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

The significant increase in the number of people older than seventy forces the physician to be acquainted with both psychological and physical alterations induced by aging and to devote an ever increasing proportion of time for recognition and treatment os such alterations. In the medical sense, the biological and physiological age is more important than the chronological age. With increasing age there is--especially concerning the digestive tract and its accessory organs--a rise in the incidence of organic affections and a decline in the frequency of functional disorders. Besides it is wise to know, that the increasing age there is often a coexistence of multiple degenerative disorders and disease states, involving many body systems and organs. On the background of this recognition it is also important to know, that prognosis too varies with age because of the coexistence of individually prognosticated disease states and moreover to realize, that elderly patients do not tolerate invasive and prolonged surgical procedures. Structural or functional disturbances of the digestive organs by aging processes do not cause death per se, but can become one important factor; degenerative sclerotic vascular alterations bear relationship to the poorly contractile vasculature that brings up difficulties in the control of hemorrhagic gastroduodenal ulcers. Many gastrointestinal disorders in elderly patients occur with an equal frequency in younger patients, some are more common in the geriatric population; these include hiatal hernia, carcinoma of esophagus, stomach, pancreas, bile ducts and colon, intestinal obstruction (ileus) by neoplastic growth, gallstone ileus, external hernia and operative adhesions and especially diverticular diseases of the colon and its complications and ischemic colitis by mesenteric vascular occlusion. Cirrhosis of the liver is often diagnosed for the first time in the older age groups while acute viral hepatitis uses to run a cholestatic course and is therefore often misdiagnosed as mechanical obstruction. In general history is difficult to obtain, the response of the organism with temperature and white blood count to stress is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often atypical. Because of this limited reaction to severe stress, early surgical intervention is imperative in the elderly patients.
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PMID:[Problems of the so-called geriatric gastrointestinal diseases]. 120 46

Cystic fibrosis (CF) is the commonest, fatal, autosomal recessive disorder and is associated with lung sepsis, pancreatic failure and elevated sweat electrolytes. The CF gene on chromosome 7 encodes a protein identified as CF transmembrane conductance regulator (CFTR) which regulates chloride ion transport in epithelial cell membranes. Almost 100 mutations have been identified in this gene which cause defective chloride-channel control. Recently, this abnormality has been reversed in affected CF cells in vitro by retrovirus-mediated transfer of a normal gene. Fifty years ago, most cases died in childhood, but now up to 80% reach adulthood. Chronic lung sepsis is the principal cause of death, and intensive antibiotic therapy with chest physiotherapy is used to control this. Advanced lung disease can be successfully treated by heart-lung transplantation. Nebulised recombinant DNase and antineutrophil elastase agents such as alpha-1-antitrypsin and secretory leucoprotease inhibitor are potentially promising new therapies. Pancreatic insufficiency is managed by high-calorie diets and enteric coated enzyme supplements. Other prominent gastrointestinal complications include meconium ileus equivalent, biliary cirrhosis and cholelithiasis. Specially dedicated CF centres have led to improved survival rates and allow experienced staff to treat the many complications of CF while promoting research in this multisystem disorder.
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PMID:Cystic fibrosis in adolescents and adults. The coming of age of cystic fibrosis. 155 Dec 44

From 1972 to 1989, 20 cases of tuberculous peritonitis were seen in Tokyo Metropolitan Geriatric Hospital. In 13 patients the diagnosis of tuberculous peritonitis was made only at autopsy, which in 7 patients was made during life. Of all 20 cases the mean age was 78 years, with a range of 63 to 96 years. There were no differences in mean ages between autopsied patients and clinically diagnosed patients. There were 11 male and 9 female patients. In autopsied patients 6 were male and 7 were female. Of the clinically diagnosed patients 5 were male and 2 were female. Seven of 13 patients who were diagnosed at autopsy had liver diseases, for example liver fibrosis, liver cirrhosis, hepatocellular carcinoma or chronic hepatitis. In 4 of 7 patients who were diagnosed during life, ileus was also present and their diagnosis of tuberculous peritonitis was made at operation. Only 6 patients had tuberculin test with intermediate strength PPD. There were no positive reactions. In patients who were diagnosed during life, abdominal swelling, anorexia, abdominal pain and fever, the most common clinical manifestations, were seen in 100%, 75%, 50% and 86%, respectively. In contrast, they were seen in 33%, 57%, 0% and 62%, respectively, in autopsied patients. The volume of ascitic fluid varied from zero to 3000 cc. Total white-cell count in the peripheral blood was within or lower than the normal range in 85% of all 20 cases. The lymphocytes count in the peripheral blood was decreased in 95% of all 20 cases. There were no characteristic features in the serum biochemical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and pathological features of tuberculous peritonitis in the elderly]. 207 56

