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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Hepatitis Information

(L through Z)

 

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

 

Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you



 

 

Common Conditions

  • Chronic Fatigue Syndrome

  • Cognitive Dysfunction

  • Depression

  • Emotional lability

  • Indigestion

  • Inflammation of the liver

  • Lymphoproliferative disorders

  • Malaise

  • Mixed cryoglobulinaemia

  • Pain in the upper right quadrant

  • Poor peripheral circulation

Significant Conditions

  • Allergies

  • Alternating constipation and diarrhea

  • Cirrhosis of the liver

  • Diabetes

  • Edema/Fluid retention

  • Fibrosis of the liver

  • Glomerulonephritis

  • Hypoglycemia

  • Irritable bowel syndrome

  • Ischemia

  • Polyarthritis

  • Psoriasis and other skin disorders

  • Sjögrens Syndrome

  • Thyroid Disorders

  • Vasculitis

Less Common Conditions

  • Cutanea Purpura Tarda

  • Hemorrhage

  • Hepatocellular Carcinoma

  • Lichen Planus

  • Non Hodgkins

  • Thrombosis and Strokes

ADDITIONAL ARTICLES:

Document Name & Link to Document Description File Size
Lack of evidence for the heterosexual transmission of hepatitis C The importance of sexual transmission in the epidemiology of hepatitis C virus (HCV) infection is still controversial. To assess the risk of heterosexual HCV transmission, we examined eighty patients with chronic HCV-associated liver disease and their spouses in a cross-sectional clinical and serological cohort study.  
Lamivudine drug treatment for nonresponders

 

Lamivudine treatment for 52 weeks is as effective in interferon nonresponders as in treatment-naive patients, finds a research team from the United States.  
L-arginine & Cirrhosis Nitric oxide (NO) is known to play an important role in modulating both the hepatic and mesenteric circulation under physiological and pathological conditions.  
LEF-liver cirrhosis Cirrhosis of the liver is a chronic, diffuse (widely spread throughout the organ), degenerative liver disease in which the parenchyma (the functional organ tissue) degenerates, the lobules are infiltrated with fat and structurally altered, dense perilobular connective tissue forms, and areas of regeneration often develop.  
Life Cycle of the Hepatitis C Virus Video  
Liver Cancer Incidence Has Tripled Since 1970s, But Survival Rates Improving Researchers also found for the first time that one- through five-year survival rates improved significantly for patients diagnosed with liver cancer between 1992 and 2005, in part because more patients were diagnosed at earlier stages, when treatment is more effective. Earlier diagnosis may be due to increasing awareness and screening to detect localized disease in patients at risk for liver cancer.  
Liver disease-animal hospital

(LARGE REPORT-INCREASED DOWN-LOAD TIME)

With: Introduction, Liver Terminology, Anatomy, Physiology, Cause, Symptoms, Diagnosis, Specific Diseases, Gall Bladder Surgery  

LIVER RETRANSPLANTATION: ETHICS AND OUTCOMES

Everybody is very familiar with this slide and we have seen it over and over again.  The reason that we keep talking about re-transplantation is that we are wasting organs for patients who got one chance already.  We have one pie and we have to slice the pie in many different ways, so if somebody got one slice, why does he have to have two

 

Liver Roulette:

Liver Roulette is a unit in which students examine the procedures involved in organ transplants and the ethical issues surrounding organ donations.

 

Liver Cirrhosis Cirrhosis of the liver is a chronic, diffuse (widely spread throughout the organ), degenerative disease in which the parenchyma (the functional organ tissue) deteriorates; the lobules are infiltrated with fat and structurally altered; dense perilobular connective tissue forms; and often areas of regeneration develop. The surviving cells multiply in an attempt to regenerate and form "islands" of living cells that are separated by scar tissue. These islands of living cells have a reduced blood supply, resulting in impaired liver function. As the cirrhotic process continues, blood flow through the liver becomes blocked; portal hypertension may occur (high blood pressure in the veins connecting the liver with the intestines and spleen); glucose and vitamin absorption decrease; the manufacturing of hormones and stomach and bowel function are affected; and noticeable facial veins may appear  

LIVER TRANSPLANTATION

Liver transplantation should ideally be offered to the patient who has a high 
risk of dying without liver transplantation, but who is likely to have prolonged 
survival and improved quality of life posttransplantation. Allocation systems 
for liver transplantation currently do not identify patients who benefit the most 
from liver transplantation. Rather, the systems are geared toward determining 
which patients should receive a donor organ on a priority. Under the previous 
allocation system, for the vast majority of patients, waiting time was the major 
determinant of liver allocation

 

Liver Transplants: How Do We Choose Who Should Live When Not All Can?

