ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In clinical trials, live attenuated and formol-inactive vaccines against hepatitis A have proved immunogenic. Problems in delivering hepatitis B vaccine to underdeveloped countries are discussed. The polymerase chain reaction can be used to show hepatitis B virus DNA in liver and serum even in hepatitis B e antigen-negative patients. Hepatitis B viral mutants have been associated with fulminant disease. Interferon therapy is successful in 30% to 50% of those treated. Late liver biopsy specimens show resolution of inflammatory change. New second-generation tests for anti-hepatitisCvirus antigen confirm positivity and give fewer false results, Hepatitis C virus RNA can be detected by polymerase chain reaction. This finding confirms infectivity and can be used to follow treatment. Mutants of hepatitis C virus are being described; their clinical significance is uncertain. There are approximately 500 million carriers of hepatitis C virus worldwide. The majority have no obvious risk factors and their mode of infection remains unclear. Interferon therapy gives long-term benefit in about 25% of chronic hepatitis C virus patients. Selection of patients to treat and dose and duration of therapy remain undecided. Ribavirin is giving interesting results.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The majority of patients with fulminant hepatitis B negative for hepatitis B e antigen are infected with a mutant virus that is unable to produce the e antigen. In Japan, about 50% of patients with fulminant non-A, non-B hepatitis are infected with hepatitis C virus but this virus does not appear to cause acute liver failure in the United States or United Kingdom. Cerebral edema is still a major cause of death and the insertion of an intracranial pressure monitoring device is currently the only method available to establish the diagnosis of intracranial hypertension and to monitor the response to therapy. The influence of cerebral blood flow on intracranial pressure remains to be determined. WhereasN-acetylcysteine improves outcome in patients with acetaminophen-induced fulminant hepatic failure, and may do so by enhancing tissue oxygen transport, steroids and insulin-glucagon therapy are of no benefit. Artificial liver support systems are being developed but have yet to prove their benefit in clinical use.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Disturbances in the immune network are believed to be the key step in the pathogenesis of autoimmune liver diseases. Contributing factors to these disarrangements may include aberrant expression of major histocompatibility complex molecules, as well as the expression of primarily intracellularly located antigens on cell surfaces, making them accessible to the immune system. A distinct immunogenetic background of autoimmune liver diseases is now well established, but shows, however, geographic differences. The detailed characterization of the targets of both humoral and cellular immune reactions provides valuable tools for the identification and classification of autoimmune liver diseases and allows new insights into its pathogenesis. Autoimmune liver diseases can be triggered by hepatotropic viruses, especially chronic hepatitis C, which can be accompanied by autoantibodies. Thus, the distinction between idiopathic autoimmune chronic active hepatitis and chronic hepatitis C is very important for decisions on treatment. Therapy of idiopathic autoimmune chronic active hepatitis relies on immunosuppressive agents, and orthotopic liver transplantation offers a favorable prognosis to those who do not sufficiently respond.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The pathophysiology of the hyperdynamic circulation in cirrhosis may be related to chronic nitric oxide synthesis induced by endotoxemia. This has potential therapeutic implications, but the maintenance of vasodilatation may be important for tissue perfusion. β-Blockers are the treatment of choice for primary prophylaxis of variceal bleeding; sclerotherapy should not be used. β-Blockers can also be considered first-line therapy for the prevention of rebleeding as they compare well with sclerotherapy, are cheap, have few side effects, and protect against bleeding from portal hypertensive gastropathy. Combined therapy with nitrovasodilators may make β-blockers more effective as portal pressure is reduced further and propranolol nonresponders become responders. The reasons for propranolol nonresponse are not clear. The transjugular intrahepatic portosystemic stent shunt is a great innovation that may substitute for surgery in both the acute and elective situation. It may become the treatment of choice for patients who bleed while awaiting a liver transplant, but surgical shunts do not complicate transplantation unduly. Inferior vena caval expandable stents in the Budd-Chiari syndrome may eventually preclude the need of suprahepatic (mesoatrial) shunts.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The precise pathogenic mechanisms of ascites formation, the hepatorenal syndrome, and hepatic encephalopathy are still unclear. However, recent studies have given us a better understanding of these processes. In this review we discuss current developments in pathogenesis with relevant applications to the evaluation and treatment of these conditions.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Spontaneous bacterial peritonitis is a very common complication of patients with advanced cirrhosis and ascites. The diagnosis of spontaneous bacterial peritonitis is based on the neutrophil count in ascitic fluid. Using improved methods of bacteriologic culture, the pathogenic bacteria may be isolated from ascitic fluid in most cases. Several risk factors for spontaneous bacterial peritonitis development have been described, including a previous episode of spontaneous bacterial peritonitis, gastrointestinal hemorrhage, and low C3 or total protein concentration in ascitic fluid. Cefotaxime is at present the empiric treatment of choice for spontaneous bacterial peritonitis. Selective intestinal decontamination with the oral administration of antibiotics, particularly norfloxacin, is a very effective method in the prevention of spontaneous bacterial peritonitis caused by bacteria of enteric origin.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Immunohistochemistry continues to illuminate the hepatic milieu, with studies further defining populations of memory T cells in chronic hepatitis, natural killer cells in liver bearing tumors, and localizing a variety of cellular and extracellular communicating moieties (interferons, major histocompatibility antigens, integrins, and adhesion molecules). In the field of tumorigenesis, the outgrowth of adenomatous nodule from cirrhosis presents one putative model of the transition to hepatocellular carcinoma. Investigations of “oval cells,” the most likely candidate for hepatic reserve stem cell, have shown shared hepatocyte-bile duct markers and proliferation on exposure to several carcinogens. In viral hepatitis, recent studies have examined the close association of the hepatitis B x antigen with other tissue markers of viral replication (surface and core antigen), the association of hepatitis C virus infection with alcoholic liver disease and hepatocellular carcinoma, and expression of interferon-α and-γ. In liver transplantation, the spectrum of lesions related to acute and chronic rejection, ischemic ballooning damage, and graft-versus-host disease is enlarging, and sometimes controversial.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Some of the highlights of this past year's advances in hepatic biochemistry and molecular biology include 1) progress in defining the function and regulation of cell surface receptors and transporter mechanisms for metabolic substrates and xenobiotics, 2) determining the mechanisms governing hepatocyte-specific gene expression, and 3) the development and testing of methods for gene transfer therapy.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This review covers the literature on pediatric hepatology published during 1991. Last year was most important for gaining new insights into active and prophylactic treatment of hepatitis B and the epidemiology of hepatitis. Occurrence of hepatitis C is reported increasingly in children who have had transfusions or in newborns of mothers who are illegal drug abusers. Much information on liver transplantation was published this past year. Because the shortage of organs is a troublesome issue, partial or segmental liver transplantation or even bipartition of the graft are important improvements for the future.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID