1/21. Intratumoral steatosis in focal nodular hyperplasia coinciding with diffuse hepatic steatosis: CT and MRI findings with histologic correlation. focal nodular hyperplasia (FNH) is a benign tumorlike condition that is thought to be a hyperplastic response to increased blood flow in an arterial malformation rather than a true neoplasm. Radiologically, FNH usually shows typical findings on unenhanced and enhanced computed tomography (CT) and magnetic resonance images (MRI), with atypical features being the exception rather than the rule. We report an unusual case of FNH with extensive fatty infiltration of the lesion illustrated on CT and MRI and proven by histopathology. ( info) |
2/21. Emerging indications for mars dialysis. mars stands for Molecular Adsorbent Recirculating System and represents an interesting option in treating patients with liver disease. There is still little known about the best time point of initiating this treatment and the exact selection criteria for patients who may benefit from this therapy. The list of potential applications using this procedure is expanding. We report on the experience in seven patients being treated with mars dialysis for chronic cholestatic liver disease and acute on chronic liver failure. From August 2000 to October 2001 seven patients received 27 mars treatments in our clinic, ranging from 2 to 12 treatments per subject. Presented cases were diagnosed as steatohepatitis because of alcoholism (n = 3), vanishing bile duct disease (n = 1), metabolic liver disease (n = 1), primary biliary cirrhosis (n = 1) and drug-induced hepatitis (n = 1). Based on this experience, we discuss the ongoing questions of various indications and the decision to initiate mars dialysis. ( info) |
3/21. obesity as a cause of "false-positive" alcohol misuse laboratory investigations. Three patients are reported with a prior history of alcohol misuse accompanied by abnormal liver toxicity tests and other indices of alcohol misuse. A decreased but persistently raised serum gamma-glutamyl transferase activity during subsequent abstinence or controlled drinking was interpreted incorrectly as due to continued alcohol misuse whereas obesity-related fatty liver was the probable cause. The value of serum carbohydrate deficient transferrin assays in the differential diagnosis of abnormal liver toxicity tests is emphasized. ( info) |
| Non-alcoholic fatty liver disease (NAFLD) commonly is associated with chronic inflammatory bowel disease (CIBD) and usually is considered to be stable and benign. However, NAFLD -- and in particular its subset, non-alcoholic steatohepatitis (NASH) -- may lead to progressive liver disease. Moreover, NAFLD sensitizes the liver to injury and increases the risk of developing acute-on-chronic liver failure following a "third hit". We here present one patient with NASH, as probably induced by long-standing Crohn's disease in the absence of ethanol consumption or abuse. The patient acquired an acute HBV infection and died from complications. As based on the clinical and histological findings, Crohn's disease appears to be a risk factor for developing NAFLD and thus to contribute to the progression into NASH. In conclusion, we suggest that Crohn's disease-related NAFLD may increase the vulnerability of the liver, which indicates that patients with a known history of CIBD merit special attention. ( info) |
| Phlegmonous enteritis is a rare inflammatory bowel disease. A 52-yr-old man with a history of alcoholic abuse was admitted to the hospital for an acute abdomen and died of septicemia and its complications. autopsy revealed phlegmonous inflammation of the ileum and severe fatty liver. Numerous Gram-negative rod bacilli were demonstrated in the ileal mucosa. Shortened villi and decreased lysozyme activity of paneth cells in the small intestine might be results of chronic alcohol ingestion. The relationship between phlegmonous enteritis and alcoholic abuse was strongly suggested in this case. ( info) |
6/21. Sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma. Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death. ( info) |
7/21. Zieve's syndrome and intracranial haemorrhage: coincidence or related disorders. Zieve's syndrome (hyperlipidaemia, anaemia and fatty liver degeneration) may rarely occur with intracranial haemorrhage. Four patients suffering from both diseases are reported. Although it remains unclear whether there is a causal relationship between the two, it seems that hyperlipidaemia may be a major cause of intracranial bleeding. One reason for the small number of reported cases may be that hyperlipidaemic serum levels rapidly decrease after alcohol withdrawal. ( info) |
8/21. Non-alcoholic steatohepatitis associated with small intestinal diverticulosis and bacterial overgrowth. A patient with hepatic histological features of steatohepatitis in association with small bowel diverticulosis and bacterial overgrowth is described. A similar histological picture in the liver is well recognised in association with bacterial overgrowth in excluded loops of small intestine. Jejunal diverticulosis should be considered as a correlate of para-alcoholic hepatitis. ( info) |
9/21. Fat deposition surrounding intracerebral hemorrhage in a patient suffering from Zieve syndrome. In a 42-year-old man, admitted a few hours after an acute cerebrovascular event, CT demonstrated a hyperdense hemorrhage surrounded by a hypodense rim similar to perifocal edema or liquefying blood, thus raising doubts about the acuteness of the event. Laboratory findings revealed Zieve-syndrome (alcoholic hyperlipemia, hemolytic anemia, and alcoholic fatty liver) and negative Hounsfield Unit measurement of the hypodense rim finally identified it as a layer of fat around the clot. ( info) |
10/21. Focal fatty infiltration of the liver in acute alcoholic liver injury: hot spots with radiocolloid SPECT scan. We present herein a case of focal fatty infiltration of the liver, in which extremely unusual findings were exhibited on single-photon emission computed tomography (SPECT) of the radiocolloid liver scan. Liver scan was performed on a 46-yr-old patient with a clinical picture of acute alcoholic hepatitis. Multiple hot spots were demonstrated by SPECT scan, and these lesions corresponded to focal fatty infiltration, which were proven by computed tomography (CT). These hot spots disappeared rapidly in accordance with the improvement in fatty change on CT, and with the improvement in the clinical picture. The hot spots in this case were believed to represent the nonuniform intrahepatic shuntings, which presumably caused the development of focal fatty infiltration as well. SPECT may be useful in detecting and monitoring the alteration of hepatic circulation in alcoholic patients with focal fatty infiltration of the liver when planar colloid liver scan shows a mottled pattern. ( info) |