Hyperacute Liver Failure with Multi-organ Dysfunction Syndrome (MODS) by Leptospirosis: A Case Report

Introduction: Leptospirosis may have multi-organ involvement in its severe form with potentially life-threatening consequences. However, acute fulminant hepatic failure is very uncommonly reported. A case study is presented here with fulminant hepatic failure and a diagnostic dilemma for etiology. Case history: A 40-year-old man with no significant medical history presented with fever, muscle pain, weakness, and pain in the upper abdomen. On clinical work, he has developed multi-organ hepatic, respiratory, and renal failure. A timely workup was done, but due to the rapid progression of the disease, the patient succumbed to the disease in the intensive care unit by the time his report for positive leptospirosis test arrived. Conclusion: Leptospirosis must be considered as an important differential diagnosis of acute liver failure patients. An early suspicion for leptospirosis in patients with fulminant hepatic failure and multi-organ failure in India particularly in the rainy season is warranted owing to its high mortality rate.

A case of liver failure caused by fatal amanita poisoning was successfully treated by open cholecystostomy drainage / 中华危重病急救医学

The fatality rate of liver failure caused by fatal amanita poisoning is high, and there are no effective antidote drugs in China. On July 30, 2020, the department of infectious diseases and liver diseases of the First People's Hospital of Yunnan Province admitted a 67-year-old female patient with liver failure caused by fatal amanita poisoning. The patient went to the emergency department for treatment due to abdominal pain, vomiting and diarrhea after eating 350-400 g of amanita mushroom for 2 days, accompanied by fatigue for 1 day. There was no abnormality in physical examination. Laboratory indexes: alanine aminotransferase (ALT) 4 798 U/L, aspartate aminotransferase (AST) 10 030 U/L, activated partial thromboplastin time (APTT) 57.5 s, prothrombin time (PT) 72.1 s, international normalized ratio (INR) 8.66, prothrombinactivity (PA) 10%. Based on the patient's medical history, clinical manifestations and laboratory data, the diagnosis was amanita peptide mushroom poisoning and acute liver failure. According to the mechanism of amanita toxin poisoning as enterohepatic circulation, endoscopic retrograde cholangiopancreatography and ultrasound-guided gallbladder puncture and drainage for drainage of bile to discharge toxins were performed to interrupt the enterohepatic circulation of toxins. However, both methods failed, so open cholecystostomy was performed. Because the patient's coagulation function was very poor, artificial hepatic plasma exchange was given to improve coagulation function before open cholecystostomy, and eventually bile was drained successfully. After a total of 19 days of comprehensive medical treatment, the patient was cured and discharged from the hospital, and no sequelae was found after 1 year of follow-up. For such patients, early identification of the disease is required, and blocking the enterohepatic circulation of toxins as soon as possible according to the characteristics and toxicological mechanism of toxins may be the key treatment for rescuing patients with liver failure poisoned by amanita toxin, and it is necessary to combine comprehensive treatments such as active fluid replacement and blood purification to further improve the survival rate.

A Case of Acute Liver Failure After Intravenous Administration of Recommended Therapeutic Dose Acetaminophen for Relief of Stage IV Lung Cancer Pain

Introduction: There are many reports about hepatotoxicity associated with acute overdose or long-term use of acetaminophen, but few reports of that associated with therapeutic doses. We present a case of acute liver failure with hepatic coma caused by therapeutic doses of intravenous acetaminophen for cancer pain relief in palliative care setting. Case: The patient was a 56-year-old woman with stage IV lung cancer and normal liver function. She was admitted to the hospital because of anorexia and cancer pain. She received 1g intravenous acetaminophen every six hours for analgesia of pleural and rib metastasis. The patient’s AST/ALT levels were elevated at 3104/1212 IU/L, while she was receiving 11 doses of intravenous acetaminophen. She was treated with oral N-acetylcysteine, hemadsorption and plasma exchange therapy. Liver function returned to normal soon. Discussion: Therapeutic doses of intravenous acetaminophen is generally used in palliative care setting, and hepatic failure may occur due to glutathione depletion in patients with cancer anorexia. The potential hazard of rare but serious complications should always be kept in mind even with therapeutic doses.

