Sex hormone changes in chronic liver disease: a matched study of alcoholic versus non-alcoholic liver disease

Men with liver disease are hypogonadal and feminized. European workers consider the liver disease itself to be the major factor but American workers blame alcohol consumption. We studied sexual dysfunction and sex hormones in three matched groups of men; controls (n = 22), those with alcoholic liver disease (n = 21), and those with non-alcoholic liver disease (n = 21). Men with alcoholic liver disease had more sexual dysfunction. Testosterone and androstenedione concentrations were lower and oestradiol and dehydroepiandrosterone sulphate levels were raised in the liver disease groups. The changes were greatest in the alcoholic liver disease group. In this, the first controlled study, liver disease per se appears to cause sexual dysfunction and sex hormone changes but these changes are amplified by ethanol.     

The Association of Autoimmune Disorders with Inflammatory Bowel Disease

Medical records of patients with ulcerative colitis (n= 858),Crohn's disease (n= 378) and coeliac disease (n = 148) wereexamined to determine the prevalence of associated autoimmunedisorders. Of outpatient controls (n= 300), 2 per cent had atleast one autoimmune disorder, compared to 7 per cent with ulcerativecolitis, 2 per cent with Crohn's disease and 6 per cent withcoeliac disease. Inclusion of primary sclerosing cholangitiswith the autoimmune disorders increased the overall prevalencein ulcerative colitis to over 9 per cent The results providefurther indirect evidence of involvement of autoimmune mechanismsin the pathogenesis of ulcerative colitis.     

The Liver in Crohn's Disease

Clinical, haematological, biochemical, bacteriological, histological,and immuno-logical data of 100 patients with Crohn's diseasehave been examined with special reference to liver disease anddysfunction. Several significant points emerged from the clinical data. Therewas a high frequency of colonic involvement (57 per cent), andalso a very high proportion of patients (48 per cent) with systemiccomplications, the commonest systemic complications being iritis(19 per cent) and sacro-ileitis (15 per cent). Nearly three-quarters(71 per cent) of the patients had been operated on at some timeand 57 per cent had had one or more bowel resections. Localcomplications had occurred in 52 per cent of patients. Biochemical liver dysfunction was common, occurring in 26 (26per cent) patients, the BSP being the test most frequently abnormal.Two patients with established chronic liver disease had considerablebiochemical liver dysfunction, but about half the patients withlesser pathological changes in the liver had no biochemicalliver dysfunction. Of the 39 patients who underwent liver biopsy, 19 (19 per cent)had pathological changes in the liver, the commonest changesfound being pericholangitis (8 per cent), focal necrosis (6per cent), and fatty change (4 per cent). Only two patientshad chronic liver disease, one patient having chronic activehepatitis and the other portal cirrhosis associated with haemosiderosis. Culture of liver tissue for bacteria or L forms was uniformlynegative. Immuno-logical studies proved unrewarding in relationto liver disease and dysfunction in patients with Crohn's disease.However, two significant differences did emerge in comparingthe results of the immunological tests in ulcerative colitiswith those in Crohn's disease. Positive immunofluorescence teststo human colon were found in 12·7 per cent of patientswith ulcerative colitis, compared with only 2·3 per centof patients with Crohn's disease. There was also a significantdifference in IgM levels, with low values of IgM more frequentin Crohn's disease and high values more frequent in ulcerativecolitis; further research will be necessary to determine theunderlying reasons for this difference. The finding that the hepatic changes in Crohn's disease areremarkably similar to those in ulcerative colitis, both in frequencyand in type, leads to several possible explanations. First,ulcerative colitis and Crohn's disease may be different manifestationsof a single disease. Secondly, the liver disease and the otherremote complications, which are also similar in Crohn's diseaseand ulcerative colitis, may be a consequence of chronic inflammatorydisease of the intestine, irrespective of its exact nature.Thirdly, ulcerative colitis and Crohn's disease may both begeneralized diseases in which the brunt falls upon the intestinaltract. The aetiology of the hepatic lesions remains obscure but somedeductions can be drawn from the present data. From clinicalconsiderations, the overt liver disease appears to behave likea viral hepatitis which has become chronic. There is no evidenceto support the view that homologous serum hepatitis from bloodtransfusion is the significant factor. Drugs do not appear tobe of any great relevance. Immunological relationships are essentiallynegative. Portal bacteraemia appears to be an unlikely causeof the overt chronic liver disease encountered in the presentstudy.     

