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

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 are presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51% and 47% of patients, respectively. Jaundice was a presenting feature in 44%. Hepatomegaly was present in 71% of patients and splenomegaly in 33%. The aetiological factors were: alcohol (36%), bush tea (18%), chronic active hepatitis (11%), drugs (7%), and haemochromatosis (2%). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24% of the patients also had diabetes mellitus., 29% were anaemic, 29% were thrombocytopenic, 4% were leukopenic, and the prothrombin time was prolonged in 22%. The albumin/globulin ratio was reversed in 71% of the patients. The alkaline phosphatase was elevated in 56%, the aspartate aminotransferase was increased in 58% and the gamma glutamyl transpeptidase in 56%. 56% of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18%; 7% had biliary cirrhosis; 7% chronic active hepatitis with cirrhosis; and 13% showed a mixed macro-micronodular pattern. Ascites and fluid overload developed in 44% of the patients. Hepatic encephalopathy occurred in 18% and upper gastrointestinal bleeding in 18%.
West Indian Med J 1997 Jun
PMID:Hepatic cirrhosis in Jamaica. 926 May 37

Hepatitis G virus (HGV) and GB virus C (GBV-C) are two newly discovered viral agents, different isolates of a positive-sense RNA virus that represents a new genus of Flaviviridae. The purpose of this review is to analyze new data that have recently been published on the epidemiology and associations between HGV and liver diseases such as posttransfusion hepatitis, acute and chronic non-A-E hepatitis, fulminant hepatitis, cryptogenic cirrhosis, and hepatocellular carcinoma. The role of HGV in coinfection with other hepatitis viruses, the response to antiviral therapy, and the impact of HGV on liver transplantation are also discussed. HGV is a transmissible blood-borne viral agent that frequently occurs as a coinfection with other hepatitis viruses due to common modes of transmission. The prevalence of HGV ranges from 0.9 to 10% among blood donors throughout the world and is found in 1.7% of volunteer blood donors in the United States. The majority of patients infected with HGV by blood transfusion do not develop chronic hepatitis, but hepatitis G viremia frequently persists without biochemical evidence of hepatitis. Serum HGV RNA has been found in 0 to 50% of patients with fulminant hepatitis of unknown etiology and 14 to 36% of patients with cryptogenic cirrhosis. The association between HGV and chronic non-A-E hepatitis remains unclear. Although HGV appears to be a hepatotrophic virus, its role in independently causing acute and chronic liver diseases remains uncertain.
West J Med 1997 Jul
PMID:Hepatitis G virus: is it a hepatitis virus? 926 69

The histopathology and clinical picture of hepatocellular carcinoma (HCC) varies between individual patients and regions. These variations are perhaps due to differences in the genetic alterations that precede hepatocarcinogenesis. In this study, the clinicopathological features of HCC were compared between southern African blacks and Japanese, indicating large differences in the frequency of underlying cirrhosis, grade of cancer cell differentiation and clinical course. Intra-abdominal bleeding and febrile, rapidly progressive HCC are more common among blacks. Such a difference is accounted for, in part, by frequent encapsulation of the tumour which is well differentiated, and grows slowly in an expanding fashion in Japan. Encapsulated HCC was not seen among the black patients studied. Other distinct clinicopathological types discussed in this paper include diffuse-type HCC which is usually caused by multiple portal spread occurring almost simultaneously; the clinical course is fulminant. Sclerosing carcinoma is frequently associated with hypercalcaemia in the United States, but not in Japan. Fibrolamellar carcinoma is nearly non-existent in Asia, whereas it is common among young adults in the West. Its prognosis is generally better than ordinary HCC. Hepatocellular carcinoma has a strong propensity to invade vessel and duct systems. Portal invasion does not produce distinct clinical signs although it may aggravate portal hypertension. Patients with tumour occlusion in the major portal vein may give rise to ischaemic hepatitis when blood pressure drops suddenly in the preterminal stage. Liver parenchyma develops submassive necrosis and clinically there is an acute rise in alanine aminotransferase (ALT). Invasion into a major hepatic vein and the inferior vena cava also occurs, but less frequently compared with portal invasion. The patient can live even with a tumour thrombus in the atrium crossing the tricuspid valves. Intraductal invasion causes acute jaundice as well as an occasional haemobilia with pain. We recently found that a distinct pathological type called 'extrahepatic growth' or 'pedunculated HCC' develops as a result of fusion of right-sided adrenal metastasis of HCC and the liver, perhaps through the 'adreno-hepatic fusion' which is rather common in cirrhotic livers.
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PMID:Hepatocellular carcinoma: clinicopathological aspects. 940 52

