alimentation even if the fluids are modified and given peripherally. High direct bilirubinemia may be the earliest clinical manifestation.

Hepatocellular carcinoma: relation to alcohol, HB-antigen and alpha-fetoprotein.

Thirteen of 16 patients with primary cancer of the liver were heavy alcoholics. Fifty per cent of them had positive alpha-fetoprotein and 25% had HB-Ag in their blood. The association of alcoholism with cancer of the liver is thus very striking and hence alcohol should be proclaimed as a carcinogenic substance.