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

Hepadnaviruses (hepatitis B viruses) cause transient and chronic infections of the liver. Transient infections run a course of several months, and chronic infections are often lifelong. Chronic infections can lead to liver failure with cirrhosis and hepatocellular carcinoma. The replication strategy of these viruses has been described in great detail, but virus-host interactions leading to acute and chronic disease are still poorly understood. Studies on how the virus evades the immune response to cause prolonged transient infections with high-titer viremia and lifelong infections with an ongoing inflammation of the liver are still at an early stage, and the role of the virus in liver cancer is still elusive. The state of knowledge in this very active field is therefore reviewed with an emphasis on past accomplishments as well as goals for the future.
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PMID:Hepatitis B virus biology. 1070 74

Hemolysis is observed in more than 50% of patients with cirrhosis. However, there has been little documentation of the association of primary biliary cirrhosis with autoimmune hemolytic anemia. Two cases, found within a single practice, of primary biliary cirrhosis coexisting with autoimmune hemolysis and a third case coexisting with hereditary spherocytosis are presented. Anemia in such patients is commonly attributed to chronic disease, and hyperbilirubinemia is attributed to primary biliary cirrhosis. These patients were considered for liver transplantation until the diagnosis of a comorbid hemolytic process was established. This association may be more prevalent than previously recognized. A diagnosis of comorbid hemolysis must always be considered in context with anemia and serum bilirubin levels that rise out of proportion to the severity of the primary biliary cirrhosis.
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PMID:Primary biliary cirrhosis and hemolytic anemia confusing serum bilirubin levels. 1085 Dec 86

Hepatitis C is a chronic disease with lethal complications and recent treatments have a strong efficacy. Ribavirin and alpha interferon combination allows obtaining a sustained viral response in 40% of patients who are theoretically protected against the progression to cirrhosis and its complications. In non responders prospective trials are in progress assessing the efficacy of stronger regimen or using sustain-release interferons. It is also possible that in non responders interferon reduces the progression of liver fibrosis permitting to reduce cirrhosis incidence and to wait for new drugs. Patients who need definitively a treatment are patients with fibrosis progression, patients with extrahepatic manifestations and those who can transmit the virus. Treatment of HCV should be systematically discussed in patients coinfected with HIV and HCV.
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PMID:[Treatment and prevention of hepatitis C]. 1090 96

This report summarizes a state-of-the-art workshop held in September 1998 on the "Natural History and Outcome of Hepatitis C Infection". Sixteen Canadian and two internationally renowned hepatologists were invited. A practical classification of HCV infection served as a framework for the meeting. The concepts of modelling of chronic disease, the epidemiology of HCV infection before the introduction of anti-HCV testing, and the outcome of various forms of chronic hepatitis C in adults and children were presented. Lectures on the outcome of HCV cirrhosis, hepatocellular carcinoma, the role of liver transplantation, the influence of host factors on outcome, iron overload in chronic hepatitis C and possible modification of the natural history by antiviral therapy were followed by discussion and consensus statements pertaining to each presentation. "The European Experience in Assessing Chronic Hepatitis C" was presented by Prof G Dusheiko from the United Kingdom, and Prof Leonard Seeff from the National Institutes of Health (United States) presented "The Epidemiology and Outcome of Hepatitis C Infection in the United States and the World".
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PMID:Hepatitis C infection: its sequelae and outcomes--State-of-the-Art Workshop, September 24 to 25, 1998. Canadian Association for the Study of the Liver. 1093 6

