Alcoholic liver disease. A review

Maxillofacial considerations in orthotopic liver transplantation

Orthotopic liver transplantation is now a widely used treatment for patients with end-stage liver disease. Lifelong pharmacologic immunosuppression renders these patients susceptible to many infections. The purpose of this article is to provide guidelines for treating the patient with end-stage liver disease, both before and after transplantation. In addition, we shall discuss some of the medical implications associated with end-stage liver disease and their clinical presentations and appropriate presurgical management. Adverse side effects of long-term immunosuppression and their effect on the oral and maxillofacial region shall also be discussed. Last, a brief discussion of FK506, the latest immunosuppressant, will be presented together with the implications of its use on our surgical treatment of these patients.

Serum selenium levels in liver diseases

A possible pathogenetic role of selenium deficiency in alcoholic cirrhosis of the liver has previously been discussed. In the present study serum selenium was analyzed in 5 groups of liver diseases. The method used for selenium determination was electrothermal atomic absorption, after thermal stabilization of selenium compounds by addition of nickel nitrate. The selenium level of a reference group of healthy Norwegian adults (n = 40) was 1.53 +/- 0.25 mumol/l. The serum concentrations of selenium in patients suffering from alcoholic cirrhosis, chronic active hepatitis and chronic persistent hepatitis were lowered to 40-80 per cent of those of the reference group. In alcoholic cirrhosis and chronic active hepatitis the decreased serum selenium concentrations were significantly correlated to decreased levels of albumin and prealbumin.

Damage of rat liver sinusoidal endothelium by ethanol

Hepatic blood in normal rats is separated from the space of Disse and hepatocytes by an ultrastructural sieve formed by pores in the sinusoidal endothelium. This sieve has previously been shown to shield hepatocytes from circulating chylomicrons, the largest of the lipoproteins, which transport most triglycerides of dietary origin. In the present paper it has been shown that the chronic ingestion of ethanol leads to a significant enlargement of pores within the sieve, increasing them from a normal median diameter of 100 nm to 120 nm. A decrease in the normal sieving of perfused labelled large and small chylomicrons has also been noted. It is postulated that the decreased shielding of hepatocytes from large chylomicrons may be a factor in the pathogenesis of alcoholic fatty liver.