Using MR velocity mapping, we studied measurements azygos (A) and portal venous blood flow (P) under fasting and postprandial conditions in 7 healthy controls (C) and 10 cirrhotics (LC). Fasting A in LC was higher than that in C. Fasting P in C was higher than that in LC. Variability of repeated measuring A and P was low in C and LC. A postprandial increase of A in LC was higher than that in C. Fasting A/P ratio in LC was higher than that in C. Our results suggest that MR velocity mapping is expected as the reproducible method for monitoring the hemodynamic change in the azygos and portal venous system.

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Patients with decompensated liver diseases are likely to develop bacterial infection. Though spontaneous bacterial peritonitis (SBP) is the most characteristic infectious complication, other infections are as important as SBP. We reviewed 11 cases of soft tissue infection we had experienced. Of 11 cases in all, one had alcoholic cirrhosis, one had alcoholic hepatitis, one had biliary cirrhosis, and the others had posthepatitic cirrhosis. All the patients were in a decompensated state. The sites of infection were lower extremities in five cases, psoas muscle in two cases, abdominal wall in one, pericardium in one, eyeball in one, and cerebellum in one. Clinical manifestations were pain of the infected site and fever in many cases. But in some case, general deterioration was the only symptom and immediate diagnosis was difficult. The prognosis was poor. We have to pay more attention to soft tissue infections in the clinical practice of liver diseases.

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We evaluated the clinical effects of lamivudine treatment in liver cirrhosis. Five cirrhotic patients with hepatitis B virus infection were treated with lamivudine. Comparison between the data at start of treatment and after 9 months of treatment showed improvement in liver function tests. They are a decrease in serum total bilirubin from 0.7-6.2 (median 3.1) to 0.8-3.1 (median 0.8) mg/dl, a decrease in ALT from 50-268 (median 74) to 19-44 (median 30) IU/l, a decrease in TTT from 20.1-33.1 (median 29.9) to 5.5-19.8 (median 14.3) Kunkel, an increase in serum albumin from 3.1-4.8 (median 3.5) to 3.1-5.1 (median 3.9) g/dl, an increase in cholinesterase from 79-211 (median 94) to 118-315 (median 206) IU/l, and a decrease in HBV DNA from 10^8.00-10^8.92 (median 10^8.32) to <10^2.00-10^5.30 (median <10^2.00) copies/ml. It was shown that lamivudine treatment for cirrhotic patients with hepatitis B virus infection has improved not only hepatic inflammation but also protein synthetic function of liver.

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To clarify the changes of brain metabolites before and after administration of the branched-chain amino acid (BCAA) enriched infusion, the proton (¹H)-magnetic resonance spectroscopy (MRS) was performed to 13 patients with liver cirrhosis. The biochemical tests including the concentration of blood ammonia (B-NH₃) were also measured. Three patients with liver cirrhosis were administered 5% glucose infusion as controls. There was a statistically positive correlation between the intensities of glutamate and glutamine complex (Glx) and the B-NH₃ levels. No correlation was found between the intensities of myo-Inositol (mI) and B-NH₃ levels. The patients with liver cirrhosis were divided into 2 groups by B-HN₃ levels. The patients with B-NH₃ levels of less than 60μg/dl showed the elevation of Glx and mI after the addition of BCAA infusion. On the other hand, the patients with B-NH₃ levels of more than 60μg/dl showed no elevation of Glx and mI after addition of BCAA infusion. These data suggested that the elevation of Glx in brain was parallel to the increase of the B-NH₃ levels and the changes of Glx by ¹H-MRS may represent the metabolite capacities of amino nitrogen in the brain after addition of BCAA.

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Diabetes mellitus due to chronic liver disease was included in the new classification by the Japan Diabetes Society in 1999. Since marked post-prandial hyperglycemia is a characteristic of chronic liver disease, it is possible that lower fasting plasma glucose (FPG) level corresponds to 2-H plasma glucose (2-H PG) level of 200mg/dl.
FPG and 2-H PG were analyzed in 236 patients (cirrhosis=193, chronic hepatitis=43) during oral glucose tolerance test (OGTT). Scatterplots of FPG and 2-HPG and linear regression analysis showed that FPG=99mg/dl and FPG=115mg/dl were corresponding values for 2-H PG of 200mg/dl in cirrhosis and chronic hepatitis respectively.
These results suggest that measuring FPG level is insufficient for the diagnosis of diabetes in chronic liver disease. It is recommended that patients with chronic liver disease undergo OGTT to evaluate their glucose tolerance even if their FPG levels are within normal range.

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[in Japanese]

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[in Japanese]

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