Blindness, Cortical ; etiology ; Chemical and Drug Induced Liver Injury ; complications ; Humans ; Liver Diseases ; complications

Aspergillosis ; complications ; Aspergillus ; Chemical and Drug Induced Liver Injury ; complications ; microbiology ; Humans

The study of the epidemiology of toxic liver injury has been limited in Korea. The number of hospitalizations for toxic liver injury has been estimated to be 2,400 persons per year. About 30~40% of fulminant hepatitis was attributed to toxic hepatitis. The frequent causative agents of toxic hepatitis in Korea are herbal medicines (34~40%), folk remedies (23~34%), and prescribed medicines (24~55%). However, the most common agents causing severe liver injury including fulminant hepatitis are herbal medicine and folk remedies. Antituberculosis drugs and acetaminophen are two common causes of fulminant hepatitis among prescribed drugs. Alcohol is one of the leading causes of chronic liver disease in Korea. No nationwide study on the epidemiology of alcoholic liver disease (ALD) has been carried out, but 7~31% of cirrhosis has been reported to be alcoholic in a few single-center studies. Alcohol could be a risk factor for the development of hepatocellular carcinoma (HCC) in chronic viral hepatitis. Several studies have shown that alcohol increased the risk of HCC in liver cirrhosis with HBsAg or anti-HCV. Furthermore, alcoholic cirrhosis with occult hepatitis B virus infection increased the risk of HCC.
Drug-Induced Liver Injury/diagnosis/*epidemiology/etiology ; Humans ; Korea/epidemiology ; Liver Cirrhosis, Alcoholic/complications/epidemiology ; Liver Diseases, Alcoholic/complications/*epidemiology ; Liver Neoplasms/etiology ; Risk Factors

Abdominal Pain ; etiology ; Adult ; Chemical and Drug Induced Liver Injury ; etiology ; Drug Eruptions ; complications ; therapy ; Humans ; Male ; Nausea ; etiology ; Treatment Outcome

OBJECTIVETo investigate the etiology of 1977 patients from northern China with acute (ALF), sub-acute (SALF) or acute-on-chronic liver (ACLF) failures.

METHODThe age, gender, etiology, pathogenesis, and prognosis of the 1977 patients with liver failures were retrospectively analyzed.

RESULTSOf the 1977 cases, the three most common causes of ALF were HEV (33.96%) or HBV (13.21%) infections or those caused by medicines (9.43%). The three predominant causes of SALF were medicines (31.53%), HEV (16.22%) or HBV (9.91%) infections, but those of the ACLF were HBV (90.29%) infection, alcoholic hepatopathy (2.65%), and HBV super infected with HEV (2.26%) infections. 90.09% (1781) patients were infected by hepatotropic viruses. Of these 1781 patients, the most common cause of their liver failures was HBV infection (92.93%). In these HBV infected patients, 77.10% were from 26 to 55 years old. From 2005 to 2007, there were 39 patients with alcoholic liver failure. In the past two years, there were 23 patients with drug induced liver failure. The improvement rate of the 1977 patients after their treatments was 35.56%. The improvement rate of HEV infected liver failure was higher than drug induced liver failure (P less than 0.05); no statistical significance was found between other groups (P more than 0.05).

CONCLUSIONDifferent types of liver failure have different predominant causes. HBV infection is the most common cause in our 1977 patients. In the past two years, the number of drug induced liver failures and alcoholic liver failures have been increasing.

Acute Disease ; Adult ; Chemical and Drug Induced Liver Injury, Chronic ; etiology ; Chronic Disease ; Female ; Hepatitis B ; complications ; Hepatitis E ; complications ; Humans ; Liver Diseases, Alcoholic ; etiology ; Liver Failure ; chemically induced ; classification ; etiology ; virology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

Herbal remedies and health foods are widely used, and their side effects have been reported. We describe two cases of symptomatic toxic hepatitis that developed in middle-aged women after ingesting arrowroot juice. The clinical manifestations were nausea, vomiting, and jaundice. The diagnosis of toxic hepatitis was made using the Roussel Uclaf Causality Assessment Method score on the basis of the patient's history and laboratory data. After supportive care, the patients showed rapid improvements of clinical symptoms, laboratory findings, and liver stiffness. Clinicians should be aware that the consumption of arrowroot juice can cause toxic hepatitis.
Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Drug-Induced Liver Injury/complications/*diagnosis/ultrasonography ; Elasticity Imaging Techniques ; Exanthema/complications ; Female ; Humans ; Marantaceae/*chemistry ; Middle Aged ; Plant Extracts/*toxicity

