Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.1.3.1 (alkaline phosphatase)
 47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirteen patients with amebic liver abscess and 26 with pyogenic abscess were identified during a 10 year period. All but one patient with an amebic abscess had emigrated or traveled to areas where amebiasis was endemic. Half of the patients in whom pyogenic abscesses developed had debilitating disease and anemia. Factors predisposing to multiple rather than solitary hepatic abscess were biliary tract disease before surgery, cancer, chemotherapy, steroid administration and alcoholism. Elevated levels of alkaline phosphatase and hypoalbuminemia were present in most patients. Three patients with amebic abscess died, two of whom has massive gastrointestinal hemorrhage from associated amebic colitis. No patient with a solitary pyogenic liver abscess died. Fifteen of 16 patients with multiple liver abscesses died. Failure to consider the diagnosis of liver abscess, confusion over interpretation of the scan, failure to operate or provide a timely operation and failure to adequately explore the abdomen or identify all abscesses were factors responsible for eight unnecessary deaths.
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PMID:Management of liver abscess. 739 87

Pyogenic hepatic abscesses are uncommon. We report our findings in 51 patients with pyogenic liver abscess treated from 1975 through 1992. Twenty-eight patients were men and twenty-three were women. The median age of patients was 46 years (range, 13 to 77 years). Fever was present in 100% of patients, abdominal pain in 58.8% and jaundice in 39.2%. Twenty eight patients (54.9%) had leukocytosis; 45% hyperbilirrubinemia and 35.3% a high serum level of alkaline phosphatase. The most common cause of abscesses was biliary tract disease (66%). Thirty-three (64.7%) were surgically treated and thirteen underwent percutaneous drainage with 90.4% and 69.2% of good results, respectively. Mortality was 9.6% in the surgical group and 0% in the percutaneously drained group. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.
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PMID:[Pyogenic hepatic abscess: report of 51 cases]. 761 Mar 34

An ELISA test for the serological diagnosis of amoebic liver abscess (ALA) was standardized and evaluated in sera from three groups of patients: (1) three patients with diagnosis confirmed by isolation of the parasite, (2) thirty seven patients with diagnosis established by clinical findings and ultrasound studies and (3) seven patients whose diagnosis were established by clinical findings and a positive double immunodifusion test. Ninety one serum samples from healthy subjects and 22 from patients with other liver or parasitic diseases were also included in the study. The optimum concentration of Entamoeba histolytica antigen was 1.25 micrograms/ml and optimum dilutions of serum and anti-human IgG -alkaline phosphatase conjugate were 1:400 and 1:4000 respectively. The cut-off point of the ELISA test in this study was an absorbance value of 0.34. The test parameters were: sensitivity = 95.7%, specificity = 100%, positive predictive value = 100% and negative predictive value = 98.2%. The ELISA test was found to be of great use as a diagnostic tool for the establishment of amoebic etiology in patients with clinical supposition of ALA. The test could also be used for seroepidemiological surveys of the prevalence of invasive amoebiasis in a given population, since it allows the processing of a greater number of samples at a lower cost than other serological tests.
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PMID:Standardization and evaluation of ELISA for the serodiagnosis of amoebic liver abscess. 782 21

One hundred and one cases of Klebsiella bacteraemia from the National University Hospital, Singapore, were reviewed retrospectively. There were 54 (53.5%) males and 47 (46.5%) females. Mean (+/- SE) age was 54 (+/- 2.4) years. Overall mortality was 26%. Nosocomial infections accounted for 20%. Underlying diabetes mellitus and malignancy were present in 36 and 26% respectively. The source of the bacteraemia was not known in 33% of cases, 17% had liver abscess, 29% had urinary tract infections, 9% had pneumonia, 10% had an abscess separate from the liver, and 3% had biliary sepsis. Elevated alkaline phosphatase (> 100 U-1) was seen in all cases of liver abscess (sensitivity 100%, specificity 27%). Nonsurvivors had a significantly lower platelet count than survivors (104 +/- 25 x 10(9)/l vs. 176 +/- 15 x 10(9)/l, unpaired t-test P < 0.05), and a platelet count of less than 150 x 10(9)/l was associated with a significantly higher mortality (37% vs. 11%, chi 2 P < 0.01). Nosocomial infection was associated with 45% mortality, whereas community-acquired infection had a lower rate of 21%, this was not statistically significant. Seventy-eight per cent of these Klebsiella isolates were sensitive to gentamicin and cotrimoxazole, and 100% to imipenem.
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PMID:Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore. 796 72

