Humans ; Liver Cirrhosis ; diagnosis ; mortality ; physiopathology ; Logistic Models ; Prognosis

Liver cirrhosis is commonly associated with bleeding complications due to portal hypertension or coagulopathy. Spontaneous muscle hematoma is a rare but potentially lethal complication of liver cirrhosis. Here we report three cases of spontaneous muscle hematoma diagnosed in patients with alcoholic liver cirrhosis. All three patients died due to recurrent bleeding and liver failure although they had undergone repeated transcatheter arterial embolization of the actively bleeding vessels. We reviewed 14 cases of spontaneous muscle hematoma that were associated with liver cirrhosis, including our cases, and found that the mortality rate was 86%, despite early diagnosis and treatment. Cirrhosis-associated spontaneous muscle hematoma occurred more frequently in patients with alcoholic liver cirrhosis, who accounted for -93% of cases. Thus, spontaneous muscle hematoma should be considered a life-threatening complication in patients with alcoholic liver cirrhosis, and abstinence from alcohol may help to prevent the occurrence of this deadly condition.
Alcoholics* ; Early Diagnosis ; Fibrosis ; Hematoma* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Liver Failure ; Mortality

No abstract available.
Humans ; Liver Cirrhosis/*diagnosis/*mortality ; Liver Diseases/*diagnosis/*mortality ; Prognosis ; Severity of Illness Index ; Survival Rate ; Time Factors

Liver cirrhosis results from chronic liver injury that leads to necroinflammation and fibrosis. The development of liver cirrhosis is significantly associated with increased morbidity and mortality. Liver biopsy has been considered to be the gold standard for the diagnosis of liver cirrhosis, which is characterized by diffuse fibrosis and the development of regenerating nodules. However, liver biopsy is invasive and has some drawbacks, such as sampling error and intraobserver and interobserver variability in the assessment of fibrosis stages. Recently, various non-invasive tests such as serum markers, radiologic tests, and elastography have been investigated to overcome the limitations of liver biopsy. This review will focus on the use of these non-invasive tests for diagnosing liver cirrhosis.
Biomarkers ; Biopsy ; Diagnosis* ; Elasticity Imaging Techniques ; Fibrosis ; Liver Cirrhosis* ; Liver* ; Mortality ; Observer Variation ; Selection Bias

BACKGROUND/AIMS: The most widely used method for diagnosing sarcopenia is the skeletal muscle index (SMI). Several studies have suggested that psoas muscle thickness per height (PMTH) is also effective for detecting sarcopenia and predicting prognosis in patients with cirrhosis. The aim of this study was to evaluate the optimal cutoff values of PMTH for detecting sarcopenia in cirrhotic patients. METHODS: All cirrhotic patients who underwent abdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Two definitions of sarcopenia were used: (1) sex-specific cutoffs of SMI (≤52.4 cm² /m² in men and ≤38.5 cm² /m² in women) for SMI-sarcopenia and (2) cutoff of PMTH ( < 16.8 mm/m) for PMTH-sarcopenia. RESULTS: Six hundred fifty-three patients were included. The average age was 53.6 ± 10.2 years, and 499 patients (76.4%) were men. PMTH correlated well with SMI in both men and women (P < 0.001). Two hundred forty-one (36.9%) patients met the criteria for SMI-sarcopenia. The best PMTH cutoff values for predicting SMI-sarcopenia were 17.3 mm/m in men and 10.4 mm/m in women, and these were defined as sex-specific cutoffs of PMTH (SsPMTH). The previously published cutoff of PMTH was defined as sex-nonspecific cutoff of PMTH (SnPMTH). Two hundred thirty (35.2%) patients were diagnosed with SsPMTH-sarcopenia, and 280 (44.4%) patients were diagnosed with SnPMTH-sarcopenia. On a multivariate Cox regression analysis, SsPMTH-sarcopenia (hazard ratio [HR], 1.944; 95% confidence interval [CI], 1.144–3.304; P=0.014) was significantly associated with mortality, while SnPMTH-sarcopenia was not (HR, 1.446; 95% CI, 0.861–2.431; P=0.164). CONCLUSIONS: PMTH was well correlated with SMI in cirrhotic patients. SsPMTH-sarcopenia was an independent predictor of mortality in these patients and more accurately predicted mortality compared to SnPMTH-sarcopenia.
Diagnosis* ; Female ; Fibrosis ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Methods ; Mortality ; Muscle, Skeletal ; Prognosis ; Psoas Muscles* ; Sarcopenia*

