Hepatic disease ischemic hepatitis

Contraindications to interferon alfa therapy include hepatic decompensation, autoimmune disease, and history of cardiac arrhythmia. Caution is advised in the setting of psychiatric disease, epilepsy, thyroid disease, ischemic cardiac disease, severe renal insufficiency, and cytopenia. Alfa interferons are abortifacient in primates and should not be administered in pregnancy. Potential drug-drug interactions include increased theophylline levels and increased methadone levels. Co-administration with didanosine is not recommended because of a risk of hepatic failure, and co-administration with zidovudine may exacerbate cytopenias. 

Contraindications to treatment include autoimmune hepatitis, decompensated liver disease, women who are pregnant or patients whose female partners are pregnant, hemoglobinopathies, creatinine clearance <50 mL/ min, hemodialysis, or ischemic cardiovascular or cerebrovascular disease. 

Hypersensitivity reactions While taking -blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. Renal/Hepatic function impairment Rarely, use of carvedilol in patients with CHF has resulted in deterioration of renal function. Patients at risk appear to be those with low blood pressure (systolic BP less than 100 mm Hg), ischemic heart disease. 

Contraindications Cerebrovascular accident (CVA), ischemicheart disease (including angina pectoris, history of Ml, silent ischemia, and Prinzmetal s angina), severe hepatic impairment, transient ischemic attack, uncontrolled hypertension, use within 14 days of MAOls, use within 24 hr of ergof amine preparations... 

It also appears that the incidence of hepatic adenomas is increased in women taking oral contraceptives. Ischemic bowel disease secondary to thrombosis of the celiac and superior and inferior mesenteric arteries and veins has also been reported in women using these drugs. 

Occasionally toxic compounds can directly damage the hepatic sinusoids and capillaries. One such toxic compound is monocrotaline, a naturally occurring pyrrolozidine alkaloid, found in certain plants (Heliotropium, Senecio, and Crotolaria species). Monocrotaline (Fig. 7.7) is metabolized to a reactive metabolite, which is directly cytotoxic to the sinusoidal and endothelial cells, causing damage and occlusion of the lumen. The blood flow in the liver is therefore reduced and ischemic damage to the hepatocytes ensues. Centrilobular necrosis results, and the venous return to the liver is blocked. Hence, this is known as veno-occlusive disease and results in extensive alteration in hepatic vasculature and function. Chronic exposure causes cirrhosis. 

A 39-year-old woman developed idiopathic thrombosis of the posterior tibial vein. Oral contraceptives and resistance to activated protein C were identified as risk factors. After initial treatment with intravenous heparin, she was given phenprocoumon and the oral contraceptive was withdrawn. After 4 months she developed subacute liver failure and phenprocoumon was withdrawn immediately. Autoimmune disease, viral hepatitis, toxic causes, and Budd-Chiari syndrome were excluded. Despite symptomatic treatment, she deteriorated further and orthotopic liver transplantation was performed. Histopathology of the explanted liver further excluded ischemic Uver cell necrosis and Budd-Chiari syndrome. 

The triptans are contraindicated in patients who have a history of ischemic or vasospastic CAD, cerebrovascular or peripheral vascular disease, or other significant cardiovascular diseases. Because triptans may cause an acute, usually small, increase in blood pressure (BP), they also are contraindicated in patients with uncontrolled hypertension. Naratriptan is contraindicated in patients with severe renal or hepatic impairment. Rizatriptan should be used with caution in patients with renal or hepatic disease but is not contraindicated in such patients. Sumatriptan, rizatriptan, and zolmitriptan are contraindicated in patients who are taking monoamine oxidase inhibitors. 

Peptide mass fingerprinting can be performed by use of MALDI-FT-ICR [94,95]. For example, Przybylski and co-woikers applied MALDI-FT-ICR to the proteomic analysis of cryoglobulins from a hepatitis C patient [96], and to alveolar proteomics associated with proteinosis and cystic fibrosis [97]. Alternatively, LC can be coupled with ESI FT-ICR for peptide mass fingerprinting [94]. Among other applications, LC coupled with ESI-FT-ICR has been used in the proteomic analysis of Escherichia coli [98], the proteomic analysis of amniotic fluid [99], the identification of brain natriuritic peptide (BNP-32) in plasma following heart failure [100], and in the molecular differentiation of ischemic and valvular heart disease [101]. 

Key contraindications include congestive heart failure (New York Heart Association class II-IV), inadequately controlled hypertension with persistent BP elevation >140/90 mmHg, established ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease, active peptic ulceration or GI bleeding, creatinine clearance <30 mL/min, or severe hepatic dysfunction [4],... 

Santra S, McKiernan P, Lander A, Dalzell AM, Baillie C, Beath S, Gupte GL. Ischemic hepatitis is a risk factor for progression of liver disease associated with parenteral nutrition in intestinal failure. J Pediatr Gastroenterol Nutr 2008 47(3) 367-9. 

The results presented here must still be compared with a variety of other minimally invasive techniques. Transarterial chemoembolization is a procedure involving the injection of lipiodol and a chemotherapeutic agent into the hepatic artery. The intention is to produce selective ischemic injury to the tumor, which relies mainly on the arterial circulation. Ka nematsu et al. (1993) did the first comparative study between hepatic resection in 67 patients and transcatheter arterial embolization (TAB) in 20 patients with resectable disease. The 1-year, 3-year, and 5-year cumulative survival rates for 67 patients undergoing surgery were 89.1%, 74.6%, and 54.6% respectively and for the 20 patients treated with TAB, 90%, 50%, and 17.50% respectively. Surgery therefore provided more favorable results (Kanematsu et al. 1993). 

The existence and the extent of glucose production from the small intestine, the muscle and the brain, therefore continues to be a matter of debate. Any advancement in this field, however, will have the potential to change the way we consider the concept of liver and kidney reciprocity, the physiological response to exercise and to feeding, and the pathogenesis of many conditions like diabetes, hypoglycecemia, liver and hepatic failure, ischemic and nerrrodegenerative diseases. 

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