Comparison of Malnutrition Risk between Patients with Liver Cirrhosis and Viral Hepatitis Carrier: A Single Center Study / 대한소화기학회지

BACKGROUND/AIMS: It is well-known that patients with chronic liver disease commonly have nutritional deficiency. In the present study, we investigated the differences in malnutrition risk between patients with liver cirrhosis and viral hepatitis carrier. METHODS: Patients with chronic liver disease who have been hospitalized at Konyang University Hospital from May 2012 to April 2013 were analyzed retrospectively. The malnutrition risk was divided into three categories (low, intermediate, and high) according to Konyang University Hospital Malnutrition Screening, which include BMI, serum albumin, total lymphocyte count (TLC), hemoglobin, weight change, appetite, and dysphagia, within 24 hours of hospitalization. RESULTS: Among a total of 460 patients, 313 had liver cirrhosis (LC), and 147 were viral hepatitis carriers. Age (p<0.001), serum albumin level (p<0.001), TLC (p=0.011), hemoglobin (p<0.001) and serum cholesterol level (p=0.005) were significant different between the two groups. However, there were no difference in height, weight, and BMI. The malnutrition risk of the patients with viral hepatitis carrier was significantly lower than that of the patients with LC (p<0.001). In addition, among 313 patients with LC, malnutrition risk of the patients with Child-Pugh class A (n=150) was significantly lower than that of the patients with class B (n=90) or C (n=73) (p<0.001). CONCLUSIONS: Viral hepatitis carrier group had significantly lower malnutrition risk than LC group. The risk of malnutrition in Child-Pugh class A group was significantly lower than that in class B or C group.

Hepatites virais e gestação

As seis formas de hepatites virais constituem uma relativamente comum e bastante séria infecção que poderá atingir as gestantes,condicionando danos a elas e seriamente comprometendo todo o evoluir da gravidez.Os quadros de hepatite aguda na gestação necessitam internação hospitalar se existir algum sinal de encefalopatia aguda, coagulopatia ou grave debilidade devido a má-nutrição.Nessas eventualidades pode haver necessidade de reposição de sangue e fatores da coagulação sanguínea,tais como plasma fresco criocipitados.Aproximadamente 10% a 20% das mulheres que são soropositivas para o HBsAg podem transmitir aos seus fetos o HBV e,entre as pacientes que são positivas para o HBsAg e HBeAg,a possibilidade de transmissão atinge os 90%.A vacinação de recém-nascidos de mães soropositivas é indicada.Há risco de transmição de hepatite intraparto.

Acute hepatitis due to dengue virus in a chronic hepatitis patient

We present a case of acute hepatitis caused by dengue virus, with a significant increase in aspartate transferase and alanine transferase levels in a chronic hepatitis patient attended at the Cane Sugar Planters Hospital of Campos dos Goytacazes, RJ.

Hepatite fulminante na Amazônia brasileira / Hepatitis fulminant in Brazilian Amazon

O autor faz uma revisão e atualização sobre os resultados das pesquisas envolvendo a hepatite de Lábrea e outras hepatites fulminantes da Amazônia ocidental brasileira, com ênfase nas características epidemiológicas, clínicas e histopatológicas e na etiologia viral, como os vírus das hepatites B e D. O potencial envolvimento de alguns outros vírus hepatotrópicos é considerado.

The author makes a revision and an update on the results of the researches involving the Labrea hepatitis and others fulminant hepatitis in western Brazilian Amazon, with emphasis in the clinical, epidemiologic, histopatologic characteristics and viral etiology as hepatitis B and D viruses. Potential etiologic role of same anothers hepatotropic virus is considered.

