RESUMO
Five cases (four females, one male) of ketoconazole-related liver damage are presented, two of whom died. All patients received ketoconazole (400 mg/day) for various mycoses. In the four women the first signs of hepatotoxicity appeared after four weeks of therapy. One fatal case developed massive necrosis with fulminant liver failure and the other, submassive necrosis. In four cases cholestasis was a prominent finding. Biochemical evidence of biliary stasis may persist for several months, as occurred in the three surviving patients of our series. The two fatal cases continued receiving the drug in spite of its adverse effects. Consequently, repeated evaluation is recommended to detect early signs of liver environment.
Assuntos
Antifúngicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas , Cetoconazol/efeitos adversos , Adulto , Idoso , Evolução Fatal , Feminino , Humanos , Fígado/patologia , Hepatopatias/patologia , Masculino , Pessoa de Meia-Idade , NecroseRESUMO
Primary biliary cirrhosis is a chronic disease of presumed autoimmune etiology, generally associated with other systemic abnormalities such as scleroderma, characteristic of Sjogren's syndrome and Raynaud's syndrome, for which pruritus is the most troublesome symptom. Treatment of this disease is a major unsolved problem. Although the use of cholestyramine has been effective, a considerable number of cases are refractory to the drug and to other agents such as corticosteroids, azathioprine and penicillamine. Plasma exchange has proven to be a useful option in four female patients with primary biliary cirrhosis--two with grade III histology and the other two with grade IV disease and intractable pruritus. The procedure was well tolerated and no side effects were observed. There was a temporary but significant attenuation of pruritus and improvement of melanoderma. Intensive plasma exchange is proposed as an alternative therapy in primary biliary cirrhosis with refractory pruritus.
Assuntos
Cirrose Hepática Biliar/terapia , Plasmaferese , Prurido/terapia , Idoso , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Over a seven-year period, we monitored 221 patients with chronic hepatitis from two medical centers. By using the counterlectrophoresis (CEP) test to detect the presence of HBsAg and anti-HBc, or both, we established that 87.7% of them had hepatitis B infection. Serum specimens originally found negative for HBsAg by CEP were further tested by reversed passive hemagglutination (RPH), and those originally found negative for anti-HBc by CEP were further tested by radioimmunoassay (RIA). Five patients were anti-HBc-positive and HBs-Ag-negative. No sex predominance was observed, but HBsAg incidence increased with increasing age. The HBeAg antigen was detected in 46.8% of the 161 cases tested for it; the most frequent subtype found was adw (63.7%). The present findings indicate that HBV infection largely contributes to the development of chronic hepatitis in Argentinian patients.