Pyogenic Liver Abscess in Crohn's Disease

We describe six cases of pyogenic liver abscess occurring among1227 Crohn's disease patients admitted to The Mount Sinai Hospitalfrom 1960 through 1982, and review the features of the sevensimilar cases that have been previously reported. Mechanismsof formation of liver abscess in these 13 patients includeddirect extension of intraabdominal abscess (three cases), propagationvia the portal vein (eight cases), biliary complications (onecase), or metastatic cancer (one case). Five of the 13 patients died. All five deaths occurred amongthe eight patients with multiple abscesses; all five patientswith solitary abscess survived. The mean age of the patientswho died was 56 years, versus 37 years for the survivors. Threeof the four patients treated with antibiotics only died; onlytwo of the nine patients who underwent some form of drainagesuccumbed. Mortality was usually attributable to failure in making thediagnosis, especially as liver function test abnormalities wereoften subtle. Furthermore, the generally nonspecific clinicalsigns and symptoms were often obscured by underlying bowel disease.If a high index of suspicion is maintained, CT scanning andultrasonography should reveal the lesion at an early stage,so that the necessary drainage procedure can be carried out,with or without concomitant resection of affected bowel anddrainage of intraabdominal abscess.     

Not Wilson's disease: a review of misdiagnosed cases

During the period 1957–1987, 189 patients with neurologicalsigns and symptoms were referred to the Wilson's disease clinicat Addenbrooke's Hospital, Cambridge. The diagnosis was notconfirmed in 52 patients. Thirty-three of these 52 patientswere sent with a definite diagnosis of Wilson's disease, and12 had received chelation treatment. Ten patients were labelledas probable Wilson's disease; in nine cases no diagnosis hadbeen made but Wilson's disease was considered a possibilityrequiring exclusion. One patient only was mistakenly reportedto have Kayser-Fleischer rings. The presenting symptoms weretremor (n = 17), involuntary movements (n = 16), difficultyin walking (n = 12), personality changes (n=4) and epilepsy(n = 3). The mean delay in referral was 8 years (range 6 monthsto 20 years). Compared with the number of patients with confirmedneurological Wilson's disease seen in this period (137 patients)the referral diagnosis was correct in only 72% of cases. Thereasons for error, both clinical and biochemical, are discussed.     

Metabolic Studies in Kidney Stone Disease

Patients with kidney stones (n=59) and healthy controls (n=31)collected a 24-hour urine sample and later underwent a 6-hour‘fast and load’ test in which an oral calcium loadwas taken after 2 hours. In the 24-hour urine sample, mean calciumexcretion was higher in patients than controls, while mean urate,oxalate and citrate levels were similar. The patients had higherlevels of fasting plasma calcium, serum calcitriol and fastingurinary calcium, and lower levels of plasma phosphate than didthe controls. Following the calcium load, plasma and urinarycalcium increased similarly in both groups. Serum parathyroidhormone (PTH) levels were similar in both groups and decreasedsimilarly following the calcium load. Multiple linear regression, relating the presence or absenceof stone formation to all variable, found the only variablessignificantly related to stone formation to be plasma levelsof calcium (p<0.001) and phosphate (p=0.001) and fastingurinary area (p<0.001), and 24-hour urinary calcium excretion(p<0.05). Urinary oxalate and citrate were not related tostone formation. The data do not support the hypothesis thatprimary stimulation by calcitriol produces a normal fastingplasma calcium level, with an exaggerated increase after anoral calcium load. The findings instead suggest an abnormalityof parathyroid cell ‘set point’, such that PTH secretioncontinues until the plasma calcium level is a little higherand the phosphate a little lower than in controls.     

