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

Pleural effusion (PE) has been increasingly diagnosed over the last eight years in the Department of Internal Medicine of the Centre Hospitalier of Kigali, Rwanda. To determine the etiology of PE and to examine its possible association with HIV-1 infection and tuberculosis (TB), the authors performed an etiological work-up, including thoracocentesis and pleural punch biopsy, of all new patients with PE of undetermined etiology referred to the Division of Pulmonary Diseases at the hospital between September 14, 1988, and October 16, 1989. 81 men and 46 women of mean age 34 years were enrolled in the study. Pleural TB was diagnosed in 86% and confirmed histologically and/or bacteriologically in 82%. 82 of the 98 pleural TB patients tested for antibody to HIV-1 were HIV-1-seropositive. Metastatic cancer was responsible for PE in six patients, Kaposi's sarcoma in three, lymphoma in one, anaplastic carcinoma in one, and adenocarcinoma in one. Non-TB pneumonia was documented in five patients and was associated with HIV-1 infection in four. Other causes of PE were congestive heart failure, decompensated cirrhosis, constrictive pericarditis, or undetermined; only one of these latter patients was HIV-seropositive. The authors therefore found TB to be the predominant cause of PE and it is strongly associated with HIV-1 infection. In an African area highly endemic for HIV-1 and Mycobacterium tuberculosis co-infection, PE should therefore be considered a good marker of TB as well as HIV-1 infection.
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PMID:Pleural effusion, tuberculosis and HIV-1 infection in Kigali, Rwanda. 844 20

Large volume paracentesis (LVP) is a safe, rapid, and effective treatment of ascites in cirrhotic patients. We investigated the effects of a 5-L aspiration of ascites on pulmonary function parameters in eight hemodynamically stable patients with cirrhosis and tense ascites. None had known lung disease or abnormal chest roentgenograms. At baseline, mean lung volumes, diffusing capacity, and arterial pO2 were all reduced from normal predicted values. Airflow, however, when related to lung volume, was normal. Post-LVP, lung volumes increased significantly; the mean expiratory reserve volume showed the greatest percent increase (105%) and correlated with the increases in the vital capacity, functional residual capacity, and total lung capacity. Airflow, the mean diffusing capacity, and arterial oxygenation were not significantly changed after LVP. We conclude that LVP significantly increases indices of lung volume but does not significantly alter parameters of airflow or gas exchange.
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PMID:Pulmonary function changes after large volume paracentesis. 850 87

Recipient vessels from the head and neck region were histologically examined in 30 patients who had undergone extensive tumor resection necessitating microvascular tissue reconstruction. Past illnesses considered to be risk factors included hypertension, myocardial disease, lung disease, cirrhosis, diabetes, nephritis, as well as extensive nicotine and alcohol abuse. Blood vessels chosen for microsurgical anastomosis were exclusively examined histologically in this study. Patients undergoing microvascular surgery demonstrated vessel abnormalities in 93%. The frequency of dysplasia was higher in the arteries than in the veins (73% and 26%, respectively). Marked thickening of the blood vessel wall and severe exfoliation of the endothelial cells were observed in most arteries. Fibrodysplasia and exfoliated endothelial cells were more frequently observed in the recipient arteries than the graft arteries. Only slight thickening of the vessel wall and mild fibrodysplasia were seen in the veins. Two graft failures were correlated to technical errors rather than pre-existing vessel lesions. This study revealed that most patients undergoing microsurgery in the head and neck region demonstrate pre-existing damage in vessels, which generally hinders anastomosis. Although the study tried to identify fully the interrelationships between the extent of dysplasia, past medical history, preoperative therapy, risk factors and factors that cause free-graft failure, pre-existing changes in the recipient and graft vessels may cause technical difficulties and must be regarded as additional factors contributing to graft failure.
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PMID:Histological changes in vessels used for microvascular reconstruction in the head and neck. 870 38

We report three patients with cystic fibrosis and one patient with primary biliary cirrhosis and plexogenic pulmonary hypertension who have undergone heart-lung-liver transplantation as a combined procedure. Liver transplantation was necessary in the three patients with cystic fibrosis because of portal hypertension secondary to either hepatic fibrosis or established cirrhosis in addition to their advanced lung disease. Three of the four patients were alive at 20, 50, and 100 months after transplantation (one patient with cystic fibrosis died on day 16 of pneumonia) with well-preserved pulmonary function (forced expiratory volume in 1 second 110%, 49%, and 100% predicted, respectively), normal hepatic function and New York Heart Association class 1 performance status. Heart-lung and concurrent liver transplantation is a feasible and successful procedure with a satisfactory long-term outcome in selected patients with advanced pulmonary and hepatic disease.
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PMID:Heart-lung-liver transplantation. 877 10

About 10% of children with CF develop hepatic cirrhosis and progressive portal hypertension. As the portal hypertension worsens these children are likely to develop serious variceal bleeding and other complications including malnutrition and a decline in respiratory function. Indices of lung function may fall as much as 50% in a year and chest infections may require frequent admissions to hospital. The respiratory symptoms are often attributed to CF related lung disease and affected children may therefore be considered unsuitable for liver transplantation. We propose a simple scoring system which can help to select patients who should be referred for assessment of liver transplantation. After careful assessment and preparation children with lung function indices as low as 30% predicted can have a successful outcome after liver transplantation. With good graft function portal hypertension is relieved and absorption, nutrition and respiratory function all improve. The improved quality of life of these children is remarkable.
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PMID:Liver transplantation for hepatic cirrhosis in cystic fibrosis. 877 48

