Serum hepatitis

Adverse effects Diarrhea is the most common side effect of tolcapone. As expected, /evocfopa-related adverse effects increase when tolcapone is added. These include postural hypotension, nausea, sleep disorders, anorexia, dyskinesias, and hallucinations. Most seriously, fulminating hepatic necrosis is associated with tolcapone use. Baseline and frequent, regular determinations of hepatic serum enzymes are suggested by the manufacturer. Any elevations above normal are cause for discontinuation. Because of the hepatotoxicity, tolcapone should only be used as an adjunct in patients on levodopa/carbidopa who are experiencing symptom fluctuations. 

Acute hepatic damage has rarely been reported with DAMB. Asymptomatic increases in hepatic serum enzyme activities were seen in one case (94). 

Despite its ubiquitous distribution, serum NTP activities appear to reflect hepatobiliary disease with considerable specificity. NTP is increased threefold to sixfold in those hepatobiliary diseases in which there is interference with the secretion of the bile. This may be due to extrahepatic causes (a stone or tumor occluding the bile duct), or it may arise from intrahepatic conditions, such as cholestasis caused by chlorpromazine, malignant infiltration of the liver, or bihary cirrhosis. When parenchymal cell damage is predominant, as in infectious hepatitis, serum NTP activity is only moderately elevated. 

Even in patients with histologically proven alcoholic hepatitis, serum alkaline phosphatase may remain within reference limits. Green et al. (G21) found normal serum alkaline phosphatase values in 20 out of 46 patients with alcoholic hepatitis, while only 4 patients showed values greater than 2.5 times the upper reference limit. Bradus et al. (B39) described 83 patients whose liver biopsies showed fatty change but no evidence of cirrhosis. Mild increases in serum alkaline phosphatase (up to 2.5 times the upper reference limit) were found in about 50%. 

Study of the mechanism of Madagan s thjrmol turbidity test (42, 49, 218) indicates some alteration in the amount or type of phospholipide bound to 3-globulins in hepatitis serum. Cohen and Thompson (49) found that addition of thymol reagent causes a marked decrease in the... 

Lewis, J. E., Mello, P. and Knauer, C. M. (1975) Isoniazid-associated hepatitis Serum enzyme determinations and histologic features. West. J. Med., 122, 371. 

Multidimensional LC has also been used to determine ursodeoxycholic acid and its conjugates in serum (14). These compounds are used in the treatment of cholesterol gallstones, hepatitis and bilary cirrhosis. These authors employed a traditional (10 X 4 mm) pre-column and a micro-bore (35 X 2 mm) analytical column that were interfaced by using a six-port switching valve. 

Intestinal absorption of digoxin is less complete compared to digitoxin. In order to improve absorption, acetylated- and methylated-digoxin derivates were developed. Digitoxin is metabolised in hepatic microsomal enzymes and can be cleared independently from renal function. The therapeutical serum level of digoxin is 0.5-2.0 ng/ml and 10-35 ng/ml of digitoxin. Steady state plateau of therapeutic plasma concentrations is reached after 4-5 half-life-times using standard daily doses [5]. 

HBV infection remains a major worldwide public health problem. The World Health Organization estimates that there are still 350 million chronic carriers of the vims, who are at risk of developing chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The success of IFN-a treatment - mainly performed as combined treatment with adenine-arabinoside - has been measured by the normalization of liver enzymes, loss of HBe antigen and of detectable viral DNA in the serum of patients. It has been estimated from several clinical trials that as many as 40% of treated HBV patients would respond to therapy with IFN-a or combined treatment with nucleoside analogues and IFN-a. 

Hepatocellular carcinoma (HCC) develops in patients with chronic liver diseases associated with hepatitis B and hepatitis C vims infections with high incidences. Here, an acyclic retinoid has been shown to suppress the posttherapeutic recurrence after interferon-y or glycerrhicin treatment in cirrhotic patients who underwent curative treatment of preceding tumors. The retinoid induced the disappearance of serum lectin-reactive a-fetoprotein (AFP-L3), a tumor marker indicating the presence of unrecognizable tumors in the remnant liver, suggesting a deletion of such minute (pre)malignant clones (clonal deletion). As a molecular mechanism of the clonal deletion, a novel mechanism of... 

Older adults are particularly susceptible to a potentially fatal hepatitis when taking isoniazd, especially if they consume alcohol on a regular basis. Two other antitubercular drugs rifampin and pyrazinamide, can cause liver dysfunction in the older adult. Careful observation and monitoring for signs of liver impairment are necessary (eg, increased serum aspartate transaminase, increased serum alanine transferase, increased serum bilirubin, and jaundice). 

Serum levels (digoxin) may be ordered daily during the period of digitalization and periodically during maintenance therapy. Periodic electrocardiograms, serum electrolytes, hepatic and renal function tests, and other laboratory studies also may be ordered. 

The primary health care provider may also order laboratory and diagnostic tests, renal and hepatic function tests, complete blood count, serum enzymes, and serum electrolytes. The nurse reviews these test results before the first dose is given and reports any abnormalities to the primary health care provider. The patient is usually placed on a cardiac monitor before aiitiarrhytiuiric drug therapy is initiated. The primary health care provider may order an ECG to provide baseline data for comparison during therapy. 

When these drugs are given to the female patient with inoperable breast carcinoma, tire nurse evaluates the patient s current status (physical, emotional, and nutritional) carefully and records tire finding in tire patient s chart. Problem areas, such as pain, any limitation of motion, and the ability to participate in tire activities of daily living, are carefully evaluated and recorded in tiie patient s record. The nurse takes and records vital signs and weight. Baseline laboratory tests may include a complete blood count, hepatic function tests, serum electrolytes, and serum and urinary calcium levels. The nurse reviews these tests and notes any abnormalities. 

Data from a single study in dogs suggest that hepatic first-pass metabolism may limit systemic availability of the parent compound following oral exposure (Braeckman et al. 1983). Placental transfer of methyl parathion was demonstrated in pregnant rats 1-3 days before parturition. Thirty minutes after administration, both methyl parathion and methyl paraoxon were found in fetal brain, liver, and muscle methyl parathion, but not methyl paraoxon, was detected in placenta and maternal liver (Ackermann and Engst 1970). Methyl parathion binds reversibly to serum albumin, but is readily distributed to the tissues (Braeckman et al. 1980, 1983). 

Worldwide, 15 million HBsAg carriers are also infected with hepatitis D/delta virus (HDV) (Gaeta et al. 2000). This situation represents a major therapentic challenge, as most of these patients have advanced liver disease, inclnding cirrhosis in 60-70% of cases, and hepatocellular carcinoma (Fattovich et al. 2000 Saracco et al. 1987). No specific HDV inhibitors have been developed, and IFN-a-based treatment is more difficnlt in HBV-HDV infection than in HBV monoinfection. HDV RNA levels in sernm can be nsed to monitor treatment efficacy. The endpoint of therapy is HDV RNA clearance and ALT normalization, and this is sometimes achieved after the end of treatment. A snstained response can lead to HBsAg clearance from serum. 

Lampertico P, Del Ninno E, Manzin A, Donato MF, Rumi MG, Lunghi G, Morabito A, Clementi M, Colombo M (1997) A randomized, controlled trial of a 24-month course of interferon alfa 2b in patients with chronic hepatitis B who had hepatitis B virus DNA without hepatitis B e antigen in serum. Hepatology 26 1621-1625... 

Pastore G, Santantonio T, Milella M, Monno L, Mariano N, Moschetta R, PolUce L (1992) Anti-HBe-positive chronic hepatitis B with HBV-DNA in the serum response to a 6-month course of lymphoblastoid interferon. J Hepatol 14 221-225 Pawlotsky JM (2006) Therapy of hepatitis C from empiricism to eradication. Hepatology 43 S207-S220... 

Ribavirin is a guanosine analog synthesized more than 35 years ago, which possesses broad-spectrum antiviral activity against several RNA and DNA viruses in vitro (Sidwell et al. 1972). When administered as monotherapy in patients with chronic hepatitis C, ribavirin induces a decline of serum alanine aminotransferase (ALT) levels while no effect on sustained virologic response is detectable (Di Bisceglie et al. 1992). 

Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, Huang GT, Iloeje UH (2006) Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 295(l) 65-73... 

Musc/skel Hepatic 2.6 2.6 (elevated serum alkaline ... 

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