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

To identify the potential impact of novel therapeutic approaches, we studied the early predictive factors of survival at the onset of acute respiratory distress syndrome (ARDS) in a 24-bed medical ICU of an academic tertiary care hospital. Over a 48-mo period, a total of 3,511 adult patients were admitted and 259 mechanically ventilated patients met ARDS criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FIO2 lower than 200 without left atrial hypertension. These patients were randomly included in a developmental sample (177 patients) and a validation sample (82 patients). Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as several severity scores (SAPS, SAPS-II, OSF) and Lung Injury Score (LIS) were collected. These variables were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles. The overall mortality rate was 65%. SAPS-II, the severity of the underlying medical conditions, the oxygenation index (mean airway pressure x FIO2 x 100/PaO2), the length of mechanical ventilation prior to ARDS, the mechanism of lung injury, cirrhosis, and occurrence of right ventricular dysfunction were independently associated with an elevated risk of death. Model calibration was very good in the developmental and validation samples (p = 0.84 and p = 0.72, respectively), as was model discrimination (area under the ROC curves of 0.95 and 0.92, respectively). Thus, the prognosis of ARDS seems to be related to the triggering risk factor, the severity of the respiratory illness, and the occurrence of a right ventricle dysfunction, after adjustment for a general severity score.
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PMID:Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. 976 63

We have shown that administration of inorganic potassium phosphates (Pi) to patients with severe diabetic ketoacidosis was able to increase the P50 (the PO2 necessary to achieve a hemoglobin saturation of 50%) by a non diphosphoglycerate (DPG) mediated effect. This suggests that the oxyhemoglobin dissociation curve (ODC) may be determined not only by pH, temperature, CO2 content and DPG but also by plasmatic ions. In order to test this hypothesis we have determined the ODC on whole blood in two groups of subjects, 49 control subjects with matching age and sex and 49 patients suffering from liver cirrhosis, acute pancreatitis, septic shock and acute respiratory distress syndrome. The patients had many ionic disorders induced either by their diseases or by the applied treatment. The mean ODC of the patients did not differ from the normal values. In contrast, the dispersion of PO2 around the saturations values was increased from 5 to 80% saturation. A forward regression analysis showed that the DPG level and the levels of inorganic phosphates and natrium (Na+) played a significant role in determining the position of the ODC according to the following equation: P50 (mmHg) = 34.5 + 0.225 DPG + 0.62 Pi-0.09 Na+, where DPG is in micromol.gHb-1 and Pi and Na+ in mEq.l-1. In separate experiments we showed that the Bohr effect as expressed in d (log PO2)/dpH amounted to -0.53, -0.46 and -0.42 for SO2 equal to 5%, 50% and 95%, respectively. The corresponding values for the temperature effect was expressed in d (log PO2)/dT amounted to 0.028, 0.024, and 0.020 respectively. The fact that ions play an role in regulating the position of the ODC of patients with ionic disorders may have therapeutical implications, preventive or curative.
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PMID:Effect of inorganic ions on the oxyhemoglobin dissociation curve of severely ill patients. 976 30

Invasive disease due to Group B streptococci has been increasingly recognized as a problem in chronically ill adults. We studied all adults presenting with bacteremia due to Group B streptococci at Hartford Hospital over a period of more than five years. Fifty-nine episodes of septicemia occurred with a mortality rate of 15.3%. Markers for mortality included cirrhosis, azotemia, transaminase elevation, respiratory distress on admission, and ionized hypocalcemia Although commonly thought of as a maternal and pediatric pathogen, nonpregnant, chronically ill adults make up the vast majority of patients with Group B streptococcal sepsis.
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PMID:Group B streptococcal bacteremia in adults at Hartford Hospital 1991-1996. 978 35

This review summarizes current strategies in the treatment of patients with pleural effusion. To determine whether a patient has a transudative or exudative pleural effusion, Light's criteria should be applied to measure the concentrations of protein and lactate dehydrogenase (LDH) in the pleural fluid and serum. If the effusion is transudative, therapy should be directed toward the underlying congestive heart failure, cirrhosis, or nephrosis. Consideration should be given to pleurodesis with a sclerosant if patients with recurrent transudative effusion have severe dyspnea due to their effusion. If the effusion is exudative, attempts should be made to define the etiology. The diagnosis of pleural malignancy is most easily established via pleural fluid cytology. If this is negative and the patient is suspected of having pleural malignancy, thoracoscopy is indicated. The concentrations of adenosine deaminase and gamma-interferon in pleural fluid are useful in the diagnosis of pleural tuberculosis. Patients with pneumonia and pleural effusion should undergo therapeutic thoracentesis; the pleural fluid should be Gram-stained and cultured, and the differential cell count, glucose and LDH concentration, and pH should be determined. Indicators of a poor prognosis include the presence of frank pus, a positive Gram-stain, a pleural glucose concentration of less than 2.2 mmol/L, a pH less than 7.00, the presence of pleural loculations, and an LDH concentration greater than three times the upper limit of normal in serum. If the pleural fluid cannot be completely evacuated because of loculations, intrapleural thrombolytic therapy should be considered. If thrombolytics are ineffective, thoracoscopy or thoracotomy with decortication should be performed. Dyspneic patients with malignant pleural effusions whose dyspnea is relieved with therapeutic thoracentesis should be considered for pleurodesis using a tetracycline derivative. Talc is not recommended because it induces acute respiratory distress syndrome in about 5% of patients, with an overall mortality of 1%.
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PMID:Management of pleural effusions. 1092 61

