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Biomedical subjects

S C Gordon

Publications and source records attributed to S C Gordon.

At least 73 records · Page 4Linked to original sources
PubMed1991

Epidemiology of hepatitis C virus infection in a suburban Detroit community.

A serum analysis for antibodies to the hepatitis C virus (HCV) was performed on a group of patients in a large suburban Detroit community hospital. The first 50 anti-HCV-positive patients with clinically suspected chronic non-A, non-B hepatitis were studied. Blood transfusions (58%) and intravenous drug use (22%) were the source of infection in most of these patients. A significant difference in age-related epidemiology was observed (p = 0.001). A remote history of intravenous drug use or tattoo application was elicited in 55% of individuals less than 40 yr old. "Sporadic" transmission occurred in 28% of individuals older than 50 yr. Sixteen percent (8/50) had no identifiable risk factors. Five of these eight patients (63%) were born and raised outside North America. Eighty percent of the 35 persons who underwent liver biopsy were found to have either chronic active hepatitis or cirrhosis. Twenty-nine percent (5/17) of the patients with anti-HCV-related cirrhosis presented with hepatocellular carcinoma. None of the patients with noncirrhotic liver disease had a primary liver tumor. We conclude that a significant number of patients in suburban America with chronic hepatitis C have no identifiable risk factors for HCV. Sporadic transmission of hepatitis C may play an important role in patients with chronic HCV-related liver disease, especially among patients born and raised outside North America.

Adult↗
PubMed1991

Liver diseases in the elderly.

The preceding discussions outline the various forms of cirrhosis that may be encountered in the elderly population. Cirrhosis is not uncommon in older patients. Although it has been stated that most cirrhosis in the elderly is due to alcohol, these assumptions are perhaps overestimations. In the authors' experience, many older patients are inappropriately labeled with alcoholic liver disease--presumed guilty until proven otherwise--and have subsequently been shown to have nonalcoholic liver disease. Careful investigation is required. Hepatotoxic drug exposure (e.g., to alpha methyldopa, nitrofurantoin, or isoniazid) should be ruled out, and hepatitis B and hepatitis C serology obtained. Primary biliary cirrhosis may occur in both sexes, and thus antimitochondrial antibody should be assayed. Severe heart disease may result in cardiac cirrhosis in the elderly, with ascites and hepatomegaly. Alpha 1-antitrypsin deficiency, primary sclerosing cholangitis, idiopathic hemochromatosis, and chronic autoimmune hepatitis may result in advanced cirrhosis in the elderly; appropriate serum studies should be obtained. If questions remain and if therapy may be changed, liver biopsy can be performed. A recent study suggested, however, that the risk of hemorrhage from liver biopsy in the elderly may be increased, especially if malignancy is present. The era of treatment for liver diseases has arrived. Colchicine, methotrexate, ursodeoxycholic acid, and others have shown promise in the treatment of PBC, primary sclerosing cholangitis, and alcoholic liver disease. Corticosteroids may be lifesaving in autoimmune liver disease. Phlebotomy remains the treatment of choice for hemochromatosis in any age group. Interferons and other antiviral agents are being used in chronic type B and type C hepatitis. Treatment of the complications of cirrhosis in the elderly may be safely accomplished. Advanced age is not a contraindication to variceal sclerotherapy. Vasopressin, however, may be contraindicated in the elderly patient if there is an underlying history of atherosclerotic coronary or peripheral vascular disease. Large-volume paracentesis and peritoneal venous shunting can afford symptomatic relief of ascites, even in the geriatric population. Finally, as noted previously, advanced age is no longer to be considered an absolute contraindication for liver transplantation. The evaluation of liver disease in the elderly may be diagnostically challenging, and its treatment rewarding.

Aged↗
PubMed1990

Focal hepatic candidiasis with perihepatic adhesions: laparoscopic and immunohistologic diagnosis.

Two patients developed fever, cholestasis, and neutropenia following chemotherapy for acute leukemia. Computed tomographic scans of the liver were nondiagnostic, but peritoneoscopy in each case showed diffuse studding of the liver surface with white plaques. Microbiological cultures of the biopsy specimens were negative, but direct immunofluorescence stains of deparaffinized sections of the biopsies confirmed candidiasis. Follow-up laparoscopy in 1 patient after 2 mo of treatment with amphotericin B showed development of diffuse perihepatic adhesions. Peritoneoscopy is valuable in the diagnosis and management of focal hepatic candidiasis, and an etiologic diagnosis can be provided by immunohistology when microbiological culture of the biopsy specimen is negative or unavailable.

