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)

Besides lymphodenopathy and splenomegaly, hepatomegaly may also be detected in 25-50% of children with juvenile rheumatoid arthritis. This is particularly evident in patients with complete Still's syndrome. The hepatomegaly increases during relapse situations and disappears during remissions. Transient icterus, elevation of aminotransferases and delayed bromsulfalein excretion have been reported, particularly in patients with complete Still's syndrome, and indicate impairment of liver function. Liver biopsies have been performed only rarely and show nonspecific infiltrations of portal fields with lymphocytes and, in a few cases, "autoimmune" hepatitis and even cirrhosis with portal hypertension. Plasma cell hepatitis with affection of joints can be readily differentiated from juvenile rheumatoid arthritis: the synovitis is merely transiet and disappears with institution of steroid therapy. As in the adult, severe liver dysfunction leads to remission of arthritis. Amyloidosis should be considered in every case of long-lasting hepatomegaly.
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PMID:[Liver pathology in juvenile chronic polyarthritis]. 91 83

The 5-years-survival rate of patients with liver cirrhosis is limited to about 25%. Still, one of the most important therapeutic procedures in case of bleeding oesophageal and fundic varices is a portasystemic shunt 6 randomized studies have been performed to compare the complete portacaval shunt with the incomplete splenorenal Warren-shunt: The hospital mortality rate (8-10%) and the 5-years-survival rate (43-47%) do not differ; but the rate of postoperative encephalopathy significantly is higher after PCA (40-26%) and the rate of recurrent bleeding significantly is higher after Warren-shunt (13-6%). In case of massively or early recurrent bleeding, we favour an emergency PCA: the mortality rate amounts to 12% in case of the socalled "early operation" (after initially successful balloon tube or sclerotherapy, 52 patients) and 47% in case of "absolute emergency shunt" because of continuing bleeding (119 patients). In the elective situation (58 patients) we favour the Warren-shunt in elderly patients with diabetes mellitus, preexisting encephalopathy or Child-B-classification.
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PMID:[Status of the portosystemic shunt in the therapy concept of portal hypertension]. 265 46

The authors have performed a longitudinal study of 118 children affected with B virus chronic hepatitis. Our first observation revealed 92 children with HBeAg positive (26 CPH, 66 CAH), 22 children with anti HBe positive (6CPH, 15 CAH, 1 cirrhosis), 4 children (CAH) with e/anti-e negative. A correlation between the severity of clinical forms and the behaviour of the e/anti-e system was not observed. Seroconversion was observed during the follow up period in 37 of 92 subjects in an average time of 59.83 +/- 32 months, time rather prolonged in patients under immunosuppressive therapy. To compare the clinical progress and the evolution of CPH and CAH respectively, always with regard to the e/anti-e system, statistically significant differences did not result. Only anti HBe positive recovered subjects, inclusive of seroconverted patients and those anti HBe from the first observation, showed significant results to the statistical analysis. Still, seroconversion corresponds frequently to a stable improvement of hepatitis. On the contrary evolution into cirrhosis was observed in 5 patients that had anti HBe antibodies.
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PMID:Correlation between e/anti e system and evolution of B virus chronic hepatitis in pediatric patients. 371 77

Patients with cirrhosis, who have survived an episode of variceal bleeding, often have far-advanced liver disease and therefore, on average, a severely restricted life expectancy. Still, the prognosis for the individual patient varies greatly depending on the presence or absence of large varices and the Child classification. Centres evaluating treatment of variceal bleeding often attract different patient populations. Comparison of the outcome of the complete series of patients is usually meaningless since results reflect the composition of the patient population rather than the applied therapy. The natural history of patients with variceal bleeding should be defined by Child category, allowing more precise definition of the therapeutic aims and subsequently assessment of the results. Persistent lowering of the portal pressure by pharmacological modulation of the portal haemodynamic system is now feasible due to the availability of long-acting oral medication. Propranolol is still the leading drug and, in one centre, its use in predominantly Child A patients was associated with a marked reduction in recurrent gastrointestinal bleeding and subsequently mortality rate. These results could not be reproduced in another centre. Both the restricted indication as well as the uncertain efficacy limit the current use of propranolol, but further pharmacological developments are bound to appear. Endoscopic sclerotherapy has become the treatment of choice in the prevention of recurrent variceal haemorrhage. The proponents of paravasal injection report excellent efficacy in combination with a low incidence of side-effects, whereas mainly theoretical reasons are advanced by users of intravariceal injections. Still, variceal haemorrhage remains an important clinical problem in the period between the start of sclerotherapy and the eradication of varices. Combination of sclerotherapy with portal antihypertensive medication might become the treatment of choice until eradication of varices has been achieved; thereafter either continued medication or repeated endoscopy will maintain an avariceal state and effective prevention of recurrent variceal bleeding.
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PMID:Prevention of recurrent variceal bleeding: non-surgical procedures. 388 14

