Cases reported "Hepatitis"

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11/18. The association between ulcerative colitis and chronic liver disease at Tygerberg Hospital.

    Twenty consecutive patients with ulcerative colitis were evaluated at the Gastro-intestinal Clinic, Tygerberg Hospital, with special reference to the biochemical tests and histological findings in the liver. Abnormal liver function tests warrant a liver biopsy, since the underlying liver disease influences the subsequent prognosis and treatment.
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12/18. Lupus hepatitis: an under-recognized disease feature associated with autoantibodies to ribosomal P.

    PURPOSE: To determine the frequency and clinical manifestations of systemic lupus erythematosus (SLE)-related liver disease and to establish whether this disease feature correlates with circulating autoantibodies to ribosomal P proteins. patients AND methods: A retrospective chart review of a large lupus cohort searching for laboratory and clinical manifestations of liver disease. A case-control study with testing of stored serum for antiribosomal P antibodies using immunoblotting, an enzyme-linked immunosorbent assay, and immunodiffusion in cases of lupus with liver involvement, and in randomly selected and ethnically-matched controls with lupus but without liver involvement. RESULTS: Of 131 patients with SLE, 4 (3%) had liver involvement that could only be ascribed to the disease itself, and 2 additional cases from elsewhere were also studied. The clinical picture of the liver involvement resembled chronic active hepatitis, but there was no serological evidence of hepatitis b or C infections. Only 1 patient had low-titer antismooth muscle antibodies, and none had antimitochondrial antibodies. Antiribosomal P antibodies were present in all 6 patients with lupus hepatitis, compared to only 2 (10%) of 20 of controls with lupus but no liver disease (P = 0.0001, odds ratio 96). CONCLUSIONS: Lupus hepatitis appears to be an infrequent but distinct manifestation of SLE which correlates strongly with the presence of antiribosomal P antibodies. Its course and prognosis are variable, ranging from chronic biochemical abnormalities of liver function to acute clinical hepatitis to hepatic failure.
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13/18. patients with chronic hepatitis--potential risks when undergoing dental surgery: review and case report.

    This is a case report of a 17-year-old male patient with chronic autoimmune active hepatitis (CAAH) who was referred to our clinic for dental treatment prior to his undergoing liver transplant surgery. Coagulation problems and the implications of long-term corticosteroid usage in patients with chronic hepatitis are presented. Differences in the etiology, histology, clinical features, laboratory findings, treatment, and prognosis are reviewed for the three separate but related forms of chronic hepatitis--persistent, lobular, and active hepatitis.
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14/18. autopsy case of hepatocellular carcinoma associated with lupoid hepatitis and complicated by malignant lymphoma.

    An 81-year-old woman in whom liver dysfunction had been pointed out 3 years previously was diagnosed as having liver cirrhosis due to lupoid hepatitis. Considering the poor prognosis of cirrhosis and her age, immunosuppressive therapy was not adopted. Nine months later, a small liver tumor was found by ultrasonography and was diagnosed as hepatocellular carcinoma (HCC). The tumor was treated with transcatheter arterial embolization, but grew continuously. She also developed gingival lymphoma that was successfully treated. Three years after initial diagnosis of lupoid hepatitis, she died of hepatic failure. An autopsy was performed and confirmed the clinical diagnosis, liver cirrhosis with HCC. HCC is regarded as a rare complication of lupoid hepatitis, but cases of HCC complicating lupoid hepatitis may increase with progress in treatment methods and elongation of survival. The present case suggests that any malignancy can be developed in long-term surviving patients with lupoid hepatitis.
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15/18. Evaluation of fulminant hepatic failure by scintigraphy with technetium-99m-GSA.

