1/31. Alcoholic liver cirrhosis complicated with torsade de pointes during plasma exchange and hemodiafiltration.A 36-year-old man with severe alcoholic hepatitis was treated with plasma exchange combined with hemodiafiltration to remove endotoxins and inflammatory cytokines. During the treatment, he had critical arrhythmia (torsade de pointes [TdP]). His laboratory data showed hypomagnesemia, which was suspected to be responsible for the development of TdP. patients with alcoholic liver disease tend to have hypomagnesemia and Q-T interval prolongation. Furthermore, hemodiafiltration may cause hypomagnesemia. Careful observation for electrolytic imbalance is necessary when clinicians treat patients with alcoholic liver failure with a liver support system.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/31. Origin of adenocarcinoma in a transplanted liver determined by microsatellite analysis.Inadvertent transmission of neoplastic cells from an organ donor can occur at the time of transplantation. Determination of recipient versus donor origin of a tumor is crucial for patient management. This report illustrates the use of microsatellite (MS) analysis to determine the origin of adenocarcinoma arising in a liver transplant. The study patient was a 42-year-old male who had received a liver transplant for hepatitis c and alcohol-related cirrhosis. At the 1-year follow-up visit, a 1.5-cm liver mass was identified during routine ultrasound of the vascular anastamoses. A liver biopsy showed a moderately differentiated adenocarcinoma. Tumor, donor, and recipient dna were isolated from the paraffin-embedded liver biopsy, pretransplant donor liver biopsy, and the explant liver tissue, respectively. MS analysis was performed by polymerase chain reaction using 5 markers: D5S346, ACTC, D2S123, D18S34, and TP53. The allelic patterns of tumor dna were identical to those of donor dna and were distinct from the dna profile of the recipient. The use of MS analysis clearly established that the adenocarcinoma was of donor origin.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
3/31. Low dose amiodarone causing pseudo-alcoholic cirrhosis.amiodarone is a commonly used anti-arrhythmic in elderly patients. Abnormal liver function is frequently reported with its use but clinically symptomatic disease is rare. hepatomegaly, cholestasis, acute hepatitis and rarely fulminant liver failure have been recorded [1, 2], however amiodarone toxicity presenting with cirrhosis is exceedingly rare. Toxic effects of amiodarone are well described with higher dosage but severe hepatic toxicity and cirrhosis with low dose amiodarone has not been reported in the English language literature. We present a report on a patient with pseudo-alcoholic cirrhosis with low dose amiodarone.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
4/31. Multibacterial sepsis in an alcohol abuser with hepatic cirrhosis.An alcohol abuser with hepatitis c developed multibacterial sepsis. His mean 100% alcohol intake reached 400 ml/day. In January 2001, he suddenly experienced fever (39 degrees C) with no other symptoms. One week later, he was admitted to our hospital and was subsequently diagnosed with sepsis associated with four species of bacteria (streptococcus constellatus, fusobacterium mortiferum, bacteroides thetaiotaomicron, and non-spore-forming anaerobic gram-positive bacillus). A drip infusion of imipenem/cilastatin was administrated, resulting in a successful therapeutic outcome. No underlying disorder was found except for gastric ulcers and hepatic cirrhosis. Damaged gastric mucosa was assumed to be the possible cause and route for the bacterial invasion.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
5/31. Levetiracetam monotherapy for liver transplant patients with seizures.Selecting an appropriate anticonvulsant for treatment of recipients of orthostatic liver transplants who have new-onset epileptic seizures can be challenging because first-line agents may contribute to worsening encephalopathy, alter the plasma concentration of immunosuppressive agents, and result in hepatotoxicity. We describe the case of a 55-year-old man who underwent orthotopic liver transplantation because of end-stage liver disease due to alcoholic cirrhosis and hepatitis c. He required two repeat transplantation procedures. After the last procedure, epileptic seizures developed, which were initially managed with phenytoin. However, the patient remained stuporous and mental status fluctuated. Breakthrough seizures later developed in the setting of rejection. Levetiracetam (500 mg orally, twice a day) was chosen for its favorable pharmacokinetic properties as an alternative to phenytoin. By the third day of levetiracetam therapy, the patient became more responsive. At most recent follow-up, 3 months after the start of levetiracetam therapy, the patient was still treated with levetiracetam monotherapy, and seizure control was judged to be excellent.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
6/31. 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 = hepatitis (Clic here for more details about this article) |
