1/100. Combining IgG and interferon alpha-2b in chronic hepatitis c virus infection.Treatment of chronic active hepatitis c virus (HCV) liver disease remains unsatisfactory. Interferon alpha 2b (IFN) has shown favorable though often unsustained effects. Besides its antiviral properties, IFN is a recognized immune modulator. We present data showing the favorable evolution of a case treated with IFN and IgG. Besides the antibody repertoire, the influence of IgG on the immune network is increasingly considered. The complex interactions resulting from combining drugs with immunomodulatory properties, such as IFN and different IgG preparations, may sound confusing. However, it might provide an insight into the outcome of chronic HCV infection, in which, evidently, immune components are heavily implicated. Prolonged treatment, with high-dose intravenous immunoglobulin (IVIG) seemed to be effective, either independently or by potentiating IFN.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/100. Management of liver failure in a haemophilic patient co-infected with human immunodeficiency and hepatitis c viruses.We present a case of liver failure in a haemophilic patient coinfected with transfusion acquired human immunodeficiency (hiv) and hepatitis c (HCV) viruses. The case illustrates the interaction of multiple viruses with accelerated progression to end stage liver disease and ultimately death. We report the impact on the patient management of two liver biopsies, which diagnosed an initial drug induced hepatitis and subsequently an atypical HCV related hepatitis.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
3/100. Transmission of hepatitis c within Australian prisons.Transmission of hepatitis c virus (HCV) within prisons has long been suspected but has not been satisfactorily documented. We present four cases of HCV infection occurring during periods of continuous imprisonment. Each subject was HCV seronegative on entering prison and on repeat testing after 4-52 months in prison, but subsequently became seropositive. Two subjects gave a history of injecting drug use, and the most likely means of infection in the other two subjects were lacerations from barbers shears and lacerations arising from physical assault. There is an urgent need for detailed study of the incidence of HCV infection and the modes of transmission in prisons.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
4/100. pulmonary valve endocarditis: mid-term follow up of pulmonary valvectomies.Four males aged 20-37 years (three drug addicts and one with a congenital mixed pulmonary valve lesion) were diagnosed in 1989, 1991 and 1993 with pulmonary valve endocarditis without tricuspid infection. Three patients were positive for hepatitis b, C or both, and one patient was hiv-positive. The predominant organism in blood cultures was staphylococcus aureus. Antibiotic treatment of pulmonary valve endocarditis had failed; thus partial or total valvectomies were performed. Postoperatively, all patients were cured of infection and initial recovery was good. At mid-term follow up (5-10 years) there were no recurrences, and tolerance of the resultant pulmonary insufficiency was good. Slight to severe tricuspid valve insufficiency developed, together with right ventricular dilatation, in all cases. hepatomegaly was apparent in two cases and peripheral edema in one. Despite treatment, the latter patient remained in moderate right ventricular failure, and may require homograft valve replacement. The other three patients remained in good clinical condition. Eradication of the infection was achieved in all patients. It is concluded that pulmonary valve resection is the treatment of choice for pulmonary valve endocarditis when antibiotic treatment has failed. Complete resection of all affected tissue should be performed in these cases. Analysis of preoperative data did not permit differentiation of those patients likely to develop right heart failure.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
5/100. Two successive hepatitis c virus infections in an intravenous drug user.We report the case of an occasional intravenous drug user who developed two successive hepatitis c virus (HCV) infections. The first infection led to seroconversion (anti-HCV antibodies detected) and the detection of HCV rna in serum. After a spontaneous recovery (normalization of alanine aminotransferase levels and HCV rna clearance), a second HCV infection was observed, with the recurrence of HCV viremia. Antibody directed against HCV serotype 1 was detected throughout the follow-up monitoring, but two different HCV strains were identified during the two infectious episodes: genotype 1a for the first and genotype 3a for the second. This observation shows that primary HCV infection does not confer protective immunity against subsequent infection with viruses of other genotypes. This may hamper the development of a vaccine. Conflicting results were obtained in genotyping and serotyping assays, suggesting that the serotyping method cannot be used to identify the HCV type in patients, such as intravenous drug users, who are exposed to successive HCV infections.- - - - - - - - - - ranking = 259.73319693914keywords = intravenous drug, drug (Clic here for more details about this article) |