    We evaluated the usefulness of hepatic receptor imaging with 99mTc-diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) to establish the diagnosis and prognosis of fulminant hepatic failure (FHF). methods: Of the 20 patients, 8 had acute hepatitis and 12 had FHF. Computer acquisition of gamma-camera data started just before the injection of 185 MBq 99mTc-GSA and stopped 20 min later. Time-activity curves for the heart and liver were generated from regions of interest (ROIs) for the whole liver and precordium. A receptor index was calculated by division of the radioactivity of the liver ROI by that of the liver plus heart ROIs 15 min after the injection. An index of blood clearance was calculated by division of the radioactivity of the heart ROI at 15 min by that of the heart ROI 5 min after the injection. RESULTS: The receptor index was less than 0.83 in all patients with FHF, but it was more than 0.83 in all patients with acute hepatitis. The index of blood clearance was more than 0.72 in all patients with FHF but less than 0.72 in all patients with acute hepatitis. All six survivors of FHF had receptor indices of 0.58 or more, but in five of the six patients who later died, the receptor index was 0.58 or less. The index of blood clearance was 0.85 or less in all survivors but 0.85 or more in the same five patients who later died. CONCLUSION: Hepatic receptor imaging with 99mTc-GSA facilitated the evaluation of hepatic function reserve and was useful in establishing the diagnosis and prognosis of FHF.
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16/18. Hepatic manifestation of malignant histiocytosis: a case study.

    Malignant histiocytosis, as defined by Rappaport, is now known as a manifestation of malignant lymphoma, the majority of which is the T-cell type. However, unlike the typical presentation of most non-Hodgkin lymphomas, this condition presents with atypical features mimicking acute hepatitis or infectious mononucleosis. The latter diagnosis is often made because of the occurrence of atypical mononuclear cells on the peripheral blood films. This is clearly seen in the seven patients we report where the initial diagnoses were that of viral fever or hepatitis. Some characteristics were found in these patients to differentiate the condition from infectious mononucleosis (IMS) and acute hepatitis (AH): paucity of lymph nodes, cholestasis and prolonged prothrombin time (PT) which is atypical IMS; persistent fever, thrombocytopaenia and disproportionately high aspartate aminotransferase which is unusual in AH in the absence of any drug or alcohol history. The PT is the most important prognosis factor. early diagnosis and treatment led to improved survival in an otherwise aggressive and rapidly fatal condition.
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17/18. Autoimmune hepatitis in inflammatory bowel disease: report of two unusual cases.

    Elevated transaminases occur in up to 17% in patients with inflammatory bowel disease. Primary sclerosing cholangitis (PSC) is an important cause for elevated liver enzymes in these patients whereas autoimmune hepatitis is rare. Both diseases can overlap. We report two patients with an autoimmune hepatitis. One patient had Crohn's disease and arthritis with morphological liver changes typical for autoimmune hepatitis but without the characteristic autoantibody pattern. The other patient suffered from ulcerative colitis. He had antinuclear and antiactin antibodies as in autoimmune hepatitis type I. however, histological examination of the liver showed bile duct changes. transaminases declined significantly in both patients after onset of steroid treatment. Therefore, the diagnosis of autoimmune hepatitis in patients with inflammatory bowel disease must not be missed, as immunosuppressive therapy improves the prognosis of the illness.
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18/18. Fatal coxsackievirus B infection in early infancy characterized by fulminant hepatitis.

    OBJECTIVES: to clarify the major features of fatal coxsackievirus B infection characterized by fulminant hepatitis in early infancy. methods: clinical manifestations and laboratory investigations concerning five consecutive young infants with overwhelming coxsackievirus B fulminant hepatitis between 1994 and 1997 were retrospectively reviewed. Aetiological diagnosis was made by viral cultures and confirmed by a neutralization test with a type-specific antiserum. RESULTS: all five had a deteriorating clinical course of severe hepatitis complicated by disseminated intravascular coagulopathy (DIC). Coxsackievirus B1 infection was established in four patients and coxsackievirus B3 in one. The pathological findings of the two cases illustrated extensive hepatocellular necrosis. Fulminant hepatitis can occur as a leading presentation of disseminated coxsackievirus B infections and dominant the clinical features in neonates and young infants. CONCLUSIONS: the liver was the target organ of fatal coxsackievirus B infection in our patients. Hepatic involvement progressed rapidly to jaundice and coagulopathy, and was considered to be indicative of poor prognosis. Coxsackievirus B hepatitis may be serious in early infancy.
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