The burden of viral hepatitis in Africa is difficult to quantify precisely because of inaccurate statistical data and underreporting. Of the various agents causing viral hepatitis, data on hepatitis B virus have been relatively more available and suggest that 15-60% of the normal population in many African countries may be positive for one or more of the serologic markers of hepatitis B virus infection, whilst the corresponding values for patients with primary liver cell carcinoma (PLCC) ranged from 49% to 80%. Liver disease was the third most common cause (12.1%) of all 4568 deaths in the medical wards of the University College Hospital, Ibadan, Nigeria, over a 14-year period. Of all causes of death from liver disease, PLCC alone accounted for 42.5% of deaths while liver cirrhosis accounted for 21.1%, and, in both diseases, HBV was the most common cause. PLCC, which accounted for 491 out of 100,000 admissions in that teaching hospital, was the most common malignancy in the medical wards and was the most common cause of death from cancer in middle-aged and elderly Nigerians. Recent reports suggest that the prevalence of hepatitis C infection in normal Africans may be as high as 10.9%, while the corresponding value for patients with PLCC would be about 18.7-38%. There is a need for control of hepatitis, particularly hepatitis B virus infection, through health education and active immunization of all newborns and other people at risk in Africa.
West Afr J Med
PMID:The burden of viral hepatitis in Africa. 947 53

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

In this article, as part of an evaluation of the future of medical education in California, we characterize the distribution of disease and injury in California; identify major factors that affect the epidemiology of disease and injury in California, and project the burden of disease and injury for California's population to the year 2007. Our goal is to elucidate the major causes of illness and disability at present and in the near future in order to focus state resources on the interventions likely to have the greatest impact. Data from various governmental agencies were utilized; the base year, 1993, is the most recent year with sufficient information available when this report was prepared. Several major risk factors have decreased, including smoking (30% decline from 1984 to 1993) and drinking and driving. However, hypertension prevalence has not changed, and overweight has increased dramatically. Poverty continues to burden about 15% of Californians, with poverty highest among children. During 1993, 220,271 Californians died, with 3 major causes accounting for 61% of these deaths: coronary heart disease (31%), cancer (23%), and stroke (7%). In terms of potential years of life lost (years lost before age 65), the most important causes of death in 1993 were unintentional injury (756 years lost/100,000 population), cancer (632 years), and the acquired immunodeficiency syndrome (AIDS; 491 years). Mortality rates were highest among blacks and lowest among Asians. Overall mortality in California has been declining for decades; in just 1 decade, from 1980 to 1991, mortality declined from 780 to 680 deaths per 100,000 population. Several major causes of death have declined, including coronary heart disease, stroke, unintentional injury, cirrhosis, and suicide, while others have increased, for example, chronic obstructive lung disease and diabetes mellitus. Death from AIDS increased dramatically in the past decade, but is leveling off, and death from cancer is beginning to decline. Rates for overall mortality and morbidity, and for most specific conditions, should continue to decline. A projected 28% population increase by 2007 will yield a corresponding increase in the absolute level of disease cases and death; a disproportionate increase in younger and older groups will yield increased conditions affecting young (unintentional injury, AIDS) and older (heart disease, cancer, stroke, diabetes mellitus) people. Californians should experience overall improved health in coming years, reaping benefits of reduced environmental and behavioral risk factors as well as improved medical treatment and rehabilitation. Coordinated strategies for health promotion, disease prevention, delivery of medical treatment, and rehabilitation are needed to maintain and improve present levels of health across the life span.
West J Med 1998 May
PMID:Disease and injury in California with projections to the year 2007. Implications for medical education. 961 96

In the period 1989-94, mortality rates for the most important causes of death in people migrated to the Tuscany from other Italian regions were analysed. The area of birth was assessed according to the information on province of birth recorded on death certificates. For this analysis we classified Italy into Tuscany and five broad areas, each including a number of political regions: North-West, North-East, Centre, South and Islands. The number of person-years for calculation of the mortality risks was based on 1991 census data, which also included information on place of birth and on current residence. The risks of death of subjects born in other Italian areas and resident in Tuscany ("migrated populations") in comparison to Tuscany born population were assessed by means of Poisson multivariate regression models. For most sites (particularly for lung and breast), cancer mortality rates were higher among North-West and North-East born people and lower among Centre, South and Islands born people. Gastric cancer mortality was higher in Tuscany born subjects. Cardiovascular diseases mortality was generally lower among people born outside of the Tuscany, with the exception of ischaemic heart disease (higher in North-West and Islands born people). Liver cirrhosis mortality was generally higher in North-West, North-East, South and Islands born subjects (with some differences between males and females). Diabetes mellitus mortality was higher in South and Islands born people. AIDS and opioids overdose mortality was higher in North-West born subjects. Mortality for external causes was higher in people born outside of the Tuscany. Both in males and females, overall mortality was higher in North-West and lower in South born people and lower in Centre and Islands born males.
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PMID:[Mortality in population migrated from other Italian regions to the Tuscany region in 1989-94]. 962 2