BACKGROUNDS: Prognosis following surgery of gastric cancer has markedly improved as a result of early diagnosis, advances in operative techniques and perioperative managements. However, gastrointestinal surgery in patients with hepatic cirrhosis has continued to be associated with a high operative morbidity and mortality. The purpose of this retrospective study is to evaluate the prognostic factors on postoperative morbidity and survival in gastric cancer patients with hepatic cirrhosis. METHODS: We analysed 24 gastric cancer patients with hepatic cirrhosis between November 1994 and October 1999 (19 patients with Child A, 5 patients with Child B) to evaluate postoperative complications and survivals. RESULTS: There were no significant differences in age, sex, stage, operative types, and range of dissection between Child A and B. Postoperative complications occurred more commonly in the patients with more severe hepatic cirrhosis (Child A 5/19, Child B 4/5, p<0.05). There was no significant difference in 5-year survival rates between patients with Child A and B hepatic cirrhosis. Only the stage of cancer was proved to be the most significant prognostic factor. CONCLUSION: Patients with gastric cancer accompanied by hepatic cirrhosis can be successfully managed surgically on the basis of an appropriate preoperative assessment of hepatic conditions, proper selection of surgical procedures, and careful perioperative management.
Child ; Early Diagnosis ; Humans ; Liver Cirrhosis* ; Mortality ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: Community-acquired pneumonia(CAP) remains a leading cause of morbidity and mortality worldwide. Recently, the evolution of drug-resistant microorganisms has become a serious problem in CAP management. Specific antimicrobial therapy is the cornerstone of CAP management. However, obtaining an accurate etiologic diagnosis clinically is not easy and empirical antimicrobial treatment is usually administered prior to the correct microbiologic diagnosis. In this study, the clinical usefulness of empirical CAP treatment was investigated. METHODS: A total 35 cases were studied prospectively over a 16-month period in Mokpo Catholic Hospital from Dec. 1995 to Mar. 1997. The microbiologic diagnosis was made by sputum, blood culture, a specific serum antibody test and an immunologic study. RESULTS: The causative organisms were isolated in 10 (30%) out of 33 cases: 8 cases and 1 case on the sputum culture and blood culture respectively, and 1 case by an indirect hemagglutinin test. 12 cases had underlying diseases: pulmonary tuberculosis 4, alcoholism 4, diabetes mellitus 3, and liver cirrhosis 1. Antimicrobial treatment was given empirically and all cases recovered. CONCLUSION: A definite microbiologic diagnosis before commencing the appropriate treatment in CAP is not straightforward. Empirical therapy according to a clinical assessment is important and helpful. However, every effort to make the correct etiologic diagnosis should be taken.
Alcoholism ; Diabetes Mellitus ; Diagnosis ; Hemagglutinins ; Jeollanam-do* ; Liver Cirrhosis ; Mortality ; Pneumonia* ; Prospective Studies ; Sputum ; Tuberculosis, Pulmonary

Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone.
Anti-Bacterial Agents* ; Bacterial Infections ; Cellulitis* ; Diagnosis ; Gastrectomy ; Gastritis* ; Humans ; Liver Cirrhosis, Alcoholic ; Mortality

BACKGROUNDThe natural history of liver cirrhosis in China has not been well understood. This study aimed to elucidate the profile and development of the complications of liver cirrhosis as well as the mortality of those cirrhotics with miscellaneous complications.

METHODSWe assembled data from the clinical characteristics, especially from the profile complications of cirrhosis on admission, and collected information by telephone or interview with patients and/or their family members in clinic to evaluate the development of complications in 920 patients enrolled in a prospective non-randomized cohort study, and followed up from June 2006 to October 2010. Mortality was calculated using Kaplan-Meier analysis and Cox regress analysis. We employed both of the Child-Pugh scoring system and model for end-stage liver disease (MELD) scoring system to compare with the accordance and veracity between liver function and the long-term outcome.

RESULTSOn admission, only 7.4% patients had no complications, 44.5% patients with one complication (ascites, esophageal/gastric varices or hepatocellular carcinoma), 33.8% patients with two coexisting complications, and 7.5% patients had complications concurrently with ascites, esophageal/gastric varices and hepatocellular carcinoma. During the follow-up (mean follow-up time was 17 months, ranging from 1.0 to 52.2 months) of all the patients, 37.5% patients survived without new complications, 62.5% patients had new complications, and the overall mortality was 53.9%. Patients with one or more complications had higher mortality (total mortality, 1-year or 3-year mortality) and shorter mean survival time than those without any complication; the major cause of mortality of these cirrhotic patients was hepatocellular carcinoma (59%). Evaluated with the Child-Pugh score system, the total mortality in those with the scores more than 12 (class C) was 71.4%, the 1-year and 3-year mortalities were 57.1% and 71.4% respectively; while evaluated with the MELD scoring system, the mortality of those with the scores more than 30 was 58.6%, the 1-year and 3-year mortalities were 44.2% and 57.8% respectively.

Adult ; China ; Female ; Humans ; Liver Cirrhosis ; complications ; diagnosis ; mortality ; pathology ; Male ; Middle Aged

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*