1
|
Ethical dilemmas in psychiatric evaluations in patients with fulminant liver failure. Curr Opin Organ Transplant 2014; 19:175-80. [DOI: 10.1097/mot.0000000000000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
2
|
Guggenheimer J, Eghtesad B, Stock DJ. Dental management of the (solid) organ transplant patient. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:383-9. [PMID: 12686921 DOI: 10.1067/moe.2003.150] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The need to provide dental care for organ transplant candidates and recipients will increase in conjunction with the continued expansion of the use of organ transplantation. For the transplant candidate, dental care usually requires application of practice standards that fall within the scope of management of the severely medically compromised patient. There are, however, few guidelines and no clinical trials or outcomes assessments that address appropriate care for transplant recipients. Furthermore, despite the high rate of infectious complications among patients who have received organ transplants, there is little evidence that dental disease contributes to this risk. This article reviews the current status of dental care practices that have been recommended and presents a rationale that can be applied as the basis for guidelines and recommendations for the treatment of the organ transplant patient.
Collapse
Affiliation(s)
- James Guggenheimer
- University of Pittsburgh School of Dental Medicine, 3501 Terrace St, Pittsburgh, PA 15261, USA.
| | | | | |
Collapse
|
3
|
Ellis AJ, Wendon JA, Williams R. Subclinical seizure activity and prophylactic phenytoin infusion in acute liver failure: a controlled clinical trial. Hepatology 2000; 32:536-41. [PMID: 10960446 DOI: 10.1053/jhep.2000.9775] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Subclinical seizure activity in the patient with encephalopathy and on ventilation with acute liver failure (ALF) is a poorly recognized entity. Its importance lies in the likely exacerbation of cerebral hypoxia and the contribution of such seizure activity to the development of cerebral edema. The aim of the present study was to document the frequency of subclinical seizure activity in a cohort of patients with ALF by using a cerebral function and activity monitor that allows continuous recording of electroencephalogram activity at the bedside and to determine whether the prophylactic administration of the antiepileptic agent phenytoin would reduce its occurrence. Forty-two patients were enrolled in a controlled clinical trial: 20 patients were given phenytoin and 22 acted as controls. Subclinical seizure activity was recorded in 3 and 10 patients, respectively, of the treated and control groups. Pupillary abnormalities indicative of seizure activity and/or raised intracranial pressure (ICP) were also seen less frequently in the phenytoin-treated group compared with the controls (5 and 11 patients, respectively). Autopsy examinations available in 19 patients showed signs of cerebral edema in only 2 (22%) of the phenytoin-treated patients compared with 7 (70%) of the controls (P <.033). Based on these findings, we recommend that patients with ALF, on reaching the stage of grade III or IV encephalopathy, should be routinely monitored for subclinical seizure activity. In this study, prophylaxis with phenytoin reduced the frequency of such seizure activity and its effects, and proved to be safe with the regimen used.
Collapse
Affiliation(s)
- A J Ellis
- Institute of Liver Studies, King's College Hospital School of Medicine and Dentistry, London, UK
| | | | | |
Collapse
|
4
|
Detry O, Arkadopoulos N, Ting P, Kahaku E, Watanabe FD, Rozga J, Demetriou AA. Clinical Use of a Bioartificial Liver in the Treatment of Acetaminophen-Induced Fulminant Hepatic Failure. Am Surg 1999. [DOI: 10.1177/000313489906501008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patients with acetaminophen-induced fulminant hepatic failure (FHF) who meet the King's College Hospital criteria have a high mortality risk (>90%) if they do not undergo liver transplantation. We have developed a treatment strategy for these patients based on the use of an extracorporeal bioartificial liver (BAD support system. In this study, we report the results of the clinical application of BAL support in patients with acetaminophen-induced FHF. All patients were admitted to a dedicated surgical intensive care unit. They were evaluated for urgent liver transplantation and received the standard medical measures, including N-acetylcysteine administration and intracranial pressure monitoring. Moreover, they underwent daily 6-hour BAL treatments. Eight patients were treated. Three patients were bridged to liver transplantation, and five patients recovered without a transplant. All patients experienced neurological and metabolic improvement after treatments with the BAL support system. The BAL support system seems to improve the outcome of high-risk patients with acetaminophen-induced FHF, even in the absence of liver transplantation. Avoiding liver transplantation is particularly important in an era of organ shortage and high cost of transplants.
