Cases Of Severe Liver Injury Research Articles

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Med Check

Two cases of severe liver injury possibly related to 5‐fluorouracil and calcium folinate

Two cases of severe liver injury possibly related to 5‐fluorouracil and calcium folinate

A technique for emergency liver packing.

Control of liver hemorrhage may present a daunting clinical scenario. Use of liver packing techniques is highly effective to control bleeding but can result in significant recurrent bleeding with pack removal. Such bleeding is particularly a problem when large portions of the hepatic parenchymal surface and Glisson's capsule have been disrupted. We describe, herein, our approach to hepatic packing in scenarios where a large component of hepatic capsular disruption has occurred. Use of a non-stick bowel bag is employed on the disrupted liver surface, which, when removed, will not result in liver rebleeding. This technique has been used successfully in the management of five cases of severe liver injury with extensive capsular disruption. Familiarity with such an approach may facilitate management of similar liver injuries.

Identification of drug-induced liver injury among 307 cases of severe liver injury: a retrospective multi-center study: George Ostapowicz, Grace Samuel, University of Texas Southwestern Medical Center, Dallas, TX; Anne M Larson, University of Washington, Seattle, WA; Timothy Davern, University of California, San Francisco, San Francisco, CA; Robert J Fontana, University of Michigan, Ann Arbor, MI; Timothy McCashland, University of Nebraska,

Identification of drug-induced liver injury among 307 cases of severe liver injury: a retrospective multi-center study: George Ostapowicz, Grace Samuel, University of Texas Southwestern Medical Center, Dallas, TX; Anne M Larson, University of Washington, Seattle, WA; Timothy Davern, University of California, San Francisco, San Francisco, CA; Robert J Fontana, University of Michigan, Ann Arbor, MI; Timothy McCashland, University of Nebraska,

SEVERE LIVER INJURY WITH HEMATOLOGICAL DISORDERS FOLLOWING THE INJECTION OF NON-IONIC CONTRAST MEDIUM. A case report

We describe a dramatic case of severe liver injury and hematological disorders following the injection of non-ionic contrast medium in a 49-year-old woman with endometrial cancer. This case developed into a fulminant hepatitis-like picture that required repeated plasmapheresis and hemodialysis.

Management of severe blunt liver injuries.

To assess the effectiveness of non-surgical treatment for severe blunt liver injuries, we retrospectively examined the files of 147 patients (excluding cases with cardiopulmonary arrest on arrival). The patients were divided into three groups according to the date of admission: Group-A (1982-85), B (1986-90) and C (1991-95). The patients were further divided on the basis of the type of injury, according to the classification proposed by the Japanese Association for the Surgery of Trauma (JAST). The types of injuries reported here were of type II, IIIa or IIIb. There was no difference in the patients' background, injury severity score (ISS), amount of intra-peritoneal hemorrhage, and amount of blood transfusion among the three groups, A, B and C. Surgical treatment was carried out in all Group-A patients, in 81.8% of Group-B patients and in 31% of Group-C patients. The hospitalization period was shorter in the Group-C, and the frequency of fatal outcome was also lower in Group-C. Non-surgical treatment has been performed since 1988 in our center, and its frequency has been increasing since then. It was applied to 6 cases (18.2%) of Type II injuries in Group-B. In total, 69% of the cases in Group-C were non-surgically treated, including cases of Type IIIa and Type IIIb injuries. Non-surgical treatment prevented 8 out of 9 cases of severe liver injury from having fatal outcomes in 1995. Moreover, 5 of those cases were of the most serious type (Type IIIb). There were three fatalities in Group-C and none in Group-B. Out of all the non-surgically treated cases, injuries to the head were the cause of fatality. Any treatment of cases showing inferior vena cava damage was generally ineffective due to heavy bleeding, unless the bleeding was stopped by surgical intervention. Non-surgical treatment is suitable for blunt liver injuries, including severe liver injuries, provided that bleeding control and close observation are maintained.