In most of the cases, hepatocellular carcinoma (HCC) develops in the setting of cirrhosis associated with hepatitis B or C infection. Thus, cirrhotic patients constitute the population at risk for HCC. This has prompted the screening of cirrhotic patients for HCC and this policy has facilitated the detection of HCC at an early and/or asymptomatic phase when potentially effective treatments are available. However, it must be stressed that the prognosis of the patients with HCC is determined not only by the stage of the HCC, but also by the functional status of the underlying liver. In such a situation in Japan, systematic subsegmentectomy using intraoperative ultrasound, trancathether arterial embolization (TAE), and percutaneous ethanol injection (PEI) were developed to treat HCC patients with cirrhosis. On the other hand in the West, liver transplantation is the therapeutic modality for small HCC with cirrhosis while small HCCs are treated mainly by PEI. However, the lack of controlled trials for the most therapeutic options in our country precludes knowing if their antitumoral effect is associated with an improved survival. In summary, the treatment of patients with HCC remains a clinical challenge with several areas to be investigated through carefully designed prospective randomized controlled trials. Ideally, this clinical research will provide us with solid therapeutic options that unequivocally improve the survival of the patients with HCC. Application of living-related liver transplantation for carefully selected adult patients with small HCC will be necessary in Japan.
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PMID:[Different strategies for treatment of hepatocellular carcinoma in the west and in the east]. 967 75

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of chronic liver disease and hepatocellular carcinoma (HCC) worldwide. In Western countries most HCC associated with HBV or HCV infection occurs in the cirrhotic liver. In a longitudinal studies of series of a Caucasian patients with compensated cirrhosis the incidence of HCC was approximately 2 and 2.5 per 100 person-years for HBV-related and HCV-related cirrhosis, respectively. The host factors of age, age at infection and male sex as well as parameters reflecting the severity of liver disease, such as bilirubin and platelets, appear to be significant predictors of liver cancer in patients with cirrhosis. It is still controversial whether HCV genotype 1b has a specific oncogenic potential. Studies from Europe have shown a low risk for HCC in patients with compensated cirrhosis type B who achieve a sustained virological and disease remission. Overall these data strengthen the epidemiological evidence of the association among HBV infection, cirrhosis and HCC in the West, indicating a similar risk for liver cancer in Caucasian patients with cirrhosis type B or C and suggest that tumors occur mainly in patients with long-standing disease. Additional factors that may promote liver cancer include concurrent HBV and HCV infection (approximately 5 fold-increase in risk) or concomitant heavy alcohol intake (synergism).
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PMID:Progression of hepatitis B and C to hepatocellular carcinoma in Western countries. 973 Mar 76

Hepatocellular carcinoma occurs almost exclusively in patients with cirrhosis, at least in the West. In most of these patients, potential curative treatments, such as resection or percutaneous alcohol injection, are usually contra-indicated. Transarterial chemoembolization may induce tumor necrosis. In order to avoid massive necrosis of the non tumoral liver, two major contra-indications have been identified: inadequate portal flow and liver failure. The influence of chemoembolization on survival was thought to be high on the basis of non randomized trials. However, no beneficial effects on survival were observed in three randomized trials. In these trials, the beneficial effect on tumor necrosis was counterbalanced by frequent deleterious effects on liver function. Moreover, progressive liver atrophy may follow repeated procedures. As there is no alternative treatment for most of these patients and chemoembolization can still be beneficial in selected cases, efforts have been made to improve patient selection and method to improve the results. Good liver function, a normal portal flow, and a well limited hypervascularized tumor are necessary conditions for treatment, which may even be curative when used in association with percutaneous alcohol injection. Moreover, arterial embolization can be performed without chemotherapy, and the procedure should not be repeated in the short term.
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PMID:Intra-arterial chemoembolization in patients with hepatocellular carcinoma. 973 Mar 82


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