Adult↗
PubMed1989

Acute type A hepatitis presenting with hypotension, bradycardia, and sinus arrest.

The cardiovascular complications of viral hepatitis are not widely recognized. Profound hypotension and a variety of dysrhythmias, including sinus arrest, have been reported in association with viral hepatitis, but most of these cases were described before the advent of specific viral serologic markers. Furthermore, previous instances of cardiovascular complications occurred during the course of an established viral syndrome. We report the cases of two previously healthy women who presented with unexplained hypotension and bradycardia as the initial manifestations of acute icteric hepatitis A. This phenomenon appears to represent a variant clinical presentation of a common viral entity.

Acute Disease↗
PubMed1989

Scintigraphic and culdoscopic diagnosis of bile peritonitis complicating liver biopsy.

After an ultrasound-guided percutaneous liver biopsy, a 37-year-old woman developed a clinical syndrome suggestive of bile peritonitis, despite the presence of nondilated bile ducts and a surgically absent gallbladder. The diagnosis was established via hepatobiliary scintigraphy, which demonstrated aberrant biliary flow, as well as by culdocentesis, which yielded bilious fluid. The patient was managed medically and recovered uneventfully; follow-up biliary scanning established resolution of bile extravasation.

Adult↗
PubMed1986

The spectrum of liver disease in the acquired immunodeficiency syndrome.

Abnormal liver chemistries, unexplained fevers, or hepatomegaly prompted 36 liver biopsies on 34 patients with the acquired immunodeficiency syndrome. The most common finding was the presence of hepatic granulomas, seen in 13 of the biopsy specimens. Eight of these granulomas were ill-defined, and 5 were more clearly associated with mycobacterial disease. Portal fibrosis and fatty infiltration were common, but a paucity of significant inflammatory activity was seen despite elevated aspartate aminotransferase levels, perhaps related to the underlying immunoincompetent status. Other noteworthy histopathologic findings included 1 patient each with peliosis hepatis and cryptococcal hepatitis. Electron-microscopic evidence of cytoplasmic tubular structures or viral particles were seen within the hepatocytes of 2 patients. It is concluded that a broad spectrum of hepatic histopathology may be seen in the acquired immunodeficiency syndrome, and that liver biopsy may be diagnostically valuable in the clinical investigation of such patients.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Resection of metachronous hepatocellular carcinomas.

We have described the rare case of a woman with no recognized predisposing factors for hepatocellular carcinoma in whom a second hepatic neoplasm was successfully resected nine years after a presumed "curative" partial hepatectomy. The importance of long-term measurements of available tumor markers as well as aggressive surgical management is emphasized.

Adult↗
PubMed1984

Prolonged intrahepatic cholestasis secondary to acute hepatitis A.

Viral hepatitis characterized by prolonged cholestasis has not been associated with a specific serologic marker. We report the cases of six patients presenting with a clinical syndrome typical of cholestatic hepatitis who were subsequently found to have acute hepatitis A. Usual features include pruritus, fever, diarrhea, and weight loss with serum bilirubin levels greater than 10 mg/dL, and a clinical course lasting at least 12 weeks. All patients recovered completely without sequelae. Knowledge of this unusual manifestation of hepatitis A may help avoid potentially invasive procedures involved in the evaluation of suspected obstructive jaundice and facilitate appropriate immunoprophylactic measures.

Acute Disease↗
PubMed1982

Mumps arthritis: unusual presentation as adult Still's disease.

The clinical spectrum of Still's disease suggests disseminated infection. Although the cause of this syndrome remains unknown, recent case reports have noted its association with various viruses. Increased antiviral titers to rubella, coxsackieviruses, and adenovirus have been noted in patients with syndromes similar to juvenile rheumatoid arthritis. We describe a patient with apparent adult Still's disease in whom a significant rise in mumps antibody titers was observed. Arthritis in association with mumps infection is a relatively rare condition. To our knowledge, this is the first report of mumps virus infection related to a disorder similar to juvenile rheumatoid arthritis.

Adolescent↗