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At least 883 records · Page 49Linked to original sources
PubMed1985

Use of atracurium and vecuronium in patients with oesophageal varices.

The effects of atracurium (initial dose 0.5 mg kg-1; incremental doses 0.2 mg kg-1) and vecuronium (initial dose 0.1 mg kg-1; incremental doses 0.04 mg kg-1) are described in patients with portal hypertension and some degree of liver dysfunction, and the findings compared with those from normal patients. With these doses there was no evidence of gross resistance to the two neuromuscular blockers in the patients with liver problems, although the duration of action of the initial dose was somewhat shorter, and the same may have been true of incremental doses. The method of elimination would suggest that atracurium may be the better drug in patients with severe liver dysfunction, but the use of small doses of vecuronium is not contraindicated in this type of patient.

Adult↗
PubMed1997

Splanchnic and extrasplanchnic arterial hemodynamics in patients with cirrhosis.

BACKGROUND/AIMS: This study was designed to assess the contribution of splanchnic and extrasplanchnic vascular hemodynamics to the hyperdynamic circulation in patients with cirrhosis. METHODS: Cardiac index and flow volume index and pulsatility index (PI) of superior mesenteric artery (SMA) and femoral artery (FA) were measured with Doppler ultrasonography in 40 controls and 86 patients with cirrhosis (Child-Pugh grade A=41, grade B=30, and grade C=15). Mean arterial pressure was also recorded to calculate systemic vascular resistance index. RESULTS: Systemic vascular resistance index was significantly lower in each Child-Pugh group than in controls. SMA blood flow index was significantly higher in each Child-Pugh group than in controls and the increase in SMA blood flow index paralleled the degree of liver dysfunction. SMA-PI was significantly lower in each Child-Pugh group than in controls and the decrease in SMA-PI paralleled the degree of liver dysfunction. FA blood flow index was slightly higher in Child-Pugh grade A patients and significantly higher in grade B patients than in controls, whereas grade C patients had normal FA blood flow index. FA-PI was significantly lower in grade A and grade B patients than in controls, whereas grade C patients had normal FA-PI. When all patients were examined together, SMA-PI significantly correlated with systemic vascular resistance index (r=0.69, p<0.01). In contrast, FA-PI did not significantly correlate with systemic vascular resistance index (r=0.15, p=0.18). CONCLUSIONS: Splanchnic arterial vasodilatation plays an important role in the pathogenesis of decreased systemic vascular resistance seen in patients with cirrhosis.

Analysis of Variance↗
PubMed2000

Subacute hepatic failure associated with a new antidiabetic agent, troglitazone: a case report with autopsy examination.

An autopsy case of fatal subacute hepatic failure after administration of troglitazone is described. The liver dysfunction developed about five months after the patient, a sixty-three-year-old woman, had been initially treated with troglitazone. The patient developed hepatic failure and died despite various hepatic auxiliary treatments such as plasmapheresis. Autopsy findings revealed focal liver cell necrosis, cholestasis and steatosis with infiltration of lymphocytes and neutrophils and lack of regenerative activity. The causative mechanism of liver dysfunction may be metabolite aberration, as a result of accumulation of hepatotoxic metabolite(s), in a category of idiosyncratic liver injury. It is proposed to monitor liver function strictly and periodically for the diabetic patients prescribed troglitazone.

Chromans↗
PubMed2006

Hydrops lysosomalis generalisatus--an underestimated side effect of hydroxyethyl starch therapy?

Hydroxyethyl starch (HES) is usually considered to be associated with limited side effects. Generalized foamy cell macrophage syndrome after HES therapy has rarely been reported since Schaefer first described it as 'hydrops lysosomalis generalisatus' in 1982. We present a 19-yr-old male who received large amounts of HES. A bone marrow and a liver biopsy were performed because of persistent thrombocytopenia and liver dysfunction. We found severe infiltration of foamy cell degenerated macrophages in both organ systems, indicating that sequelae of HES therapy have to be included in the differential diagnosis of bone marrow and liver dysfunction.

