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Biomedical subjects

S Sherlock

Publications and source records attributed to S Sherlock.

At least 19 recordsLinked to original sources
PubMed2000

Primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune cholangitis.

Primary biliary cirrhosis (PBC), and autoimmune cholangitis are presumed to be autoimmune cholestatic diseases, but the relevant antigens are unknown. Primary biliary cirrhosis is diagnosed by a positive serum mitochondrial antibody test. It usually affects women and has a very long course, culminating in liver transplantation or death. Ursodeoxycholic acid is probably the appropriate treatment. Primary sclerosing cholangitis (PSC) is marked by progressive destruction of extrahepatic and intrahepatic bile ducts. There is no specific diagnostic test or treatment. Cholangiocarcinoma is the dreaded complication and precludes liver transplantation, the only chance of a cure. Autoimmune cholangitis overlaps PBC and autoimmune chronic hepatitis. It is a rare condition, resembling PBC but with a negative serum mitochondrial antibody test; however, serum antinuclear antibodies and smooth muscle antibodies are present in high titers.

Autoimmune Diseases↗
PubMed1999

The hepatic flaviviridae: summary.

Hepatitis C envelope proteins (E1, E2) induce protective neutralizing antibodies. The extent of sequence diversity reflects the host's ability to control viral populations and the response to antiviral therapy. Attempts to prepare effective vaccines against HCV are foiled by lack of prolonged protective immunity. Plasmid vaccines and the use of uninfectious virus-like particles are being developed. HCV induces a cellular humoral immune response, but this is inadequate to clear the virus and the disease becomes chronic. In any patient, the natural history of HCV infection depends on the age when infected, and the presence of other diseases. The transfusion-related disease has a worse prognosis than that transmitted by syringes and needles. The outlook in 'healthy blood donors' is uncertain. Interferon therapy for 3 or preferably 6 months results in a sustained response in about 30% of patients. Negative serum HCV RNA and normal AST values after 3 months of therapy indicates that there may be a sustained response. Whether or not to stop treatment at that time if HCV is still positive remains a matter of debate. The role of interferon treatment in preventing progression to cirrhosis and hepatocellular cancer is still uncertain. Ribavirin therapy alone reduces transaminases and hepatic histology improves. Improved results follow the combination of ribavirin with interferon. Ribavirin may have immuno-modularity and anti-inflammatory actions. Hepatitis G virus (HGV) is unlikely to play a significant role in liver disease in man.

Animals↗
PubMed1998

Focal nodular hyperplasia in a young female.

A 41-year-old woman, who was taking oral contraceptive drugs, presented with a symptomless hepatic mass lesion shown by abdominal ultrasound. Doppler ultrasound, computed tomography (unenhanced and enhanced with contrast) and magnetic resonance imaging after intravenous gadolinium suggested this was focal nodular hyperplasia. Ultrasound-guided liver biopsy had been performed elsewhere and was also diagnostic. The differential diagnosis of hepatic mass lesion is illustrated and particularly the distinction of focal nodular hyperplasia from adenoma. The importance of radiological imaging techniques is stressed. Clinical management is discussed.

Adult↗
PubMed1998

Overview of chronic cholestatic conditions in adults: terminology and definitions.

The cholangiopathies represent diseases and syndromes affecting the biliary system at any site between the canals of Hering and the ampulla of Vater. Hepato-canalicular cholestasis reflects biliary secretory failure of the hepatocyte caused by disturbances of intracellular organelles or damage to the bile canalicular excretory functions. Drug reactions are related especially to antibiotics, phenothiazine derivates and carbamazepine. Immune-mediated cholangiopathies cause destruction and reduction of interlobular bile ducts, and are sometimes called vanishing bile duct diseases. They include primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune cholangitis, chronic hepatic allograft rejection, graft-versus-host disease and chronic cholestatic sarcoidosis. Ischemic (vascular) cholangiopathies include traumatic, hepatic arteritis and mechanical causes. Infectious cholangiopathies usually are associated with the immunosuppressed patient.

Autoimmune Diseases↗
PubMed1998

Carbon dioxide embolism following diagnostic hysteroscopy.

A 50-year-old woman ASA 2 underwent carbon dioxide hysteroscopy under general anaesthesia. Monitoring showed a sudden and rapid fall in end-tidal carbon dioxide followed by oxygen desaturation. She became pulseless and cyanosed. Resuscitation with oxygen, intravenous adrenaline and head-down tilt restored her to haemodynamic stability. Hyperbaric therapy was also administered as air embolism could not be excluded.

Anesthesia, General↗
PubMed1998

Ludwig Symposium on biliary disorders. Autoimmune cholangitis: a unique entity?

