Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We analyze retrospectively all bacteremic episodes seen between January and December, 1987 in our institution. From a total number of blood cultures performed of 897, 145 were positive (16%), and 67 of them considered as contamination (7.5%). There were 78 episodes of bacteremia in 74 patients, 38 males and 36 females. Forty-eight episodes were community-acquired and 30 were nosocomial bacteremia episodes. Aerobic bacteria were isolated in 64 cases, anaerobic bacteria in 9 cases and polymicrobial bacteremia in 5 cases. The most commonly isolated microorganism was S. epidermidis in nosocomial cases and E. coli in community-acquired cases. Predisposing conditions registered were diabetes mellitus in 16 cases (20%), cirrhosis of the liver in 3 (4%), corticosteroid therapy in 7 (9%) and surgical procedures in 19 (24%). Shock was seen in 16 cases (20%), DIC in 8 cases (10%) and ARDS in 5 (6.5%). Appropriate antibiotic treatment was used in 60 episodes (77%). Seventeen patients (22%) died. Prognostic factors identified were: nosocomial bacteremia (p less than 0.05), corticosteroid prior therapy (p less than 0.05), underlying disease UF or RF (p less than 0.0001) and the presence of shock (p less than 0.0001). Mean hospital stay was 20.1 days in bacteremic patients vs. 7.6 days in non bacteremic patients (p less than 0.00001).
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PMID:[Bacteremia in a community hospital. Review of 78 cases]. 193 41

In 1985, 100 episodes of klebsiella pneumoniae bacteremia in 98 patients were treated at the Veterans General Hospital--Taipei. The disease was community acquired in 58% and nosocomially acquired in 42%; unimicrobial in 86% and part of a polymicrobial bacteremia in 14%. Medical records of 90 episodes were available and were analyzed. Portals of entry, in decreasing order of frequency, were hepatobiliary (24%), respiratory (20%), and urinary tract (19%). Diabetes mellitus, which was found in 25 (28%) patients, was the most common underlying disease, followed by malignancies in 13 (14%), biliary tract abnormalities in 9 (10%), and cirrhosis of the liver in 8 (9%). The most frequent clinical findings were fever (89%) and leukocytosis (60%), followed by thrombocytopenia (27%), jaundice secondary to bacteremia (22%) and shock (21%). The course of one (1%) patient, who was diabetic and had a liver abscess, was complicated by metastatic septic endophthalmitis and meningitis. Overall case fatality was 46%. Poor prognostic factors included inappropriate antibiotic therapy, respiratory tract as a portal of entry and the presence of shock. Cephalosporins and aminoglycosides were the most active antibiotics. The use of one or more antibiotics, which included at least one cephalosporin, with in vitro activity against the corresponding isolate, with adequate dosage and an appropriate route of administration significantly reduced deaths directly attributed to K. pneumoniae septicemia, 32% (18/57), compared with 88% (21/24) in patients who were not treated appropriately (p less than 0.001). Combination therapy with a cephalosporin and aminoglycoside in conjunction with surgery in selected cases is the treatment of choice for K. pneumoniae bacteremia.
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PMID:Klebsiella pneumoniae bacteremia: analysis of 100 episodes. 198 35

Hispanics are the fastest growing minority in the United States. Typically, they are divided into five subgroups: Mexican American, Puerto Rican, Cuban American, Central or South American, and "other" Hispanics. Risk factors for morbidity and mortality vary among these subgroups. Use of health care services is affected by perceived health care needs, insurance status, income, culture, and language. Compared with whites, Hispanics are more likely to live in poverty, be unemployed or underemployed, and have little education and no private insurance. Hispanics are at an increased risk for certain medical conditions, including diabetes, hypertension, tuberculosis, human immunodeficiency virus infection, alcoholism, cirrhosis, specific cancers, and violent deaths. Proportionate to their representation in the population, there are few Hispanic health providers, emphasizing the need for all medical personnel to be knowledgeable about Hispanic health care needs.
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PMID:Hispanic health in the United States. Council on Scientific Affairs. 198 56

The nosological classification of chronic liver disease (CLD) seems to be unsatisfactory when clinical problems are faced such as the liver cirrhosis-diabetes mellitus and the autoimmune diseases-primary biliary cirrhosis (PBC) associations; the concept of PBC as a systemic disease; the multiorgan involvement of chronic active hepatitis. Accordingly, the Authors hypothesize that the present histopathological-based nosology of CLD will be modified as a result of a better understanding of the varied metabolic and immunologic derangements induced by CLD.
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PMID:[Need of updating hepatological nosology]. 202 77

