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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case is described of a young drug addict suffering from acute viral hepatitis type C evolving towards coma and fatal outcome. The clinical features were those typical of fulminant hepatitis which so far have been considered infrequent in infections due to HCV.
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PMID:[A case of fulminating hepatitis C]. 827 61

Two sets of prognostic indicators were recently proposed for selection of patients with acute liver failure for emergency liver transplantation. According to the London criteria, patients with non-paracetamol-induced acute liver failure should be referred for liver transplantation when the prothrombin time is > 100 s or when any three of the following prognostic indicators are present: age < 10 or > 40 yr; non-A, non-B hepatitis, halothane hepatitis or idiosyncratic drug reaction; duration of jaundice before onset of encephalopathy > 7 days; prothrombin time > 50 s; serum bilirubin > 300 mumol/l. According to the Clichy criteria, in acute viral hepatitis, liver transplantation should be decided in patients with coma or confusion, and Factor V < 20% (age < 30 yr) or < 30% (age > 30 yr). To assess the accuracy of these criteria, 81 non-transplanted patients with non-paracetamol-induced acute liver failure were retrospectively studied. The mortality rate was 0.81. The predictive accuracies, respectively on admission and 48 h before death, were 0.80 and 0.79 for the London criteria, and 0.60 and 0.73 for the Clichy criteria. The positive and negative predictive values, 48 h before death, were 0.89 and 0.47 for the London criteria, and 0.89 and 0.36 for the Clichy criteria, respectively. In the 49 patients with acute viral liver failure, the results of the Clichy criteria were similar. In a subgroup of 24 patients who had not received either fresh frozen plasma or sedative-hypnotic drug, the positive predictive values were equal to 1 for the two sets of prognostic indicators, but the predictive accuracies only slightly increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Emergency liver transplantation for acute liver failure. Evaluation of London and Clichy criteria. 844 7

Tyzzer's disease, caused by Bacillus piliformis and characterized by a multifocal, necrotizing hepatitis was diagnosed in a 25 days old, male, German warmblood foal. The animal was submitted to the clinic of horses because of colic symptoms and a severe depression. Upon arrival it was comatose, recumbent and showed opisthotonos. Due to a severe, metabolic acidosis and a rapid progression of the disease, the foal was euthanatized. In immediately formalin-fixed tissue samples Bacillus piliformis was detected in the cytoplasma of hepatocytes by different histological techniques (Giemsa stain, silver impregnation technique by Warthin-Starry, immunohistology). This case is discussed within a literature review.
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PMID:[Infection with Bacillus piliformis (Tyzzer's disease) in foals]. 846 78

A 28-year-old drug addict who had injected intravenously died of hepatic failure and coma caused by fulminant hepatitis (simultaneously: hepatitis A, persistent hepatitis B, hepatitis C and superinfection by delta hepatitis). Liver histology disclosed cirrhosis with severe necrotizing hepatitis and extensive microvesicular steatosis, compatible with a delta virus infection. Moderate pulmonary fat embolism (grade I-II according to Falzi) was accompanied by fat deposits in alveolar macrophages. It is postulated that protracted fat mobilization from necrotizing hepatocytes may be the cause of pulmonary fat embolism; the extravasation of fat from the vessels into the alveoli results in phagocytosis by alveolar macrophages.
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PMID:[An unusual form of a pulmonary fat embolism in fulminant viral hepatitis]. 865 Jan 46

Little information is available on acute liver failure (ALF) in the United States. We gathered demographic data retrospectively for a 2-year period from July 1994 to June 1996 on all cases of ALF from 13 hospitals (12 liver transplant centers). Data on the patients included age, hepatic coma grade on admission, presumed cause, transplantation, and outcome. Among 295 patients, 74 (25%) survived spontaneously, 121 (41%) underwent transplantation, and 99 (34%) died without undergoing transplantation. Ninety-two of 121 patients (76%) survived 1 year after transplantation. Acetaminophen overdose was the most frequent cause (60 patients; 20%), followed by cryptogenic/non A non B non C (NANBNC; 15%), idiosyncratic drug reactions (12%), hepatitis B (10%), and hepatitis A (7%). Spontaneous survival rates were highest for patients with acetaminophen overdose (57%) and hepatitis A (40%) and lowest for those with Wilson's disease (no survivors of 18 patients). The transplantation rate was highest for Wilson's disease (17 of 18 patients; 94%) and lowest for autoimmune hepatitis (29%) and acetaminophen overdose (12%). Age did not differ between survivors and nonsurvivors, perhaps reflecting a selection bias for patients transferred to liver transplant centers. Coma grade on admission was not a significant determinant of outcome, but showed a trend toward affecting both survival and transplantation rate. These findings on retrospectively studied patients from the United States differ from those previously gathered in the United Kingdom and France, highlighting the need for further study of trends in each country.
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PMID:Etiology and outcome for 295 patients with acute liver failure in the United States. 987 98

