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)

In this prospective study of 240 black patients with liver enlargement admitted to the medical wards of King Edward VIII Hospital, Durban, a cause for the hepatomegaly was found in 92.5% of cases (63.8% without recourse to biopsy, 28.7% after liver biopsy). The commonest cause was congestive heart failure (36.7%), followed by amoebic liver abscess (7.1%), hepatocellular carcinoma (5.8%) and cirrhosis (5.4%). Liver biopsy provided the diagnosis in 90.8% of patients with initial unexplained hepatomegaly. The diagnostic yield of liver biopsy was increased by submitting 3 biopsy specimens for histological examination. The 3 specimens are obtained using a single intercostal entry site and redirecting the biopsy needle, without increasing the risk of complications. Hepatic tuberculosis was present in 9.2% of patients who underwent biopsy. There were no consistent clinical findings in these patients. Therefore, in communities in which tuberculosis is endemic, all patients with unexplained hepatomegaly require liver biopsy since it provides the only means of making this diagnosis.
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PMID:Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients. 300 36

At a time when the acquired immunodeficiency syndrome as well as hepatitis and other blood-borne diseases are a threat to patients with bleeding disorders who need treatment with blood products, it is rewarding to realize that a number of these patients can be safely and effectively treated with their own desmopressin-stimulated F.VIII:C and vWF. Desmopressin is clinically useful for treatment of patients with moderate and mild hemophilia. The limits of the clinical indications are established by the nature of the bleeding episode, the resting factor level, the level that must be achieved, and the length of time the level must be maintained to manage any given bleeding episode. In von Willebrand disease, desmopressin can be used more extensively to raise F.VIII:C levels than in classic hemophilia, because fewer of the patients have the severe form of the disease that is unresponsive to desmopressin. Increases in the level of F.VIII:C of about four times the resting value can be expected both in hemophilia and von Willebrand disease, but it must be borne in mind that the range of individual responses is large. Even though it is not easy to correct the prolonged bleeding time, particularly in patients with dysfunctional vWF, this drawback is of clinical relevance only in a minority of cases. A role for the use of desmopressin in acquired diseases of primary hemostasis has been proposed more recently, and experience is more limited than in congenital bleeding disorders. Uremia is probably the most firmly established indication because it has been shown that the bleeding time is often dramatically shortened by desmopressin, and hemorrhages can be stopped or prevented before surgical procedures. The indications for use of the compound in liver cirrhosis and congenital and acquired platelet dysfunctions are promising but much less established from a clinical standpoint. The bulk of available clinical experience is based on intravenous administration. Intranasal and subcutaneous administration have been successfully attempted and might be more convenient in selected circumstances, such as home treatment and the stimulation of blood donors to provide more abundant supplies of F.VIII:C and vWF. However, the responses after intranasal administration are less predictable and consistent than after intravenous administration. Desmopressin has few troublesome side-effects. Mild facial flushing, a small increase in heart rate, and, more rarely, mild headache can occur transiently during infusion. Signs of hyponatremia or cerebral edema are extremely rare, providing that excessive fluid intake is avoided.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Desmopressin (DDAVP) for treatment of disorders of hemostasis. 310 87

