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1.
Am Fam Physician ; 64(10): 1735-40, 2001 Nov 15.
Article in English | MEDLINE | ID: mdl-11759080

ABSTRACT

Cirrhosis is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. The modified Child-Pugh score, which ranks the severity of cirrhosis based on signs and liver function test results, has been shown to predict survival. Strategies have been established to prevent complications in patients with cirrhosis. Esophageal varices can be identified by endoscopy; if large varices are present, prophylactic nonselective beta blocker therapy should be administered. Alpha-fetoprotein testing and ultrasonography can be effective in screening for hepatocellular carcinoma. Vaccines should be administered to prevent secondary infections. The use of nonsteroidal anti-inflammatory drugs should be avoided, and patients should maintain a balanced diet containing 1 to 1.5 g of protein per kg per day. An extensive assessment should be performed before patients with cirrhosis undergo elective surgery. Before advanced liver decompensation occurs, patients should be referred for liver transplantation evaluation. If advanced cirrhosis is present and transplantation is not feasible, survival is between one and two years.


Subject(s)
Liver Cirrhosis/complications , Liver Cirrhosis/therapy , Anti-Inflammatory Agents, Non-Steroidal , Ascites/etiology , Ascites/prevention & control , Carcinoma, Hepatocellular/etiology , Carcinoma, Hepatocellular/prevention & control , Contraindications , Diet , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/prevention & control , Humans , Liver Neoplasms/etiology , Liver Neoplasms/prevention & control , Liver Transplantation , Palliative Care , Peritonitis/etiology , Peritonitis/prevention & control , Primary Prevention , Vaccination
2.
Am Fam Physician ; 64(9): 1555-60, 2001 Nov 01.
Article in English | MEDLINE | ID: mdl-11730310

ABSTRACT

Chronic liver disease is the 10th leading cause of death in the United States. Hepatitis C virus infection is the most frequent cause of chronic liver disease and the most common indication for liver transplantation. Preventive care can significantly reduce the progression of liver disease. Alcohol and hepatitis C virus are synergistic in hastening the development of cirrhosis; therefore, patients with hepatitis C infection should abstain from alcohol use. Because superinfection with hepatitis A or B virus can lead to liver failure, vaccination is recommended. Potentially hepatotoxic medications should be used with caution in patients with chronic liver disease. In general, nonsteroidal anti-inflammatory drugs should be avoided; acetaminophen in a dosage below 2 g per day is the safest choice. Many herbal remedies are potentially hepatotoxic, and only milk thistle can be used safely in patients who have chronic liver disease. Weight reduction and exercise can improve liver function in patients with fatty liver.


Subject(s)
Alcohol Drinking/adverse effects , Family Practice , Liver Diseases/prevention & control , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Chemical and Drug Induced Liver Injury/prevention & control , Chronic Disease , Diet , Exercise , Hepatitis C/prevention & control , Humans , Liver Diseases/etiology , Liver Diseases/mortality
3.
Talanta ; 23(4): 337-8, 1976 Apr.
Article in English | MEDLINE | ID: mdl-18961871

ABSTRACT

Alkyl and aryl substituted 4, 4, 6-trimethyl-(1H, 4H)2-pyrimidinethiols react selectively with palladium(II) in strong acids, forming yellow complexes (lambda(max) 430 nm) extractable into non-polar solvents. By an extractive spectrophotometric procedure, microgram amounts of palladium may be determined in the presence of milligram amounts of many species, including all the other platinum-group metals.

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