Liver abscess is a rare but serious complication of Crohn's disease. Intra-abdominal abscesses, fistulous disease, and metronidazole or steroid therapy have all been reported to be important predisposing factors in the pathogenesis of the disease, and the mortality has been reported to be high. We report six patients who developed a liver abscess as a complication of Crohn's disease. Three patients presented with a liver abscess as the first manifestation of Crohn's disease and two others had quiescent disease at presentation. The diagnosis was delayed by 1-8 wk after the onset of fever because of the paucity of signs indicating a hepatic infection. None of the patients had intra-abdominal abscesses, active fistulas, or metronidazole therapy before the onset of symptoms. The only predisposing conditions identified were two minor skin infections in patients developing staphylococcal liver abscesses. Nonoperative catheter drainage was successful in four of the six patients. One patient required surgical placement of drains, and the patient with the longest delay before diagnosis required hepatic lobectomy because of extensive necrosis. Shaking chills, fever with leukocytosis, and an elevated alkaline phosphatase are suggestive of a liver abscess and should prompt an ultrasound examination. Catheter drainage with antibiotic therapy is effective if the liver abscess is diagnosed before extensive necrosis has occurred. Minor skin infections may predispose to staphylococcal liver abscess in some cases.
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PMID:Liver abscess in Crohn's disease. 801 70

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.
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PMID:The changing patterns of liver abscess during the past 20 years--a study of 482 cases. 812 39

Nineteen consecutive patients of pyogenic liver abscess (13 males, 6 females, mean age 45.2 +/- 6, 5 years) were studied over a period of 5 years for the clinical profile and therapeutic efficacy of percutaneous aspiration. Majority of them presented with spiking fever (94.7%), pain over right upper quadrant of abdomen (53.8%) and often with prostration and shock (31.6%). The onset has been rather acute in patients with multiple abscesses (7 cases). Ascites (10.5%), clubbing of fingers (15.8%) and splenomegaly (10.5%) were observed in cases with long duration of illness. There has been the polymorphonuclear leucocytosis (89.5%) and mild to moderate anaemia (52.6%). Jaundice (42.1%) was usually mild degree (serum bilirubin 4.6 +/- 2.4 mg/dl). The serum transaminases and alkaline phosphatase were raised in 94.9% of cases. Ultrasonography revealed predominantly hypoechoic (54.1%) areas with frequent distal acoustic enhancement and internal echoes (21.6%). Seven patients had multiple abscesses with 25 lesions (size 5.2 +/- 4.6 cms) situated mainly over antero-inferior segment of the right lobe (45.9%) of the liver. The blood and pus cultures demonstrated the micro-organisms (positive in 63.9% and 86.6% respectively) predominantly of bowel flora including facultative gram negative rods and anaerobes. Mortality was 26.5% and pleuro-pulmonary complications were the commonest (26.4%) one. 15 cases were treated by percutaneous aspiration, proper antibiotic and metronidazole with encouraging results (only two deaths). Complete resolution of abscess took place in 14.2 +/- 1.2 weeks (range 6 weeks to 7.5 months). It is emphasized that percutaneous needle aspiration is useful both for diagnosis and treatment of pyogenic liver abscess.
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PMID:Clinico-therapeutic profile of pyogenic liver abscess. 822 94

