Clinical Study of the Acute Hepatitis due to Salmonella typhi / 대한간학회지

BACKGROUND/AIM: It is not easy to differentiate Salmonella from acute viral hepatitis (AVH), especially in the case of jaundice. Therefore we analyzed the differences between Salmonella hepatitis and AVH-B. METHOD: Our study was performed retrospectively on 11 patients with acute hepatitis who had positive blood culture for Salmonella typhi and 11 patients with AVH-B as controls. RESULT: The greater proportion of patients with Salmonella experienced fever, headache, diarrhea, relative bradycardia and hepatomegaly in contrast to the patients with AVH-B (p<0.05). But jaundice was detected more frequently in patients with AVH-B. The laboratory findings that were noted more in Salmonella patients than AVH-B patients were: left shift of leukocyte, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, lower peak levels of aminotransferase and total bilirubin, a trend toward a higher peak level of serum LDH and lower ratio of ALT/LDH expressed as a multiple of the upper limit of normal level on admission (p<0.05). Acute cholecystitis was complicated in 2 patients with Salmonella. One was resolved by cholecystostomy and the other had surgical intervention. The other 9 patients recovered with appropriate administration of antibiotics. CONCLUSION: The clues that raise the possibility of Salmonella over AVH-B include: high fever, headache, diarrhea, relative bradycardia, hepatmegaly, left shift of leukocyte, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, a markedly elevated serum level of LDH and lower ALT/LDH ratio (less than 4) on admission. Of these, ALT/LDH ratio is the best discriminator between Salmonella and AVH-B. Early diagnosis and appropriate administration of antibiotics are necessary for the successful treatment of Salmonella.

Uneventful Recovery of Hepatic Dysfunction following Isoflurane Anesthesia in a Pateint with Acute Viral Hepatitis B / 대한마취과학회지

Elective operation should be postponed in patient with acute hepatitis because of the increased risk of morbidity and mortality. Especially, surgery carried out in the presence of acute viral hepatitis is associated with high incidence of major complications The authors have recently experienced a patient who was performed emergency craniotomy for epidural hematoma. At that time, the patient was in midst of acute viral hepatitis B. Major in- halational anesthetic was isoflurane and muscle relaxant was atracurium. Fortunately, the preoperative hepatic dysfunction was not exacerbated and recovered uneventfully. The choice of anesthetics and the proper pre-and intraoperative anesthetic managements are reviewed.