Non alcoholic fatty liver disease in a young male with celiac disease.

A young emaciated male, known case of celiac disease came with complaints of diarrhea along with 5kgs of weight loss in 3 months' time. He had severe electrolyte abnormalities along with low albumin, low calcium and a high phosphate with deranged liver function test. Ultrasound abdomen had shown fatty liver. Nutrition consult was sought and he was found to have a BMI of 6.8kg/m2. He was started on nutrition support along with supportive therapy, which resulted in weight gain and improvement in his condition.

Frequency of Hepatotropic Viruses Leading To Deranged Liver Function Tests in Renal Transplant Recipients.

OBJECTIVES: The preferred modality for renal replacement therapy is renal transplantation. Marked improvements in early graft survival and long-term graft function have made renal transplantation a more cost-effective alternative to dialysis. The presence of liver disease in the posttransplant period adversely affects graft function and survival. Determining the cause of deranged liver function tests can be helpful in treating the underlying cause, leading to improved graft survival and overall quality of life in patients after renal transplant. Here, we determined the frequency of hepatotropic viral infections leading to deranged liver function tests in renal transplant recipients. MATERIALS AND METHODS: Our study included 132 patients with deranged liver function tests who had undergone renal transplant within the past 6 months. Reactivity and nonreactivity of hepatotropic viruses leading to deranged liver function tests were recorded. RESULTS: Average age of patients was 37.17 ± 8.75 years. There were 84 male (63.64%) and 48 female (36.36%) patients. Rates of hepatitis C virus antibodies and hepatitis B surface antigen were 62.88% (83/132) and 37.12% (49/132), respectively, whereas no patients had hepatitis E virus immunoglobulin M antibodies or hepatitis A virus immunoglobulin M antibodies. CONCLUSIONS: Among the hepatotropic viral infections leading to deranged liver function tests in renal transplant recipients, hepatitis B virus accounted for a small fraction. In contrast, hepatitis C virus was highly prevalent in transplant recipients who developed deranged liver function tests. Renal transplant recipients with hepatic viral infections have worse patient and allograft survival after transplant compared with noninfected renal transplant recipients. We recommend that transplant candidates be screened for hepatitis B and C virus infection, thus allowing increased graft survival and improved quality of life in renal transplant recipients.

Adverse events following transarterial chemoembolization for hepatocellular carcinoma and factors predicting such events.

OBJECTIVE: To document the adverse events after transarterial chemoembolisation and factors predicting such events. METHODS: The prospective observational study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from November 2009 to November 2011. All patients diagnosed as hepatocellular carcinoma were included in this study. Complications developing within the first 6 weeks of the procedure were recorded. SPSS version 16 was used for statistical analysis. RESULTS: Of the total 80 patients, 59 (73.8%) were male. The overall mean age was 52.25 +/- 9.24 (range: 28-76 years). Most common etiology was hepatitis C related cirrhosis in 55 (68.8%). Adverse events developed in 46 (57.5%) patients. Post transarterial chemoembolisation syndrome was seen in 37 (46.3%). Of those with the syndrome, 24 (64.8%) patients had no additional complications, while 3 (8%) had renal dysfunction, 2 (5%) hypertensive crisis, and 1 (2.7%) patient each had urinary tract infection, pneumonia and sepsis. Decompensation of cirrhosis occurred in 6 (7.5%) patients of whom 3 (50%) developed sepsis and died. The syndrome was associated with tumour size > 5cm (p = 0.001) and higher dose of lipoidol (p = 0.0001). Decompensation of cirrhosis was associated with low basal albumin (p = 0.002), advanced basal child turcotte pugh (p = 0.005) and model for end-stage liver disease (p = 0.006) scores. CONCLUSION: Transarterial chemoembolisation, though generally safe, may lead to serious complications in patients with advanced liver disease. Post-procedure syndrome was associated with increased tumour size and lipoidol dose.

Thalamic and midbrain infarct during transarterial chemoembolization of hepatocellular carcinoma.

Transarterial chemoembolization (TACE) is a well accepted and a relatively safe procedure, however certain rare and serious complications may occur during or after the procedure with profound morbidity and mortality. Only a few cases have been reported describing cerebral embolization during the procedure. We are reporting a case in which cerebral lipiodal embolization occurred in the second session of TACE, during the procedure and without any evidence of pulmonary embolism causing midbrain and thalamic infarct. The possible explanation could be an aberrant connection between the hepatic and pulmonary vessels which might have developed due to the involvement of the diaphragm, pleura and pulmonary vessels after the first session of TACE.