7/31. diagnosis of hepatocellular carcinoma (HCC) in a high-risk patient by using transgastric EUS-guided fine-needle biopsy (EUS-FNA).Hepatocellular carcinoma (HCC) is the most common primary malignancy arising within the liver and most often affects individuals with chronic hepatitis and/or liver cirrhosis. patients often present at an advanced stage of disease or with poor liver function, thus limiting treatment options and resulting in a poor prognosis of the disease. Therefore, an early tissue-based diagnosis of HCC is necessary to direct further work-up and treatment. We present the case of a 70-year-old man with alcoholic cirrhosis at stage child C, in whom a tumor nodule was found incidentally within the left lobe of the liver. Percutaneous biopsy was deemed too dangerous because a deteriorated liver function with coagulopathy was present, and a significant amount of ascites surrounded the small cirrhotic liver. To obtain a conclusive diagnosis, we performed transgastric fine-needle biopsy of the tumor under direct endosonographic guidance (EUS-FNA) without complications. Cytologic examination confirmed the presence of a well differentiated HCC. Based on this finding, super-selective CT-guided angiography and chemoembolization were subsequently performed without complications and the patient remained free of tumor relapse for the 8 months of surveillance. We conclude that EUS-guided fine-needle biopsy and cytologic examination represent a reliable alternative for tissue sampling in HCC, particularly in selected high-risk patients such as those with poor liver function and coagulation disorders; this should be assessed in prospective clinical trials.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
8/31. asialoglycoprotein receptor facilitates hemolysis in patients with alcoholic liver cirrhosis.hemolysis in patients with advanced alcoholic liver disease is a common clinical problem and indicates an unfavorable prognosis. In many cases, the etiology of the hemolysis remains unknown. We observed three patients with alcoholic liver disease, suffering from severe hemolytic anemia, requiring multiple blood transfusions. Steroid therapy was ineffective and two of the patients died. All patients had a soluble variant of the human asialoglycoprotein receptor (s-ASGP-R) in their serum, as well as high titers of autoantibodies against this receptor (anti-ASGP-R). Consecutively, examination of 60 patients with alcoholic liver disease revealed a high incidence for s-ASGP-R (36%) and anti-ASGP-R (27%) in patients with alcoholic liver cirrhosis (ALC) compared to patients with cirrhosis due to viral hepatitis. The potential etiology of hemolysis was studied in vitro on erythrocytes from patients with ALC and from healthy donors. Isolated ASGP-R but not anti-ASGP-R bound to the surface of erythrocytes preferentially of blood group A1 and caused dose-dependent agglutination and hemolysis, while this phenomenon was much lower using erythrocytes of the blood group B and almost absent with blood group O-erythrocytes. Furthermore, agglutination and hemolysis only occurred in erythrocytes from ALC-patients or after the pre-treatment of cells with neuraminidase. ASGP-R induced agglutination and hemolysis was blocked by the competitive ASGP-R inhibitor asialofetuin. In conclusion, our results indicate a new, non-immunological mechanism for hemolysis in patients with alcoholic liver disease, mediated through agglutination by a soluble variant of the human asialoglycoprotein receptor and mechanical shear stress.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
9/31. Spontaneous orbital subperiosteal hematomas in patients with liver disease.Spontaneous orbital subperiosteal hematomas are rare entities. They are often associated with systemic coagulopathies. We present two cases of spontaneous orbital subperiosteal hematomas in patients with systemic coagulopathies resulting from liver disease. One patient was diagnosed with hepatitis b and had spontaneous resolution of the hematoma. Another patient had alcoholic cirrhosis and required an orbitotomy for drainage of a hematoma for compressive optic neuropathy. With the rising incidence of hepatitis b and the prevalence of alcoholic liver disease, it is important to include liver disease in the systemic evaluation of patients with spontaneous orbital subperiosteal hematomas.- - - - - - - - - - ranking = 2keywords = hepatitis (Clic here for more details about this article) |
10/31. Multiple hypervascular liver nodules in a heavy drinker of alcohol.A case of hypervascular nodules in the liver, but without hepatitis b or C virus infection in a 38-year-old woman with a history of alcohol abuse is presented. An ultrasound disclosed 1-2-cm hypoechoic tumors in the right and left lobes. magnetic resonance imaging showed high-intensity tumors at both the T1-weighted and T2-weighted sequences. Incremental dynamic computed tomography and hepatic angiography revealed hypervascular tumors. Ultrasound-guided needle biopsy revealed no evidence of hepatocellular carcinoma, metastatic liver cancer, hemangioendothelioma, inflammatory pseudotumors or pseudolymphoma, but demonstrated stellate-scar fibrosis septa, which contained small unpaired arteries without hyperplasia dividing the nodule. Moreover, marked pericellular fibrosis, neutrophilic infiltration and mallory bodies were observed in the cytoplasm. There was no evidence of bile duct proliferation. From these findings, the diagnosis of alcohol-induced fibrosis, distinctly different from focal nodular hyperplasia, was tenable. Further studies may provide insights into the pathogenesis of nodule formation and hypervascularity in heavy drinkers of alcohol.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
| | Next -> |