Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis.

BACKGROUND AND OBJECTIVES: Acute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure. MATERIALS AND METHODS: A total of 335 patients who received TPE between 2010-2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22-84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE. RESULTS: Acute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed. CONCLUSION: TPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.

Acupuncture stimulation attenuates TNF-α production via vagal modulation in the concanavalin A model of hepatitis.

BACKGROUND: A growing body of evidence shows that neuronal activity is involved in modulating the efficacy of acupuncture therapy. However, it has been seldom investigated whether neuronal activity following acupuncture stimulation is effective at regulating hepatic inflammation. OBJECTIVE: Using the concanavalin A (ConA) model of hepatitis, we investigated the regulation of inflammatory cytokine tumor necrosis factor (TNF)-α in the liver tissue and the blood after acupuncture stimulation at ST36. METHODS: Mice were subjected to ConA injection, acupuncture stimulation at ST36 by manual acupuncture (MA) or electroacupuncture (EA) procedures, and vagotomy (VNX). Liver tissue and blood were collected for TNF-α analysis. TNF-α mRNA was analyzed by real-time polymerase chain reaction (PCR), and TNF-α, CD11b, CD68, and Erk1/2 proteins were analyzed by Western blotting, immunofluorescence staining, and enzyme-linked immunosorbent assay. RESULTS: TNF-α mRNA and protein were induced in CD11b-positive hepatic cells and the plasma at 6-24 h after ConA injection. The application of MA or EA was very effective at attenuating the production of TNF-α. Anti-inflammatory effects of acupuncture were greatly suppressed by VNX in ConA-injected animals, suggesting the requirement of vagus nerve activity in acupuncture-mediated anti-inflammatory responses. Electrical stimulation of the sciatic nerve (SNS) resulted in an anti-inflammatory effect similar to acupuncture stimulation. In parallel with TNF-α, production of phospho-Erk1/2, which was induced in the liver tissue, was downregulated by MA and EA in liver cells. CONCLUSION: The regulatory effects of acupuncture stimulation on inflammatory responses in the liver may be modulated through the activation of the vagus nerve pathway.

Cautiously using natural medicine to treat liver problems.

Natural medicine is a system of therapy that administrates natural agents and their derivatives to treat human diseases. This medicine has been used to treat many kinds of human diseases for thousands of years. The treatment protocols of natural medicine are integrative in nature, and are required to utilize the most appropriate therapies to address the needs of the individual patient. Because of the relative convenience, safety and efficacy, natural medicine is now increasing worldwide. Naturopathic doctors are licensed in many areas of the world and regulated partly by law in these areas, which is quite different from various other forms of complementary and alternative medicine. Liver diseases, such as hepatitis, liver cirrhosis and liver carcinoma, are serious health problems worldwide. Nearly half of the natural agents used in treatment of liver diseases today are natural products and their derivatives. Although natural medicine is beneficial and safe, physicians should pay close attention to the potential side-effects of the naturopathic agents, which lead to liver injury, interstitial pneumonia and acute respiratory failure. Therefore, when administrating naturopathic protocols to patients for the treatment of liver diseases, we should try our best to prevent and avoid as much as possible the negative impact of these medicines. This article highlights the current practice and recommended improvement of natural medicines in the treatment of liver diseases and gives some specific examples to emphasize the prevention and management of adverse reactions of the natural agents and suggests that natural medicine should be cautiously used to treat liver problems.

Hepatotoxicity associated with weight loss or sports dietary supplements, including OxyELITE Pro™ - United States, 2013.

In September 2013, the Hawaii Department of Health (HDOH) was notified of seven adults who developed acute hepatitis after taking OxyELITE Pro™, a weight loss and sports dietary supplement. CDC assisted HDOH with their investigation, then conducted case-finding outside of Hawaii with FDA and the Department of Defense (DoD). We defined cases as acute hepatitis of unknown etiology that occurred from April 1, 2013, through December 5, 2013, following exposure to a weight loss or muscle-building dietary supplement, such as OxyELITE Pro™. We conducted case-finding through multiple sources, including data from poison centers (National Poison Data System [NPDS]) and FDA MedWatch. We identified 40 case-patients in 23 states and two military bases with acute hepatitis of unknown etiology and exposure to a weight loss or muscle building dietary supplement. Of 35 case-patients who reported their race, 15 (42.9%) reported white and 9 (25.7%) reported Asian. Commonly reported symptoms included jaundice, fatigue, and dark urine. Twenty-five (62.5%) case-patients reported taking OxyELITE Pro™. Of these 25 patients, 17 of 22 (77.3%) with available data were hospitalized and 1 received a liver transplant. NPDS and FDA MedWatch each captured seven (17.5%) case-patients. Improving the ability to search surveillance systems like NPDS and FDA MedWatch for individual and grouped dietary supplements, as well as coordinating case-finding with DoD, may benefit ongoing surveillance efforts and future outbreak responses involving adverse health effects from dietary supplements. This investigation highlights opportunities and challenges in using multiple sources to identify cases of suspected supplement associated adverse events. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Exploring Hepatitis From the Perspective of Iranian Traditional Medicine: Using a Qualitative Approach.

Hepatitis is a global health problem, with significant adverse impacts on patients' quality of life. In this study, we aimed to review major resources of Iranian traditional medicine and determine whether the etiology and semiology of hepatitis, in particular chronic hepatitis, in traditional and conventional medicine might be aligned. Through such studies, we might be able to develop new approaches for clinical research to improve our current knowledge on the etiology and treatment of this condition. In this qualitative study, recently published studies, scientific databases, and reliable Iranian traditional medicine resources, including the Canon of Medicine, were searched. The integrative use of conventional and traditional medicine for diagnostic and therapeutic purposes could be evaluated to develop new modalities for dealing with this condition. An integrated approach is recommended in clinical research in order to find more efficient and safer treatment.

[The influence of the low-frequency laser radiation on microcirculatory disorders in the patients presenting with chronic viral hepatitis].

AIM: The objective of the present study was to elucidate the character of microcirculatory disorders in the patients presenting with chronic viral hepatitis and to evaluate the possibilities for the correction of the associated disorders with the use of laser irradiation. Material and methods. All the patients were divided into three groups. Group 1 was comprised of 30 patients who were treated by means of traditional medicamental therapy alone; they served as controls. Group 2 consisted of 45 patients treated by intravenous laser irradiation in addition to traditional medicamental therapy. The patients of group 3 (n=45) received a course of laser skin treatment. The state of microcirculation was assessed by the laser Doppler flowmetry (LDF) technique with the help of a LAKK-02 apparatus (<> Research and Manufacturing Complex, Moscow, Russia). RESULTS: The study has demonstrated heterogeneity of the types of microcirculation with the statistically significant increase in the frequency of its pathological cases. All the patients treated with the use of low-intensity laser therapy exhibited a significant improvement of the blood flow characteristics regardless of the initial hemodynamic type of microcirculation. CONCLUSION: It is concluded that the application of laser irradiation as a component of the combined treatment of the patients presenting with chronic viral hepatitis facilitates correction of microcirculatory disorders.

Interés terapéutico del fruto cardo mariano / Therapeutic interest of milk thistle fruit

La actividad antipatotóxica del fruto de cardo mariano y de la silimarina es conocida desde hace muchos años. Su efecto positivo sobre el hígado está basado en las acciones antioxidante, estabilizadora de membrana, favorecedora de la síntesis proteica, antivirásica, antiinflamatoria, inmunomoduladora y anticolestásica de la silimarina y su principal componente, la silibinina. Su eficacia clínica ha sido demostrada en distintos tipos de alteraciones hepáticas, principalmente en las producidas por alcohol y las causadas po virus. Diversos estudios han establecido el papel quimiopreventivo de la silimarina y de la silibinina en distintas áreas celulares cancerosas, así como su efecto estimulante sobre la secreción láctea, además de su actuación en otros ámbitos (protección ósea, neuroprotección, aterogénesis, etc.). a este conjunto de datos, que apuntan hacia posibles nuevas aplicaciones de los productos obtenidos a partir del cardo mariano, se une su amplio margen terapéutico y su baja toxicidad (AU)

