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Elevated Liver Enzymes (elevated + liver_enzyme)
Selected AbstractsORIGINAL ARTICLE: Human Serum Complement C3 and Factor H in the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet CountAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2009Elif Ari Problem, Hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome) is a life-threatening variant of severe pre-eclampsia in pregnant women. The complement system may play a role in the pathogenesis of this condition. We sought to determine serum complement 3 (C3) levels and its regulatory protein complement factor H (FH) in the HELLP syndrome. Method of study, Twenty-two pre-eclamptic patients with HELLP syndrome (mean age: 27.8 ± 6.2 years), 21 pre-eclamptic patients without HELLP syndrome (mean age: 27.5 ± 6.8 years) and 24 normotensive, healthy pregnant women (mean age: 26.1 ± 4.4 years) were included in this study. Serum concentrations of C3 and FH were measured in all participants. Results, Concentrations of C3 and FH did not differ significantly between the study groups. In patients with the HELLP syndrome, FH levels were positively associated with platelet count. Conclusion, These findings did not support a major role of complement activation in the HELLP syndrome. In patients with HELLP, lower levels of FH are correlated with a reduced platelet count. [source] Erythema dyschromicum perstans and hepatitis C virus infectionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2001George J. Kontochristopoulos MD A 48-year-old woman with a 10-month history of widespread, hyperpigmented, slightly pruritic macules, with a red border, involving the trunk and the proximal limbs (Fig. 1) was referred to our outpatient department. The oral mucosa, palms, soles, scalp, and nails were normal. Figure 1. Multiple hyperpigmented macules with an active border on the trunk Laboratory tests showed elevated liver enzymes [alanine aminotransferase (ALT), 68 IU/L (normal value, <,40 IU/L); aspartate aminotransferase (AST), 41 IU/L (normal value, <,40 IU/L)], the presence of antibodies to hepatitis C virus (anti-HCV) and HCV RNA (Amplicor Roche). In addition, cryoglobulinemia type III (IgM,,,, IgG,,,) was detected with a high cryocrit value, and there was detectable C-reactive protein, rheumatoid factor, and a low titer of antinuclear antibodies (1 : 80). A percutaneous liver biopsy showed changes compatible with mild chronic hepatitis (grade, 6; stage, 0). The possible source of infection was unknown, as the patient had no history of parenteral transmission (e.g. blood transfusions, intravenous illicit drug use). A skin biopsy specimen from the active border of a lesion showed hyperkeratosis, parakeratosis, and hydropic degeneration of the basal cell layer, with the formation of colloid bodies in the epidermis. A moderate perivascular lymphohistiocytic infiltrate with melanophages and free melanin granules was observed in the upper dermis (Fig. 2). Immunostaining of paraffin-embedded tissue sections with the TORDJT-22 IgG1 mouse monoclonal antibody to HCV (Biogenex, Son Ramon, USA), which is specific for the nonstructural region of HCV (NS3-NSH, C100 antigen) using the avidin,biotin,peroxidase complex (ABC) as well as the alkaline phosphatase antialkaline phosphatase (APAAP) methods, failed to detect HCV in the lesion of erythema dyschromicum perstans (EDP) (Nakopoulou L, Manolaki N, Lazaris A et al. Tissue immunodetection of C100 hepatitis C virus antigen in major thalassemic patients. Hepato-Gastroenterol 1999; 46: 2515,2520). Direct immunofluorescence showed IgG, IgM, IgA, and fibrinogen deposits on colloid bodies. EDP was diagnosed on the basis of these clinical and laboratory findings. Figure 2. Hydropic degeneration of the basal cell layer with colloid bodies in the epidermis. Moderate perivascular lymphohistiocytic infiltrate with melanophages and free melanin granules in the upper dermis (hematoxylin and eosin, ×,200) The patient was treated with interferon-,2b (Intron-A, Schering Plough Athens, Greece), 3 MU thrice weekly subcutaneously for 12 months, with additional topical steroid application. There was no response to this treatment with new lesions appearing in previously unaffected areas of the trunk and extremities. HCV RNA remained persistently positive. Thus, a modified regimen with interferon-,2b, 6 MU thrice weekly for 6 months, was tried. At the end of the treatment course, the eruption of EDP had greatly improved. Liver enzymes were normal (ALT, 22 IU/L; AST, 24 IU/L) and HCV RNA had become negative. Four months later, however, cutaneous lesions reappeared and hepatitis C relapsed. At this time point, combination therapy of interferon-,2b, 3 MU thrice weekly, with ribavirin, 1000 mg daily, was given. Six months later, liver enzymes were normal (ALT, 42 IU/L; AST, 39 IU/L), HCV RNA was negative, and the lesions of EDP had resolved. [source] Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factorsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009Alexis St. George Abstract Background and Aim:, Non-alcoholic fatty liver disease associated with insulin resistance is the most common cause of abnormal liver tests in clinical practice. To date, practical and effective strategies to improve the metabolic profile of this large group of patients have not been well characterised. We sought to assess