The effect of successful liver transplantation on menstrual function was assessed by questionnaire in 44 women transplanted for various types of end stage liver disease, acute liver failure or malignant disease. Significant amenorrhoea (>one year) was present in 48% of women with chronic liver disease before transplantation, and was reversed within 10 months of surgery in all but one of the premenopausal patients who had primary amenorrhoea and hypogonadotrophic hypogonadism. Two patients became pregnant five months and 1-5 years after transplantation, but in one instance the pregnancy was unsuccessful, possibly as a consequence of cyclosporin related intrauterine growth retardation.
SYNOPSISThe necropsy findings in a 5-year-old girl with congenital hepatic fibrosis are described. She had been followed since the age of 18 months and finally developed hepatocellular failure. Extensive haemorrhagic necrosis was found at necropsy and was probably related to the terminal illness. Other unusual findings were areas of typical post-necrotic cirrhosis and marked centrilobular and diffuse emphysema of the lungs. It is suggested that the latter was also congenital in origin.A distinct form of hepatic fibrosis often occurring together with congenital cystic disease of the kidneys was first described by MacMahon in 1929 The early history of this child has already been described in detail (case 1, Kerr et al., 1961). To summarize, she was the product of a normal pregnancy and delivery and had apparently developed normally until the age of 16 months. At that time abdominal distention was noted, and subsequent investigations in hospital revealed gross hepato-splenomegaly with normal liver function tests apart from a raised serum alkaline phosphatase level
and length of history (M Whitaker, personal communication). Some, albeit few, malignant lesions were not clinically recognised in this study and doctors should be wary of discarding skin specimens as malignant and incompletely excised lesions may recur. Referral for histological examination avoids delayed diagnosis and should effect prompt and adequate further treatment if required.In conclusion, the performance of skin biopsies by general practitioners could be improved. All skin specimens should be sent for histological examination for feedback of both diagnostic skill and quality of excision.
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