Hepatic haemangiomas: possible association with female sex hormones.

BACKGROUND AND AIMS: The association of hepatic haemangiomas with female sex hormones is not entirely clear. We prospectively evaluated the impact of female sex hormones on the natural history of liver haemangiomas. METHODS: We followed 94 women with 181 haemangiomas diagnosed by ultrasound for a period of1-17 years (mean 7.3 (5.5) years). The location, number, size, and ultrasonographic pattern of the lesions were evaluated. Patients were also evaluated by questionnaire for gynaecological and reproductive history. We compared the change in number and size of haemangiomas in patients who received or did not receive exogenous hormonal treatment. RESULTS: Age at first period was inversely associated with the size of haemangiomas (r = 0.181, p = 0.015) while age at menopause was positively correlated with the number of haemangiomas detected at first ultrasound (r = 0.542, p<0.0001). During follow up, no change in the ultrasonographic pattern or number of haemangiomas was observed. An increase in the size of the lesions was demonstrated in 5/22 (22.7%) hormone therapy exposed patients compared with 7/72 (9.7%) controls. Three variables (ultrasonographic pattern, number of haemangiomas, and hormone therapy) predicted whether or not a given haemangioma would increase in size. A hypoechoic pattern increased the risk of progression while a hyperechoic pattern decreases that risk (p = 0.003). The number of haemangiomas was inversely associated with the likelihood of progression (p = 0.006) and hormone therapy increased the risk of haemangioma enlargement (p = 0.05). CONCLUSIONS: Hepatic haemangiomas seem to be influenced by both endogenous and exogenous female sex hormones although significant enlargement occurs only in a minority of patients. Consequently, routine liver ultrasound follow up in women with hepatic haemangiomas receiving hormone therapy appears appropriate.

[Clinico-laboratory characteristics of the cholestatic form of acute alcoholic hepatitis]. / Kliniko-laboratornye osobennosti kholestaticheskoi formy ostrogo alkogol'nogo gepatita.

Altogether 108 patients with acute alcoholic hepatitis (AAH) were examined. Of these, 14 patients (13%) presented with the cholestatic pattern of AAH, 45 with extrahepatic cholestasis, and 45 were healthy. As compared with the total patients' group with AAH, the patients with the cholestatic form consumed alcohol in greater amounts. Due to intensive jaundice, 50% of the patients were admitted by error to the infectious clinic and 32% to the surgical one. The disease runs a comparatively grave course, the general conditions gets deteriorated, the body temperature rises, the patient senses pains in the right hypochondrium, skin pruritus is lacking. As compared with other patterns of cholestasis, cholestatic AAH is characterized by a higher thymol test, higher levels of cholesterol, low density lipoproteins, activation of gamma-glutamyl transpeptidase and aspartate aminotransferase and by a lower level of leukocytes, bilirubin, free fatty acids and alkaline phosphatase. Verification of the diagnosis demands the use of certain up-to-date instrumental methods. To identify the cause of cholestasis, great diagnostic significance is attached to echography.

[Changes in the levels of serum lipids and lipoprotein fractions of patients with acute alcoholic hepatitis]. / Izmenenie urovnia nekotorykh syvorotochnykh lipidov i lipoproteinovykh fraktsii u bol'nykh ostrym alkogol'nym gepatitom.

Some serum lipid and lipoprotein fractions were investigated in 58 patients with acute alcoholic hepatitis and in 20 clinically healthy subjects. A significantly higher level of cholesterol, total lipids, triglycerides, LDL-cholesterol, free cholesterol and a lower level of esterified cholesterol were detected in the patients with alcoholic hepatitis. The level of beta-lipoproteins was raised, a beta-lipoproteins/alpha-lipoproteins ratio rising significantly. In 71% of the patients the presence of LP-cholesterol as a symptom of evident or clinically latent cholestasis was revealed. The above changes were correlated, to a large extent, with the gravity of liver affection.