Incidence of cholelithiasis among patients with cirrhosis and portal hypertension

One hundred and two patients with cirrhosis and portal hypertension were evaluated sonographically to determine the presence or absence of cholelithiasis. The gallbladder was visualized in 80 of 102 patients. Cholelithiasis was present in 43 of 80 cases (54%). All 22 patients in whom the gallbladder was not seen sonographically had had a previous cholecystectomy. Five of them were operated on prior to development of cirrhosis with portal hypertension, but 14 of the remaining 17 (82%) had evidence of cholelithiasis at pathology. Hence, there was an overall incidence of cholelithiasis of 59% among out 97 patients. This study as well as previous autopsy data indicate an increased incidence of cholelithiasis in patients with cirrhosis, irrespective of etiology or sex. The incidence of cholelithiasis in this study, however, was approximately twice that previously reported in cirrhotics at autopsy. Furthermore, patients with portosystemic shunts showed a significantly higher incidence of cholelithiasis compared to patients who were not shunted (68% vs 49%, p = 0.028). We believe the severity and duration of cirrhosis in our patient population, all with documented portal hypertension, may be the cause of this increased incidence.     

Incidence and risk factors for hepatocellular carcinoma in 967 patients with cirrhosis

Purpose: To determine the incidence of hepatocellular carcinoma in cirrhosis and to examine the influence of age and sex, and the contribution of etiological factors. Methods: 967 patients with liver cirrhosis and free of hepatocellular carcinoma were enrolled in this longitudinal, retrospective and observational study. Monitoring for hepatocellular carcinoma was scheduled at 3- to 6-month intervals. The mean (±SD) length of follow-up was 60.3 ± 51.7 months (range 6–258). Results: During the observation period, hepatocellular carcinoma developed in 64 patients. The calculated annual incidence was 2.1%. The probability of being free of liver cancer was 92% at 5 years, 80% at 10 years, and 69% at 15 years. Age was the only independent risk factor for the development of malignancy in the multivariate analysis. There were no differences according to male sex, alcohol abuse, and chronic hepatitis B and C virus infection. Conclusions: The annual incidence of hepatocellular carcinoma was 2.1%. These results, although confirming that age is a risk factor for hepatocellular carcinoma in cirrhosis, indicate that alcohol abuse, male sex, and concurrent hepatitis B and C virus infection do not involve a higher risk of developing liver cancer.     

Incidence and characteristics of type 2 hepatorenal syndrome in patients with cirrhosis and refractory ascites

BACKGROUND AND AIM: Type 2 hepatorenal syndrome (HRS) is a well described progressive impairment of renal function in patients with cirrhosis but its natural history, especially in patients with refractory ascites, is not well known. The aim of this study was to assess the incidence, predictive factors and outcome of type 2 HRS in patients with cirrhosis and refractory ascites. PATIENTS AND METHODS: Thirty patients with refractory ascites were followed-up for 17.5 +/- 26.3 months. The clinical characteristics, biological findings and outcome were analysed. The occurrence of renal dysfunction, and type 2 HRS in particular, was systematically analysed. RESULTS: Twenty-five patients (83.3%) developed renal dysfunction. Type 2 HRS was diagnosed in 16 patients (53.3%). Patients with type 2 HRS were older than patients without (64.8 +/- 9.1 yr vs 52.8 +/- 9.0 yr ; p < 0.001). All the others studied variables were similar between type 2 HRS and non-type 2 HRS patients. There was no significant difference in the overall probability of survival between these 2 groups. CONCLUSIONS: In patients with cirrhosis and refractory ascites, the development of type 2 HRS is frequent but does not occur in more severe liver disease and does not affect prognosis.     

Incidence of pericardial effusion and study of left ventricular function in patients with hepatic cirrhosis with ascites

Like hydrothorax, ascites and edema, pericardial effusion is present in decompensated hepatic cirrhosis. In order to evaluate the extent of effusion and to assess whether it is concomitant with left ventricular dysfunction, 21 patients who had been hospitalised for hepatic cirrhosis and ascites were studied following echocardiographic examinations and compared to 21 subjects without signs of cardiopathy. The following findings were statistically significant: the increased presence of pericardial effusion in patients with cirrhosis in comparison to controls, and likewise the higher ejection fraction in the former group. No differences were found between the two groups with regard to the size of the left ventricle. Within the group of patients affected by cirrhosis, the sole statistically significant difference between those patients with pericardial effusion and those without was observed with regard to the telediastolic diameter, which was greater in patients with pericardial effusion. In conclusion, pericardial effusion is common in patients with hepatic cirrhosis and ascites and is not accompanied by left ventricular dysfunction.     