At this time, when the acquired immunodeficiency syndrome, hepatitis, and other blood-borne diseases threaten patients, with bleeding disorders, who need treatment with blood products, it is rewarding to realize that a number of them can be safely and effectively treated through the stimulation of their own VIII:C and vWF production with desmopressin. Desmopressin is clinically useful for treatment of patients with moderate and mild hemophilia. The limits of the clinical indications are the nature of the bleeding episode, the resting factor level, the level that must be achieved, and the length of time the level must be maintained to manage any given bleeding episode. Desmopressin can be used more extensively to raise VIII:C in von Willebrand's disease, than in classic hemophilia, because fewer of the patients have the severe form of the disease that is unresponsive to desmopressin. VIII:C increases to about four times the resting values that can be expected in both hemophilia and von Willebrand's disease, but it must be kept in mind that the range of individual responses is large. Even though it is not easy to correct the prolonged bleeding time, particularly in patients with dysfunctional vWF, this drawback is of clinical importance for only a minority of cases. Use of desmopressin in acquired diseases of primary hemostasis has been proposed more recently, and our experience is more limited than for congenital bleeding disorders. Uremia is probably the most firmly established indication, because the bleeding time is often dramatically shortened by desmopressin, and hemorrhages can be stopped or prevented. The indications for the compound in liver cirrhosis and congenital and acquired platelet dysfunctions are promising but much less well-established. The mechanism of action of desmopressin is not well-known, and more work must be done to fill this important gap. This problem is not only of theoretical importance, because understanding of the mechanism of action of the compound should open up new perspectives into understanding the physiological mechanisms that regulate hemostasis. Many unclarified aspects of the mechanism of desmopressin action might be elucidated by using specific antagonists and also by using appropriate animal models. (Dogs and primates respond partially to desmopressin, but rats and rabbits do not respond at all).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Vasopressin analogues. Their role in disorders of hemostasis. 312 21

A retrospective study was designed to analyse the mode of presentation, clinical signs, haematological, biochemical and histological features in 46 Indian patients admitted with cirrhosis to R. K. Khan and King Edward VIII Hospitals, Durban, between 1977-1981. The commonest presenting feature was swelling of the body followed by pain in the right upper quadrant, most patients had hepatomegaly, jaundice and ascites, and splenomegaly was detected in one-third of cases. Biochemical investigations indicated that most patients had a high globulin and low albumin concentration. Liver function tests revealed raised bilirubin and gamma-glutamyltransferase values in most cases. On histological examination, micronodular cirrhosis predominated (95%) with a high incidence of fat and iron deposition. Changes consistent with alcoholic hepatitis were superimposed in one-third of cases while immunological and viral markers were absent. This study suggests that alcohol is the predominant cause of cirrhosis in Natal Indians.
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PMID:Patterns of cirrhosis in Natal Indians. 320 19

Patients with liver disease have a wide range of coagulation problems. Patients with parenchymal liver disease are likely to have reduced synthesis of proteins and inhibitors (Table 1), whereas dysfibrinogenemia and hyperplenism develop in cirrhosis. Patients with cholestasis without cirrhosis often have elevated levels of fibrinogen, Factors V and VIII, probably due to reduced clearance of proteins (Table 1). The hemostatic defects in liver disease are complex and multifactorial. They are often unpredictable and the mechanisms elusive. Developments in molecular genetics and immunology have shown that both qualitative and quantitative abnormalities of coagulation proteins and protein inhibitors contribute to the abnormalities in liver disease. Future research will certainly result in a better understanding of these defects and more effective therapy.
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PMID:Hemostasis in liver disease. 331 57

Coagulation disorders in liver disease (cirrhosis or acute hepatic necrosis) may be assessed by the laboratory evaluation of factors V, VII, VIII and IX, and fibrinolysis. Tests of platelet and vascular function do not significantly contribute to this assessment. The response of the factors to vitamin K and to fresh frozen plasma contribute to the assessment of bleeding potential and prognosis.
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PMID:Laboratory assessment of coagulation disorders in liver disease. 638 86

The effects of standardized venous occlusion (VO) on factor VIII-von Willebrand factor (F VIII-VWF) components (F VIII:C, F VIIIR:AG, F VIIIR:RCof) and on fibrinolytic activity were investigated in 45 healthy subjects, in 28 women on oral contraceptives, and in 78 patients with various chronic diseases (28 with peripheral arterial disease, 19 with liver cirrhosis, 13 with rheumatoid arthritis, and 18 with diabetes). All the three F VIII-VWF components showed highly significant increases, although not of the same magnitude, with consequent variations in the ratios between them. A significant activation of fibrinolysis was also demonstrated with both euglobulin lysis time (ELT) and diluted blood clot lysis time (DBCLT). A strong linear correlation between pre- and post-stasis values was recorded for all the F VIII-VWF components and for the two fibrinolysis tests. No significant relationship was, on the contrary, found between F VIII-VWF and fibrinolytic parameters.
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PMID:Correlation between changes induced by venous occlusion on factor VIII-von Willebrand factor components and fibrinolytic activity. 642 15