Electron Microscopic Mesenchymal Response in Chronic Viral Hepatitis / 대한간학회지

BACKGROUND/AIMS: This study was designed to clarify the fine structures of the hepatocytes and mesencymal tissues in chronic hepatitis according to severity. METHOD: For the purpose of elucidating the ultrastructural characteristics of mesenchymal tissues, liver biopsy specimens were studied by light and electron microscopy in 20 patients with chronic hepatitis. RESULTS: 1) Hepatocytes in mesenchymal tissues were thought to be in the stage of regenerated or degenerated process. 2) Regenerating nodules were surrounded by a basement membrane-like materials in the space of Disse. 3) In the widened Disse space the deposition of collagen fiber bundles and increased numbers of hepatic stellate cells in necrotic area were observed. 4) In necrotic areas, hepatic mesenchymal cell response including an increase of collagen fibers and fibroblast, angiogenesis, and a proliferation of bile ductules were also observed. CONCLUSIONS: These observations suggest that the fibrosis in severe chronic hepatitis was accompanied by the mesenchymal response including the proliferation of hepatic stellate cells, fibroblasts, capillarization of Disse space, and mesenchymal proliferation. Finally, this fibrosis observed electron microscopically may be a cause of functional hepatic failure.

Neonatal hepatitis--an autopsy study of 14 cases.

Fourteen autopsy cases of neonatal hepatitis have been studied. Of these seven cases were due to infections viz.: cytomegalovirus infection (four cases), probable cases of congenital syphilis (two cases) and neonatal herpes (one case). The remaining seven cases were of Idiopathic Neonatal Hepatitis (INH) with giant cell change in six cases. Even in these cases (INH) there was a high index of suspicion of intrauterine or acquired infection in view of severe mononuclear inflammation in the pancreas, alimentary tract and lungs. Most of these neonates with INH had low birth weight and two were preterm pointing towards a prenatal insult. The orcein stain and Periodic Acid Schiff (PAS) with diastase in all the cases were negative making hepatitis B virus infection and infinity 1 antitrypsin deficiency less likely. These autopsies represent the tip of the iceberg and only the severe cases of infection. The fatal outcome could have been prevented by maternal screening for infections and earlier clinical diagnosis.

Notables resultados obtenidos en el tratamiento de las hepatitis virales A y B, con la asociación de aspirina y vitamina C: estudio sobre posible efecto inmunomodulador de la aspirina / Remarkable results to get in the treatment of the viral hepatitis A and B with the association, of aspirn and vitamin C

La Hepatitis Viral, es un problema da salud a nivel mundial, de frecuente observación que afecta a veces en forma severa como sucede en el caso de la Hepatitis B. Era preocupante ver, como esta enfermedad no tuviera otra alternativa terapéutica que la dieta, las vitaminas del complejo B y el reposo. Por lo cual, me hice un planteamiento teórico con el objetivo de buscar esa otra posibilidad y poder dar así algo en favor de la mejoría y recuperación de estos pacientes. En primer término, pensé en un antiinflamatorio no esteroideo (AINE) ya que, el principal problema era una inflamación provocada por la afectación viral. Escogimos a la ASPIRINA porque seunía las condiciones de ser un AINE conocido y de probados afectos antiinflamatorios. Lo asociamos con vitamina C como elemento coadyuvante, por su conocida acción protectora en infecciones, además de un importante efecto antioxidante y de favorecer la recuperación tisular. Durante veinte años de observación y estudios, pacientemente analizando casos para llegar a conclusiones ciertas, las cuales sobrepasaron mis expectativas, al obtener resultados sorprendentes con mejorías notables en el 100 por ciento de los casos tratados. Estos resultados sugerían además un efecto inhibidor, ya que no podía ser explicado solamente por la acción antiinflamatoria de la ASPIRINA; lo que me llevó a pensar en la participación de un mecanismo INMUNOMODULADOR, ejercido posiblemente a través de una estimulación de la respuesta inmune humoral y/o mediada por células, en cuya expresión efectora estarían implicadas las sub-poblaciones de linfocitos T CD4+, comoson los T1 y T2, mediante sus secreciones efectoras. Siendo esta la primera vez que se observa y describe este efecto de la ASPIRINA, en infecciones virales hepáticas

