201
|
Benyoub K, Muller M, Bonnet A, Simon R, Gazon M, Duperret S, Aubrun F, Viale JP. Amounts of bile acids and bilirubin removed during single-pass albumin dialysis in patients with liver failure. Ther Apher Dial 2012; 15:504-6. [PMID: 21974706 DOI: 10.1111/j.1744-9987.2011.00980.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
202
|
Kuroda H, Takikawa Y, Onodera M, Kakisaka K, Yoshida Y, Kataoka K, Sawara K, Miyamoto Y, Oikawa K, Endo R, Suzuki K. Serial changes of liver stiffness measured by acoustic radiation force impulse imaging in acute liver failure: a case report. J Clin Ultrasound 2012; 40:99-104. [PMID: 22086825 DOI: 10.1002/jcu.20893] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 09/19/2011] [Indexed: 05/31/2023]
Abstract
Acoustic radiation force impulse (ARFI) imaging is a new technology used to determine liver elasticity. We report the case of a patient that survived hyperacute-type acute liver failure (ALF) and who showed a dramatic change in the value of shear wave velocity (SWV) measured by ARFI, which corresponded with the severity of her liver damage. The value of SWV increased significantly up to 3.6 ± 0.3 m/s during the encephalopathy phase and then decreased along with the recovery of liver function, the blood flow of the right portal vein, and the liver volume. These findings suggest the value of SWV in ALF as a reliable marker of liver tissue damage. Further investigations of the pathophysiological significance of SWV in ALF are warranted.
Collapse
Affiliation(s)
- Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, School of Medicine, Uchimaru 19-1, Morioka, Iwate, 020-8505, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
203
|
Liu HM, Wang XB, Zeng H, Yang ZY. [Survival analysis of short-term prognosis of patients with HBV-related acute-on-chronic liver failure]. Zhonghua Yi Xue Za Zhi 2012; 92:21-24. [PMID: 22490652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the independent risk factors of influencing short-term survival and prognosis of patients with HBV-related acute-on-chronic liver failure (HBV-ACLF). METHODS The clinical data of 338 HBV-ACLF patients hospitalized from January 2007 to December 2010 were collected and analyzed by a Cox regression model. RESULTS The Cox regression analysis showed that gastrointestinal hemorrhage, hepatorenal syndrome, electrolyte imbalance and hepatic encephalopathy could significantly increase their recent mortality risks. And the values of relative risk (RR) were 2.526, 2.356, 2.068 and 1.896 respectively. Prothrombin activity (Exp(β): 0.821) and opportunity of antiviral therapy (Exp(β) of early stage: 0.526; Exp(β) of medium stage: 0.601) were protective factors of reduced mortality. CONCLUSION Gastrointestinal hemorrhage, hepatorenal syndrome, electrolyte imbalance, hepatic encephalopathy, prothrombin activity and opportunity of antiviral therapy are independent risk factors of influencing short-term survival and prognosis of HBV-ACLF patients. The combination of MELD score and multivariate analysis is a more scientific method of determining the prognosis of HBV-related ACLF.
Collapse
Affiliation(s)
- Hui-min Liu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | | | | |
Collapse
|
204
|
de Blauw MH. An unusual complication of a central venous catheter placement. Neth J Med 2012; 70:40-44. [PMID: 22271813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- M H de Blauw
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
| |
Collapse
|
205
|
Bramstedt KA, Popovich M. Managing patients whose family members are physicians. Minerva Anestesiol 2012; 78:63-68. [PMID: 21525827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The ethical complexities involving physicians who treat their own family members are well known and it is generally accepted that such practice should not occur. We present three anonymous cases in which patient family members who worked as physicians complicated the medical care of their hospitalized relatives. When a health care worker's family member becomes a hospital patient, the situation can be emotionally charged due to the medical insight the multiple parties have, as well as the desire of relatives to be protective of their family members. Clinician-relatives need to allow the medical team to assume the role of caretaker when their family members are hospitalized. Teams may need to employ limit setting in order to ensure fair and consistent care for all patients on the ward, and to prevent escalation of emotionally charged situations.
Collapse
Affiliation(s)
- K A Bramstedt
- California Pacific Medical Center, San Francisco, USA.
| | | |
Collapse
|
206
|
Tummolo A, Colella V, Bellantuono R, Giordano M, Messina G, Puteo F, Sorino P, De Palo T. [Apheresis in children: procedures and outcome]. G Ital Nefrol 2012; 29 Suppl 54:S125-S129. [PMID: 22388843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Apheresis procedures are used in children to treat an increasing number of conditions by removing different types of substances from the bloodstream. In a previous study we evaluated the first results of our experience in children, emphasizing the solutions adopted to overcome technical difficulties and to adapt adult apheresis procedures to a pediatric population. The aim of the present study is to present data on a larger number of patients in whom apheresis was the main treatment. Ninety-three children (50 m, 43 f) affected by renal and/or extrarenal diseases were included. They were treated with LDL apheresis, protein A immunoadsorption, or plasma exchange. Our therapeutic protocol was the same as described in the previous study. Renal diseases and immunological disorders remained the most common conditions requiring this therapeutic approach. However, hemolytic uremic syndrome (HUS) was no longer the most frequent renal condition to be treated, as apheresis is currently the first treatment option only in cases of atypical HUS. In this series we also treated small children, showing that low weight should no longer be considered a contraindication to apheresis procedures. The low rate of complications and the overall satisfactory clinical results with increasingly advanced technical procedures make a wider use of apheresis in children realistic in the years to come.
Collapse
Affiliation(s)
- Albina Tummolo
- U.O. Nefrologia e Dialisi Pediatrica, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
207
|
Mietka-Ciszowska A, Stojakowska M, Groszek B. [Severe paracetamol poisoning complicated with liver and renal failure--case report and review of literature]. Przegl Lek 2012; 69:614-617. [PMID: 23243945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED Paracetamol is a widely known over-the-counter analgesic and antipyretic which, in acute poisoning usually causes liver damage, and less commonly damage to the kidney, heart, and pancreas. In the present paper we report a case of acute suicidal paracetamol intoxication complicated by acute hepatic and renal failure. The discussion covers the pathogenesis, clinical course, and treatment of acute renal failure in the course of paracetamol poisoning. CASE REPORT A thirty-four-year-old woman was admitted to hospital in the second day after ingestion of nearly 17 g of acetaminophen. During admission to the hospital, the maximum values of transaminases (AST 19 350 U/L, ALT 11 760 U/L) were found; they have gradually normalized over the next few weeks. Sequentially monitored serum creatinine showed an upward trend, reaching a value of 588 micromol/L in the fifth day after drug ingestion. The patient underwent 1 haemodiafiltration and 4 haemodialysis treatments resulting in an improvement in renal function. CONCLUSIONS In acute acetaminophen poisoning, in addition to standard monitoring of liver function, the monitoring of kidney function is necessary because of the risk of acute renal failure due to acute tubular necrosis. Kidney damage is likely to be transient and generally will not need long-term renal replacement therapy.
Collapse
Affiliation(s)
- Aneta Mietka-Ciszowska
- Oddział Toksykologii i Chorób Wewnetrznych, Szpital Specjalistyczny im. Ludwika Rydygiera w Krakowie.
| | | | | |
Collapse
|
208
|
Shi XL, Chu XH, Zhang Y, Han B, Gu JY, Xiao JQ, Tan JJ, Ding YT. [The efficacy research of multi-layer flat-plate bioartificial liver on acute liver failure]. Zhonghua Wai Ke Za Zhi 2011; 49:1026-1030. [PMID: 22333426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the efficacy of newly developed multi-layer flat-plate bioartificial liver in treatment of canines with acute liver failure. METHODS Porcine hepatocytes and bone marrow mesenchymal stem cells were cocultured in newly developed multi-layer flat-plate bioreactor. Acute liver failure in canine models was induced by D-galactosamine administration.Sixteen canine models were divided into two groups: treatment group (n = 8) and control group (n = 8). Biochemical parameters were determined for 7 days after treatment and liver specimens were collected for histological analysis. RESULTS Hepatic encephalopathy and general conditions were significantly improved in the treatment group, but no changes in the control group. Alanine aminotransferase was significantly decreased from (1512 ± 183) U/L to (86 ± 25) U/L in the treatment group, aspartate aminotransferase was significantly decreased from (1472 ± 365) U/L to (46 ± 11) U/L, lactate dehydrogenase was significantly decreased from (463 ± 76) U/L to (312 ± 84) U/L, total bilirubin was significantly decreased from (28.8 ± 6.2) µmol/L to (12.5 ± 3.6) µmol/L, ammonia was significantly decreased from (56 ± 15) µmol/L to (34 ± 10) µmol/L, and prothrombin time were significantly decreased in the treatment group but increased in the control group, albumin was improved in the treatment group but decreased in the control group. There were 5 canines survived in the treatment group but only 3 in the control group. But there was no difference on survival rates between the two group (P = 0.294). CONCLUSION The application of newly developed multi-layer flat-plate bioartificial liver system was effective in the treatment of canines with acute liver failure.
Collapse
Affiliation(s)
- Xiao-lei Shi
- Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | | | | | | | | | | | | | | |
Collapse
|
209
|
Tan S, Aronowitz P. A common fungus, an unusual (and deadly) infection. Am J Med 2011; 124:1023-4. [PMID: 22017779 DOI: 10.1016/j.amjmed.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Susanna Tan
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, CA, USA.
| | | |
Collapse
|
210
|
|
211
|
You SL, Liu HL, Rong YH, Zhu B, Liu WS, Mao PY, Xin SJ. [Clinical study on hybrid bioartificial liver supporting system for acute on chronic liver failure patients]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2011; 25:387-389. [PMID: 22338233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To construct an hybrid bioartificial liver supporting system, and observe its effectiveness and safety on patients with acute on chronic liver failure. METHODS Hybrid bioartificial liver supporting system (HBALSS) was constructed using bioreactor with HepG2 cells transfected with human augmenter of liver regeneration (hALR) gene. 12 acute on chronic liver failure patients were divided into 2 groups randomly. The treatment group was treated with the hybrid bioartificial liver support system. The group underwent plasma exchange was used as control. RESULTS In the treatment group, four patients recovered, one patient died of hepatic encephalopathy, one patient died of hepatorenal syndrome, one patient recovered, but died of gastrointestnal bleeding after 1 year. In control group, two patients recovered, one patient underwent orthotropic liver transplantation, and three patients died of liver failure. CONCLUSION The hybrid bioartificial liver supporting system with HepG2 cell line was established successfully and have certain safety and effectiveness on acute on chronic liver failure patients.
Collapse
Affiliation(s)
- Shao-Li You
- Liver Failure Therapeutic and Research Center, 302 Hospital of PLA, Beijing 100039, China
| | | | | | | | | | | | | |
Collapse
|
212
|
Abstract
Acute liver failure (ALF) is uncommon in the United States, but presents acutely and catastrophically, often with deadly consequences. Hepatic encephalopathy, cerebral edema, elevated intracranial pressure, and intracranial hemorrhage due to coagulopathy are common occurrences in patients with ALF. Appropriate management of multi-system organ failure and neurological complications are essential in bridging patients to transplant and ensuring satisfactory outcomes.
Collapse
Affiliation(s)
- Jennifer A Frontera
- Neuroscience Intensive Care Unit, Department of Neurosurgery, Mount Sinai School of Medicine, One Gustave Levy Place, P.O. Box 1136, New York, NY 10029, USA.
| | | |
Collapse
|
213
|
Abstract
ALF is a multisystem disorder necessitating both predictive and reactive management strategies to support and protect organs from the initial and subsequent insults encountered. Early referral to a specialist liver centre with the option of liver transplantation is recommended. Furthermore, a good understanding of the poor prognostic variables is necessary to determine those most at risk of developing ALF in order to facilitate timely, safe transfer and listing for liver transplantation.
Collapse
Affiliation(s)
- Andy Slack
- The Institute of Liver Studies, King's College Hospital, London.
| | | |
Collapse
|
214
|
Shanmugam NP, Bansal S, Greenough A, Verma A, Dhawan A. Neonatal liver failure: aetiologies and management--state of the art. Eur J Pediatr 2011; 170:573-81. [PMID: 20886352 DOI: 10.1007/s00431-010-1309-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/15/2010] [Indexed: 12/19/2022]
Abstract
Acute liver failure in neonates is rare, but carries a high mortality. Neonatal liver failure can be defined as "failure of the synthetic function of liver within 4 weeks of birth". Encephalopathy is not essential for the diagnosis. Acute liver failure in neonates differs from children with regard to aetiology and outcome. Common causes of neonatal liver failure are neonatal hemochromatosis, haematological malignancies, viral infections and liver-based metabolic defects. Early diagnosis and referral to a paediatric liver centre is recommended as liver transplantation is the only definitive treatment when supportive or a disease-specific treatment fails.
Collapse
Affiliation(s)
- Naresh P Shanmugam
- Paediatric Liver, GI & Nutrition Centre, King's College Hospital, London, UK
| | | | | | | | | |
Collapse
|
215
|
Faghfoury H, Baruteau J, de Baulny HO, Häberle J, Schulze A. Transient fulminant liver failure as an initial presentation in citrullinemia type I. Mol Genet Metab 2011; 102:413-7. [PMID: 21227727 DOI: 10.1016/j.ymgme.2010.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/11/2010] [Accepted: 12/11/2010] [Indexed: 12/22/2022]
Abstract
Citrullinemia type I (CTLN1) is a urea cycle disorder which typically presents in the neonatal period or infancy with hyperammonemia and concurrent neurologic deterioration. We report a 15-month-old female with CTLN1 who presented with encephalopathy and seizures with hyperammonemia requiring emergency treatment. Although there was a rapid resolution of her hyperammonemia, she developed fulminant liver failure. The severe increase of transaminases (aspartate aminotransferase and alanine aminotransferase levels peaking at 19,794 UI/L and 19,938 UI/L, respectively) and concurrent disturbances in her hepatic synthetic functions led to the consideration of a liver transplantation. However, there was a normalization of her liver function tests over the course of weeks with supportive therapy alone. Molecular analysis of the ASS1 gene confirmed the diagnosis of CTLN1 by revealing the known mutation c.1087C>T (p.R363W) on the paternal allele and an intronic nucleotide exchange leading to an insertion of 69 bp on the transcript resulting in a frameshift and premature stop of translation on the maternal allele. We also briefly report another case of CTLN1 where liver failure was a prominent feature of the presentation. Fulminant liver failure has been described with a variety of other urea cycle disorders, but has been described in infantile onset presentation of CTLN1 in only two other cases recently. Our observation suggests that in some cases of CTLN1 with acute liver failure, emergency intervention such as transplantation is not warranted despite evidence of severe hepatotoxicity.
Collapse
Affiliation(s)
- Hannaneh Faghfoury
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
216
|
Yang XA, Zhang K, Shu X, Cao H, Xu QH. [Adenoviruses mediated BCL-X1 overexpression protects mice from fulminant hepatic failure]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2011; 25:109-111. [PMID: 21863631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To indentify the relation between hepatic cells apoptosis and the lesion of liver tissue in acute toxic lethal hepatitis. METHODS 60 Wistar mice were randomly divided into normal control, model group and treatment group. Normal control and model group were pretreated by portal vein injection of normal saline, the treatment group was pretreated by portal vein injection of BCL-X1 adenoviruses. The mice of model group and treatment group were received an injection of D-galn and LPS to establish fulminant hepatic failure models 7 days after pretrement. To observe BCL-X1 expression, serum ALT, AST, hepatocyte apoptosis rate, and mortality rate of the three groups. RESULTS The BCL-X1 expression was higher in treatment group than in model group; 6 hours after fulminant hepatic failure models were established,the serum ALT, AST level of treatment group was lower than model group;The hepatocyte apoptosis rate of treatment group was lower than model group. The death rate of treatment group was lower than model group. CONCLUSION In fulminant mice hepatic failure models, the hepatocyte apoptosis rate has a positive correlation with death rate, the overexpression of BCL-X1 can decrease the hepatocyte apoptosis rate and the death rate.
Collapse
Affiliation(s)
- Xiao-an Yang
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | | | | | | | | |
Collapse
|
217
|
|
218
|
|
219
|
Kieslichová E, Rocen M, Franková S, Trunecka P. [Acute liver failure: present recommendations]. Cas Lek Cesk 2011; 150:24-30. [PMID: 21404484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Acute liver failure is a life threatening illness whose mortality rate remains high. For the survival an early diagnosis is crucial as well as the use of specific and supportive therapy and the determination of patient's need for urgent liver transplantation. At the first signs of the disease progression it is necessary to contact a transplantation centre. The patient with acute liver failure should be admitted to intensive care unit of a hospital capable to perform liver transplantation. Liver transplantation is limited by the availability of organs. It is possible to expand the time required for spontaneous liver regeneration or transplantation by using liver supporting systems. The therapy of the acute liver failure is multidisciplinary and should be performed in specialized centers.
Collapse
Affiliation(s)
- Eva Kieslichová
- Institut klinické a experimentální medicíny v Praze, Transplantcentrum, Klinika anesteziologie, resuscitace a intenzivní péce.
| | | | | | | |
Collapse
|
220
|
Wiśniewski M, Barwina M, Zajac M, Sein Anand J. [SPAD--new possibilities?]. Przegl Lek 2011; 68:483-485. [PMID: 22010444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED The number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years. Various methods of extracorporeal liver support have been described in this paper, with particular emphasis on modified single pass albumin dialysis (SPAD). CONCLUSIONS 1. Single pass albumin dialysis (SPAD) is a promising method of extracorporeal liver support. 2. Due to widespread availability of continuous renal replacement therapy equipment it can be performed in most units providing intensive care. 3. No additional costs due to purchase of equipment or training of personnel are necessary to perform SPAD. 4. Further studies are necessary to establish optimal concentration of human albumin in dialysate and flow rates of blood and dialysate during the procedure. 5. Development of biocompatible replacement of human albumin would promote more frequent use of SPAD.
Collapse
Affiliation(s)
- Marek Wiśniewski
- Zakład Toksykologii Klinicznej, Gdańskiego Uniwersytetu Medycznego
| | | | | | | |
Collapse
|
221
|
de Groot MJ, Cuppen M, Eling M, Verheijen FW, Rings EHHM, Reijngoud DJ, de Vries MMC, van Spronsen FJ. Metabolic investigations prevent liver transplantation in two young children with citrullinemia type I. J Inherit Metab Dis 2010; 33 Suppl 3:S413-6. [PMID: 20852933 PMCID: PMC3757263 DOI: 10.1007/s10545-010-9207-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/17/2010] [Accepted: 08/27/2010] [Indexed: 11/25/2022]
Abstract
Acute liver failure may be caused by a variety of disorders including inborn errors of metabolism. In those cases, rapid metabolic investigations and adequate treatment may avoid the need for liver transplantation. We report two patients who presented with acute liver failure and were referred to our center for liver transplantation work-up. Urgent metabolic investigations revealed citrullinemia type I. Treatment for citrullinemia type I avoided the need for liver transplantation. Acute liver failure as a presentation of citrullinemia type I has not previously been reported in young children. Although acute liver failure has occasionally been described in other urea cycle disorders, these disorders may be underestimated as a cause. Timely diagnosis and treatment of these disorders may avoid liver transplantation and improve clinical outcome. Therefore, urea cycle disorders should be included in the differential diagnosis in young children presenting with acute liver failure.
Collapse
MESH Headings
- Administration, Oral
- Arginine/administration & dosage
- Biomarkers/blood
- Cells, Cultured
- Citrullinemia/blood
- Citrullinemia/complications
- Citrullinemia/diagnosis
- Citrullinemia/therapy
- Diagnosis, Differential
- Diet, Protein-Restricted
- Drug Therapy, Combination
- Female
- Glucose/administration & dosage
- Humans
- Infant
- Infusions, Intravenous
- Liver Failure, Acute/blood
- Liver Failure, Acute/diagnosis
- Liver Failure, Acute/etiology
- Liver Failure, Acute/therapy
- Liver Transplantation
- Male
- Predictive Value of Tests
- Sodium Benzoate/administration & dosage
- Treatment Outcome
- Unnecessary Procedures
Collapse
Affiliation(s)
- Martijn J. de Groot
- Department of Pediatrics, Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Center for Liver, Digestive and Metabolic Diseases, GUIDE Graduate School for Drug Exploration, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel Cuppen
- Department of Pediatrics, Slingeland Hospital, Doetinchem, The Netherlands
| | - Marc Eling
- Department of Pediatrics, Slingeland Hospital, Doetinchem, The Netherlands
| | - Frans W. Verheijen
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Edmond H. H. M. Rings
- Department of Pediatrics, Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Center for Liver, Digestive and Metabolic Diseases, GUIDE Graduate School for Drug Exploration, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Reijngoud
- Center for Liver, Digestive and Metabolic Diseases, GUIDE Graduate School for Drug Exploration, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maaike M. C. de Vries
- Department of Metabolic Diseases, Nijmegen Center for Mitochondrial Disorders, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Francjan J. van Spronsen
- Department of Pediatrics, Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Center for Liver, Digestive and Metabolic Diseases, GUIDE Graduate School for Drug Exploration, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
222
|
Lehner S, Stemmler HJ, Mück A, Braess J, Parhofer KG. Prognostic parameters and risk stratification in intensive care patients with severe liver diseases. J Gastrointestin Liver Dis 2010; 19:399-404. [PMID: 21188331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIM Acute or chronic liver failure is associated with numerous complications and patients may require intensive care treatment, which is complex, time-consuming and often highly resource-intensive. Thus, it is necessary to identify clinical parameters that allow quick risk stratification. METHODS In 117 patients with acute or chronic liver failure requiring ICU admission, the clinical parameters, risk scores and results of microbiological examinations were documented and correlated with the outcome (survivor vs. non-survivor). RESULTS Predictors of outcome were: Child-Pugh-Score (p < 0.01), MELD-Score (p < 0.01), SAPS-II-Score (p < 0.05), bilirubin (p < 0.01), Glasgow Coma Scale (GCS) (p < 0.02), urine output (p < 0.01), requirement of catecholamine administration (p <0.004), serum creatinine (p < 0.01). The strongest predictors of outcome were in a multivariate model GCS (p = 0.006) and MELD-score (p = 0.001). CONCLUSIONS Risk stratification in our patient collective was feasible. Apart from parameters to assess kidney function and circulation, various scoring systems that had previously not been evaluated for this kind of patient collective seem to be the main predictors of outcome.
Collapse
Affiliation(s)
- Sebastian Lehner
- Department of Internal Medicine II, Department of Nuclear Medicine Ludwig Maximilians University Campus Großhadern, Marchioninistraße 15,81377 Munich, Germany.
| | | | | | | | | |
Collapse
|
223
|
Abstract
Over the last decade the interest in hepatocyte transplantation has been growing continuously and this treatment may represent an alternative clinical approach for patients with acute liver failure and life-threatening liver-based metabolic disorders. The technology also serves as the proof of concept and reference for future development in stem cell technology. This chapter reviews the field of hepatocyte transplantation from bench to bedside.
Collapse
Affiliation(s)
- Anil Dhawan
- King's Cell Isolation Unit, King's College Hospital, London, UK
| | | | | | | |
Collapse
|
224
|
Cozzi P, Chiumello D, Tubiolo D, Sicignano A, Brandi G, Bianchi P, Coppola S, Caspani ML, Rossi G. Total hepatectomy, recombinant activated factor VII and rescue liver transplantation. Minerva Anestesiol 2010; 76:550-553. [PMID: 20613697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The aim of this paper was to describe a case of acute liver failure treated with total hepatectomy, recombinant activated factor VII and rescue liver transplantation. We reported our experience with a 51-year-old-woman who developed a massive portal thrombosis after cadaveric liver transplantation for hepatic epithelioid hemangioendothelioma and who then required a total hepatectomy and porto-caval shunt as a bridge procedure while waiting for an urgent new liver transplantation. Subsequently, the patient developed severe hemodynamic instability, massive abdominal and mucosal bleeding and acute renal failure that were managed with infusion of high doses of inotropes, red blood cells and fresh frozen plasma as well as continuous veno-venous hemofiltration. Due to persistent, uncontrolled bleeding, we considered the off-label use of rFVIIa. This caused a correction of the prothrombin times and allowed for sufficient hemostasis. The patient received a new cadaveric liver that was reperfused 38 hours after the first graft was removed. The transplanted liver showed immediate recovery, the hemodynamics ameliorated and the patient was fully awake at day five. In the case of an anhepatic phase complicated by severe bleeding that is unresponsiveness to several transfusions, a single administration of rFVIIa should be considered as a rescue therapy to control massive bleeding.
Collapse
Affiliation(s)
- P Cozzi
- Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
225
|
Kortgen A, Hetz H, Morgenthaler NG, Paxian G, Hitzler P, Krenn CG, Bauer M. Vasoactive mediators in patients with acute liver failure treated with albumin dialysis. Liver Int 2010; 30:634-6. [PMID: 19780957 DOI: 10.1111/j.1478-3231.2009.02129.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
226
|
Bémeur C, Desjardins P, Butterworth RF. Antioxidant and anti-inflammatory effects of mild hypothermia in the attenuation of liver injury due to azoxymethane toxicity in the mouse. Metab Brain Dis 2010; 25:23-9. [PMID: 20198438 DOI: 10.1007/s11011-010-9186-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 01/06/2010] [Indexed: 12/19/2022]
Abstract
Previous studies have demonstrated protective effects of mild hypothermia following acetaminophen (APAP)-induced acute liver failure (ALF). However, effects of this treatment in ALF due to other toxins have not yet been fully investigated. In the present study, the effects of mild hypothermia in relation to liver pathology, hepatic and cerebral glutathione, plasma ammonia concentrations, progression of encephalopathy, cerebral edema, and plasma proinflammatory cytokines were assessed in mice with ALF resulting from azoxymethane (AOM) hepatotoxicity, a well characterized model of toxic liver injury. Male C57BL/6 mice were treated with AOM (100 microg/g; i.p.) or saline and sacrificed at coma stages of encephalopathy in parallel with AOM mice maintained mildly hypothermic (35 degrees C). AOM treatment led to hepatic damage, significant increase in plasma transaminase activity, decreased hepatic glutathione levels, and brain GSH/GSSG ratios as well as selective increases in expression of plasma proinflammatory cytokines. Mild hypothermia resulted in reduced hepatic damage, improvement in neurological function, normalization of glutathione levels, and selective attenuation in expression of circulating proinflammatory cytokines. These findings demonstrate that the beneficial effects of mild hypothermia in experimental AOM-induced ALF involve both antioxidant and anti-inflammatory mechanisms.
Collapse
Affiliation(s)
- Chantal Bémeur
- Neuroscience Research Unit, St-Luc Hospital (CHUM), University of Montreal, 1058 St-Denis Street, Montreal, Quebec, Canada, H2X 3J4
| | | | | |
Collapse
|
227
|
Grodzicki M, Kotulski M, Leonowicz D, Zieniewicz K, Krawczyk M. Results of treatment of acute liver failure patients with use of the prometheus FPSA system. Transplant Proc 2010; 41:3079-81. [PMID: 19857681 DOI: 10.1016/j.transproceed.2009.08.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Herein we have presented the results of treatment of acute liver failure (ALF) patients with the use of the Prometheus FPSA dialysis system. MATERIALS AND METHODS To January 2009, we performed 278 FPSA procedures in 114 patients, including 52 experience and ALF. The patients who underwent the FPSA procedure consisted of 32 women and 20 men of overall mean age of 33 +/- 12 years. The causes of ALF were: Wilson's disease (n = 15), unknown origin ALF (n = 11), amanita phalloides intoxication (n = 7), paracetamol intoxication (n = 8), acute hepatitis B virus (HBV)/hepatitis C virus (HCV) infection (n = 7), liver insufficiency after parenchymal resection (n = 2) drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome (n = 1), rabdomyolysis (n = 1), or primary nonfunction (PNF) after orthotopic liver transplantation (OLT) (n = 1). All procedures were performed using the Prometheus 4008H Fresenius Medical Care liver support system. The average number of treatments per patient was 2.41 and the average time for each FPSA treatment was 6.3 hours. The average heparin dose used during the procedure was 750 IU/h. RESULTS After the whole treatment regimen, we observed significant improvements in the biochemical results. The average concentrations improved: serum ammonia (before 249.2 mug/dL versus after 109.7 mug/dL); serum bilirubin (before 21.53 mg/dL versus after 8.81 mg/dL), serum aspartate aminotransferase (AST; before 2456.4 U/L versus after 1068.8 U/L); serum alanine aminotransferase (ALT; before 2958.2 U/L versus after 1595.8 U/L); serum urea (before 58.5 mg/dL versus after 21.1 mg/dL); serum creatinine (before 2.9 mg/dL versus after 1.7 mg/dL); and pH value (before 7.11 versus after 7.32). After Prometheus treatment OLT was performed in 33 patients. Among the 28 who survived (53.8%), 22 underwent OLT and 6 did not have OLT. Among the 24 patients who died (46.2%), 13 were before OLT and 11 after OLT. CONCLUSION The Prometheus 4008H Fresenius Medical Care Liver support system was useful method of detoxification for patients with ALF, serving as an element of pretransplantation care.
Collapse
Affiliation(s)
- M Grodzicki
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, UI. Banacha 1A, 02-097 Warsaw, Poland
| | | | | | | | | |
Collapse
|
228
|
Abstract
Acute-on-Chronic Liver Failure (ACLF) is a recently introduced term defined as severe acute deterioration of an established liver disease. This entity usually develops after an acute insult. The main clinical manifestations are hepatorenal syndrome, hepatic encephalopathy and organ failure, with a high risk of death in the short term. The true incidence of ACLF remains difficult to determine due to confusions surrounding the definition of this entity, but seems to be 40% at 5 years in patients with advanced cirrhosis, which translates into 4,000 cases in Europe within this time span. The treatment of choice is liver transplantation. However, due to the shortage of suitable organs and morbidity and mortality in these patients, other options must be used.
Collapse
Affiliation(s)
- Angels Escorsell Mañosa
- UCI-Institut de Malalties Digestives i Metabòliques, Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERehd, Barcelona, España.
| | | |
Collapse
|
229
|
Li H, Jiang N, Zhang J, Wang GS, Yang Y, Chen GH. Transplantation of human thioredoxin gene-modified hepatocytes for treatment of acute liver failure in rat model. Chin Med J (Engl) 2009; 122:2631-2635. [PMID: 19951583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Mostly because of the limited number and proliferative ability of the transplanted hepatocytes, hepatocyte transplantation offers only temporary support to the hepatic function with rather poor functional replacement of the damaged liver parenchyma. This study aimed to observe the therapeutic effect of human thioredoxin (hTrx) gene-modified hepatocytes on experimental acute liver failure in rats. METHODS hTrx cDNA was obtained by reverse transcription-polymerase chain reaction (RT-PCR) from human osteosarcoma 143 (TK-) cells to construct the recombinant retrovirus vector pLEGFP/hTrx, which was packaged into PA317 cells to collect the recombinant retrovirus containing hTrx gene. After titration and characterization, the recombinant retrovirus was applied to primary cultured rat hepatocyte for infection to generate hTrx gene-modified rat hepatocytes, whose viability and antioxidative capacity were examined by immunohistochemistry and MTT assay, respectively. In a Sprague-Dawley (SD) rat model of acute liver failure, the modified hepatocytes were injected into the spleen, and the hepatic function and survival rate of the recipient rats were evaluated at different time points after the transplantation. RESULTS NIH3T3 cells infected by the recombinant retrovirus were capable of expressing bioactive hTrx in the form of fusion proteins. Immunohistochemistry demonstrated normal function of the hTrx gene-modified hepatocytes, which possessed strong antioxidative capacity as shown by MTT assay. Transplantation of the modified hepatocytes in rats with acute liver failure resulted in significantly lowered serum alanine aminotransferase (ALT) and total bilirubin (TBIL) levels (P < 0.05). The hepatocytes exhibited long-term survival and efficient proliferation after transplantation. Fourteen days after the operation, the rat models receiving hTrx gene-modified hepatocytes had significantly higher survival rate than those without the transplantation. CONCLUSION hTrx gene-modified hepatocyte transplantation can effectively alleviate acute liver failure in rats.
Collapse
Affiliation(s)
- Hua Li
- Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China
| | | | | | | | | | | |
Collapse
|
230
|
Alberto SF, Pires SS, Figueiredo A, Deus JRD. [Acute liver failure]. ACTA MEDICA PORT 2009; 22:809-820. [PMID: 20350465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 12/21/2008] [Indexed: 05/29/2023]
Abstract
Acute liver failure refers to the rapid development of severe acute liver injury with impaired synthetic function in a patient who previously had a normal liver or a well compensated liver disease. Its aetiology is diversified and it provides one of the best indicators of prognosis thus being crucial its quick identification. Because it can progress to multiple organ failure syndrome these patients should be managed in an Intensive Care Unit. The first therapeutic approach consists of intensive care support until treatment for specific aetiologies can be started. Besides encephalopathy, many other complications can develop causing the high rates of morbidity and mortality of acute liver failure and so they need tight surveillance and treatment. Liver support systems are therapeutic options still in study and without proven success in a long term period which makes hepatic transplantation the final therapeutic. Given the wide limitations of hepatic transplantation the final decision is based on a correct diagnosis and prognostic scoring systems.
Collapse
|
231
|
Qi YM, Zhang M, Chen YJ, Xu J, Yang H. [Application of total nutrient admixture in acute hepatic failure rats]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:771-775. [PMID: 19874694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To study the therapeutic efficacy of total nutrition admixture (TNA) containing 30.6% BCAA, MCT/LCT, glucose, vitamin, electrolytes in rat with acute hepatic failure (AHF). METHOD 30 Wistar rats were randomly divided into 4 groups: Normal control, AHF control, Fat-free nutrient admixture group, TNA group. AHF model was induced by D-galactosamine Liver and renal function, nitrogen balance, plasma total protein, albumin, prealbumin, fibronectin, hemoglobin, aminogram, tumor necrosis factor, lymphocyte transformation rate, glucose, blood fat tests etc were determined. RESULTS The improvement of liver and renal function was better in TNA group than those in other groups. ALT ALP TBil BUN were lower in TNA group than those in other groups. TP, ALB, PA, N-balance in TNA group were significantly higher than those in other groups. The spectrum of plasma amino acids of the TNA group was close to the normal and the control group. The TNF in TNA group were significantly higher than that in Fat-free nutrient admixture group. The stimulation index in TNA group was significantly higher than that in other groups. The difference of triglyceride in TNA group and normal diet was statistically significant, The difference of cholesterol in TNA group and Fat-free nutrient admixture was statistically significant, The difference of lipid peroxidation in four groups was not statistically significant. CONCLUSION Nutritional supportive treatment is necessary for AHF.
Collapse
Affiliation(s)
- Yu-Mei Qi
- Department of Nutrition, Tianjin Third Central Hospital, Tianjin 300170, China.
| | | | | | | | | |
Collapse
|
232
|
Forde KA, Reddy KR, Troxel AB, Sanders CM, Lee WM. Racial and ethnic differences in presentation, etiology, and outcomes of acute liver failure in the United States. Clin Gastroenterol Hepatol 2009; 7:1121-6. [PMID: 19501192 PMCID: PMC3642774 DOI: 10.1016/j.cgh.2009.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 05/24/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In patients with chronic liver disease, race plays a role in the rate of survival after transplantation. It is not known how race and ethnicity influence the presentation, etiology, and outcomes in patients with acute liver failure (ALF). METHODS A retrospective cohort study was conducted using the ALF Study Group database to assess differences between racial and ethnic groups in subjects with ALF. RESULTS In the cohort of 927 subjects (81.8% white, 12.8% black, and 5.4% Asian), enrolled between January 1998 and March 2006, age, sex, and level of education were comparable among the groups. Differences were found in the prevalence of psychiatric illness and the use of medications. Racial groups also differed with respect to etiology of ALF. Whites presented more frequently with acetaminophen toxicity (51% vs 27%; P < .001). By day 21, 228 (30%) whites, 46 (39%) blacks, and 11 (22%) Asians had died. There were no significant differences found in the overall mortality rate after adjustment for potential confounders including etiology of ALF, encephalopathy, age, sex, admission laboratory values, and region. The odds of liver transplantation were higher among Asians and Hispanics; however, this finding was attenuated after adjustment for the previously-described confounders (adjusted odds ratio, 1.50; 95% confidence interval, 0.72-3.13; and adjusted odds ratio, 1.89; 95% confidence interval, 1.08-3.30, respectively). CONCLUSIONS In patients with ALF, there were no significant differences in survival or rate of liver transplantation among racial and ethnic groups except for transplantation in Hispanics.
Collapse
Affiliation(s)
- Kimberly A Forde
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 Ravdin, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | |
Collapse
|
233
|
Alam S, Azam G, Mustafa G, Azad AK, Haque I, Gani S, Ahmad N, Alam K, Khan M. Natural course of fulminant hepatic failure: the scenario in Bangladesh and the differences from the west. Saudi J Gastroenterol 2009; 15:229-33. [PMID: 19794267 PMCID: PMC2981838 DOI: 10.4103/1319-3767.56094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 02/21/2009] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIM Fulminant hepatic failure (FHF) is a devastating complication of acute viral hepatitis, leading to death in most cases. The etiology and predictors of outcome differ according to the geographical region. This study was conducted with the aim of evaluating the etiology, complications, and outcome of FHF in Bangladesh. PATIENTS AND METHODS In this prospective study, we included 67 consecutive cases of FHF presenting to the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, between November 2003 and May 2008. Thirty-nine of the patients were male and 28 were female. Data was analyzed using SPSS, version 13.0. RESULTS The mean age of the subjects was 31.9 +/- 11 .7 years. Hepatitis E virus (HEV) was the commonest etiological factor for FHF (50 cases, 74.6%); of the 50 cases with HEV infection, 43 (64.2%) were not coinfected with any other virus, four cases were Hepatitis B virus (HBV) carriers, and three had coinfection with hepatitis A virus (HAV). HBV was the cause of FHF in nine (13.4%) patients. HCV, paracetamol, and alcohol were not responsible for any of the cases. Most of the patients (57 patients, 85%) developed FHF within 2 weeks of the onset of jaundice. Of the 67 patients, 49 (73.1%) died. Cerebral edema was the single most common cause of death (48 patients, 71.6%). Other complications were renal failure (23 patients, 34.3%), sepsis (15 patients, 22.4%), electrolyte imbalance (12 patients 17.9%), and bleeding tendency (7 patients, 10.4%). Occurrence of cerebral edema, longer prothrombin time, higher grade of encephalopathy, and longer jaundice-to-encephalopathy interval had significant negative influence on outcome. CONCLUSIONS The etiology of FHF in Bangladesh is different from that in the West. Prolongation of prothrombin time and occurrence of cerebral edema are predictors of the worst prognosis.
Collapse
Affiliation(s)
- Shahinul Alam
- Departments of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh.
| | | | | | | | | | | | | | | | | |
Collapse
|
234
|
Rusu EE, Voiculescu M, Zilisteanu DS, Ismail G. Molecular adsorbents recirculating system in patients with severe liver failure. Experience of a single Romanian centre. J Gastrointestin Liver Dis 2009; 18:311-316. [PMID: 19795025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM This is a retrospective, observational study regarding the experience of the Fundeni Clinical Institute in the application of the Molecular Adsorbents Recirculating System in patients with liver failure. METHOD From January 2002 until December 2007, we performed 50 MARS sessions in 27 patients, mean age 38.96+/-19.58 years. The etiology of liver failure was as follows: acute liver failure (ALF) in 7 patients, acute-on-chronic liver failure (AoCLF) in 10 patients, post-liver transplantation in 8 patients, and post-hepatectomy in 2 patients. RESULTS We noticed the following clinical effects: improvement in general condition, in neurological status, marked regression of jaundice and pruritus, improvement in renal function and in hemodynamic status. Of the 7 patients with ALF, 3 patients (42.8 %) survived due to their own liver recovery. Only 2 patients (20%) with AoCLF survived. In this group, one patient was transplanted, one patient is alive, and the mean survival of the remaining patients was 24.5+/-34.6 days. In the post-liver transplantation group, one patient was retransplanted, one patient is alive and the mean survival of the other 6 patients was 28.5+/-39.8 days. One patient with post-hepatectomy liver failure presented spontaneous liver recovery. CONCLUSION MARS therapy was well tolerated by the patients. MARS therapy efficiently removed water soluble and albumin-bound toxins. The unfavorable prognostic factors were the association with multi organ failure and sepsis.
Collapse
Affiliation(s)
- Elena-Emanuela Rusu
- Center of Internal Medicine and Nephrology, Fundeni Clinical Institute, 258 Fundeni Street, sector 2 Bucharest, Romania
| | | | | | | |
Collapse
|
235
|
Liu Y, Kang YZ, Xia WZ, Zhou HC, Wang Y, Gao Y. [Artificial and bioartificial liver support systems for acute and acute-on-chronic liver failure: a meta-analysis]. Nan Fang Yi Ke Da Xue Xue Bao 2009; 29:1529-1532. [PMID: 19726283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the effect of artificial and bioartificial liver support systems for management of acute and acute-on-chronic liver failure. METHODS Articles documenting randomized clinical trials concerning any liver support systems vs standard conservative therapy, published between January, 1970 and June, 2008, were retrieved by database searching. Of the 1134 articles retrieved, 12 randomized trials involving 479 patients were included. The data were extracted and the trial quality was assessed by 2 independent reviewers. The primary outcome measure was all-cause mortality, and the results were combined on the risk ratio (RR) scale. RESULTS Of the 12 trials included, 10 assessed artificial liver support systems for acute or acute-on-chronic liver failure, and 2 assessed bioartificial systems for acute liver failure. Overall, the liver support systems had moderate effect on mortality compared with standard conservative therapy (RR=0.80; 95% CI 0.664-0.969, P=0.022). Meta-regression indicated that the effect of the support systems depended on the type of liver failure (P=0.00). In stratified meta-analyses, the support systems appeared to reduce the mortality by 43% in acute-on-chronic liver failure (RR=0.57; 95% CI 0.39-0.84, P=0.004), but not in acute liver failure (RR=0.899; 95% CI 0.72-1.12, P=0.361). CONCLUSION Artificial liver support systems reduce the mortality of acute-on-chronic liver failure as compared with standard conservative therapy, but have no significant effect on the mortality of acute liver failure. Bioartificial liver support systems lower the mortality rates in both acute and acute-on-chronic liver failure, and should be the future focus of development.
Collapse
Affiliation(s)
- Yong Liu
- Second Department of Hepatobiliary, Institute for Regeneration Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
| | | | | | | | | | | |
Collapse
|
236
|
Yoshimi A, Nannya Y, Ueda K, Asano D, Yamamoto G, Kumano K, Hangaishi A, Matsui Y, Takahashi T, Imai Y, Sugawara Y, Kokudo N, Kurokawa M. Successful hematopoietic stem cell transplantation from an HLA-identical sibling in a patient with aplastic anemia after HLA-haploidentical living-related liver transplantation for fulminant hepatitis. Biol Blood Marrow Transplant 2009; 15:389-90. [PMID: 19203732 DOI: 10.1016/j.bbmt.2008.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 11/13/2008] [Indexed: 11/17/2022]
|
237
|
Tuñón MJ, Alvarez M, Culebras JM, González-Gallego J. An overview of animal models for investigating the pathogenesis and therapeutic strategies in acute hepatic failure. World J Gastroenterol 2009; 15:3086-98. [PMID: 19575487 PMCID: PMC2705730 DOI: 10.3748/wjg.15.3086] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/23/2009] [Accepted: 05/30/2009] [Indexed: 02/06/2023] Open
Abstract
Acute hepatic failure (AHF) is a severe liver injury accompanied by hepatic encephalopathy which causes multiorgan failure with an extremely high mortality rate, even if intensive care is provided. Management of severe AHF continues to be one of the most challenging problems in clinical medicine. Liver transplantation has been shown to be the most effective therapy, but the procedure is limited by shortage of donor organs. Although a number of clinical trials testing different liver assist devices are under way, these systems alone have no significant effect on patient survival and are only regarded as a useful approach to bridge patients with AHF to liver transplantation. As a result, reproducible experimental animal models resembling the clinical conditions are still needed. The three main approaches used to create an animal model for AHF are: surgical procedures, toxic liver injury and infective procedures. Most common models are based on surgical techniques (total/partial hepatectomy, complete/transient devascularization) or the use of hepatotoxic drugs (acetaminophen, galactosamine, thioacetamide, and others), and very few satisfactory viral models are available. We have recently developed a viral model of AHF by means of the inoculation of rabbits with the virus of rabbit hemorrhagic disease. This model displays biochemical and histological characteristics, and clinical features that resemble those in human AHF. In the present article an overview is given of the most widely used animal models of AHF, and their main advantages and disadvantages are reviewed.
Collapse
|
238
|
Benois A, Coton T, Peycru T, Maslin J, Dardare E, Abdoul I, Raynaud L, Sergent H. [Acute liver failure and severe exertional heat stroke: uneasy management in Africa]. Med Trop (Mars) 2009; 69:289-292. [PMID: 19702155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Exertional heat stroke (EHS) is a medical emergency defined as tissue injury secondary to a prolonged period of extreme hyperthemia during strenuous physical activity. In the vast majority of cases, EHS is associated with minimal liver involvement with no clinical manifestations. However acute hepatic insufficiency has been reported including a few cases treated by liver transplantation but with poor results suggesting that conservative management is preferable. The purpose of this report is to describe a patient who developed EHS with acute liver insufficiency and multiple organ failure in Djibouti. Despite the remote location and limited medical resources available, full recovery was achieved with conservative therapy and intensive care.
Collapse
Affiliation(s)
- A Benois
- Services médicaux, hôpital Bouffard, Djibouti.
| | | | | | | | | | | | | | | |
Collapse
|
239
|
LI LJ. [More studies on mechanism of liver failure and artificial liver therapy]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:321-323. [PMID: 19497190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
240
|
GUO LM. [The evaluation for principles and clinical application of combined artificial liver therapy]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:326-327. [PMID: 19497192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Li-min GUO
- Center of Critical Care Medicine, Ditan Hospital, Beijing 100015, China.
| |
Collapse
|
241
|
Zheng SJ, Chen P, Duan ZP. [Therapeutic use of small interfering RNA in acute liver failure animal model]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:238-240. [PMID: 19335996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Su-Jun Zheng
- Artificial Liver Centre, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | | | | |
Collapse
|
242
|
Montejo González JC, Catalán González M, Meneu Díaz JC, Moreno Elola-Olaso A, De la Cruz J, Moreno González E. Artificial liver support system in acute liver failure patients waiting liver transplantation. Hepatogastroenterology 2009; 56:456-461. [PMID: 19579620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS To assess the efficacy of the Molecular Adsorbent Recirculating System MARS (GAMBRO LUNDIA AB, Europe) in patients with acute liver failure waiting for liver transplantation. METHODOLOGY Case-control study in a medical-surgical ICU of a referral hospital. Patients admitted to ICU with severe acute liver failure of any etiology were included. Conventional treatment was applied in all cases according to patient's clinical condition. Patients were treated with MARS after the implementation of this therapy in the ICU. Patients without this treatment were the control group. RESULTS Were included 45 patients (control group: 26, MARS group: 19). Comparison between groups showed only differences in plasma bilirrubin levels in the first 24 hours. ICU mortality was 52.63% in the treatment group and 42.3% in the control group (p = 0.49). In the control group 17 patients (65.4%) received a liver transplant and 11 (57.9%) in the MARS group. ICU mortality was lower for transplanted patients in the study group (27.27% vs. 87.5%) (p = 0.019). Kaplan-Meier survival curves indicate that MARS-treated patients before liver transplantation had better survival. CONCLUSIONS Combination therapy with MARS and liver transplantation seems to be the more effective therapeutic option for patients with severe ALF.