Osteoporosis in Chronic Cholestatic Liver Disease

Assessment for both trabecular and cortical osteoporosis wascarried out in 36 unselected patients with chronic cholestaticliver disease of whom a number had received corticosteroidsduring the course of their illness. Symptoms suggestive of osteoporosiswere present in 42 per cent of patients of whom 11 per centhad evidence of one or more wedged or collapsed vertebrae. Therewas a highly significant decrease in the cortical area (totalarea ratio of the second metacarpal (p = 0.05), bone mineralcontent at the metaphyseal site of the radius (p = 0.01) andthe total trabecular bone volume of the iliac crest biopsies(p = 0.005) in the 31 female patients when compared with ageand sex-matched healthy controls). There was a nonsignificantdecrease in total trabecular bone volume of the iliac crestand bone mineral content of the radial metaphysis in the malescompared with age and sex-matched controls but the corticalplate thickness of the iliac crest (p = 0.005) and bone mineralcontent of the radial diaphysis (p = 0.02) were significantlyhigher. In total, 42 per cent of patients had evidence of eitherexcessive cortical (28 per cent) and/or trabecular (36 per cent)bone loss as judged by radiological and histological criteria.Only the total trabecular bone volume of the iliac crest, ofall the parameters measured was significantly (p = 0.02) lowerin patients with backache compared with those without back pain.Significantly greater bone loss was demonstrated at all sitesmeasured in those patients that were receiving or had receivedcorticosteroids in the past. ^*Present address: Department od Histopathology,University Hospitalof Wales,Health Park,Cardiff.     

Percutaneous Transluminal Angioplasty Improves Blood Pressure and Renal Function in Renovascular Hypertension

Thirty-three patients with renal angiographic evidence of significantrenal artery stenosis were referred for percutaneous transluminalangioplasty. The indications were poorly controlled hypertension(n=13) or hypertension associated with deteriorating renal function(n=20). Their mean age was 56 (23–73) years (12 males,21 females). Causes of the renal artery stenosis were fibromusculardysplasia (n=8) and atheromatous changes (n=25). Four patientswere excluded, three due to technical failure. Forty-five angioplastieswere performed in 29 patients with a mean observation periodafter angioplasty of 18 (one to 60) months. During this periodeight patients (28 per cent) had a diastolic blood preasureof less than 90 mnHg without antihypertensive drugs, a further15 patients (52 per cent) had improved blood pressure controlwith a significant reduction in the number and amount of antihypertensivedrugs, but six patients (20 per cent) showed no improvementin blood pressure. Hypertension associated with the stenosisof fibromuscular dysplasia responded better to angioplasty thanhypertension associated with atheromatous renal artery stenosis.Improvement in renal function was noted in eight patients withno change in 16 patients. Two patients with end-stage renalfailure and atheromatous intrarenal vascular disease becamedialysis dependent within four weeks of the procedure. One majorand four minor complications occurred but there were no deathsrelated to angioplasty. Together with results from other centresthis study indicates that percutaneous transluminal angioplastyshould be considered the initial treatment choice for all patientswith renovascular hypertension due to fibromuscular dysplasiaand atheromatous renal artery stenosis     

Hepatic Perfusion Parameters of Contrast-Enhanced Ultrasonography Correlate With the Severity of Chronic Liver Disease

In the study described here, we introduced a new ratio acquired with contrast-enhanced ultrasonography (CEUS): a liver parenchyma blood supply ratio that differentiates arterial and portal phases. Our purpose was to determine whether this ratio and other liver parenchyma perfusion parameters acquired with CEUS can be correlated with the severity of chronic liver disease. Twelve patients with non-cirrhotic chronic liver disease, 35 patients with cirrhosis (child class A: n = 10; child class B: n = 13; child class C: n = 12) and 21 healthy volunteers were examined by CEUS. Time–intensity curves were drawn for regions of interest located in liver parenchyma and right kidney cortex using QLAB quantification software. The arterial and portal phases were differentiated by the time to the maximum enhancement of right kidney and liver parenchyma perfusion data acquired from the time–intensity curves: the intensity of liver parenchyma perfused by hepatic arterial flow (I_ap), the intensity of total perfusion of liver parenchyma (I_peak), the intensity of liver parenchyma perfused by portal venous flow (I_pp) and the ratio of portal perfusion to total perfusion of liver parenchyma expressed by the parameters I_pp/I_peak, I_peak, I_pp and I_pp/I_peak significantly decreased in patients with cirrhosis and in patients with non-cirrhotic chronic liver disease, whereas I_ap increased. The parameters I_pp, I_peak, I_pp/I_peak and I_ap correlated with the severity of chronic liver disease (r = ?0.938, p < 0.001; r = ?0.790, p < 0.001; r = ?0.931 p < 0.001; r = 0.31, p < 0.05). The diagnostic accuracy rates for cirrhosis expressed as areas under receiver operating characteristic curves were 0.93 for I_peak, 0.98 for I_pp, 0.98 for I_pp/I_peak, and 0.69 for I_ap. Liver parenchyma perfusion parameters obtained by CEUS were correlated with the severity of chronic liver disease and have the potential to assess cirrhosis non-invasively.     

