Halothane hepatitis.
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Chemical and Drug Induced Liver Injury↗
Biomedical subjects
J M Neuberger
Publications and source records attributed to J M Neuberger.
Delayed perforation of the esophagus after variceal sclerotherapy and hepatic transplantation.
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Esophageal Perforation↗
Thyroid hormone receptor expression in the "sick euthyroid" syndrome.
To explore the hypothesis that alteration of T3 receptor expression may be an important mechanism controlling the tissue effects of thyroid hormones in the "sick euthyroid" syndrome, specific triiodothyronine (T3) receptor mRNAs were measured in tissues from normal subjects and from patients with liver disease, chronic renal failure, or with multiple organ failure on an intensive care unit (ICU). In all patient groups circulating free thyroxine and free T3 were reduced, while thyroid stimulating hormone remained normal. In patients with liver or renal disease, there were significant increases in levels of both alpha and beta T3 receptor mRNAs in peripheral mononuclear cells (PMNCs); in ICU patients there was a significant increase in beta mRNA. In patients with liver disease increases in T3 receptor mRNAs were not confined to PMNCs but were also found in liver biopsy specimens when levels were compared with those in normal donor liver. After liver transplantation, receptor mRNAs in PMNCs were similar to those in controls; likewise beta mRNA was similar in liver tissue to normal liver. There was, however, persistent elevation in alpha receptor mRNA. Increases in T3 receptor expression in non-thyroidal illness may be responsible for the maintenance of euthyroidism in the face of reduced levels of circulating thyroid hormones.
Adolescent↗
Halothane and hepatitis. Incidence, predisposing factors and exposure guidelines.
Despite early controversy, it is now recognised that halothane anaesthesia may be followed by abnormalities of liver function. The resulting hepatitis may take 1 of 2 forms: in type I, there is a minor degree of disturbance of liver function shown by increased serum transaminases or glutathione-S-transferase in up to 25 to 30% of patients; subsequent re-exposure to halothane is not necessarily associated with evidence of liver damage. In contrast, type II hepatitis is often associated with massive liver cell necrosis, frequently leading to fulminant hepatic failure. This type of liver damage has clinical, serological and immunological features compatible with an immune-mediated idiosyncratic reaction. The incidence is low (between 1 in 3500 and 1 in 35,000 anaesthetic procedures), but the mechanism of halothane hepatitis remains uncertain: there have been extensive animal models showing that halothane has a direct hepatotoxic potential, although the relevance of this to the human patient is not yet clear. Prevention of halothane hepatitis may be difficult, and the only clear way of reducing the incidence is to avoid re-exposure to halothane in those patients who have had a previous adverse reaction to the drug, demonstrated either by unexplained pyrexia or by jaundice. Halothane should also be avoided in those patients where there is a family history of sensitisation to the drug. In such cases, halothane-free equipment should be used, and exposure to other volatile non-halogenated anaesthetics should be avoided.
Animals↗
Impact of the site of arterial anastomosis on the risk of biliary complications after liver transplantation.
Biliary complications are an important cause of morbidity after orthotopic liver transplantation (OLT). It has been suggested that the denervation of recipient bile duct and the sphincter of Oddi may contribute to biliary complications. Recipient bile duct and the sphincter of Oddi receive its regulatory innervation through the nerve plexus around the gastroduodenal artery (GDA). These nerves are likely to be severed if recipient hepatic artery is divided at or proximal to the origin of GDA during arterial anastomosis of OLT (proximal arterial anastomosis). This study was carried out to determine the impact of the site of arterial anastomosis on the incidence of biliary complications. A total of 331 transplants by a single surgeon (JACB) were analysed. Patients with Roux-en-Y choledochoduodenostomy were excluded. Biliary complications were noted in 16.9% patients during first three months after transplantation. Incidence of biliary complications in patients with proximal and distal arterial anastomosis was found to be 17.2% and 12.9% respectively (ns). We conclude that the site of arterial anastomosis as an index of sphincter of Oddi denervation does not significantly influence the incidence of biliary complications.
Adult↗