Collapse
|
243
|
Denisova EN, Sharipova VR, Purlo NV, Sukhanova GA, Biriukova LS. [Use of fractional plasma separation and adsorption (Prometheus technology) in the treatment of acute liver failure]. Anesteziol Reanimatol 2009:45-49. [PMID: 19514440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents the results of treating 8 patients with acute liver failure, by using the separation and adsorption of fractional plasma (Prometheus technology). Twenty-five procedures lasting 5-6 hours were performed. Anticoagulation with heparin was made under guidance of coagulogram parameters. The results of testing blood parameters before and after a procedure and hemodynamic parameters are given. The investigations have demonstrated the effectiveness and safety of the procedure.
Collapse
|
244
|
Jiang W, Desjardins P, Butterworth RF. Hypothermia attenuates oxidative/nitrosative stress, encephalopathy and brain edema in acute (ischemic) liver failure. Neurochem Int 2009; 55:124-8. [PMID: 19428816 DOI: 10.1016/j.neuint.2009.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/10/2009] [Accepted: 02/16/2009] [Indexed: 01/20/2023]
Abstract
Encephalopathy and brain edema are serious complications of acute liver failure (ALF). The precise pathophysiologic mechanisms responsible have not been fully elucidated but it has been suggested that oxidative/nitrosative stress is involved. In the present study we evaluated the role of oxidative/nitrosative stress in the pathogenesis of hepatic encephalopathy and brain edema in rats with ALF resulting from hepatic devascularization. We also studied the effect of hypothermia, a treatment previously shown to delay the progression of encephalopathy and the onset of brain edema, on ALF-induced oxidative stress. ALF rats were sacrificed at precoma and coma stages of encephalopathy along with their appropriate sham-operated controls. Hypothermic ALF rats were sacrificed in parallel with normothermic comatose ALF rats. Nitric oxide production in plasma and brain was assessed indirectly by measuring the level of its stable end products, nitrite/nitrate (NOx), using the Griess reagent. Expression of nitric oxide synthase (NOS) isoforms and heme oxygenase-1 (HO-1) were measured using real-time quantitative PCR, Western blot analysis and immunohistochemistry. Increased nitrite/nitrate levels were observed in the plasma and frontal cortex in ALF rats at coma stage of encephalopathy compared to sham-operated controls. Increased expression of HO-1 protein and mRNA was observed in the frontal cortex of ALF rats at both precoma and coma stages of encephalopathy. Significant increases in expression of endothelial and inducible NOS mRNA isoforms also occurred at precoma and coma stages of encephalopathy. Expression of the neuronal nitric oxide synthase isoform (nNOS) was not altered by ALF. Hypothermia normalized nitrite/nitrate levels in brain and significantly attenuated HO-1, eNOS and iNOS expression. These results suggest that, oxidative/nitrosative stress participates in the pathogenesis of brain edema and its complications in ALF and that the beneficial effect of hypothermia depends in part on its ability to inhibit oxidative/nitrosative stress-related mechanisms.
Collapse
Affiliation(s)
- Wenlei Jiang
- Neuroscience Research Unit, Saint-Luc Hospital, CHUM, Campus Saint-Luc, University of Montreal, Montreal, Quebec, Canada
| | | | | |
Collapse
|
245
|
Abstract
Hepatic assist remains elusive. Bioartificial livers (BALs), consisting of liver cells or tissue in a synthetic housing, have been promising but have not proven successful in clinical trials. Artificial livers that consist of sophisticated sorbents and membranes cannot support a failing liver but may shorten episodes of acute decompensation in patients with stable cirrhosis. These artificial livers are most likely to find a place as temporary support prior to transplantation. True liver support will require a BAL. This article proposes goals for making a clinically useful BAL, with attention to systems biology and potential sources of hepatocytes.
Collapse
Affiliation(s)
- Norman L Sussman
- University of Utah, 30 North 1900 East, SOM 4R118, Salt Lake City, UT 84132-2410, USA.
| | | | | |
Collapse
|
246
|
Tang B, Wang HF. [Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:78-80. [PMID: 19203464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Bo Tang
- Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
| | | |
Collapse
|
247
|
Zhang DF. [Update hepatology in 2008]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:1-4. [PMID: 19391278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
248
|
|
249
|
Duan ZP, Chin Y. [Prospect of severe hepatitis and liver failure]. Zhonghua Gan Zang Bing Za Zhi 2009; 17:10-11. [PMID: 19391281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
MESH Headings
- Acute Disease
- Antigens, CD/blood
- Antigens, Differentiation, Myelomonocytic/blood
- Hepatitis, Viral, Human/classification
- Hepatitis, Viral, Human/pathology
- Hepatitis, Viral, Human/therapy
- Humans
- Liver Failure, Acute/etiology
- Liver Failure, Acute/pathology
- Liver Failure, Acute/therapy
- Liver Transplantation
- Liver, Artificial
- Prognosis
- Receptors, Cell Surface/blood
- Troponin I/blood
Collapse
Affiliation(s)
- Zhong-Ping Duan
- Artificial Liver Center, Beijing You'an Hospital, Afilliated to Capital University of Medical Sciences, Beijing, China.
| | | |
Collapse
|
250
|
Ooi ET, Ganesananthan S, Anil R, Kwok FY, Sinniah M. Gastrointestinal manifestations of dengue infection in adults. Med J Malaysia 2008; 63:401-405. [PMID: 19803300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This is a retrospective study of the gastrointestinal symptoms, signs and laboratory parameters in adult dengue patients admitted to Kuala Lumpur Hospital from 1st December 2004 to 31st December 2004. Clinical and laboratory parameters that may predict the need for intensive care were investigated. Six hundred sixty-six patients with clinical and biochemical features consistent with dengue infection were identified. Patients were stratified into those who required intensive care and those who were managed in non high dependency wards. Serum alanine aminotransaminase (ALT) levels were normal in 22.8% of patients and 5.9% of patients had acute fulminant hepatitis. More patients with dengue haemorrhagic fever (DHF) had elevated ALT levels as compared to patients with classic dengue fever (DF) (p = 0.012). Patients with DF had a statistically significant lower mean ALT level as compared to patients with DHF. Abdominal pain (p = 0.01) and tenderness (p<0.001), gastrointestinal bleed (p<0.001), jaundice (p<0.001), hepatomegaly (p<0.001) and ascites (p<0.001) were predictors of need for intensive care. We conclude that gastrointestinal manifestations are very common in dengue patients. Presence of abdominal pain and tenderness, gastrointestinal bleed, jaundice, hepatomegaly and ascites can be used to triage patients requiring intensive care.
Collapse
Affiliation(s)
- E T Ooi
- Medical Department, Kuala Lumpur General Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
| | | | | | | | | |
Collapse
|