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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nuclear Magnetic Resonance (NMR) tomography has already attained a position in clinical use beside the established techniques ultrasound (US) und computerized tomography (CT) for the examination of the liver and its related diseases. In assessing its methodical significance one has to differentiate between focal liver lesions and damages of the liver parenchyma. Focal lesions may be identified with NMR just as safely as with US and CT. However, NMR produces additional information, especially in the echo-dense lesions in US, where both NMR and angio-CT can differentiate between echo-dense metastases, haemangiomas and fatty tumours. In damages of the liver parenchyma NMR seems to become the method of choice. Quantitative tissue differentiation is possible by determining the relaxation times. In fatty degeneration of the liver focal fatty infiltration and circumscribed cirrhotic changes can be discerned. It is possible to identify cirrhoses directly and not merely by indirect criteria as is the case with US and CT. NMR can also differentiate between aethylic (prolonged T1) and primary-biliary cirrhosis (shortened T1). Haemochromatosis may be identified with CT, the accompanying secondary cirrhotic change, however, can only be detected by NMR. In liver cell carcinoma, e.g. secondary to cirrhosis, cancer nodes and cirrhotic regeneration nodes may be differentiated. Whole body NMR spectroscopy is still under research. Once it is perfected for clinical use it will change the entire laboratory medicine.
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PMID:[Nuclear magnetic resonance tomography in the study of the liver and its diseases]. 299 7

Among 1 257 patients subjected to liver-spleen (RES) scintigraphy and radionuclide angiography (RNA), there were 13 cases of histologically confirmed hepatocellular carcinoma (1%). All 13 patients had scintigraphic findings indicating cirrhosis. Histologically, cirrhosis was present in only 9 out of 11 cases in which liver parenchyma was available for examination. One patient had hemochromatosis without evidence of cirrhosis. In 11 cases, the tumor was clearly demonstrated as a defect in the static scintigram. However, in 2 cases with cirrhosis and poorly differentiated hepatocellular carcinoma, the tumor nodules were hardly discernible. In RNA, the tumor displayed high activity in the arterial phase and decreasing activity during the portal phase, ending up as a defect. At RNA, the lesion was clearly outlined in 12 cases, including the 2 patients in whom the scintigraphic findings were inconclusive; in one case with severe cirrhosis and a well differentiated hepatocellular carcinoma, the tumor was barely detectable. We conclude that a combination of RNA and scintigraphy is a valuable screening which usually provides a correct diagnosis in hepatocellular carcinoma.
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PMID:Radionuclide angiography and scintigraphy in hepatocellular carcinoma. 300 Jan 40

In 67 patients (mean age 51 years, range 26-79), at diagnosis of primary haemochromatosis (PH), grade III or IV liver iron overload was present in all cases, cirrhosis in 85%, transferrin saturation greater than 80% in 75%, serum ferritin greater than 1000 micrograms/l in 84%, and overt diabetes in 48%. Alcohol intake was greater than 150 g/day in 11 patients; six were chronic hepatitis B surface antigen (HBsAg) carriers. HLA-A3 and B7 antigens were present in 64% and 23% versus respectively 22% (p less than 0.01) and 9% (p less than 0.025) in controls. Iron overload was found in the stomach, duodenum, skin and bone marrow in 57, 43, 45 and 59% of the patients studied. Sixty-three patients were followed for 1-260 months (median 24); 43 received regular iron-depleting treatment and 20 did not because of liver failure, cancer or refusal. Cumulative survival was 79%, 67% and 61% at 1, 4 and 10 years, respectively. Ten patients died from hepatocellular carcinoma and two from extrahepatic cancer. The early high mortality rate was due to some cases of advanced disease or cancer. Cumulative survival in the regularly treated group was 95% at 1 year and 91% at 4 and 10 years, which was higher than in the untreated group.
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PMID:Clinical, biochemical and histological features of primary haemochromatosis: a report of 67 cases. 302 81

