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

Two cases with spontaneous regression of a histologically confirmed hepatocellular carcinoma (HCC) are presented. This rarely seen phenomenon of a spontaneous tumor involution is discussed and compared with the current literature. The clinical symptoms were very similar to that of a liver abscess. A 56-year-old male suffered from a multicentric, highly differentiated, trabecular HCC. First symptoms were epigastric pain, septic fever and arthritis. The tumor marker AFP was constantly normal and no hepatitis could be verified. A resection of the tumor was performed. In patient 2, a 74-year-old male, a multicentric, clear cell HCC was found. The patient had completely recovered from hepatitis type B and within the liver tissue no viruses could be identified. Clinical symptoms were mainly characterized by upper abdominal pain and septic fever. AFP was excessively elevated (3850 ng/ml) but returned to normal preoperatively. In both cases, the specimen showed a subtotal necrotic HCC with insignificant amounts of vital tumor cells. Neither patient had a liver cirrhosis macroscopically, however patient 2 had local periportal fibrosis histologically. After 24 and 41 months of follow-up, respectively, both patients are in good health
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PMID:Spontaneous regression of hepatocellular carcinoma confirmed by surgical specimen: report of two cases and review of the literature. 992 45

Primary hemochromatosis is rare in Taiwan. Hepatocellular carcinoma (HCC) is endemic in Taiwan, but HCC with initial presentation as pyogenic liver abscess is unusual. We report a case of HCC presenting as pyogenic liver abscess in a hemochromatotic patient with cirrhosis. The patient underwent hepatectomy and had a smooth postoperative course. Unfortunately, he died of pneumonia eight months after surgery. HCC should be considered in the differential diagnosis in hemochromatotic patients with a pyogenic liver abscess.
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PMID:Hepatocellular carcinoma presenting as a pyogenic liver abscess in a patient with hemochromatosis. 1064 51

We carried out a molecular characteristic-based epidemiological survey of various hepatitis viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), and GB virus C (GBV-C)/hepatitis G virus (HGV), in Myanmar. The study population of 403 subjects consisted of 213 healthy individuals residing in the city of Yangon, Myanmar, and the surrounding suburbs and 190 liver disease patients (155 virus-related liver disease patients and 35 nonviral disease patients). The infection rates of the viruses among the 213 healthy subjects were as follows: 8% for HBV (16 patients), 2% for HCV (4 patients), and 8% for GBV-C/HGV (17 patients). In contrast, for 155 patients with acute hepatitis, chronic hepatitis, liver cirrhosis, or hepatocellular carcinoma, the infection rates were 30% for HBV (46 patients), 27% for HCV (41 patients), and 11% for GBV-C/HGV (17 patients). In the nonviral liver disease group of 35 patients with alcoholic liver disease, fatty liver, liver abscess, and biliary disease, the infection rates were 6% for HBV (2 patients), 20% for HCV (7 patients), and 26% for GBV-C/HGV (9 patients). The most common viral genotypes were type C of HBV (77%), type 3b of HCV (67%), and type 2 of GBV-C/HGV (67%). Moreover, testing for HEV among 371 subjects resulted in the detection of anti-HEV immunoglobulin G (IgG) in 117 patients (32%). The age prevalence of anti-HEV IgG was 3% for patients younger than 20 years and 30% or more for patients 20 years of age or older. Furthermore, a high prevalence of anti-HEV IgG (24%) was also found in swine living together with humans in Yangon. These results suggest that these hepatitis virus infections are widespread in Myanmar and have led to a high incidence of acute and chronic liver disease patients in the region.
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PMID:Molecular characteristic-based epidemiology of hepatitis B, C, and E viruses and GB virus C/hepatitis G virus in Myanmar. 1128 83

