The portal venous system was evaluated by real-time ultrasonography in 100 consecutive cirrhotic patients and 100 pair-matched controls to assess the sensitivity and specificity of ultrasound findings in detecting or excluding cirrhosis. The best discriminant findings were the expiration diameters of the superior mesenteric and the splenic vein and, chiefly. their sum corrected by body surfitce. In cirrhotics the calibers of the splanchnic veins significantly increase in relation to the extent of esophageal varices, but in individual patients this increase cannot predict the extent of varices, which are the main determinant of the bleeding risk. (Key words: liver, cirrhosis of; esophageal varices; portal hypertension; splanchnic vein measurements)Abdominal ultrasonography is being used more extensively in patients with liver cirrhosis. 1 -3 Previous studies have shown that in cirrhotic patients several sonographic findin gs may be observed, including alterations in splanchnic veins such as an increase in the caliber of splanchnic veins, and a diminished response of portal vessels to breathing. · -6The diagnostic usefulness of these findings, however, largely depends on the reliability of control data, which have never been obtained in a large series of matched healthy controls. -1-l'l Enlarged splanchnic vessels are possibly caused by portal hypertension, which is also responsible for the development of esophageal varices. Varices are well-known determinants of survival in these patients; large varices increase the risk of gastrointestinal hemorrhage.11 In a previous report, ultrasonography was proposed as a technique to identify patients with a high risk of bleeding.10 However, only the diameter of splanchnic vessels was considered and no detailed information was given regarding breathing.We report a detailed evaluation of the diagnostic

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The contribution of hyperammonemia to plasma amino acid imbalance in patients with liver disease was assessed in 10 subjects with chronic hepatitis and in 17 advanced cirrhotics. Insulin, glucagon, and plasma amino acids were determined both in the basal state and 45 min after oral ammonium chloride, at doses used in the ammonia-tolerance test. In cirrhotics, ammonia increased to 3 times basal values, in association with a rise in insulin and, more marked, in glucagon. Aromatic amino acids and free tryptophan further increased, while a significant fall in branched-chain amino acids and glutamate was observed. The increase in ammonia levels strongly correlated with the increase in glucagon (r = 0.707). Two patients, with large esophageal varices, showed signs of disturbed consciousness, in association with a marked rise in ammonia and in the ration of free tryptophan to the sum of neutral amino acids. In patients with chronic hepatitis, whose ammonia levels rose slightly, minor variations in pancreatic glucoregulatory hormones and plasma amino acids were observed, as also happened in 10 healthy subjects following ammonium chloride ingestion. Our data fit with the hypothesis that the plasma amino acid imbalance of cirrhotics may be partly due to ammonia-induced changes in pancreatic hormones.

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ABSTRACT— In a longitudinal study liver volume and liver function were measured in a series of 12 patients undergoing partial liver resection for focal hepatic lesions. Ultrasonography revealed that liver volume, reduced by about 50% by the resection, progressively increased, and 6 months after surgery it returned to nearly normal values. A variable reduction in routine liver function tests was observed, possibly reflecting the influence of the different reserve synthetic capacity of the liver and, in the early postoperative phase, plasma half‐life of liver products and blood loss or changes in plasma volume. The galactose elimination capacity was only marginally reduced in the early period (from a pre‐surgery value of 2.49 ± SE 0.21 mmol/min to 2.31 ± 0.14 after 7 days; p = ns) and reached a nadir at 14 days (1.97 ± 0.16; p<0.001). When expressed per unit of liver volume, the galactose elimination (22 ± 2 μmol/min per unit before resection) progressively decreased during the regeneration phase from 36 ± 4 at 14 days to 26 ± 3 at 6 months (P vs 14‐day: <0.01). At 6 months both galactose elimination and galactose elimination per unit of liver volume were no longer different from baseline values. Our data show that, following hepatic resection, both liver volume and liver function increase and progressively return to nearly normal values. In agreement with data obtained in animal studies, it appears that the metabolic activity of the remaining parenchyma is increased in the early postoperative phase, and it slows down in the course of regeneration.

The liver and spleen size and the splanchnic vessel caliber were evaluated by means of real‐time ultrasonography in 12 consecutive patients who underwent a partial hepatic resection for benign or malignant lesions. All parameters were evaluated before surgery and 14 days, 28 days, two months, and six months after the partial hepatic resection. The liver size, which was halved after the resection, progressively increased during the follow‐up. The splanchnic veins showed, at 14 and 28 days, a significant increase in caliber and a reduced compliance to breathing, which progressively returned to normal levels. The spleen size increased after partial hepatectomy and remained enlarged throughout the study. Ultrasonography was able to detect that partial hepatic resection is followed by a progressive regeneration of the residual parenchyma and by a transient increase in portal pressure, which returns to normal levels when the liver regenerates.

Background: Clinical guidelines warrant a comprehensive assessment prior to maintenance treatment with amiodarone and repeated monitoring for the appearance of adverse reactions. The aim of the study was to evaluate the adherence to these guidelines. Methods: A retrospective chart review of adult patients treated with oral amiodarone for at least 3 months. Data were collected from computerized medical records and subjected to descriptive statistical analysis. Results: 100 patients were included in the final analysis. Average age was 76.6 years (range 28 to 93 years). 61% were males. All were treated with amiodarone for atrial fibrillation with maintenance daily dose of 200mg. Average duration of treatment in the study was 35.9 months (range 3 to 83 months). Almost all patients (97%) were evaluated for thyroid and liver functions prior to treatment. While liver functions were properly monitored every 6 months during treatment (in 96% of patients), TSH was repeatedly monitored every 6 months in only 59% of patients. In another 32% of patients, the adherence to TSH monitoring was partial. Most patients (84%) completed a chest XR before treatment but only 2% completed respiratory function test as recommended. None of the patients completed chest XR annually as recommended; it was carried out only partially. Approximately two-thirds of the patients (64%) were examined by an ophthalmologist prior to treatment; regular surveillance ophthalmic checkups were not consistent. Directed neurological evaluation was not recorded for any of the patients prior to treatment, nor was periodical neurological examination during treatment, unless symptoms appeared. Conclusions: In this study the adherence to recommended clinical guidelines for monitoring adverse reactions of amiodarone was found to be poor. Interventions to improve compliance with these guidelines are needed. Background: Aripiprazole is mainly metabolized in the liver by CYP2D6 and CYP3A4 and it is also a substrate of P-glycoprotein.

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