Antihepatotoxic activity of milk thistle fruit and silymarin has been known for many years. The positive effect on the liver is based on the antioxidant, membrane stabilizing, protein synthesis increase, antiviral, anti-inflammatory, immunomodulatory and anticolestatic actions of sylimarin and its major constituten, silybinin. Its clinical efficacy has been shown in several types for liver disorders, namely those produced by alcohol and those caused by virus. Several studies have established the chemopreventive role of sylimarin and silybinin in different cancer cell lines and its stimulating effect on lactation, as well as their beneficial effects in other areas (bone protection, neuroprotection, atherogenesis,e tc.). All these data point to possible new applications of the products derived from milk thistle that, in addition, show a wide therapeutic range and low toxicity (AU)

Autoimmune liver diseases.

Autoimmune liver diseases are characterized histologically by a dense mononuclear cell infiltrate in the portal tract and serologically by high levels of transaminases and immunoglobulin G (IgG) and positive autoantibodies, in the absence of a known etiology. In pediatrics, there are three liver disorders in which liver damage is likely to arise from an autoimmune attack: autoimmune hepatitis (AIH); autoimmune sclerosing cholangitis (ASC); and de novo autoimmune hepatitis after liver transplantation. The exact pathogenesis of AIH is still unknown, but it is known that unidentified environmental factors, and occasionally drugs, might trigger disease in genetically-susceptible individuals. The clinical spectrum of disease is very wide, ranging from asymptomatic individual with abnormal liver function test to fulminant liver failure. The diagnosis is based on the combination of biochemical and histological parameters, and exclusion of other liver diseases. It is a relatively rare but devastating disease, which progresses rapidly unless immunosuppressive treatment is started promptly. Standard therapy consists of a combination of corticosteroids and azathioprine, which is efficacious in 80% of patients. Alternative therapies are increasingly being explored in patients who do not respond to the standard treatment and/or have intolerable side effects. The purpose of this review was to provide an overview of the current knowledge on pediatric autoimmune liver disease.

Neonatal jaundice.

Neonatal jaundice lasting greater than 2 weeks should be investigated. Pale stools and dark or yellow urine are evidence of liver disease, which should be urgently investigated. The neonatal hepatitis syndrome has many causes, and a structured approach to investigation is mandatory. It should be possible to confirm or exclude biliary atresia within one week, so that definitive surgery is not delayed unnecessarily. Babies with the neonatal hepatitis syndrome should have vigorous fat-soluble vitamin supplementation, including parenteral vitamin K if coagulation is abnormal. The prognosis for infants with idiopathic neonatal hepatitis and multifactorial cholestasis is excellent.

[Clinical evaluation of therapeutic effects of "Cooling the blood and invigorating blood circulation" method on hepatitis hyperbilirubinemia].

BACKGROUND: To explore the effect of treating hepatitis hyperbilirubinemia with Chinese traditional "cooling the blood and invigorating blood circulation" method. METHODS: Seventy-two patients were randomly divided into two groups. The control group (n=36) was treated with hepatocyte growth factor (HGF) 80-120 mg daily on the basis of routine western medicine treatment. The therapy group (n=36) was treated with "cooling the blood and invigorating blood circulation" decoction on the basis of routine western medicine treatment. After using the medicine for 28 days, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB) in plasma were measured to compare the effects of the two methods. RESULTS: The effective rate of the therapy group was 80.55%, that of the control group was 50%. There was significant difference in efficacy between the two groups (P<0.05). CONCLUSION: "Cooling the blood and invigorating blood circulation" method may be effective and safe in the treatment of hepatitis hyperbilirubinemia.

Acute hepatitis induced by an Aloe vera preparation: a case report.

AIM: Aloe vera, plant extracts of Aloe barbadensis miller, is widely used in phytomedicine. The first case of acute hepatitis due to this compound was described. METHODS: Description of a clinical case. RESULTS: Hepatitis in a 57-year old female could be linked to the ingestion of Aloe barbadensis miller compounds. The patient's hepatitis resolved completely after discontinuing this medication. CONCLUSION: The case emphasizes the importance of considering phytopharmaceutical over-the-counter drugs as causative agents of hepatitis.

Herbal and complementary and alternative medicine therapies for liver disease. A focus on Chinese traditional medicine in hepatitis C virus.

This article presents herbal and alternative therapies used in the treatment of liver disease, both as adjunctive or complementary treatment to Western pharmaceutical strategies, and as an alternative treatment in liver disease, particularly for Hepatitis C Virus. There is a special emphasis on traditional Chinese herbal medicine.

Les infections digestives / Digestive infections

Aigues ou chroniques, elles sont fréquentes et sauf nécessité absolue, il convient de résister à la tentation d´une antibiothérapie systénatique. On en connaît les iatrogènes. (AU)

[Transcutaneous electric stimulation of the liver and bile ducts during active enterosorption in combined surgical treatment of obstructive jaundice of nontumorous etiology]. / Cherezshkirna elektrostymuliatsiia pechinky ta zhovchovyvidnykh shliakhiv na foni aktyvnoï enterosorbtsiï v kompleksnomu khirurhichnomu likuvanni obturatsiinoï zhovtianytsi nepukhlynnoho henezu.

The influence of transcutaneous electrostimulation of liver and biliferous ducts while conduction of desintoxication using chitinous enterosorbent "Mikoton" on the result of treatment of hepatargy in patients with obstructive jaundice of nontumoral genesis in the early postoperative period was studied.

[Chronic hepatitis]. / Hepatitis crónica.

Medical literature about chronic hepatitis is reviewed. This unresolving disease caused by viruses, drugs or unknown factors may progress to in cirrhosis and hepatocarcinoma. A classification based on liver biopsy histology into chronic persistent and chronic active types has been largely abandoned and emphasis is placed on recognizing the etiology of the various types. One is associated with continuing hepatitis B virus infection; another is related to chronic hepatitis C virus infection and the third is termed autoinmune, because of the association with positive serum autoantibodies. A fourth type with similar clinical functional and morphologic features is found with some drug reactions. Long term corticoesteroid therapy is usually successful in autoinmune type. Associations between antibodies to liver-kidney microsomes and the hepatitis C virus can cause diagnostic difficulties. Antiviral treatment of chronic hepatitis B and C with interpheron alfa is employed, controlling symptoms and abnormal biochemistry and the progression to cirrhosis and liver cancer in 30 to 40% patients. Alternative therapies or combinations with interpheron are being evaluated waiting for final results.

Síndrome colestático neonatal: perspectiva y manejo médico-quirúrgico / Neonatal cholestasis. A review of the surgical treatment

El síndrome colestático neonatal obedece a múltiples causas, muchas de las cuales son aún desconocidas; el diagnóstico diferencial suele realizarse en mucho tiempo, lo cual repercute negativamente en la evolución y el pronóstico del lactante con ictericia obstructiva susceptible de corrección quirúrgica. La responsabilidad de agilizar su envío a los servicios quirúrgicos y/o continuar su estudio en el menor tiempo posible, reside en el pediatra clínico. En esta revisión se señalan las causas más frecuentes de colestasis neonatal que requieren tratamiento quirúrgico temprano, se sugiere una estrategia de toma de decisiones rápida para mejorar los resultados a corto y mediano plazo, con las técnicas actuales de tratamiento