the effect at 3 months of a behavior change-based lifestyle intervention on the metabolic profile of patients characterised by elevated liver enzymes. Methods:, A total of 152 patients with elevated liver enzymes, central obesity and a range of metabolic risk factors were randomised to either a moderate- (6 sessions/10 weeks) or low-intensity (3 sessions/4 weeks) lifestyle counselling intervention or control group. Results:, There was improvement in all metabolic risk factors in the moderate-intensity group, versus a smaller number of changes in the low-intensity intervention group and no change in any metabolic risk factors in control subjects. Reduction in liver enzymes was greatest in the moderate-intensity intervention group and least in the control group. The likelihood of elevated alanine aminotransferase (ALT) levels in both the moderate and low-intensity groups was reduced by over 70% compared to controls. The proportion of subjects achieving weight loss (, 2%) was significantly higher in the moderate-intensity intervention group (66%) versus the low-intensity intervention group (39%; P < 0.05) and controls (29%; P < 0.001). Conclusions:, Moderate and even low-intensity lifestyle counselling interventions targeting improvement in physical activity and nutritional behaviors and modest weight loss are a practical and effective method for improving the health of patients with elevated liver enzymes and a range of metabolic risk factors. [source] Infectious Mononucleosis,Like Syndromes in Febrile Travelers Returning From the TropicsJOURNAL OF TRAVEL MEDICINE, Issue 4 2006Emmanuel Bottieau MD Background Infectious mononucleosis (IM), resulting from Epstein,Barr virus (EBV) infection, and IM-like syndromes, mainly due to cytomegalovirus (CMV), Toxoplasma gondii, or human immunodeficiency virus (HIV), have been occasionally reported in travelers returning from the tropics. Our objective was to investigate the prevalence, outcome, and diagnostic predictors of these syndromes in febrile travelers. Methods Between April 2000 and March 2005, all febrile travelers and migrants presenting at our referral centers within 12 months after a tropical stay were prospectively included. We identified all patients serologically diagnosed with IM or IM-like syndrome and compared them with the rest of the cohort. Results During the 5-year period, 72/1,842 patients (4%) were diagnosed with an IM-like syndrome, including 36 CMV, 16 T gondii, 15 EBV, and 5 HIV primary infections. All patients were western travelers or expatriates. Mean delay before consultation was 2 weeks. Most patients had consulted other practitioners and/or received presumptive treatment. A minority of patients presented with IM clinical features. Lymphocytosis ,40% of the white blood cells (WBC) and reactive/atypical lymphocyte morphology were observed in 60 and 30% of the patients. The four diseases were indistinguishable. Protracted fever and asthenia were common but complications rarely occurred. IM-like syndromes were independently associated with fever >7 days, lymphadenopathy, elevated liver enzymes, and lymphocytosis ,40% of WBC. Diagnostic probability increased to >20% if at least three of these predictors were present. Conclusions Diagnosis of IM and IM-like syndrome is not uncommon in febrile travelers, with a higher proportion of primary CMV, T gondii, and HIV infections than in nonimported series. Consequently, classic IM clinical and laboratory features are often lacking. All four pathogens should be systematically considered because early diagnosis should avoid unnecessary investigations and treatment and allow early intervention in case of primary HIV infection. [source] Abnormal glucose tolerance in young male patients with nonalcoholic fatty liver diseaseLIVER INTERNATIONAL, Issue 4 2009Jung Won Yun Abstract Objective: The association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and metabolic syndrome has been documented for obese men and middle-aged men. This study was designed to determine the relationship between NAFLD and the oral glucose tolerance test (OGTT) to predict preclinical diabetes in nondiabetic young male patients (<30 years old). Methods: A total of 75 male patients who had elevated liver enzymes and who were diagnosed with NAFLD were enrolled in this study. A standard 75 g OGTT was carried out on all patients. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were defined as a fasting plasma glucose (FPG) level ,100 mg/dl but <126 mg/dl, and a 2-h post-load glucose on the OGTT of ,140 mg/dl, but <200 mg/dl respectively. Results: According to the OGTT results, 24 (32%) patients were diagnosed as having IGT and 12 (16%) patients were diagnosed as having diabetes. Among the 48 patients with normal fasting glucose, 18 (37.6%) patients showed abnormal glucose tolerance (15 had IGT and three had diabetes). The NAFLD patients with abnormal glucose tolerance showed significant differences in age, weight, body mass index, waist,hip ratio, alanine aminotransferase, total bilirubin, total cholesterol, low-density lipoprotein cholesterol, triglyceride, insulin, FPG and homeostasis model for insulin resistance (HOMA-IR). Multiple regression analysis showed that age, FPG and HOMA-IR were independent predictors of abnormal glucose tolerance. Conclusions: Although the patients were young men, an OGTT should be recommended for