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)

Tuberculosis had been the leading cause of death in Japan until 1950, and in these days there were about 3 million patients with active tuberculosis every year. From about 1950 to 1960 surgery was the treatment of choice if there were cavities and the lesions were regional. The number of patients who had thoracoplasties and/or pulmonary resections at national sanatoriums during the period of 1954 to 1961 was about 200,000. Since national sanatoriums had about 25% of the total beds for tuberculosis in Japan at that time, the total number of surgically treated patients would be around four times this number, that is 0.8 to 1.0 million. Many of those who survived suffered later from complications, which included chronic respiratory failures, chronic hepatitis (hepatitis C), liver cirrhosis and/or hepatic cell carcinomas. There are at least 50,000 patients who are under home oxygen therapy (HOT) in Japan, of whom about 30% are those with pulmonary tuberculosis sequelae (TBS). The survival rate after the start of HOT in these patients was found better in those who had surgical treatments than in those who had medical treatments only. Since hypercapnea was more common in the former, better survival rates in the hypercapnic than in the normocapnic patients with TBS as a whole could be due to the fact that more of the surgically treated patients were included in the hypercapnic group. For this reason, it is premature to conclude that hypercapnea is an independent favorable prognostic factor in TBS patients with chronic respiratory failure. Because more than one-forth of thoracoplasties and/or pulmonary resections were done in national sanatoriums, it is the responsibility of those who are now working in national hospitals to treat and support these patients with TBS who developed complications such as respiratory failures, chronic hepatitis, liver cirrhosis, and/or hepatic cell carcinomas.
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PMID:[Tuberculosis sequelae in Japan]. 1006 50

A 66-year-old woman had been treated for 3 years by her local physician with Sho-saiko-to for chronic hepatitis C virus (HCV) infection and liver cirrhosis. She was admitted to our hospital because of cough, fever, and infiltrative shadows on chest x-ray films. Sho-saiko-to-induced pneumonitis was diagnosed and steroid therapy started. Though a temporary improvement was observed, interstitial pneumonitis relapsed and the patient died of respiratory failure and liver dysfunction. Autopsy findings showed diffuse alveolar damage and honeycombing. Furthermore, reverse-transcriptase polymerase chain reaction techniques detected HCV-RNA in specimens of fibrotic lung tissue. For comparison, HCV-RNA was not histologically detected in lung tissue specimens from 4 control subjects who were positive for HCV antibodies but who did not have interstitial lung disease. It was speculated that the progression of interstitial pneumonia in the present case may have been caused by HCV in combination with Sho-saiko-to-induced lung injury.
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PMID:[An autopsy case of interstitial pneumonia probably induced by Sho-saiko-to]. 1070 45

The prognostic significance of elevated cardiac troponin levels (CTL) in hospitalized patients with no other evidence of myocardial ischemia or injury is largely unknown. Fifty patients (mean age 61 +/- 15 years, 15 women) out of 580 consecutive hospitalized patients were selected based on normal CK-MB and at least 3-fold increase of CTL. The medical charts of these patients were reviewed and a 1-year follow-up was performed. The most frequent admission diagnoses were exacerbation of congestive heart failure (22%), stroke (20%) followed by respiratory failure (6%), cirrhosis (6%), gastrointestinal bleeding (6%), end-stage renal disease (4%), atrial fibrillation (4%) and metastatic malignancies (4%). Abnormal CTL prompted a cardiology consult in 48% of patients, an echocardiogram in 44%, myocardial perfusion study in 10% and coronary angiography in 1 patient. Of 21 deaths, only 1 was related to an acute coronary event. The measurement of CTL in patients without definite clinical or electrocardiographic evidence of myocardial ischemia and with a wide spectrum of clinical diagnoses does not predict in-hospital and at 1 year cardiovascular complications and/or cardiac death.
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PMID:Elevated cardiac troponin levels do not predict adverse outcomes in hospitalized patients without clinical manifestations of acute coronary syndromes. 1089 99

Brain natriuretic peptide (BNP) is a recently discovered peptide, secreted by the atria and ventricles in response to parietal distension. It was recently proposed as a screening test for left ventricular failure. The authors assayed this peptide at rest in 37 patients with chronic heart failure due to left ventricular systolic dysfunction and another 20 patients with various diseases (respiratory failure, cirrhosis, heart transplantation, "diastolic" heart failure) but normal left ventricular systolic function. A significant increase compared to normal values was observed not only in the group of heart failure patients, but also in patients with all other diseases. BNP was significantly higher in NYHA class IV patients. The relationship between plasma BNP levels and ejection fraction was not significant. On the other hand, a good correlation was observed between BNP and left ventricular filling parameters evaluated by cardiac Doppler: E wave deceleration time (r = -0.53, p = 0.001), E/A ratio: r = 0.57 p = 0.005) or VO2 max (r = -0.55, p < 0.005).
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PMID:[Brain natriuretic peptide (BNP) in coronary insufficiency: relationship with left ventricular filling and exercise tolerance]. 1255 77