Gallstones in patients with liver cirrhosis: Incidence,etiology, clinical and therapeutical aspects

Gallstones occur in about one third of the patients having liver cirrhosis. Pigment gallstones are the most frequent type, while cholesterol stones represent about 15% of all stones in cirrhotics. Increased secretion of unconjugated bilirubin, increased hydrolysis of conjugated bilirubin in the bile, reduced secretion of bile acids and phospholipds in bile favor pigment lithogenesis in cirrhotics. Gallbladder hypomotility also contributes to lithogenesis. The most recent data regarding risk factors for gallstones are presented. Gallstone prevalence increases with age, with a ratio male/female higher than in the general population. Chronic alcoholism, viral C cirrhosis, and non-alcoholic fatty liver disease are the underlying liver diseases most often associated with gallstones. Gallstones are often asymptomatic, and discovered incidentally. If asymptomatic, expectant management is recommended, as for asymptomatic gallstones in the general population. However, a closer follow-up of these patients is necessary in order to earlier treat symptoms or complications. For symptomatic stones, laparoscopic cholecystectomy has become the therapy of choice. Child-Pugh class and MELD score are the best predictors of outcome after cholecystectomy. Patients with severe liver disease are at highest surgical risk, therefore gallstone complications should be treated using noninvasive or minimally invasive procedures, until stabilization of the patient condition.     

Incidence of congenital toxoplasmosis in the Republic of Slovenia.

Over a 12-month period, 3959 pregnant women were systematically tested with the Sabin-Feldman dye test in order to assess the incidence of congenital toxoplasmosis in Slovenia. The results suggest that this is approximately 3/1000 live births. This relatively high incidence of congenital toxoplasmosis in Slovenia may make the costing of preventive screening programmes justifiable.     

男性肝硬化患者并发骨质疏松及阿仑膦酸钠的近期疗效观察

目的观察男性肝硬化患者骨质疏松的发生率并评价阿仑膦酸钠的近期疗效。方法127例男性肝硬化患者接受骨密度检测，并对其中筛检出的骨质疏松患者进行阿仑膦酸钠治疗，疗程6个月，对比观察治疗前后骨密度的改变和骨转化指标。结果男性肝硬化患者的骨质疏松发生率为（57．48％），显著高于正常对照组（P〈0．01），且与肝功能分级相关；阿仑膦酸钠治疗6个月后，患者腰椎，股骨颈，Ward’s三角区骨密度值显著上升（P均〈0．05）。治疗后血清钙升高，血清磷、尿DPD／Cr值下降。结论男性肝硬化患者存在较高的骨质疏松的发生率，阿仑膦酸钠治疗男性肝硬化并发骨质疏松的近期疗效显著。     

吉林地区肝炎肝硬化患者相关骨营养不良的发病情况

目的 探讨吉林地区肝炎肝硬化患者中骨营养不良的发病情况,为相关并发症的防治提供理论依据.方法 选择肝炎肝硬化的男性住院患者65例作为研究对象组,所选人群均排除肾脏疾病及内分泌系疾病.选择普通男性健康人群30例为对照组,所选人群均排除肝病、肾脏疾病及内分泌系疾病.检测Ca2+、血清甲状旁腺素(PTH)及降钙素(CT)、碱性磷酸酶同工酶(ALP3)、左侧桡骨下1/3处骨密度值.结果 研究对象组存在明显的血钙水平偏低,并且伴有PTH升高而CT水平相对偏低,骨源性ALP3明显高于对照组,骨密度降低.结论 吉林地区肝硬化患者普遍存在骨吸收增加、骨形成下降的情况,主要表现为骨营养不良及骨质疏松症.     

Incidence of large oesophageal varices in patients with cirrhosis: application to prophylaxis of first bleeding.

Because several studies have suggested that beta blockers are effective in the prophylaxis of first variceal bleeding in cirrhosis, screening for oesophageal varices might be appropriate. We prospectively studied 84 cirrhotic patients without obvious evidence of large oesophageal varices and previous bleeding during a mean follow up of 16 months. At entry to the study 41 patients had no oesophageal varices and in 43 these were grade 1. The subsequent percentages of patients without large oesophageal varices were 74% at one year and 52% at two years. Univariate analysis showed that a longer duration of cirrhosis (p less than 0.05) and grade 1 oesophageal varices at entry (p less than 0.001) were predictive factors for the occurrence of large oesophageal varices, whereas, multivariate analysis showed that the initial size of the oesophageal varices (p less than 0.001), a high initial Child-Pugh score, and a smaller improvement in Child-Pugh score during the study were independent risk factors. Among patients with grades 0 and 1 oesophageal varices at the start of the study the proportions with large oesophageal varices at two years were 31% and 70% respectively. We have calculated that, accepting a maximum risk of first bleeding of 10% without prophylactic treatment, a patient without oesophageal varices should be screened endoscopically every other year, while a patient with grade 1 disease should benefit from one annual upper gastrointestinal endoscopy.     