A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. Heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. Autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.
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PMID:Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism. 1102 Aug 95

Hepatic hydrothorax is a dreaded complication in patients with liver cirrhosis. Placement of chest tubes can alleviate respiratory distress, but patients often succumb due to excessive fluid and protein loss via the open drain. Our case illustrates that high-dose octreotide can strongly reduce hepatic hydrothorax drainage volume. This allows removal of the chest tube, which would otherwise not have been possible.
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PMID:Treatment of hepatic hydrothorax and reduction of chest tube output with octreotide. 1150 67

This report describes a patient with biliary atresia (BA) associated with polysplenia syndrome who showed a rapid progression of intrapulmonary arteriovenous shunting (IPS), resulting in a fatal outcome. Intrauterine ultrasonography at 36 weeks of gestation revealed fetal abnormalities, including situs inversus, absent retrohepatic inferior vena cava, and azygous connection. She was diagnosed postnatally as BA because of persistent acholic stool and neonatal jaundice. She underwent hepatic portoenterostomy at age 158 days. The gallbladder and the hepatic ducts were hypoplastic, and the common bile duct was absent. Magnetic resonance image and operative findings also identified polysplenia and an absent portal trunk. Liver histology showed cirrhotic changes and bile duct proliferation. Postoperatively, she achieved good bile secretion, with gradual decrease of total bilirubin. However, she had repeated febrile episodes, and computerized tomography at age 7 months showed multiple liver cysts. Thereafter, she presented with exertional dyspnea. Contrast-enhanced echocardiography showed IPS with a degree of 2/III at age 8 months and 3/III at 10 months. (99m)Technetium-labeled macroaggregated albumin ((99m)Tc-MAA) scintigraphy revealed a shunt ratio of 25.5% at 9 months and 39.7% at 10 months. Percutaneous transhepatic drainage of the bile cysts was performed without success. Sludged bile was obtained. However, respiratory distress rapidly progressed, and she died at age 11 months. In the present patient, the association of polysplenia syndrome and absent portal vein with BA, as well as liver cirrhosis, seemed to be contributing factors to rapid progression of IPS in early life.
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PMID:Rapid progression of intrapulmonary arteriovenous shunting in polysplenia syndrome associated with biliary atresia. 1274 50

The appropriateness of albumin use and baseline albumin usage patterns were studied. Institutional practice patterns regarding the use of albumin were compared to criteria established by an independent expert panel. Fifty-three institutions, all of which were members of VHA or the University Health-System Consortium, participated in the evaluation. Investigators collected data over an eight-week period from the medical records, pharmacy records, and hospital billing data of adult (18 years of age or older) and pediatric (age 1-17 years) patients for whom albumin was prescribed. Data collected included patient-specific information, the prescribing physician's specialty area, patient location (level of care) when albumin was prescribed, primary reasons for prescribing albumin, and details of albumin use. Data were collected for 1649 adult and 23 pediatric patients. Albumin was prescribed inappropriately in 57.8% and appropriately in 28.2% of adults; appropriateness of use was unknown in 14% of the patients reviewed. The most common indication for albumin use was hypotension/hypovolemia (23.9%), followed by bypass-pump priming (16.3%), intradialytic blood pressure support (9.6%), and serum albumin values less than 2 g/dL (8.6%). Albumin was prescribed inappropriately 100% of the time when used for intradialytic blood pressure support, low serum albumin values, and acute respiratory distress syndrome. The most appropriate use of albumin occurred in patients with postsurgical hypotension and hypovolemia (67.8%), nephrotic syndrome (79.3%), non-hemorrhagic shock (44.3%), hemorrhagic shock (51.9%), and cirrhosis and paracentesis (31.3%). Albumin was inappropriately prescribed for 57.8% of adult patients and 52.2% of pediatric patients. The mean number of total grams used by patients receiving albumin appropriately was similar to those patients inappropriately receiving albumin.
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PMID:Evaluation of the appropriate use of albumin in adult and pediatric patients. 1290 Oct 34

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

A 52-year-old man with history of post-hepatitic cirrhosis presented with ascitis and respiratory distress. Chest X-ray on admission showed a large right hydrothorax. Thoracentesis yielded a large volume of a clear transudate fluid. Peritoneal scintigraphy showed rapid migration of radiotracer into the right pleural cavity, confirming the abdominal origin of the pleural fluid and suspecting a large diaphragmatic defect. MR imaging study using ultrafast sequences confirmed the large diaphragmatic defect.
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PMID:Large diaphragmatic defect as the cause of hydrothorax in a cirrhotic patient: demonstration with peritoneal scintigraphy and magnetic resonance imaging. 1506 41


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