Nephrotic Range Proteinuria - A Good Predictive Index of Disease in IgA Nephropathy?

A combined retrospective and prospective study of 86 patientswith IgA nephropathy was conducted to determine whether thelevel of proteinuria was a good predictive index of progressivedisease. The patients fell into three groups: Group A, 31 patientswith proteinuria of less than 1g/day, Group B, 31 patients withproteinuria of 1 to 3.5g/day; and Group C, 24 patients withproteinuria of more than 3.5 g/day. The groups are comparablein age of presentation, sex ratio, and duration of study andshowed no difference in serum creatinine levels, creatinineclearance, incidence of hypertension or incidence of impairedrenal function. Compared with the patients in the other groups,those in Group C did not have increased incidence of progressivedisease. Nevertheless, they have a higher incidence of nephroticsyndrome (p<0.001), a lower incidence of macroscopic haematuria(p<0.05), lower serum albumin (p<0.05) and heavier proteinuria(p<0.01). Severity of proteinuria had no significant correlationwith the severity of renal histopathologic changes. Clinicalobservations divided the 24 patients with nephrotic range proteinuriainto three well-defined groups with different prognoses. Sixpatients had progressive disease with decreasing proteinuria.Five of these remained hypertensive and their initial renalbiopsy showed advanced pathologic changes. Thirteen patientshad persistent proteinuria although the renal function remainedunchanged. Three of these were treated with steroid but failedto respond, and their renal histopathologic changes were usuallymoderate. The remaining five patients showed good response tosteroid treatment although two became steroid-dependent. Theirrenal histopathology showed mild alteration. Our findings suggestthat severe proteinuria in IgA nephropathy does not inevitablyindicate a poor prognosis.     

Acoustic Radiation Force Impulse Elastography for Chronic Liver Disease: Comparison with Ultrasound-Based Scores of Experienced Radiologists,Child-Pugh Scores and Liver Function Tests

The purpose of our study was to investigate whether acoustic radiation force impulse (ARFI) elastography provides better diagnostic performance for diagnosis of chronic liver disease and correlates better with Child-Pugh scores and liver function tests, compared with an ultrasound (US) scoring system based on visual assessment of conventional B-mode US images by experienced radiologists. Five hundred and twenty-one patients with clinically proven chronic liver disease (n = 293), fatty liver (n = 95) or normal liver (n = 133) were included in this study. B-mode liver US and ARFI elastography were performed in all patients. ARFI elastography was performed at least five times, with each measurement obtained at a different area of the right hepatic lobe; mean shear wave velocity (SWV) was calculated for each patient. The mean SWV was compared with US-based scores from two radiologists (based on liver surface nodularity, parenchyma echotexture and hepatic vein contour), Child-Pugh scores and liver function tests. The mean SWV of the normal liver group was 1.08 m/s ± 0.15; of the fatty liver group, 1.02 m/s ± 0.16; and of the chronic liver disease group, 1.66 m/s ± 0.60 (p < 0.001). The area under the receiver operating characteristics curve of the mean SWV in ARFI elastography was significantly higher than that of the conventional B-mode US-based scores by two radiologists (0.89 vs. 0.74 and 0.77, p < 0.05), with a sensitivity of 75.4% and a specificity of 89.5% at the cut-off value of 1.22 m/s. The sensitivity of the mean SWV was significantly higher than the US-based scores (p < 0.001), although the specificity was not (p > 0.05). The mean SWV was better correlated with Child-Pugh scores and all liver function tests (except total protein) than the US-based scores from two radiologists. In conclusion, ARFI elastography showed better diagnostic performance than visual assessment of experienced radiologists for diagnosis of chronic liver disease, as well as for evaluation of the severity of chronic liver disease. (E-mail: leejy4u@snu.ac.kr)     

