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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Substantial empirical evidence suggests that alcohol consumption is an important cause of cirrhosis mortality levels. However, recent research has failed to find the expected positive relationship between consumption and cirrhosis mortality, in both the United States and Canada, when data from the mid-1970s through the late 1980s are analysed. Although recent studies have investigated a number of possible explanations, this study examines the hypothesis that an increase in the provision of treatment for alcoholism resulted in a disjuncture in the established relationship between consumption and cirrhosis deaths. This hypothesis is evaluated with a multivariate time series model in which the relationship between consumption and cirrhosis mortality is estimated with controls for treatment and the unemployment rate, using data from the US state of North Carolina. The results indicate that with treatment controlled, changes in cirrhosis mortality are independent of consumption. Further, treatment has a significant short-term lagged effect on cirrhosis mortality, suggesting that the impact of treatment on chronic alcohol abusers may be one of delaying the consequences of such abuse.
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PMID:Effect of alcoholism treatment on cirrhosis mortality: a 20-year multivariate time series analysis. 132 35

Macroregenerative nodules, also called nodules of adenomatous hyperplasia, have been well documented in Japan. Extensive studies support the hypothesis that in the Japanese population these lesions represent a possible pathway for hepatocarcinogenesis. However, reporting of these lesions in non-Japanese populations has so far been rare. We examined 44 sequential cirrhotic hepatectomy specimens from adult patients who underwent orthotopic liver transplantation at our institution. All livers were serially sectioned every 0.5 cm. Macroregenerative nodules were defined as regenerative nodules at least 1 cm in diameter. Forty-eight macroregenerative nodules were found in 11 livers (25% of livers). The antecedent diseases in these livers included hepatitis C (3), alcoholism (2), primary biliary cirrhosis (2) (one with iron overload), cryptogenic cirrhosis (2), hepatitis B (1) and alpha 1-antitrypsin deficiency (1). The macroregenerative nodules often differed from the surrounding nodular parenchyma in color, texture or the degree to which they bulged beyond the cut liver surface. Three livers contained grossly apparent hepatocellular carcinomas. Microscopically, macroregenerative nodules could be classified as those with (type 2) and without (type 1) dysplasia. Four livers had type 1 lesions, two had type 2 lesions and five had lesions of both types. We found 36 type 1 lesions in all and 12 type 2 lesions, 3 containing foci of microscopic carcinoma. All hepatocellular carcinomas arose in livers containing macroregenerative nodules (either type). Liver cell dysplasia, large-cell or small-cell, was observed in cirrhotic nodules of 27 livers. Microscopic or macroscopic hepatocellular carcinoma occurred in three livers with large-cell but not small-cell dysplasia and in one liver without dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Macroregenerative nodules and hepatocellular carcinoma in forty-four sequential adult liver explants with cirrhosis. 132 12

Due to the high prevalence in the population of both viral hepatitis and alcoholism it is not uncommon to find patients with chronic hepatitis in whom both these stigmata are simultaneously present. In such cases, the risk of evolution to cirrhosis is thought to be greater. In this study was evaluated 104 alcoholic patients (50 of whom had hepatic biopsy), with or without antibodies (ab) to hepatitis C virus (HCV). In addition, we retrospectively examined 183 hepatic biopsies of alcoholic patients with or without hepatitis B virus (HBV markers). At the end of the study the following conclusions were drawn: (i) Contact with HBV is unlikely to effect either the histologic picture or the course of alcoholic liver disease. (ii) The incidence of ab to HCV is higher in more advanced stages of the disease. (iii) As regards biopsies of alcoholic patients, sometimes it was impossible to establish a relationship between piece-meal necrosis or portitis and viral markers of hepatitis; therefore, other factors may be synergic with alcohol (ie nutritional, immunologic, genetic factors, concomitant diseases, etc.). For each of these factors, the relative risk of cirrhotic evolution could be assessed by a multicenter survey with case-control design.
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PMID:[The role of HBV and HCV viruses in the pathogenesis of hepatic lesions in alcoholics]. 133 53