A novel virus(TTV) was isolated from patients with post-transfusion hepatitis of unknown etiology. We studied the prevalence of TTV in 26 patients with fulminant hepatic failure. Serum samples at admission from seven(27%) of the 26 patients were positive for TTV. TTV was also detected in 29(27%) of the 106 healthy blood donors. There were no differences in the positive rate between patients with fulminant hepatic failure and healthy blood donors. There were no differences in clinical findings, or duration from onset to coma in patients with and without TTV. However, the outcome of the patients with TTV was significant worse than those without. TTV may not cause severe hepatitis such as fulminant hepatic failure.
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PMID:[Prevalence of TT virus in patients with fulminant hepatic failure in Japan]. 1039 Sep 94

Sixty cases of P. falciparum and 165 cases of P. vivax were studied clinically along with species identification of parasite after examination of the blood slide by experts at Calcutta. It was observed that malaria had been changing its clinical profile. The classic paroxysm is evident only in 40% cases of P. falciparum and 47.27% of P. vivax malaria, but the difference between the two groups is not statistically significant. On the other hand continuous or remittent type of fever has been observed in 40% and 27.27% cases of P. falciparum and P. vivax respectively, while absence of classic paroxysms of fever, in association with splenomegaly when present, poses a diagnostic difficulty with enteric fever. Association of jaundice in 40% and 9.09% cases with P. falciparum and P. vivax respectively along with hepatomegaly in 80% and 63.63% in them in conjunction with nausea and/or vomiting leads to clinical mimicry with infective hepatitis. Splenomegaly which has been described as cardinal feature of malaria was observed in 40% cases with P. falciparum and only in 18.18% cases of P. vivax malaria and this is a clear deviation from earlier description and this difference between the two groups is highly significant at 99% level of confidence. Co-existent enteric fever was observed in 3.33% of falciparum and 2.6% of vivax malaria, though this difference is not statistically significant. Acute respiratory distress was observed in 6.6% of P. falciparum malaria only. Oliguria with impaired renal function was noted in 5% cases of P. falciparum malaria. The present study has also noted convulsion or coma in 8.33%, purpura with disseminated intravascular coagulation in 3.33% and black water fever in 3.33% cases in falciparum malaria which were not observed in cases with vivax malaria and these differences are statistically significant. However, stupor with bilateral extensor planter response was observed in two cases (1.3%) of vivax malaria.
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PMID:Changing scenario of malaria: a study at Calcutta. 1044 29

A novel virus (TT virus) was isolated from patients with posttransfusion hepatitis of unknown etiology. We studied the prevalence of TT virus in 26 patients with fulminant hepatic failure without risk factors, including blood transfusion, and also examined 106 healthy blood donors as controls. We assayed serum TT virus DNA by seminested polymerase chain reactions and also examined the genotypes of this virus. Serum was obtained at admission from patients with fulminant hepatic failure. Serum samples at admission from seven (27%) of the 26 patients were positive for TT virus DNA. There were no differences in clinical findings, duration from onset to coma, or results of laboratory tests in patients with and without TT virus DNA. However, all 7 patients with TT virus died, whereas 9 of the 19 patients without TT virus died. The outcome for patients with fulminant hepatic failure and TT virus was significantly worse than for patients without the virus (P = 0.0227). TT virus was also detected in 29 (27%) of the 106 healthy blood donors. The genotype of the TT virus was mainly 1a in both groups. There were no differences in the rate of positivity and the genotypes of TT virus between patients with fulminant hepatic failure and healthy blood donors. TT virus infection may not cause severe hepatitis, such as fulminant hepatic failure, but it may indicate a poor outcome in such patients.
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PMID:Prevalence of TT virus in patients with fulminant hepatic failure in Japan. 1053 86