Incidence of congenital toxoplasmosis in southern Brazil: a prospective study

The study aimed to determine the incidence of congenital infection by Toxoplasma gondii and to describe neonatal and maternal characteristics regarding newborn infants treated at a teaching hospital in the town of Passo Fundo, State of Rio Grande do Sul, Brazil. Cord blood samples collected from 1,250 live newborns were analyzed. The laboratory diagnosis was established by the detection of Toxoplasma gondii IgM using an enzyme linked fluorescent assay. Gestational age, intrauterine growth, anthropometric measures, and prenatal characteristics were assessed. The incidence of congenital toxoplasmosis at birth was 8/10,000 (95%CI 0.2-44.5). Mean birthweight was 3,080 +/- 215.56 grams and mean gestational age was 38.43 +/- 1.88 weeks. With regard to prenatal care, 58% of the pregnant patients visited their doctors five times or more and 38.9% were serologically tested for toxoplasmosis in the first trimester of pregnancy. The incidence of congenital toxoplasmosis was similar to that found in most studies conducted in our country and abroad. Our study sample is representative of the town of Passo Fundo and therefore it is possible to consider the frequency observed as the prevalence of the disease in this town during the study period.     

Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients

Portal vein thrombosis was thought to be a common complication of liver cirrhosis in the past. The incidence of angiographically demonstrable portal vein thrombosis was studied in 708 consecutive patients with unequivocal cirrhosis seen in the past 10 yr in whom either transhepatic portography or superior mesenteric arterial portography clearly delineated the major portal vein system. Excluding 2 cases that were thought to be associated with past splenectomy, there were 4 cases of portal vein thrombosis related to cirrhosis, all in a decompensated stage. The calculated incidence of portal vein thrombosis was 0.573% of all cirrhotic patients without splenectomy in the past. They constituted 23.5% of the 17 cases of extrahepatic portal vein obstruction encountered during the same period. There were 78 cases of idiopathic portal hypertension similarly studied angiographically, and the incidence of portal vein thrombosis unrelated to splenectomy was 2.86%. A statistical survey based on 247,728 necropsies recorded in the Japan Autopsy Registries of 1975-1982 showed a 0.05489% incidence of portal vein thrombosis and a 6.58857% incidence of cirrhosis of all types among them, suggesting that portal vein thrombosis is not a common complication of cirrhosis in Japan in recent years.     

Sulphadiazine desensitization in patients with AIDS and cerebral toxoplasmosis

The objectives of this study were to evaluate the efficacy of a sulphadiazine desensitization protocol to treat patients with AIDS and cerebral toxoplasmosis (CT) and known sulphonamide allergy, to ensure that an adequate dose of sulphadiazine (2-4 g/day) was achieved rapidly (within 4-5 days), and to assess the effect of concurrent corticosteroid (CS) administration on the success rate of the regimen. Sixteen patients with CT and a past history or current manifestations of sulphonamide allergy were desensitized to sulphadiazine from October 1988 to December 1989. The protocol employed the oral administration of gradually increasing increments of sulphadiazine 3-hourly over 5 days. Success was defined as tolerance of 2-4 g oral sulphadiazine per day for at least 7 days until death or the present time without any allergic reactions. Our success rated overall was 10 out of 16 patients (62%). Seven patients achieved a final dose of 4 g/day and three a dose of 2 g/day. Concurrent CS administration did not appear to affect the outcome in the small number of patients studied. Our sulphadiazine regimen rapidly, successfully and safely desensitized patients with CT and sulphonamide allergy, allowing the optimal first-line treatment to continue. The aetiology of allergy in HIV-infected patients and the mechanisms by which desensitization works are unknown.     