Hepatitis B virus (HBV) serological markers were investigated in 40 incident cases of hepatocellular carcinoma (HCC) and in two age and sex matched control groups, comprising 40 patients with other cancers and 80 healthy individuals, resident in Bahia, Brazil. Serologic tests were done by radioimmunoassay. The study observed high proportion of seropositivity to HBsAg (42.5%) and of those presenting HBsAg or antiHBc (65.0%) among HCC cases, higher in men than women and in those aged 17 to 30 years old. HBsAg seropositivity among HCC patients was greater than in the control group with other cancers (7.5%) and in healthy controls (2.5%), corresponding to odds ratio estimates of 15.0 (95% CI 3.29, 68.30) and 33.0 (95% CI 9.13, 119.28), both statistically significant. HBeAg was not observed and antiHBe was present in 41.2% of cases, suggesting the absence of viral replication, possibly with viral DNA integration into the hepatocyte genome. The presence of cirrhosis was associated with HBsAg seropositivity among HCC cases. A history of chronic alcoholism is shown to be more frequently related to those cases with cirrhosis. This study highlights the relevant association between HCC and HBV in Northeast Brazil, particularly for young individuals, and the high risk of development of HCC for HBsAg carriers.
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PMID:A case-control study on the association of hepatitis B virus infection and hepatocellular carcinoma in northeast Brazil. 134 17

The present paper is devoted to overview the basic concepts of ethanol-induced hepatic injury and therapeutic modalities by which alcoholic liver disease can be alleviated. The role of alcohol dehydrogenase of both hepatic and gastric origin as well as the importance of the number one metabolite acetaldehyde are discussed, furthermore the effects of microsomal ethanol oxidizing system are also described. The features of the major clinicopathological consequences of alcohol abuse fatty liver, alcoholic hepatitis are briefly outlined, and the basic pathogenetic mechanisms that lead to cirrhosis--cell necrosis, regeneration and fibroplasia--are shown. The understanding of the pathophysiology of alcohol-induced liver injury may improve the therapy with drugs and nutritional factors, and allow successful prevention through the early recognition of heavy drinkers before their social or medical disintegration. In the management of alcoholic liver diseases, among the true hepatoprotective agents a naturally occurring flavonoid silymarin and an active methyl-donor metabolite S-adenosyl-L-methionine seem to be promising. An antifibrotic treatment with colchicine might also be of importance. Further prospective, well-designed, controlled clinical trials are still warranted to evaluate real efficacy of these drugs. The hepatic consequences of alcohol abuse may be treatable, however, prevention would be the true resolution of the major global health problem of alcoholism.
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PMID:Pathogenesis and management of alcoholic liver injury. 134

In every patient, in particular males of all ages presenting with chronically progressive diseases or cirrhosis of the liver, ultrasonography and an AFP test should be performed at intervals of six months. If hepatocellular carcinoma of the liver (HCC) is suspected (i.e. by increase of AFP or a positive result in ultrasonography), diagnosis should be confirmed by further investigations such as fine-needle biopsy guided by sonography, angiography and CT-scan. Adequate therapeutical measures such as resection of the tumor, chemotherapy, injection of alcohol or liver transplantation can thus be initiated in time. Besides efforts for early diagnosis of carcinoma of the liver, preventive measures (vaccination for hepatitis B, restrictive use of blood transfusion, reduction of alcoholism, thorough therapy of hemochromatosis, etc.) may contribute to the reduction of chronic diseases of the liver and of associated HCC.
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PMID:[Early diagnosis of hepatocellular carcinoma]. 137 85

The clinical significance and prognosis of culture-negative neutrocytic ascites in cirrhotic patients is a controversial topic. In the present study, the clinical and humoral presentation and the short- and long-term prognosis were analyzed in 36 patients with cirrhosis and culture-positive spontaneous bacterial peritonitis and in 28 patients with cirrhosis and ascitic fluid polymorphonuclear count greater than 250/mm3, a negative ascitic fluid culture, and without previous antibiotic therapy. On admission there were no significant differences between groups related to age, sex, alcoholism, fever, abdominal pain, serum albumin, serum urea, serum creatinine, Child-Pugh score, polymorphonuclear count, and total protein concentration in ascitic fluid. A greater frequency of positive blood culture was found in patients with spontaneous bacterial peritonitis (15/21 vs 2/18) (P < 0.001). Mortality during the first episode was 36% in patients with spontaneous bacterial peritonitis and 46% in patients with culture-negative neutrocytic ascites (NS). Mortality during follow-up was high and survival probability at 12 months was 32% in spontaneous bacterial peritonitis and 31% in culture-negative neutrocytic ascites. The probability of recurrence at 12 months was 33% in spontaneous bacterial peritonitis and 34% in culture-negative neutrocytic ascites. Our results show that spontaneous bacterial peritonitis and culture-negative neutrocytic ascites are variants of the same disease with a high mortality and poor prognosis.
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PMID:Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease. 139 94