From January 1, 1975 to July 1, 1984, 37 patients with a tentative diagnosis of hepatocarcinoma on cirrhosis were operated upon. There were 34 men and 3 women, aged from 32 to 82 years (mean: 60 years). The diagnosis of cirrhosis rested either on a history of liver failure associated with clinical and biochemical signs of hepatocellular dysfunction (4 cases), or on a positive liver biopsy (5 cases). In 20 cases the diagnosis was suspected on account of abnormal liver function tests, but in 8 patients it was revealed by macroscopic examination of the liver during surgery. Cirrhosis was attributed to chronic alcoholism in 25 cases, haemochromatosis in 11 cases and positive HBs antigen in 7 cases. The diagnosis of hepatocarcinoma, suggested by altered general condition or recent pain, rested on the finding of a tumoral image at scintigraphy (16 cases), ultrasonography (19 cases), computed tomography (7 cases), arteriography (17 cases) or laparoscopy (7 cases). In only 7/32 patients was the alpha-foetoprotein level higher than 500 ng/l. Surgery confirmed the diagnosis of hepatocarcinoma in every case but that of cirrhosis in only 14/37 cases; 10 patients had lesion of hepatic fibrosis and 1 had regenerative nodular hyperplasia. In 10 cases no accurate histological diagnosis could be made since the liver tissue sample had been taken too close to the tumour. The finding of normal liver tissue shows that one should not refrain from operating merely because the diagnosis of cirrhosis rests on clinical grounds. Since 1979, surgical treatment consists in an attempt to excise the tumour. Per-operative mortality is the same with excision surgery (21%) as with exploratory or palliative surgery (17%). Fourteen excisions were performed (i.e. aresectability rate of 38% for the series): 2 liver transplantations, 2 right hepatectomies, 2 left hepatectomies, 2 left lobectomies, 2 bisegmentectomies and 3 tumorectomies. The survival rate of 2 years was 27%, as opposed to 5% with exploratory or palliative surgery. Systematic monitoring of cirrhosis with ultrasonography should result in early diagnosis of hepatocarcinoma at a stage where limited hepatic excision is possible and the chances of surviving are highest.
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PMID:[Surgical treatment of hepatoma on a cirrhotic liver]. 302 88

Hemochromatosis is a disease in which the inappropriate absorption of iron over 30-40 yr results in tissue iron overload and the development of cirrhosis of the liver, diabetes, hypogonadism, arthropathy, and skin pigmentation. We present an infant who died at 2 days of age, and who was found to have massive iron overload in the liver. This case is consistent with a rare condition that has been called neonatal hemochromatosis. This disease is discussed in the context of an overview of iron metabolism and adult hemochromatosis.
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PMID:Neonatal hemochromatosis: a case and review of the literature. 327 60

Although alcoholic liver disease is often associated with some increase in hepatic iron stores, it is now established that when gross iron overload is present, this is due to genetic hemochromatosis. Furthermore, there appears to be a critical iron concentration necessary for the induction of hepatic fibrosis. Lipid peroxidation induced by ethanol and/or iron would appear to play a major role in hepatic damage in both humans and experimental animals. Although the exact mechanism(s) of induction of lipid peroxidation by ethanol and iron remains to be elucidated, both toxins can exert a synergistic effect upon hepatic lipid peroxidation. Iron overload has also been shown to stimulate directly hepatocyte and hepatic procollagen mRNA expression, which is further stimulated by ethanol. The observed synergism between iron and alcohol with respect to both hepatic lipid peroxidation and collagen biosynthesis offers a possible explanation of the apparent early onset of fibrosis and cirrhosis in patients with iron overload who have an excessive alcohol intake.
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PMID:Association between alcoholism and increased hepatic iron stores. 327 62

A survey of literature data and the author's own observation of 18 patients with hemochromatosis (H) have shown that H is a polysyndrome disease. Men aged 35 to 60 suffer more frequently. Its most significant symptoms and syndromes are skin hyperpigmentation, hypersideremia, liver cirrhosis, diabetes, cardiomyopathy, and endocrinopathy. Three variants in a course of H--mild, average severe and severe (complicated)--were defined with regard to the duration of disease, a degree of morphofunctional changes and insufficiency of the affected organs. Intravital diagnosis of H was possible in clinical awareness and in the detection of hypersideremia and hemosiderin in liver and skin biopsy specimens. Multimodality therapy (blood-letting, desferal and insulin) promoted compensation of metabolic derangement, stabilization and even regression of disease.
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PMID:[Hemochromatosis: the clinical picture, diagnosis and treatment]. 328 99