Amiodarone is a di-iodated benzofuran derivative that is commonly used to treat patients with various cardiac arrhythmias. It is associated with side effects that involve the liver, thyroid, and other organs. Approximately 1-3% of patients treated with amiodarone suffer from symptomatic liver disease. Thyroid dysfunction occurs in 10% of patients treated with amiodarone. A 65-year-old woman with coronary heart disease and atrial fibrillation was administered with amiodarone. She developed nausea, vomiting, dyspepsia, and sweating within 9 months of amiodarone administration (200 mg orally once a day). Results of the laboratory finding showed increased hepatic enzymes, and low thyroid hormone levels. A liver biopsy showed irregular arrangement of hepatocytes and diffuse micro- and macrovesicular fatty changes. Electron microscopy findings showed pleomorphic mitochondria with crystalloid inclusions and membrane-bound lysosomal structures. The liver and thyroid functions returned to normal, after the amiodarone was stopped. We describe an unusual case in which amiodarone induced hepatitis and hypothyroidism simultaneously. Physicians should take a close look to the adverse event when using amiodarone which can cause adverse effects in multiple organs.
Aged ; Amiodarone/*adverse effects/therapeutic use ; Arrhythmias, Cardiac/drug therapy ; Drug-Induced Liver Injury/*complications/pathology/*radiography ; Female ; Fibrosis/pathology ; Humans ; Hypothyroidism/*chemically induced/*complications ; Microscopy, Electron ; Mitochondria/drug effects/metabolism ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: The importance of postoperative management of those who have undergone intracardiac repair for congenital heart diseases has increased in recent years. In this study, we investigated postoperative complications and their relations to preoperative age or duration of the intubation and artificial ventilation in infants with large symptomatic ventricular septal defect. METHODS: Between January, 1993 and December, 1996, sixty infants underwent primary closure of a ventricular septal defect (VSD). The patients were divided into two groups based on preoperative age : group 1, infants aged 6 month or less (n=40), and group 2, infants aged more than 6 month (n=20). And, another three groups were divided into 3 groups due to the duration of the intubation and artificial ventilation including < 24 hour and 24-48 hour, >48 hour, respectively. We compared the incidence of complications such as infection, respiratory or cardiovascular complications among each group. RESULTS: No specific differences between two age groups were found, but the incidence of right bundle branch block was high in age group of 6 month or less (P<0.05). The incidence of sepsis was high in group of >48 hour (P<0.05). And also, arrhythmias, atelectasis, toxic hepatitis were more frequently observed in the former group. CONCLUSION: These results indicate that early weaning of the artificial ventilation in infants with large symptomatic ventricular septal defect could protect them from development of severe life- threatening infection such as sepsis. We suggest 48 hours or less as the optimal duration of artificial ventilation. Additionally, earlier weaning could provide earlier oral feeding or earlier ambulation, which is improve respiratory homeostasis.
Arrhythmias, Cardiac ; Bundle-Branch Block ; Drug-Induced Liver Injury ; Heart Diseases ; Heart Septal Defects, Ventricular* ; Homeostasis ; Humans ; Incidence ; Infant* ; Intubation ; Postoperative Complications* ; Pulmonary Atelectasis ; Sepsis ; Ventilation* ; Walking ; Weaning

Acute liver failure (ALF) is a rare condition in which rapid deterioration of liver function results in altered mentation and coagulopathy in individuals without previously recognized liver disease. The outcomes of patients with ALF vary greatly according to etiology, and the etiology of ALF varies markedly by geographical region. In Korea, about 90% of ALF are associated with etiologies that usually result in poor outcomes, including hepatitis B virus (HBV) infection and herbal remedies. The main causes of death in patients with ALF are increased intracranial pressure, systemic infection, and multi-organ failure. Recent advances in the intensive care of patients with ALF have contributed to a marked improvement in their overall survival. Emergency adult to adult living-donor liver transplantation (LDLT) can be performed expeditiously and safely for patients with ALF, and greatly improves survival rate as well as deceased-donor transplantation. As the window during which transplantation is possible is limited, emergency adult LDLT should be considered to be one of the first-line treatment options in patients with ALF, especially in regions in which ALFs are caused by etiologies associated with poor outcome and the supply of organs is very limited.
Drug-Induced Liver Injury/complications ; Hepatitis B/complications ; Humans ; Kidney Failure, Acute/etiology ; Liver Failure, Acute/*etiology/mortality/therapy ; Liver Transplantation ; Prognosis ; Republic of Korea ; Respiration Disorders/etiology ; Survival Rate

BACKGROUND/AIMS: Drug-induced liver injury (DILI) is a frequent cause of pediatric liver disease; however, the data on DILI are remarkably limited. METHODS: All 69 children hospitalized with DILI between January 2009 and December 2011 were retrospectively studied. RESULTS: A total of 37.7% of the children had medical histories of respiratory infection. The clinical injury patterns were as follows: hepatocellular 89.9%, cholestatic 2.9%, and mixed 7.2%. Liver biopsies from 55 children most frequently demonstrated chronic (47.3%) and acute (27.3%) hepatitis. Hypersensitivity features, namely, fever (31.9%), rash (21.7%), and eosinophilia (1.4%), were found. Twenty-four children (34.8%) developed chronic DILI. Antibiotics (26.1%) were the most common Western medicines (WMs) causing DILI, and the major implicated herbs were Ephedra sinica and Polygonum multiflorum. Compared with WM, the children whose injuries were caused by Chinese herbal medicine (CHM) showed a higher level of total bilirubin (1.4 mg/dL vs 16.6 mg/dL, p=0.004) and a longer prothrombin time (11.8 seconds vs 17.3 seconds, p=0.012), but they exhibited less chronic DILI (2/15 vs 18/39, p=0.031). CONCLUSIONS: Most cases of DILI in children are caused by antibiotics or CHM used to treat respiratory infection and present with hepatocellular injury. Compared with WM, CHM is more likely to cause severe liver injury, but liver injury caused by CHM is curable.
Anti-Bacterial Agents/*adverse effects ; Bilirubin/blood ; Child ; Child, Preschool ; China ; Drug-Induced Liver Injury/blood/*etiology/pathology ; Drugs, Chinese Herbal/*adverse effects ; Female ; Humans ; Liver/pathology ; Male ; Prothrombin Time ; Respiratory Tract Infections/*complications/drug therapy ; Retrospective Studies