Portal hypertension is a main cause for the development of esophago-gastric varices, ascites and hepatic nephropathy in liver cirrhosis. Reduction of portal pressure by a transjugular intrahepatic portosystemic shunt (TIPS) procedure has been possible for the last decade. The treatment reduces the risk for variceal bleeding, reduces ascites formation and may improve renal function in hepatic nephropathy. Improved survival, however, has not yet been documented. Complications comprise procedure related events (puncture of liver capsule, bleeding, infection, hemolysis with mortality 1-5%), shunt stenosis (30-80% during the first year but reversible), and encephalopathy (30% intermittent, 10% chronic). Indications for the procedure are primarily variceal bleeding resistant to conventional pharmacologic and endoscopic treatment. Absolute and relative contraindications are severe hepatic failure, a history of hepatic encephalopathy, infections, respiratory failure, and non-hepatic renal insufficiency.
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PMID:[Transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of complications of portal hypertension in patients with liver cirrhosis]. 1259 38

More procedures used in transection of the liver parenchyma include also resection by means of a harmonious scalpel with an enhanced haemostatic effect. Based on analysis of 51 patients operated on account of liver disease using a harmonious scalpel, the authors evaluate its asset to the liver resection technique. The harmonious scalpel was used in transection of the liver in seven patients with benign liver disease (inborn cysts, follicular nodular hyperplasia, haemangioma, hepatocellular adenoma) and in 44 with malignant disease (hepatocellular carcinoma, metastases, most frequently, i.e. 34x of colorectal carcinoma). Anatomical liver resection (hemihepatectomy, lateral bisegmentectomy, segmentectomy) was implemented in 34 patients, and in 17 a wedge-shaped resection. Transection of the parenchyma by a harmonious scalpel was made using 10 mm coagulation scissors, i.e. their blunt blade with a lower oscillation grade. The preoperative blood loss was from 30 to 300 ml. As to postoperative complications 2 patients developed cholascos, 2 fluidothorax, 1 respiratory failure and 2 early infection. Liver resection by means of a harmonious scalpel is a new method of parenchyma transection with adherence to the resection line without damage of the deeper structures, reducing preoperative haemorrhage and minimalizing the extent of resection in liver diseases with impaired regeneration of the parenchyma (cirrhosis). Liver transection by a harmonious scalpel is a safe method where it is essential to respect recommended technical parameters, incl. the necessary time.
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PMID:[Liver transection with the harmonic scalpel in elective liver surgery]. 1266 83

A-55-year-old man ingested unknown amount of snail poison bait containing metaldehyde. He was mentally retarded and presented pica. On admission, his vital sign was stable, and the extremeties were spastic. Then, gastric lavage was unsuccessful because of massive unbited food. Activated charcoal and cathartic were administrated. On the next day, general convulsion occurred and respiratory distress advanced, so he was intubated. On the 3rd day, infiltration shadow appeared on chest roentogenogram and, his respiration was assisted mechanically. Thereby, acute lung injury advanced regardless of tracheostomy, kinetic therapy, antibiotics and steroid pulse therapy. He died of respiratory failure on the 33rd day. Serum test showed HBs and HBe antigen, CT scan revealed ascites and splenomegaly; the clinical course might be worsened by liver cirrhosis. HPLC revealed metaldehyde in the serum (total 80.6 microg/ml). He ingested 2.7 g of metaldehyde maximally estimated. Although Japan Poison Information Center reported that snail poison bait poisoning is often in dogs in Japan, human poisoning is rare.
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PMID:[Case report-fatal snail bait (metaldehyde) overdose presenting aspiration pneumonia]. 1474 May 68

