Studies on Liv.52 in hepatic disorders

Part II: Indian Childhood Cirrhosis and Miscellaneous Conditions — 97 Cases
Sharma, N.L., M.D., D.C.H. (Lond.), F.R.S.T.M.&H. (Eng.), D.T.M., D.P.H. (Cal.), Professor and Head of the Department of Pediatrics
Lahori, U.C., M.D., D.C.H., Research Scholar and
Mehta, S.K., B.Sc., M.B.,B.S., D.C.H., Research Scholar, King George’s Medical College, Lucknow, U.P., India.

Table VIII: Liver Function Tests in cases of Indian Childhood Cirrhosis receiving Liv.52 (21 patients)
Time		Serum protein in gm%										Serum bilirubin in mg%												Thymol turbidity
Up to 4			4 – 5		5 – 6		6 – 7		Above 7		Less than 2		2 – 5		5 – 10		3 – 13		14–30		31–50		1 – 4		4 – 8
Initially		5*		7		6		2		1		19		2		–		5		10		6		15		6
After 2 weeks		1		9		7		2		1		10		–		1		6		12		2		15		5
After 4 weeks		–		3		11		1		–		15		–		–		7		8		–		12		3
After 8 weeks		–		4		7		2				10		3		–		6		7		–		9		4
After 12 weeks		–		2		8		–				7		3		–		5		4		1		7		3
After 14 weeks		2		1		3		4				7		2		1		6		3		1		7		3
After 18 weeks		3		–		1		6				7		–		3		7		2		1		7		3
* One patient left against medical advice after 10 days One patient died
Others recovered and repeat was not necessary

Table IX: L.F.T. in infantile cirrhosis with no treatment (20 patients)
Time		Serum protein in gm%										Serum bilirubin in mg%												Thymol turbidity
Up to 4			4 – 5		5 – 6		6 – 7		Above 7		Less than 2		2 – 5		5 – 10		3 – 13		14–30		31–50		1 – 4		4 – 8
Initially		5		8		3		2		2		10		1		–		4		10		6		16		4
After 2 weeks		4		9		4		2		1		17		2		1		3		13		4		17		3
After 4 weeks		2		8		3		2		–		14		1		–		2		11		2		13		2
After 8 weeks		2		8		3		–		–		10		3		–		–		10		3		8		5
After 12 weeks		1		7		2		–		–		7		3		–		–		8		2		5		5
After 14 weeks		6		3		–		1		–		5		3		2		2		6		2		2		8
After 18 weeks		8		–		1		–		1		4		2		4		2		2		6		2		8

In the Liv.52 group 20% cases progressed to stage III compared to 45% in the control.

Liver biopsy showed cellular damage of variable degree, hyaline inclusions in hepatocyte, fibrosis with disruption of lobular architecture, mainly monocytic infiltration, no fatty change, minimal parenchymal regeneration. No repeat biopsy could be done. Though the cases treated with Liv.52 showed clinical and laboratory improvement during the period of observation, it would be difficult to forecast the ultimate outcome in this disease.

GROUP III

Miscellaneous Group

This group consisted of 56 cases (a) 35 of malnutrition (b) 18 of anaemia and (c) 3 of infections.

Thirty five malnutrition cases were divided into cases of kwashiorkor and marasmus. Most of the cases of kwashiorkor showed stunted growth, mental changes like apathy, irritability and oedema, anorexia, other gastrointestinal symptoms, skin and hair changes, enlarged liver and low serum proteins. Most of the marasmus cases showed marked loss of weight, gastrointestinal symptoms, loss of subcutaneous fat and wrinkling of skin, enlarged liver, probably secondary to recurrent non-specific infections. In all these cases liver function tests and serum protein studies were carried out and the diagnosis of kwashiorkor was supported by liver biopsy.

Eighteen anaemia cases presented with pallor and poor dietetic history, chronic, recurrent diarrhoeas, along with history of worms. Routine stool and blood examination and reticulocyte count were done. These cases were of iron deficiency anaemia.


There were three cases of primary tuberculosis confirmed on clinical laboratory and radiological studies.

These 56 cases of the miscellaneous group were divided into two sub-groups:

Sub-Group III A: On Liv.52 plus specific therapy — 31 cases.

Sub-Group III B: Control, on only specific therapy — 25 cases.

OBSERVATIONS AND RESULTS

In Group III — Miscellaneous group – 56 cases

This group included cases of hepatomegaly of diverse aetiology, like malnutrition, anaemia, primary tuberculosis. The cases on Liv.52 definitely showed a quicker response in the form of earlier improvement of appetite and irritability rapid regression of liver size, rise in haemoglobin percentage, rapid gain in weight, shortened hospital stay, return of liver function tests to normal (Table XI and XII). Liver biopsies in kwashiorkor cases showed fatty infiltration. Repeat biopsy could not be done.

Table X: Total no. of miscellaneous cases = 56
	Signs and Symptoms				Number with positive signs and symptoms		Percentage
1.	Fever				34		60.71
2.	Anorexia				46		82.14
3.	Vomiting				5		8.93
4.	Diarrhoea				43		76.78
5.	Constipation				2		3.75
6.	Abdominal distension				45		80.35
7.	Jaundice				Nil		—
8.	Irritability				26		42.85
9.	Oedema				21		37.5
10.	Underweight				56		100
11.	Anaemia				56		100
12.	Lymphadenopathy				36		64.3
13.	Liver size—		Up to 3 cm		44		78.57
3 to 5 cm						12		21.43
14.	Spleen—		Up to 3 cm		6		10.7
3 to 5 cm						–		–

Table XI: Improvement in clinical features with Liv.52 in the miscellaneous group, as compared to controls
Clinical Features			Improvement in Days with Liv.52		Improvement in Days in Controls
Near Average			Range	Near Average	Range
1.	Anorexia		5	2-12	10	3-16
2.	Anaemia		6	5-9	9	6-12
3.	Irritability		7	5-9	13	7-20
4.	Enlarged Liver		10	6-16	14	7-18

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