ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Living donor liver transplantation was developed in response to a shortage of full-size grafts for children. The progression from reduced-size cadaveric grafts to use of living donors occurred subsequent to expansion of liver anatomy knowledge and practical use of hepatic segments. A major benefit of pediatric live donor liver transplantation is the grafting of children without using livers from the cadaver donor pool. A major drawback of the procedure relates to the need to perform surgery and assign risk to an otherwise healthy individual. The ethical challenge has been discussed in detail and, although not ideal, the procedure “passes muster” on grounds of informed consent and the good of helping another human being. Formidable success appears to have been attained with the adult-to-adult procedure thus far; however, the transplant community still awaits center-specific and compiled data to determine whether the procedure truly reduces adult waiting list times for liver transplant recipients with minimal donor risk.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Management of gastroesophageal reflux disease (GERD) is based on the concept that gastric contents, principally acid and pepsin, are responsible for esophageal injury and symptoms of reflux disease. Pharmacologic management in the year 2001 revolves around the basic principle that control of intragastric pH correlates with esophageal healing and, subsequently, symptom relief. Although the majority of patients respond to a single daily dose of a proton pump inhibitor, many patients with reflux disease are “refractory” even to twice daily doses of these drugs. Potential reasons for this less than optimal response can be found when carefully examining the intragastric pH responses of healthy subjects and patients with GERD to these agents when taken at various times of the day, in proximity to meals, and in higher doses. In the past several years, we have explored many of these issues in attempting to understand the mechanisms behind incomplete response to proton pump inhibitors, using combined intragastric and intraesophageal pH monitoring. The “lessons learned” from these and supportive studies are the subject of this review.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

GoalsTo elucidate the natural progression of hepatolithiasis that showed no signs at the time of initial presentation.StudyOver a 17-year period, we observed 122 of 311 patients with hepatolithiasis who reported no symptoms and, thus, who received no treatment at initial presentation. The follow-up period was for up to 15 years (mean, 10.08 years).ResultsFourteen of 112 patients (11.5%) developed some symptoms attributed to hepatolithiasis. The interval until the onset of symptoms ranged from 9 months to 7.33 years (mean, 3.42 years ). The developing symptoms included abdominal pain, hepatic abscess, cholangitis, and cholangiocarcinoma. Nine of the 14 patients (64.3%) developed stone migration to the extrahepatic bile duct at the onset of clinical symptoms. The incidence of lobar liver atrophy on computed tomography in the patients with symptomatic hepatolithiasis (13 of 14 patients; 92.9%) was significantly higher than that in the patients with asymptomatic hepatolithiasis (14 of 108 patients; 13.0%). The prognosis of the patients with symptomatic hepatolithiasis were as follows: 2 died of cholangiocarcinoma, 1 died of hepatic failure, and 11 survived. Fifteen of asymptomatic patients died, but none of these deaths were attributed to hepatolithiasis.ConclusionsClose observation is an alternative management at initial presentation for patients with asymptomatic hepatolithiasis without extrahepatic stones or lobar liver atrophy.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Isocitrate dehydrogenase (ICDH) may be useful for differentiating centrilobular from periportal necrosis in rats with liver injury. In this study, we assessed the usefulness of ICDH as a marker of centrilobular necrosis in patients with hyperthyroidism. Isocitrate dehydrogenase and alanine aminotransferase (ALT) activities were measured in the plasma of 56 patients with hyperthyroidism, 16 patients with chronic viral hepatitis (CVH), and 17 controls. Isocitrate dehydrogenase levels were higher in patients with hyperthyroidism than in those with CVH or in the controls (p< 0.01 andp< 0.001, respectively), even though ALT levels were higher in patients with CVH than in patients with hyperthyroidism (p< 0.01). Isocitrate dehydrogenase/ALT ratios were also higher in patients with hyperthyroidism than in those with CVH (p< 0.0001). Isocitrate dehydrogenase correlated to ALT levels in patients with hyperthyroidism or CVH (p< 0.05). In a patient with hyperthyroidism, ICDH levels decreased progressively to normal, and the ALT level and thyroid function were normalized. Thus, the plasma ICDH or ICDH/ALT ratio might be useful for differentiating centrilobular from periportal necrosis and for monitoring the degree of hepatic necrosis in patients with hyperthyroidism.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundEgypt has one of the highest prevalence rates of hepatitis C virus (HCV) infection in the world; however, the risk and attribution related to HCV in Egyptian patients with hepatocellular carcinoma (HCC) remains unknown.GoalsThe current study was undertaken to estimate the risk of HCC in relation to HCV in Egypt.StudyThirty-three patients with HCC and 35 healthy controls who had a similar socioeconomic status were prospectively enrolled at the University of Cairo National Cancer Institute.ResultsAnti-HCV antibodies were present in 75.8% of the patients and in 42.9% of the controls (p= 0.01); hepatitis B surface antigen (HBsAg) was present in 15.2% of the patients and in 2.9% of the controls (p= 0.03). In addition, the sex-and age-adjusted odds ratio (OR) for anti-HCV antibodies was 5.1 (95% CI = 1.5–17.4) and for HBsAg was 13.2 (95% CI = 1.2–148.2). ConcurrentSchistosoma mansoniand anti-HCV was associated with an OR of 10.3 (95% CI = 1.3–79.8), which was higher than that for anti-HCV (6.5; 95% CI = 1.6–26.6) andS. mansoniinfection (0.2; 95% CI = 0.1–6.2) alone. Finally, we estimated the attributable fraction of HCC to HCV to be 64% in this study population and 48% in the general Egyptian population.ConclusionsBoth HCV and hepatitis B virus infection increase the risk of HCC in Egyptian patients, whereas isolatedSchistosomainfection does not. Because of the very high prevalence rate of HCV in the general Egyptian population, it accounts for most HCC cases in Egypt.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Psychologic factors in functional dyspepsia have been discussed in many previous articles. However, the relationship between depression and functional dyspepsia is still obscure. We investigated the impact of depression on clinical symptoms and gastric dysrhythmia in functional dyspepsia. Thirty-nine patients with functional dyspepsia and 18 healthy subjects were included. Patients were investigated with clinical symptoms assessment, Zung's self-rating depression scale, and electrogastrography. Patients with functional dyspepsia were divided into two groups: 21 patients with depression and 18 patients without depression. The depressed patients had similar total gastrointestinal symptom severity scores compared with the nondepressed patients, but with higher total symptom frequency scores (p< 0.05). With regards to symptoms, the depressed patients had higher abdominal fullness severity and frequency scores and nausea frequency scores. The patients with functional dyspepsia had a lower percentage of normal slow wave in both the fasting and fed states and a higher percentage of bradygastria in the fasting state and tachygastria in the postprandial state (p< 0.05). There was no significant difference in the percentage of bradygastria or tachygastria between the depressed and nondepressed patients. There was no correlation between the specific type of electrogastrographic abnormality and the presence or absence of depression in functional dyspepsia patients.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundElevated plasma total homocysteine (tHcy) is associated with a higher risk of thrombosis. Crohn's disease (CD) is associated with hypercoagulability of undefined etiology. We investigated tHcy in patients with CD and its relationship with vitamin status, disease activity, location, duration, and history of terminal ileum (TI) resection.StudyWe examined fasting plasma tHcy, folate, serum vitamin B12levels, and sedimentation rate in consecutive adult patients with CD. Harvey–Bradshaw index of CD activity and history of TI resection and thromboembolism were recorded.ResultsMedian plasma tHcy was 10.2 &mgr;mol/L in 125 patients with CD. Men (n= 60) had higher plasma tHcy than women (n= 65) (11.2 vs. 9.1 &mgr;mol/L;p= 0.004). Patients with a history of TI resection showed lower serum B12levels (293 vs. 503 pg/mL;p< 0.001) and higher plasma tHcy levels (11.0 vs. 9.35 &mgr;mol/L;p= 0.027) than patients without such history. Multivariate analysis showed history of TI resection, serum B12, and creatinine levels to be significant predictors of elevated plasma tHcy. Fourteen patients with CD with a history of thrombosis had an elevated median plasma tHcy of 11.6 &mgr;mol/L.ConclusionsTerminal ileum resection contributes to elevated plasma tHcy levels in CD cases. We recommend tHcy screening in patients with CD, especially in those with prior history of TI resection, and the initiation of vitamin supplementation when appropriate.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The efficacy of long-term interferon therapy for chronic hepatitis C infection with symptomatic mixed cryoglobulinemia has not clearly been defined. We describe a patient with chronic hepatitis C, symptomatic mixed cryoglobulinemia (cutaneous vasculitis), and membranoproliferative glomerulonephritis (MPGN) who responded clinically, biochemically, and virologically to a 1-year course of interferon therapy. Interferon side effects were minimal. Relapse occurred when interferon was discontinued, and suppressive maintenance interferon therapy was required for clinical, biochemical, and virologic remission. During the 5th year of maintenance therapy, she developed potential side effects that necessitated discontinuation of interferon treatment. After treatment stoppage, a clinical, biochemical, and virologic remission was maintained for more than 1 year. However, the potential side effects, which included eye irritation, arthralgias, myalgias, fatigue, insomnia, memory loss, and depression, persisted. Ophthalmologic, rheumatologic, and neurologic evaluations were nondiagnostic. Psychometric testing revealed dementia and mood disorder. Because the disabling symptoms persisted after 9 months, a health-related quality of life assessment was carried out with the SF-36 survey. Compared with healthy individuals and patients with chronic hepatitis C, our case had a lower health-related quality of life assessment on six out of seven scales and on four out of seven scales of the SF-36 survey, respectively. This case report indicates that long-term maintenance interferon therapy was effective in the treatment of symptomatic mixed cryoglobulinemia and its renal complications and resulted in a clinical, biochemical, and virologic sustained response. It is postulated that the side effects of long-term interferon therapy in this setting may be problematic.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We report a case of Barrett's adenocarcinoma of the esophagus with lymphoid stroma. We believe this is the first reported case of this entity, although six previous cases of esophageal lymphoepithelioma-like carcinoma have been reported. The esophageal tumor from a 58-year-old man was examined histologically. In situ hybridization to detect Epstein–Barr virus (EBV) was also performed. The tumor consisted of a poorly differentiated adenocarcinoma with dense lymphoid cell infiltration in the invasive portions and a well-differentiated adenocarcinoma without lymphoid stroma in the mucosa. Barrett's epithelium was observed adjacent to the carcinoma. No positive signals for EBV were detected in the tumor cells. Six previously reported patients with esophageal lymphoepithelioma-like carcinomas, and the current patient, all survived for longer than 24 months, a better outcome than that of patients with esophageal squamous cell carcinomas of usual type. The data suggest that this tumor arose as a mucosal, well-differentiated adenocarcinoma without lymphoid stroma and that EBV had no relation to either its pathogenesis or progression.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID