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Fulltext Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis

Tai ML, Goh KL, Mohd-Taib SH, Rampal S, Mahadeva S

Nutr J, 2010;9:27.
PMID: 20576106 DOI: 10.1186/1475-2891-9-27

There is limited data on the nutritional status of Asian patients with various aetiologies of cirrhosis. This study aimed to determine the prevalence of malnutrition and to compare nutritional differences between various aetiologies.

Matched MeSH terms: Liver Cirrhosis/complications*; Liver Cirrhosis, Alcoholic/complications
Percutaneous, non-operative radio frequency ablation for haemostasis of ruptured hepatocellular carcinoma

Manikam J, Mahadeva S, Goh KL, Abdullah BJ

Hepatogastroenterology, 2009 Jan-Feb;56(89):227-30.
PMID: 19453063

Spontaneous rupture and hemorrhage is a devastating complication of hepatocellular carcinoma (HCC). Results from current therapeutic modalities remain varied. Recent development of percutaneous radiofrequency ablation (RFA) in the management of this condition has shown promise. We describe 2 cases of ruptured HCC in which nonoperative, percutaneous radio frequency ablation (RFA) was successful in achieving hemostasis. The advantageous of RFA over other interventional techniques in the management of ruptured HCC are discussed.

Matched MeSH terms: Liver Neoplasms/pathology; Liver Neoplasms/radiography; Liver Neoplasms/surgery*
Fulltext Congenital hepatic fibrosis in a child with autosomal dominant polycystic kidney disease

Kanaheswari Y, Hamzaini AH, Wong SW

Med J Malaysia, 2008 Aug;63(3):251-3.
PMID: 19248702 MyJurnal

The association of congenital hepatic fibrosis (CHF) with autosomal recessive polycystic kidney disease (ARPKD) is well known and occurs in approximately 50% of cases. However the association of CHF with autosomal dominant polycystic kidney disease (ADPKD) is less well known and less well documented. We report a child with neonatal onset of hypertension due to ADPKD who later develops portal hypertension due to CHF in childhood. A review of this rare association follows.

Matched MeSH terms: Liver Cirrhosis/complications*; Liver Cirrhosis/congenital*; Liver Cirrhosis/diagnosis
Mitochondrial hepatopathies: advances in genetics and pathogenesis

Lee WS, Sokol RJ

Hepatology, 2007 Jun;45(6):1555-65.
PMID: 17538929

Hepatic involvement is a common feature in childhood mitochondrial hepatopathies, particularly in the neonatal period. Respiratory chain disorders may present as neonatal acute liver failure, hepatic steatohepatitis, cholestasis, or cirrhosis with chronic liver failure of insidious onset. In recent years, specific molecular defects (mutations in nuclear genes such as SCO1, BCS1L, POLG, DGUOK, and MPV17 and the deletion or rearrangement of mitochondrial DNA) have been identified, with the promise of genetic and prenatal diagnosis. The current treatment of mitochondrial hepatopathies is largely ineffective, and the prognosis is generally poor. The role of liver transplantation in patients with liver failure remains poorly defined because of the systemic nature of the disease, which does not respond to transplantation. Prospective, longitudinal, multicentered studies will be needed to address the gaps in our knowledge in these rare liver diseases.

Matched MeSH terms: Liver Diseases/etiology; Liver Diseases/genetics*; Liver Diseases/pathology*
[Current trends of NASH/NAFLD in Asia-Pacific region]

Ishii H

Nippon Rinsho, 2006 Jun;64(6):1017-9.
PMID: 16768103

In Japan, much attention has been paid to NASH and NAFLD for the past several years and the prevalence of this disease entity has been estimated, and NASH is thought to be present in 10% of those who have fatty liver diseases. Other points out the prevalence of NASH in Japan as 6 to 8 hundred thousand patients. The last two or three decades have seen the evolution of Western-style life of near complete inactivity, energy-dense food choices and liberal fiscal resources to obtain them and other means to avoid physical activity. Moreover, what is increasingly apparent is that NASH and NAFLD is not a Western disease and many population groups in the Asia-Pacific region are particularly prone to type 2 diabetes. Thus, it is not surprising that NASH has increasingly been diagnosed in several regions in Asia including Indonesia, Malaysia, Philippines, Thailand and India.

Matched MeSH terms: Fatty Liver/etiology; Fatty Liver/epidemiology*; Fatty Liver/prevention & control
The effect of neem (Azadirachta indica) extract and dietary selenium on distribution of selenium in hepatocarcinogenesis induced rat

Hanachi P, Loh LN, Fauziah O, Rafiuz ZH, Tee ST, Lye CW, et al.

Med J Malaysia, 2004 May;59 Suppl B:208-9.
PMID: 15468891

Neem, Azadirachta indica, is a plant from the family Meliaceae, known as "Pokok Semambu" in Malay community. It has been extensively used in India as traditional Ayurvedic and folklore minedicine for the treatment of various diseases. This study aimed to determine the distribution of selenium in the liver of rats during hepatocarcinogenesis when neem aqueous extract and dietary selenium was supplemented.

Matched MeSH terms: Liver/pathology*; Liver Neoplasms, Experimental/pathology*
Aetiology and classification of acute liver failure

Rosmawati M

Med J Malaysia, 2005 Jul;60 Suppl B:125-6.
PMID: 16108192
Matched MeSH terms: Liver Failure, Acute/classification*; Liver Failure, Acute/etiology*; Liver Failure, Acute/pathology
Fulltext The correlation between cytopenia and esophageal varices in patients with liver cirrhosis

Gue CS, Yap CK, Ng HS

Med J Malaysia, 2004 Dec;59(5):604-8.
PMID: 15889562

This retrospective study analysed the case records of 200 patients in the Department of Gastroenterology, Singapore General Hospital from February 2000 to January 2001 who had liver cirrhosis and underwent gastroscopy for the detection of varices. The aim of this study was to determine any relationship between leucopenia, thrombocytopenia and the occurrence of esophageal varices in a cirrhotic population. Our results showed that the diagnostic yield of varices grade 2 and 3 was 6.3% if platelet count was > 150,000/mm3, 25% if platelet count was 100,000 to 150,000/mm3, 38.9% if platelet count was 50,000-99,000/mm3 and 100% if platelet count was <50,000/mm3. Similarly, the diagnostic yield of varices grade 2 and 3 was 19.4% if total white count was > 4,000/mm3, 66.7% if total white count was 3,000- 4,000/mm3 and 94.8% if total white count was < 3,000/mm5. We conclude that thrombocytopenia and leucopenia can be used to stratify risk for occurrence of esophageal varices in cirrhotic patients and gastroscopy will have a high yield for varices when platelet count is < 150,000/mm3 or total white is < 4,000/mm.

Matched MeSH terms: Liver Cirrhosis/blood*; Liver Cirrhosis/complications; Liver Cirrhosis/diagnosis
Fulltext Radiologically occult hepatocellular carcinoma in a cirrhotic liver presenting with bilateral adrenal metastases

Mundada P, Tan ML, Soh AW

Med J Malaysia, 2015 Aug;70(4):256-8.
PMID: 26358025

Although it is common to have extra-hepatic metastasis of hepatocellular carcinoma (HCC) at the time of presentation, it is extremely rare to have extra-hepatic metastatic HCC without a detectable primary in the liver. We report a unique case in which a patient presented with bilateral large adrenal masses which were subsequently proven to be metastases from HCC. However, there was no tumour seen in the liver on imaging.

Matched MeSH terms: Liver Neoplasms
Fibrolamellar hepatocellular carcinoma: a case report

Khoo JJ, Clouston A

Malays J Pathol, 2001 Dec;23(2):115-8.
PMID: 12166592

A 6-year-old Malay boy presented with fever and abdominal pain for 2 months. Computerised tomography showed a nodular mass in the left lobe of the liver. There was also portal vein thrombosis on the left side. Serum alpha-fetoprotein was not elevated and Hepatitis B antigen was negative. Biopsy of the liver mass led to a histological diagnosis of fibrolamellar hepatocellular carcinoma. In view of extensive tumour involvement, he could not be operated on but was treated with chemotherapy. However, the tumour did not respond. While this is expected for fibrolamellar hepatocellular carcinoma, the possibility of the tumour having a component of ordinary hepatocellular carcinoma could not be excluded as the tumour was not resected. Fibrolamellar hepatocellular carcinoma is a rare histological subtype of hepatocellular carcinoma, associated with a better prognosis. It affects the younger age group and has no association with cirrhosis, hepatitis B virus infection or exposure to oral contraceptives, all of which are implicated in ordinary hepatocellular carcinoma. Serum alpha-fetoprotein level is usually within normal limits and other laboratory values are not contributory to the diagnosis. The diagnosis is usually suggested by radiographic studies viz. CT scan of the abdomen, which would show an irregular non-homogenous mass in the liver, and confirmed by histological examination. The most characteristic microscopical feature is fibrosis arranged in a lamellar fashion around polygonal and deeply eosinophilic neoplastic hepatocytes.