The 15 year mortality rates and causes of death are reported for the Paris Prospective Study cohort of 7180 working men, aged between 44 and 55 years who attended the first follow-up examination. All subjects were classified as normoglycaemic, impaired glucose tolerant or diabetic according to the WHO criteria, following an oral glucose tolerance test. The relative risks of death in comparison to the normoglycaemic group were 1.6 for impaired glucose tolerant and 2.3 for diabetic subjects; for death due to coronary heart disease: 1.7 and 2.3 respectively; for death due to alcohol and cirrhosis: 7.0 and 13.3 respectively. It appears that in this cohort a proportion of subjects screened as diabetic have impaired liver function and disturbed carbohydrate metabolism, due to excessive alcohol consumption. Alcohol should be investigated as a possible risk factor for diabetes, particularly in epidemiological studies where diabetes is diagnosed by the oral glucose tolerance test and the population has a high consumption of alcohol.
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PMID:The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective Study after 15 years of follow-up. 203 51

Alcoholic liver disease includes steatosis, alcoholic hepatitis and cirrhosis. Other liver diseases of genetic origin, but with a curious association with alcohol intake, are hemochromatosis and porphyria cutanea tarda. The attribution of chronic hepatitis to alcohol intake remains speculative, and the association may reflect hepatitis C infection. Hepatic injury attributed to alcohol includes the changes reported in the fetal alcohol syndrome. Steatosis, the characteristic consequence of excess alcohol intake, is usually macrovesicular and rarely microvesicular. Acute intrahepatic cholestasis, which in rare instances accompanies steatosis, must be distinguished from other causes of intrahepatic cholestasis (e.g., drug-induced) and from mechanical obstruction of the intrahepatic bile ducts (e.g., pancreatitis, choledocholithiasis) before being accepted. Alcoholic hepatitis (steatonecrosis) is characterized by a constellation of lesions: steatosis, Mallory bodies (with or without a neutrophilic inflammatory response), megamitochondria, occlusive lesions of terminal hepatic venules, and a lattice-like pattern of pericellular fibrosis. All these lesions mainly affect zone 3 of the hepatic acinus. Other changes, observed at the ultrastructural level, are of importance in progression of the disease. They include widespread cytoplasmic shedding, and capillarization and defenestration of sinusoids. Progressive fibrosis complicating alcoholic hepatitis eventually leads to cirrhosis that is typically micronodular but can evolve to a mixed or macronodular pattern. Hepatocellular carcinoma occurs in 5 to 15% of patients with alcoholic liver disease. The clinical syndrome of alcoholic liver disease is the result of three factors--parenchymal insufficiency, portal hypertension and the clinical consequences of extrahepatic damage produced by alcohol. At the several phases of the life history of alcoholic liver disease, the individual factors play a different role. The clinical manifestations of alcoholic steatosis are mainly extrahepatic in origin. Those of alcoholic hepatitis reflect mainly parenchymal insufficiency and those of cirrhosis are mainly those of portal hypertension. Alcoholic liver injury appears to be generated by the effects of ethanol metabolism and the toxic effects of acetaldehyde, perhaps the immune responses to alcohol- or acetaldehyde-altered proteins, and questionably enhanced by viral hepatitis. Alcoholic hepatitis may be mimicked histologically, and to a varying degree clinically, by a number of conditions (obesity, diabetes, several drug-induced injuries, jejunoileal bypass, and related "shortcircuiting" of the bowel). Perhaps the most important facet of the hepatotoxicity of alcohol is its enhancement of the effects of a number of other hepatotoxic agents, among which acetaminophen is the prime example.
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PMID:Alcoholic liver disease: pathologic, pathogenetic and clinical aspects. 205 45

Alcohol-like liver disease may be observed in patients with obesity or non insulin-dependent diabetes, or after treatment with such antianginal drugs as amiodarone and perhexiline maleate. In such cases cirrhosis is associated, at histology, with foci of acidophilic necroris, Mallory's bodies and inflammatory neutrophilic infiltrates. Alcohol-like liver disease is rare. It affects mostly women in their fifties and usually is clinically latent. Abnormalities of liver function tests mainly consist of increased serum aminotransferase levels. Complications of portal hypertension are uncommon. The pathogenesis of the disease remains purely hypothetical. In practice, in the absence of antianginal therapy the finding of cirrhosis in an obese and/or diabetic patient should prompt a search for excessive alcohol consumption before ascribing the cirrhosis to obesity and/or diabetes.
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PMID:[Pseudo-alcoholic cirrhosis]. 206 19

