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

Between 1912 and 1980, many English language publications analyzed the correlation between clinicians' diagnoses and postmortem examinations. Surprisingly, the percentage of cases with undiagnosed principal underlying diseases or primary causes of death has not diminished during this period. The autopsy's unvarying percentage yield does not indicate a lack of progress, however, since bacterial pneumonia, hepatic cirrhosis, and common tumors were missed routinely in earlier eras but were rarely missed after 1970. Pulmonary embolism remains commonly missed, but the striking recent finding is the emergence of fungal and other systemic infections that were rarely noted in prior eras. Progress in diagnosis and treatment may allow patients to live longer and new or obscure diseases may develop that will often be missed clinically. An appropriately high autopsy rate will be required if medical progress is to continue.
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PMID:Diagnostic advances v the value of the autopsy. 1912-1980. 637 22

The clinical and pathologic findings are reported in seven consecutive patients with progressive and fatal pulmonary hypertension which was not explained by predisposing cardiac or pulmonary diseases. Pulmonary arterial lesions consisted of atherosclerosis of the elastic pulmonary arteries, and medial hypertrophy and concentric laminar fibrosis of the muscular pulmonary arteries in seven patients, plexiform lesions in six patients and necrotizing vasculitis in one patient. Pulmonary emboli were not identified. Five patients had manifestations of autoimmune disease, including laboratory abnormalities (positive antinuclear antibody, positive latex agglutination for rheumatoid factor, hypergammaglobulinemia or antimitochondrial antibody) in four, necrotizing vasculitis in one, Raynaud's phenomenon in two and clinical evidence of multisystem collagen vascular disease in two. Five patients had liver disease which developed prior to or concomitant with the onset of pulmonary hypertension. At autopsy, one patient had prominent periportal fibrosis and four had macronodular (postnecrotic) cirrhosis (active in three and inactive in one). Four of these five patients with liver disease and pulmonary hypertension had evidence of autoimmune phenomena. The findings in the seven patients suggest an association between autoimmune disease, plexogenic pulmonary hypertension and liver disease of the chronic active hepatitis-postnecrotic cirrhosis type.
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PMID:Severe pulmonary hypertension associated with macronodular (postnecrotic) cirrhosis and autoimmune phenomena. 742 41

In 1096 cases of death (autopsy rate 63.8%) the accuracy of clinical diagnoses was investigated by comparing clinical diagnoses with recorded autopsy findings. -- In 81.3% of the cases the primary disease had been determined correctly. In more than half of these cases the immediate cause of death or an additional disease contributing to death had not been correctly identified. In 16% of the cases the diagnosis proved to be inadequate. -- In 2.6% of all cases the primary disease, cause of death and accompanying illnesses were misdiagnosed. Most of these patients had stayed in the hospital for a much shorter time than the rest of the patients. -- Among conditions clinically diagnosed as cirrhosis of the liver, pulmonary embolism, myocardial infarction, cerebral hemorrhage, and malignant tumors -- pulmonary embolism was by far the most frequent condition to go unrecognized, i.e. in 50% of th cases in which it was present. Primary liver cell carcinoma proved to be the malignant tumor most frequently not identified by clinical studies. -- Four clinical diagnoses (shock, septicemia, diabetes mellitus and uremia) were often unsupported by morphological findings. Yet there were 13 clinically undiagnosed cases of septicemia in which findings at post mortem examination revealed this condition. These cases also underline the importance of autopsies.
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PMID:Autopsy and clinical diagnosis. 1879 61

The treatment of subarachnoid haemorrhage caused by aneurysm in comatose patients with or without midbrain symptoms is a matter of controversy. The question is, which comatose patients will profit from aneurysm surgery and which will not? In a retrospective study, 573 patients were examined between 1986 and 1992. Of these, 116 were in poor condition (Hunt and Hess Grade IV or V). The following management protocol was used: after computer tomography, a decision was made whether intensive medical treatment was performed or not. The reason for not operating was essentially the severity of the cerebral haemorrhage and poor or absent intracranial filling on angiography. Extracerebral causes were renal failure, sepsis, liver cirrhosis and pulmonary embolism. The direct early aneurysm operation was performed in the clinical deterioration phase in patients with space-occupying haematomas. In dilatation of the ventricle system, external drainage was initially positioned, in the case of bilateral haematocephalus, two-sided drainage was positioned, then intensive medical treatment and angiography were performed. The aneurysm operation was then ruled out if there was no clinical improvement. Aneurysm operation was performed on 57 of the 116 patients; 13 died, 32 showed a good and 12 a poor or fair outcome. 15 patients had mid-brain syndrome, and 5 of them died. Based on our experience, we draw the following conclusion: the Hunt and Hess scale alone is not a sufficient basis for decision taking. Some of the comatose patients, even in mid-brain syndrome, profit from an early operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Modulated surgery in the management of ruptured intracranial aneurysm in poor grade patients. 791 32

The authors report their experience with 6 patients requiring liver transplantation who suffered with liver infestation by Echinococcus granulosus. One patient presented with acute Budd-Chiari syndrome because obstruction of hepatic veins was produced during the first operation; the other 5 patients received liver transplants for terminal chronic liver disease (2 secondary sclerosing cholangitis, 2 secondary biliary cirrhosis, and 1 postnecrotic cirrhosis of the liver). All the patients had been operated previously on for hydatidosis and were at the end of liver functional disorder. Some of the patients had undergone many operations, making the transplantation procedure even more difficult. One patient required a second transplant for primary graft failure; he died 40 days later from cerebrovascular accident. Another patient died 7 months after transplant from pulmonary embolism. The other 4 patients are alive and in optimal condition 37-65 months after transplantation. Hepatic hydatidosis--in principle, a benign disease--can cause hepatic complications that eventually require liver transplantation. The transplantation procedure is more difficult than usual in these cases. Although postoperative complications are frequent, most patients achieve prolonged survival and a good quality of life.
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PMID:Liver transplantation for Echinococcus granulosus hydatid disease. 794 Jul 13

A retrospective analysis of 3042 autopsies was carried out to determine and compare the discrepancy rates between clinical and autopsy diagnoses as well as the sensitivity and specificity of clinical diagnostics in 10 diseases in 1977/78 and 1987/88. The autopsy rate decreased from 80% to 39%, which might explain the increased discrepancy rate from 22% to 27% regarding the diagnoses of major, principal diseases. The accuracy of clinical diagnostics seemed to improve during the period for some of the diseases (pulmonary embolism, peptic ulcer, infectious carditis, peritonitis), while it worsened for others (acute myocardial infarction, thrombosis of the mesenteric artery, ruptured aortic aneurysm, tuberculosis) or remained unchanged (cirrhosis of the liver, malignant tumours regarded as a whole group). The findings underline the importance of autopsies and their cumulative studies in assessing the accuracy and providing data for the determination of necessary fallibility of clinical diagnostics.
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PMID:Clinical diagnostic accuracy audited by autopsy in a university hospital in two eras. 801 82

We compared arterial blood gas analysis and 99mTc-MAA lung perfusion scintigraphy before and after endoscopic injection sclerotherapy (EIS) in 17 cases of esophageal varices complicating liver cirrhosis. EIS was performed by the intra-variceal injection method with 5% ethanolamine oleate (EO) as the sclerosant agent. In blood gas analysis, the mean values of partial arterial oxygen tension (PaO2) and oxygen saturation (SaO2) were decreased, and the mean value of alveolar-arterial O2 difference (AaDO2) was increased, compared with before EIS while breathing room air. On lung perfusion scintigram, the pulmonary blood flow was markedly decreased, demonstrating hypoperfusion and/or perfusion defect, compared with before EIS in most the cases. It was suggested that pulmonary embolism and/or pulmonary circulatory disturbance occurred after EIS. It is important to note that pulmonary circulatory disturbances potentially may occur after EIS without any accompanying symptoms such as dyspnea, cough, or hemoptysis.
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PMID:[Pulmonary circulatory disturbance following endoscopic injection sclerotherapy]. 836 22

The development of an acute pleural effusion during the immediate postoperative period after abdominal or pelvic surgery is not uncommon. In symptomatic patients, pleural effusions often are thought to result from a complication of pulmonary embolism or parapneumonic effusion. We present a patient in whom an acute unilateral hepatic hydrothorax developed after elective total abdominal hysterectomy. Pleural effusion continued to reaccumulate for several days. After extensive efforts failed to reveal the cause of effusion, intraperitoneal radioisotope study confirmed a peritoneopleural communication associated with unsuspected and asymptomatic hepatitis C-induced cirrhosis of the liver with portal hypertension.
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PMID:Acute massive postoperative pleural effusion associated with asymptomatic hepatitis C-induced cirrhosis of the liver. 921 42

This trial represents the Egyptian experience in cyanoacrylate injection for hemostasis of bleeding gastric varices. One hundred patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis were included. All patients presented with bleeding from gastric varices either fundal (80 patients) or inferior extension of esophageal varices (20 patients) were enrolled. Injection therapy was administered as the first active measure. No tamponade or drugs were used. Cyanoacrylate was mixed with lipid and injected through a hand-made probe. A mean of 3 (range 1-9) ampoules of cyanoacrylate were used per injection session. Bleeding stopped at the end of all sessions. Ten patients (12.5%) with fundal varices had rebleeding during the first 24 hours. Reinjection could control bleeding in 6 patients with a total success rate of 95%. Four patients were managed surgically. Fatal pulmonary embolism developed in one patient (1.25%) with fundal varix. Five more patients (6.25%) died from bleeding-related liver failure. In conclusion, injection of cyanoacrylate is highly satisfactory in controlling bleeding from both types of gastric varices.
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PMID:Endoscopic control of gastric variceal bleeding with butyl cyanoacrylate in patients with schistosomiasis. 925 78

A 26-year-old woman, after cesarean section in the 33rd week of gestation, developed after delivery thrombosis of the popliteal vein, pulmonary embolism and thrombosis of the portal vein. After completion of a six month period of oral anticoagulation, laboratory investigations revealed diminished levels of plasminogen and free protein S antigen as well as APC-resistance due to heterozygous FV R506Q mutation. After six uneventful years, abdominal sonography and magnetic resonance examination, performed because of abdominal pain, showed liver cirrhosis with Budd-Chiari syndrome. Additional hematological investigations led to the diagnosis of polycythemia vera. Association of myeloproliferative disorders, mainly polycythemia vera, with splanchnic venous thrombosis is well known and should always be looked for.
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PMID:[A 26-year-old woman with splanchnic vein thrombosis as the initial manifestation of polycythemia vera]. 1051 20


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