With a scarce, non-renewable resource such as livers for transplantation, shouldn’t the individuals who receive organs be the persons who need them most? If recipients could be selected based on need, allocation finally could be divorced from onerous criteria such as social value. Since need in this context can be equated with death (if life-saving treatment is withheld), the manner in which recipients are chosen becomes paramount. On an existential level, the question may be reduced simply to choosing who should live when not all can.

 

Martin studies tainted blood lawsuit

THE government is considering hiring an American law firm to take a multi-million-dollar case against US-based drug companies implicated in infecting Irish haemophiliacs with HIV and hepatitis C.

 

MELD Scores of Liver Transplant Recipients According to Size of Waiting List

 

The Model for Endstage Liver Disease (MELD) score serves as the basis for the distribution of deceased-donor (DD) livers and was developed in response to ‘the final rule’ mandate, whose stated principle is to allocate livers according to a patient’s medical need, with less emphasis on keeping organs in the local procurement area.

85 kb pdf

More people getting liver cancer

The study focused on hepatocellular carcinoma (HCC), the most common primary malignant tumor of the liver. People infected with chronic hepatitis B or C, or cirrhosis, face a substantially increased risk of developing this cancer

 

 

National Hepatitis C Needs Assessment PowerPoint Presentation 133 kb

Neurovisual Visual Impairment

In conclusion, subclinical neurovisual impairment is a frequent, largely unrecognized complication of low-dose IFN therapy, and patients with chronic hepatitis B and older age appear to be most susceptible. This apparently innocuous complication is long lasting, possibly irreversible in some patients, with yet undetermined consequences on visual function.

 

Opportunistic Infections still exist

At the 10th Conference on Retroviruses and Opportunistic Infections (CROI), there was broad and outspoken recognition that opportunistic infections (OIs) continue to cause morbidity and mortality in patients who are unaware of their HIV infection, individuals who have inadequate access to healthcare

 

PANCREATIC TAIL ADENOCARCINOMA PRESENTING AS EARLY SINISTRAL PORTAL HYPERTENSION The patient had sinistral portal hypertension, a clinical syndrome consisting of splenic vein thrombosis caused by pancreatic adenocarcinoma of tail manifested as isolated gastric varices with patent portal vein and normal hepatic function. By presenting this case, I want to draw attention to a rare syndrome, sinistral (left-sided) portal hypertension secondary to pancreatic adenocarcinoma of the tail.  
Pharmacological Treatment of Portal Hypertension Continuing advances in the knowledge of the pathophysiology of portal hypertension result in the progressive expansion of the spectrum of drugs with a potential role for clinical practice, with objectives that now tend to include the prevention of the enlargement or even the development of esophageal varices. This systematic review summarizes the evidence of efficacy of drug therapy for portal hypertension and draws recommendations for clinical practice. Although there is not yet enough evidence to support the treatment for the prevention of the development or enlargement of varices, nonselective beta-blockers are the first-choice therapy to prevent the first bleeding in patients with medium or large-sized varices and rebleeding in patients surviving a bleeding episode.  
Portal Hypertension Increases in portal pressure cause development of a portosystemic collateral circulation with resultant compensatory portosystemic shunting and disturbed intrahepatic circulation. These factors are partly responsible for the important complications of chronic liver disease, including variceal bleeding, hepatic encephalopathy, ascites, hepatorenal syndrome, recurrent infection, and abnormalities in coagulation. Variceal bleeding is the most serious complication and is an important cause of death in patients with cirrhotic liver disease  
Portal hypertension Clinical strategies for managing portal hypertension have undergone significant refinements over the past half-century. This evolution has been driven by advances in our understanding of the physiology of both the disease and the therapies employed against it. Today, clinical management of the portal hypertensive patient is a truly multidisciplinary endeavor, requiring the coordinated efforts of skilled intensivists, gastroenterologists, hepatologists, interventional radiologists, and surgeons. Nevertheless, portal hypertension and its manifold complications remain some of the most vexing problems encountered in modern medicine and surgery.  

Portal Hypertensive Bleeding

Bleeding from esophageal varices occurs in approximately 30% of patients with chronic liver disease and portal hypertension.

