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Chronic dialysis patients frequently present with necrotic skin lesions. The differential diagnoses are broad and complex. The main focus of this paper is differentiating features of two diagnostic entities: Warfarin induced skin necrosis and calciphylaxis as early recognition and treatment may prevent the significant mortality. We discuss a case involving a hemodialysis patient, who developed necrotic skin lesions over her thighs and gluteal areas shortly after restarting warfarin for atrial fibrillation without heparin bridging therapy. Incisional biopsies and pathology report were consistent with warfarin induced skin necrosis. Significant improvement of the lesions following discontinuation of Warfarin was also confirming the diagnosis of Warfarin Induced Skin Necrosis.

Effects of n-butanol fraction of Gongronema latifolium leave extract on some liver function and histological parameters in CCl4-induced oxidative damage in Wistar albino rats were assessed. Fifty-four (54) Wistar albino rats were divided into treatment group and LD50 groups. Group A (normal control) was given feed and water, Group B (vehicle control) was injected with olive oil intraperitoneally, while the rest groups (C, D, E, F and G) were injected intraperitoneally with a single dose of CCl4 (148 mg/kg) as a 1:1 (v/v) solution in olive oil and all the animals were fasted for 36 hours. This was repeated once every week for a period of four (4) weeks. At the end of 28 days of treatment, liver marker enzymes studies showed that there was significant (p 0.05) difference of these liver marker enzymes and bilirubin levels between the normal control and induced treated groups. Antioxidant assay on the liver homogenate showed that there was significant (p 0.05) difference between the normal control and induced treated groups. These findings suggested that n-butanol fraction of methanolic leave extract of G. latifolium may have anti-hepatotoxic and antioxidative effects against CCl4-induced liver damage in rats.

Objectives: The recurrence of HCV post liver transplantation endangers patient and graft survival. The aim of this study is to analyze the risk factors for HCV recurrence, the effect of the recurrence and its management on the outcome of liver transplantation. Materials and methods: After exclusion of the 6 months mortality, dual HCV and HCC patients, about fifty five HCV related LDLT patients were enrolled in the study and were followed up from 6 to 60 months. Demographic, preoperative, intraoperative and postoperative data were studies. HCV recurrence was defined by elevated transaminases, positive serum HCV RNA and liver biopsy findings. Univariate and multivariate analysis were done on all data to detect the favoring factors of HCV recurrence. Results: HCV recurrence occurred in 21/55 of the patients and one of them developed cirrhosis on follow up. By univariate analysis; CMV infection, mean operative time (12.490 ± 1.8952), acute cellular rejection and pulse steroids treatment were predictors of HCV recurrence (P

Background: Surgical Hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for hepatocellular carcinoma in cirrhotic liver. However, hepatic resection, in the presence of cirrhosis is associated with high risk of hemorrhage; thus, good clinical results can only be achieved by minimizing operative blood loss. The tremendous progress in microwave technology has recently attracted considerable attention. Here we describe the treatment outcomes achieved at our institution for intraoperative use of the microwave tissue precoagulation in hepatic resection as part of our strategy for the treatment of HCC. Methods: Twenty-six selected patients received elective hepatic resections using intraoperative microwave tissue precoagulation as their initial therapy for hepatocellular carcinoma in cirrhotic liver. The patients who were enrolled for our study were chosen according to the Barcelona criteria for HCC management. The safety, therapeutic effect and recurrence were prospectively evaluated and analyzed. Results: All the procedures were completed as planned. The median duration of the operation was 118 (range, 65-250) minutes with a median resection time of 45 (range 30-80) minutes. The median blood loss for resection was 165 (range, 100-750) mL. One patient required blood transfusion. The average time taken to coagulate the anticipated liver transection plane was less than 15 min. There was no operative mortality. The median postoperative hospital stay was 6 days. The median follow-up of patients was 14 months. At last follow up, recurrent tumors were noted in three (11.5%) of the patients (local in one and remote in two of the patients). Conclusion: Our initial results show that surgical microwave tissue precoagulation in liver resection for hepatocellular carcinoma in cirrhotic liver is safe and effective treatment. It achieves an acceptable recurrence rate. Longer follow-up is required to determine the long-term outcome of this new treatment modality.