Labrea-like hepatitis in Vitória, Espirito Santo state, Brazil: report of a case

É relatado um caso de hepatite fulminante com esteatose microvesicular semelhante à hepatite de Lábrea, diagnosticado em Vitória (E. Santo). Um adolescente de 16 anos deu entrada no Pronto Socorro do Hospital Universitário Cassiano A Moraes apresentando epistaxe grave, agitaçäo psicomotora, icterícia e vômitos hemorrágicos, vindo a falecer dois dias depois da admissäo. A doença havia iniciado cinco dias antes com febre, dores musculares, urina escura e icterícia e evoluiu com agitaçäo psicomotora, torpor e coma. O figado e o baço näo eram palpáveis. O HBsAg foi negativo no soro. A autópsia mostrou hepatite aguda com necrose líticam confluente nas áreas mediozonal e perioportal, com esteatose microvesicular maciça nos hepatócitos remanescentes. O exsudato era predominantemente de monunucleares e o retículo mostrava áreas de condensaçäo nas zonas de necrose, sem faixas de colapso. Os espaços porta eram edemaciados com discreto infiltrado de monunucleares e escassa proliferaçäo biliar. Exceto pelo aspecto confluente (submaciço) da necrose o caso apresenta várias características clínicas e morfológicas semelhantes à hepatite de Lábrea observada na Amazônia Ocidental, servindo de argumento a favor da idéia de que o quadro anatômico dessa hepatite possivelmente näo está relacionado a nenhum fator peculiar daquela regiäo

Perinonitis bacteriana espontánea asociada a hepatitis fulminante / Spontaneous bacterialperitonitis associated with fulminant hepatitis

Se presenta una niña de 8 años de edad, con un cuadro de hepatitis fulminante y peritonitis bacteriana espontánea (PBE) por E. coli. Su evolución fue desfavorable, falleciendo a los 22 días de internación. Se realizó necropsia parcial, la cual confirmó el diagnóstico. Se comenta la excepcional asociación de peritonitis primaria a enfermedad hepática aguda

Clinical Light and Electron Microscopic Studies of Acute and Chronic Active Viral Hepatitis

Clinical, light and electron microscopic studies of 6 cases of acute and 8 cases of chronic active hepatitis were made and results were compared. Light microscopically acute viral hepatitis was dominated by intralobular changes characterized by ballooning degeneration, random individual and small group cell necrosis of hepatocytes with mononuclear cell reaction, cholestasis and Kupffer cell proliferation, while chronic. active hepatitis was dominated by periportal and portal changes characterized by piecemeal necrosis, heavy mononuclear cell infiltration, moderate fibrosis and mild biliary proliferation. Kupffer cell proliferation with large amount of diastase-resistant PAS positive pigments and patchy reticulin condensation were noted in both acute and chronic active hepatitis, but reticulin condensation was more advanced in chronic active hepatitis. Electron microscopically, acute hepatitis showed marked changes of nucleus, RER, bile canaliculus, and decrease of glycogen content, while chronic active hepatitis showed marked changes of mitochondria with giant fomrs and intramitochondrial inclusion, increase of polyribosomes and glycogen content, and appearance of collagen bundles in the sinusoidal wall. Kupffer cell changes were very marked in both acute and chronic active hepatitis showing large numbers of dense bodies. These dense bodies in acute cases were in the form of secondary lysosomes while they were residual bodies in chronic cases. A case which showed ground glass appearing cytoplasm by light microscopy showed massive fibrillar and tubular structures by electron microscopy. In all cases, no definite virus-like particles were observed within either the nucleus or cytoplasm. From the data, it was evident that distinction between acute and chronic active hepatitis is more clearly made with light microscopy, and the ultrastructural changes of intralobular lesions showed more similarities than differences. The meaning of minor ultrastructural differences is not clear and further evaluation is desirable. Clinically, acute cases showed higher serum bilirubin, transaminase level and hypoalbuminemia while in chronic active hepatitis serum globulin level was higher and hepatomegaly was more regularly observed.