This study investigated the long-term survival rates of 85 patients with hereditary hemochromatosis. Eighty-five patients with documented hereditary hemochromatosis diagnosed between 1958 and 1989 and followed up at the University Hospital (University of Western Ontario) medical center were retrospectively reviewed for this analysis. The current status of the patient was assessed by interview or written questionnaire completed by the patient or the family physician. Estimates of differences in survival rates were obtained using Kaplan-Meier life-table and Cox regression analysis. Liver histology, clinical features of the disease, and number of venesections were analyzed to determine their relationship to survival. In the course of a mean follow-up interval of 8.1 +/- 6.8 years (range, 0-31 years), there were 17 deaths among the 85 hemochromatosis patients. Patients with cirrhosis at the time of diagnosis were 5.5 times more likely to die than noncirrhotic patients. Patients who were noncirrhotic at the time of diagnosis had an estimated survival that was not significantly different from age- and sex-matched members of the normal population. Diabetes did not increase the risk of death after data were controlled for the presence of cirrhosis. Early diagnosis and treatment of hemochromatosis in the precirrhotic stage can lead to long-term survival similar to that in the general population. The presence of cirrhosis significantly increases mortality and is the major clinical factor affecting survival.
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PMID:Long-term survival analysis in hereditary hemochromatosis. 206 12

Risk factors for cholelithiasis were investigated in a case-control study conducted in northern Italy on 195 incident cases of gallstone disease requiring surgery (119 females, 76 males) and 1122 controls in hospital for acute, non-digestive tract, non-neoplastic conditions. There was no consistent association with socio-demographic indicators, such as marital status, education and social class nor with smoking and coffee consumption. The relative risk of cholelithiasis decreased with increasing alcohol consumption: compared with non-drinkers, the odds ratio (OR) was 0.8 for one to three drinks per day and 0.5 for over three. A direct association was observed with measures of body weight: relative to leaner individuals, the multivariate ORs were 1.2, 2.1 and 2.4 for subsequent levels of body mass. These trends in risk were statistically significant, consistent in the two sexes, and not apparently modified by adjustment for major identified potential confounding factors. History of hepatitis and liver cirrhosis were reported more frequently by cases, but it is difficult to assess the role of recall bias on these risk factors. No association was found with diabetes, thyroid disease and several digestive tract disorders. For females, no consistent pattern of risk was observed up to four births, but women with five or more births had an OR of 2.9 (95% confidence interval (Cl) = 1.1-7.3). The risk decreased with increasing age at first and last birth, both trends being statistically significant. Overweight and alcohol consumption were the most important risk and protective factors respectively for cholelithiasis requiring surgical intervention in this population.
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PMID:Risk factors for gallstone disease requiring surgery. 206 22

Glucose intolerance often occurs in liver cirrhosis; therefore a long-term control of plasma glucose levels appears to be important. For this purpose glycated hemoglobin A (HbA1c) determination is proposed as a suitable method, while no data are available on fructosamine test. In 98 cirrhotic patients serum fructosamine and HbA1c levels were compared with those of normal controls and among cirrhotic patients grouped in non glucose-intolerant and with non insulin-dependent (NIDDM) or insulin-dependent diabetes mellitus (IDDM). The mean HbA1c values of cirrhotic patients with normal glycemic control were significantly lower than normal, and only a few IDDM and NIDDM cirrhotic patients showed high values of HbA1c, indicating that HbA1c is often underestimated in these patients. On the contrary, serum fructosamine levels were on the average higher than normal in nondiabetic patients, but they were significantly higher in IDDM and NIDDM patients than in nondiabetics, and the 72% of NIDDM and 85% of IDDM patients had fructosamine levels higher than the upper normal value. In conclusion, in diabetic patients with liver cirrhosis fructosamine seems to be a more suitable test than HbA1c for monitoring blood glucose levels.
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PMID:Fructosamine and glycated hemoglobin as indices of glycemic control in patients with liver cirrhosis. 207 78


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