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)

Conventional treatment of esophageal cancer with surgery or radiation alone has afforded few long-term survivors. In order to improve outcome and determine the efficacy of a combined modality approach, this prospective study was performed. Between May 1993 and August 1994, 27 patients with loco-regional squamous cell carcinoma of the esophagus were treated with 2 courses of combined fluorouracil(1000mg per square meter of body-surface area daily for 5 days) and cisplatin(60mg per square meter on the first day)(D1 and D29) plus 48Gy of radiation therapy(RT) over 4 weeks. A transhiatal esophagectomy was planned 3-4 weeks after chemoradiotherapy. Twenty-seven patients completed a full course of therapy. Clinical response was evaluable in 26 patients: 22 patients showed improvement and relief from dysphagia, 2 patients stable disease, and 2 patients progression. One patient died of sepsis 1 week after completion of chemoradiotherapy and was excluded from the analysis. Ten patients underwent operation after chemoradiation. Of them, 5 showed complete histologic response. One of the complete responders died of recurred disease 8.5months after operation, the other 2 patients died of sudden death, and sepsis from wound deheiscence 7 days after operation, respectively. Nine patients refused operation because of excellent relief of their dysphagia and 6 patients were denied because of disease progression(2), fear of operations(2), old age and family member's disapprovement(1), and underlying liver cirrhosis(1). The last one patient was awaiting for operation. Of 13 patients who refused or denied operation, 6 patients finished further chemotherapy and radiatherapy(external radiation 1200 cGy+intracavitary radiation 900 cGy, 2 cycles of 5FU+cisplatin). This intensive preoperative chemoradiotherapy is feasible, and allows for a high rate of resectability and a high rate of complete pathologic response in a locoregional esophageal cancer. Toxicity is considerable but manageable. This study warrants further investigation.
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PMID:Preoperative chemoradiotherapy for locoregional esophageal cancer: preliminary report. 757 91

A population-based cohort of 120 Danish men, discharged with a hospital diagnosis of primary hemochromatosis from 1977 to 1989, was followed up to 1989 for subsequent cancer risk. Nineteen subjects (including 6 with primary liver cancers) were excluded from the analysis, either because they died within the same month of hemochromatosis diagnosis or because they had cancer prior to diagnosis of hemochromatosis. Among the 101 remaining subjects, 4 primary liver cancers occurred one year or more after the diagnosis of hemochromatosis, far surpassing the expected number based on incidence rates from the Danish population (standardized incidence ratio 92.9, 95% confidence interval 25.0 to 237.9). The excess of liver cancer was associated with cirrhosis and included cholangiocarcinoma as well as hepatocellular carcinoma. Significantly elevated risks were also observed for non-hepatic cancers (13 cases; SIR 3.5, 95% CI 1.9 to 6.0), notably esophageal cancer (2 cases; SIR 42.9, 95% CI 4.8 to 154.9) and skin melanoma (2 cases; SIR 27.8, 95% CI 3.1 to 100.3). The results of this population-based study are in accordance with the hypothesis that patients with primary hemochromatosis have a substantial risk of primary liver cancer. Further studies of hemochromatosis may be useful in clarifying the relation of non-hepatic malignancies to body iron stores in the general population.
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PMID:Cancer risk following primary hemochromatosis: a population-based cohort study in Denmark. 782 8

National Prohibition in the USA (1919-1933) was followed by an era in which medical scientists played an important role in minimizing the harmful effects of alcohol. Cirrhosis, cardiomyopathy, adverse fetal effects, and esophageal cancer are examples of alcohol-related health problems that were well known at the beginning of the 20th century but were dismissed during the late 1930's and early 1940's, only to be rediscovered during the 1960's and afterwards. This eclipse in knowledge occurred because of skepticism about earlier claims that had been made in the name of scientific temperance and, most importantly, because of changing standards for medical evidence. The paradigm for disease causation that gave birth to modern medicine was based on microbiology and reinforced by hormone and nutrition discoveries. Most alcohol-related health problems are poorly explained by this paradigm. The more recent epidemiologic paradigm for noninfectious disease is more applicable to the health risks associated with heavy drinking. A transformation of knowledge about alcohol's relationship to disease has occurred.
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PMID:The post-repeal eclipse in knowledge about the harmful effects of alcohol. 832 65