Síndrome hepatorrenal en falla hepática aguda sobre crónica / Hepatorrenal syndrome in acute on chronic hepatic failure

Resumen La insuficiencia hepática aguda sobre crónica (ACLF, por su nombre en inglés: Acute-on-Chronic Liver Failure) es una entidad de reciente caracterización que se presenta como una descompensación aguda de una hepatopatía crónica, la cual puede ir asociada a falla en diferentes órganos y presentar una alta mortalidad. Su incidencia alcanza hasta un 30% de pacientes que consultan por complicaciones asociadas a cirrosis de base. Dentro de los factores precipitantes más frecuentes se encuentran las infecciones bacterianas, el alcoholismo y la reactivación de hepatitis virales; no obstante, hasta en un 40% de los casos no se identifica ningún factor precipitante. La fisiopatología de esta entidad aún es desconocida en cierta medida, pero se plantea la existencia de una respuesta inflamatoria excesiva en su desarrollo. No existe ningún tratamiento específico y su manejo se basa en el tratamiento para complicaciones asociadas, soporte y finalmente trasplante hepático. La disfunción renal es un hallazgo común en pacientes con enfermedad hepática. Se pensaba que el síndrome hepatorrenal era de carácter meramente funcional. Ahora, ante la evidencia de algún grado de daño tubular relacionado, se ha mejorado la comprensión de la fisiopatología de dicha entidad, lo que ha obligado recientemente a replantear los criterios diagnósticos y la clasificación de la enfermedad. Describimos el caso clínico de una paciente atendida en un centro hospitalario en la ciudad de Pereira, Risaralda. Ella presentó bacteriemia por cocos Gram positivos de origen no claro, lo que se consideró como el factor precipitante; tuvo deterioro clínico, con aparición de síndrome hepatorrenal y falla multiorgánica, lo que finalmente la llevo a la muerte, a pesar del manejo multidisciplinario.

Abstract Acute-on-chronic liver failure (ACLF) is a recently characterized entity that presents as an acute decompensation of chronic liver disease. It can be associated with failure in different organs and presents a high mortality rate. Its incidence reaches up to 30% on patients consulting for complications derived from cirrhosis. Among the most frequent precipitating factors, there are bacterial infections, alcoholism, and reactivation of viral hepatitis; however, in up to 40% of the cases, no precipitating factor is identified. The pathophysiology of this entity is still unknown to a certain extent, but the existence of an excessive inflammatory response in its development is suggested. There is no specific treatment and its management is based on treatment for associated complications, support, and finally liver transplantation. Kidney dysfunction is a common finding in patients with liver disease. The understanding of the pathophysiology of this entity, previously thought to be purely functional in nature, yet now given the evidence of some degree of related tubular damage, has improved and has recently entailed a rethink of the diagnostic criteria and the classification of the illness. We describe the clinical case of a patient treated at a hospital in the city of Pereira, Risaralda, who presented bacteremia due to Gram-positive cocci of unclear origin, considered as the precipitating factor. The patient had clinical deterioration, as well as the onset of hepatorenal syndrome and multi-organ failure, finally leading to death despite multidisciplinary treatment.

Hígado y SARS-CoV-2: aspectos claves de la literatura / Liver and SARS-CoV-2: Literature key aspects

Resumen El nuevo coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2), virus que se ha expandido por todo el mundo, produce una infección respiratoria aguda capaz de producir la muerte; sin embargo, el daño en otros órganos también es frecuente. Diversos estudios han evidenciado alteraciones en pruebas de lesión hepáticas, las cuales se han asociado con enfermedad grave y mayor estancia hospitalaria; así mismo, en la infección por el virus en pacientes con enfermedad hepática preexistente se observó una elevación significativa de las aminotransferasas durante el curso de la enfermedad y mayor riesgo de enfermedad grave. La explicación fisiopatológica de la afectación hepática en estos pacientes abarca el efecto citopático directo producido por la unión del virus a la enzima convertidora de la angiotensina II (ECA-II) a los hepatocitos y colangiocitos, una respuesta inmunitaria desproporcionada y, en algunos casos, la hepatotoxicidad por medicamentos.