Since 1984 the peritoneovenous shunt has been installed in 33 patients (10 females - 30.3%; 23 males - 69.7%) of the average age of 54 +/- 8, all in the phase of therapeutically resistant ascites (alcoholic cirrhosis 28 - 84.85%; 4 - 12.12% posthepatitic cirrhosis; and 1 - 3.03% hepatic amyloidosis). The control group consisted of 39 patients (11 females - 28.2% and 28 males - 71.8%) treated in an identical time span with the strict conduction of medicament-diet therapy. The aim of this study was to check the value of this method on our own clinical-patient material, and therefore establish the incidence of complications. By the use of a unique protocol we followed mortality, morbidity, body weight, belly circumference, diuresis, the ultrasonographic finding of the abdominal cavity and the complications which appeared. Out of the group operated on 19 (57%) of the patients died, and so did all the control group patients as well. The average life duration was 275 +/- 810 days in the group operated on, and 44 +/- 29 (p less than 0.005) in the control group. All those alive (14.33-42.42%) lived longer than six months. Six patients lived longer than one year (42.85%), 4 (28.47%) longer than two years, and one (7.14%) longer than three years. There is a statistically significant decrease in body weight, belly circumference, diuresis increase and the consequent ascites withdrawal. DIC occurred in 2 patients, shunt malposition in 2, saccular dilatation in 1, plastic peritonitis in 6, and ileus in 1 patient. Not one of the listed complications resulted by death.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Therapy of resistant ascites using the peritoneojugular (Leveen shunt)]. 228 15

Although dehydrated obstructing mucus is thought to account for the obstructive pathology involving the lungs, the pancreas, the reproductive system, and the intestinal tract, its relationship with CF-associated liver disease remains largely hypothetical and little is known about possible risk factors. Complete clinical and autopsy records were available in 38 of 73 deaths occurring over a 10-year period. The liver was normal in only five cases, and they were all infants. Steatosis was the only lesion present in 9, hypoxic liver disease was documented in 8, and biliary cirrhosis in 16 (focal in 10 and multilobular in 6). There was no relationship between the presence of cirrhosis, gallbladder abnormalities, age at death, and clinical status recorded during the year precoding their demise. Mucus plugs characterized by amorphous eosinophilic material within proliferated bile ductules were present in 75% of children with focal or multilobular biliary cirrhosis as opposed to 14% in those without (p = 0.015). A history of meconium ileus or its equivalent was recorded more frequently (p = 0.038) in those with cirrhosis. Finally, biliary cirrhosis was invariably present when there was a history of meconium ileus or its equivalent and when mucus plugs were noted. These findings suggest that patients with intestinal obstruction are at greater risk for the development of cirrhosis and that strategies should be developed to increase the detergent capacity of bile and its flow in order to decrease the viscosity of mucus in the biliary tree.
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PMID:Meconium ileus and its equivalent as a risk factor for the development of cirrhosis: an autopsy study in cystic fibrosis. 277 65

