We studied the tissue plasminogen activator (t-PA) levels in the plasma of patients with acute hapatitis (AH), severe acute hepatitis (AHs) and fulminant hepatitis (FH) . Plasma t-PA levels were measured consecutively on the first, third and seventh days of hospitalization. Plasma t-PA levels were markedly higher in AHs and FH than in AH (p<0.05, p<0.01, respectively) on the first day, but did not differ significantly between AHs and FH on this day. The t-PA levels decreased markedly on the third and seventh days in AHs (both p<0.05), but did not change from the first day to the third and seventh days in FH. The t-PA levels on the third and seventh days were higher in FH than in AHs (both p<0.05). There was a significant increase in the plasma t-PA level before an episode of encephalopathy in FH, compared with levels in AHs. These observations suggest that t-PA level may be useful as a prognostic parameter in patients with acute hepatic injury.
Five cirrhotic patients with refractory ascites were treated with transjugular intrahepatic portosystemic shunt (TIPS). Before TIPS, although patients were received salt restriction (5g/day), diuretic therapy (furosemide 112mg/day, spironolactone 140mg/day), albumin infusion and paracentesis, ascites did not show improvement. After TIPS, urine volume and urinary sodium excretion increased significantly. Mean body weight decreased significantly from 73kg before TIPS to 63kg a month after TIPS. Improvement of ascites after TIPS were associated with a significant reduction in the dose of diuretics. On discharge, complete resolution of ascites was found in 2 patients and mild ascites remained in 3 other patients. Four patients presented 6 episodes of shunt stenosis in the follow-up period, and were treated with balloon dilatation. Ascites increased on shunt dysfunction and showed improvement after balloon dilatation. Post-TIPS encephalopathy was seen in 2 patients and one of 2 was disabled. In conclusion, although post-TIPS shunt dysfunction and encephalopathy are common, TIPS is an effective therapy for refractory ascites in patients with cirrhosis.