Health networks: can they be the solution?

Decreased hepatic function in patients with hepatoma or liver metastasis monitored by a hepatocyte specific galactosylated radioligand Summary 9'Tc-galactosylated neoglycoalbumin ("mTc-NGA) is a hepatocyte-specific tracer that, after injection into the blood stream, delivers radioactivity selectively to the liver. This is based upon chemical recognition and binding by the hepatic binding protein (HBP), a receptor specific for galactosylated glyco-proteins. Liver tissue samples were obtained intraoperatively from patients undergoing surgery for various cancers. The concentration of specific HBP receptors in the liver (normal liver, hepatoma, liver metastasis) was calculated from the in vitro binding of 99mTc-NGA. One week after surgery, the in vivo HBP density was also measured in some of these patients after injection of 3.5 mg (50 nmol per patient) "mTc-NGA (150-200 MBq) for simulation of 9'Tc-NGA kinetics. Comparison of in vitro and in vivo HBP concentration in the liver showed values in the same concentration range. In patients with hepatoma or liver metastasis a significantly (P<0.01) decreased global HBP density was found in vivo compared to controls. The values obtained for in vivo HBP concentration in the liver amounted to 0.38 ± 0.05 gmol 1-' liver for patients with hepatoma, to 0.4 ± 0.1 gAmol 1-in patients with liver metastasis and to 94 ± 0.05 timol 1-liver in cancer patients without liver malignancy. In vitro investigation of HBP density revealed the malignant liver tissue to have a significantly (P<0.0001) decreased or almost (completely) absent HBP receptor density compared to the normal tissue apart from the cancer area. It is concluded that determination of HBP density in vivo via a specific tracer is a new, simple and reliable approach for the determination of remaining hepatic function in patients with primary or secondary liver cancer. Methods for the determination of functional liver mass in patients with liver disease are still being improved. In contrast to creatinine clearance as a parameter of kidney function , the measurement of a single liver function parameter does not reflect overall hepatic capacity due to the multitude of metabolic tasks of the liver including synthesis, uptake, degradation and secretion of bile. Although a number of quantitative tests of liver function, i.e. elimination of bromo-sulphophtalein (Haecki et al., 1976), antipyrine (Andreasen et al., 1974) or aminopyrine (Bircher et al., 1976), exist, they are usually time consuming, difficult to apply and may have adverse effects and are therefore not extensively used. Recently, Stadalnik and co-workers (Stadalnik et al., …