Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The acute form of tyrosinemia type I usually causes severe hepatocellular dysfunction. We report a 4-month-old infant with hepatosplenomegaly, ascites, and multiple intrahepatic mass lesions mimicking hepatoma. A marked increase of serum alpha-fetoprotein (97.6 micrograms/ml) and multiple small low-density lesions in the liver demonstrated by computed tomography suggested the presence of hepatoma. The liver specimens obtained at laparatomy showed mixed nodular cirrhosis with fatty metamorphosis. Serum levels of tyrosine (6.6 mg/100 ml) and methionine (5.9 mg/100 ml) were increased. Urinary organic acid analyses disclosed increased excretions of succinylacetone (1,330 mg/g creatinine) and delta-amino-levulinic acid (113.6 mg/g creatinine). Histological abnormalities and biochemical evidences led to the correct diagnosis. This case emphasizes the need for complete investigations of puzzling cases and warns against undue reliance on noninvasive imaging techniques.
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PMID:An acute form of tyrosinemia type I with multiple intrahepatic mass lesions. 169 41

Serum alpha-fetoprotein from 146 patients with hepatocellular carcinoma, other malignancies, and benign liver diseases, was fractionated by lectin-affinity electrophoresis coupled with our sensitive detection method of antibody-affinity blotting. Compared with chronic hepatitis and liver cirrhosis, hepatocellular carcinoma was characterized by the increase in proportions of lentil lectin A-reactive alpha-fetoprotein-L3 and erythroagglutinating phytohemagglutinin-reactive alpha-fetoprotein-P4; the yolk sac tumor was characterized by the increase of concanavalin A-nonreactive alpha-fetoprotein-C1, lentil lectin-A-weakly reactive alpha-fetoprotein-L2, erythroagglutinating phytohemagglutinin-strongly reactive alpha-fetoprotein-P5, and Allomyrina dichotoma lectin-nonreactive, slow-migrating alpha-fetoprotein-Als; and gastrointestinal tumors were characterized by alpha-fetoprotein-C1, alpha-fetoprotein-L2, alpha-fetoprotein-L3, alpha-fetoprotein-P5 and Allomyrina dichotoma-nonreactive alpha-fetoprotein-A1. By combined evaluation of alpha-fetoprotein-L3 and alpha-fetoprotein-P4, hepatocellular carcinoma was discriminated from chronic hepatitis and liver cirrhosis with a sensitivity of 97% at a specificity of 99.7%. Because the alpha-fetoprotein level of the studied cases ranged from 60-1,500,000 ng/mL (60-1,500,000 micrograms/L), mostly greater than 200 ng/mL (200 micrograms/L), additional patients with lower levels of alpha-fetoprotein [16-177 ng/mL (16-177 micrograms/L) for 16 cases of hepatocellular carcinoma with liver cirrhosis and 28-185 ng/mL (28-185 micrograms/L) for 17 cases of liver cirrhosis alone] were analyzed for alpha-fetoprotein-L3 and alpha-fetoprotein-P4. The resulting sensitivity for combined evaluation was still as high as 88% at the same high specificity of 99.7%, indicating that the simultaneous analysis of alpha-fetoprotein-L3 and alpha-fetoprotein-P4 is effective in monitoring the evolution of hepatocellular carcinoma in cirrhotic patients.
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PMID:Lectin-reactive profiles of alpha-fetoprotein characterizing hepatocellular carcinoma and related conditions. 169 5

By means of Datura stramonium agglutinin (DSA) affinity electrophoresis, human alpha-fetoprotein (AFP) was resolved into five bands, AFP-D1, D2, D3, D4 and D5, in order of decreasing mobility. AFP-D1, which had no affinity for DSA, comprised more than 84% of the intensity of total AFP bands. The percentage of AFP-D2 increased marginally in hepatitis and liver cirrhosis with or without hepatocellular carcinoma. AFP-D3 increased characteristically in hepatocellular carcinoma and AFP-D4, which had the highest affinity for DSA, increased up to 12% in other tumors, mostly of gastrointestinal origin. AFP-D5 showed no consistent changes among the benign and malignant diseases. The assay of AFP-D3 and D4 proved useful as a highly specific marker of hepatocellular carcinoma and other tumors, respectively.
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PMID:Datura stramonium agglutinin-reactive alpha-fetoprotein isoforms in hepatocellular carcinoma and other tumors. 169 89

