The Effect of Surgical Operations on the Bromsulfalein-Retention Test

Tagnon, Henri; Robbins, Guy F.; Nichols, Mary P.

doi:10.1056/nejm194804152381603

Cited by 27 publications

(7 citation statements)

References 4 publications

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“…The present results also show that the non-specific effects of surgery and anaesthesia transiently depress BSP clearance in the rat as in man (Tagnon, Robbins, and Nichols, 1948). Nevertheless, small bowel resection caused further significant impairment of BSP clearance, particularly after removal of the distal small bowel.…”

Section: Discussionsupporting

confidence: 69%

Liver structure and function following small bowel resection

Gupta¹,

Neale²,

Dowling³

1973

Gut

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SUMMARY The observation that patients with extensive small bowel resection have impaired hepatocellular function with reduced BSP clearance and fatty change in biopsies from the liver led to a systematic study of liver structure and function following proximal and distal small bowel resection in the rat.While anaesthesia and surgery impaired BSP clearance per se, small bowel resection further reduced BSP clearance with impairment of both uptake and excretion phases of BSP excretion.The increased BSP retention was more marked after distal than after proximal small bowel resection, but in both experimental groups the abnormalities of BSP excretion spontaneously returned to normal three to four weeks after surgery.Circulating liver enzymes were normal but serum alkaline phosphatase was significantly depressed, particularly after distal resection. Isoenzyme studies showed that the depression of serum AP was due to a reduced intestinal isoenzyme. While serum levels remained consistently depressed up to eight weeks after proximal resection, in parallel with mucosal regeneration, serum AP returned to normal two to four weeks after ileectomy.While these minor changes in hepatic structure and function would normally be of little clinical importance, the additional insult of hepatic dysfunction may well be important in malnourished patients after extensive small bowel resection.

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Section: Discussionsupporting

confidence: 69%

Liver structure and function following small bowel resection

Gupta¹,

Neale²,

Dowling³

1973

Gut

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“…Since there is evidence that 17-hydroxycorticosterone is the principal hormone secreted by the human adrenal cortex (2), it would appear that the circulating level of the adrenocortical hormones is regulated not only by the degree of stimulation of the adrenal cortex but by the functional state of the liver. In view of the fact that liver function is depressed during surgery (9) and other stresses (10)(11)(12), it is likely that the elevated plasma 17-hydroxycorticosteroid level observed under these circumstances may be ascribed in part to adrenal stimulation and in part to impaired hepatic function.…”

Section: Discussionmentioning

confidence: 99%

17-Hydroxycorticosteroid Metabolism in Liver Disease1

Brown¹,

Willardson²,

Samuels³

et al. 1954

J. Clin. Invest.

128

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Considerable evidence has been accumulated to indicate that the liver is concerned in the metabolism of steroids (1). The development of methods for the measurement of 17-hydroxycorticosteroids in the plasma (2) and in the urine (3) has enabled us to study the role of the liver in the handling of 17-hydroxycorticosterone (hydrocortisone) and related compounds. This communication will consider the plasma levels and the urinary excretion of the 17-hydroxycorticoids in patients with liver disease as compared with a group of normal subjects. MATERIALS AND METHODSTwelve patients with liver disease and eleven normal subjects were studied. Of the twelve patients with liver disease, there were nine with cirrhosis, two with hepatitis and one with metastatic carcinoma. Serial studies were carried out in the patients with hepatitis to note the effects of improvement in liver function. The "normal subjects" were hospital personnel or convalescing hospital patients who were free of liver disease, fever, and endocrine abnormalities.These subjects were given intravenously a solution containing 0.02 per cent hydrocortisone (free alcohol), 5 per cent dextrose and 1 per cent alcohol. A sufficient quantity of this commercially-prepared solution.2 was administered to give the subject 1 mg. of hydrocortisone for each kilogram of body weight.Control bloods were drawn shortly after 8 A.M., following which the infusion was administered over a 30-minute period. Blood samples for the estimation of the 17-hydroxycorticosteroid level of the plasma were drawn at 1, 2, 4, and 6 hours after the beginning of the infusion. After the infusion, the subjects were allowed to have breakfast and to be up and about, if they were ambulatory.The plasma was separated within two hours and stored in a frozen state until the analysis could be carried out. The estimation of the plasma 17-hydroxycorticosteroid

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“…Boyce and McFetridge (1938), using Quick's hippuric acid test, concluded that there was a marked decrease in hepatic function after operation, and Tagnon, Robbins, and Nichols (1948) and Geller and Tagnon (1950) showed that bromsulphalein excretion was impaired post-operatively. Zamcheck, Chalmers, and Davidson (1949) found liver biopsy evidence of acute inflammation of the liver at the end of operation in six patients, which was not present when the abdomen was opened.…”

Section: Pre-operative Evidence Of Liver Dysfunctionmentioning

confidence: 99%

Early jaundice after open-heart surgery

Lockey¹,

McIntyre²,

Ross³

et al. 1967

Thorax

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Two hundred and thirty-two patients subjected to open-heart surgery have been analysed regarding early post-operative jaundice. The overall incidence of jaundice was 13%, being 55% where the mitral valve and 5% where the aortic valve was predominantly involved. Only one out of 59 patients in whom a congenital lesion was repaired became jaundiced. Hyperbilirubinaemia without jaundice was common. The biochemical pattern of the jaundice was singularly constant, the most striking feature being the rise in serum bilirubin level. The highest value occurred between the second and tenth post-operative days. At total levels less than about 4 mg. /100 ml. the unconjugated fraction usually equalled or exceeded the conjugated. The alkaline phosphatase was normal in the first post-operative week but was sometimes slightly raised in the second, when the bilirubin levels were usually falling. The S.G.P.T. was normal or very slightly raised. Bilirubinuria was present. Centrilobular congestion with no evidence of extrahepatic biliary obstruction was found at post-mortem examination, and liver biopsy in three very severely jaundiced patients revealed only intrahepatic cholestasis. Pre-operative evidence of liver dysfunction was found in 13 patients who subsequently became jaundiced. Twelve had lesions predominantly affecting the mitral valve. Haemolysis, heart failure, and infection probably all played a part, and the effect of operation per se on liver function has been discussed. Drugs and viral hepatitis do not seem implicated in our patients. Maintenance of lower venous pressures in the post-operative period and the use of less blood reduced both the incidence and severity of jaundice.

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The Effect of Surgical Operations on the Bromsulfalein-Retention Test

Cited by 27 publications

References 4 publications

Liver structure and function following small bowel resection

Liver structure and function following small bowel resection

17-Hydroxycorticosteroid Metabolism in Liver Disease1

Early jaundice after open-heart surgery

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