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Acute Deterioration (acute + deterioration)
Selected AbstractsHistologic and biochemical changes during the evolution of chronic rejection of liver allograftsHEPATOLOGY, Issue 3 2002Desley A. H. Neil Criteria for histologic diagnosis of chronic rejection (CR) are based on changes seen late in the disease process that are likely to be irreversible and unresponsive to treatment. Changes occurring during the evolution of CR are less clearly defined. The serial biopsy specimens, failed allografts, and biochemical profiles of 28 patients who underwent retransplantation for CR were examined with the aim of identifying histologic and biochemical features that were present during the early stages of CR. For each case, a point of acute deterioration in liver function tests (LFTs) was identified ("start time" [ST]) that subsequently progressed to graft failure. Biopsy specimens before, at the time of ("start biopsy" [SB]), and after the ST were assessed histologically, and findings were correlated with the biochemical changes. CR resulted from acute rejection (AR) that did not resolve. Centrilobular necroinflammation (CLNI) associated with an elevated aspartate transaminase (AST) level and portal tract features of AR were present at the start. Portal AR features resolved, CLNI persisted, AST level remained elevated, and bilirubin and alkaline phosphatase levels progressively increased throughout the evolution of CR. Portal tracts also showed a loss of small arterial and bile duct branches, with arterial loss occurring early and bile duct loss as a later progressive lesion. Foam cell arteriopathy was rarely seen in needle biopsy specimens. In conclusion, findings from this study may help identify patients at risk of progressing to graft loss from CR at a stage when the disease process is potentially reversible and amenable to treatment. [source] Central Pontine Signal Changes in Wilson's Disease: Distinct MRI Morphology and Sequential Changes with De-Coppering TherapyJOURNAL OF NEUROIMAGING, Issue 4 2007Sanjib Sinha DM ABSTRACT BACKGROUND AND PURPOSE Reports of central pontine myelinolysis (CPM)-like changes in Wilson's disease (WD) and its sequential changes are exceptional. The aim was to study the MRI characteristics of CPM-like changes in WD and the serial changes. METHODS Among the 121 patients of WD, twenty (M:F:9:11, age at onset: 14.2 ± 4.6 years) had features similar to CPM. All had progressive neuropsychiatric form of WD. All except five were on de-coppering treatment. None had acute deterioration or hepatic failure. Ten patients underwent repeat studies. RESULTS Twenty patients with CPM-like changes manifested with characteristic phenotype of WD. Three distinct patterns of CPM-like changes were observed: (a) characteristic round shape -7, (b) "bisected" -9, and (c) "trisected" -4. Only one had signal changes suggesting extra-pontine myelinolysis. All patients had contiguous involvement of midbrain. Serial MRI evaluation in 10 patients, at mean interval period of 17.4 ± 13.2 months, revealed complete reversal in one, partial improvement in five, and no change in three. Clinical and MRI improvement occurred pari passu, except in one. CONCLUSIONS CPM-like changes in WD are perhaps under-recognized and are distinct from the commonly known "osmotic demyelination." It is potentially reversible similar to other MRI features of WD. [source] The pathophysiological basis of acute-on-chronic liver failureLIVER INTERNATIONAL, Issue 2002S Sen Abstract: The vast majority of patients that are referred to a specialist hepatological centre suffer from acute deterioration of their chronic liver disease. Yet, this entity of acute-on-chronic liver failure remains poorly defined. With the emergence of newer liver support strategies, it has become necessary to define this entity, its pathophysiology and the short and long-term prognosis. This review focuses upon how a precipitant such as an episode of gastrointestinal bleeding or sepsis may start a cascade of events that culminate in end-organ dysfunction and liver failure. We briefly review the pathophysiological basis of the therapeutic modalities that are available. Our current strategy for the management of liver failure involves supportive therapy for the end-organs with the hope that the liver function would recover if sufficient time for such a recovery is allowed. Because liver failure, whether of the acute or acute-on-chronic variety, is potentially reversible, the stage is set for the application of newer liver support strategies to enhance the recovery process. [source] Two-stage total hepatectomy and liver transplantation for acute deterioration of chronic liver disease: A new bridge to transplantationLIVER TRANSPLANTATION, Issue 4 2004Michael J. Guirl Two-stage total hepatectomy and liver transplantation has been reported for acute liver disease such as fulminant hepatic failure, primary