 

Pregnancy and pregnancy outcome in hepatitis C type 1b A large cohort of rhesus-negative women in Ireland were inadvertently infected with hepatitis C virus following exposure to contaminated anti-D immunoglobulin in 1977–8. This major iatrogenic episode was discovered in 1994. We studied 36 women who had been infected after their first pregnancy, and compared them to an age- and parity-matched control group of rhesus-positive women. The presence of hepatitis C antibody was confirmed in all 36 by enzyme-linked immunosorbent assay and by recombinant immunoblot assay, while 26 (72%) of the cohort were HCV-RNA-positive (type 1b) on PCR testing. In the 20 years post-infection, all members of the study group had at least one pregnancy, and mean parity was 3.5. They had a total of 100 pregnancies and 85 of these went to term. There were four premature births, one being a twin pregnancy, and 11 spontaneous miscarriages. One miscarriage occurred in the pregnancy following HCV infection. There were two neonatal deaths due to severe congenital abnormalities in the PCR-positive women. Of the children born to HCV-RNA positive mothers, only one (2.3%) tested positive for the virus. Significant portal fibrosis on liver biopsy was confined to HCV-RNA-positive mothers apart from one single exception in the antibody-positive HCV-RNA-negative group. Comparison with the control group showed no increase in spontaneous miscarriage rate, and no significant difference in obstetric complications; birth weights were similar for the two groups.  

 

Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients Patients on chronic haemodialysis treatment have been identified by serological testing with second and third generation immunosorbent assays (ELISA) as a high risk group for hepatitis C virus (HCV) infection Hepatitis C is the most common cause of chronic viral liver disease in haemodialysis patients. Due to parenteral transmission of the virus, HCV contaminated blood transfusion was identified as the main risk factor for viral transmission before the availability of reliable HCV screening of blood products in 1990. The extensive use of recombinant erythropoietin to correct renal anaemia in haemodialysis patients resulted in a significant reduction in blood transfusions. However, previous studies have shown that de novo infections in single haemodialysis units may still occur in the absence of other parenteral risk factors. Furthermore, some reports demonstrated that the duration of haemodialysis is an independent predictor of HCV infection in chronic haemodialysis patients  
Preventive Strategies in Chronic Liver Disease: Cirrhosis Cirrhosis is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. The modified Child-Pugh score, which ranks the severity of cirrhosis based on signs and liver function test results, has been shown to predict survival. Strategies have been established to prevent complications in patients with cirrhosis. Esophageal varices can be identified by endoscopy; if large varices are present, prophylactic nonselective beta blocker therapy should be administered. Alpha-fetoprotein testing and ultrasonography can be effective in screening for hepatocellular carcinoma. Vaccines should be administered to prevent secondary infections  

Ramatex On Rack Again

Their concerns peaked last week, when at least two employees were forced to return to the Philippines after being declared sick and unfit to work, assertions they dispute. A group of about five were told by the company nurse that they had contracted hepatitis C - a viral infection of the liver.

 

Re-combo--On the Sides

With the combo came a combination of side effects that have left many hepatitis patients suffering long after their treatment is through.

 

Recovery from Hepatitis A

An outbreak of hepatitis A occurred in a north Georgia trailer park served by a private well. Of 18 residents who were serosusceptible to hepatitis A virus (HAV), 16 (89%) developed hepatitis

 

Refractory Ascites

Ascites, the most common complication associated with cirrhosis, occurs in 50% of patients within 10 years of diagnosis of compensated cirrhosis. Development of ascites is a poor prognostic indicator, with a 50% 2-year survival, worsening significantly to 20% to 50% at 1 year when it becomes refractory to medical therapy.

 

Research & Policy Recommendations for Hepatitis C Virus (HCV)/HIV Coinfection The unfolding epidemic of hepatitis C virus (HCV) infection is a serious and growing problem. An estimated 170 million people around the world are infected. In the United States, at least four million people have been exposed to HCV, and 2.7 million of them have developed chronic hepatitis C. Chronically infected persons can either remain asymptomatic, progress very slowly, maintain mild to moderate liver scarring or develop serious liver damage, such as cirrhosis or hepatocellular carcinoma (HCC). Hepatitis C-related liver damage has become the chief cause for liver transplantation in this country, and ten to twelve thousand people die each year from HCV-associated end-stage liver disease (ESLD). HCV disease is a particularly severe problem for HIV-positive people. Up to a quarter of all people with HIV in the U.S. may be coinfected with HCV. The progression of hepatitis C is accelerated in HIV-positive individuals, and HCV-related ESLD has become a leading cause of death in those with HIV.  
Researcher Says Disease Will Strain the State's Hospitals and Transplant Units While new cases of infection will decline in the future, Dr. Davis and colleagues predict that more people who already have HCV infection will experience progression of liver disease -- to cirrhosis and hepatocellular carcinoma, for example. Chronic HCV is the most common indication for liver transplantation in the U.S., affecting 50 percent of all patients receiving liver transplants. And, the disease frequently recurs following liver transplantation, sometimes leading to cirrhosis and liver failure a second time.  