Between January 1983 and January 1990, 89 patients with primary epithelial hepatic malignancy were admitted to the Department of Surgery, University of Heidelberg, for surgical treatment. Histopathologically, tumours were hepatocellular carcinoma (HCC) 75, fimbrolamellar carcinoma (FLC) 1 and cholangiocellular carcinoma (CCC) 13. Concomitant liver cirrhosis was found in 61%. Among the cirrhotic patients, hepatitis-B infection was found in 65% and post-alcoholic cirrhosis in 30%. Pre-operative alpha-fetoprotein serum levels were elevated in 66% of the patients with HCC and none of the patients with CCC or FLC. The resectability rate was 35.9% (32/83). Twenty-six patients underwent curative resection; six were resected palliatively. In 44 patients exploratory laparotomy and biopsy only were performed. Thirteen patients remained without any surgical procedure. The hospital mortality rate after resection was 21.8%. Short-term prognosis depended predominantly on concomitant cirrhosis associated with peri-operative blood loss and extent of hepatic resection. Long-term survival rates after curative resection were 78%, 55% and 21% for 1, 3, and 5 years, respectively. Prognostic factors of long-term survival were investigated by the Kaplan-Meier method.
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PMID:Clinico-pathological features and surgical management of primary epithelial hepatic malignancies. 169 13

The changes in the plasma level of PIVKA-II (Protein Induced by Vitamin K Absence or Antagonist-II) following the treatment or progress of the disease was studied in 60 patients with hepatocellular carcinoma. The positivity rate determined by the changes in PIVKA-II was 58.4 percent (35/60 cases) and was about the same as those reported so far, all of which were obtained by a single determination of PIVKA-II. Plasma PIVKA-II was elevated in 61.9 percent (13/21 cases) of alpha-fetoprotein negative patients and it was almost identical with the overall positivity rate. In parallel with serum alpha-fetoprotein, the plasma level of PIVKA-II was decreased after the surgery or transcatheter arterial embolization and was increased when the recurrence or progress of the disease was observed. Furthermore, the nonspecific elevation of PIVKA-II due to the associated liver cirrhosis or chronic hepatitis was infrequent compared with that of alpha-fetoprotein. In 18 cases positive with both PIVKA-II and alpha-fetoprotein, a close correlation (R = 0.91) was observed between the changes of these markers during the progress or treatment of the disease. Thus, it was suggested that determination of PIVKA-II in blood might be useful not only in the diagnosis but in monitoring the progress or the effectiveness of treatments in hepatocellular carcinoma.
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PMID:[The clinical significance of PIVKA-II determination in patients with hepatocellular carcinoma: a comparative study with alpha-fetoprotein]. 169 80

From 1980 to 1988, 161 patients underwent total extirpation of primary hepatocellular carcinoma. There were 18 operative or hospital deaths. Recurrence of tumor was diagnosed in 69 of the remaining 143 patients during follow-up treatment with monthly serum alpha-fetoprotein measurements and imaging studies that were performed every three months. There were 61 men and eight women whose ages ranged from 33 to 78 years. The histologic factors noted were cirrhosis of the liver in 60 patients and chronic hepatitis in nine. There were multiple or diffuse recurrences (Type A) in 34 instances, one to three nodular recurrences (Type B) in 21, marginal recurrences (Type C) in 11 and a mixed form of the latter two in three instances. Two-thirds of the recurrences were found within 1.5 years and the second peak was noted between 2.0 and 2.5 years. Sex of patient, hepatitis B virus, type of tumor, capsule, extent of hepatic resection and postoperative chemotherapy did not influence the rate of recurrence, but cirrhotic livers had a significantly higher recurrence rate. A second hepatic resection was performed upon 20 patients with a five year survival rate of 26.8 per cent. Good results were obtained by chemoembolization of the hepatic artery. Prevention and adequate treatment of intrahepatic recurrence are of paramount importance in achieving better surgical results for hepatocellular carcinoma.
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PMID:Assessment of pattern and treatment of intrahepatic recurrence after resection of hepatocellular carcinoma. 169 50

