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Query: UMLS:C0015695 (fatty liver)
 13,941 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study of computed tomographically guided core needle biopsy samples was done to determine whether diagnostic accuracy could be improved in these specimens. Eighteen specimens from 16 patients were analyzed by routine and immunohistochemical stains on paraffin-embedded tissue and DNA probe hybridization on frozen tissue. Pathologic diagnoses based on light microscopy and immunostaining were malignant lymphoma (8), lymphoid tissue (1), malignant tumor (3), fibrous tissue (2), fatty liver and hepatic adenoma (2), giant cell tumor (1), and necrotic tissue (1). Analyzable DNA was obtained from nine specimens (50%); 67% of those yielding insufficient DNA (six of nine) were samples of benign liver, connective tissue, and necrotic tissue. Extracted DNA was hybridized with probes for JH, JK, CT beta, and bc/II. In 67% of analyzable cases (six of nine) the diagnosis of lymphoma was confirmed; in 33% the diagnosis of lymphoma or nonlymphoma was aided or resolved when the pathologic diagnosis was uncertain. Of the eight cases of lymphoma diagnosed by light microscopy, six were confirmed by genotyping and two yielded insufficient DNA for analysis. In all nine cases with sufficient DNA, hybridization identified B-cell monoclonality and confirmed or excluded follicular center cell origin, data not uniformly obtained with other studies. Molecular analysis can be a useful adjunct to routine methods of diagnosis of needle specimens, improving diagnostic accuracy in at least one-third of cases.
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PMID:Improved diagnostic accuracy in needle biopsy interpretation using molecular probes. 815 41

In this study we compared the ultrasound findings of 203 hospitalized patients with a variety of reference methods: biopsy, computed tomography and laboratory liver function tests with the aim of defining their clinical relevance. The ultrasound findings were assignable to 3 groups: normal, descriptive and definitive. When ultrasound described a liver as normal, or showing "increased echogenicity" or "altered configuration", the figures of normal clinical reference methods were almost identical (i.e., 70% normal). When a definitive ultrasound diagnosis ("cirrhosis", "fatty liver" or "cardiac congestion") was made, the percentage of otherwise normal livers decreased to less than 20% and was 0% for cirrhosis and cardiac congestion. The positive predictive value for a single abnormal criterion in ultrasound was between 16% and 21%, while for a definitive diagnosis it was between 67% and 100%. Many of our patients, however, had additional risk factors for liver abnormalities, such as obesity, diabetes mellitus or chemotherapy for malignancies. These risk factors can induce morphological parenchymal alterations without blood test abnormalities and, although correctly diagnosed by ultrasound, elude other reference methods in patients without biopsy. In conclusion, the finding of a single abnormal criterion of liver abnormality in ultrasound should be treated with caution. Ultrasound diagnoses of "fatty liver", "cirrhosis", diagnosed by additional signs of portal hypertension, or "cardiac congestion", yield more information. A normal ultrasound does not exclude the presence of fatty liver or cirrhosis.
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PMID:Clinical relevance of abnormal liver findings with ultrasound. 817 26

Hepatic dysfunction is common in patients who receive intensive chemotherapy and it is important to determine the etiology in order to institute appropriate therapy. The role of laparoscopic liver biopsy in patients with neutropenia, thrombocytopenia, or both was evaluated as a mean of making treatment decisions and as a determinant of clinical outcome. Laparoscopic liver biopsy was performed in 29 subjects who were receiving intensive cytotoxic therapy with or without bone marrow transplantation. One to three direct-vision laparoscopic liver biopsies were performed in each patient using a Tru-cut needle during general anesthesia. Platelet concentrate transfusions were usually given before, during, and immediately after biopsy. Bleeding was controlled with spatula electrocautery. Thirty-two biopsies were obtained in 29 patients. At the time of liver biopsy, white blood cell and platelet counts ranged from 0 to 14,300/microliters (median: 2500/microliters), and 1000 to 47,000/microliters (median: 20,000/microliters), respectively. Bleeding at the liver biopsy site was readily controlled during the procedure without clinical evidence of significant bleeding; no procedure-related complications were noted and no patients required re-exploration. All biopsies were informative and the lesions observed in 32 biopsies revealed graft-versus-host disease (n = 5), hepatic candidiasis (n =1), hepatic veno-occlusive disease (n = 3), cholestasis (n = 19), hemosiderosis (n = 26), toxic injury (n = 8), hepatic steatosis (n = 4), granuloma (n = 1), viral infection (n =1), and malignancy (n = 1). Laparoscopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients who were thrombocytopenic and immunosuppressed. The diagnosis obtained at laparoscopic liver biopsy altered therapy in nine of 29 (31%) patients.
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PMID:Laparoscopic liver biopsy to evaluate hepatic dysfunction in patients with hematologic malignancies: a useful tool to effect changes in management. 872 71