Health workers took blood examples from 130 9-70 year old patients with liver cirrhosis admitted to the Department of Gastroenterology at BYL Nair Hospital in Bombay, India, between January 1990 and February 1992. Since patients with liver cirrhosis tend to undergo many blood transfusions in emergency situations, because of vomiting blood, researchers wanted to determine whether an association exists between HIV infection and liver cirrhosis. Laboratory personnel tested the samples for anti-HIV antibodies using first the ELISA and then confirming positive samples with the Western Blot (WB) test. The ELISA revealed 11 positive samples (5 were WB positive; 4 were WB negative, and 2 had indeterminate results) and the WB confirmed 5 HIV positive cases (all being 20 to 50 year old males). Thus, the HIV seroprevalence was 3.8% among the liver cirrhosis cases. 1 HIV-positive patient had earlier engaged in homosexual intercourse, 2 others had had multiple sexual partners. 4 HIV=positive patients had chronic alcoholism. 1 HIV-positive patient suffered from extensive intra abdominal tuberculosis and died during his hospital stay. None of the HIV-positive patients had earlier undergone a blood transfusion. The researchers called for more studies to confirm a relationship between HIV infection and liver cirrhosis with or without alcoholism.
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PMID:HIV infection in patients of liver cirrhosis. 139 3

A prospective evaluation was conducted of 94 unselected patients ("all comers") with biopsy-proven Child's class C cirrhosis (93% alcoholic) and endoscopically proven acutely bleeding esophageal varices who underwent emergency portacaval shunt (EPCS) (85% side-to-side, 15% end-to-side) within 8 hours of initial contact (mean, 6.1 hours) during the past 12 years. Follow-up has been 100% and includes all patients for at least 1 year, and 61 patients (65%) for 5 to 12 years. Incidence of serious risk factors on initial contact was: ascites, 97%; jaundice, 86%; portal-systemic encephalopathy including past history, 71%; severe muscle wasting, 96%; alcohol ingestion within 7 days, 66%; delirium tremens, 16%; serum albumin, less than or equal to 2.5 g/dL 76%; indocyanine green dye retention greater than or equal to 50% in 45 minutes, 66%; serum glutamic-oxaloacetic transaminase greater than or equal to 100 units/L, 60%; hyperdynamic cardiac output greater than or equal to 6 L/minute, 98%. Mean Child's point score was 13.7 out of a maximum of 15. EPCS reduced mean corrected free portal pressure from 286 to 23 mm saline, and permanently controlled variceal bleeding in every patient. Of the 94 patients, 74 (80%) left the hospital alive and 68 (72%) survived 1 year. Five-year actuarial survival rate is 64%. Hepatic failure was the main cause of death during initial hospitalization as well as during follow-up, when it was related to continued alcoholism. Portal-systemic encephalopathy, which was present on initial contact in 55% of patients, occurred at some time during follow-up in 18.7%, but was recurrent and required dietary protein restriction in only 9%, all of whom had resumed alcoholism. The low incidence of portal-systemic encephalopathy was attributable to the lifelong program of follow-up with regular dietary counseling and continued emphasis on both protein restriction to 60 g/day and abstinence from alcohol. Abstinence was sustained in 69%, liver function improved in 82%, general health was judged excellent or good in 73%, and Child's risk class converted to class B in 73% and class A in 21%. Excluding retirees because of age, 42% were gainfully employed or engaged in full-time housekeeping. Long-term shunt patency was documented in 100% of survivors by yearly angiography or Doppler ultrasonography. It is concluded that EPCS within 8 hours of initial contact permanently controls variceal hemorrhage and results in prolonged survival and a life of acceptable quality in many alcoholic cirrhotic patients in Child's class C.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Is portal-systemic shunt worthwhile in Child's class C cirrhosis? Long-term results of emergency shunt in 94 patients with bleeding varices. 141 75

Although in demand, there is only limited information available regarding the patterns of mortality among Natives in Canada. Mortality rates for residents of Canadian Indian Reserves (IRs) and Registered Indians were calculated for the periods 1979-1988 and 1981 respectively. Proportionate mortality ratios and age-standardized mortality rates for residents of Indian Reserves were similar to those obtained for Registered Indians. Standardized mortality ratios were calculated using both Canadian mortality and mortality in selected isolated rural populations as references. Dramatically increased risks were observed among Native populations for mortality from alcoholism/liver cirrhosis, homicide, suicide and pneumonia. While SMRs calculated using mortality rates in rural populations appeared to be preferable to those using Canadian rates, the use of Canadian rates does not alter the conclusion that IRs have significantly elevated mortality from environmental and social causes which, although improving, require continuing control efforts.
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PMID:Indian Reserve and registered Indian mortality in Canada. 147 61


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