By William M. Lee, Roger Williams, Jean-Pierre Benhamou, Jacques Bernuau
Acute liver failure (ALF), or fulminant hepatic failure, is a special scientific syndrome that crosses scientific disciplines. a comparatively infrequent situation, ALF continues to be an immense concentration of medical and examine realization. With the arrival 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 extraordinary workforce of participants to explain the etiology, pathology and remedy of this significant syndrome. additionally lined are consensus thoughts in liver transplantation for ALF sufferers, in addition to descriptions of synthetic and bioartificial liver support units. a bit on destiny remedies contains hepatocyte transplantation, auxiliary grafts and different transitority liver aid. impressive for the excessive point of the authors' services, this accomplished quantity may still end up worthy.
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The explanation for enhanced endotoxin activation of Kupffer cells in hepatotoxicity is unknown. Since the ultimate and full extent of liver injury involves these extra-hepatocyte events, targeting therapy or prevention of hepatotoxicity toward blocking tumor necrosis factor (TNF) or leukocyte adhesion appears to be a fruitful area for future clinical investigation. PREDICTABLE VERSUS UNPREDICTABLE HEPATOTOXICITY Hepatotoxicity from drugs can be viewed as predictable or unpredictable. Predictable injury is dose-related, usually reproducible in animal models and the liver injury is due to the intrinsic toxicity of a drug or its metabolites.
VoxSanguinis67: 19-24. , Rueff, B. and Benhamou, J-P. 1986. Fulminant and subfulminant liver failure: definitions and causes. Sem Liver Dis 6: 97-106. ,Thiers, V. etal. 1984. BA17288: 270-1. K. et al. 1991. IgM-antibody response to hepatitis C virus antigens in acute and chronic post-transfusion non-A, non-B hepatitis. J VirolMeth 35: 343-52. , Sheen, I-S. and Liaw, Y-F. 1994. The role of hepatitis C virus in fulminant viral hepatitis in an area with endemic hepatitis A and B. Gastroenterology 107: 189-95.
Thus, in contrast to rapid clearance of viremia in severe acute hepatitis B, unusually severe clinical manifestations of HAV infection in adults have been associated with persistent viremia. The diagnosis of acute HAV infection in patients with fulminant hepatic failure is usually straightforward, as most patients have high titers of IgM antibodies at time of hospitalization. However, as many as 5 percent of patients tested within several days of onset of symptoms may have undetectable anti-HAV responses (Liaw et al.