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Biomedical subjects

J L Achord

Publications and source records attributed to J L Achord.

At least 19 recordsLinked to original sources
PubMed1992

Spontaneous bacterial peritonitis in cirrhosis: clinical and laboratory features, survival and prognostic indicators.

This is a retrospective study of 35 patients with spontaneous bacterial peritonitis and liver cirrhosis identified between 1981 and 1989. The mean age of all patients was 44 years, with a range of 16 to 68. Criteria for spontaneous bacterial peritonitis included either a positive ascites culture with a polymorphonuclear cell concentration greater than 250 cells per mm3 (18 cases) or a negative ascitic fluid culture with a polymorphonuclear cell count greater than 500 cells per mm3 and no evident intra-abdominal source of infection (17 cases). Twenty-one patients were male and 14 female. The most frequent presenting symptoms were abdominal pain and fever, noted in 20 (57%) and 19 (54%) patients, respectively, while 5 patients (14%) were completely asymptomatic. The overall mortality in this series was 54% (19 of 35 patients). The presence of encephalopathy or renal insufficiency was associated with a high mortality rate (73% and 87%, respectively). Encephalopathy was present in 67% of the non-survivors, but in only 25% of the survivors (p < 0.0025); likewise, renal failure was observed in 68% of the non-survivors, but in only 12.5% of those who survived (p < 0.001). The use of newer-generation cephalosporins and penicillins led to a diminished mortality (42%) as compared with that (64%) observed in patients treated with conventional antibiotic regimens.

Adolescent↗
PubMed1991

The clinical management of cirrhosis.

The discipline of hepatology is being rapidly advanced by several methods of investigation, most notably those of molecular and genetic biology. The polymerase chain reaction holds very great promise in unraveling the implications of hepatic virus infections. At the present time, we have no method of reversing established cirrhosis, and those with life threatening impairment of liver function can only look to liver transplants for salvage. The clinician can therefore best serve by identifying liver disease before cirrhosis and its complications occur. With effective case finding, and the continued development of therapeutic interventions directed toward known or suspected etiologic and pathogenic factors, many productive, high-quality years can be added to the lifespans of many patients.

Alcohol Drinking↗
PubMed1991

Peritoneal blastomycosis.

Blastomycosis is a systemic fungal infection caused by Blastomyces dermatitidis. Involvement of the peritoneum is unusual, with only two previously reported cases that occurred in association with disseminated disease. A single case of histopathologically proven blastomycosis involving the peritoneum is presented, as well as a short overview of previously published cases on gastrointestinal and peritoneal blastomycosis. The case is unique in that chronic peritonitis was the only manifestation of disease. The diagnosis was made by laparoscopy.

Adult↗
PubMed1989

Cirrhosis of the liver: new concepts.

Cirrhosis is a histologic term that requires liver biopsy for definitive diagnosis. Although we may usefully classify cirrhosis by cause, such as alcoholic cirrhosis, the morphologic diagnosis is confined to only a few descriptive terms. Cirrhosis is the end result of hepatocellular necrosis that initiates the inflammatory process. Hepatocellular necrosis induced by the hepatoviruses is caused by the host response to the parasitized cells rather than by the viruses themselves. Inflammatory cells, apparently by diverse mechanisms that include the immune system, stimulate the deposition of collagen around hepatocytes and in sinusoidal membranes, causing profound alteration in hepatocyte function and hepatic blood flow. Fully developed cirrhosis cannot be reversed with therapy presently available. Efforts to change morbidity and mortality of this common disease include preventive measures, attempts to manipulate the immune response, efforts to influence the biologic process of fibrosis, and, finally, attempts to induce resorption of established collagen. No acceptable therapy to prevent cirrhosis currently exists, but there is reason to believe that one can and will be developed in the future, probably through the discovery of better methods of eliminating the persistent infection by hepatoviruses. The most encouraging results to date come from experiments using prednisone followed by interferon, and from very preliminary results with methotrexate in specific circumstances. In the meantime, the clinician will continue to support the existing physiology, minimize and treat the complications, and offer support to the patient and family.

Humans↗