Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial

瞄准：在幸存上调查长期的白朊管理的效果，腹水的复发和另外的复杂并发症的发作。方法：为第一发作的腹水招收的 100 个连续病人被使随机化加人的白朊收到利尿剂第一年和 25 g 里的 25 g/wk 每二 wk 此后(组 1 ) 或利尿剂独自一个(组 2 ) 。没有肝移植，主要端点是幸存。第二等的端点是腹水的复发和另外的复杂并发症的出现。结果：中部的后续是 84 (2-120 ) 瞬间。对待白朊的病人有显著地更大的累积幸存率(Breslow test=7.05， P=0.0078 ) 并且腹水复发的更低的概率(51% 对 94% ， P【0.0001 ) 。长期的白朊注入导致了 16 瞬间的幸存的吝啬的增加。结论：在第一发作的腹水以后的长期的白朊管理显著地改进病人的幸存并且减少腹水复发的风险。

Small diameter H-graft porta-caval shunt performed at different stages of liver disease

BACKGROUND: Partial porto-systemic shunts have been popularized because of reported low rate of mortality and morbidity (especially encephalopathy, liver failure and oc- clusion). To further investigate these assumptions, we ret- rospectively reviewed the results of partial porta-caval shunts performed at different stages of liver disease. METHODS: Twenty-nine cirrhotic patients underwent a partial porta-caval shunt with a ringed polytetrafluoroethy- lene interposition prosthesis of 8-mm ( 20 patients) or 10- mm (9 patients) in diameter. Pre- and post-shunt porta- caval pressure was measured in all patients. Twelve patients (41.4%) belonged to Child A, 11 Child B (37.9%), and 6 Child C (20.7%). Eleven patients (37.9%) suffered from hepatic encephalopathy preoperatively. Twelve patients (41%) were operated on in emergency/urgency. RESULTS: Porta-caval pressure gradient, reduced signifi- cantly using either 8- or 10-mm prosthesis. The overall ear- ly mortality and morbidity were 13. 8% and 48% respec- tively. The early mortality and morbidity were different be- tween patients of Child A and B when compared to those of Child C (0 vs 66.6% and 34.8% vs 66.6% respectively). No patient re-bled early from varices. The overall late mor- tality and morbidity were 40% and 64% respectively. Shunt thrombosis and stenosis took place in 16% and 8% of the two groups of patients respectively; variceal re-bleeding oc- curred in 4 patients (16%). Encephalopathy occurred post- operatively in 5 patients (20%), acute in 3 patients (12%), and chronic in 2 (8%). The actuarial survival rate at 3 and 5 years was 92% and 75% for patients of Child A, 70% and 60% for patients of Child B, and 0% for patients of Child C. CONCLUSIONS: Our results indicate that partial porta-ca- val shunt with a small diameter interposition H-graft is an effective procedure for the treatment of variceal bleeding, as well as for the prevention of re-bleeding in patients of Child A and those of Child B, as an elective or emergency/ urgency procedure, with a low rate of complications and encephalopathy. This technique could be used safely in pa- tients with good liver function but they should be moni- tored closely because of the risk of shunt occlusion.

Uveitis in autoimmune hepatitis:A case report

在这份病案报告，我们第一次描述在自体免疫的肝炎(AIH ) 和眼色素层炎之间的一个协会，没有关于另外的可能的病原学的任何疑问，例如 HCV，自从在为 HCV 相关的肝炎的测试能是可得到的以前，所有旧报告与虹膜睫状体炎描述 AIH 的协会。有反常的肝功能测试和球结膜的充血的一个 38 岁的商人进入医院。在承认，与坚持的发烧介绍的病人，关节痛，结膜充血，白细胞增多和增加的 ESR 前的六年，指了尖锐风湿热。系统病的存在，通常与眼色素层炎联系的大多数，没有结果，被调查，病人然后与热门 corticosteroids 被对待。他解决的症状。为反原子的抗体的测试是阳性的，在 1:320 的一个效价，与一个有斑点、核仁的染色的模式。肝超声与肝的增加的回响结构显示出温和肝肿大。经皮的肝活体检视在超声帮助下面被执行。组织学的检查在门，仙子门和小叶片的区域上显示出 necroinflammation，纤维变性门道与仙子门纤维变性和偶尔的 portal-to-portal bridgings，但是未经触动的肝的建筑学。某 hepatocytes 在小叶片的区域显示出含铁血黄素的恰好看得清的小粒。胆小管没有任何重要词法改变。METAVIR 分数是 A2-F3，根据修改 HAI 等级 / 纤维变性阶段。病人被诊断与温和活动和纤维变性有 AIH 并且在 25 mg 泼尼松上被解除，进入临床、生物化学的宽恕，进一步的证实诊断。在分泌物以后，病人继续在 5 mg 的剂量作为一个门诊病人与 corticosteroids 有治疗。在 2002 年 1 月，病人被重新接纳到医院。为反原子的抗体的测试是阳性的，在 1:320 的一个效价，与一个有斑点、核仁的染色的模式。反光滑的肌肉抗体测试也是阳性的(1:160 ) ，当 anti-LKM 抗体是否定的时。眼科学检查在角膜在左眼，和基质损害的前房揭示了煽动性的房间和 proteinaceous 闪光。他在抑制免疫力的治疗(加为二个星期的热门抗菌素治疗的 5 mg 泼尼松) 上被维持然后排出。症状的完全的宽恕在后续上被登记。目前(2005 年 7 月) ，病人在泼尼松(5 mg ) 上并且没有症状。肝功能测试也在正常范围以内。