Abstract The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus that has spread around the world, causes an acute respiratory infection and it may also cause death. The damage that can cause in other organs is frequent. Many studies had also shown alterations in liver function tests, that are then related to serious illness and with hospitalization requirements. Moreover, in patients infected with the virus that had underlying liver disease, a significant increase in the level of aminotransferases was observed in the course of the disease. A greater risk of serious illness was also detected. The pathophysiological explanation of liver injury in those patients covers the direct cytopathic effect produced by binding the virus, the angiotensin-converting enzyme (ACE2) to the hepatocytes and the cholangiocytes, excessive immune response, and in some cases, drug-induced hepatotoxicity.

Effect of Wenyang Jiedu Huayu Granule on TLR4 mRNA, TNF-α and Hepatocyte Apoptosis in IETM Rats with Hepatic Failure / 中国实验方剂学杂志

Objective::To investigate the relationship between Toll-like receptor 4 (TLR4) mRNA and its downstream inflammatory factor-tumor necrosis factor-α (TNF-α) and hepatocyte apoptosis in mice with intestinal endotoxemia (IETM) of hepatic failure, and explore the regulatory mechanism of Wenyang Jiedu Huayu granule on endotoxin-induced hepatocyte apoptosis. Method::The 85 SPF male SD rats were randomly divided into normal group, model group, TLR4 monoclonal antibody group and Wenyang Jiedu Huayu granule group. D-galactosamine (D-Gal) intraperitoneal injection was performed to establish the IETM model of hepatic failure. The TLR4 monoclonal antibody group and the Wenyang Jiedu Huayu granule group were given Wenyang Jiedu Huayu granule solution by gavage 5 days before the modeling. The normal group and the model group were given isovolumetric distilled water. Each group was given by gavage until sacrifice. Rats in each group were randomly sacrificed at 24, 48, 72 h, respectively, and samples were collected. The levels of serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected at 24, 48, 72 h. The pathological changes of liver tissue were observed by hematoxylin and eosin(HE) staining. The expression of TLR4 in liver tissue was detected by real-time fluorescence quantitative PCR (Real-time PCR). The expression of TNF-α in liver tissue was detected by enzyme-linked immunosorbent assay (ELISA). The apoptotic rate of hepatocytes was detected by flow cytometry. Result::Compared with the normal group, ALT and AST were increased in model group, while the pathological injury degree of liver tissue was significantly increased. The expressions of TLR4 mRNA and TNF-α were increased (P<0.05, P<0.01), whereas the apoptosis rate of liver cells was significantly increased (P<0.05, P<0.01). Compared with the model group, ALT and AST were decreased in Wenyang Jiedu Huayu granule group (P<0.01), and the degree of pathological injury of liver tissue was significantly reduced (P<0.05). The expressions of TLR4 mRNA and TNF-α were significantly decreased (P<0.01), and the apoptosis rate of liver cells was also reduced (P<0.01). Conclusion::TLR4 mRNA and TNF-α are positively correlated with hepatocyte apoptosis in liver failure. Wenyang Jiedu Huayu granule can improve liver function, alleviate liver cell injury and reduce liver cell apoptosis in IETM mice with hepatic failure. The mechanism may be related to its ability to down-regulate the expression of liver TLR4 mRNA, inhibit the release of TNF-α, and reduce the rate of hepatocyte apoptosis.

Insuficiencia hepática fulminante por paracetamol / Fulminant hepatic failure due to paracetamol

Resumen: La insuficiencia hepática aguda es una enfermedad poco común pero que amenaza la vida y afecta con mayor frecuencia a pacientes que no tienen enfermedades preexistentes del hígado. El paracetamol (acetaminofén) es uno de los medicamentos analgésicos-antipiréticos prescritos con más frecuencia por los médicos y automedicados por las personas, cuyos efectos adversos son desde molestias leves hasta efectos adversos letales, que no necesariamente requieren la dosis tóxica para causar tales efectos graves. No es sorprendente que el paracetamol sigue siendo causa importante de sobredosis: desde intoxicaciones intencionadas (suicida) y no intencionadas (consumo crónico), cuyos efectos graves van desde la insuficiencia hepática fulminante relacionada con sobredosis hasta la muerte; la mitad de estos episodios se atribuyen al paracetamol y estos casos parecen estar aumentando cada vez más debido a su fácil acceso y venta libre. El objetivo de este artículo es comunicar un caso y revisar la bibliografía al respecto.

Abstract: Acute liver failure is a rare disease but life-threatening, and occurs more frequently in patients without preexisting liver disease. Paracetamol (acetaminophen) is one of the analgesic-antipyretic drugs most frequently prescribed by physicians and self- medicated by people, whose adverse effects are mild discomfort and even lethal side effects that do not necessarily require the toxic dose to cause such serious effects. Not surprisingly, acetaminophen remains a major cause of overdose: from intentional poisoning (suicide) and unintentional (chronic use), whose major effects are ranging from fulminant hepatic failure related to overdose to death; half of these episodes are attributable to paracetamol, and these cases seem to be increasing more and more, because of its easy access and free sale. The aim of this paper is to present a case report and a literature review.

Study of Cardiac Function in Alcoholic Cirrhotic Patients

Introduction: Cardiac dysfunction in patients with cirrhosisoccurs in the setting of a circulatory dysfunction characterizedby a marked splanchnic arterial vasodilation. Circulatory changescan lead to the cardiac dilatation of the left chambers and thedevelopment of functional changes in the heart. The present studyis intended to assess cardiac functions in patients of liver cirrhosis.Material and methods: It was a cross sectional study conductedamong 74 diagnosed cases of liver cirrhosis, admitted todepartment of general medicine, KIMS Hospital during the 6months study duration.Results: Overall LVDD was diagnosed in 59 cases (79.73%).Out of which, 47.29% cases presented with Stage 1 (impairedrelaxation) LVDD, Stage 2 LVDD (pseudo normal) among31.08% and only one patient had severe restrictive type of(Stage 3) LVDD.Conclusion: Left ventricular diastolic dysfunction iscommonly associated with advancement of hepaticdysfunction while systolic function is maintained till advancedhepatic failure

A prospective study of N-acetylcysteine treatment in drug-induced fulminant hepatic failure

Background: Acute liver failure (ALF) is a rare but severe, life-threatening, complex, multisystemic gastroenterological emergency. Its rapid progression and high mortality demand early diagnosis and expert management. Drug-induced ALF (DI-ALF) remains the uncommon cause of ALF in India. To date, there is no established treatment for DI-ALF other than liver transplantation and little is known about the use of N-acetylcysteine (NAC) in DI-ALF. A prospective case-control study was carried with the aim to determine the effect of NAC on mortality of DI-FHF patients and also to evaluate the safety and efficacy of NAC use.Methods: A total of 18 patients with a diagnosis of DI-FHF were included in the study. 10 patients received NAC infusion for 72 hours whereas the control group received placebo. The variables evaluated were demographic, signs and symptoms, biochemical parameters, outcome and length of hospital stay.Results: Out of 18 DI-FHF patients, 13 (72.2%) had anti-tuberculosis therapy (ATT) induced FHF and 5 (27.8%) patients had ayurvedic induced FHF. The two groups were comparable for the various baseline characteristics (age, INR, alanine aminotransferase, creatinine, albumin, grade of encephalopathy, etc.). The mortality decreased to 20% with the use of NAC versus 75% in the control group (P=0.023). Use of NAC was associated with a shorter length of hospital stay of survived patients (P=0.043). Moreover, the overall survival was improved by NAC (P=0.023) in DI-FHF. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF use (P=0.019).Conclusions: Author recommended the use of NAC along with conventional treatments in patients with DI-FHF in non-transplant centers while awaiting referrals. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF with NAC administration and its use was safe.