Hepatocellular carcinoma is different from other solid tumors. Because of concomitant cirrhosis or multiple lesions, most hepatocellular carcinoma is unresectable. Still worse, hepatocellular carcinoma frequently recurs after surgical resection; the 5-year cumulative recurrence rate is 70-90% even after curative hepatectomy. The situation is similar in small hepatocellular carcinoma 2 cm or less in diameter. Thus, non-surgical treatment plays an important role. At present, we think that percutaneous ethanol injection therapy (PEIT) is best for the treatment of hepatocellular carcinoma because of its local curativity, minimal adverse effect on liver function, and the easy feasibility of repeated treatment for recurrence. We have recently treated about 85% of hepatocellular carcinoma cases by PEIT and have achieved satisfactory long-term results. Here we describe our results in PEIT for small hepatocellular carcinoma. By the end of December 1995, we performed PEIT on 410 patients with hepatocellular carcinoma. Among them, 140 patients were diagnosed as having small hepatocellular carcinoma 2 cm or less in diameter. The 1-, 3-, 5-, 7-, and 10-year survival rates of the 140 patients were 93%, 73%, 55%, 51%, and 32%, respectively. Furthermore, in 83 patients who had a single, small hepatocellular carcinoma 2 cm or less in diameter, the 1-, 3-, 5-, 7-, and 10-year survival rates were 92%, 82%, 72%, 66%, and 66%, respectively. Thus PEIT achieved satisfactory long-term survival rates in the treatment of small hepatocellular carcinoma.
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PMID:[Percutaneous ethanol injection therapy for small hepatocellular carcinoma]. 867 30

Chronic alcoholism in patients with chronic hepatitis C hastens disease progression toward development of cirrhosis and hepatocellular carcinoma. Approximately 30% of alcoholic patients with liver disease are infected with the hepatitis C virus (HCV), the primary risk factor being a history of injection drug use. The histologic pattern in alcoholics is typically indistinguishable from nonalcoholic patients similarly infected with chronic hepatitis C. The mechanism(s) involved in alcohol-induced enhancement of chronic hepatitis C have not entirely been established but may involve increased viral replication, iron overload, and immune suppression. Still to be determined is the minimum amount of daily alcohol intake, if any, that can be ingested without enhancing progressive liver injury. However, chronic hepatitis C patients undergoing treatment with interferon must abstain from any alcohol intake, because the efficacy of interferon therapy is significantly lower in those who continue to drink. Future research efforts are needed in order to further delineate the epidemiology and pathogenesis of chronic hepatitis C in the alcoholic patient.
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PMID:The alcoholic patient with hepatitis C virus infection. 1065 67

Most frequent complications in patients with liver cirrhosis are due to portal hypertension. Beside ascites circumvent vessels formate with vasodilatation. Due to counterregulation a secondary hyperaldosteronism develops with release of vasocontrictive agents. If conservative and endoscopic methods fail, indication for building a portosystemic shunt is given. The TIPSS procedure is less invasive than the surgical method of Warren-Shunt, so the radiological intervention has replaced surgery. Reducing the portal pressure by the shunt, the clinical complications change for the better. Still problems are defined as hepatic encephalopathy and right ventricular heart failure. Regular follow up investigations have to be performed to detect complications in the shunt. Using regular clinical and radiological check up TIPSS is of clinical benefit with good long term results.
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PMID:[Transjugular portosystemic stent shunt (TIPSS) as intervention in clinical complications of portal hypertension]. 1171 78

Hepatitis C virus (HCV) is responsible for the development of a chronic carrier state that can lead to the induction of cirrhosis and liver cancer. These clinical manifestations are believed to be the direct consequence of the viral persistence and the incapacity of the host to develop vigorous and sustained immune responses. Still contradictory data suggest the existence of neutralizing antibodies specifically directed at the second glycoprotein (E2). These antibodies may nonetheless play only a minor role in the control of infection. In contrast, it is now generally recognized that cellular-mediated immune responses, CD4+ and CD8+ mediated, if in place early enough, of a vigorous and polyclonal nature as well as long-lasting, appear by themselves competent enough to control an infection. One of the mechanisms possibly responsible for the establishment and persistence of a chronic infection could be the alteration of the ability of antigen-presenting cells (dendritic cells) to stimulate a T cell response. Such alteration could be the result of a direct infection of these cells by HCV.
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PMID:[Role of neutralizing antibodies and cellular immunity in hepatitis C virus infection]. 1180 9

Diagnosis of hepatitis B and hepatitis C viral infections can be achieved by highly specific and sensitive primary serological screening assays. Still more costly amplification systems on the qualitative and quantitative detection of HBV-DNA and HCV-RNA are only used for answering special clinical questions. They are relevant to indicate antiviral therapy or to control the outcome of treatment. They are rarely necessary for diagnostic purposes as it may happen in immunosuppressed persons. While in hepatitis B activities of aminotransferases and liver histology usually present a good correlation this is not dependably seen in hepatitis C. Histologic evaluation still appears the only reliable diagnostic procedure for determining inflammatory activity and fibrosis progression in hepatitis C. Liver biopsy therefore is considered mandatory prior to initiation of treatment especially since only patients suffering from severe disease with progression to liver cirrhosis may benefit from today's standard treatment procedures.
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PMID:[Diagnosis of B and C viral hepatitis: new developments and relevance for general practice]. 1209 30

Although several mouse models of AIH have been described, no model is ideal. Indeed, the disease is self-limited in each model, and none is associated with significant liver fibrosis or progression to cirrhosis. Nevertheless, these models should be useful for testing different hypotheses regarding the initiation of AIH. Still, each model poses unique limitations. The EAIH model initiated by immunization with crude liver antigens in CFA has been plagued by a high prevalence of hepatitis lesions in CFA controls and inconsistencies in results. The TGF beta-1 and IL-2 deficient models lead to high in utero mortality and short median life spans in the surviving animals. Lastly, all models require more detailed characterization of the antigen specificity of infiltrating liver T cells and the pathogenesis of liver cell injury.
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PMID:Animal models of autoimmunity. 1236 80


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