Although patients with cirrhosis of the liver show relative immunosuppression and therefore have increased susceptibility to most infections, they rarely develop liver abscesses. In a retrospective case review, the pathogens causing the liver abscesses observed, between January 1992 and December 2001 at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 44 hospitalized patients diagnosed as cases of liver cirrhosis were investigated. The most common clinical symptoms and signs of the abscesses--abdominal pain (80%), fever and chills (73%), and abdominal tenderness (73%)--were similar to those seen in non-cirrhotic patients with abscesses. The frequency of liver abscess among the cirrhotic patients was low (0.46%). Most (71%) of the abscesses were in the right lobe and most (71%) of those with abscesses only had a single abscess. Surprisingly, many of the abscesses (36%) were apparently caused by amoebae. Bacterial pathogens were identified in eight patients (18%) by blood culture and 15 (34%) patients by pus culture. Seven (16%) of the blood cultures and 13 (30%) of the pus contained Gram-negative aerobes, indicating that such pathogens, particularly Klebsiella pneumoniae (in six pus and six blood cultures) and Escherichia coli (in three pus cultures and one blood), were the most common causes of the bacterial abscesses. Pus culture appeared more successful than blood culture for bacterial abscesses, and amoebic abscesses could always be identified by direct microscopical examination of pus samples. Aspiration of liver abscesses, to obtain pus samples for culture and microscopy, is therefore recommended.
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PMID:Causative agents of liver abscess in those with liver cirrhosis: a 10-year case review of hospitalized patients in Thailand. 1219 12

The majority of patients with primary or metastatic liver tumors are not candidates for resection because of the size, location, or multifocality of their tumors, or because of inadequate hepatic function related to cirrhosis. Radiofrequency ablation (RFA) is an evolving technique for treating patients with unresectable primary or metastatic liver cancers. After obtaining the approval of our institutional review board for this study, 12 patients with HCC and 6 patients with metastatic liver tumors were treated using the LeVeen RF ablation system at the Department of Surgery of Osaka National Hospital between March 2000 and February 2002. Informed consent was obtained from all patients. Ultrasound-guided RFA was done during open surgery. In 12 patients, RFA was performed during laparotomy, while in 6 patients it was done transdiaphragmatically during thoracotomy. All treated tumors showed complete necrosis on imaging after the completion of RFA. After a median follow-up period of 288 days, the tumor had recurred in 5 out of 18 patients, and the median overall survival rate was 362 days. No deaths or major complications occurred in these 18 patients. Liver function tests (ALT, AST, GGT) that were elevated after RFA returned to baseline in most patients by day 7. In 5 patients who underwent RFA at laparotomy, bile leakage and liver abscess developed. There were no cases of bile duct injury or liver abscess in the patients receiving transdiaphragmatic RFA. In conclusion, transdiaphragmatic RFA during thoracotomy is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies.
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PMID:[Transdiaphragmatic radiofrequency ablation of malignant liver tumors]. 1248 43

Radiofrequency (RF)-assisted thermal ablation has been used with increasing frequency for unresectable hepatic tumors. This new approach employs RF energy to coagulate the liver at the hepatic resection line after which hepatic resection is performed with the use of a common scalpel. This procedure was used in three patients with hepatocellular carcinoma and in five patients with colorectal metastasis to the liver. These eight patients underwent a total of two left bisegmentectomies, three segmentectomies, and seven wedge resections. Mean operative time was 220 minutes. A mean of 78 sessions of RF-assisted ablation were required for these resections. Mean blood loss was 46 ml; no device other than RF ablation was required to obtain hemostasis. None of the patients needed a blood transfusion. Preoperative hemoglobin was 12.8 gm/dl and postoperative hemoglobin was 11.3 gm/dl. There were no perioperative deaths. Postoperative complications occurred in two patients: a liver abscess in one and heart failure in the other. The mean hospital stay was 9.4 days. This new approach, integrated with other techniques, reduces blood loss and coagulates the margins of resection during liver surgery. This new technique has two limitations: (1) it cannot be applied near main portal pedicles, and (2) it requires a long operative time. The best indication for this technique is when segmentectomy is required in patients with cirrhosis. Its role in major hepatic resections has yet to be determined. Further progress in the development of thermal ablation techniques and experience gained during the learning curve should help reduce the operative time, thereby improving the safety and efficacy of this procedure.
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PMID:Radiofrequency-assisted liver resection. 1312 59