Acute liver failure secondary to chronic lymphocytic leukemia

Chronic lymphocytic leukemia is an indolent malignancy of lymphocytes commonly seen in elderly. Dissemination of malignancy is a rare cause of acute liver failure and has rarely been reported. Here we describe the case of a sixty five year old male presenting with acute liver failure. He is a diabetic with no known history of seropositive hepatitis, drug intake or any addictions. Bone marrow and liver biopsy suggestive of chronic lymphocytic leukemia. He eventually succumbed to his illness.

Etiological profile and clinical characteristics in fulminant hepatic failure in North India

Background: Acute liver failure (ALF) is a rare but severe, life-threatening, multisystemic medical emergency. ALF of duration <8 weeks in a patient is considered as fulminant hepatic failure (FHF). Its rapid progression and high mortality demand early diagnosis and expert management. Clinical and etiological profile varies with geographical area and time. The objective of this prospective study was to determine the clinical characteristics and etiological profile of FHF.Methods: A total of eighty consecutive patients with a diagnosis of FHF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters (bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), internal normalization ratio (INR) etc.) and etiological profile.Results: Most of the patients were <35 years of age and males. Viral hepatitis 35 (43.8%) was the most common cause of FHF but the majority of the patients 25 (31.2%) had undetermined etiology. Among viral causes, acute hepatitis E was most common followed by hepatitis B and A. Drug or toxic induced liver failure (18.8%) also contributed a significant proportion of cases. The three groups (viral, drug-induced and indeterminate) were comparable for the various baseline characteristics (bilirubin, alanine aminotransferase, INR, creatinine, albumin, grade of encephalopathy, MELD score etc.).Conclusions: Like the rest of India, viral hepatitis was the common cause of FHF but the majority of the patients 25 (31.2%) had undetermined etiology. Our study highlights the differences in the profile of FHF from other earlier studies in India and the west. Each different etiology leads to a similar final common pathway. Trying to determine etiology is essential, however, as outcomes and the use of antidotes depend on the identification of the causative process.

​Efficacy Of Early N-Acetylcysteine In Rat Killer Paste Poisoning

Introduction: Rat killer paste (yellow phosphorous) is one of the most common forms of poisoning in South India. It causeshepatotoxicity. No specific antidote has been found. Recently, N-acetylcysteine is used as supportive therapy in many casesof acute liver failure.Aim: This study aims to evaluate the effectiveness of early N-acetylcysteine in preventing the rat killer paste poisoning.Methods: Patients who ingested rat killer paste poison and age >12 years were included in the study. Patients having jaundice,liver disease, and age <12 years were excluded from the study.Results: Among 30 patients studied, five patients died, seven patients developed hepatitis, one patient developed acute kidneyinjury with hepatitis, and one patient developed hyponatremia.Conclusion: Early initiation of N-acetylcysteine had a significant impact in reducing mortality.

Risk factors for sepsis in patients with hepatic failure / 中华危重病急救医学

Objective To analyze the pathogenic characteristics of sepsis in patients with hepatic failure, and to explore the risk factors for sepsis in patients with liver failure. Methods The data of 221 patients with hepatic failure admitted to Tianjin Second People's Hospital from January 2014 to December 2018 were retrospectively collected. The patients were divided into two groups according to whether they suffered from sepsis or not. The pathogeny results of blood culture in patients with sepsis were observed. The levels of white blood cell (WBC), neutrophil (Neut), platelet (PLT), lactic acid (Lac), C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. The risk factors for sepsis in patients with hepatic failure were analyzed by multivariate Logistic regression analysis. Results Among 221 patients, 27 cases had incomplete data and were excluded. Finally, 194 cases were enrolled in the analysis, including 52 in sepsis group and 142 in non-sepsis group. From 2014 to 2018, there were 11, 12, 11, 11 and 8 positive cases of sepsis in patients with liver failure. The positive rate of Gram-positive (G+) bacteria increased year by year (2, 3, 4, 5 and 4 cases of G+ bacteria from 2014 to 2018). There was no significant difference in demographic and medical history data, such as gender, age and history of diabetes mellitus between the two groups. Compared with non-sepsis group, Neut, Lac, CRP and PCT in sepsis group were significantly increased [Neut:0.81±0.09 vs. 0.74±0.15, Lac (mmol/L): 3.04±0.61 vs. 2.00±0.43, CRP (mg/L): 44.09±8.37 vs. 40.54±8.37, PCT (μg/L): 0.34±0.12 vs. 0.31±0.11], with significant differences (all P < 0.05). But there was no statistical difference in WBC or PLT between the two groups. The multivariate Logistic regression model incorporated the indicators with statistical significance in univariate analysis. The results showed that Lac was an independent factor of sepsis in patients with hepatic failure [odds ratio (OR) = 58.286, 95% confidence interval (95%CI) = 16.633-204.247, P =0.000]. Conclusions For patients with hepatic failure infection, the ratio of G+ bacteria increased year by year. Elevated Lac is an independent risk factor for sepsis in patients with liver failure.