There is increasing evidence that both iron overload and iron deficiency are associated with significant abnormalities of immune function. In diseases associated with iron overload there is increased susceptibility to both infection and neoplasia. The precise mechanisms are still being unravelled but iron overload has been shown to impair antigen-specific immune responses and to reduce the number of functional helper precursor cells. Similarly, iron in vitro in concentrations reported to be present in the serum of patients with iron overload impairs the generation of cytotoxic T-cells, enhances suppressor T-cell activity and reduces the proliferative capacity of helper T-cells. The predominant tumor seen in iron overload is primary hepatocellular carcinoma; however other aetiological factors appear to be involved in addition to iron overload, especially hepatic cirrhosis. Nevertheless, primary liver cancer occurs much more frequently in hemochromatosis than in other forms of cirrhosis. Iron deficiency is associated with an altered response to infection but the relationship is again a complex one. The cellular mechanisms involved have yet to be clearly defined, although impaired T and B cell function have been demonstrated.
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PMID:Iron status and cellular immune competence. 328 53

Three sibling and two isolated-case perinates (4 newborn, 1 stillborn) died with siderotic cirrhosis and widespread parenchymal siderosis, the latter similar to that seen in both hereditary and secondary hemochromatosis. Reticuloendothelial siderosis was absent, as occurs in primary hemochromatosis. Studies of iron metabolism were performed antemortem in two of the siblings and ante-, post- and internatally in their mother, who showed hyperferremia antenatally. The only finding in the affected family suggestive of hereditary hemochromatosis was the commonly associated HLA haplotype (A3, B7) in the mother and an infant. Liver morphology, including immunocytochemistry and ultrastructure, was similar in the 5 infants and suggested that liver disease commenced as massive necrosis in midfetal life. Histologic grading and chemical assays for iron and copper on liver and spleen of the 5 index cases were compared with 26 controls; placentas were compared with 12 control placentas. Hepatic iron concentration, but not hepatic copper concentration, was significantly increased in index cases, compared with controls. Hepatic iron to copper ratio was significantly increased in index cases, compared with controls, but this ratio was unaltered in spleen and placenta. Total hepatic iron, but not total hepatic copper, was significantly increased in index cases, compared with a subgroup of 11 controls of low gestational age, similar to the fetal stage when liver disease commenced in utero. The results suggest that, irrespective of the fetal liver disease being genetic or acquired, hepatic iron overload was directly involved in pathogenesis.
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PMID:Perinatal hemochromatosis. Clinical, morphologic, and quantitative iron studies. 330 44

This study investigated insulin receptor binding (number and affinity) to erythrocytes in patients with precirrhotic hemochromatosis, patients with cirrhosis, and healthy subjects. To evaluate plasma glucose and insulin levels, an oral glucose tolerance test (OGTT) was performed in all subjects. In the fasting state, all patients exhibited normal glucose levels. Precirrhotic patients showed slight impairment of glucose tolerance while cirrhotic patients were strikingly glucose intolerant. In both patient groups, fasting plasma insulin levels were increased. Following the glucose load, plasma insulin levels were significantly enhanced in precirrhotic patients at 90 and 120 min and increased at all times in cirrhotic patients. In the postabsorptive state (in the presence of hyperinsulinemia) insulin binding and the number and affinity of insulin receptors of erythrocytes were not different in precirrhotic or cirrhotic patients when compared to controls. We conclude that studies of insulin binding on erythrocytes do not contribute to the evaluation of the pathogenesis of insulin resistance in liver disease.
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PMID:Insulin binding to erythrocytes in hyperinsulinemic patients with precirrhotic hemochromatosis and cirrhosis. 331 88


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