Serological studies on toxoplasmosis in patients with typhoid fever

Summary Serological tests for toxoplasmosis were applied in 134 patients with typhoid fever confirmed by bacteriological and serological studies and in 27 patients with a clinical picture of typhoid fever not confirmed by laboratory measures. The total of positives (dye test [DT] 1:16 and more) was 57.5% in the confirmed typhoid group and 41% in the unconfirmed cases. This difference has no statistical importance. The complement fixation test (CFT) was negative in all cases. Positive DT results were more frequent in the typhoid patients with positive cultures (66.8%) than in those with negative cultures (50.8%); the difference was not found to be statistically significant. A higher proportion of positive DT reactions was found in patients with confirmed typhoid fever (57.5%) than in apparently healthy people (45%). The possible causes of these results were discussed from the epidemiological point of view. In 61 sera from 47 patients with toxoplasmosis, agglutination tests (AgT) for infectious diseases were performed. Four of them (6.5%) were positive (AgT 1:100 or more) and 14 (22.9%) gave doubtful results (AgT 1:50). It is concluded that—except in the case of mixed infection—the positive and doubtful AgT results may be due to nonspecific typhoid reactions.

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Serologische Toxoplasmose-Untersuchungen bei Typhuskranken

Zusammenfassung Es wurden bei 134 Patienten mit einem bakteriologisch und serologisch gesicherten Typhus abdominalis und bei 27 Patienten mit dem klinischen Bild eines Typhus serologische Toxoplasmen-Tests durchgeführt. 57.5% der gesicherten Typhuskranken waren im Sabin-Feldman-Test (SFT) positiv und 41% in der nicht gesicherten Gruppe. Dieser Unterschied ist statistisch irrelevant. Der Komplement-Fixation-Test (CFT) war bei allen negativ. Der positive SFT war häufiger bei Patienten mit positiven Blutkulturen anzutreffen, jedoch bestand kein statistisch signifikanter Unterschied zu den Patienten mit negativen Kulturen. Ein höherer Anteil von positiven SFT wurde andererseits bei den klinisch gesicherten Typhus-Patienten (57.5%) gefunden im Vergleich zu einer gesunden Population (45%). Die möglichen Gründe für diese Beobachtungen wurden im Zusammenhang mit epidemiologischen Gesichtspunkten diskutiert. In 61 Sera wurde die Toxoplasmose-Agglutination (TA) durchgeführt. Vier (6.5%) waren positiv (TA 1:100 oder mehr) und bei 14 (22.9%) wurden fragliche Resultate (TA 1:50) festgestellt. Es wird daraus geschlossen, daß mit Ausnahme von Mischinfektionen die positiven und fraglichpositiven TA möglicherweise durch unspezifische Typhus-Reaktionen hervorgerufen werden.

     

Serologic evidence of toxoplasmosis among patients with polymyositis

The prevalence and quantity of anti-Toxoplasma antibodies were greater in a group of 10 patients with polymyositis than in patients with other inflammatory muscle diseases or other diseases. Eight of these patients with polymyositis had positive Sabin-Feldman tests. Complement-fixing antibodies, usually associated with recent infection, were present in five of them. These patients had no other findings suggestive of acute toxoplasmosis except for myocarditis, which occurred in one. The prevalence of positive serologic findings was not related to age, birthplace or steroid therapy. Most positive results in patients with polymyositis occurred in those who had had the disease for 1 year or less. Sequential antibody titers were obtained in four patients with polymyositis. All had unusually elevated antibody titers early in the disease with a fall in titers after several months. Attempts at isolation of T. gondii from three of these patients failed. Three patients were treated with pyrimethamine and sulfonamides; one died within weeks and the other two showed gradual improvement within months.     

Seroepidemiology of toxoplasmosis in renal patients

Toxoplasmosis is an important parasitic disease in immunosuppressed patients. This prospective study was conducted to determine the seroprevalence, associated risk factors and the incidence of clinically confirmed toxoplasmosis among renal patients at the University of Malaya Medical Center, Kuala Lumpur, Malaysia. We interviewed 247 renal patients, each of whom answered an epidemiological questionnaire, and collected blood samples for measurement of anti-Toxoplasma IgG and IgM antibodies by ELISA. Overall seroprevalence of latent toxoplasmosis was observed in 126 (51%) renal patients. Race (Malays), marital status (married) and primary level of education, were all factors associated with a greater chance of Toxoplasma infection. A case of clinically confirned toxoplasmosis was diagnosed in a renal transplant recipient as a result of immunosuppression. Based on the findings obtained, this preliminary study shows a high prevalence of latent toxoplasmosis in renal patients. Risk factors may have significantly contributed to Toxoplasma acquisition in these patients. We recommend further studies be carried out to monitor for trends in toxoplasmosis among immunosuppressed patients.