Incidence Of Silicosis And Silicotuberculosis In Coal And Stone Industry In The State Of Chhattisgarh

Silicosis is an occupational disease reported in silica, stone & mining industry. No proper report on workers in industries using silica in stones and coal has been done from Chhattisgarh till date. Detailed history, lung functions and chest x-ray were done. Diagnosis was made on the basis of radiology & history. Data analysis was done with the help of the statistical package for social sciences software. The Chi-square test was used for determining the relationship between qualitative data and descriptive statistics was used where required. Out of the total 16 reported cases, 13 had respiratory symptoms. Radiological abnormalities were noted in all. Lung functions revealed obstruction in 25%, restriction in 12.5 %, while mixed ventilatory defects in 62.5% subjects. 16 cases of silicosis and silicotuberculosis were reported. They had high respiratory morbidity (81.25%), cough and dyspnea being predominant symptoms. Duration of exposure correlates with radiological findings and increased incidence of silicosis

Virus de la hepatitis E en una gestante joven / Hepatitis E virus in a young pregnant woman

Se presenta el caso clínico de una gestante de 20 años de edad, nulípara, con antecedente de asma intermitente, asintomática, quien ingresó con un síndrome ictérico en el Hospital Ginecoobstétrico Mariana Grajales Coello de Santiago de Cuba. Luego de realizarle los estudios pertinentes se concluyó que presentaba una hepatitis E complicada, la cual requirió cuidados intensivos; con el diagnóstico oportuno y el tratamiento eficaz se pudo garantizar su supervivencia

The case report of a 20 years nulliparous pregnant woman with history of intermittent, asymptomatic asthma is presented, who was admitted with an icteric syndrome in Mariana Grajales Coello Gynecoobstetric Hospital of Santiago de Cuba. After carrying out him the pertinent studies it was concluded that she presented a complicated hepatitis E, which required intensive cares; with the opportune diagnosis and the effective treatment her survival could be guaranteed

Fatal neurological complication after liver transplantation in acute hepatic failure patient with hepatic encephalopathy / 고신대학교의과대학학술지

Liver transplantation is a current definitive treatment for those with end-stage liver disease. Hepatic encephalopathy is a common complication of hepatic failure, which can be improved and aggravated by various causes. It is important to differentiate hepatic encephalopathy from other diseases causing brain dysfunction such as cerebral hemorrhage, which is also related to high mortality after liver transplant surgery. A 37-year-old patient was presented with acute liver failure and high ammonia levels and seizure-like symptoms. Computed tomography (CT) of his brain showed mild brain atrophy, regarded as a symptom of hepatic encephalopathy, and treated to decrease blood ammonia level. Deceased donor liver transplantation was performed and liver function and ammonia level normalized after surgery, but the patient showed symptoms of involuntary muscle contraction and showed loss of pupil reflex and fixation without recovery of consciousness. Brain CT showed brain edema and bilateral cerebral infarction, and the patient died after a few days. The purpose of this case report is to emphasize the importance of preoperative neurological evaluation, careful transplantation decision, and proper perioperative management of liver transplantation in patients with acute hepatic encephalopathy.

