Duodenal variceal bleeding treated with a transjugular intrahepatic portosystemic shunt.
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Biomedical subjects
Publications and source records attributed to P Sort.
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Gram negative infections, particularly by E. coli, are usually observed in cirrhotic patients while infections by Cryptococcus neoformans are commonly found in immunosuppressed patients. The case of a cirrhotic patient with hepatitis C virus infection who developed pleural infection by C. neoformans is presented. No disease other than cirrhosis was observed in the patient. The treatment with oral fluconazole was initiated with good clinical response and infection cure. The efficacy of fluconazole in infections by this microorganism has been reported in other cases, mainly in patients with acquired immunodeficiency syndrome. The fact that the patient may be a liver transplant candidate, given the hepatic cirrhosis, leads to speculation as to the need for chronic treatment with fluconazole to avoid reactivation of C. neoformans on initiation of pharmacologic immunosuppression.
The hepatorenal syndrome is a severe and common complication of patients with advanced cirrhosis and ascites. It is characterised not only by renal failure but also by marked alterations in systemic haemodynamics. Renal failure is due to a marked hypoperfusion of the kidney secondary to renal vasoconstriction. Although the pathogenesis of hepatorenal syndrome is not completely understood, it is thought to be the extreme manifestation of the underfilling of the arterial circulation secondary to an arterial vasodilation, located mainly in the splanchnic circulation. Recently, a revised definition and diagnostic criteria of hepatorenal syndrome have been proposed. The prognosis of patients with hepatorenal syndrome is very poor. Liver transplantation is the only effective treatment but it is not applicable in most cases due to short survival. New therapies developed during the last years, such as the use of systemic vasoconstrictors or transjugular intra-hepatic portosystemic shunts appear to be promising, but prospective investigations are needed to delineate their real usefulness.