Preexposure of blood samples to perchloric acid permitted an accurate, quantitative measurement of endotoxin levels as low as 1 pg/ml using a colorimetric limulus test. Conventional chloroform and dilution-heating methods were unsatisfactory because of high residual nonspecific amidolytic activity and poor recovery. The normal peripheral plasma endotoxin level was less than 10 pg/ml when Escherichia coli 0111:B4 endotoxin was used as a reference. One nanogram in this assay was equivalent to 2.9 endotoxin units of USP reference standard endotoxin (E. coli 0113). High values were noted in portal venous blood and in cases of acute hepatitis, liver cirrhosis, strangulation ileus, pyothorax, lung abscess, diffuse panbronchiolitis, and pneumonia. Normal human plasma and serum exhibited a high capacity to inactivate added endotoxin. E. coli 0111:B4 and Salmonella minnesota 9700 were more susceptible to inactivation than Pseudomonas aeruginosa endotoxin. This inactivating activity was temperature dependent, was maximal between 37 degrees and 45 degrees C, and disappeared completely after heating plasma or serum to 56 degrees C for 30 minutes prior to the addition of endotoxin. The E. coli 0111:B4 endotoxin-inactivating activity of normal platelet-rich plasma, platelet-poor plasma, and serum, all at 37 degrees C, was 8.1 +/- 3.1, 11.7 +/- 4.5, and 15.2 +/- 4.9 micrograms/min/ml (mean +/- SD; n = 4), respectively. Endotoxin-inactivating activity was markedly decreased in plasma from patients with endotoxemia, but returned to normal with recovery from the underlying illness.
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PMID:Addition of perchloric acid to blood samples for colorimetric limulus test using chromogenic substrate: comparison with conventional procedures and clinical applications. 608 54

Cystic fibrosis is the most common fatal inherited disease of Caucasians. At present, cystic fibrosis accounts for most cases of chronic progressive pulmonary disease and for many other clinical features in the first three decades of life. Thus, it is a challenge to both pediatricians and internists, particularly chest physicians. The diagnosis is based on the triad of chronic obstructive pulmonary disease, pancreatic insufficiency, and increased levels of electrolytes in the sweat. The cardinal test for confirmation of the diagnosis is the "sweat test," which is an excellent discriminant for cystic fibrosis, even in adults. Ancillary features of cystic fibrosis may be of diagnostic assistance (eg, nasal polyposis, Pseudomonas aeruginosa in sputum, azoospermia, and others). Treatment of the pulmonary disease must be emphasized. Choice of antibiotics should be based on the results of sputum culture, but P aeruginosa is the most common pathogen. Removal of secretions by regular postural drainage and percussion is an integral part of the program. Pneumothorax, massive hemoptysis, cor pulmonale, and other complications may be encountered. Sinusitis is almost universal, and nasal polyposis is frequently present. Pancreatic insufficiency occurs in over 80 percent of the patients with cystic fibrosis and may result in intestinal malabsorption. Massive salt loss through the sweat in hot weather, a distinctive type of biliary cirrhosis without jaundice, gallbladder abnormalities, cholelithiasis, and diabetes mellitus also may be found. Of special importance are intestinal obstructive complications (meconium ileus in newborn infants with cystic fibrosis and intestinal obstruction due to fecal accumulation or intussusception in adults). Azoospermia is present in 95 percent of men and there is reduced fertility in women; however, pregnancy does occur in cystic fibrosis. This chronic and ultimately fatal disease produces a predictable set of psychosocial complications.
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PMID:Diagnosis and treatment of cystic fibrosis. An update. 637 70

Because the lifespan of patients with cystic fibrosis is now longer, both pediatricians and adult care physicians are involved in the health care strategy. Respiratory manifestations occur due to bronchial dilatation and chronic bronchial infection, mainly due to Staphylococcus aureus and Pseudomonas. Episodes of adult infection are frequent and death usually results from respiratory failure. Characteristically, the disease also involves exocrine pancreas insufficiency. Other intestinal tract manifestations include meconial ileus and liver disease which may reach the stage of biliary cirrhosis. Nutritional disorders are frequent. Clinically there are respiratory and digestive tract disorders, pansinusitis and frequent nasal polyposis, sometimes associated with diabetes mellitus or joint pain. Male sterility results from bilateral agenesia of the vas deferens and in the female, fertility is decreased although pregnancy is possible. Clinical presentation suggests the diagnosis which is confirmed by a sweat test and genetic analysis. Care should be provided by a centre specialized in cystic fibrosis. The main treatments rely on respiratory physical therapy, antibiotics and gastroprotected pancrease extracts.
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PMID:[Mucoviscidosis: in children and adults]. 756 75