Splenic Influences on the Blood in Chronic Liver Disease

The Influence of the spleen on the blood has been assessed ina series of 187 consecutive patients with chronic liver disease.Patients were described as having ‘hypersplenism’if the white blood count and/or platelet count were below 4·0x10⁹and 100x10⁹/1 respectively at the time of biopsy diagnosis andon at least one subsequent occasion. Using this definition 17per cent of patients with alcoholic cirrhosis had hypersplenism,compared with 38 per cent with cryptogenic cirrhosis and 26per cent with active chronic hepatitis. Studies with ⁵¹Cr labelled autogenous erythrocytes in 36 ofthe patients with different types of chronic liver disease showedthat the spleen rarely caused anaemia either by excessive splenicpooling or splenic haemolysis. Further studies with ⁵¹Cr labelledplatelets in 20 other patients showed that the splenic plateletpool was usually considerably increased and the platelet lifespan reduced. Some patients showed excessive destruction ofplatelets in the spleen but none of these features consistentlyrelated to thrombocytopenia. Splenic enlargement per se did not cause expansion of the plasmavolume in chronic liver disease. Of a total of 17 patients who underwent surgical operationsfor reduction of portal pressure five had hyperspienism butin these the haematological state was not significantly improvedat one month. However, none of the survivors of these operationssubsequently developed hyperspienism. One patient with severehypersplenism who underwent simple splenectomy was cured ofleucopenia but not of thrombocytopenia.     

Expression of Heat Shock Protein 70 in Rabbit Liver After Contrast-Enhanced Ultrasound and Radiofrequency Ablation

Heat shock proteins (HSPs) induced by thermal ablation therapy may help presenting tumor antigen to the host immune system and be a valuable adjuvant in the ablation therapy of liver cancer. This paper described our preliminary study on the expression of HSP70 in rabbit liver after contrast-enhanced ultrasound (CEUS) and radiofrequency (RF) ablation. Twenty-five male New Zealand white rabbits were divided into five groups as: control group (n=5), ultrasound group (n=5), CEUS group (n=5), RF group (n=5) and CEUS + RF group (n=5). Clinical ultrasound and RF ablation equipment were used in the present experiment. Sonazoid was used as the contrast agent. All the animals were sacrificed 24 h after the procedure, and HSP70 was detected by immunohistochemistry staining and Western blot analysis. In the groups without RF ablation, there was no evidence of HSP70 expression in the liver tissue of the control group and ultrasound group, whereas positive HSP70 expression was detected in the liver tissue of the CEUS group, with a mean optical density of 0.33. In the RF and CEUS + RF groups, there were cells showing HSP70 expression in the normal liver tissue far from the ablation region. The mean densities of HSP70 expression were 0.31 in the RF group and 0.35 in the CEUS + RF group, respectively. With regard to the distribution of HSP70 expression of the RF and CEUS + RF groups, the marginal areas were stronger than liver tissue 1 cm away from the margin, and the ablated tissues showed no evidence of HSP70 expression. The mean density of HSP70 expression in the marginal areas were 0.47 in the RF group and 0.42 in the CEUS + RF group, respectively. CEUS using Sonazoid may produce HSP70 expression in the normal liver parenchyma after CEUS examination and RF ablation. (E-mail: moriyasu@tokyo-med.ac.jp)     

Progression of Diabetic Autonomic Neuropathy over a Decade in Insulin-Dependent Diabetics