Vibrio vulnificus is a Gram-negative, motile, curved bacillus of the family Vibrionaceae that is a rare cause of gastroenteritis, septicemia, and wound infections in humans. V. vulnificus is halophilic, flourishes in warm temperatures, and is part of the bacterial flora of the marine environment. The location of our health care setting, on the Gulf of Mexico, has given us the opportunity to observe a wide variety of clinical presentations of infections caused by this organism. In the first case, a 27-year-old man struck by lightning while windsurfing was found pulseless in the water and was resuscitated. The patient subsequently developed cardiac arrhythmias, respiratory failure, and necrotizing fasciitis, blood cultures yielded V. vulnificus. After antibiotic therapy and several fasciotomies, the patient recovered. The second case was that of a 43-year-old Asian man employed as an oyster shucker who presented with complaints of redness, tearing, and photophobia of the right eye. The diagnosis of corneal ulcer secondary to V. vulnificus was made after culture of the right eye revealed the organism. The third case involved a 46-year-old man who presented with complaints of abdominal pain, nausea, chills, and bullous lesions on the lower extremities. He developed disseminated intravascular coagulation, and cultures of the lesions on his lower extremities showed V. vulnificus. Initially, the patient denied any exposure to raw seafood or seawater, but he eventually remembered eating raw oysters 3 days before his illness. The fourth case is that of a 32-year-old, human immunodeficiency virus-positive, hepatitis C-positive woman with cirrhosis who presented with productive cough, chills, fever, and red spots on her extremities and buttocks. Blood cultures revealed V. vulnificus and the patient was treated with antibiotics and improved clinically. These four cases illustrate the wide range of clinical presentations associated with this organism.
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PMID:Varied clinical presentations of Vibrio vulnificus infections: a report of four unusual cases and review of the literature. 1498 56

Previously we reported combined chemo-immunotherapy, using interferon (IFN)-alpha and 5-fluorouracil (5-FU) for patients with advanced hepatocellular carcinoma (HCC), and this regimen improved the prognosis. Recently, we experienced an HCC patient who died of severe interstitial pneumonia during the combined IFN-alpha and 5-FU therapy. This is the first report of the occurrence of interstitial pneumonia during combined IFN-alpha and 5-FU treatment. A 60-year-old-man was admitted to Osaka University Hospital to receive systemic chemo-immunotherapy for recurrent HCC. In the second week of the chemo-immunotherapy, he showed a decreased level of consciousness, and respiratory insufficiency. Emergency roentgenogram revealed diffuse infiltration in both lungs. Respiratory dysfunction due to interstitial pneumonia was suspected, and steroid pulse therapy was started. However, the patient showed respiratory failure, and he died 32 days after the start of the therapy. Autopsy findings showed atelectasis in the bilateral lungs, which showed elastic hard solidity and a dark red color; esophageal varices were also shown, and there was cirrhosis with a large tumor in the liver. Microscopically, the alveolar wall showed marked fibrous thickness and moderate inflammatory change, which is consistent with acute interstitial pneumonia, and the acute pulmonary change was suspected to have been the cause of death. The association of IFN with the development of interstitial pneumonia has been reported. However, the prognosis of IFN-induced interstitial pneumonia has mostly been favorable when the medication was discontinued. It has been postulated that interstitial pneumonia induced by the combination of IFN and 5-FU may be therapy-resistant. The combination of IFN-alpha and 5-FU is a useful therapy for patients with advanced HCC, such as that with portal vein invasion or multiple metastatic foci. Thus, interstitial pneumonia in these patients should be carefully managed.
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PMID:Interstitial pneumonia induced by combined intraarterial 5-fluorouracil and subcutaneous interferon-alpha therapy for advanced hepatocellular carcinoma. 1533 75

A 70-year-old man with liver cirrhosis and previous gastrectomy admitted for fever, coughing, and bloody sputum soon after convalescing from pulmonary tuberculosis had a peripheral white blood cell count of 9,900/microL, C-reactive protein of 14.1mg/dL, serum albumin of 2.0g/dL, and serum positive for antiaspergillus and beta-D glucan antibodies. Chest radiography showed thickening of the walls of the large residual cavities with previous tuberculosis lesions and infiltrates around them. On day 2 of hospitalization, Aspergillus fumigatus without other bacillus was detected in sputum culture taken on admission. Despite immediate treatment with intravenous micafungin and oral itraconazole and improved brief initial improvement, his general condition abruptly deteriorated into frequent massive hemoptysis and he developed of shock, respiratory failure, and severe malnutrition, dying 30 days later. Autopsy findings showed pulmonary aspergillosis in and around the large cavities and on the other side of the lungs. Pulmonary aspergillosis without hematological malignanciy and immunosuppression can thus be abruptly severe and fatal due to malnourishment stemming from pre-existing conditions such as chronic hepatitis despite prompt, ordinarily adequate medical treatment.
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PMID:[Autopsy case of pulmonary aspergillosis soon after convalescence from pulmonary tuberculosis]. 1644 78


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