18 research outputs found
Genome-wide meta-analyses identify three loci associated with primary biliary cirrhosis
Hepatocellular Carcinoma Presenting as Right Supraclavicular Lymphadenopathy
Two patients, one with previously undiagnosed liver disease, presenting with right supraclavicular lymphadenopathy were subsequently diagnosed with hepatocellular carcinoma. This presentation has only been previously described once, and the mechanism of this unusual presentation is discussed
Muscle Cramps: A ‘Complication‘ of Cirrhosis
Muscle cramps are a common complaint in clinical
practice. They are associated with various metabolic, endocrine,
neurological and electrolyte abnormalities. A variety of hypotheses
have been generated to explain the cause of muscle cramping,
yet none has been able to support a consistent pathophysiological
mechanism. Muscle cramps are painful, involuntary contractions
of skeletal muscle. They occur frequently in individuals with cirrhosis,
regardless of the etiology, and are thought to be a symptom
of cirrhotic-stage liver disease.
The pathophysiology of these cramps remains elusive; hence, a
specific therapy has not been identified. Many therapeutic approaches
have been offered, yet their efficacy, safety and mechanism
of action remain poorly defined. This review defines muscle
cramps and illuminates its prevalence in the cirrhotic individual.
Current theories relating to the pathogenesis of muscle cramps are
reviewed, and an overview of the various pharmacological agents
that have had therapeutic success for this distressing and frustrating
symptom is provided
Metastatic Breast Cancer Presenting as Fulminant Hepatic Failure: A Case Report and Literature Review
A case of metastatic breast carcinoma presenting as fatal fulminant
hepatic failure is presented. The patient did not have previously diagnosed
breast cancer and presented with ascites, Jaundice, abdominal pain, nausea,
vomiting and hepatic encephalopathy. She died within four weeks of the onset.
Seven similar cases previously reported are reviewed. Metastatic carcinoma
should he considered in the differential diagnosis of fulminant hepatic failure
Right Phrenic Nerve Injury in Orthotopic Liver Transplantation
Right hemidiaphragm paralysis has been previously documented in patients after orthotopic liver transplantation (OLT) and it may contribute to the development of postoperative pulmonary problems. It has been postulated that a crush injury to the right phrenic nerve during OLT is the cause of dysfunction of the right hemidiaphragm. To assess the incidence and effect of right phrenic nerve injury after OLT, we prospectively studied 48 adult liver recipients. Twelve patients who underwent liver resection (LR), in whom the suprahepatic vena cava was not clamped, were used as a comparison group. Diaphragm excursion by ultrasound and pulmonary function were performed preoperatively and postoperatively; transcutaneous phrenic nerve conduction studies were performed postoperatively. Right phrenic nerve injury and hemidiaphragm paralysis occurred in 79% and 38% of the liver recipients but not after LR. Conduction along the right phrenic nerve was absent in 53% and reduced in another 26%. Left phrenic nerve conduction and left hemidiaphragm excursion were normal in both liver recipients and the patients who had LR. Liver recipients with no conduction in the right phrenic nerve had a significantly greater decrease in vital capacity in the supine position (29 +/- 9.8%) compared with those with some conduction (14 +/- 6.9%, P \u3c 0.001). However, neither the time on the ventilator nor the hospital stay was significantly different in the latter two groups. Complete recovery of phrenic nerve conduction and diaphragm function took until nine months in some patients. Right phrenic nerve injury is common after OLT and it is the cause of right hemidiaphragm dysfunction