NAFLD patients with elevated liver enzymes and IFG to predict the risk of type 2 diabetes. [source] EBV-negative lymphoproliferative disease with hyper-IgA, in a child with combined liver and small bowel transplantationPEDIATRIC TRANSPLANTATION, Issue 3 2004Clotilde Des Robert Abstract:, A 4-year-old boy presented 14 months after liver and small bowel transplantation with fever, diarrhea, elevated liver enzymes, thrombocytopenia and autoantibodies. Total gammaglobulins level was normal but the level of plasma IgA1 was very high. The blood PCR for Epstein,Barr virus (EBV) was negative. The ileal biopsy disclosed a lymphoplasmacytic infiltration. The EBER probe was negative on the small bowel biopsies. The child was considered as suffering from a non-EBV-induced posttransplant lymphoproliferative disorder (PTLD). The high IgA level was presumed to be secreted by proliferating plasma cells in the transplanted bowel. Immunosuppression was reduced; but the efficacy was incomplete and an anti-CD20 antibody was added. There was complete resolution of symptoms and normalization of the IgA level. As IgA1 is mostly of intestinal origin, this unusual presentation of PTLD should lead to a high suspicion of a small bowel proliferating process. [source] ORIGINAL ARTICLE: Human Serum Complement C3 and Factor H in the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet CountAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2009Elif Ari Problem, Hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome) is a life-threatening variant of severe pre-eclampsia in pregnant women. The complement system may play a role in the pathogenesis of this condition. We sought to determine serum complement 3 (C3) levels and its regulatory protein complement factor H (FH) in the HELLP syndrome. Method of study, Twenty-two pre-eclamptic patients with HELLP syndrome (mean age: 27.8 ± 6.2 years), 21 pre-eclamptic patients without HELLP syndrome (mean age: 27.5 ± 6.8 years) and 24 normotensive, healthy pregnant women (mean age: 26.1 ± 4.4 years) were included in this study. Serum concentrations of C3 and FH were measured in all participants. Results, Concentrations of C3 and FH did not differ significantly between the study groups. In patients with the HELLP syndrome, FH levels were positively associated with platelet count. Conclusion, These findings did not support a major role of complement activation in the HELLP syndrome. In patients with HELLP, lower levels of FH are correlated with a reduced platelet count. [source] Lack of correlation between fatty acid oxidation disorders and haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome?ACTA PAEDIATRICA, Issue 1 2005M. Holub Abstract Aim: Fatty acid ,-oxidation defects comprise a heterogeneous group of disorders that may precipitate acute life threatening metabolic crises particularly during catabolic episodes. Several studies have demonstrated a possible association between fatty acid ,-oxidation defects, including long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency and severe pregnancy complications. However, the precise percentage of women with haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome associated with foetal fatty acid ,-oxidation defects is not known. Methods: We carried out a multicentre retrospective study on 88 infants, born to women with HELLP syndrome. Acylcarnitine profiles from blood dried on filter paper cards were analysed by tandem mass spectrometry for the diagnosis of fatty acid ,-oxidation defects. In addition, we screened for the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation using a standard restriction fragment length polymorphism polymerase chain reaction method. Results: None of the infants studied carried the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation. There was no evidence of fatty acid ,-oxidation defects, including long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, as expected by unremarkable acylcarnitine profiles, while three infants with fatty acid ,-oxidation defects were diagnosed in the control group. Conclusions: Neither foetal long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, including heterozygosity for the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation, nor fatty acid ,-oxidation defects in general are a major risk factor for HELLP syndrome in Austria. [source] Clinical presentation of leptospirosis: a retrospective study of 34 patients admitted to a single institution in metropolitan FranceCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2005S. Jauréguiberry Abstract Leptospirosis has a highly variable clinical presentation, which may be related to different infecting serovars, host factors, or a combination of these. This study investigated retrospectively 34 consecutive patients with serologically confirmed leptospirosis admitted during the period 1992,2002. On admission, the most frequent symptoms were fever (100%), headache (75%), myalgia (55%), arthralgia (45%) and vomiting (39%). Pertinent laboratory findings included lymphopenia (85%), thrombocytopenia (75%), elevated liver enzymes (87%) and renal abnormalities (proteinuria, 77%; haematuria, 58%; elevated serum creatinine, 53%). The study confirmed the variable clinical and biological symptoms of leptospirosis, and indicated that lymphopenia is a common feature of leptospirosis cases. [source] | ||||||||||