Cases of isolated tuberculous liver abscess are rare. The diagnosis is often delayed or missed because of nonspecific symptoms and the disease's rare occurrence. Less than 25 cases have been documented in the imaging literature to date. This report demonstrates the difficulty in correctly diagnosing local hepatic tuberculosis. We report the case of a 56-year-old male with hepatitis C-related liver cirrhosis and end-stage renal disease treated with hemodialysis, who developed intermittent fever and hepatomegaly with unusual multiple hyperechoic hepatic lesions on ultrasound. To our knowledge, this is only the second reported case of hyperechoic mass-like hepatic lesions on ultrasound and the only case without pulmonary involvement. A greater awareness of this rare clinical entity may prevent needless surgical interventions, because the prognosis of hepatic tuberculous abscess is good for the majority of patients if diagnosed early and prompt, effective treatment is administered.
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PMID:Isolated tuberculous liver abscesses with multiple hyperechoic masses on ultrasound: a case report and review of the literature. 1470 95

Half of cirrhosis patients die within two years after diagnosis, in most cases from cirrhosis related causes; most frequently variceal bleeding closely followed by infections. There seems to exist associations between infection and other complications such as malnutrition, hepatic encephalopathy and variceal bleeding. Cirrhosis patients have an acquired immune deficiency because of dyshomeostasis and malnutrition. All host defence systems are compromised, e.g. the acute phase response, and macrophage, neutrocyte, and lymphocyte functions. Simultaneously, there is increased microbiotic invasion, due to increased nosocomial exposure, intestinal translocation, aspiration, skin lesions, and trauma. Compared to the background population, the mortality of infections is more than 20 times increased in cirrhosis. The incidence of peritonitis, bacteremia, urinary tract infection, pneumonia, meningitis, tuberculosis, liver abscess is increased more than tenfold, and the mortality of each episode 3-10 times higher. The systemic response and accompanying classical symptoms are usually weakened. When positive isolates can be obtained the flora tends to be of an opportunistic nature. Infection should be suspected in any cirrhotic patient with an unexpected deterioration of clinical course. Treatment should be started on suspicion and with large dose broad-spectrum antibiotics (avoiding aminoglycosides). Antibiotic prophylaxis is efficacious at variceal bleeding, recurrent peritonitis, and at very low protein ascites, but otherwise is associated with risk of infection with multi-resistant strains.
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PMID:Cirrhosis and bacterial infections. 1472 75

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.
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PMID:[A case of Salmonella liver abscess]. 1663 85

A 63-year-old woman was admitted for cholecystitis and underwent a laparoscopic cholecystectomy (LC). She experienced abdominal pain and hemobilia 11 days after the LC. Angiography was performed but it did not show any source of bleeding. Thereafter, at 27 days after LC, a repeat angiogram was performed which revealed a pseudoaneurysm (PA) arising from a cystic artery stump and an embolized PA sack. However, another PA arising from near the embolized PA and liver abscess was observed 4 days after embolization. The arterial collateral flow was evaluated by endovascular balloon occlusion of the right hepatic artery and it was embolized proximal and distal to the bleeding point. The embolization of the partial hepatic artery was effective for PA when packing the PA sack proved to be insufficient. In patients with liver cirrhosis or liver abscess who require an adequate arterial liver flow, it is important to evaluate the collateral arterial flow before hepatic artery embolization.
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PMID:Hemobilia and cystic artery stump pseudoaneurysm associated with liver abscess after a laparoscopic cholecystectomy: report of a case. 1851 42


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