[Cirrhosis with severe hypoxemia and pulmonary arteriovenous shunts, apropos a a case].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to M Beaugrand.
Explore the source record for details and available documents.
Cirrhotic ascites are highly susceptible to spontaneous bacterial infection, whereas carcinogenic ascites are seldom infected. This difference may be explained by differences in their chemotactic, bactericidal and/or opsomic activities. We measured the chemotactic and opsonic activity of ascitic fluids from 35 alcoholic cirrhotic ascites and of 12 peritoneal carcinogenic ascites. Chemotactic activity was measured by the under-agarose technique and opsonic activity by a luminol-enhanced method. Ascitic fluids from alcoholic cirrhosis had low chemotactic (62 +/- 24.5% that of N-formylated peptide) and opsonic (67 +/- 50% of normal serum) activities on normal human neutrophils. In contrast, ascitic fluids from peritoneal carcinoma were found to possess high opsonic activity (114 +/- 49% of normal serum) and chemotactic activity similar to that of N-formylated peptide. During a 3-month follow-up, 11 spontaneous bacterial infections were observed among the first group against none in the carcinogenic group.
A study from five hepatology units documenting 157 cases of drug-induced hepatitis and a second study from a laboratory of immunology which tested more than 100,000 sera permitted us to establish the frequency of antiorganelle antibodies and their diagnostic value in drug-induced hepatitis. In drug-induced hepatitis caused by a heterogenous group of drugs consisting of ajmaline, aminopterine, isaxonine, isoniazid, perhexiline, phenylbutazone and troleandromycine, antiorganelle antibodies were absent or rare. In drug-induced hepatitis caused by another heterogenous group of drugs, including clometacin, fenofibrate, oxyphenisatin and papaverine, antismooth muscle, antinucleus and antimitochondria antibodies were found in isolation or in different combinations in 70% of cases. From the presence of antismooth muscle antibodies in sera, we could trace 30 cases of clometacin-induced hepatitis. The third group included drug-induced hepatitis with special antibody:iproniazid-induced hepatitis with antimitochondrial antibody 6 and tienilic acid (ticrynafen)-induced hepatitis with antiliver/kidney microsome antibody 2 (anti-LKM2). These two antibodies are rare in routine sera and were absent in patients who received the drug and had no liver damage. From the presence of corresponding antibodies, we detected six cases of iproniazid-induced hepatitis and 67 cases of tienilic acid-induced hepatitis. Antiorganelle antibodies found in high titers disappeared in 2 to 24 months following withdrawal of the offending drug. The fourth group was represented by halothane-induced hepatitis; antiliver/kidney microsome antibody 1 was weak and infrequent. Similarities between drug-induced hepatitis of the second group and lupoïd hepatitis suggest that drugs may reveal this spontaneous disorder.(ABSTRACT TRUNCATED AT 250 WORDS)
HIGH INCIDENCE: Because of the high incidence of hepatocellular carcinoma (HCC) in patients with cirrhosis (3 to 5% per year) and the fact that curative treatment is currently available only for small sized tumors careful screening is warranted in this high risk population. Earlier screening attempts produced disappointing results in terms of cure and survival, particularly in Europe. Progress in ultrasonography, a better understanding of the risk of developing HCC, and most importantly the advent of local percutaneous treatments have greatly affected the data which should be reexamined. SCREENING METHODS: Patients with cirrhosis, particularly alcoholic or viral cirrhosis, should undergo regular ultrasound examinations, every six months for most screening protocols although the best timing remains unknown. Assay of serum alpha-fetoprotein is of limited use due to its low sensitivity and specificity. Diagnosis of HCC is basically based on helicoidal computed tomography and/or magnetic resonance imaging findings, with or without pathological proof (ultrasound-guided biopsy) that may be difficult to obtain. A probabilistic diagnosis is therefore retained if necessary, based on the presence of risk factors and arterial hypervascularization of a liver nodule. EARLY TREATMENT: With ultrasound screening, the diagnosis of HCC can generally be established early, when curative transplantation, resection or local percutaneous destruction are still feasible. The percutaneous methods use chemical or physical agents to destroy the tumor. There are few contraindications so curative treatment can be proposed for large number of patients. Large-scale prospective studies will be completed in the upcoming years and are expected to provide evidence validating the principle of screening and early treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We report a case of polyarteritis nodosa occurring in a patient with hepatitis C, ten days after the beginning of alpha-IFN therapy. There was no cryoglobulinemia. Serum HCV-RNA was detectable before INF therapy and disappeared during the vasculites. The patient received boli of methylprednisolone and the neurological and skin lesions regressed after 5 months. This observation could suggest a precocious response to alpha-INF and a relationship between INF and the occurrence of vasculites.
Explore the source record for details and available documents.