Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recent advances in techniques to determine free drug concentrations have lead to a substantial increase in the monitoring of this parameter in clinical practice. The majority of drug binding to macromolecules in serum can be accounted for by association with albumin and alpha 1-acid glycoprotein. Albumin is the primary binding protein for acidic drugs, while binding to alpha 1-acid glycoprotein is more commonly observed with basic lipophilic agents. Alterations in the concentrations of either of these macromolecules can result in significant changes in free fraction. Diseases such as cirrhosis, nephrotic syndrome and malnourishment can result in hypoalbuminaemia. Burn injury, cancer, chronic pain syndrome, myocardial infarction, inflammatory diseases and trauma are all associated with elevations in the concentration of alpha 1-acid glycoprotein. Treatment with a number of drugs has also been shown to increase alpha 1-acid glycoprotein serum concentrations. A wide variety of biological fluids have been examined for their ability to provide an estimation of free drug concentration at receptor sites. The most useful fluid for estimating free drug concentrations appears to be plasma or serum, with subsequent treatment of the sample to separate free and bound drug by an appropriate technique. The two most widely used methods are equilibrium dialysis and ultrafiltration. Of these two, ultrafiltration has the greatest utility clinically because it is rapid and relatively simple. The major difficulty associated with this method involves the binding of drug to the ultrafilters, but significant progress has been made in solving this problem. Several authors have endorsed the routine use of free drug concentration monitoring. Data examining the clinical usefulness of free drug concentration monitoring for phenytoin, carbamazepine, valproic acid, disopyramide and lignocaine (lidocaine) are reviewed. While available evidence suggests that free concentrations may correlate with clinical effects better than total drug concentrations, there are insufficient data to justify the recommendation of the routine use of free drug concentration monitoring for any of these agents at present.
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PMID:Free drug concentration monitoring in clinical practice. Rationale and current status. 354 37

Early diagnosis and treatment of stricture of the common bile duct from chronic pancreatitis are essential as the life-threatening complications of biliary cirrhosis and acute cholangitis can occur even in the absence of clinical jaundice. In a series of 40 patients with longstanding chronic pancreatitis and stricture of the common bile duct, findings included chronic pain in 26 patients, jaundice in 17 patients, secondary biliary cirrhosis in six patients and acute cholangitis in six patients. Persistent elevation of the alkaline phosphatase level was the most sensitive laboratory indicator of occult obstruction of the biliary tract. The diagnostic long tapered stenosis of the distal common bile duct was delineated by percutaneous transhepatic cholangiography in 21 of 22 patients and endoscopic retrograde cholangiopancreatography in eight of 11 patients. Operative decompression of the biliary tract included 32 biliary-enteric bypasses, three sphincteroplasty procedures and three emergency tube drainages. There was one postoperative death and seven other patients had postoperative complications. Sphincteroplasty failed to relieve the obstruction in two patients and two patients with biliary-enteric bypass had late anastomotic strictures develop which required reoperation. Only seven patients were free of pain at follow-up study which ranged from 0.5 to 15.0 years. Clinical suspicion based upon persistent hyperaklalinphosphatemia, diagnosis by cholangiography and decompression of the biliary tract by choledochoenterostomy can reliably avert the lethal complications of stricture of the common bile duct caused by chronic pancreatitis.
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PMID:Stricture of the common bile duct from chronic pancreatitis. 360 41

A series of twenty-seven patients with benign non-traumatic biliary strictures is presented. Fifteen strictures were associated with chronic pancreatitis, and were typically long, tapered strictures of the intrapancreatic portion of the common bile duct. Twelve were associated with choledocholithiasis; these were usually short-segment and occurred both above and below stones in the duct. These strictures are important surgically, since they may produce pain, cholestasis and cholangitis, stone formation, and biliary cirrhosis. They may be difficult to distinguish from bile duct or pancreatic carcinomas. In the patients with chronic pancreatitis, treatment by biliary bypass was effective in the presence of cholestasis, but was ineffective for chronic pain. Treatment by biliary bypass or sphincteroplasty was highly effective in those patients with choledocholithiasis.
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PMID:Benign biliary strictures associated with chronic pancreatitis and gallstones. 693 59

Fourteen children (10 boys and 4 girls, aged 8 to 17 years) had 20 pheochromocytomas treated over a 36-year period from 1959 to 1995 inclusive. Nine patients had 11 tumors before 1980; 5 children had 9 tumors up to 1987. There were no new children with pheochromocytomas at our hospital from 1988 to 1995. Hypertension, sweating, headache, and visual blurring were the most common symptoms and signs (average 5 months). The most reliable biochemical investigations were the urinary catecholamines and norepinephrine. Before 1980, intravenous pyelography and angiography were most successful in localizing the tumor, but since then ultrasonography and computerized tomography have been the radiological investigations of choice. Early involvement of the anesthesiologist in the preoperative control of the hypertension is essential; blood pressure (BP) control was achieved with phenoxybenzamine. The main anesthetic drugs used were: sodium thiopental, fentanyl, methoxyflurane, isoflurane, nitrous oxide, and metocurine. Sixteen tumors were adrenal and 4 were extra-adrenal (1 intrathoracic and 1 extradural). All except 2 tumors were completely resected; they ranged in size from 1.3 to 14 cm. Ligation of the tumor's venous drainage was usually associated with a sudden, temporary fall in systemic BP. There were 2 children with malignant tumors. Four patients had five recurrences (second pheochromocytoma) within 6 years, and all were heralded by a return of their original symptoms and signs. One girl was left with no adrenal tissue. The only complication was in a boy with a large, partly-resected malignant right adrenal tumor who had a subphrenic abscess drained and was left with a temporary bile fistula, cirrhosis, and chronic pain. All children were normotensive when discharged from hospital and remain alive and well with a follow-up of 7 to 36 years. There were no deaths. Long-term follow-up is essential. Key word Pheochromocytoma
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PMID:Pediatric pheochromocytoma. A 36-year review. 935 33