We had already made a report on outcome of schizophrenia (1986). The patients, 129 typical schizophrenia, were continuously observed over 30 years in the Kawagoe Dojinkai Hospital. Recently, we again evaluated their prognoses according to the same criteria as adopted in the first report, and divided them into the following five groups. [symbol: see text]: completely remitted group (21 persons, 16.3%), [symbol: see text]: almost remitted cases now holding jobs (23 persons, 17.8%), [symbol: see text]: Slightly remitted group showing good adjustment at home or hospital (41 persons, 31.8%), [symbol: see text]: maladjusted cases always showing an unfavorable condition (25 persons, 19.4%), x : incurable cases (19 persons, 14.7%). 1) In the last 8 years, there were 30 persons (23.3% of the whole patients) who showed prognostic changes (10 persons improved, 20 persons worsen). While the second group ([symbol: see text]) has seen fewer persons (12 persons down) than previous study, the third group ([symbol: see text]) has seen more persons (9 persons up). Each three groups, that is, the first two groups ([symbol: see text] + [symbol: see text], 44 persons, 34.1%), the third group ([symbol: see text], 41 persons, 31.8%), and the forth and fifth groups ([symbol: see text] + x, 44 persons, 34.1%) accounted for a third of the whole patients. It is after 32 years on the average (extending from 21 to 50 years) from the onset of illness that they showed prognostic changes. 2) Generally speaking, catatonic patients had favorable prognoses, hebephrenic patients unfavorable ones, and paranoid patients medium ones. But 4 improved persons in the forth and fifth groups were all hebephrenic type. 3) 17 among the 30 persons who showed prognostic changes were unstable type. They took a wave-like course. 4) 27 of all the 129 patients were dead. 25 were dead from disease mentioned below. Malignancy (8 persons), Cerebral vascular disease, Pneumonia and Diabetes (3 persons), Heart-failure (2 persons), Ileus, Myocardial infarction, Hepato-cirrhosis, Gastric ulcer, Tuberculosis and Natural death (1 person). 2 persons committed suicide. 5) Outcome of 45 patients who discontinued our medical therapy became clear as follows. [symbol: see text] + [symbol: see text]: 18 persons (40.0%), [symbol: see text]: 9 persons (20.0%), [symbol: see text] + x : 18 persons (40.0%). A smaller percentage of the patients belongs to the third group ([symbol: see text]) than that of our patients who were continuously followed by us.
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PMID:[Outcome of schizophrenia--extended observation (more than 30 years) of 129 typical schizophrenic cases [III]]. 773 53

Cefotaxime is the most commonly used antibiotic for initial therapy of spontaneous bacterial peritonitis in cirrhosis. However, since the introduction of cefotaxime no study has been performed to investigate factors influencing prognosis in cirrhotic patients with this type of infection. In this study, predictive factors for infection resolution and patient survival were investigated in 213 consecutive episodes of spontaneous bacterial peritonitis in 185 cirrhotic patients. All patients were initially treated with cefotaxime. One hundred sixty-five episodes (77%) resolved with cefotaxime alone, and two more episodes (1%), initially unresponsive to cefotaxime, were cured after modification of antibiotic therapy. In a multivariate analysis (stepwise logistic regression), only 4 of 51 clinical and laboratory variables obtained at the time of diagnosis of infection were identified as independent predictors of infection resolution: band neutrophils in white blood cell count, community-acquired vs. hospital-acquired peritonitis, blood urea nitrogen level and serum aspartate aminotransferase level. No patient experienced serious adverse effects related to cefotaxime. Eighty-two patients died during hospitalization (38% mortality rate in relation to the 213 episodes of peritonitis). In the multivariate analysis, six variables were independently correlated with survival: blood urea nitrogen level, serum aspartate aminotransferase level, community-acquired vs. hospital-acquired peritonitis, age, Child-Pugh score and ileus. No microbiological data had predictive value for infection resolution or survival.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. 842 22


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