CT is an important technique in liver imaging. To improve the detection of focal liver lesions the use of non-specific, water-soluble contrast media (CM) is mandatory. However, even with use of these CM the sensitivity in tumour detection is low. In the development of liver-specific CM, the majority of the agents have been targeted to the reticuloendothelial system (RES). The clinical use of RES-specific contrast agents has been hampered by frequent adverse reactions, and a new concept whereby the CM is taken up by the hepatocytes has been developed as an alternative. Such a CM is taken up by normal liver parenchyma but not by tumour cells, enhancing the difference between normal and pathological tissue, and therefore improving the diagnostic sensitivity. In the present investigation, FP 736-03 and FP 736-04, two hepatocyte-specific lipid emulsions, have been studied using animal models. In normal liver parenchyma dose-dependent enhancement was found, whereas in tumour tissue of experimental liver metastases and hepatocellular carcinoma, no enhancement was noted. The virtually unchanged attenuation in tumour tissue meant that the liver-to-lesion contrast increased steadily during the observation period. In an attempt to establish the relationship between enhancement and tumour detection, the accumulated doses of FP 736-04 were used. Increasing accuracy in the diagnosis of liver metastases was found up to an enhancement level of 30 HU. A further increase yielded similar detection rates, but a higher proportion of false-positive results. Comparison with iohexol was rendered difficult by the occurrence of image artefacts when this CM was used. However, FP 736-03 proved superior to both native and iohexol-enhanced CT for detection of hepatic metastases. The efficacy of FP 736-04 was also studied in diseased hepatic parenchyma. In cases of fatty liver infiltration, enhancement by FP 736-04 was significantly reduced as compared with normal controls. The degree of enhancement observed in cirrhotic livers did not differ significantly from that in the controls. These preclinical investigations have shown that the hepatocyte-specific lipid emulsions FP 736-03 and FP 736-04 improve the diagnostic accuracy of focal liver lesions as compared to native and water-soluble CM-enhanced CT. FP 736-04 is taken up by diseased liver parenchyma. However, the detection of malignancy in steatotic and cirrhotic livers has not yet been studied with use of this CM.
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PMID:Hepatocyte-specific contrast media for CT. An experimental investigation. 916 54

Valine-depleted amino acid imbalance solution markedly inhibits tumor growth but causes fatty liver as a side effect. However, much remains unknown about the mechanism of the development of fatty liver. Valine-depleted amino acid imbalance solution containing various concentrations of calories was administered to tumor-bearing rats for four days by means of total parenteral nutritional methods to investigate the interaction of caloric intake and the development of fatty liver. Compared with the total parenteral nutrition control group the triglyceride content of the liver rose significantly in the group given valine-depleted amino acid imbalance solution with an increase in caloric intake. Plasma total protein and albumin significantly decreased. The very-low-density lipoprotein concentration in serum was also significantly lower than that in the control group. Valine-depleted amino acid imbalance caused hypoproteinemia, suggesting a fall in synthesis of apolipoproteins in the liver indispensable for lipid release. Along with the increase in the total caloric intake, triglyceride synthesis in the liver increased, resulting in augmentation of fatty content of the liver, probably because of the decreased lipid release.
Nutr Cancer 1997
PMID:Effects of caloric intake on anticancer therapy in rats with valine-depleted amino acid imbalance. 920 Jan 58

Hyperechoic pseudotumors usually are considered "spared areas" in a fatty liver; they frequently are detected at the fourth hepatic segment close to the portal vein. Over a 3 year period, we observed 14 patients with a hyperechoic pseudotumor in otherwise normal livers; all of these lesions resembled a hyperechoic pseudotumor of the fourth segment with respect to site and morphology. In all cases echographic findings did not significantly change during the follow-up period ranging from 4 to 12 months. Computed tomographic examination was normal in two cases, whereas in the remaining 12 cases the hyperechoic lesion was appreciable as a hypodense area on both direct and dynamic scans; the contrast enhancement was never typical for a malignancy of a hemangioma. Six patients also underwent a color Doppler and power Doppler examination, which never demonstrated intralesional or perilesional abnormalities in the vascular signals. Three patients, who underwent surgery for adenocarcinoma of the large bowel, had intraoperative sonography and sonographically guided biopsy; a hepatic steatosis was diagnosed at histologic examination in all cases. The uniqueness of the cases presented here lies on the finding of focal steatosis at a site where, according to the most credible hypothesis, intracellular deposition of triglycerides is less likely because of possible variation of the regional portal circulation. From a practical point of view it should be emphasized that, in addition to the more frequent hypoechoic pseudolesions, hyperechoic pseudonodular images just anterior to the portal vein can be observed in normal livers; in our experience these lesions should be interpreted as a focal steatosis in an atypical site.
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PMID:Hyperechoic pseudotumors in segment IV of the liver. 932 75