The prognosis for diabetics with autonomic neuropathy is littleknown. We therefore studied the progress of young insulin-dependentdiabetics, first identified as having abnormal autonomic function10–15 years ago. We have shown that the mortality of diabeticswith symptomatic authonomic neuropathy is increased, but isless than previously reported. Mortality in asymptomatic diabeticswith an isolated abnormality in autonomic function tests isnot increased. The heart rate variability declines at 1.02±0.47(SD) per annum in diabetics with an initially normal heart ratevariability. While symptoms of autonomic neuropathy do not usuallyremit even over a decade, they do not commonly progress. Three groups of young insulin-dependent diabetics had heartrate variability tested between 1972 and 1977 and have beenreviewed 10–15 years later. Group A (n=49) had symptomaticautonomic neuropathy and an abnormal heart rate variability(<12), Group B (n=24) were asymptomatic yet had an abnormalheart rate variability and Group C (n=38) were asymptomaticand had a normal heart rate variability (16–26). The 10-yearsurvival in Group A (73.4 per cent) was less (P<0.05) thanin Groups B (91.7 per cent) or C (89.5 per cent) which did notdiffer from each other. The 18 Group A deaths were due predominantlyto renal failure (n=4), myocardial infarction in patients withnephropathy (n=3) and sudden unexpected death (n=3). The chiefsymptoms of autonomic neuropathy-diarrhoea, postural hypotensionand gustatory sweating, were very persistent but did not necessarilydeteriorate or become disabling in the majority of patients.The development of autonomic symptoms in asymptomatic patientswith abnormal heart rate variability was uncommon over a decade.     

Impaired Water Excretion and Elevated Plasma Vasopressin in Patients with Alcohol-withdrawal Symptoms

SUMMARY Reports describing the fluid balance status of alcoholics inwithdrawal are varied, and conflicting. We examined this questionby recording values for a variety of parameters in responseto a standard water load test. Compared with age and sex matchedhealthy volunteers (n=14), alcoholics in withdrawal (n=17) exhibitedlower cumulative urine output (p=0. 0001), higher minimum urineosmolality (p=0. 0001), lower serum sodium (p=0. 0024 beforeloading) and elevated plasma arginine vasopressin levels (p=0.0045 before loading). We believe that these findings are bestexplained by a resetting of osmoreceptors, a supposition inkeeping with contemporary views on the pathogenesis of alcoholdependence and withdrawal. This additional evidence of an antidiuretic state in alcoholwithdrawal leads us to question the practice of fluid supplementationin its management and we suggest that this policy be revised.     

Liver lesion detection: Comparison between excitation-spoiling fat suppression and regular spin-echo at 1.5T

The role of excitation-spoiling fat suppression (fatsat) imaging in the detection of liver lesions was assessed comparing short TR/TE and long TR/ TE spin-echo (SE) sequences with and without excitation-spoiling fat suppression in 25 patients at 1.5T. The study included patients with liver metastases (n = 21), primary liver cancer (n=3), and hepatic adenoma (n=1). Liver lesion detection and lesionliver signal-to-noise ratios (SNR) were determined for the various imaging sequences in a prospective fashion. Liver lesion-liver SNR were highest for long TR/TE (2000-2500/70-80) fatsat images (12.7±4.8) compared to long TR/TE regular SE (2000-2500/70-80) images (8.8±5.6) [(p = ns) (not significant)], short TR/TE (200-400/15-20) fatsat images (-6.2±4.8) (p=0.05), and short TR/TE regular SE images (-4.9±3.2) (p<0.01). Lesion detection was greatest for long TR/TE fatsat (86) followed by long TR/TE regular SE (78) (p=0.05), short TR/TE fatsat (65) (p<0.01), and short TR/TE regular SE (60) (p<0.01). The results of this study suggest that excitation-spoiling fat suppression may improve liver lesion detection and conspicuity.     

Psychiatric outcome in alcoholic liver transplant patients

We investigated drinking behaviour and psychiatric outcome ofpatients with alcoholic liver disease after liver transplantation,to help assess the advisability of the procedure in these patients.English-speaking patients (n = 20) transplanted for alcoholicliver disease and informants, and patients transplanted fornon-alcoholic liver disease (n = 54), were assessed by semi-structuredinterviews and standardized questionnaires 1–6 years followingtransplantation. All alcoholics were abstinent for several monthsafter transplantation, but only one patient remained totallyabstinent. Sixteen of the 20 alcoholics later returned to regulardrinking; the mean daily alcohol consumption was 3.5 units.Forty percent of the group were drinking above the recommendedsafe levels for the general population and over 50% were ‘binge’drinking intermittently. The alcoholic liver transplant patientsdid not have higher levels of psychiatric or physical morbiditythan controls. Patients with alcoholic liver disease returnto drinking after a period of abstinence following liver transplantation,although at lower levels than before. Their vulnerability toalcohol abuse is not explained by higher levels of physicalor psychiatric morbidity.     