Researchers fear ultimate toll of hepatitis C may surpass AIDS

A stealthy enemy is lurking inside the bodies of millions of Americans that some medical experts fear may prove as devastating as AIDS.

 

Researchers find 2 genes used by HCV

New findings published in the Proceedings of the National Academy of Sciences by researchers at Immusol Inc. and the University of California at San Diego (UCSD), reveal two human genes that the hepatitis C virus (Hepatitis C Virus) uses to reproduce itself.

 

Risks of Liver and other types of Cancer

Cancer risk in patients with cirrhosis could be modified by factors such as changes in hormonal levels, impaired metabolism of carcinogens, or alteration of immunological status.

 

Safer Tattooing & Hepatitis C

Rules to live by if you wish to have a tattoo

327 kb pdf

Screening for depression in a Hepatitis C population

Depression is reported as a serious adverse event of antiviral therapy used to treat patients with hepatitis C (Hepatitis C Virus); therefore, there is a need to identify a reliable and valid measure of depressive symptoms for this population

 

Search Engine for Drug Names

What's in a name? The potential for thousands of prescription drug errors each year, according to the Institute of Medicine. And now the risk has the Food and Drug Administration asking what it can do to avoid potentially confusing and dangerous medication brandnames.

 

Severe dry cracking skin

The skin protects the body from outside substances, chemicals, and bacteria and contributes to temperature maintenance and other homeostatic functions.

 

Sex and Hepatitis C Transmission While there is sufficient evidence to support the conclusion that sexual transmission of hepatitis C virus (HCV) occurs, quantifying the magnitude of an individual's risk of HCV acquisition by sexual contact has been more challenging. The available data suggest the efficiency of transmission by the sexual route is low. Nonetheless, since sex is a common behavior and the reservoir of HCV-infected individuals is substantial, sexual contact likely contributes to the total burden of HCV infection in the United States  

Silent Liver Diseases in Autopsies from Forensic Medicine of Tehran

 

Most of the chronic liver diseases, even in advanced stages, may cause no prominent clinical signs or symptoms. They either go undiagnosed or are found incidentally during general health check-ups, investigations for other diseases, surgery, or autopsy. The underlying causes of chronic liver diseases vary in different geographic areas and are based on various factors such as socioeconomic status, life style, diet, local or regional infections, and other endemic diseases.  

Silymarin, cirrhosis and diabetes: an abstract

Several studies have demonstrated that diabetic patients with cirrhosis require insulin treatment because of insulin resistance. As chronic alcoholic liver damage is partly due to the lipoperoxidation of hepatic cell membranes, anti-oxidizing agents may be useful in treating or preventing damage due to free radicals.

 

Sinistral portal hypertension

 

Sinistral, or left-sided, portal hypertension is a rare cause of upper gastrointestinal haemorrhage. Isolated gastric varices result from thrombosis or obstruction of the splenic vein resulting in back pressure changes in the left portal system. The primary pathology usually arises in the pancreas and common aetiologies include pancreatitis and pancreatic neoplasms. Four illustrative case histories from patients with sinistral portal hypertension are discussed, followed by a review of the literature highlighting the aetiology and management of this condition. Pdf 111 kb

Sjogrens syndrome-What is it?

Sjogren's Syndrome is a chronic disorder that causes insufficient moisture production in certain glands of the body. It occurs when a person's normally protective immune system attacks and destroys moisture-producing glands, including salivary glands and lacrimal (tear-producing) glands.

