1/4. Acute lymphoblastic leukemia presenting as acute hepatic failure in childhood.We report a 7-year old white girl who was admitted because of acute severe hepatic failure. Her complete blood count revealed pancytopenia and a bone marrow aspiration was consistent with acute lymphoblastic leukemia (ALL). Blasts cells were positive for cytoplasmic CD3 and cell surface T-associated markers. Viral, metabolic, immune and toxic causes for hepatic failure were ruled out. Treatment pre-phase with prednisone was started and liver function tests clearly improved after one-week therapy. However, due to her hepatic insufficiency, daily etoposide was administered orally during 15 days. On day 33 complete remission was achieved and hepatic function was normal, except for an increase in the bilirubin level which normalized on day 72. She received our current treatment for intermediate risk ALL and is still receiving continuation phase therapy, currently, with normal liver function and good tolerance to chemotherapy 8 months after achieving complete remission.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
2/4. Emerging indications for mars dialysis.mars stands for Molecular Adsorbent Recirculating System and represents an interesting option in treating patients with liver disease. There is still little known about the best time point of initiating this treatment and the exact selection criteria for patients who may benefit from this therapy. The list of potential applications using this procedure is expanding. We report on the experience in seven patients being treated with mars dialysis for chronic cholestatic liver disease and acute on chronic liver failure. From August 2000 to October 2001 seven patients received 27 mars treatments in our clinic, ranging from 2 to 12 treatments per subject. Presented cases were diagnosed as steatohepatitis because of alcoholism (n = 3), vanishing bile duct disease (n = 1), metabolic liver disease (n = 1), primary biliary cirrhosis (n = 1) and drug-induced hepatitis (n = 1). Based on this experience, we discuss the ongoing questions of various indications and the decision to initiate mars dialysis.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
3/4. Successful treatment of an adult with amanita phalloides-induced fulminant liver failure with molecular adsorbent recirculating system (mars).Despite significant advances in intensive care management of amanita phalloides-induced fulminant liver failure (FLF), patients with this condition still have a high mortality rate in the absence of orthotopic liver transplantation. Molecular Adsorbent Recirculating System (mars) is a new, cell-free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin-bound toxins, and a highly effective depurative therapy in adults with wild mushroom-induced FLF. We report the case of a 39 year old woman with amanita phalloides-induced FLF, admitted to our intensive care unit (ICU) and treated with mars. Our patient had severe hepatic dysfunction: hepatic encephalopathy (grade II), ALT = 5022 (2475-10098) IU/L, bilirubin = 7.18 (4.8-10.1) mg/dL, prothrombin time (PT) = 90.4 (29.3-140.4) s. mars sessions had an immediate impact on liver tests: statistically significant decrease in ammonia, ALT and PT. hepatic encephalopathy was successfully reduced. The patient survived and the hepatic function completely recovered. mars appears to be a safe and highly effective depurative therapy in adults with amanita phalloides-induced FLF.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
4/4. Successful treatment of aspergillus brain abscess in a child with acute lymphoblastic leukemia and liver failure.Invasive fungal infection continues to pose a significant threat to immunocompromised patients, with cerebral aspergillosis being among the most feared ones. The authors describe an adolescent girl with acute lymphoblastic leukemia (ALL) with subsequent acute liver failure, who developed an aspergillus brain abscess. The patient was treated with combined antifungal therapy using amphotericin b local instillation, prolonged systemic amphotericin b colloidal dispersion along with vinca alkaloids-containing chemotherapy, followed by neurosurgical debridement and oral voriconazole in the setting of ongoing antileukemic maintenance chemotherapy. Her ALL remains now in complete remission 30 months from diagnosis, with no evidence of fungal infection.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |