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https://www.readbyqxmd.com/read/29441172/association-of-direct-bilirubin-level-with-postoperative-outcome-in-critically-ill-postoperative-patients
#1
Masaharu Nagae, Moritoki Egi, Kenta Kubota, Shohei Makino, Satoshi Mizobuchi
Background: Hyperbilirubinemia is a common postoperative complication. Elevated direct bilirubin (D-Bil) and indirect bilirubin (I-Bil) levels are related to different pathophysiologies; therefore, their associations with outcomes also differ. However, there have been few comparative studies of such associations in postoperative patients. Methods: This retrospective study compared the associations of postoperative D-Bil and I-Bil with outcomes. We included adult patients requiring postoperative intensive care for more than 48 hours between 2008 and 2013, except those undergoing liver operations...
February 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29440324/natural-history-clinical-manifestations-and-pathogenesis-of-hepatitis-a
#2
Eui-Cheol Shin, Sook-Hyang Jeong
Hepatitis A virus (HAV) is transmitted by the fecal-oral route and is a major cause of acute viral hepatitis. The clinical manifestations of HAV infection range from asymptomatic infection to acute liver failure (ALF), but do not include progression to chronic hepatitis. Risk factors for severe acute hepatitis A are older age (>40 years) and preexisting liver disease. Some patients may show atypical clinical features such as relapsing hepatitis, prolonged cholestasis, or extrahepatic manifestations. Almost all hepatitis A patients spontaneously recover with supportive care...
February 12, 2018: Cold Spring Harbor Perspectives in Medicine
https://www.readbyqxmd.com/read/29438158/intensive-care-unit-enhanced-recovery-pathway-for-patients-undergoing-orthotopic-liver-transplants-recipients-a-prospective-observational-study
#3
Adam B King, Clark D Kensinger, Yaping Shi, Matthew S Shotwell, Seth J Karp, Pratik P Pandharipande, J Kelly Wright, Liza M Weavind
BACKGROUND: Liver transplant recipients continue to have high perioperative resource utilization and prolonged length of stay despite improvements in perioperative care. Enhanced recovery pathways have been shown in other surgical populations to produce reductions in hospital resource utilization. METHODS: A prospective, observational study was performed to examine the effect of an enhanced recovery pathway for postoperative care after liver transplantation. Outcomes from patients undergoing liver transplantation from November 1, 2013, to October 31, 2014, managed by the pathway were compared to transplant recipients from the year before pathway implementation...
February 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29429201/-survey-on-the-prevalence-of-continuous-blood-purification-in-chinese-pediatric-critical-care
#4
X Yang, S Y Qian, Y M Zhu, X Xu, C F Liu, F Xu, X X Ren, Y Wang, Y C Zhang, G P Lu
Objective: To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China. Methods: A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected...
February 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/29427322/comparison-of-risk-factors-and-outcomes-of-daptomycin-susceptible-and-nonsusceptible-vancomycin-resistant-enterococcus-faecium-infections-in-liver-transplant-recipients
#5
Jessica D Lewis, Andrew J Barros, Costi D Sifri
BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) infections are common in liver transplant recipients (LTRs). Daptomycin (DAP) is an important treatment for such infections; however, DAP-nonsusceptible VRE (DNS-VRE) are increasingly frequent. The purpose of this study was to compare clinical characteristics and outcomes of LTRs with infections due to DNS-VRE and DAP-susceptible VRE (DS-VRE). METHODS: A single center, retrospective review of patients who underwent liver transplantation between 1/1/2010 and 12/31/15 and developed infections due to DS-VRE or DNS-VRE post-transplant was performed...
February 10, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/29416381/all-guns-blazing-management-and-survival-of-massive-valproic-acid-overdose-case-report-and-literature-review
#6
Shaikha Al Jawder, Eiman AlJishi, Shaikhah Al-Otaibi, Mohammed S Al-Shahrani
A 51-year-old woman, who intentionally ingested a massive dose of ~60 g of valproic acid which she was using as a mood stabilizer for bipolar affective disorder, presented within 30 minutes of ingestion to the emergency department. The patient was asymptomatic and was immediately started on decontamination therapy with activated charcoal (AC). Drug serum levels, liver functions, and ammonia levels were tested and followed up during treatment. Due to the massive ingestion and continuous rise in serum drug levels, the patient received regular multiple doses of AC, as well as l-carnitine for liver protection...
2018: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/29413209/adults-with-liver-failure-in-the-intensive-care-unit-a-transplant-primer-for-nurses
#7
REVIEW
Cheryl W McGinnis, Stacia M Hays
Liver transplant is the standard of care for treatment of many liver diseases. Patients with acute liver failure or end-stage liver disease may require intensive care management. Nurses play a vital role in the care of these patients before and immediately after transplant. Optimal patient outcomes depend on intensive care nurses being able to understand the process of liver failure and the necessary patient management during the pretransplant and early posttransplant periods. This article provides critical care nurses with an overview of liver disease and transplant for adult patients with a diagnosis of liver failure...
March 2018: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29407307/acute-liver-failure-due-to-amanita-phalloides-poisoning-therapeutic-approach-and-outcome
#8
E Kieslichova, S Frankova, M Protus, D Merta, E Uchytilova, J Fronek, J Sperl
INTRODUCTION: Amanita phalloides poisoning is a potentially fatal cause of acute liver failure. The aim of this study was to analyze the impact of initial patients' characteristics and different treatment modalities on the outcome of patients with liver failure caused by Amanita poisoning. MATERIAL AND METHODS: We retrospectively evaluated 23 patients admitted to our center between July 2007 and August 2016. RESULTS: Mean time interval between Amanita phalloides ingestion and the onset of gastrointestinal symptoms was 12...
January 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29407306/short-term-results-of-liver-transplantation-with-octogenarian-donors
#9
L Gajate Martín, A Martín Grande, D Parise Roux, C González Cibrián, C Fernández Martín, M A Rodríguez Gandía, A López Buenadicha
BACKGROUND: There are increasingly more patients awaiting liver transplantation while the number of donors has remained stable. It has been proven that grafts from donors older than 60 years have comparable results with those from younger donors. It is unclear whether this is so with donors older than 80 years old. MATERIAL AND METHODS: This was a retrospective study of all adult liver transplantations at our institution between March 2011 and December 2015. We compared 1-, 3-, 6-, and 12-month graft survival rates from donors <80 years and ≥80 years...
January 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29405671/light-sedation-with-dexmedetomidine-a-practical-approach-for-the-intensivist-in-different-icu-patients
#10
Stefano Romagnoli, Angela Amigoni, Ilaria Blangetti, Giampaolo Casella, Cosimo Chelazzi, Francesco Forfori, Cristiana Garisto, Maria C Mondardini, Marco Moltrasio, Daniela Pasero, Tiziana Principi, Zaccaria Ricci, Fabio Tarantino, Giorgio Conti
Light sedation, corresponding to a Richmond AgitationSedation Scale between 0 and 1 is a priority of modern critical care practice. Dexmedetomidine, a highly selective, central, 2adrenoceptor agonist, is increasingly administered in the intensive care units (ICUs) as an effective drug to induce light sedation, analgesia and a quasiphysiological sleep in critically ill patients. Although in general dexmedetomidine is well tolerated, side effects as bradycardia, hypertension, and hypotension may occur. Although a general dosing range is suggested, different ICU patients may require different and highly precise titration that may significantly vary due to neurological status, cardiorespiratory function, baseline blood pressure, heart rate, liver efficiency, age and coadministration of other sedatives...
February 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29404521/drug-idiosyncrasy-due-to-pirfenidone-presenting-as-acute-liver-failure-case-report-and-mini-review-of-the-literature
#11
REVIEW
Nipun Verma, Pramod Kumar, Suvradeep Mitra, Sunil Taneja, Sahajal Dhooria, Ashim Das, Ajay Duseja, Radha Krishan Dhiman, Yogesh Chawla
Idiosyncratic drug-induced liver injury (DILI) is ranked among the top most common etiologies of acute liver failure (ALF). It carries poor transplant-free survival. Pirfenidone is an anti-inflammatory and antifibrotic drug that is commonly used for the treatment of idiopathic pulmonary fibrosis (IPF). Hepatotoxicity due to pirfenidone is rare and generally manifests as a mild rise in serum aminotransferases. In this mini-review, we report an unusual case of idiosyncratic DILI due to pirfenidone presenting as ALF, with emphasis on the definition, classification, diagnostic criteria, histopathology, molecular markers, and treatment options for DILI and related ALF...
February 2018: Hepatology communications
https://www.readbyqxmd.com/read/29404491/remodeling-the-model-for-end-stage-liver-disease-for-predicting-mortality-risk-in-critically-ill-patients-with-cirrhosis-and-acute-kidney-injury
#12
Xiao-Dong Zhou, Qin-Fen Chen, Dan-Qin Sun, Chen-Fei Zheng, Dong-Jie Liang, Jian Zhou, Song-Jie Wang, Wen-Yue Liu, Sven Van Poucke, Xiao-Dong Wang, Ke-Qing Shi, Wei-Jian Huang, Ming-Hua Zheng
Serum creatinine measurement demonstrates a poor specificity and sensitivity for the early diagnosis of acute kidney injury (AKI) in patients with cirrhosis. The existing model for end-stage liver disease (MELD) score reveals multiple pitfalls in critically ill patients with cirrhosis and acute kidney injury (CAKI). The aim of this study was to re-evaluate the role of creatinine values in the existing MELD score and to develop a novel score for CAKI, named the "acute kidney injury-model for end-stage liver disease score" (AKI-MELD score)...
October 2017: Hepatology communications
https://www.readbyqxmd.com/read/29399279/predicting-early-outcomes-of-liver-transplantation-in-young-children-the-early-study
#13
Rashid Alobaidi, Natalie Anton, Dominic Cave, Elham Khodayari Moez, Ari R Joffe
AIM: To determine potentially modifiable predictors of early outcomes after liver transplantation in children of age < 3 years. METHODS: This study was a retrospective chart review including all consecutive children of age less than 3-years-old having had a liver transplant done at the Western Canadian referral center from June 2005 to June 2015. Pre-specified potential predictor variables and primary and secondary outcomes were recorded using standard definitions and a case report form...
January 27, 2018: World Journal of Hepatology
https://www.readbyqxmd.com/read/29397624/-retrospective-analysis-of-diagnosis-and-treatment-of-breast-cancer-in-pregnancy
#14
F W Wang, S M Fu, Y C Jin, X H Gong, H D Cheng, K J Wu
Objective: To investigate the principles of diagnosis and treatment of breast cancer during pregnancy. Methods: Clinical data of patients with breast cancer during pregnancy admitted to Obstetrics and Gynecology Hospital of Fudan University between January 2012 to July 2017 were analyzed retrospectively. A total of 17 patients were diagnosed with breast cancer in pregnancy, the median age was 32 years (range from 25 to 45 years old), pathological staging revealed 2 patient with stage 0, 1 with stage Ⅱa, 7 with stage Ⅱb, 1 with stage Ⅲa, 2 with stage Ⅲc, 4 with stage Ⅳ...
February 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29394711/-a-case-report-of-long-term-survival-after-excision-for-needle-tract-implantation-of-biopsy-and-hepatectomy-for-cholangiocarcinoma-with-gall-bladder-hemorrhage
#15
Kotaro Miyazawa, Shigeru Yoshioka, Masayuki Shiobara, Kazuo Wakatsuki, Syuka Arai, Kosuke Suda, Toshiaki Aida, Tetsutaro Miyoshi, Hirofumi Saito, Kazuto Yamazaki
A 77-year-old men with abdominal pain suffered from gall bladder hemorrhage and liver abcess was admitted for intensive care of severe acute cholangitis. He had hemobilia which was treated by the endoscopic retrograde bile duct drainage. After 2 months treatment with rest for purulent myelitis, he had neoplastic change of liver abcess diagnosed as intrahepatic bile duct cancer by percutaneous core needle biopsy. He underwent surgery as central bisegmentectomy and left the hospital at home 3 months later after rehabilitation for surgical site infection...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29393492/dexmedetomidine-impairs-p%C3%A2-glycoprotein%C3%A2-mediated-efflux-function-in-l02-cells-via-the-adenosine-5-%C3%A2-monophosphate%C3%A2-activated-protein-kinase-nuclear-factor%C3%A2-%C3%AE%C2%BAb-pathway
#16
Guo-Rong He, Xiao-Kun Lin, Yong-Biao Wang, Cong-De Chen
Dexmedetomidine (DEX) a type of the anaesthetic that has been widely used in anaesthesia and intensive care. However, whether DEX affects the pharmacokinetics of drugs remains elusive. As hepatic P‑glycoprotein (P‑gp) serves a critical role in the disposition of drugs, the present study aimed to address whether P‑gp function could be affected by DEX in vitro. In the present study, L02 cells (a normal human liver cell line) were exposed to DEX for 24 h and P‑gp function was evaluated by the intracellular accumulation of Rhodamine 123...
February 2, 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29391265/efficacy-of-granulocyte-colony-stimulating-factor-and-n-acetyl-cysteine-therapies-in-patients-with-severe-alcoholic-hepatitis
#17
Virendra Singh, Amarjit Keisham, Ashish Bhalla, Navneet Sharma, Ritesh Agarwal, Ratiram Sharma, Akash Singh
BACKGROUND & AIMS: Patients with alcoholic hepatitis (AH) have high mortality, so new therapies are needed. Administration of granulocyte colony stimulating factor (GCSF) increases survival times of patients with AH. It is not known whether addition of N-acetyl cysteine (NAC) to GCSF could further increase survival time. We performed a randomized controlled pilot study to compare the efficacy of standard medical therapy with pentoxifylline to treatment with a combination of GCSF and standard medical therapy as well as to the combination of NAC, GCSF, and standard medical therapy in patients with severe AH...
January 29, 2018: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29388442/liver-function-assessment-by-indocyanine-green-plasma-disappearance-rate-in-patients-with-intra-abdominal-hypertension-after-non-hepatic-abdominal-surgery
#18
Natasa Kovac, Mladen Peric
BACKGROUND AND OBJECTIVE: Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15 minutes (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery...
February 1, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29383510/epidemiology-causes-evolution-and-outcome-in-a-single-center-cohort-of-1116-critically-ill-patients-with-hypoxic-hepatitis
#19
Astrid Van den Broecke, Laura Van Coile, Alexander Decruyenaere, Kirsten Colpaert, Dominique Benoit, Hans Van Vlierberghe, Johan Decruyenaere
BACKGROUND: Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to cardiac, circulatory or respiratory failure. The aim of this study is to investigate its epidemiology, causes, evolution and outcome. METHODS: The screened population consisted of all adults admitted to the intensive care unit (ICU) at the Ghent University Hospital between January 1, 2007 and September 21, 2015...
January 30, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29381921/immediate-postoperative-tracheal-extubation-in-a-liver-transplant-recipient-with-encephalopathy-and-the-mayo-end-stage-liver-disease-score-of-41-a-care-compliant-case-report-revealed-meaningful-challenge-in-recovery-after-surgery-eras-for-liver-transplantation
#20
Jianbo Li, Chengdi Wang, Nan Chen, Jiulin Song, Yan Sun, Qin Yao, Lunan Yan, Jiayin Yang
RATIONALE: Immediate postoperative tracheal extubation (IPTE) is one of the most important subject in recovery after surgery (ERAS) for liver transplantation. However, the criteria for IPTE is not uniform at present. PATIENT CONCERNS: We reported a successful IPTE in a liver transplant recipient with encephalopathy and a high Mayo end-stage liver disease (MELD) score of 41, which beyond the so-called criteria reported in the literature. The patient was 48-year-old man, admitted in September 2016 for end-stage liver cirrhosis secondary to hepatitis B...
November 2017: Medicine (Baltimore)
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