We present a case of epidural hematoma in a liver cirrhosis patient with a depressed platelet count but normal prothrombin and activated thromboplastin times. A 60-year-old woman hospitalized with liver cirrhosis was referred to us for low back pain. She suffered the fracture of the body of the 12 th thoracic vertebra in a fall. Her platelet count was below normal ranges, but, other coagulation tests were within normal ranges. We inserted an 18-gauge epidural catheter at Th 12-L1 interspace. Twenty-one days later, paresis and hypesthesia in both legs, and a loss of sphincter function occurred. Magnetic resonance imaging revealed a posteriorly placed hematoma extending from Th 12 to L1. Considering the hemorrhagic tendency and hepatic insufficiency, we did not perform laminectomy. After 4 days, the patient's strength began to recover, and after 7 days paresis and hypesthesia improved. We should avoid performing epidural catheterization to improve chronic pain for a patient with liver cirrhosis if his or her platelet count is below 100,000.mm-3.
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PMID:[Epidural hematoma associated with epidural catheterization in a cirrhotic patient]. 962 71

Evidence of immune stimulation has been noted in opiate dependent patients for many decades. Documented changes have included lymphadenopathy, round cell infiltration of the hepatic portal triads, diffuse peri-bronchitis, hyperglobulinaemia, lymphocytosis, monocytosis, systemic cytokine stimulation, and cytokine and chemokine activation within the neuraxis. A parallel literature describes an elevated list of chronic degenerative disease as common in such patients including neurodegenerative conditions, atherosclerosis, nephrosclerosis, hepatic fibrosis and cirrhosis, chronic obstructive and fibrotic lung disease, osteoporosis, chronic periodontitis, various cancers, hair greying, and stem cell suppression. All of these disorders are now known to have an important immunological role in their pathogenic pathways. The multisystem nature of these myriad changes strongly suggest that the ageing process itself is stimulated in these patients. The link between the immunostimulation on the one hand and the elevated and temporally advanced nature of the chronic degenerative diseases on the other appears not to have been made in the literature. Moreover as immunostimulation is also believed to be an important, potent and principal contributor to the ageing process it appears that experimental and studies of this putative link are warranted. Verification of such an hypothesis would also carry management implications for dose and duration of chronic pain and addiction treatment, pharmacotherapeutic selection, and novel treatments such as long term naltrexone implant therapy and heroin trials.
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PMID:Chronic immune stimulation as a contributing cause of chronic disease in opiate addiction including multi-system ageing. 2080 Mar 62

Pain management in patients with liver cirrhosis is a real challenge and is often inadequate due to a lack of therapeutic efficacy or the high incidence of adverse effects. The focus of treatment differs depending on whether the pain is acute or chronic and involves understanding the causative pathophysiological mechanism. Analgesics should be started with the minimum effective dose and should be titrated slowly with avoidance of polypharmacy. Adverse effects must be monitored, especially sedation and constipation, which predispose the patient to the development of hepatic encephalopathy. The first-line drug is paracetamol, which is safe at doses of 2-3g/day. Non-steroidal anti-inflammatory agents are contraindicated because they can cause acute renal failure and/or gastrointestinal bleeding. Tramadol is a safe option for moderate-severe pain. The opioids with the best safety profile are fentanyl and hydromorphone, with methadone as an alternative. Topical treatment can reduce oral drug consumption. In neuropathic pain the first-line therapeutic option is gabapentin. The use of antidepressants such as amitriptyline can be considered in some patients. Interventional techniques are a valuable tool in moderate to severe pain, since they allow a reduction in drug therapy and consequently its adverse effects. Psychological treatment, physical therapy and rehabilitation should be considered as part of multimodality therapy in the management of chronic pain.
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PMID:[Pain management in patients with liver cirrhosis]. 2430 82

Hepatitis C is a common cause of cirrhosis, hepatocellular carcinoma, and liver transplant. Although it is usually asymptomatic, new screening recommendations will lead to increased recognition by primary care physicians. Rapidly evolving treatment recommendations are making this a treatable infection for many patients. Recognition of the infection and initiation of treatment for appropriate patients will decrease the likelihood of progression to cirrhosis and hepatocellular carcinoma. Primary care physicians have the difficult task of managing comorbid conditions, such as chronic pain and hyperlipidemia, in patients with hepatitis C, as well as a potential for treating hepatitis C.
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PMID:Hepatitis C for primary care physicians. 2461 Jan 91

This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.
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PMID:Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. 2763 76

Ketamine has been typically administered in short-term, few doses in the clinical setting of acute pain. Its hallucinogenic side effects have made it popular as a recreational drug. Reports of urological, biliary and liver abnormalities have been reported, mainly in cases of abuse. It is now increasingly used for chronic pain conditions, and here we report liver abnormalities and ultimately cirrhosis in an adult on regular ketamine for chronic facial pain. Abnormal liver function tests were detected incidentally, and with no other cause for liver disease found, liver biopsy was performed. This showed fibrosis with incomplete cirrhosis.
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PMID:Ketamine as a possible cause of cirrhosis in a patient with chronic pain. 2883 72


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