By William M. Lee, Roger Williams, Jean-Pierre Benhamou, Jacques Bernuau
Acute liver failure (ALF), or fulminant hepatic failure, is a special medical syndrome that crosses scientific disciplines. a comparatively infrequent situation, ALF continues to be an enormous concentration of medical and learn awareness. With the appearance of transplantation, the significance of realizing administration of ALF has taken on a brand new urgency. during this first quantity devoted to ALF, the editors assemble a distinct workforce of individuals to explain the etiology, pathology and remedy of this crucial syndrome. additionally coated are consensus concepts in liver transplantation for ALF sufferers, in addition to descriptions of man-made and bioartificial liver help units. a piece on destiny remedies contains hepatocyte transplantation, auxiliary grafts and different transitority liver help. striking for the excessive point of the authors' services, this complete quantity may still end up important.
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However, recurrent syncytial giant cells were observed in posttransplant biopsies in five of fourteen cases. Two of these five patients died and two required repeat transplantation because of recurrent liver failure. One of the latter patients developed giant cell hepatitis again in a second allograft. While these authors could not find viral particles in livers with giant cell hepatitis, they did identify human papilloma virus 6 by PCR analysis in liver tissue from three pretransplant and four posttransplant livers.
Lancet 341: 123. , Purdy, M. et al. 1994. Hepatitis C and E in non-A non-B fulminant hepatic failure: a polymerase chain reaction and serological study. J Hepatol20: 580-8. , Rosina, F. et al. 1988. Serologic markers with fulminant hepatitis in persons positive for hepatitis B surface antigen. Ann Intern Med 108: 380-3. , Akahane, Y. et al. 1995. Hepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitis. Ann Intern Med 122: 241-8. S. 1986. Evolving concepts of the CLINICAL SYNDROME AND ETIOLOGY clinical and serologic consequences of hepatitis B virus infection.
Toxicants and anoxia may also kill by apoptosis, especially when doses are low or hypoxia is mild. Immune mediated cell death not involving complement, that is cytotoxic T cells, is mainly via apoptosis. This appears as shriveled nuclei with characteristic chromatin condensation and eosinophilic condensation of the whole cell (Councilman body). Lytic necrosis generally elicits a secondary inflammatory reaction whereas apoptosis does not (Searle et al. 1982; Vaux 1993). Aside from lytic necrosis or apoptosis, certain agents may induce a microvesicular steatosis producing an apparent metabolic poisoning of the liver without collapse.