Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The natural history of HIV infection continues to change with improved diagnostic and therapeutic modalities available to manage opportunistic infections and malignancies. Antiretroviral therapy with zidovudine and other investigational agents has improved the median survival of AIDS patients from 11 months in 1985 to 18-25 months at present. Most importantly, early intervention with zidovudine can delay onset of clinical illness in asymptomatic patients and progression to AIDS in symptomatic patients. A 500 mg/d dose has been found as effective as previously recommended doses of 1200-1500 mg/day. Lower doses decrease the incidence and severity of adverse effects and therapeutic benefit appears to be greatest in asymptomatic patients with CD4 lymphocyte counts less than 500/ul. Indications for zidovudine, therefore, have been expanded to include asymptomatic adults with CD4 lymphocyte counts less than 500/ul. Concerning early intervention with zidovudine, studies were not designed to measure survival or define the optimal timing of intervention based on immunologic status. In addition, long-term benefits are not clearly defined, particularly since the drug seems to lose clinical effectiveness after approximately two years, probably due to emergence of resistant HIV strains. Adverse effects continue to occur even at low doses including headaches, nausea, anemia and neutropenia, myopathy and possible hepatitis. Nevertheless, the overall clinical benefit seems to be greatest, albeit temporary, in asymptomatic patients. The optimal dosage appears to be 500-600 mg/d; however, this may not be sufficient for infection in the central nervous system.
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PMID:Management of HIV infection in adults. 175 30

A Phase I/II clinical trial was designed for patients with malignancies of the liver and porta hepatis. This protocol employed three concepts: a) boost treatment to gross tumor within the liver for selected patients, determined by the dose-volume histogram (DVH) of the normal liver that would be irradiated by boost treatment; b) concurrent use of intraarterial hepatic 5-fluorodeoxyuridine (FdUrd) as a radiosensitizer; and c) hyperfractionation (1.5 Gy fractions given bid greater than 4 hr apart). This report describes the results of treatment of the first 33 patients entered onto this study, with a minimum follow-up of 1 year. Twenty patients received only whole liver irradiation (33 Gy). Thirteen patients were treated with whole liver irradiation (30 Gy) plus a 15 Gy (6 patients) or 30 Gy (7 patients) boost (total 45 Gy and 60 Gy to the tumor, respectively). Forty-eight percent of the evaluable patients (14/29) had an objective response, based on CT scan. The median duration of response was 8 months. The chief toxicities were fatigue, nausea, gastritis, and diarrhea, which were less than or equal to grade 2 in severity. Two patients developed mild radiation hepatitis which was treated successfully with diuretics. These data suggest that the treatment of intrahepatic malignancies can be guided by the concept of DVH analysis of the normal liver to allow the safe administration of doses of radiation that are potentially tumoricidal and are well above those that would be predicted to be tolerable for the whole liver.
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PMID:Treatment of cancers involving the liver and porta hepatis with external beam irradiation and intraarterial hepatic fluorodeoxyuridine. 184 63

Effectiveness, toxicity and complications of 5-fluorouracil (FU) and mitomycin-C (MMC) treatment were analyzed in 30 patients with metastatic colorectal cancer confined to the liver. The treatment schedule was FU 2.0-2.5 g/day for 5 days followed by MMC 10 mg/m2 every 2 h on day 6 to a maximum total dose of 60 mg. Treatment courses were repeated every 6 weeks and were given on an outpatient basis via external pump and arterial port systems. In 30 fully evaluable patients, one complete response, 17 partial responses (overall response rate 60%), and stabilization of disease in 8 patients (26%) were obtained for a median duration of 13 months. Median overall survival was 18.2 months (25.5 months for responding patients, 15 months for nonresponders). Grade 1-2 toxicity (WHO classification) consisted of leukopenia (23%), mucositis (20%), nausea/vomiting (16%), and abdominal pain (10%). Two patients (7%) developed severe mucositis. No life-threatening side effects were observed; in particular, there was no sclerosing cholangitis or chemical hepatitis. Catheter-related problems (occlusion, displacement, rupture, infection) occurred in 10 patients (33%) at a median follow-up time of 12 months. We conclude that intra-arterial FU and MMC constitute an effective, safe, and nontoxic treatment in metastatic colorectal cancer confined to the liver. Catheter-related problems are the most important factors limiting treatment.
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PMID:Phase II study of intra-arterial fluorouracil and mitomycin-C for liver metastases of colorectal cancer. 190 15

