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

We report on the treatment of invasive aspergillosis with the new triazole antimycotic agent itraconazole. All 11 patients suffered from pulmonary invasive aspergillosis. Two patients also had cerebral aspergillosis; in one of these patients the paranasal sinuses were also invaded. Underlying diseases were acute lymphoblastic leukaemia (n = 3), acute myeloid leukaemia (n = 4); one patient underwent allogeneic bone marrow transplantation before he developed aspergillosis; another was transplanted after successful aspergillosis treatment, liver cirrhosis (n = 1), lung infarction after pulmonary embolism (n = 1), chronic bronchitis after pulmonary tuberculosis (n = 1) and AIDS (n = 1). In five cases initial diagnosis was established by means of mycological methods and clinical signs. In six patients invasive pulmonary aspergillosis was initially diagnosed due to the clinical criteria presented in this paper. Secondary mycological confirmation after onset of therapy was achieved in five out of these six patients. All of the patients initially responded to therapy. One female patient experienced a relapse of aspergillosis and died of cerebral involvement and relapsing leukaemia. Two further patients died due to underlying diseases (pulmonary embolism, relapsing leukaemia). Nine patients (82%) were cured of the mycosis, including the patient with cerebral involvement; two underwent surgical resection of residual pulmonary lesions. Itraconazole is a very effective drug for treatment of invasive aspergillosis. Therapeutic efficacy can be optimized by early diagnosis using clinical criteria and prompt start of treatment.
Mycoses
PMID:Therapy of invasive aspergillosis with itraconazole: improvement of therapeutic efficacy by early diagnosis. 166 78

348 spleens surgically removed have been examined microscopically and classified into 3 groups: (I) 154 emergency splenectomies (86 traumatic ruptures, 44 enlarged supramesocolic exeresis, 44 cirrhosis), (II) 143 therapeutic splenectomies (135 cases of hypersplenism among which 10 apparently primitive, 7 myeloproliferative syndromes, 1 hairy cell leukemia), and (III) 51 diagnostic splenectomies (7 non specific inflammations, 2 tuberculosis, 1 mycosis, 6 echinococcosis, 12 leukemias, 9 non-Hodgkin's lymphomas, 13 Hodgkin's lymphomas, 1 primary splenic hemangioma). The study of the first group material, obtained especially of traumatic rupture, has been very valuable to follow the spleen microscopic structure in normal humans of different age. The latter two group cases have raised interesting problems of microscopic diagnosis, permitting at the same time a better understanding of the pathology of this organ.
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PMID:Microscopic patterns in surgically removed spleens. 180 84

The pharmacokinetics of a single 100 mg i.v. dose of fluconazole were studied in parallel groups of ten normal subjects and nine patients with liver cirrhosis, a condition with a high risk of life-threatening fungal infection. The following mean pharmacokinetic parameters were found for the patient group: terminal elimination constant 0.0101/h (normal 0.0214/h); mean residence time 134 h (normal 46.7h); area under the curve 200 h.mg/L(normal 69.4 h.mg/L); plasma clearance 0.96 L/h.kg(normal 2.16 L/h.kg). All these differences were statistically significant (P < 0.05). The majority of the patients were being concomitantly treated with duretics (frusemide and spironolactone). It is suggested that the known slight interaction between such drugs and fluconazole was intensified by the disease state. These results emphasize the need for caution in the treatment with fluconazole of patients with severe liver disease. Nevertheless, in view of the wide range of values found in the patients, and low toxicity of fluconazole, a dosage reduction in cirrhosis does not seem to be justified in the present state of knowledge.
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PMID:Single-dose pharmacokinetics of fluconazole in patients with liver cirrhosis. 759 77

We report the first case of primary cutaneous aspergillosis caused by Aspergillus ustus, a species that seldom infects human beings. The patient, a 62-year-old liver transplant recipient with end-stage hepatitis C-induced cirrhosis, was receiving the experimental immunosuppressive drug FK-506. Trauma to the skin of the right arm from tape and from an arm board holding intravenous and intraarterial catheters in place and to the left leg from an occlusive knee brace may have contributed to this unusual mycosis. The patient's cutaneous aspergillosis responded to a combination of intravenous amphotericin B and topical terbinafine cream. Although the patient died shortly thereafter from hepatic failure, there was no evidence of systemic aspergillosis.
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PMID:Primary cutaneous infection by Aspergillus ustus in a 62-year-old liver transplant recipient. 803 2

A clinical assessment of fungal infection in hepatobiliary and pancreatic diseases during 1975 and 1991 was made and 25 cases of systemic mycosis were noted. Among 25 cases there were 20 liver diseases (hepatocellular carcinoma 12, liver cirrhosis 5, fulminant hepatitis 2, polyarteritis nodosa 1), 2 cases of gallbladder cancer and 3 cases of pancreatic cancer. The fungus was consisted of 14 cases (56%) of Candida, 9 cases of Aspergillus (36%), and 2 cases of Cryptococcus (8%). Fungal infection was most frequent in the lung (8 cases) and esophagus (6 cases), but rarely in the stomach, lymph node, liver, thyroid, kidney and gallbladder. Generalized fungus infection was noted in four cases (16%). Fatal fungal infection was complicated in liver cirrhosis (2 cases), fulminant hepatitis (one case), gallbladder cancer (one case) and cystadenocarcinoma of the pancreas (one case). In five fatal cases three cases of Aspergillus pneumonia and two cases of Candida septicemia were included. Glucocorticoid was used in 13 cases (52%) and anti-cancer drugs was administered in two cases (12%). However, in 9 cases (36%) without treatment of glucocorticoid or anti-cancer drug fungal infection was detected. In conclusion, there is a possibility of fungal infection in grave hepatic diseases and empirical administration of anti-fungal agent may be necessary.
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PMID:[Fungal infection in hepatobiliary and pancreatic diseases: clinical evaluation in autopsy cases]. 820 88