The frequency and severity of fatty infiltration of the liver in patients receiving 5-fluorouracil (5-FU) and folinic acid has not been documented systematically. Its development can result in difficulty assessing disease progression, and treatment may be altered inappropriately. Twenty-seven patients with colon cancer and liver metastases receiving 5-FU and folinic acid were studied with computerized tomography (CT) before treatment and after six or 12 cycles of chemotherapy. Forty-seven per cent of patients developed hepatic steatosis during treatment. There was no correlation between development of hepatic steatosis and the dose of chemotherapy or the liver function tests. Hepatic steatosis occurs commonly in patients receiving 5-FU and folinic acid and can be severe. Its development can make hepatic metastases difficult to assess and if its benign nature is not appreciated treatment may be inappropriately altered.
Br J Cancer 1998 Jun
PMID:Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. 966 83

Type "B" lactic acidosis has been described in patients receiving the nucleoside analogs zidovudine, didanosine, and fialuridine. Lactic acidosis has also been described in 4 patients receiving combination therapy with stavudine and lamivudine. We describe the development of chronic type "B" lactic acidosis in 3 patients receiving stavudine as a single agent and in 2 patients receiving combination therapy with stavudine and either lamivudine or delavirdine, a nonnucleoside analog. All patients presented with abdominal pain, vomiting, and hepatic steatosis. Other signs of mitochondrial toxicity included pancreatitis and myopathy (2 cases). The mean duration of stavudine therapy was 9.4 months, and the mean observed peak lactate level+/-SD was 10.3+/-5 mmol/L. After discontinuation of stavudine treatment, lactic acidosis improved in 4 patients after 4-60 weeks, and 1 patient died. Evaluations for other causes of lactic acidosis, including hypoxemia, malignancy, sepsis, and cardiogenic shock, were negative.
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PMID:Lactic acidosis associated with stavudine administration: a report of five cases. 1061 55

Magnetic resonance imaging (MRI) relies on the physical properties of unpaired protons in tissues to generate images. Unpaired protons behave like tiny bar magnets and will align themselves in a magnetic field. Radiofrequency pulses will excite these aligned protons to higher energy states. As they return to their original state, they will release this energy as radio waves. The frequency of the radio waves depends on the local magnetic field and by varying this over a subject, it is possible to build the images we are familiar with. In general, MRI has not been sufficiently sensitive or specific in the assessment of diffuse liver disease for clinical use. However, because of the specific characteristics of fat and iron, it may be useful in the assessment of hepatic steatosis and iron overload. Magnetic resonance imaging is useful in the assessment of focal liver disease, particularly in conjunction with contrast agents. Haemangiomas have a characteristic bright appearance on T2 weighted images because of the slow flowing blood in dilated sinusoids. Focal nodular hyperplasia (FNH) has a homogenous appearance, and enhances early in the arterial phase after gadolinium injection, while the central scar typically enhances late. Hepatic adenomas have a more heterogenous appearance and also enhance in the arterial phase, but less briskly than FNH. Hepatocellular carcinoma is similar to an adenoma, but typically occurs in a cirrhotic liver and has earlier washout of contrast. The appearance of metastases depends on the underlying primary malignancy. Overall, MRI appears more sensitive and specific than computed tomography with contrast for the detection and evaluation of malignant lesions.
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PMID:Magnetic resonance imaging (MRI) and diseases of the liver and biliary tract. Part 1. Basic principles, MRI in the assessment of diffuse and focal hepatic disease. 1105 26

The rising prevalence of obesity is accompanied by an increasing number of patients with the metabolic complications of obesity. The major complications come under the heading of the metabolic syndrome. This syndrome is characterized by plasma lipid disorders (atherogenic dyslipidemia), raised blood pressure, elevated plasma glucose, and a prothrombotic state. The clinical consequences of the metabolic syndrome are coronary heart disease and stroke, type 2 diabetes and its complications, fatty liver, cholesterol gallstones, and possibly some forms of cancer. At the heart of the metabolic syndrome is insulin resistance, which represents a generalized derangement in metabolic processes. Obesity is the predominant factor leading to insulin resistance, although other factors play a role. The mechanistic link between insulin resistance and the metabolic syndrome is complex. The relationship is modulated by yet other factors, such as physical activity, body fat distribution, hormones, and a person's genetic polymorphic architecture. A better understanding of the molecular basis of this relationship is needed to suggest new targets for prevention and treatment of the complications of obesity. In addition, understanding at the clinical level will lead to improved management of these complications.
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PMID:Metabolic complications of obesity. 1118 17


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