It is estimated that over 350 million people live with a chronic hepatitis B virus (HBV) infection, claiming over one million deaths per year due to progress of the chronic disease to cirrhosis and/or hepatocellular carcinoma (HCC). An extended program of immunization including hepatitis B vaccine for children under one year of age has been launched in more than 110 countries. Recent studies conclude that mass hepatitis B immunization is effective in preventing HBV infection and has resulted in a decrease in the occurrence of HCC in children living in countries where hepatitis B is endemic. However, the vast majority of infected children live in the poorest developing countries in Africa and Asia that currently cannot afford the vaccine or lack the basic infrastructure necessary to deliver a national immunization service. The Global Alliance for Vaccines and Immunization (GAVI) was established in 1999 as an alliance of WHO, UNICEF, the World Bank, industry, foundations, and other partners to reinvent immunization for the 21st century, by forging a common vision and new ways of working together at global, regional and national levels. WHO recommends global elimination of hepatitis B by universal infant and/or adolescent immunization, but health planners in Sweden and the other Scandinavian countries, the Netherlands and UK have not yet been convinced of the cost-effectiveness of HB-prevention through routine childhood immunization with HB-vaccine. The inclusion of hepatitis B vaccine in already available multivalent vaccines may alter this situation in the future, but until then an intensified vaccination strategy aimed at those groups of individuals that are particularly at risk for hepatitis B should be adopted in accordance with the recommendations of The Swedish National Board of Health (SOSFS 1991:2) and local instructions from the County Medical Officer for Communicable Disease Control.
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PMID:[WHO spearheads global initiative to eradicate hepatitis B]. 1101 26

Infection with hepatitis C virus (HCV) represents a major public health concern today because of its prevalence in the United States. Acute HCV is commonly asymptomatic and often results in chronic disease. However, symptoms related to chronic disease may not appear for decades. Patients with HCV have a broad spectrum of symptoms, which vary from elevated liver function test results to cirrhosis, liver cancer and end stage liver disease. Past treatment therapies have not been highly effective; however, a new treatment is currently available. Today, many high-risk activities are associated with HCV infection. Blood transfusions are no longer a risk factor. However, 20% of individuals who received transfused blood products contracted hepatitis C nearly two decades ago. Therefore, cancer survivors who received blood products to combat chemotherapy induced anemia and thrombocytopenia before 1980 represent a population at risk. It is important that nurses caring for these patients understand the pathophysiology, etiology, transmission, and course of HCV. This knowledge will enable nurses to encourage serological testing to identify infected individuals. Once identified, patients with hepatitis C can receive social support and appropriate referrals to help them deal with the psychosocial issues related to long-term effects and secondary illnesses.
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PMID:Hepatitis C virus infection and long-term survivors of childhood cancer: issues for the pediatric oncology nurse. 1117 5

Palliative care in the elderly appropriately takes place within a spectrum of curative, rehabilitative, preventive, and chronic disease management interventions, and seeks to optimize quality of life. Setting priorities among numerous legitimate treatment goals is the central task in the care of chronically ill frail individuals. Decision-making can be challenging when the goal of providing comfort comes into conflict with the goal of prolonging life, and should be guided whenever possible by consistently expressed preferences of the patient. The assessment and relief of distressing physical and psychological symptoms should receive active attention at all stages in the care of the frail elderly, both in the context of acute medical and surgical interventions and during the terminal phase of life. Pain and dyspnea are frequently reported by significant proportions of elderly individuals hospitalized for chronic lung disease, heart failure, and cirrhosis as well as for malignancies. In the treatment of dementia, the types of interventions that improve quality of life will differ in the early and late phases of the illness.
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PMID:[Role of palliation in the care of the elderly]. 1150 13

Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease. It was first identified in 1989, as being distinct from hepatitis A and hepatitis B. The HCV does not attack the immune system, but rather causes an inflammatory reaction that is localized within the liver, involving the entire organ. About 80% of patients with acute hepatitis C will develop chronic HCV, of which about 20-30% will progress to cirrhosis and its consequences, over 10-20 years. After 20-40 years, a smaller proportion of patients with chronic disease will develop hepatocellular carcinoma. The course and outcome of the disease vary considerably. In some individuals, spontaneous remission occurs over a few years; in others, the disease is more severe, progressing to cirrhosis and end-stage liver disease. Despite biochemical and pathological confirmation of the diagnosis, patients are often asymptomatic for many years. Hepatic failure occurs late in the disease. Factors suggesting a poor prognosis include high serum transaminase levels, active cirrhosis on liver biopsy, and an increased viral load (HCV RNA), as well as associated medical conditions such as alcoholic liver disease, hepatitis B viral (HBV) infection, or human immunodeficiency virus (HIV). Nutrition has been recognized as a prognostic indicator in patients with chronic liver failure. However, standardized approaches for the diagnosis and classification of malnutrition in this population have not been consistently applied before implementing nutrition intervention. Common criteria for the assessment of malnutrition, weight and body mass index (BMI) for example, do not give accurate data in patients with chronic liver disease, complicated by ascites and edema. In addition, the chronic inflammatory reaction of liver failure progresses slowly, so that subtle nutritional deficits are not obvious at early stages of the disease. A review of the literature has been undertaken to identify current nutritional guidelines for patients with hepatitis C as well as chronic hepatitis.
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PMID:Nutritional guidelines for persons infected with the hepatitis C virus: a review of the literature. 1151 51

