Paul B. Szanto

Transition of Fatty Liver into Cirrhosis

Summary The different clinicopathologic groups of the nutritional fatty liver-cirrhosis syndrome are described and correlated with the stages of formation of the connective tissue membranes and septums that develop during the transition of the fatty liver into cirrhosis. The large fatty liver without cirrhosis but associated with fatal hepatic failure represents the key stage for this study. Subdivision by septums is the basic mechanism of cirrhosis formation as revealed by three-dimensional reconstruction. Of these septums, those arising in the center of the lobule seem to be related to fat accumulation itself, whereas all other types of septums are related either to alternation in time and space in the structure of the liver or, more important, to hepatic necrosis. Avoidance of hepatic necrosis, a great deal of which appears to be caused by nonspecific intercurrent infection, may therefore be of therapeutic importance equal to that of removal of fat from the liver.

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.

Protective Effect of Vitamin B12 Upon Hepatic Injury Produced by Carbon Tetrachloride.

Summary Administration of 15 /xg per 100 g body weight of vitamin B12 to rats preceding acute C:C14 intoxication inhibits the development of histologic changes, especially fatty metamorphosis and depletion of ribonucleic acid. In addition, there is less deposition of lipids determined biocheamically and less BSP retention than in the intoxicated controls. These results are tentatively related to an effect of vitamin B12 on cytoplasmatic ribonucleic acid, which has been shown to disappear early in hepatic, injury.

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.