Overlap syndromes between cholestatic autoimmune chronic hepatitis and primary biliary cirrhosis are being increasingly discussed. The diagnosis depends particularly on the pattern of serum autoantibodies, whether suggestive of one condition or the other. The autoantibodies have an important diagnostic role, but their contribution in mediating bile duct and hepatocellular injury is uncertain. In this report, five patients (three women and two men) are described with hepatic histologic features resembling primary biliary cirrhosis but with negative results for serum antimitochondrial antibody (M2) tests. Serum antinuclear antibody of diffuse type is strongly positive. The serum transaminase levels are 4 to 6 times the upper limit of normal, and serum gamma-glutamyl transpeptidase values are substantially increased. The response to prednisolone therapy is partial: inflammation is reduced, but the serum gamma-glutamyl transpeptidase level remains high and bile duct lesions persist. This condition, which is an overlap between primary biliary cirrhosis and autoimmune hepatitis, has been termed "autoimmune cholangitis." Treatment with ursodeoxycholic acid is recommended, and prednisolone therapy may be considered even though beneficial results have not been impressive.

Adolescent↗
PubMed1996

Hepatitis C virus: a historical perspective.

Identification and diagnosis of the infecting agent responsible for hepatitis C have only recently occurred. Recognition of an infecting agent distinct from that resulting in hepatitis A or B was made approximately 50 years ago. However, the ability to screen and detect this agent was possible only after molecular biology studies which led to the cloning of parts of the hepatitis C virus (HCV) and the development of a diagnostic antibody test reported by Michael Houghton and colleagues in 1989. The discovery and cloning of HCV has led to a greater understanding of its relationship to acute and chronic hepatitis, cirrhosis, primary liver cancer, and extrahepatic conditions including essential cryoglobulinemia, glomerulonephritis, and serum autoantibody positivity. New antibody tests and quantitation of HCV-RNA have allowed better diagnosis of infectivity and monitoring of treatment effects. HCV genotypes are being related to the natural history of the disease and the effects of treatment. Research continues on HCV hepatitis and other newly identified viral hepatitis agents.

Animals↗
PubMed1995

VI International Symposium on Viral Hepatitis: summary.

The VI International Symposium on Viral Hepatitis was held in Madrid, Spain, 3-5 February 1994, under the chairmanship of Dr Vicente Carreño. Over 800 attended from more than 30 countries. Considerable advances have been made since the fifth conference, which was held in 1992. These relate particularly to the role of hepatitis B virus (HBV) mutants and hepatitis C virus (HCV) genotypes and the prolonged assessment of interferon and its side-effects. The role of newer antiviral drugs alone or in combination was stressed. Emphasis was on assessment by serum markers of the actual virus, HBV-DNA and HCV-RNA, rather than by nonspecific serum transaminase estimations.

Antiviral Agents↗
PubMed1995

Antiviral therapy for chronic hepatitis C viral infection.

Hepatitis C affects at least 200 million people worldwide. It can be followed by chronic hepatitis, cirrhosis, and primary liver cancer. Outcome assessments in controlled trials of antiviral therapy are based on serum transaminase values, serum HCV-RNA determinations, and liver biopsy scores. Patients most likely to respond to antiviral treatment are relatively young, have low serum HCV-RNA and transaminase levels, and do not have cirrhosis. Patients whose disease is caused by genotype 1b HCV isolates are unlikely to respond. Interferon alfa (3 million units [MU] three times a week for 6 months) is associated with a 50% response rate and a 50% relapse rate--an overall response rate of 25%. Increasing the duration of therapy may increase the sustained response rate. Ribavirin, given orally, may be used for patients who fail to respond to or relapse after interferon therapy. Its side effects are few. Treatment results in a fall in transaminase levels and some decrease in hepatic inflammation, but serum HCV RNA (viral titer) is unaltered. Combinations of interferon with ribavirin are giving promising results with increased sustained, complete responses.

Antiviral Agents↗
PubMed1994

Primary biliary cirrhosis: clarifying the issues.

Primary biliary cirrhosis is a disease of unknown etiology characterized by the destruction of small intrahepatic bile ducts, probably on an immunologic basis. The disease predominantly affects females. Serum biochemical tests reveal cholestasis, and a serum mitochondrial antibody is usually present. Other diseases, largely autoimmune, may be associated. Main extra- and intrahepatic bile ducts are patent. Treatment is symptomatic, and particular attention must be paid to the control of pruritus and to the prevention of fat-soluble vitamin and calcium deficiencies. Many immunosuppressant drugs have been tested but largely abandoned because of their failure to prolong life, inability to improve hepatic histology, or side-effects. Hepatic transplantation is the ultimate solution and should be considered sooner rather than later. The disease probably recurs in the transplanted liver.

Diagnosis, Differential↗