1/11. Primary effusion lymphoma in an hiv-negative patient with no serologic evidence of Kaposi's sarcoma virus.Primary effusion lymphoma (PEL) is a newly described high-grade B cell lymphoma which develops in association with Kaposi's sarcoma-associated herpesvirus (KSV) in human immunodeficiency virus (hiv)-infected individuals. We hereby describe a very unusual presentation of PEL that developed in the abdominal cavity of an hiv negative, KSV negative patient with a 1-year history of refractory ascites due to alcohol-related liver cirrhosis. Possible factors aiding lymphomagenesis in the cirrhotic state are discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/11. Acute hepatic encephalopathy with diffuse cortical lesions.Acute hepatic encephalopathy is a poorly defined syndrome of heterogeneous aetiology. We report a 49-year-old woman with alcoholic cirrhosis and hereditary haemorrhagic telangiectasia who developed acute hepatic coma induced by severe gastrointestinal bleeding. Laboratory analysis revealed excessively elevated blood ammonia. MRI showed lesions compatible with chronic hepatic encephalopathy and widespread cortical signal change sparing the perirolandic and occipital cortex. The cortical lesions resembled those of hypoxic brain damage and were interpreted as acute toxic cortical laminar necrosis.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
3/11. Kaposi's visceral sarcoma in liver transplant recipients.We report three cases of Kaposi's sarcoma after orthotopic liver transplantation performed for cirrhosis related to hepatitis c virus (one case), ethanol (one case), or both (one case). All patients displayed disease within the first year after liver transplantation, and only in one case was the diagnosis obtained before the patient died. All three patients were on tacrolimus-steroid therapy, and in one case mycophenolate mofetil was added to treat acute persistent rejection.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/11. gynecomastia. A bothersome but readily treatable problem.Although breast enlargement in boys and men can cause both psychological and physical distress, the disorder is rarely serious and is readily treatable. Several factors can lead to the estrogenic excess that causes growth of breast tissue. Dr Jacobs describes a patient with gynecomastia related to cirrhosis of the liver who responded promptly to a brief course of tamoxifen citrate therapy.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/11. Gastric hemorrhage and Kaposi's sarcoma treated with radiotherapy.A 66-year-old man, with advanced alcoholic liver disease with Kaposi's sarcoma involving the stomach and the skin of the lower extremities, developed upper gastrointestinal hemorrhage. He was treated with radiation therapy to the stomach and the skin with rapid resolution of the gastric lesions, as demonstrated by serial endoscopy.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/11. Spindle coma in benzodiazepine toxicity: case report.A forty-two year old female with known alcoholic liver disease was given intravenous lorazepam and diazepam for delirium tremens. This resulted in a comatose state with depression of some brainstem reflexes. Her initial EEG showed a pattern of spindle coma with some responsivity of the background. Clinical improvement occurred with cessation of the benzodiazepines and the EEG showed a return to normal patterns. A review of the literature showed no previous description of this pattern in benzodiazepine coma. Two reports of spindle coma are noted with alcohol and imipramine. The prognostic significance of this pattern in drug overdose is therefore not definitive by itself. Outcome is probably more dependent on the clinical condition of the patient and the reversibility of the drug toxicity.- - - - - - - - - - ranking = 1.6keywords = coma (Clic here for more details about this article) |
7/11. Spontaneous rupture of the spleen complicating portal hypertension.A 54-year-old male with alcoholic liver cirrhosis and hepatic coma grade IV is described, who succumbed as a result of spontaneous rupture of the spleen. A relationship to portal hypertension is suggested, although haemorrhagic diathesis and sepsis may have been contributing factors.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
8/11. Spontaneous umbilical hernia rupture: a report of three cases.Three cases of spontaneous umbilical hernia rupture in patients with alcoholic liver disease and ascites are reported. Eighteen cases have been previously reported in the literature. These 21 cases are reviewed in an attempt to determine precipitating events, prognostic factors, complications, and the results of therapy. All patients had significant ascites prior to umbilical rupture. Ulceration of the umbilicus prior to rupture was common (81%). The subsequent presence of peritonitis, hypotension, renal failure, gastrointestinal hemorrhage or hepatic coma was associated with significant mortality (80%). All patients with a serum albumin above 2.4 gm./dl. survived. There were no survivors in those patients who did not receive surgical treatment. Based upon the outcome of these 21 patients optimal treatment of this disorder would seem to be early surgical repair of the umbilical hernia, appropriate fluid and electrolyte replacement, antiobiotics and measures to reduce intraabdominal pressure.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
9/11. Left hepatic lobe atrophy and partial budd-chiari syndrome in a patient with alcoholic liver cirrhosis.The unusual association of alcoholic liver cirrhosis, atrophy of the left hepatic lobe and endophlebitis of the left hepatic vein (partial Budd-Chiari-Syndrome) has been observed in a 72-year-old male. The atrophy of the left hepatic lobe was diagnosed by liver scanning and laparoscopy. The patient's condition finally deteriorated and he died in a chronic form of hepatic coma. At autopsy the right hepatic vein, the branches of the portal vein and the extrahepatic bile ducts were normal. The left hepatic vein showed the histological picture of an organized endophlebitis of indeterminate age.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
10/11. Ischemic hepatitis in cirrhosis. Rare but lethal.We report two cases of ischemic hepatitis in patients with alcoholic cirrhosis. In both, hepatic ischemia was induced by hemorrhagic shock and severe sepsis. Despite control of the bleeding and restoration of normal hemodynamics, liver failure deteriorated to hepatic coma and death in both cases. Ischemic hepatitis occurred in 1.5% of 130 consecutive cases of cirrhosis admitted for hemorrhage on our medical intensive care unit. Although cirrhotic patients run an increased risk of ischemic hepatitis, our experience and our review of the literature indicate that this condition is rare in these patients.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
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