Historical records were used to reconstruct an outbreak of chlorance and acute liver toxicity due to chlorinated naphthalene exposure at a New York State plant which manufactured "Navy cables" during World War II. A cohort mortality study was conducted of the population (n = 9,028) employed at the plant from 1940 to 1944. Vital status was followed through December 31, 1985. The study found an excess of deaths from cirrhosis of the liver [observed (OBS) = 150; standardized mortality ratio (SMR) = 1.84; 95% confidence interval (CI) = 1.56-2.16]; cirrhosis deaths were elevated to a similar degree in the 460 individuals who had chlorance (OBS = 8; SMR = 1.51; CI = 0.65-2.98). The SMR for "non-alcoholic cirrhosis" (OBS = 83; SMR = 1.67; CI = 1.33-2.07) was similar to the SMR for "alcoholic cirrhosis" (OBS = 59; SMR = 1.96; CI = 1.49-2.53). There was no evidence for increased alcoholism in the overall cohort based on mortality from alcohol-related causes of death other than cirrhosis (SMR for esophageal cancer = 1.01 and for deaths from alcoholism = 0.99). We conclude that the excess mortality from cirrhosis of the liver observed in this cohort is due to the chronic effect of chlorinated naphthalene exposure.
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PMID:Acute and chronic liver toxicity resulting from exposure to chlorinated naphthalenes at a cable manufacturing plant during World War II. 884 54

Genetic polymorphisms of various cytochromes P450 have recently been described and could be implicated in the individual susceptibility of alcoholics to ethanol-related diseases. Rsal and Dral polymorphisms of CYP2E1 and Mspl polymorphism of CYP1A1 were studied in 260 controls and 511 alcoholic patients, without any clinical symptoms (n = 202) or with various ethanol-related diseases (n = 309), such as liver cirrhosis (n = 110), esophageal cancer (n = 62), upper aerodigestive tract cancer (n = 96), and other miscellaneous diseases (n = 41). Frequencies of the mutated alleles were found to be 2.5% (Rsal), 7.9% (Dral), and 8.7% (Mspl) in controls; 4%, 14.1%, and 12% in alcoholics without clinical symptoms; and 3.1%, 12.5%, and 11.2% in alcoholics with ethanol-related diseases. The only significant difference was found in the Dral polymorphism, whose frequency was enhanced in alcoholics with (p < 0.05) or without ethanol-related diseases (p < 0.01) when compared with controls. No differences were found between alcoholics without clinical symptoms and alcoholics with cirrhosis, esophageal cancer, or upper aerodigestive tract cancer. However, in liver cirrhosis and in ethanol-related cancers, the rare Dral-C allele was three times less frequent in patients under the age of 45 than in older patients, suggesting a protective role for this allele. In conclusion, our data indicate that the aforementioned mutations do not play a critical role in the development of cirrhosis, esophageal cancer, or upper aerodigestive tract cancers in Caucasians.
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PMID:Cytochromes P4502E1 and P4501A1 genotypes and susceptibility to cirrhosis or upper aerodigestive tract cancer in alcoholic caucasians. 889 24

Primary double cancers of the liver and esophagus are extremely rare. Only 7 cases, both cancers resected, were reported. A 2 stage surgical procedure has been recommended for such a case. We experienced 3 consecutive patients who underwent successful simultaneous radical resection with a good outcome. Case 1 with an advanced esophageal cancer (EC) and hepatocellular carcinoma (HCC) without liver dysfunction received subtotal esophagectomy and posterior segmentectomy of the liver under a thoraco-laparotomy. Case 2, with an early stage EC and HCC with Child A cirrhosis, received the same surgical procedures as case 1 to complete stanching under good visibility for esophagectomy, because of his bleeding tendency due to liver dysfunction. But post operative bleeding from the thoracic cavity continued for 5 consecutive postoperative days. Case 3, with an early stage EC and cholangiocellular carcinoma (CCC), underwent transhiatal esophagectomy and right hepatic lobectomy under laparotomy. All cases received active enteral nutritional (EN) support from the early postoperative day with good outcomes. In conclusion, simultaneous radical resection for synchronous cancers of the esophagus and liver might be a possible indication for patients who have little or slight liver dysfunction. In the case with liver dysfunction, esophagectomy should be performed under thoracotomy, but transhiatal resection, for complete stanching, even in the early stage EC. Post-operative EN support is essential for these patients to obtain a good outcome.
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PMID:Procedures of simultaneous radical resection indicated for primary synchronous esophageal and liver cancers--from the personal experience of three cases. 890 74