Mitochondria are involved in fatty acid beta-oxidation, the tricarboxylic acid cycle, and oxidative phosphorylation, which provide most of the cell energy. Mitochondria are also the main source of reactive oxygen species in the cell and are involved in cell demise through opening of the mitochondrial permeability transition pore. It was therefore to be expected that mitochondrial dysfunction could be a major mechanism of drug-induced liver disease. Microvesicular steatosis (which may cause liver failure, coma, and death) is the consequence of severe impairment of mitochondrial beta-oxidation. Endogenous compounds (such as cytokines or female sex hormones) or xenobiotics (including toxins such as ethanol and drugs such as aspirin, valproic acid, ibuprofen, or zidovudine) can inhibit beta-oxidation directly or through a primary effect on the mitochondrial genome or the respiratory chain itself. In some patients, infections and cytokines, or inborn errors of beta-oxidation enzymes or the mitochondrial genome, may favor the appearance of drug-induced microvesicular steatosis. Nonalcoholic steatohepatitis may develop under conditions causing prolonged, microvesicular, and/or macrovacuolar steatosis. In this condition, chronic impairment of mitochondrial beta-oxidation (causing steatosis) and the respiratory chain (increasing the production of ROS) lead to lipid peroxidation, which, in turn, may cause the diverse lesions of steatohepatitis, namely, necrosis, inflammation, Mallory's bodies, and fibrosis. Finally, mitochondria are involved in several forms of drug-induced cytolytic hepatitis, through inhibition or uncoupling of respiration or through a drug-induced or reactive metabolite-induced mitochondrial permeability transition. The latter effect commits hepatocytes to either apoptosis or necrosis, depending on the number of organelles that have undergone the permeability transition.
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PMID:Hepatotoxicity due to mitochondrial dysfunction. 1081 31

As reported in the literature, the mortality rates for patients with Acute Hepatic Failure (AHF) approaches 80% in cases in which liver transplantation is not possible. Post-transplant mortality mostly depends on the severity of the neurological condition at the time of the operation (20% in I-II degree coma patients and 44% in III degree coma patients). The primary indications for liver transplantation in AHF are Fulminant Hepatitis (FH)(93%), Subfulminant Hepatitis (5%) and other indications (2%). Other causes of AHF are Primary Non-Function (PNF) and Delayed Function (DF), which occur in 7-10%. Therefore it becomes necessary to monitor the patients with a Liver Support Device to be able to improve the clinical condition of the patients before liver transplantation (LT). In our experience we used the Molecular Adsorbent Recirculating System (MARS) (MARS Monitor; Teraklin AG, Rostock Germany), which enables the selective removal of albumin-bound substances accumulating in liver failure by the use of albumin-enriched dialysate. The system is used as a bridging device to orthotopic liver transplantation (OLT) of patients with FHF. We studied 34 patients, including 16 males and 18 females: 9 were affected by Primary-Non-Function (PNF), nine by Fulminant Hepatitis (FH), six by Delayed-Non-Function (DNF), and ten by Acute on Chronic Hepatic Failure (AOCHF). The average age of the patients was 41.8 years and the average number of applications was 6.4; the median length of application was about eight hours. The parameters that we monitored, before and after each treatment, were neurological status (EEG, cerebral CT, Glasgow Coma Score), haemodynamic parameters, acid base equilibrium, and blood gas analysis. We also monitored hepatic and renal function. In addition, the clinical conditions of the patients were monitored using kidney and liver ultrasound/ultrasonography (US). Inclusion criteria were bilirubin > 15 mg/dL, ammonia > 160 micro g/dL and a Glasgow Coma Score between 6 and 11. The reduction of bilirubin and ammonia were very significant (P < 0.01), whereas the changes of International Normalized Ratio (INR) were not significant. Also the modifications of albumin, total protein, sodium, potassium and calcium were not significant. In conclusion, four out of nine patients with PNF are alive without a second transplantation and were discharged after about 48 days; four out of nine underwent OLT, while one out of nine died; five out of six patients with DF are alive without a second transplantation, and they were discharged after an average time of 55.5 days, one out of six died; six out of nine patients with fulminant hepatitis underwent OLT and four of these are alive, while two died due to sepsis; three patients are alive without OLT. Four patients with AOCHF underwent OLT and are alive, three patients are alive and on a waiting list, two died while on a waiting list and one patient who experienced reactivation of HBV infection during chemotherapy for non-Hodgkin's lymphoma is alive. In spite of the limited number of cases of our study, we believe that MARS can be applied with high tolerance for a very long period of time. In addition, its repeatability allows it to be used in patients with DNF and FH as a bridge to transplant. In patients with DNF, it is used while waiting for complete recovery of the transplanted organ.
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PMID:MARS (Molecular Adsorbent Recirculating System): experience in 34 cases of acute liver failure. 1222 Mar 3


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