Frederick Steigmann

Correlation of liver function and liver structure: Clinical applications

Abstract 1.1. An attempt has been made to illustrate the aid in diagnosis and management of liver diseases derived from the use of liver function tests and liver biopsy findings, and correlations between them. 2.2. The significance of a series of liver function tests and the indications and contraindications of liver biopsy in liver disease and other hepatomegalies are briefly diseussed. 3.3. Correlation between morphologic and functional findings helps in evaluation of liver function tests and reveals that most liver function tests give abnormal results in diffuse parenchymal diseases whereas in focal alterations, regardless of severity, none or only a few tests may be pathologic. 4.4. Based on morphologic and functional criteria, acute hepatic damage was subdivided into viral, toxic, biliary and purulent types; different forms in each group were illustrated by clinical, laboratory and morphologic criteria. The various forms of cirrhosis were similarly discussed. 5.5. The improvement in diagnosis of liver diseases derived from use of liver function tests and the additional help of liver biopsies is demonstrated. Liver biopsy also can be applied to the critical evaluation of therapeutic procedures in hepatic disease.

Infectious hepatitis (homologous serum type) in drug addicts.

Summary Twenty-three patients with infectious hepatitis (homologous serum type) which occurred among heroin addicts, predominantly of school age, are reported. Epidemiological evidence indicated that the disease was contracted and spread among this group by means of contaminated syringes and needles. The medical, public health and socio-economic problems associated with this disease among narcotic addicts are stressed.

The Enigma of Tuberculous Peritonitis

Summary Twenty-three patients with puzzling systemic and abdominal complaints were diagnosed as having tuberculous peritonitis: 20 by means of peritoneoscopy and 3 by laparotomy. Of the 23 patients, only 7 were correctly diagnosed clinically before the definitive procedures. Our observations suggest that in a 20- to 50-year old Negro patient with abdominal swelling or pain, or both, with associated symptoms of systemic infection such as fever, wasting, and night sweats, and signs of ascites or gaseous distention and abdominal tenderness, tuberculous peritonitis must be considered in the differential diagnosis. The clinical impression can be supported by finding tuberculosis elsewhere in the body and by the characteristic ascitic fluid containing over 3.5 gm. of protein per 100 ml. The definitive diagnosis, however, can be made by visualization of the peritoneal cavity, by peritoneoscopy or laparotomy, and by obtaining material for histologic and bacteriologic examinations. Prompt antituberculous therapy may be lifesaving.

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.

Comparison of Vitamin A of Liver Biopsy Specimens with Plasma Vitamin A in Man.

Summary The vitamin A content of biopsy specimens of human livers determined chemically and by fluorescence microscopy was compared with the plasma vitamin A level. No parallelism was found between liver and plasma vitamin A, except that subjects with high blood levels had at least an average liver storage.

DIFFERENTIAL DIAGNOSIS BETWEEN MEDICAL AND SURGICAL JAUNDICE BY LABORATORY TESTS

Excerpt Despite the great strides of laboratory medicine in the past two decades and the subsequent elaboration of many liver function tests, the jaundiced patient still presents today a challengin...

Studies on colon irritation

The bowel movement of 45 normal and 58 individuals with abdominal complaints were studied. Stools were examined for the effect of bran on the bowel movements, and for signs of colon irritation.

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.

Immunoglobulin and autoantibody response in acute and chronic liver disease

Abstract Serum immunoglobulin and nonorgan-specific autoimmune responses (autoantibody response) were studied in 269 patients with a variety of acute and chronic liver disease. A majority of patients with hepatitis B antigen (HB Ag)-positive and HB Agnegative acute viral hepatitis showed a mild elevation in total globulin, gamma globulin, immunoglobulin G (IgG) levels and a moderate elevation in immunoglobulin M (IgM) levels during the first 2 weeks of illness; these levels began to subside by the 8th week of illness and were completely normal by the 12th week, concomitant with the return of normal transaminase values. Serum complement (C 3 ) levels were low in 20 per cent of the patients with acute viral hepatitis, during the first 2 weeks of illness and returned to normal thereafter. Of the 80 patients with acute viral hepatitis, 42.5 per cent had smooth muscle antibody (SMA), 20.5 per cent had mitochondrial antibody (MA), 10 per cent had rheumatoid factor (RA), and none had antinuclear antibody (ANA); these nonorgan-specific autoimmune markers were only transiently present (mean, 2 weeks) and became undetectable as the patients condition improved. There was no difference in these immunologic responses between patients with HB Ag-positive and HB Ag-negative acute viral hepatitis. High levels of gamma globulin and IgG were seen in chronic active liver disease, either of viral or alcoholic etiology. Serum immunoglobulin A (IgA) levels were elevated only in those with alcoholic liver disease, whereas IgM levels were high in those with liver disease associated with an active hepatocellular damage either of alcoholic or viral etiology. HB Ag-positive blood donors with asymptomatic mild liver disease had normal immunochemistry values.

Significance of vitamin A alcohol and ester partitioning under normal and pathologic circumstances.

Summary Plasma vitamin A esters rise markedly after intake of vitamin A. They are elevated significantly in nephrosis and slightly and irregularly in conditions associated with hepatic impairment. The plasma vitamin A alcohol level does not change after the intake of vitamin A but is elevated in nephritis and sometimes in recovery from conditions associated with hypovitaminemia A. It is significantly decreased in malnutrition, infections, hepatic and wasting diseases, apparently due to reduced storage in and/or release from the liver. The vitamin A alcohol level, therefore, excels the total vitamin A level as index of hepatic vitamin A storage and vitamin A nutrition.