6/100. Dilated bile duct in patients receiving narcotic substitution: an early report.Narcotic substitution is now widely used. morphine can induce a spasm of the sphincter of oddi but dilation of bile duct has been reported only in an anecdotal case. In June 1995, we observed a first case of dilation of the common bile duct without organic obstacle in a hepatitis c virus (HCV)-infected patient who was under narcotic substitution, suggesting a causal relationship. We conducted a prospective study to evaluate the precise prevalence of bile duct abnormalities related to narcotic substitution in active intravenous drug or ex-intravenous drug users referred to our liver unit for histologic evaluation of HCV infection. We conducted a prospective study in a 30-month period of 334 HCV-infected patients, including 36 receiving narcotic substitution with methadone or buprenorphine. biliary tract was analyzed by ultrasonography and by endoscopy ultrasound in cases of bile duct abnormalities. Of the 36 patients under narcotic substitution, 3 (8.3%) had asymptomatic dilated bile duct without organic obstacle--defined as a common bile duct > or =9 mm--compared to 1 of 298 (0.03%; p < 0.001) of those who did not receive substitution. Narcotic substitution may lead to bile duct dilation that does not require invasive diagnosis procedures.- - - - - - - - - - ranking = 86.577732313045keywords = intravenous drug, drug (Clic here for more details about this article) |
7/100. Recent advances in hepatitis c.Nearly 2% of Americans are infected with the hepatitis c virus, resulting in 8,000-10,000 deaths each year. The virus can be eradicated with interferon plus ribavirin in about 40% of patients treated for one year. patients with a history of intravenous drug abuse or transfusion before July 1992 should be screened for hepatitis c, as should members of other high-risk groups. Infected patients should be counseled and if possible offered treatment. This will prevent unnecessary deaths from liver failure and hepatocarcinoma.- - - - - - - - - - ranking = 77.577128090901keywords = intravenous drug, drug abuse, drug, abuse (Clic here for more details about this article) |
8/100. Hepatitis after intravenous buprenorphine misuse in heroin addicts.BACKGROUND: Sublingual buprenorphine is used as a substitution drug in heroin addicts. Although buprenorphine inhibits mitochondrial function at high concentrations in experimental animals, these effects should not occur after therapeutic sublingual doses, which give very low plasma concentrations. case reports: We report four cases of former heroin addicts infected with hepatitis c virus and placed on substitution therapy with buprenorphine. These patients exhibited a marked increase in serum alanine amino transferase (30-, 37-, 13- and 50-times the upper limit of normal, respectively) after injecting buprenorphine intravenously and three of them also became jaundiced. Interruption of buprenorphine injections was associated with prompt recovery, even though two of these patients continued buprenorphine by the sublingual route. A fifth patient carrying the hepatitis c and human immunodeficiency viruses, developed jaundice and asterixis with panlobular liver necrosis and microvesicular steatosis after using sublingual buprenorphine and small doses of paracetamol and aspirin. CONCLUSIONS: Although buprenorphine hepatitis is most uncommon even after intravenous misuse, addicts placed on buprenorphine substitution should be repeatedly warned not to use it intravenously. Higher drug concentrations could trigger hepatitis in a few intravenous users, possibly those whose mitochondrial function is already impaired by viral infections and other factors.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
9/100. Trends in rheumatic disease: update on new diagnostic and treatment strategies.Advances in our understanding of the pathophysiology of rheumatic and immunologic diseases have led to improved therapies, such as tumor necrosis factor inhibitors and bisphosphonates. These drugs can not only alleviate symptoms but also alter the course of the disease. However, they also have significant potential side effects, which mandate, more than ever, correct diagnosis and vigilant monitoring for toxicity.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
10/100. ranitidine-related stevens-johnson syndrome in patients with severe liver diseases: a report of two cases.ranitidine is widely used and well tolerated. ranitidine-related skin eruption is rare and usually mild. We presented two patients who developed stevens-johnson syndrome after ranitidine therapy. Before therapy, both patients had severe liver disease and jaundice. The first was a case of ketoconazole-induced hepatitis, and the second was a case of hepatitis c-related liver cirrhosis with hepatocellular carcinoma. ranitidine was the most likely drug responsible for causing stevens-johnson syndrome in these two patients.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
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