Plasma S-nitrosothiols are believed to function as a circulating form of nitric oxide that affects both vascular function and platelet aggregation. However, the formation of circulating S-nitrosothiols in relation to acute and chronic disease is largely unknown. Plasma S-nitrosothiols were measured by chemiluminescence in rats with biliary cirrhosis or controls, and the effect of lipopolysaccharide (LPS) on their formation was determined. Plasma S-nitrosothiols were increased in rats with cirrhosis (206 +/- 59 nM) compared to controls (51 +/- 6 nM, p <.001). Two hours following injection of LPS (0.5 mg/kg) plasma S-nitrosothiols increased to 108 +/- 23 nM in controls (p <.01) and to 1335 +/- 423 nM in cirrhotic rats (p <.001). The plasma clearance and half-life of S-nitrosoalbumin, the predominant circulating S-nitrosothiol, were similar in control and cirrhotic rats, confirming that the increased plasma concentrations were due to increased synthesis. Because reactive nitrogen species, such as peroxynitrite, may cause the formation of S-nitrosothiols in vivo, we determined the levels of nitrotyrosine by gas chromatography/mass spectrometry as an index for these nitrating and nitrosating radicals. Hepatic nitrotyrosine levels were increased at 7.0 +/- 1.2 ng/mg in cirrhotic rats compared to controls (2.0 +/- 0.2 ng/mg, p <.01). Hepatic nitrotyrosine levels increased by 2.3-fold and 1.5-fold in control and cirrhotic rats, respectively, at 2 h following injection of LPS (p <.01). Strong positive staining for nitrotyrosine was shown by immunohistochemistry in all the livers of the rats with cirrhosis. We conclude that there is increased formation of S-nitrosothiols and nitrotyrosine in biliary cirrhosis, and this is markedly upregulated during endotoxemia.
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PMID:Increased formation of S-nitrothiols and nitrotyrosine in cirrhotic rats during endotoxemia. 1155 17

(1) Rheumatoid arthritis, a chronic disease, is defined by a set of clinical, radiological and biochemical criteria. The diagnosis is initially uncertain. (2) Many patients have functional disability 10 years after onset, while others may have little or none. (3) The symptomatic and long-term efficacy of physical (nondrug, nonsurgical) therapies is poorly documented. (4) Various surgical approaches may restore a degree of functional capacity. (5) The use of paracetamol, possibly combined with codeine, can avoid recourse to nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are the best-assessed analgesics in this setting but carry a risk of severe adverse effects. (6) All long term treatments for rheumatoid arthritis carry a risk of severe adverse effects, and their chronic effects are poorly documented. There is no firm evidence that long term treatments reduce the risk of serious disability or death. (7) Methotrexate is the best-tolerated slow-acting antirheumatic in the medium term, despite a risk of hepatic cirrhosis, pulmonary fibrosis and haematological disorders. (8) Hydroxychloroquine and sulfasalazine are less effective. Hydroxychloroquine carries a risk of retinal damage, while sulfasalazine can cause haematological disorders and skin problems. Chloroquine seems to be slightly more effective than hydroxychloroquine, but at the cost of more adverse effects. (9) The adverse effects of D-penicillamine and injectable gold salts often require treatment withdrawal. (10) The risks associated with immunosuppressants such as ciclosporin mean that these agents should not be used for first-line treatment. (11) The place of various combinations of slow-acting antirheumatics remains to be established. (12) Recourse to systemic steroids must be minimised but is sometimes unavoidable. Low doses are usually adequate. (13) Treatment risks in elderly subjects and patients with comorbidity must be taken into account. (14) Women and men of child-bearing potential who have rheumatoid arthritis must be warned about the toxicity of antirheumatic drugs for the fetus and the effects on fertility.
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PMID:Treatment of rheumatoid arthritis: unknown long-term effects. 1171 62


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