Pyogenic liver abscess (PLA) is an important entity with a changing clinical spectrum and may be more prevalent than previously reported. PLA remains most common in older patients, although we found a trend in age range downward. In contrast to earlier reports, PLA affected male and female patients with equal frequency. The most common known cause of PLA remains biliary tract disease, but the majority of patients with PLA were those in whom no underlying cause of PLA could be identified. Single PLA was more common than multiple PLA regardless of etiology. The clinical presentation of patients with PLA ia nonspecific and emphasizes the fact that a high index of suspicion is often required to make the diagnosis. Jaundice and a markedly elevated alkaline phosphatase are clues to the possibility of biliary tract involvement, but may not distinguish patients with liver abscess from those with other hepatic processes. While plain chest and abdominal X-rays were often abnormal and may point to the right upper quadrant as a source of abnormality, ultrasound (US) and abdominal computed tomography (CT) play a central role in this disease. Not only are they often paramount in elucidating the diagnosis of PLA, but US and CT are critical because of their ability to provide other useful information that may address the cause of PLA (that is the biliary tract, and in the case of abdominal CT, other structures). Further, our data suggest that in patients without clinical or imaging evidence of biliary tract disease or pylephlebitis, aggressive random evaluation of the intestinal tract is unwarranted. Percutaneous drainage combined with intravenous antibiotics was the most common therapeutic modality and resulted in cure in 76% of all patients in which it was used (compared to 65% with antibiotics alone and 61% with surgery) and has been successful in 90% of patients over the last 5 years (n = 50). In this study, percutaneous catheter drainage (PCD) appeared to result in a higher cure rate than percutaneous needle aspiration (PNA) but comparative studies are required to further address and determine their relative efficacies. Intravenous antibiotics alone are an important option in carefully selected patients. Surgical intervention as a primary mode of therapy has been almost completely replaced by less invasive approaches such as PCD/PNA, but remains an important consideration in patients who fail these therapies. Although PLA was once considered a fatal disease, the prognosis is now excellent. We have identified a subgroup of patients with no or low-level elevations in bilirubin and alkaline phosphatase and most often single right-sided PLA who do not have a readily identifiable cause of PLA (that is, cryptogenic), as having a particularly favorable prognosis. Death due to PLA is now limited primarily to those patients with severe underlying disease processes, including malignancy.
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PMID:Pyogenic liver abscess. Changes in etiology, management, and outcome. 860 31

In the period of 1989-1995 seven patients with amebic liver abscess were observed in Clinic of Infectious Diseases of Pomeranian Medical School in Szczecin. The diagnosis has been made on the base of epidemiological data, presence of intrahepatic defect by a scanning procedure of liver (ultrasonography, CT, scintigraphy) and positive serologic test for amebiasis. All patients were male of Polish nationality, 29-57 years old, who became ill after travel to Africa or India. Intestinal amebiasis was present only in two cases. Five patients had acute onset of disease and two chronic. The most common complaints included fever, abdominal pain, anorexia. A cough, chest pain, diarrhea or weight lose were less common. At physical examination paleness of skin, subjaundice, abdominal tenderness, hepatomegaly and sometimes pleural effusion have been observed. Laboratory tests revealed high RBS, leucocytosis and mild anemia. Slightly higher serum level of bilirubin, alkaline phosphatase were transient. Trophozoits of Entamoeba histolytica have been found in stool specimens of one only patient. Amebic antibodies tested with indirect hemagglutination (IHA) were present in all cases. Visual technics have shown abscess of 3 to 9 cm in diameter located at right liver lobe. Six patients have been treated with both chemotherapy (metronidazole or/and dehydroemetine) and "skin needle" aspiration. In two cases recrudescence of abscess has been observed after one and three years respectively. These two patients have been undergone second course of treatment with using not only needle aspiration and metronidazole/dehydroemetine but luminal agents as well.
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PMID:[Amebic liver abscess--personal observations]. 892 39

A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.
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PMID:Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment. 914 69


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