Adult↗
PubMed2001

Cardiac dysfunction because of secondary hemochromatosis caused by congenital non-spherocytic hemolytic anemia.

Most patients diagnosed with secondary hemochromatosis have had repeated blood transfusions. Cardiac failure accounts for approximately one-third of the deaths associated with hemochromatosis. Liver dysfunction or hormonal disorders such as diabetes generally precede cardiac failure. A 23-year-old woman with hemochromatosis had, despite significant left ventricular dysfunction, liver function within the normal range on biochemical evaluation. She was treated for congestive heart failure and given desferoxamine intravenously. She did not have primary hemochromatosis, and had not received multiple blood transfusions or iron supplement. As a child the patient had been diagnosed with congenital non-spherocytic hemolytic anemia not requiring transfusion; thus, this is a unique case of secondary hemochromatosis.

Adult↗
PubMed2002

[Hodgkin's disease presenting with progressive liver failure].

We report an unusual case of a 70-year-old man with a diagnosis of Hodgkin's disease, who presented with fever and liver dysfunction. A few cervical lymph nodes, less than 1 cm in diameter were palpable, but other lymph nodes were not detected even by CT scan. Blood cell counts showed thrombocytopenia (platelet counts 6.8 x 10(4)/microliter), and some values for liver enzymes were out of the normal range (AST 56 U/l, ALT 87 U/l, LDH 347 U/l, ALP 1,529 U/l, and gamma-GTP 190 U/l). Abdominal CT scan showed diffuse enlargement of the liver and spleen. Endoscopic retrograde biliary cholangiopancreatography was performed because of progressive jaundice, but no abnormality was found in the biliary tract. A few granulomas were observed in bone marrow clot specimens, but tumor cells were not detected. A diagnosis of Hodgkin's disease was established by a cervical lymph node biopsy. Chemotherapy was immediately instituted, and both the jaundice and fever improved dramatically. Because cervical lymph nodes were not detected at one month after the onset and liver dysfunction appeared before cytopenia, it is suggested that the site of the primary lesion in this case was the liver.

Aged↗
PubMed1991

[Drug induced hepatitis following sevoflurane anesthesia in a child].

A new volatile anesthetic, sevoflurane, is widely used in Japan. We first report a patient who developed liver dysfunction following sevoflurane anesthesia. He had a resection of the bilateral extra toes at the age of eleven months. Although no problems occurred during the operation, he had serious liver dysfunction. Fourteen days after operation, serum GOT was elevated to the maximum of 836U. The pathogenesis is considered to be related to sevoflurane anesthesia, because viral hepatitis was excluded, and sevoflurane is considerably positive in lymphocyte stimulation test in contrast with antibiotics.

Anesthesia, Inhalation↗
PubMed1996

Intravenous thiodan (30% endosulfan in xylene).

OBJECTIVE: We report the first case of intravenous self-poisoning with Thiodan (30% endosulfan in xylene). CASE REPORT: A 28-year-old woman with a past history of epilepsy presented with refractory grand mal seizures after injecting 1 mL of Thiodan intravenously. She developed liver dysfunction, proximal myopathy secondary to rhabdomyolysis and renal failure. INTERVENTIONS AND OUTCOMES: The seizures were terminated with midazolam and thiopentone. Mechanical ventilation was required for nine days. Renal and liver dysfunction resolved with supportive measures only. Hemodialysis was not required. Pulmonary complications and neurological sequelae were minimal with the patient making a full recovery over three months. CONCLUSION: The intravenous adminis-tration of a small dose of endosulfan in xylene caused the rapid onset of severe grand mal seizures. The absence of pulmonary edema in this case suggests aspiration to be the cause of pulmonary toxicity due to oral endosulfan poisoning.

Acidosis↗
PubMed1994

[Gonadal dysfunctions in liver cirrhosis].

Testicular atrophy, loss of libido and feminization are observed in patients with nonalcoholic liver cirrhosis, Serum total and free testosterone levels are decreased in patients with advanced liver cirrhosis and is normal in compensated cirrhotic patients. In compensated liver cirrhosis, sex hormone binding globulin is increased, and is related with increasing serum total testosterone. Serum total and free estradiol levels and ratio of estradiol to testosterone are increased in cirrhotic patients. Hyperestrogenization is related with female physical characteristics. Gonadal dysfunctions observed in cirrhotic patients are primary in the gonadal failure, then a concomitant with pituitary defect occurs. These abnormalities in liver cirrhosis are reversible.

Adult↗
PubMedDate not supplied

Abnormalities of liver function and hepatic damage associated with total parenteral nutrition.

Liver dysfunction associated with total parenteral nutrition (TPN) probably is of multifactorial etiology. Available data justify the following recommendations. First, patients should be given balanced and complete solutions tailored to their specific needs and should not be overfed. Second, serum liver enzymes should be measured at least once a week. Third, oral or enteral intake, even if minimal, should be instituted as soon as possible. Fourth, glutamine may prove useful, although this measure is experimental. Finally, if liver dysfunction is detected, oral metronidazole, neomycin, or gentamicin may prove beneficial.

Animals↗
PubMedDate not supplied

Impact of positive preoperative surveillance blood cultures from chronic indwelling catheters in cadaveric intestinal transplant recipients.

Recurrent bloodstream infections are a common indication for intestinal transplantation (ITx). Often, clinical symptoms may be absent in the setting of bacteremia, especially in patients with chronic liver disease. This study investigated the incidence and impact of positive blood cultures (BCx) obtained from central venous catheters used for total parenteral nutrition (TPN) in asymptomatic patients immediately prior to cadaveric ITx. Of 13 consecutive patients transplanted between November 2003 and November 2004, 12 underwent preoperative surveillance BCx with four positives (33%). Isolates included Staphylococcus epidermidis (n = 2), methicillin-resistant Staphylococcus aureus, and Citrobacter freundii. All four patients with positive BCx displayed liver dysfunction at the time of transplant (> or = grade 2 fibrosis, total bilirubin >8.0 g/dL), three of whom were inpatients. In contrast, only three of eight nonbacteremic patients showed liver disease of comparable severity. Liver dysfunction and inpatient status at the time of transplant appear to predict positive blood cultures. Postoperative length of stay and time on the ventilator were significantly longer among bacteremic as compared with nonbacteremic patients, but there were no differences in intraoperative blood use, time to total parenteral nutrition independence, or operative time between bacteremic and nonbacteremic patients. Our study showed that occult bacteremia in asymptomatic pre-intestinal transplant patients was not uncommon and may increase postoperative morbidity. Preemptive removal of long-term central venous catheters should be considered prior to ITx.

Cadaver↗
PubMed1983

The role of tubuloglomerular feedback in acute impairment of renal function in obstructive jaundice.

Acute renal functional impairment not infrequently accompanies liver dysfunction and, particularly with bile duct obstruction, may be extremely severe. Recent studies suggest that tubuloglomerular feedback (TGF) activated by circulating non-electrolyte factors which occur during liver dysfunction may contribute to the intense renal vasoconstriction thought to be central to the functional renal impairment. In this study, serum from two patients with obstructive jaundice (OJ) and renal impairment, and from rats with OJ due to bile duct ligation were either dialysed or treated with furosemide, known to block electrolyte-mediated TGF. These sera, when perfused into loops of Henle in rat nephrons, induced a significant fall of 28% in stop-flow pressure, an indirect measure of glomerular capillary pressure thus implying arteriolar vasoconstriction. These findings are consistent with the hypothesis that circulating, non-electrolyte factors, which stimulate TGF, occur in cases of obstructive jaundice and that these may contribute to the renal impairment.

Acute Kidney Injury↗
PubMedDate not supplied

Successful outcome with methimazole and lithium combination therapy for propylthiouracil-induced hepatotoxicity.