A 49 year old female was started on disulfiram. Six weeks later she was given naproxen because of epicondylitis. After 5 days' treatment with naproxen she complained of nausea, anorexia and jaundice. At admission, bilirubin was 452 mumol/l, aspartate aminotransferase (ASAT) 1925 U/I, alanine aminotransferase (ALAT) 2815 U/I and prothrombin time measured as Normotest was 27%. The patient developed a fulminant hepatitis and died in hepatic coma almost four weeks after the introduction of naproxen. Postmortem examination disclosed a small liver (1,100 g) and histological examination showed massive necrosis and collapse of the lobules. The naproxen was the most probable cause of death, but it is impossible to exclude disulfiram as causative agent.
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PMID:[Fulminating hepatitis after treatment with naproxen and/or disulfiram?]. 200 Jun 13

25 children (18 boys and 7 girls) were treated for non-Hodgkin's lymphomas (NHL) during 1982-1990. The age at diagnosis was 2-15 years. Five of the 25 children died. Of the 25 children 6 patients had the diagnosis of intraabdominal NHL. The presenting abdominal symptoms for these 6 patients were abdominal pain in 4 cases, nausea 3, abdominal distention 2, icterus 1 and diarrhoea 1. Four of the 6 patients with abdominal NHL underwent laparotomy but the diagnosis was unknown before surgery. The indication for explorative laparotomy was in all cases a tumor of unknown etiology combined with ascites in 2 cases and icterus in 1 case. At surgery there was a tumor localized around the porta hepatitis in 1 case and in the right ovarium in 1 case. Furthermore, spread infiltrative growth of tumor was found in 3 cases, with infiltration of the peritoneum in 2 of these cases. A specimen for peroperative histological examination was taken and gave the conclusive diagnosis of NHL in 4 of 6 cases. Staging laparotomy, palliative tumor resection and radical surgery are preferably avoided. For proper treatment an adequate biopsy is important. The management of children with NHL is a multidisciplinary approach.
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PMID:Abdominal manifestations of non-Hodgkin's lymphomas. 203 8

We describe the clinical features, liver histology, and ultrastructure in reversible diclofenac-induced hepatitis and review previous reports of this entity. Although rarely reported, diclofenac hepatitis may be severe, and even fatal. Symptoms, which develop from 1 week to 11 months after starting the drug, include jaundice, pruritus, fever, abdominal pain, nausea, vomiting, and rash. Bilirubin and alkaline phosphatase are mildly elevated, transaminases often markedly so. The nature of the idiosyncratic injury appears variable, some cases having features of a hypersensitivity reaction, most being more suggestive of a toxic metabolic effect. Light microscopy shows a nonspecific hepatitis with portal and lobular activity, and focal hepatocellular injury that may progress to zonal or massive necrosis. The ultrastructural features in our case are typical of drug or toxin injury. This may be of value in distinguishing this entity from other forms of hepatitis, which is important in view of the frequent reversibility of this potentially lethal form of injury.
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PMID:Reversible hepatitis associated with diclofenac. 203 30

Ranitidine was first marketed in 1981; since then many patients have been treated such that much experience has been accumulated on the safety of this histamine H2-receptor antagonist in the treatment of gastroduodenal disease. A wide array of ranitidine-associated side effects has been described, but infrequently. As so much information is now available, the aim of this review is to assess the weight of evidence for a causal link between ranitidine and the reported side effects. Overall, ranitidine is well tolerated. The incidence of general side effects at less than 2% is very similar to placebo. Headaches, tiredness, dizziness and mild gastrointestinal disturbance (e.g. diarrhoea, constipation and nausea) are among the most frequent complaints, but have very seldom resulted in stopping treatment. Cardiovascular side effects are extremely rare and unpredictable with the usual doses of oral ranitidine (at most 1 in 1 million patients). They mostly comprise sinusal bradycardia and atrioventricular blockade, especially after rapid intravenous administration, receding after cessation of the drug. Clinical studies, however, have not shown a significant pharmacological effect of ranitidine on the cardiovascular system via H2-receptors, even though individual sensitivities cannot be ruled out in a few isolated reports. Ranitidine is unlikely to be directly hepatotoxic: a transient change in liver function tests has been noted in only 1 in 100 to 1 in 1000 patients. Several cases of mixed hepatitis have been reported, but very few were fully documented. The incidence of ranitidine-associated acute hepatitis has been estimated to be less than 1 in 100,000 patients. Neuropsychiatric complications may be less common and clinically quite similar to those reported with cimetidine, i.e. confusion, disorientation, hallucinations, delirium. These side effects have occurred especially in critically ill and multiple-therapy patients, or patients with chronic renal or hepatic failure, so that the direct causal link with ranitidine treatment was often difficult to ascertain. Even though an H2-receptor-mediated effect is an attractive hypothesis (since similar complications were noted with other H2-receptor antagonists), other mechanisms have been suggested to play a role, e.g. cholinergic or histaminic effects. The overall incidence of neuropsychiatric complications is probably markedly less than 1%. White cell injury (i.e. agranulocytosis) appears to be the most frequent haematological complication, even though case reports are very few and poorly documented.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Side effects of ranitidine. 204 87