The rhino-orbito-cerebral mucormycosis is an acute rapidly progressive fungal infection. This disease is caused by a zygomycetes fungus, most often from the Rhizopus genus. This fungus is saprophitic of the nasal cavity and paranasal sinuses. It becomes pathogenic in some particular conditions, specially during diabetes mellitus. Histopathological study is the only method allowing the diagnosis, by revealing the tissue invasion by characteristic hyphae. Mycologic study allows a definitive identification of the fungus. The authors report a case of rhino-orbito-cerebral mucormycosis in a 44 year-old woman with cirrhosis. She presented an acute blindness and ophthalmoplegia. Despite of a rapid histologic diagnosis from the nasal and ethmoidal biopsies, the patient died 3 days after.
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PMID:[Rhino-orbito-cerebral mucormycosis caused by Rhizopus oryzae.A typical case in a cirrhotic patient]. 839 43

A wide range of nontumorous hepatic diseases may have an impact on liver function and serve as indications for computed tomographic (CT) or magnetic resonance (MR) imaging. New imaging techniques such as spiral CT and fast MR imaging aid in detecting and characterizing these disease processes and in assessing the extent of disease. Infectious liver disease (eg, hepatic abscess, echinococcal disease, fungal infection) typically has low attenuation at CT and high signal intensity at T2-weighted MR imaging. Cholangitis is characterized by ductal dilatation at both CT and MR imaging. In acute portal vein thrombosis, the thrombus has low attenuation at CT and is hyperintense relative to liver at MR imaging. Hepatic infarcts usually appear as well-circumscribed, peripheral, wedge-shaped areas of decreased attenuation at CT. The causes or complications of cirrhosis can be most readily identified with MR imaging. In patients with chronic radiation-induced hepatitis, CT shows the irradiated parenchyma as a region of increased attenuation, whereas T1- and T2-weighted MR imaging demonstrate geographic areas of low and high signal intensity, respectively. Hemachromatosis has homogeneously increased liver attenuation at CT and decreased signal intensity at gradient-echo MR imaging in particular. Familiarity with the CT and MR imaging features of the spectrum of nonneoplastic conditions of the liver is essential in making an accurate diagnosis.
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PMID:Nonneoplastic liver disease: evaluation with CT and MR imaging. 967 68

Mucormycosis is an opportunistic fungal infection caused by Mucorales. The disease is uncommon and produces serious and rapidly fatal infection in diabetic or immunocompromised patients. The classical presentation of rhinocerebral mucormycosis is involvement of nasal mucosa with invasion of paranasal sinuses and orbit. Early diagnosis is based on (direct) histological examination and computed tomography scan. Unfortunately the clinical signs and symptoms do not occur in all cases. A high index of suspicion is needed not only in typical groups of immunocompromised patients or diabetics, but also in patients with serious chronic diseases. We report a patient who was not diabetic, but she had a history of cirrhosis and well compensated renal failure.
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PMID:Rhinocerebral mucormycosis in a patient with cirrhosis and chronic renal failure. 1282 1

Mucormycosis is a rare but highly invasive fungal infection that occurs in transplant recipients. The literature contains descriptions of 12 cases of mucormycosis after orthotopic liver transplantation (OLT). This report describes the fatal courses in four patients at our center who developed mucormycosis after liver transplantation. Of 51 liver transplant recipients who received grafts between December 1993 and April 2003, 4 (7.8%; 3 males and 1 female) developed mucormycosis. The primary liver diseases in the four cases were Wilson's disease, autoimmune hepatitis, primary biliary cirrhosis, and cryptogenic cirrhosis. Three of the transplants were harvested by another team and shipped to our center. We concluded that selection of poor transplant candidates, prolonged antibiotic therapy and/or hospitalization prior to OLT, and breaks in aseptic technique during harvesting, shipping, and during operation are the main reasons for the high incidence of mucormycosis in our OLT patients.
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PMID:Outcome of mucormycosis in liver transplantation: four cases and a review of literature. 1585 21

Coccidioidomycosis is an endemic fungal infection in the southwestern United States. It causes morbidity and mortality among solid organ transplant recipients who reside in or visit the endemic area or who receive organs from donors infected with the fungus. This paper reviews current literature addressing these infections in liver transplantation programs, including risk factors, clinical manifestations in persons with cirrhosis or who have had a liver transplantation, prophylaxis, treatment, and outcomes.
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PMID:Coccidioidomycosis in liver transplantation. 1638 59


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