ABSTRACT
Introduction: In Western countries, the most frequent aetiology of acute liver failure (ALF) is acetaminophen overdose, while in developing countries viral infections [hepatitis A virus and hepatitis B virus (HBV)] predominate. Aim: To evaluate the epidemiology, clinical characteristics, outcome and prognostic factors of survival of patients with ALF in Greece during the last 6 years. Results: A total of 40 patients, 28 females (70%), with a median age of 37.4+/-18.6 years (range: 15-84) with ALF were studied. HBV infection was the cause in 53% of them (compared with 74% from a previous study reported in the early 1980s), drug toxicity in 15% and undetermined in 13%. The overall survival was 57.5%, including 94% with and 15% without liver transplantation. Forty-five per cent of our patients had emergency liver transplantation in European Centers within a median time of 3.3 days (1-9) from admission. The total bilirubin level at admission and the development of infections were found to be significantly associated with poor outcome. Conclusions: Hepatitis B virus still remains the most important cause of ALF in Greece, but shows a significant decrease as compared with studies in the early 1980s. Almost half of our patients needed emergency liver transplantation and had a very good survival rate. The other 15% of the patients presented spontaneous survival only with intensive medical support.
Subject(s)
Amanita , Emergency Medical Services/standards , Liver Failure, Acute/diagnosis , Liver Transplantation/standards , Mushroom Poisoning/complications , Disease Progression , Female , Hepatic Encephalopathy/etiology , Humans , Liver Failure, Acute/chemically induced , Liver Failure, Acute/surgery , Male , Mushroom Poisoning/diagnosis , Patient Selection , Predictive Value of Tests , Prognosis , Prothrombin Time , Transaminases/bloodABSTRACT
Heat stroke is the result of exposure to high environmental temperature and strenuous exercise representing a medical emergency characterized by an elevated core body temperature and central nervous system disorders. Slightly elevated liver enzymes, lacking clinical significance, seem to be frequent in heat stroke, whereas severe, clinically relevant, hepatocellular injury has been observed in only a minority of cases. In the present report we describe the case of an otherwise healthy young asylum-seeking refugee from East Timor, who developed severe heat stroke during his transportation to Greece in a closed container on a ship under unusually high temperatures. He was admitted to the hospital with severe multi-organ failure. After a short period of initial improvement, he developed severe hepatocellular injury and hepatic encephalopathy. Other causes of liver damage were excluded. The patient completely recovered.
Subject(s)
Coma/etiology , Heat Stroke/complications , Liver Failure, Acute/etiology , Multiple Organ Failure/etiology , Refugees , Adult , Coma/therapy , Greece , Heat Stroke/therapy , Humans , Liver/injuries , Liver Failure, Acute/therapy , Male , Multiple Organ Failure/therapy , Ships , Timor-Leste , TransportationABSTRACT
Infection with Toxoplasma gondii (T. gondii) in immunocompetent adults is usually asymptomatic and needs no specific therapy. We report the case of a 16-year-old previous healthy adolescent who presented with bleeding due to immune-mediated thrombocytopenic purpura during an acute acquired T. gondii infection. Treatment with prednisolone and immunoglobulin resulted in a relative increase in the platelet count. Taking into account the fact that the patient became immunocompromised under corticosteroids, specific antitoxoplasmal treatment has been added. The difficulties in treatment decision in this rare case are discussed.