Glucocorticoids and liver diseases / 中华肝脏病杂志

Glucocorticoids is a type of steroid hormone secreted from zona fasciculata of adrenal cortex.As an immune and inflammatory inhibitor, glucocorticoids has been used to treat many kinds of diseases.T cell response plays a crucial role in the pathogenesis of liver diseases. However, the role of glucocorticoids in the mechanism and treatment of liver disease in current clinical practice is controversial. This paper summarizes the progress of glucocorticoid use for the treatment of liver diseases in recent years. References will be provided for how to grasp the indications,application timing and proper dosage of glucocorticoids in liver diseases.

The application of bilirubin adsorption in the salvage therapy of hepatic failure / 中国小儿急救医学

Acute liver failure has a high mortality and leads to hyperbilirubinemia which could process to multiple organ failure and death. The bilirubin adsorption treatment can specifically remove a large amount of bilirubin in the body and can reuse own plasma and albumin to reduce allergic reactions. Bilirubin adsorbent materials including adsorbent resin and polymer adsorbent,show better effects in liver failure. Bili-rubin adsorption is used less in pediatric acute liver failure in domestic,it needs to perform multi-center clini-cal cooperative research to evaluate the response.

Summary of experience in the establishment of rat models with orthotopic liver transplantation from donation after cardiac death / 器官移植

Objective To explore the skills and summarize the experience in the establishment of orthotopic liver transplantation rat models from donation after cardiac death (DCD). Methods According to the time of warm ischemia, 120 rats were divided into 3 groups: group A (warm ischemia for 0 min, n=40 pairs), group B (warm ischemia for 10 min, n=40 pairs) and group C (warm ischemia for 20 min, n=40 pairs). Orthotopic liver transplantation was performed by the modified two-cuff technique in 3 groups. The time of each stage of surgery was recorded in 3 groups. The survival rate at the end of surgery, 24 h, 72 h and 7 d after surgery was recorded in 3 groups. The dead rats were immediately subject to anatomical examination to identify the cause of death. Results The cold ischemia time of donor liver, anhepatic phase and operation time of the recipients did not significantly differ among three groups (all P>0.05). In groups A, B and C, the survival rate at the end of surgery was 97%, 97%, and 100% respectively. The survival rate at postoperative 24 h was 92%, 90% and 92% respectively. The survival rate at postoperative 72 h was 90%, 80% and 77% respectively. The survival rate at postoperative 7 d was 85%, 70% and 57% respectively. The survival rate at the end of surgery, postoperative 24 h and 72 h did not significantly differ among 3 groups (all P>0.05). At postoperative 7 d, the survival rate in group C was significantly lower than that in group A (P<0.05). Surgical operation was the major cause of intraoperative and postoperative 24 h death. Bile leakage and ischemic hepatic failure were the causes of death at postoperative 72 h. Biliary duct complications were the main causes of death at postoperative 7 d. The quantity of rats developing with biliary duct complications was increased along with the prolongation of warm ischemic time. Conclusions The success of stable establishment of rat models with orthotopic liver transplantation from DCD depends upon the protection of the liver and biliary function. The difficulty lies in the anastomosis of the suprahepatic inferior vena cava and the shortening of anhepatic phase.

Leucemia linfoblástica aguda con grave alteración hepática como manifestación inicial: presentación de dos casos y revisión de la literatura / Acute lymphoblastic leukemia causing hepatic failure: report of two cases

Hematological diseases may cause acute hepatic failure and are seldom sought. We report two cases illustrating this situation. A 16-year-old male presented with an acute liver failure: a bone marrow biopsy showed complete infiltration with lymphoid type blasts. A flow cytometry confirmed the presence of an acute lymphoblastic leukemia. The patient died days later. A 20-year-old female presented with acute liver failure: due to a pancytopenia, a bone marrow biopsy was performed, which confirmed the presence of an acute lymphoblastic leukemia. Chemotherapy was started immediately. The patient had a favorable evolution.