Seventeen patients with cirrhosis and histologically defined, ultrasonically detected, large regenerative nodules of the liver were followed without treatment for more than 1 yr (range = 13 to 51 mo). During the follow-up period, none of the nodules were demonstrated sonographically to have enlarged. Computed tomography and/or hepatic angiography were also performed in 14 patients, but there was no evidence of malignant transformation in these lesions. None of the 17 patients showed acute elevation of serum alpha-fetoprotein levels. Furthermore, four nodules became undetectable by these imaging procedures. Follow-up biopsy performed in seven patients revealed no significant histological changes from the first biopsy sample. However, HCCs developed apart from these large regenerative nodules in four patients. These HCCs suddenly appeared and did not seem to have been derived from preexisting large regenerative nodules. From these observations, it was not possible to regard a large regenerative nodule having no cytological atypia as a high-potential premalignant lesion. Their precancerous potentiality needs to be compared with that of ordinary pseudolobules.
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PMID:Histological features and clinical course of large regenerative nodules: evaluation of their precancerous potentiality. 169 71

This article presents 14 patients of single-nodular minute hepatocellular carcinoma (HCC less than or equal to 2 cm) with coexisting cirrhosis. Of these nine patients were discovered by alpha-fetoprotein (AFP) mass screening or health check-up; and five by follow-up observations of chronic liver disease. All the 14 patients received radical resection with no operative mortality. The 1-5 year survival rates after resection were 100% (14/14), 100% (12/12), 100% (11/11), 100% (9/9), and 100% (7/7), respectively. This study demonstrates that the key point of further improvement in the detection of minute HCC lies in the establishment of diagnosis at a relatively low AFP level (less than 200 ng/ml). Realtime ultrasonography is the diagnostic modality of first choice in screening and monitoring. Surgery is strongly indicated for minute HCC with compensated liver function; Limited resection is the main type of resection for minute HCC with liver cirrhosis. The present data also indicate that HCC is not always multicentric in origin, even in patients with liver cirrhosis Intrahepatic spreading rather than multicentric origin may play a more important role in the multinodular pattern of HCC.
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PMID:[Diagnosis, treatment and prognosis of single-nodular minute hepatocellular carcinoma]. 169 22

We prospectively monitored 140 cirrhotic patients for the development of hepatocellular carcinoma for 6 yr, using periodical screening by high-resolution convex-array ultrasonography and alpha-fetoprotein. Twenty-eight patients were positive for HBs antigen, 26 patients had received blood transfusions and were negative for HBs antigen and 26 patients had a history of heavy drinking. We detected hepatocellular carcinoma in 40 patients during this period. The overall cumulative incidence of hepatocellular carcinoma in the 6 yr was 39%; the cumulative incidence was 59% in patients with HBsAg, 53% in patients who had had blood transfusions and were negative for HBsAg and 22% in patients who had a history of heavy drinking and who were without HBsAg. Detection of the carcinoma in 85% of these 40 patients was based on results of ultrasonography. Twenty-six of the patients (65%) had a small hepatocellular carcinoma of 2 cm or less. alpha-Fetoprotein levels were lower than 100 ng/ml in 56% of these 40 patients. Patients with cirrhosis are at high risk of developing hepatocellular carcinoma, especially patients with HBsAg or with a history of blood transfusion who are negative for HBsAg. Periodic monitoring by use of ultrasonography in particular is recommended for early detection of hepatocellular carcinoma.
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PMID:Prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis. 169 3

We describe the results of our study on the early detection of the development of hepatocellular carcinoma among patients with chronic liver disease. Over a period of 18 years, 33 patients were diagnosed as having hepatocellular carcinoma. From 1970 to 1978, we used serum alpha-fetoprotein determination, liver palpation, and radionuclide liver scans. In addition to alpha-fetoprotein determination, computed tomography and ultrasonography were introduced in 1979. However, we did not have any general guidelines for the use of these imaging modalities. From 1984 onwards, ultrasonography and serum alpha-fetoprotein determination have been performed every three months and computed tomography every year in patients whose right hepatic lobe had atrophied due to liver cirrhosis. On the basis of this screening program, 50% of the detected hepatocellular carcinoma (9/18) were found to be smaller than 1.9 cm in diameter, and tumor resection was performed in 11 out of 18 patients (61%).
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PMID:Early diagnosis of hepatocellular carcinoma. 170 11


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