Rise In Transaminase Levels Research Articles

Hemophilia: The Past, the Present, and the Future.

Hemophilia: The Past, the Present, and the Future.

Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy.

Backgrounds/AimsThe aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign.MethodsBetween January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients.ResultsThe mean postoperative length of hospital stay was 20.3±4 days. The mean number of days until removal of nasogastric tube was 6.3±1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866±236 IU/L versus 146±48 IU/L; p<0.001). For both γ-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards.ConclusionsThis study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.

Thrombolysis of portal vein thrombosis after splenectomy following liver transplantation

Thrombolysis of portal vein thrombosis after splenectomy following liver transplantation

P178 - A pilot study of elemental diet for chronic pouchitis

P178 - A pilot study of elemental diet for chronic pouchitis

Marked Flare in Hepatic Aminotransferases During Treatment with Pegylated Interferon for Chronic Hepatitis C, Genotype 2: A Case Report

Chronic hepatitis C (CHC) is the most common cause of chronic liver disease and is the leading cause of liver transplantation in the United States [1, 2]. It is a progressive disease that can lead to cirrhosis, liver failure, hepatocellular carcinoma, and death [1, 2]. Hence, it is very important that the disease be treated in its early stages, with the goal of obtaining sustained virologic response, which will effectively reduce the morbidity and mortality associated with this disease. The currently approved therapy for CHC is pegylated interferon plus ribavirin for 24 weeks or 48 weeks, based upon genotype [3]. The use of pegylated interferon and ribavirin combination therapy is associated with many side effects, and close monitoring of patients is required while they are on the therapy. We report an unusual case of marked flares in hepatic aminotransferases during each of two consecutive courses of pegylated interferon and ribavirin therapy for CHC genotype 2. There are very limited published data on the hepatotoxicity or liver enzyme flares associated with interferon therapy. In earlier data from a large retrospective study performed on 11,241 patients with chronic viral hepatitis (80% being CHC) treated with alfa interferon, only four patients had fatal side effects due to liver failure, and all four patients demonstrated a significant rise in aminotransferase levels [4]. It is possible that large, prospective, clinical trials may have revealed individual cases similar to our case but were not individually reported. Interferon maintenance trials, such as Hepatitis C Antiviral Long-term Treatment Against Cirrhosis (HALT-C) and Colchicine versus Peg-Intron Long-Term (COPILOT) may ultimately demonstrate transient alanine aminotransferase (ALT) flares, but these include predominantly nonresponder subjects and have not yet been published. Moreover, natural flares of serum ALT values in CHC patients are not very well-defined.

Central perivenulitis: A common and potentially important finding in late posttransplant liver biopsies

Central perivenulitis: A common and potentially important finding in late posttransplant liver biopsies

Hepatitis B Virus: Something Old, Something New

Hepatitis B Virus: Something Old, Something New

Viral hepatitis

The hepatitis A, B, C, D and E viruses primarily target the liver to cause viral hepatitis. Hepatitis A (HAV) and E (HEV) viruses are transmitted by the faecal-oral route and cause acute viral hepatitis. Acute viral hepatitis may be asymptomatic, with a rise in aminotransferase levels, it may be symptomatic, with or without jaundice, or it may present as fulminant hepatitis. The hepatitis B (HBV), C (HCV) and D viruses are parenterally transmitted and can cause acute and chronic infections. When they persist in the chronic carrier state they may cause chronic hepatitis, cirrhosis and hepatocellular carcinoma. The diagnosis of viral hepatitis in based on serology and molecular detection of the virus. There are no specific drug therapies available for patients with acute hepatitis A or hepatitis E infection, and management in based on symptomatic relief. Currently available treatments for chronic hepatitis B an C have limited efficacy, are expensive and may have severe side effects. Patients should be carefully selected and managed by a specialist with experience in this field. Vaccines are available for HAV and HBV.

Yondelis (trabectedin, ET-743): the development of an anticancer agent of marine origin.

Yondelis (trabectedin, ET-743) is a novel antitumor agent derived from a marine source, the Caribbean tunicate Ecteinascidia turbinata. Preclinical studies demonstrated activity at low concentrations against a variety of tumors. The mechanism by which ET-743 exerts its antitumor activity has not been completely elucidated yet. Binding to the minor groove of DNA which causes a bend towards the major groove has been demonstrated. Furthermore, ET-743 interferes with DNA binding proteins and transcription factors. Clinical studies have been initiated as phase I dose-finding studies at four different treatment regimens. Dose-limiting toxicities were hematological, including neutropenia and thrombocytopenia. Furthermore, significant liver toxicity was observed, especially as a rise in transaminase levels. Antitumor activity in phase I and phase II trials was studied in multiple tumor types, including soft tissue sarcomas, melanomas and breast cancer. ET-743 is currently being extensively investigated in advanced soft tissue sarcomas. The present review describes the development of ET-743, highlighting chemical properties, mode of action, metabolism and preclinical and clinical studies.

