The aims of this study were to determine the diagnostic effectiveness of fasting and postprandial serum bile acid determinations in liver diseases, and to compare results with those of conventional liver function tests.In 322 patients with biopsy-proved liver disease and 93 healthy subjects, fasting and postprandial (2 hr) serum levels of cholic, chenodeoxycholic, and lithocholic acid conjugates and conventional liver function tests were evaluated. Data were subjected to variance and discriminant and factor analyses.Fasting serum bile acids were higher in patients when compared to controls and were significantly higher in severe than in mild liver diseases. Determination of cholic plus lithocholic acid provided the highest discrimination capacity.The percent of correct allocation was 75.4% for conventional liver function tests, 70.1% for fasting serum bile acids and increased to 79.6% when liver function tests plus serum bile acids were considered. Postprandial percentages were always lower than fasting. Factor analysis identified two factors possibly related to cytolysis and protein synthesis. The serum bile acid concentrations highly correlated with both factors.We conclude that serum bile acid determinations increase the diagnostic and discriminant capacities of liver function tests and are more sensitive and discriminant when obtained in fasting than postprandially.Although it has been known for many years that serum bile acids (SBAs) are elevated in liver diseases (l), clinical application has been limited by technical difficulties. Fluorimetric and enzymatic techniques have limited sensitivity at low SBA concentrations (2, 3), and gas-liquid chromatography requires time-consuming extraction procedures (4,5). The use of these techniques was probably the major cause of conflicting results when SBA postprandial determination was proposed as more sensitive than fasting levels (6-8).Although these problems have been overcome by development of specific and sensitive radioimmunoassays (9, lo), at present, clinical usefulness of these determinations has not been completely established, since available results are preliminary. Data are lacking regarding the diagnostic effectiveness of SBA determination. The aims of this study were, therefore, to determine sensitiv- Received October 19, 1982; accepted March 31,1983 Address reprint requests to: Enrico Roda, M.D., Clinca Medica 3, Policlinico S. Orsola Via Massarenti, 9, 40100 Bologna, Italy. ity and discrimination capacity of fasting and postprandial SBA determinations in liver diseases and to compare results with those of conventional liver function tests. MATERIALS AND METHODSThree hundred and twenty two patients (187 males, 135 females; mean age 48 years, range 28 to 70 years) with biopsy-proved liver disease and 93 control subjects (n) (54 males, 39 females; mean age 45 years, range 20 to 68 years) were studied.In 322 patients, the diagnosis of liver disease was based on agreement of biopsy readings obtained by two experienced pathologists. Each pathologist, who...
The local and systemic effects, as well as the repair mechanisms, of sterile absolute ethyl alcohol injection were evaluated at a range of doses (0.1-2.0 mL/kg body weight) in rabbit liver in order to confirm the feasibility and safety of local treatment of tumours in man. Saline injection was used in the control animals. The animals were killed at varying intervals (range: 1-30 days after injection), and the liver was studied by gross and microscopic examination. The ethyl alcohol injection was well tolerated and did not induce significant systemic side-effects. All doses could induce necrosis and none proved to be lethal. The alcohol injection produced an area of coagulation necrosis, the size of which appeared to be dose-related, and which was surrounded by granulation tissue, gradually repairing the necrotic lesion; the adjacent tissue was intact, or had signs of mild steatosis. However, at higher doses (1.0 and 2.0 mL/kg bodyweight), necrotic lesions were observed in the liver both near and remote from the site of injection. Fine needle percutaneous alcohol injection is effective in producing necrotic lesions which appear to be dose-related; at higher doses, however, an unpredictable intrahepatic diffusion may occur.
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