Matched MeSH terms: Liver Neoplasms/pathology*; Liver Neoplasms/radiography; Liver Neoplasms/ultrasonography
Fulltext Maternal deaths due to liver disease in Malaysia

Ravindran J, Jayadev R, Lachmanan SR, Merican I

Med J Malaysia, 2000 Jun;55(2):209-19.
PMID: 19839149

Liver disease is an important and serious condition in pregnancy. The Confidential Enquiries Into Maternal Deaths in Malaysia showed that there were 23 maternal deaths attributed to liver disease between 1991-1994. Over the same period, there were 1066 reported maternal deaths with 929 of them being due to direct and indirect causes. Thus 2.15% of such deaths were due to liver disease in Malaysia. The three main causes of maternal deaths due to liver disease in pregnancy were hepatitis (6 cases), acute fatty liver in pregnancy (6 cases) and septicaemia (4 cases). Liver disease is common at a mean of thirty weeks of gestation with a preponderance to women of low parity. Only two patients in this series had no antenatal care. The majority of cases (45.8%) presented between 28-37 weeks of gestation. All cases delivered by spontaneous vaginal delivery. Remediable factors that were identified included failure to appreciate the severity of disease. Case summaries of all the cases of maternal deaths due to liver disease are discussed and a guideline to management of liver disease in pregnancy presented.

Matched MeSH terms: Liver Diseases/ethnology; Liver Diseases/mortality*; Liver Diseases/physiopathology
Glutathione S-transferase and gamma-glutamyl transpeptidase activities in cultured rat hepatocytes treated with tocotrienol and tocopherol

Ong FB, Wan Ngah WZ, Shamaan NA, Md Top AG, Marzuki A, Khalid AK

Comp Biochem Physiol C Comp Pharmacol Toxicol, 1993 Sep;106(1):237-40.
PMID: 7903615

1. The effect of tocotrienol and tocopherol on glutathione S-transferase (GST) and gamma-glutamyl transpeptidase (GGT) activities in cultured rat hepatocytes were investigated. 2. Tocotrienol and tocopherol significantly decreased GGT activities at 5 days in culture but tocotrienol also significantly decreased GGT activities at 1-2 days. 3. Tocotrienol and tocopherol treatment significantly decreased GST activities at 3 days compared to the control but tocotrienol also decreased GST activities at 1-3 days. 4. Tocotrienol showed a more pronounced effect at a dosage of greater than 50 microM tocotrienol at 1-3 days in culture compared to the control.

Matched MeSH terms: Liver/cytology; Liver/drug effects; Liver/enzymology*
Cytophagic histiocytic panniculitis: a diagnostic dilemma

Cheah PL, Looi LM, Tan PE, Bosco J, Kuperan P

Hematol Oncol, 1992 Nov-Dec;10(6):331-7.
PMID: 1296933

Cytophagic histiocytic panniculitis (CHP) is a recently recognized entity that frequently poses a perplexing diagnostic problem. Although the classical case presents with a relapsing fever, subcutaneous nodules, pancytopenia and liver dysfunction, most patients have in addition a multitude of other manifestations which confuse the clinical picture. Notwithstanding the variable clinical course, the disease frequently terminates in fatal hemorrhage. Diagnosis is based on histological features. A lobular panniculitis with an infiltrate of cytologically benign cytophagocytic histiocytes in skin nodules is the sine qua non of CHP. Hence, a deep skin biopsy which includes subcutaneous fat is mandatory to establish the diagnosis. Published information regarding this newly described entity remains scarce and we report two cases of CHP, one occurring in a 30-year-old Kadazan man and another in a 17-year-old Chinese woman seen at the University Hospital, Kuala Lumpur. The latter case presented with exudative ascites, an unusual feature, possibly due to intra-abdominal panniculitis. In addition, we record the development of cirrhosis in the same patient.