Atypical strain of hepatitis E virus (HEV) from North India

Hepatitis E virus (HEV) infection was detected during an epidemic in North India. Virus particles present in the stool of an acutely ill patient (YAM-67) was transmitted intravenously into rhesus monkeys (M. mulata) and orally to a human volunteer. Virus-like particles (VLPs) of 32-34 nm were detected in the bile of monkeys and in the stools of the human volunteer by means of solid phase immune electron microscopy (SPIEM) with acute homologous and heterologous sera. The VLPs were confirmed to be HEV by a reverse transcription polymerase chain reaction (RT-PCR). Virus-like particles from human volunteer stools were passaged further into rhesus monkeys. A bimodal rise in aminotransferase levels were observed in the animals, and liver histopathology indicated mild to severe form of hepatitis. Further, SPIEM and RT-PCR analysis in monkey bile revealed presence of virus from 15 to 45 days post-inoculation. Rechallenge of the animals 6 months after recovery with the same viral inoculum failed to produce abnormal liver function tests indicating the presence of protective immunity during this period. The VLPs in the stool from the patient (YAM-67) with epidemic hepatitis were found to retain infectivity even after several cycles of freeze-thawing and exposure at 37 degrees C for 2 days. Moreover, these VLPs from the patient, human volunteer, and monkeys did not react with an anti-HEV chimpanzee serum from NIH, Bethesda, MD. These findings indicate that this North India isolate of HEV is an atypical strain of HEV. The present study further validates that the rhesus monkey is a suitable experimental model for HEV.

Absence of detectable hepatitis B virus DNA in sera and liver of chimpanzees with non-A, non-B hepatitis.

The risk of hepatitis B infections has been reduced by screening of blood donors for hepatitis B surface antigen (HBsAg). However, recipients remain at significant risk of developing post-transfusion hepatitis. Studies have shown that non-A, non-B hepatitis virus(es) are responsible for the majority of post-transfusion hepatitis infections. In spite of many efforts, these non-A, non-B hepatitis viruses have not yet been identified. Epidemiological studies, however, suggest that non-A, non-B hepatitis shares many features with hepatitis B. Recently, Wands et al [1982] showed, in chimpanzees infected with non-A, non-B hepatitis agents, the presence of antigenemia or viremia by radioimmunoassay with monoclonal antibodies directed toward distinct determinants of HBsAg and by molecular hybridization analysis. They suggested that non-A, non-B hepatitis agents may be related, but distinct variant(s) of hepatitis B virus (HBV). In this study, five chimpanzees were inoculated with three different agents that have been shown to transmit non-A, non-B hepatitis. The following inocula were used (I) a factor VIII preparation kindly provided by D.W. Bradley, (II) acute phase serum from a chimpanzee infected with the F strain kindly provided by A.J. Zuckerman, and (III) a DS-antigen serum previously shown by us to transmit non-A, non-B hepatitis [Duermeyer et al, 1983]. All chimpanzees developed a rise in transaminase levels between 8 and 10 weeks after inoculation. None of the chimpanzees was positive for any markers of HBV infection. No evidence was obtained of infection with hepatitis A, cytomegalovirus, or Epstein-Barr virus. One chimpanzee developed chronic liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)

A New Antigen-Antibody System

A new antigen-antibody system was recently described in hepatitis B surface antigen (HB_sAg)-positive sera. Despite indications of heterogeneity in specificity, the designations "<i>e</i>antigen" and "<i>e</i>antibodies" are used for the system as such in this article. Eight of 17 long-term carriers of HB_sAg with a histological picture of chronic persistent hepatitis or chronic aggressive hepatitis carried the<i>e</i>antigen, while none had demonstrable<i>e</i>antibodies in serum. Ten of 12 healthy carriers with e antibodies were blood donors who had donated 95 units of blood; none of these carriers was associated with a reported case of posttransfusion hepatitis. In five individuals in the incubation stage of hepatitis B,<i>e</i>antigen appeared simultaneously with HB_sAg but before the rise in transaminase levels. This finding further links<i>e</i>antigen to hepatitis B. (<i>JAMA</i>231:356-359, 1975)

A new antigen-antibody system. Clinical significance in long-term carriers of hepatitis B surface antigen.

A new antigen-antibody system was recently described in hepatitis B surface antigen (HBSAG(-positive sera. Despite indications of heterogeneity in specificity, the designations "e antigen" and "e antibodies" are used for the system as such in this articly. E'IGHT OF 17 long-term carriers of HBSAg with a histological picture of chronic persistent hepatitis or chronic aggressive hepatitis carried the e antigen, while none had demonstrable e antibodies in serum. Ten of 12 healthy carriers with e antibodies were blood donors who had donated 95 units of blood; none of these carriers was associeated with a reported case of posttransfusion hepatitis. In five individuals in the incubation stage of hepatitis B, e antigen appeared simultaneously with HBSAg but before the rise in transaminase levels. This finding further links e antigen to hepatitis B.

Serum transaminases during salicylate therapy.

In 8 out of 32 juvenile patients suffering from chronic polyarthritis and in one patient with dermatomyositis, raised transaminase levels were found; the salicylate level was above 35 mg/100 ml in all except one. Reduction in the salicylate level led to a prompt fall in the serum transaminases. Despite a rise in alkaline phosphatase in three cases there was no other evidence of liver dysfunction in the children. Only one of the adults showed a rise in transaminase levels, and she had mild cirrhosis.