 

Sources of Hepatitis C Infection Power Point Presentation  
The Multidimensional Burden of Hepatitis C and Its Treatment Approximately 3.2 million persons in the United States are chronically infected with HCV; however, this number is thought to be underestimated because it does not include the individuals who are incarcerated, homeless, or confined to hospitals, mental health, or drug rehabilitation facilities (Armstrong et al., 2006). In the United States, infection with HCV is associated with 10,000-12,000 deaths per year (Shehab, 2004). Mortality associated with HCV infection is primarily the result of the development of cirrhosis, liver decompensation, or hepatocellular carcinoma. pdf 1156 kb

The patient's perspective in hepatitis C: coping with HCV

“…..the complexity of managing some (CHC) chronic hepatitis C patients may rapidly exceed the training, skills, and resources of their primary care physician (PCP) or medical specialist……. Investigators have reported CNS abnormalities in CHC patients compared with uninfected controls”

 

The Ten Commandments For Hepatitis Survival

Self-explanatory

 

Transfusion Related Acute Lung injury

This is to alert you to the possibility that patients who receive blood products, particularly plasma-containing products, may be at risk for Transfusion Related Acute Lung Injury (TRALI), a serious pulmonary syndrome that can lead to death if not recognized and treated appropriately.

 

Transplantation in the Patient with Hepatitis C HCV infection is a significant problem in the patient with end-stage renal disease. Nosocomial transmission of HCV in the dialysis unit is a risk factor for HCV infection. Dedicated machines and a larger nursing staff are mandatory in units with a high prevalence of HCV infection. HCV-positive patients should be tested for HCV-RNA to document ongoing infection. Management of HCV-RNA-positive patients on the waiting list includes biopsy to provide interferon treatment if chronic hepatitis is present. After transplantation, liver disease is more frequent in HCV-positive patients than in HCV-negative patients. In the long run, this leads to significant liver complications.  
Treatment of Patients with Cirrhosis and Portal Hypertension The VA Hepatitis C Resource Center Program-Cirrhosis represents the end stage of any chronic liver disease.  Hepatitis C and alcohol are currently the main causes of cirrhosis in the United States.  Two major syndromes result from cirrhosis:  Two major syndromes result from cirrhosis: portal hypertension and hepatic insufficiency. Pdf 1059 kb

Type 2 Diabetes and HCV

US researchers, writing in the Annals of Internal Medicine, report the results of a study which found that people over 40, who had antibodies to hepatitis C, were over three times as likely as those without antibodies to have type 2 diabetes.

 

Update from New Zealand’s battle with Hepatitis C

Some New Zealand hepatitis C sufferers living with "a time bomb in their livers" now have a better chance of being cured with the Government's agreement to a more effective treatment.

 

Vaccine for Hepatitis

When we only had tests for hepatitis A and hepatitis B it was called Non A Non B hepatitis. It most often followed blood transfusion. We know since 1988 that 97% of Non A Non B hepatitis is caused by hepatitis C virus (Hepatitis C Virus). It is one of six viruses (A,B,C,D,E,G)

 

Victims tell of tears, pain from hepatitis

Too weak to stand, Pamela Wallace asked if she could sit to address the court. Once a faceless, nameless plaintiff in a class-action lawsuit, Wallace chose Friday to identify herself, by name and profession, by offering personal details and private longings, and by detailing, once and for all, what she has lost

 

Vitiligo

Vitiligo is an autoimmune disease characterized by depigmentation of the skin due to destruction of melanocytes. Interferons have been used for the treatment of chronic hepatitis C and some malignancies. We report interferon alpha-2a-induced vitiligo in a male patient with chronic active hepatitis C.

 

Waiting for a liver - Hidden costs of the organ shortage

Discussion about the economics of end-stage liver disease has typically focused on the high cost of liver transplantation, but the management of complications in patients waiting for an organ can also be very expensive.

 

WGO-OMGE Practice Guideline - Treatment of Esophageal Varices

About 30% of patients with esophageal varices will bleed within the first year of diagnosis. Despite all advances in intensive care, bleeding episodes still carry a high mortality, which mainly depends on the severity of the underlying liver disease. The mortality of any bleeding episode may range from <10% in well compensated Child-Pugh A to >70% in advanced Child-Pugh C cirrhotics, respectively. Once a patient has bled, the risk of re-bleeding is high, reaching 80% within one year

 

What you need to know-liver biopsy

Liver biopsy in usually the most specific test to asses the nature and severity of liver disease.

14 kb pdf

When Family Members just can't Understand

There are probably few things in life that are more hurtful than being rejected by family members when we need them most. Unfortunately, many patients find that a diagnosis of hepatitis C not only causes friends to scatter, but also contributes to some families literally splitting apart.

 

When health supplements may do harm

Dr Benjamin Ansell article, describing visit to store specializing in dietary supplements in search of ones that could prevent heart attack, cautions that clerks know little about what supplements contain and possible risks; notes that, despite claims by manufacturers, pill forms of vitamins and supplements have proved to be no more effective than placebos;

 

 

 

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