Ascites is a common manifestation of portal hypertension in patients with cirrhosis. Approximately 5% of patients with cirrhosis may develop a pleural effusion. This is usually right sided. In the absence of cardiac or lung disease, the presence of a pleural effusion in a cirrhotic patient is known as hepatic hydrothorax. Small volumes of fluid within the pleura may be associated with significant respiratory symptoms which require the clinician to rapidly remove the fluid. The development of hepatic hydrothorax is secondary to passage of ascites from the abdomen to the pleural space via defects in the diaphragm. Once the diagnosis of hepatic hydrothorax is established with certainty, medical therapy with salt restriction and diuretics is initiated. When these measures are ineffective the patient has refractory hepatic hydrothorax. Based on current studies, transjugular intrahepatic portal systemic shunts appear to be the most effective form of treatment for these patients.
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PMID:Hepatic hydrothorax. 930 27

The association between alpha1-antitrypsin (A1AT) deficiency and glomerulonephritis has only sporadically been reported, and mostly based upon autopsy findings, as opposed to the more frequent linkage between A1AT deficiency and lung emphysema with or without hepatic cirrhosis. The present case report describes a 30-year-old man with A1AT deficiency, without evidence of lung disease, who developed hepatic cirrhosis in early childhood and IgA glomerulonephritis and hypertension in adult life. The IgA nephritis followed an unusual course, with a sudden deterioration of the renal function, possibly induced by uncontrolled hypertension or the possible occurrence of vasculitis. After 6 months of hemodialysis, the patient successfully underwent living-related-donor kidney transplantation.
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PMID:Alpha-1-antitrypsin deficiency associated with hepatic cirrhosis and IgA nephritis. 934 92

The hepatopulmonary syndrome (HPS) is a reversible pulmonary insufficiency in association with liver disease, most frequently liver cirrhosis. The pathogenesis of HPS is poorly understood. HPS is characterized by arterial hypoxemia caused by intrapulmonary arteriovenous shunts or marked vasodilatation of the pulmonary vessels and ventilation-perfusion mismatch in the absence of intrinsic heart or lung disease. Typical clinical signs are dyspnea in the upright position which improves in supine position (platypnoe) and decrease of arterial pO2 in the upright position (orthodeoxia). The diagnosis of HPS is based on clinical features, arterial blood gas analyses in supine and upright position, contrast echocardiography and lung perfusion scanning. Arteriovenous fistula can be excluded by pulmonary angiography. There is no established medical treatment of HPS. New medical and noninvasive therapies, such as transjugular intrahepatic Stent-shunt (TIPS), lead to improvement of HPS. These treatment modalities need further elucidation. HPS was shown to be reversible after orthotopic liver transplantation (OLTx) in some cases. Severe HPS, therefore, may be an indication rather than a contraindication for OLTx.
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PMID:[Hepatopulmonary syndrome]. 957 9

Since 1983 large number of people are being encountered with arsenic toxicity due to drinking of arsenic contaminated water (0.05-3.2 mg/l) in 6 districts of West Bengal. Clinical and various laboratory investigations were carried out on 156 patients to ascertain the nature and degree of morbidity and mortality that occurred due to chronic arsenic toxicity. All the patients studied had typical rain drop like skin pigmentation (being inclusion criteria) while thickening of palm and sole were found in 65.5% patients. Other features included weakness (70%), gastro-intestinal symptoms (58.6%), involvement of respiratory system (57.08%) and nervous system (50.6%). Lung function tests showed restrictive lung disease in 53% (9/17) and combined obstructive and restrictive lung disease in 41% (7/17) of patients. Abnormal electromyography was found in 34.8% (10/29) and altered nerve conduction velocity in 34.8% (10/29) of cases. Enlargement of liver was found in 120 cases (76.9%) while splenomegaly in 31.4% cases. Liver function test showed elevated globulin level in 15.8% and alkaline phosphatase in 51.3%, alanine amino transferase (ALT) in 11.8% and aspartate amino transferase (AST) in 27.6% of cases. Evidence of portal hypertension was found in 33.3% patients. Liver biopsy reports of 45 patients showed non-cirrhotic portal fibrosis in 41, cirrhosis in 2 and normal histology in 2 cases. There was no correlation between the quantity of arsenic taken through water and the level of arsenic in hair, nail, liver tissues and the degree of fibrosis. There were 5 deaths of which one had skin cancer. The various non-cancer manifestations which were observed in these patients were much severe than those reported in similar cases in other parts of the world.
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PMID:Chronic arsenic toxicity in west Bengal--the worst calamity in the world. 960 Nov 81

Liver transplantation continues to be successful and effective treatment for acute and chronic liver failure, and many important lessons have been learned. The development of innovative operative techniques has much reduced the waiting list mortality rate and has extended transplantation to younger and sicker children and to those with functionally normal livers who may benefit from auxiliary liver transplantation. The incidence and range of postoperative complications have improved with increased medical and surgical expertise. As information on long-term outcome for liver transplantation is gained, it is clear that many children will benefit from early elective liver transplantation before the development of significant growth or psychosocial retardation. Early transplantation is also indicated in children with cirrhosis and intrapulmonary shunting or cystic fibrosis with moderate lung disease. During the same period, evolving medical therapy has altered the natural history, patient selection, and timing of transplantation in children with tyrosinaemia type I, primary bile acid disorders, neonatal haemochromatosis, and potentially, cystic fibrosis. It is now clear that children with significant multisystem disease, such as mitochondrial disorders or severe systemic oxalosis, are no longer suitable candidates for liver transplantation. The successful development of liver transplantation has brought good quality life to many children and their families. There are still many lessons to learn and there are future challenges such as the ever-increasing problems of donor scarcity and the search for potent but less toxic immunosuppressive agents.
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PMID:Current results and evolving indications for liver transplantation in children. 970 57


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