Relationship between biochemical and virological responses to interferon therapy in chronic hepatitis C infection. Consensus Interferon Study Group.

We have investigated the relationship between serum alanine aminotransferase (ALT) and hepatitis C virus (HCV) RNA in the assessment of responses to interferon (IFN) therapy in chronic HCV infection. Data from 704 patients with HCV infection who were randomized to receive consensus IFN-alpha (CIFN) 3 micrograms (n = 232 patients) or 9 micrograms (n = 232 patients), or IFN-alpha 2b 3 million units (MU) (n = 240 patients), were used for these analyses. All patients were treated three times weekly.

Pharmacokinetics of ondansetron in patients with hepatic insufficiency.

Ondansetron is primarily eliminated via hepatic metabolism; thus, liver disease may affect its clearance. The pharmacokinetics of ondansetron in patients with different degrees of hepatic insufficiency (N = 12 with hepatic impairment, as categorized by Pugh's classification method) were assessed and the results compared with results for age- and gender-matched control subjects with normal liver function (n = 12). A secondary objective was to correlate the Pugh method of assessing hepatic impairment and quantitative metabolic markers used to assess hepatic function (antipyrine clearance and indocyanine green clearance) with changes in the pharmacokinetics of ondansetron.

Comparison of quantitative methods to assess hepatic function: Pugh's classification, indocyanine green, antipyrine, and dextromethorphan.

Study Objectives: To compare three quantitative metabolic markers used to assess hepatic function, indocyanine green (ICG), a high-extraction marker; antipyrine, a low-extraction marker; and dextromethorphan, a P-450IID6 marker, with the clinically used Pugh's classification.

Design: Comparison of 12 healthy controls with 12 age- and sex-matched patients with different degrees of liver disease.

Setting: Research center in a university-affiliated teaching hospital.

Rocky Mountain spotted fever mimicking acute cholecystitis.

Rocky Mountain spotted fever can present with predominantly abdominal symptoms including nausea, vomiting, diarrhea, and abdominal pain. Two elderly patients presented with an acute febrile illness and abdominal symptoms. Rash was not present initially.

Hepatobiliary disease that precedes ulcerative colitis.

There is a variable temporal relationship between the presenting symptoms of inflammatory bowel disease and associated hepatic disease: hepatobiliary disease may precede, occur with, or occur many years after the onset of the bowel disease. We describe six patients in whom hepatobiliary disease of initially obscure origin preceded the development of inflammatory bowel disease. The colitis which subsequently developed in these patients was symptomatically mild.

Isolated duodenal varix: an unusual cause of gastrointestinal hemorrhage.

We have reported an unusual case of upper gastrointestinal hemorrhage due to an isolated varix involving the second portion of the duodenum. The varix originated directly from the inferior vena cava and did not communicate with the portal venous system. The diagnosis was made preoperatively by upper gastrointestinal endoscopy.

Fatal herpetic hepatitis in pregnancy.

Disseminated herpetic infections are becoming more commonly reported during pregnancy. Such infections almost always occur in the third trimester and are usually associated with a primary infection, which serves as a portal of entry. Because of the high fetal and maternal mortality associated with this condition, early diagnosis and treatment are essential.

Chronic hepatitis in patients with hemophilia A: histologic studies in patients with intermittently abnormal liver function tests.

Recent studies in multiply transfused patients with hemophilia A and persistent liver function abnormalities have shown a high incidence of chronic active hepatitis. The purpose of the present study was to determine the severity of liver disease in multiply transfused patients with intermittent liver enzyme abnormalities. Fifteen patients with elevated enzymes on two or three out of four determinations at 6-mo intervals were studied.

Cirrhosis, variceal bleeding, and distal splenorenal shunt in hemophilia A.

Chronic liver disease has become a significant complication of the therapy of hemophilia disorders. We describe two patients with hemophilia A and hepatitis B virus hepatitis who progressed to cirrhosis with bleeding esophageal varices. Each underwent distal splenorenal shunt under plasma concentrate therapy without difficulty.

Medical complications of hemophilia.

The modern, comprehensive care of patients with hemophilia requires an awareness that complications other than those caused by acute hemorrhage can occur. The use of newer, more potent plasma concentrates has been accompanied by an increased incidence of liver disease in transfusion-requiring hemophiliacs. The progression to chronic active hepatitis and cirrhosis are particularly ominous developments in these patients.

Liver-spleen imaging in patients with subacute hepatic necrosis and chronic hepatitis.

Tc-99m-sulfur colloid reticuloendothelial images and percutaneous liver biopsies are correlated in 54 patients who presented with signs and symptoms of subacute hepatic necrosis or chronic active hepatitis. The scored Tc-99m-sulfur colloid scan is compared to the histological severity of disease. Serial scans and biopsies are compared.

Treatment of alcoholic hepatitis with encephalopathy. Comparison of prednisolone with caloric supplements.

A previous report from this institution demonstrated significant improvement of caloric intake and survival in patients with alcoholic hepatitis and hepatic encephalopathy given prednisolone when compared with placebo. The purpose of this study was to compare the effects of prednisolone with a regimen of 1600 calories per day without prednisolone. Fourteen patients with alcoholic hepatitis and encephalopathy were studied.

Fatal hepatic necrosis after halothane anesthesia in a boy with juvenile rheumatoid arthritis: a case report.

Hepatitis from halothane is usually diagnosed by excluding other possible causes. Whether preexisting hepatic damage, which can occur in certain autoimmune disorders, contraindicates the use of halothane has yet to be proven. The case of a 14-year-old boy with early-onset juvenile rheumatoid arthritis who developed fatal hepatic necrosis 13 days after halothane anesthesia is presented.

Liver biopsy in hemophilia A.

Hepatitis is a significant complication of the treatment of hemophilia A with factor VIII concentrates. Chronic liver disease in these patients is infrequently documented in the literature. The results of percutaneous liver biopsy, under the coverage of glycine-precipitated factor VIII, in six patients with hemophilia A who had the persistence of abnormal liver-function tests for at least 6 months, are described.