[Approach to antiplatelet and anticoagulant therapy before endoscopic procedures]

The use of anticoagulant and antiplatelet agents has become more prevalent during the past decades. These drugs may potentially cause gastrointestinal [GI] bleeding. Thus, there is an increasing need for GI endoscopy in patients who take these medications. In patients who take anticoagulant and antiplatelet agents, the appropriate conditions under which endoscopic procedures should be performed remain unclear. In this manuscript, we reviewed studies regarding this context in an attempt to present a practical guideline for management these patients

Drug induced liver injury: a review article

The incidence of drug induced liver injury [DILI] is about 1/1000 to 1/10000 among patients who receive therapeutic drug doses. Drug induced hepatotoxicity is a major cause of acute and chronic liver disease. The severity of liver damage ranges from nonspecific changes in liver structure to acute liver failure, cirrhosis and liver cancer. Some common agents that can cause liver injury are acetaminophen, antibiotics, statins, INH and herbal drugs. Drug-induced hepatotoxicity can be categorized based on the pattern of liver enzyme alteration [hepatocellular, cholestatic or mixed pattern], the mechanism of hepatotoxicity [direct, immune mediated or idiosyncratic] and hjstologic findings on liver biopsy [steatosis or sinusoidal obstruction syndrome]. Treatment options for DILI include discontinuing the drug, conservative measurements and liver transplantation in the case of non-acetaminophen induced hepatotoxicity

Lipoid proteinosis: a case report urbach and wiethe disease

Lipoid proteinosis [LP] is a rare autosomal recessive disease characterized by the deposition of an amorphous hyaline material in the skin, mucosa and viscera. The classic manifestation is onset in infancy with a hoarse cry due to laryngeal infiltration. Skin and mucous changes develope, and the disease follows a slowly progressive course. In this case report, a 49 year-old man presented with a longstanding hoarseness since childhood, dysphagia and asymptomatic skin lesions. Esophageal biopsy showed the deposition of homogenous eosinophilic hyaline-like material compatible with LP

[ overview on acute liver failure; prognosis and treatment]

Acute liver failure [ALF] is an uncommon, devastating syndrome of which over 2000 cases occur annually in the USA, with a mortality rate of about 80%. ALF is defined by the sudden onset of hepatic encephalopathy and coagulopathy [INR>/=1.5] in an otherwise healthy person. The most common etiologies are acute viral hepatitis A and B, medication overdose [e.g., acetaminophen] and idiosyncratic drug reactions. The outcome of ALF is determined by its etiology, the degree of hepatic encephalopathy present on admission and by complications, particularly infection. In the era of orthotopic liver transplantation and with improvements in the intensive care of patients with ALF, spontaneous recovery and overall survival now exceed 40% and 65%, respectively. Increased information about the etiologies and treatment options of this syndrome will improve the survival rate of our patients. In this study, we have decided to discuss the main issues of ALF by reviewing the literature and recent papers

[Liver mass: an overview on diagnosis]

Liver lesion is a common condition, which often detect incidentally. A large proportion of liver masses can be diagnosed by progression in imaging modalities. Although, definite diagnosis of liver mass's nature can be made by biopsy of lesion and histopathologic examination, but with imaging findings, we can approach to the diagnosis. In this study, we review many valuable articles and scientific references to define main aspects of diagnosis of liver masses