Matched MeSH terms: Liver/pathology; Liver/physiopathology; Liver Function Tests
Alpha-fetoprotein in hepatocellular carcinoma: a serological and histochemical study in Malaysian patients

Yap SF, Peh SC

Malays J Pathol, 1991 Dec;13(2):115-8.
PMID: 1726642

Serum alpha-fetoprotein (AFP) levels and its expression in liver tissue was studied in 50 cases of histologically confirmed hepatocellular carcinoma (HCC). Serum AFP levels were elevated (greater than 20iu/ml) in 35/50 (70%) of the cases, 28 of whom had levels greater than 500 iu/ml, which is highly suggestive of HCC. These results indicate that serum AFP, by itself, is a relatively insensitive diagnostic test for HCC. Although elevated levels in high risk patients provide a specific clue, a negative result does not exclude the diagnosis of HCC. Expression of AFP by tumour cells paralleled that of serum in the majority of cases. However, tissue AFP was negative in 7 patients who had markedly elevated serum AFP. This observation may be a reflection of preferential excretion of the tumour antigen or differential expression of the antigen by the tumour cells. None of the patients with normal serum AFP demonstrated a reaction for tissue AFP. There was no correlation between AFP production and tumour differentiation.

Matched MeSH terms: Liver Neoplasms/blood; Liver Neoplasms/pathology; Liver Neoplasms/chemistry*
Effects of insulin on the structure and metabolism of glucogen in chemically-induced diabetic rats

Kwan TK, Thambyrajah V

Med J Malaysia, 1978 Dec;33(2):178-83.
PMID: 755172
Matched MeSH terms: Liver/drug effects; Liver/enzymology; Liver/metabolism*
Post-hepatectomy Lactate: Should We Add More?

Ariffin AC

World J Surg, 2018 05;42(5):1563-1564.
PMID: 28932972 DOI: 10.1007/s00268-017-4252-8
Matched MeSH terms: Liver
Assessment of hepatic steatosis by controlled attenuation parameter using the M and XL probes: an individual patient data meta-analysis

Petroff D, Blank V, Newsome PN, Shalimar, Voican CS, Thiele M, et al.

Lancet Gastroenterol Hepatol, 2021 03;6(3):185-198.
PMID: 33460567 DOI: 10.1016/S2468-1253(20)30357-5

BACKGROUND: Diagnostic tools for liver disease can now include estimation of the grade of hepatic steatosis (S0 to S3). Controlled attenuation parameter (CAP) is a non-invasive method for assessing hepatic steatosis that has become available for patients who are obese (FibroScan XL probe), but a consensus has not yet been reached regarding cutoffs and its diagnostic performance. We aimed to assess diagnostic properties and identify relevant covariates with use of an individual patient data meta-analysis.
METHODS: We did an individual patient data meta-analysis, in which we searched PubMed and Web of Science for studies published from database inception until April 30, 2019. Studies reporting original biopsy-controlled data of CAP for non-invasive grading of steatosis were eligible. Probe recommendation was based on automated selection, manual assessment of skin-to-liver-capsule distance, and a body-mass index (BMI) criterion. Receiver operating characteristic methods and mixed models were used to assess diagnostic properties and covariates. Patients with non-alcoholic fatty liver disease (NAFLD) were analysed separately because they are the predominant patient group when using the XL probe. This study is registered with PROSPERO, CRD42018099284.
FINDINGS: 16 studies reported histology-controlled CAP including the XL probe, and individual data from 13 papers and 2346 patients were included. Patients with a mean age of 46·5 years (SD 14·5) were recruited from 20 centres in nine countries. 2283 patients had data for BMI; 673 (29%) were normal weight (BMI <25 kg/m2), 530 (23%) were overweight (BMI ≥25 to <30 kg/m2), and 1080 (47%) were obese (BMI ≥30 kg/m2). 1277 (54%) patients had NAFLD, 474 (20%) had viral hepatitis, 285 (12%) had alcohol-associated liver disease, and 310 (13%) had other liver disease aetiologies. The XL probe was recommended in 1050 patients, 930 (89%) of whom had NAFLD; among the patients with NAFLD, the areas under the curve were 0·819 (95% CI 0·769-0·869) for S0 versus S1 to S3 and 0·754 (0·720-0·787) for S0 to S1 versus S2 to S3. CAP values were independently affected by aetiology, diabetes, BMI, aspartate aminotransferase, and sex. Optimal cutoffs differed substantially across aetiologies. Risk of bias according to QUADAS-2 was low.
INTERPRETATION: CAP cutoffs varied according to cause, and can effectively recognise significant steatosis in patients with viral hepatitis. CAP cannot grade steatosis in patients with NAFLD adequately, but its value in a NAFLD screening setting needs to be studied, ideally with methods beyond the traditional histological reference standard.
FUNDING: The German Federal Ministry of Education and Research and Echosens.