OBJECTIVE: To assess the efficacy and safety of combination therapy with methimazole and lithium carbonate in management of severe thyrotoxicosis and propylthiouracil-induced hepatotoxicity. METHODS: We present a case report of a patient with severe thyrotoxicosis and worsening liver dysfunction after propylthiouracil therapy, and we review the pertinent literature. RESULTS: In a 49-year-old man with severe thyrotoxicosis and propylthiouracil-induced hepatotoxicity, indices of liver function continued to increase despite discontinuation of propylthiouracil treatment. Adjunctive therapy with methimazole and lithium resulted in prompt remission of clinical manifestations and normalization of thyroid hormone indices, as well as a gradual reversal of liver dysfunction. CONCLUSION: Adjunctive therapy with methimazole and lithium is synergistic in promptly achieving a euthyroid state. Therefore, this combination therapy provides a safe and effective alternative option in patients with thyrotoxicosis associated with propylthiouracil-induced hepatotoxicity.

Journal Article↗
PubMed1984

[A case of refractory acute lymphocytic leukemia who achieved a complete remission by mitoxantrone].

A 21-year-old male was diagnosed as having acute lymphocytic leukemia in March 1982. The patient was immediately treated with VENP [vincristine (VCR), Endoxan (EX), Natulan, prednisolone (Pred)] therapy, yielding a partial remission. After one course of AAAP [ACNU, adriamycin (ADM), methotrexate (MTX), Pred] therapy, a combination chemotherapy with behenoyl-arabinocytosine, daunomycin (DM), vindesine and Pred was administered, which produced a complete remission lasting for 52 days. For the relapse, L-Asparaginase (L-Asp) and Pred therapy, large doses of MTX, the combination chemotherapy with VCR, EX, L-Asp and Pred and VEMP (VCR, EX, 6-MP, Pred) therapy were administered consecutively, PR was maintained but CR was not achieved. While receiving the combination chemotherapy consisting of VCR, EX, carbocone and Pred, the leukemic cells of his bone marrow increased gradually and reached to 70%; at that time cumulative doses of DM and ADM reached to 360 mg and 120 mg respectively. Thereafter mitoxantrone (MX) was administered on a 5-day iv schedule using daily dose of 4 mg/m2. Leukopenia was prolonged and liver dysfunction appeared, and they were recovered gradually. Two additional courses of MX using the same schedule and daily dose were given combined with Pred. Prolonged leukopenia and transitional liver dysfunction were also observed. He attained a CR, which was of short duration. It was clinically indicated that MX did not have a complete cross-resistance with many antileukemic agents including DM and ADM.

Adult↗
PubMed2003

The decreasing incidence of diaphragmatic dysfunction in liver transplantation: a probable advantage of the piggy-back liver transplant technique.

BACKGROUND: Pediatric orthotopic liver transplantation (OLT) has a low mortality. Some children, however, have an adverse outcome defined as a prolonged ventilatory support requirement and protracted pediatric intensive care unit (PICU) stay. The aim of this study was to determine if that adverse outcome related to the child's condition pre-OLT and/or the development of a pleural effusion or diaphragmatic dysfunction. METHODS: The study included 210 children with a median age at transplantation of 45.5 months (range 0.2-252 months). Fourteen had undergone retransplantation. The duration of ventilatory support (intermittent positive pressure ventilation [IPPV]) and PICU admission and development of a pleural effusion and/or diaphragmatic dysfunction were documented for each child. The patients were divided into three groups according to whether they had acute liver failure (ALF), chronic liver disease at home (CHOM), or chronic liver failure sufficiently ill to be in the hospital awaiting transplantation (CHOSP). RESULTS: The 36 children with ALF were of similar age to the 138 CHOM and 36 CHOSP children but required longer IPPV (P < 0.0001) and PICU stay (P < 0.0001). Overall, 17 children developed diaphragmatic dysfunction and 138 pleural effusions; affected children required longer IPPV and PICU stay (P <0.01). Regression analysis demonstrated that diaphragmatic dysfunction, but not pleural effusion development, was associated with prolonged ventilation (P <0.01) and protracted PICU stay (P <0.05). Other risk factors were ALF (P <0.01), retransplantation (P <0.01), and young age (P <0.05). CONCLUSION: Diaphragmatic dysfunction adversely influences PICU morbidity after OLT. Early assessment of diaphragmatic function, and if necessary aggressive management, might improve outcome.

Journal Article↗