Klebsiella pneumoniae liver abscess (KLA) is an emerging infectious liver disease in developed countries such as the United States. This is particularly common in the East Asians living in the United States who has other comorbid medical problems, especially diabetes mellitus. Metastatic infections involving non-contiguous areas originating from Klebsiella pneumoniae liver abscess have been documented as being the causal source for endophthalmitis, brain abscess, lung abscess, psoas abscess, splenic abscess and septic arthritis. The incidence of metastatic infection in the setting of KLA is higher than in liver abscesses of any other bacterial origin.

Objective: Image-guided microwave coagulation therapy as a minimally invasive technique has been widely used for the treatment of small HCC in patients who have high surgical risks. However, tumor residual after thermal albation is still the main reason of HCC recurrence. Laparoscopic resection of the tumor after thermal ablation will take advantage of reducing the risk of tumor residual without increasing the risk of hepatic failure. The aim of this study was to evaluate the feasibility and safety of this technique. Methods: From 2008 to 2010, 18 patients (15 men and 3 women; age range, 35-77 years) with HCC and associated severe liver cirrhosis underwent microwave coagulation therapy combined with laparoscopic liver resection. Inclusion criteria were solitary, peripheral or subcapsular HCC lesions localised to the left or anterior right segments; lesion size less than 4 cm; Child-Pugh grading class B or class C. Mortality, morbidity and recurrence rates were analyzed. Results: A total of 18 patients were included. There was no conversion to open operation. The mean operation time was 105 min (range, 70~155 min) and the mean blood loss during operation was 95 ml (range, 40~160 ml). No patient needed blood transfusion. The complications after operation included: pneumonia in 1 patient and mild transient jaundice in 2 patients (

Adrenal Insufficiency (AI), defined as deficient production or action of glucocorticoids resulting from either a structural damage of adrenal glands (primary adrenal insufficiency) or an impairment of the hypothalamic-pituitary axis (secondary adrenal disease), is being reported with increasing frequency in patients with liver disease, and some authors proposed the term “hepato-adrenal syndrome”. The prevalence of AI in patients with liver disease varies widely according to the study population: critically ill patients (33-92%), stable cirrhosis (31-60%), or decompensated cirrhosis, such as variceal bleeding (30-48%) and ascites (26-64%). However there is no current consensus about diagnostic criteria to define AI in patients with liver disease, and its prognostic relevance in stable cirrhosis is still unclear.

Background: Liver cirrhosis is a major cause of death in many developed countries. Binge drinking has been shown to increase the risk of liver cirrhosis. Objective: The aim of this study was to examine the aggregate-level relation between the alcohol consumption and liver cirrhosis mortality rates in Russia. Method: Age-standardized sex-specific male and female liver cirrhosis mortality data for the period 1970- 2005 and data on overall alcohol consumption were analyzed by means ARIMA (Autoregressive Integrated Moving Average) time series analysis. Results: Alcohol consumption was significantly associated with both male and female liver cirrhosis mortality rates: a 1 liter increase in overall alcohol consumption would result in a 7.0% increase in the male liver cirrhosis mortality rate and in 6.2% increase in the female mortality rate. The results of the analysis suggest that 61.4% of all male liver cirrhosis deaths and 56.4% female deaths in Russia could be attributed to alcohol. Conclusions: The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the liver cirrhosis mortality rate in Russian Federation. The findings from the present study have important implications in regards alcohol-related mortality prevention indicating that a restrictive alcohol policy can be considered as an effective measure of prevention in countries with higher rate of alcohol consumption.