Collapse
Affiliation(s)
- Olivier Detry
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| | - Nikolaos Arkadopoulos
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| | - Paul Ting
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| | - Elaine Kahaku
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| | - Frederick D. Watanabe
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| | - Jacek Rozga
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| | - Achilles A. Demetriou
- Liver Support Unit, Department of Surgery, Cedars Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, California
| |
Collapse
|
5
|
Moses PL, Schroeder B, Alkhatib O, Ferrentino N, Suppan T, Lidofsky SD. Severe hepatotoxicity associated with bromfenac sodium. Am J Gastroenterol 1999; 94:1393-6. [PMID: 10235225 DOI: 10.1111/j.1572-0241.1999.01093.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Subacute hepatitis and liver failure occurred in a 40-yr-old woman following a 1-month course of treatment with the nonsteroidal anti-inflammatory drug bromfenac. Serologies for hepatitis A, B, and C were negative, as were antinuclear antibodies and ceruloplasmin. A transjugular liver biopsy demonstrated submassive hepatic necrosis. The clinical course was complicated by encephalopathy, fluid retention, and spontaneous bacterial peritonitis, prompting consideration for liver transplantation. With supportive measures, jaundice and fluid retention resolved over a 3-month period. We conclude that prolonged use of bromfenac was the etiological agent in this case, and that this drug can cause severe hepatotoxicity resulting in liver failure.
Collapse
Affiliation(s)
- P L Moses
- Department of Medicine, University of Vermont College of Medicine, Burlington 05401, USA
| | | | | | | | | | | |
Collapse
|
6
|
Yoshiba M. Recent Progress in the Treatment of Fulminant Hepatic Failure in Japan. J Infect Chemother 1998. [DOI: 10.1007/bf02489960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
7
|
Hassanein TI, Wahlstrom HE, Zamora JU, Van Thiel DH. Conventional care of fulminant hepatic failure: medical and surgical aspects. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 1997; 1:33-7. [PMID: 10225778 DOI: 10.1111/j.1744-9987.1997.tb00010.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fulminant hepatic failure (FHF) is a clinical syndrome with a poor outcome. Survival rates are between 10% and 40% depending on the etiology of hepatic necrosis. Multiple supportive modalities have been tried to improve patient outcome. However, orthotopic liver transplantation has been shown to be the most effective therapy at improving survival. Management of these patients requires invasive monitoring, mechanical ventilation, and infection prophylaxis, all of which are conducted most efficiently in specialized units. The goal is to allow the native liver to regenerate and to prevent the development of complications while maintaining the patient in a condition suitable for orthotopic liver transplantation. Therapeutic plasma exchange improves survival in patients with sufficient residual capacity for regeneration. It is effective in restoring hemostasis, improving neurological function, and prolonging biochemical stability of patients awaiting liver transplantation. Hepatoprotective and hepatotrophic substances are still in the experimental stage. Auxiliary liver grafting and artificial liver support devices have proved to be an adjunct or a bridge to transplantation; however, they are not yet widely available.
Collapse
|
8
|
Abstract
Hepatitis is a diagnosis that can easily be missed by the physician. The morbidity of this disease is significant when one takes into account all the cases that either do not have a typical presentation or are misdiagnosed. The emergency physician bears substantial responsibility in the diagnosis and intervention of patients with hepatitis, and needs to develop a systematic way of approaching the patient with a viral syndrome or other vague complaints that will allow appropriate consideration of this diagnosis.
Collapse
Affiliation(s)
- J D Bondesson
- Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia, USA
| | | |
Collapse
|