A hemostatic survey was done on 14 Bedlington terriers, 13 of which have the recently discovered copper toxicosis. Their hepatic copper ranged from 109 to 9,888 microgram/g dry weight and their ages from 8 months to 8 years. Despite histologic evidence of hepatitis in younger dogs and cirrhosis in older ones, plasmatic coagulation factors were not depressed. In fact, the hemophilic factors VIII, IX and XI were above normal, more closely related to the age of the dog than to the hepatic copper. Furthermore, their platelet were unusually sensitive to adenosine diphosphate exposure. Offsprings of matings between Bedlington terriers and Beagles seem to be normal.
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PMID:Hemostasis in the copper-laden Bedlington terrier: a possible model of Wilson's disease. 737 1

Resection of large hepatocellular carcinoma (HCC) located in the central portion of the liver remains a surgical challenge. Over a 2 year period, from July 1989, 19 HCC patients whose main tumour (mean diameter 11.3 cm, range 6-19 cm) was located in the central part of the liver (defined as Couinaud's segments IV, V, VIII) had liver resections. Liver cirrhosis was found in 14 patients (73.7%). Extended major hepatectomy could be performed in only three patients. The operative morbidity and mortality were 26.3% and 0%, respectively. The resection margin in 14 patients was less than 1 cm. At the time this paper was written 11 patients were alive and disease free, five patients survived longer than 30 months. The 1 year disease free rate and survival rate were 73.7% and 84.2%, respectively. The preliminary results reveal that with careful preservation of non-tumourous liver, resection of centrally located large HCC is still advocated even in a cirrhotic liver, and that the resection margin width should not be a major concern.
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PMID:Preliminary results of hepatic resection for centrally located large hepatocellular carcinoma. 839 Dec 52

For hepatectomy of Couinaud's segment VII or VIII, severe compression and mobilization of the liver is required to establish the operative field via the usual transabdominal approach. Compression of the cirrhotic liver impairs hepatic and systemic blood circulation, which may cause liver dysfunction. We adopted a transthoracic transdiaphragmatic approach for hepatectomy of segment VII or VIII in cirrhotic patients to establish a good operative field without compressing the liver. The aim of this study was to evaluate the benefits of this approach. Forty-four patients with hepatocellular carcinoma (HCC) complicating liver cirrhosis who underwent limited hepatectomy of Couinaud's segment VII or VIII were studied. The patients were randomized to two groups preoperatively: group I (n = 22), transabdominal approach; group II (n = 22), transthoracic transdiaphragmatic approach. There were no differences in preoperative liver function tests, hepatic functional reserve, or extent of tumor between the two groups. The operative time in group II was significantly shorter than that in group I (243 +/- 50 versus 313 +/- 80 minutes;p < 0.01). Operative blood loss in group II was also significantly smaller than that in group I (1190 +/- 1098 versus 2679 +/- 2267 g;p < 0.01). Serum lactate dehydrogenase levels on postoperative day 1 in group II were significantly lower than those in group I (587 +/- 154 versus 791 +/- 383 IU/L;p < 0.05). Major postoperative complications were significantly fewer in group II. It was concluded that the transthoracic transdiaphragmatic approach is a useful method for hepatectomy of segments VII and VIII in cirrhotic patients.
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PMID:Transthoracic transdiaphragmatic approach for hepatectomy of Couinaud's segments VII and VIII. 894 83


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