graft failure, severe hepatic trauma, and spontaneous hepatic rupture secondary to hemolysis, elevated liver function tests, low platelets syndrome, and preeclampsia. This is the first report of patients with cirrhosis to undergo a 2-stage total hepatectomy and liver transplantation. From 1984 to 2002, our institution performed 2008 orthotopic liver transplantations. We identified 4 patients with chronic liver disease who underwent a 2-stage hepatectomy and liver transplantation. This is a retrospective review of these 4 patients and a review of the literature on this procedure. All 4 patients were young men with an age range of 29,31 years and had underlying cirrhosis as well as a previous transjugular intrahepatic portosystemic shunt (TIPS)procedure. Acute decompensation fulfilling Ringes' criteria for toxic liver syndrome secondary to an upper gastrointestinal bleed occurred in all patients. The approximate average time between hepatectomy and liver transplantation was 20 hours (range: 8,42 hours). In all cases, the explanted liver showed histological changes of acute hepatic necrosis within the background of cirrhosis. After hepatectomy, vasopressor requirements were well documented in 2 patients. For 1 patient, there was a clear improvement in their hemodynamic status. The mean hospital stay of the 4 patients was 63 days. All patients were discharged from the hospital and are alive and well with adequate liver function at 6 to 37 months follow-up. Two-stage total hepatectomy and liver transplantation may be a life-saving procedure in highly selected cirrhotic patients with acute hepatic decompensation and multiorgan dysfunction. (Liver Transpl 2004;10:564,570.) [source] Physiological risk factors, early warning scoring systems and organizational changesNURSING IN CRITICAL CARE, Issue 5 2007Carolyn C Johnstone Abstract Currently, medical and surgical wards tend to have a higher number of sicker and more dependent patients. There is also a growing recognition that several indicators of acute deterioration are being missed, leading to adverse consequences for the patients. As a result, many initiatives have been designed to try to reduce these consequences, including the development of early warning scoring or track and trigger systems and medical response and critical care outreach teams. This paper briefly discusses the risk factors associated with acute deterioration, the use of early warning scoring or track and trigger systems and the role of outreach teams. The aim of this paper is to discuss the development and subsequent implementation of early warning scoring systems (EWS) or track and trigger systems. It will also discuss the associated organizational changes; the main organizational change discussed will be the introduction outreach teams. For this paper, a pragmatic search strategy was implemented using the following terms: early warning score and scoring, track and trigger systems, decision-making tools, critical care outreach and medical emergency teams. The databases used included CINHAL (1997,2007), Medline, Blackwell Synergy and Science Direct, as these would enable the retrieval of relevant literature in the area of triggering of response to acute deterioration in clinical condition. A 10-year limit was initially set, although review of the literature identified resulted in a widening of this to include some of the relevant (and occasionally more dated) literature referred to in these papers. A total of 645 were accessed; of these 135 were retrieved as they appeared to meet the inclusion criteria, but only 35 have been included in this review. The term decision-making tools accounted for the largest number (500), but most of these were irrelevant. EWS are not always used to their full potential, raising the question of their impact. The impact of outreach teams and medical emergency teams has yet to be fully defined. For clinical practice, this means that care must be taken when developing and implementing these changes. The rigour of the development process needs to be considered along with reflection upon how to best meet local requirements. [source] Antiepiligrin (laminin 5) cicatricial pemphigoid complicated and exacerbated by herpes simplex virus type 2 infectionAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2001Tanya K Gilmour SUMMARY A 50-year-old man with antiepiligrin (laminin 5) cicatricial pemphigoid (AeCP) involving the eyes, mouth and skin required a combination of systemic drug therapies to suppress the ocular disease. Herpes simplex virus type 2 infection of the mouth and pharynx precipitated an acute deterioration, with laryngeal involvement and an increase in oral ulceration. This is an unusual complication of long-term immunosuppression and illustrates some of the difficulties in the management of patients with AeCP. Clinical improvement was obtained with oral antiviral therapy and adjustment of his immunosuppressive regimen. [source] |