超声弹性成像组织弥散定量分析技术在脂肪肝分度中的应用

目的 探讨超声弹性组织弥散定量分析技术在脂肪肝分度中的应用价值。方法 将75例脂肪肝患者(脂肪肝组)分为轻度(28例)、中度(26例)、重度(21例)3亚组,另设正常对照组30名。对所有受检者进行常规超声扫查后,使用实时组织超声弹性成像技术进行扫查,并行组织弥散定量分析,测量ROI内应变均值。结果 各组间超声弹性成像图表现有不同特点。弹性成像ROI内应变均值在各组间差异有统计学意义(P<0.05)。结论 超声弹性组织弥散定量分析技术在评价脂肪肝程度中具有独特优势和广阔的应用前景。     

Propranolol in Chronic Liver Disease: A Controlled Trial of its Effect and Safety over Twelve Months

The effect and safety of propranolol (Inderal-LA) in 95 patientswith mild to moderate chronic liver disease was studied in adouble-blind placebo controlled trial. Over a 12-month period,three patients in the propranolol group died compared with eightin the control population. Upper gastrointestinal bleeding occurredin the placebo group only. Twenty-five patients were withdrawn,12 in the propranolol and 13 in the placebo group. No deteriorationin clinical condition or liver function tests was observed inthe propranolol-treated patients, although serum testosteronelevels fell significantly compared with the control patients.This study shows that long-term treatment with propranolol issafe in patients with chronic liver disease but further studiesare required to define whether or not patients will benefit.Our observations on the response to placebo suggest that a significantproportion of patients are not likely to tolerate drug treatmentfor portal hypertension well.     

Iron Overload, but not Treatment with Desferrioxamine Favours the Development of Septicemia in Patients on Maintenance Hemodialysis

During a 19-month period we determined the incidence of bacterialinfection among 39 patients treated with desferrioxamine whohad end-stage renal disease and were undergoing maintenancehemodialysis. Twenty-three received desferrioxamine becauseof aluminium-related bone disease, and 16 because of iron overload.A control group of 193 patients on maintenance hemodialysisbut without desferrioxamine was used. No difference was foundin the incidence of septicemia or of all bacterial infectionsbetween the patients with aluminium-related bone disease treatedwith desferrioxamine and the control patients (0.12 vs. 0.12septicemia per patient-therapy-year, p>0.05; 0.23 vs. 0.26bacterial infections per patient-therapy-year, p>0.05). Theincidence of septicemia in patients treated with desferrioxaminefor iron overload, however, was almost three times that in thecontrol patients (0.36 vs. 0.12 septicemia per patient-therapy-year,p<0.01). To assess the effect of iron overload itself, wedetermined the frequency of bacterial infection in patientson regular hemodialysis who have never received desferrioxamine.These were subdivided into three groups according to serum ferritinlevel which indicated normal or low iron stores (Group I: serumferritin 10-330 µg1/1, n=125), moderate (Group II: serumferritin 331-1000 µg/1, n=49) or more advanced iron overload(Group III: serum ferritin 1001-2000 µg/1, n=10). Comparedto patients with normal or low serum ferritin levels (GroupI), we found a significantly higher rate of bacterial infectionamong patients in Group II compared with Group I (0.18 vs. 0.34infections per patient-therapy-year, p<0.05) and Group IIIcompared with Group I (0.18 vs. 0.58 infections per patient-therapy-year,p<0.01). These results suggest that treatment with desferrioxaminedoes not favour the development of septicemia or bacterial infectionindependently of iron overload and that iron overload itselfmay predispose patients on regular hemodialysis to bacterialinfection.