The aim of the study was to examine the frequency, severity, persistence and etiology of relapses occurring during the hepatitis A viral infection. Therefore, a prospective study of 910 patients suffering from hepatitis A (HA) was carried out. The clinical examination and determination of glutamyl pyruvic transaminase (GPT) in the serum every 7-14 days till recovery (usually during 6--8 months) were performed. HAV infection was confirmed by detecting anti-HAV IgM in the blood of all the examined by radioimmunoassay. In 876 (93.3%) patients HA had typical clinical features and a monophasic course. All cases made a rapid clinical recovery and liver function tests improved strikingly between 1 and 4 months after the onset of illness. However, in 34 (3.7%) of 910 patients, after an asymptomatic interval of 4--8 weeks, relapsing hepatitis occurred. Mild clinical symptoms: fatigue, myalgia, nausea, epigastric discomfort accompanied by the elevated levels of GPT in the serum were noticed in 11 patients, while 3 of them redeveloped jaundice. In 23 remaining patients relapses of hepatitis were asymptomatic, except for the reappearance of icterus in six cases. The only way to establish the exacerbation of the disease was through the pathological findings of GPT in the serum, which increased 10--60 times above the upper limit of the normal value. While 25 patients had one relapse, in 9 there were two or more relapses, so that hepatitis had a biphasic or polyphasic course. The second relapse was registered 3--6 weeks after the first one disappeared. Through biochemical tests the average values of the GPT were established: 1566 U/L in the acute stage, 107 U/L during the early stage of convalescence and 1016 U/L during the first relapse of hepatitis. After the first relapse and during remission, in 9 patients the average values of GPT in the serum were 84 U/L, while during the second relapse 518 U/L. Clinical signs of relapsing hepatitis disappeared approximately in 4 days, but liver function tests decreased slowly and persisted elevated between 5 and 12 months. A possibility of establishing the etiology of relapsing hepatitis, which has yet remained unknown, is discussed. Anti-HAV IgM were present in all 34 patients during the initial and relapsing phase of hepatitis and in 26 cases in the latter phase of convalescence between 9 and 11 months after the beginning of the disease. Serological tests excluded infection with hepatitis B, cytomegalovirus and Epstein-Barr virus. With a great probability other infections and toxic agents damaging the liver could have been excluded.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Recurrences of viral hepatitis A]. 207 29

The effects of ketoconazole, a synthetic imidazole derivate, were evaluated in 42 women affected by acne (17 cases) and/or hirsutism (36 cases) treated with 400 mg/day for 3-6 months. Androstenedione, total and free testosterone, 5 alpha dihydrotestosterone and dehydroepiandrosterone levels progressively dropped during treatment while 17 alpha hydroxyprogesterone, estradiol, ACTH, cortisol, LH and FSH levels increased. Dehydroepiandrosterone sulfate decreased only towards the end of treatment, while estrone, sex hormone binding globulin, and PRL remained unchanged. Daily mean +/- SD rate of hair growth, measured by a special image analysis processor, decreased within 3 months of therapy from 0.258 +/- 0.058 to 0.184 +/- 0.039 mm/day (P less than 0.02) and mean +/- SD hair diameter from 0.123 +/- 0.015 to 0.110 +/- 0.013 mm (P less than 0.05) together with decreasing hormone levels. The therapeutic effects of ketoconazole on hirsutism was evident at 6 months in only 14 subjects, while no significant change in hirsutism score was recorded in 22 women who failed to complete the therapy. Acne improved in all cases. Several side effects and complications arose during treatment, such as headache, nausea, loss of scalp hair, hepatitis, and biochemical changes. Even though ketoconazole improves hyperandrogenism, only selected patients are eligible for treatment as scrupulous monitoring is required.
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PMID:Ketoconazole therapy for women with acne and/or hirsutism. 216 69

We reported a case of disulfiram-induced hepatitis with unique clinical features and compared our case with others in the literature. Our patient had headache, mild fever, nausea, vomiting, rash, and eosinophilia after 3 weeks of disulfiram therapy. Subsequent liver biopsy showed low-grade lobular hepatitis. After disulfiram therapy was discontinued, symptoms subsided and results of liver function tests returned to normal.
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PMID:Disulfiram-induced hepatitis. 219 96


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