Matched MeSH terms: Liver/pathology*; Non-alcoholic Fatty Liver Disease/etiology
Liver disease in mitochondrial disorders

Lee WS, Sokol RJ

Semin Liver Dis, 2007 Aug;27(3):259-73.
PMID: 17682973

Liver involvement, a common feature in childhood mitochondrial hepatopathies, particularly in the neonatal period, may manifest as neonatal acute liver failure, hepatic steatohepatitis, cholestasis, or cirrhosis with chronic liver failure of insidious onset. There are usually significant neuromuscular symptoms, multisystem involvement, and lactic acidemia. The liver disease is usually progressive and eventually fatal. Current medical therapy of mitochondrial hepatopathies is largely ineffective, and the prognosis is usually poor. The role of liver transplantation in patients with liver failure remains poorly defined because of the systemic nature of the disease that does not respond to transplantation. Several specific molecular defects (mutations in nuclear genes such as SCO1, BCS1L, POLG, DGUOK, and MPV17 and deletion or rearrangement of mitochondrial DNA) have been identified in recent years. Prospective, longitudinal multicenter studies will be needed to address the gaps in our knowledge in these rare liver diseases.

Matched MeSH terms: Liver Diseases/diagnosis; Liver Diseases/etiology*; Liver Diseases/therapy*
Fulltext Hepatic calculi

Balasegaram M

Ann Surg, 1972 Feb;175(2):149-54..
PMID: 5059599
Matched MeSH terms: Liver Diseases/complications*; Liver Diseases/etiology*; Liver Diseases/surgery*
Fulltext Bleeding outcome during a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia: a prospective study

Fariz-Safhan MN, Tee HP, Abu Dzarr GA, Sapari S, Lee YY

Trop Biomed, 2014 Jun;31(2):270-80.
PMID: 25134895 MyJurnal

During a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia, one of the worst hit areas in the country at that time, we undertook a prospective study. We aimed to describe the bleeding outcome and changes in the liver and hematologic profiles that were associated with major bleeding outcome during the outbreak. All suspected cases of dengue admitted into the only referral hospital in the region during the outbreak were screened for WHO 2002 criteria and serology. Liver function, hematologic profile and severity of bleeding outcome were carefully documented. The association between symptoms, liver and hematologic impairments with the type of dengue infection (classical vs. hemorrhagic) and bleeding outcome (major vs. non-major) was tested. Dengue fever was confirmed in 183 cases (12.5/100,000 population) and 144 cases were analysed. 59.7% were dengue hemorrhagic fever, 3.5% were dengue shock syndrome and there were 3 in-hospital deaths. Major bleeding outcome (gastrointestinal bleeding, intracranial bleeding or haemoptysis) was present in 14.6%. Elevated AST, ALT and bilirubin were associated with increasing severity of bleeding outcome (all P < 0.05). Platelet count and albumin level were inversely associated with increasing severity of bleeding outcome (both P < 0.001). With multivariable analysis, dengue hemorrhagic fever was more likely in the presence of abdominal pain (OR 1.1, 95% CI 0.02- 1.6) and elevated AST (OR 1.0, 95% CI 1.0-1.1) but the presence of pleural effusion (OR 5.8, 95% CI: 1.1-29.9) and elevated AST (OR 1.008, 95% CI: 1.005-1.01) predicted a severe bleeding outcome. As a conclusion, the common presence of a severe hemorrhagic form of dengue fever may explain the rising death toll in recent outbreaks and the worst impairment in liver and hematologic profiles was seen in major bleeding outcome.
Study site: Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia

Matched MeSH terms: Liver/pathology; Liver/physiopathology; Liver Function Tests

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