Outcomes of surgery for gastric cancer or esophageal cancer in cirrhotic patients are not favorable. The preoperative assessment of liver function utilizing Child's classification or indocyanine green (ICG) excretion test can be a predictive factor of postoperative mortality. Operative risk is acceptable if patients are classified as Child's class A, and surgical procedures should be avoided in patients either classified as Child's class C or having ICG-R15 of 25% or more. To avoid postoperative complications, it is important to minimize the operative procedure and to ligate vessels instead of using electrocautery. Surgical stress and risk can further be reduced by a two stage operation for esophageal cancer and by gastrectomy with reduced lymph node dissection of D1 for gastric cancer. However, because curability of existing cancer is also required for surgical procedures, the status of liver cirrhosis and the stage of cancers should be considered in surgical treatment of gastric cancer or esophageal cancer in patients with liver cirrhosis.
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PMID:[Surgery for upper gastrointestinal diseases in cirrhotic patients]. 933 Mar 81

Drinking mutagenic downstream water from the Huangpu River was hypothesized to have increased the risk for male esophageal cancer in Shanghai, China. The authors conducted a population-based case-control study of a total of 71 esophageal cancer deaths and 1,122 controls collected during a 5-year follow-up period, 1984-1988, from four male cohorts born before January 1, 1944, living in four communities consuming water with different mutagenicities in the Shanghai area. The controls represented a 1% random sample of the defined living cohorts selected at the end of each of the 5 years of follow-up. Logistic regression showed an odds ratio of 2.77 (95% confidence interval: 1.52, 5.03) for drinking mutagenic downstream water from the river versus drinking nonmutagenic upstream water after controlling for possible confounders including age, disease history (hepatitis, cirrhosis, schistosomiasis, digestive tract ulcer), hazardous occupational history, pesticide exposure, lifestyle factors (cigarette smoking, tea intake, and alcohol intake), dietary habits (intake of pickled vegetables, maize, peanuts, and cured meat), education, poverty, urban environment, and water chlorination.
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PMID:Mutagenic drinking water and risk of male esophageal cancer: a population-based case-control study. 1047 43

We evaluated the mortality risk among 306 male alcoholics living in Osaka, Japan, at the time of initial diagnosis between 1972 and 1983, with regard to the cause of death, length of time from diagnosis, and participation in an alcohol abstinence self-help group. By the closing date on 1 March 1992, 110 of the 306 alcoholics had died, yielding an observed-to-expected (O/E) ratio of 4.5 [95% confidence interval (CI) = 3.7-5.4]. The alcoholics had significantly elevated mortality risks from all malignant neoplasms (O/E = 2.1, 95%CI = 1.2-3.3), esophageal cancer (O/E = 8.4, 95%CI = 1.7-24.5), diseases of the circulatory system (O/E = 4.4, 95%CI = 3.0-6.2), liver cirrhosis (O/E = 15.9, 95%CI = 10.2-23.6), diseases of the genitourinary system (O/E = 6.3, 95%CI = 1.3-18.5), and external death (O/E = 10.3, 95%CI = 6.3-15.8). The mortality risk from all causes still remained significantly high beyond the tenth year following initial diagnosis (O/E = 2.6, 95%CI = 1.0-6.2). The mortality risks from liver cirrhosis and external death (such as suicide) were highest within the first year following diagnosis, and were still high beyond the tenth year. A significantly high mortality risk from diseases of the circulatory system was observed between the first and ninth years, and the mortality risk from all malignant neoplasms was significantly elevated beyond 10 years following diagnosis. Alcoholics who did not join a self-help group soon after the initial institutional treatment had different cause-specific and time-specific mortality risks from those who did join a self-help group. These findings show the importance of long-term clinical follow-up of male alcoholics, taking into consideration the cause-specific mortality.
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PMID:Cause-specific mortality risk among male alcoholics residing in the Osaka metropolitan area. 1155 41

We performed venous shunt procedure in the reconstruction of the esophagus after esophagectomy using the gastric tube in two cases of esophageal cancer with portal hypertension due to liver cirrhosis. In both cases, the short-term postoperative course was uneventful, without congestion in the gastric tube. In Case 1 where the short gastric vein had been used as the shunt vein, the long-term postoperative course was also uneventful, without hepatic encephalopathy or hemorrhage from deterioration of the varices of the gastric tube. However, in Case 2 where the left gastroepiploic vein had been used, hepatic encephalopathy developed due to excessive shunt flow. These results suggested that appropriate shunt flow could be expected by using short gastric vein.
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PMID:Two cases of esophageal cancer with portal hypertension: esophagectomy with venous shunt procedure. 1181 94


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