AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations(variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis.METHO...AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations(variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis.METHODS: We identified original articles reported through February 2015 in MEDLINE, Scopus, Science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%CI.RESULTS: A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality(OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites(OR = 2.52, 95%CI: 1.63-3.89, P < 0.001). There was insufficient data available to determine the pooled effect on other markers of decompensation including gastroesophageal variceal bleeding or hepatic encephalopathy. CONCLUSION: Portal vein thrombosis appears to increase mortality and ascites, however, the relatively small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.展开更多
近年来，食物过敏在世界范围内受到广泛关注。自2010年来，世界上很多学术团体发布了关于食物过敏，特别是牛奶蛋白过敏（cow's milk protein allergy，CMPA）的指南、共识或建议。包括2010年世界过敏组织（World Allergy Organizat...近年来，食物过敏在世界范围内受到广泛关注。自2010年来，世界上很多学术团体发布了关于食物过敏，特别是牛奶蛋白过敏（cow's milk protein allergy，CMPA）的指南、共识或建议。包括2010年世界过敏组织（World Allergy Organization，WAO）发布的《牛奶蛋白过敏诊断和理论依据》[1]，2012年8月欧洲儿科肠胃病学、肝病和营养学会（European Society for Paediatric Gastroenterology,Hepatology,and Nutrition，ESPGHAN）发布的《婴幼儿和儿童牛奶蛋白过敏的诊断方法和治疗原则》[2]，中华医学会2013年发布的《中国婴幼儿牛奶蛋白过敏诊治循证建议》[3]和2017年发布的《食物过敏相关消化道疾病诊断与管理专家共识》[4]，2017年英国牵头发布的《国际MAP指南（international MAP Milk Allergy in Primary Care guideline）》，以下简称《iMAP指南》[5]。展开更多
肝细胞癌（hepatocellular carcinoma，HCC）是原发性肝癌的最常见病理类型，占85%~90%。目前，全球各国和地区均积极制定适合自身国情的HCC临床实践指南，主要包括美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN...肝细胞癌（hepatocellular carcinoma，HCC）是原发性肝癌的最常见病理类型，占85%~90%。目前，全球各国和地区均积极制定适合自身国情的HCC临床实践指南，主要包括美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）指南、美国肝病研究学会（American Association for the Study of Liver Diseases，AASLD）指南、欧洲肝病研究学会（European Association for the Study of the Liver，EASL）指南、亚太肝病研究学会（Asian Pacific Association for the Study of the Liver，APASL）指南、日本肝病学会（Japan Society of Hepatology，JSH）指南、韩国肝癌研究组（Korean Liver Cancer Study Group，KLCSG）和国立癌症中心（National Cancer Center，NCC）指南等。2011年，中国卫生和计划生育委员会（原卫生部）颁布了原发性肝癌诊疗规范（以下简称规范），并于2017年修订更新。这些指南和规范均由多学科专家团队结合最新循证医学证据经充分讨论而建立，并定期更新，对规范和指导HCC的临床实践起到了积极推动作用。影像检查是高危人群中HCC筛查及诊断的主要方法。全球不同地区HCC发病率不一，基础肝病背景也显著不同，导致筛查方案、检查技术及诊断流程均有很大差异。笔者通过深入解读我国2017年版规范相关内容，并与国际诊断指南进行对比，旨在提高对HCC的诊断水平。展开更多
The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA), also called ecstasy, is a neurotoxin widely consumed among young people that has increased in recent years because it is a recreational drug, of whi...The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA), also called ecstasy, is a neurotoxin widely consumed among young people that has increased in recent years because it is a recreational drug, of which immediate effects are known such as a greater sensation of well-being, extroversion, increased sensory perception. However, its long-term effects have been described very little in the medical literature, including damage to the heart, central nervous system, kidney, etc. One of its little-known effects is hepatotoxicity, of which few cases are known associated with fulminant hepatitis, which is a rapidly deteriorating condition that is generally associated with a syndrome of multiple organ dysfunction and death. Therefore, it is very important to know this type of damage in the short and long term. The following case is of a 39-year-old man who came to our service due to jaundice syndrome and the only history of MDMA consumption, who as the days went by met the criteria for fulminant liver failure, with damage to multiple organs (organ dysfunction syndrome).展开更多
BACKGROUND Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites,esophageal/gastric varices or encephalopat...BACKGROUND Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites,esophageal/gastric varices or encephalopathy.The most common sequelae associated with liver cirrhosis are neurologic and neuropsychiatric impairments labeled as hepatic encephalopathy(HE).Well established triggers for HE include infection,gastrointestinal bleeding,constipation,and medications.Alterations to the gut microbiome is one of the leading ammonia producers in the body,and therefore may make patients more susceptible to HE.AIM To investigate the relationship between the use of proton pump inhibitors(PPIs)and HE in patients with cirrhosis.METHODS This is a single center,retrospective analysis.Patients were included in the study with an admitting diagnosis of HE.The degree of HE was determined from subjective and objective portions of hospital admission notes using the West Haven Criteria.The primary outcome of the study was to evaluate the grade of HE in PPI users versus non-users at admission to the hospital and throughout their hospital course.Secondary outcomes included rate of infection,gastrointestinal bleeding within the last 12 mo,mean ammonia level,and model for end-stage liver disease scores at admission.RESULTS The HE grade at admission using the West Haven Criteria was 2.3 in the PPI group compared to 1.7 in the PPI nonuser group(P=0.001).The average length of hospital stay in PPI group was 8.3 d compared to 6.5 d in PPI nonusers(P=0.046).Twenty-seven(31.8%)patients in the PPI user group required an Intensive Care Unit admission during their hospital course compared to 6 in the PPI nonuser group(16.7%)(P=0.138).Finally,10(11.8%)patients in the PPI group expired during their hospital stay compared to 1 in the PPI nonuser group(2.8%)(P=0.220).CONCLUSION Chronic PPI use in cirrhotic patients is associated with significantly higher average West Haven Criteria for HE compared to patients that do not use PPIs.展开更多
The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent...The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent of machine learning provides a unique opportunity to harness vast datasets,identifying subtle patterns and factors that elude conventional prognostic methods.Machine learning models,equipped with the ability to analyse intricate relationships within datasets,have shown promise in predicting outcomes in various medical disciplines.In the context of HCC,the application of machine learning to predict early recurrence holds potential for personalized postoperative care strategies.This editorial comments on the study carried out exploring the merits and efficacy of random survival forests(RSF)in identifying significant risk factors for recurrence,stratifying patients at low and high risk of HCC recurrence and comparing this to traditional COX proportional hazard models(CPH).In doing so,the study demonstrated that the RSF models are superior to traditional CPH models in predicting recurrence of HCC and represent a giant leap towards precision medicine.展开更多
Acute liver failure(ALF)is a rare cause of liver-related mortality worldwide,with an estimated annual global incidence of more than one million cases.While drug-induced liver injury,including acetaminophen toxicity,is...Acute liver failure(ALF)is a rare cause of liver-related mortality worldwide,with an estimated annual global incidence of more than one million cases.While drug-induced liver injury,including acetaminophen toxicity,is the leading cause of ALF in the Western world,viral infections remain a significant cause of ALF and the most common cause in many developing nations.Given the high mortality rates associated with ALF,healthcare providers should be aware of the broad range of viral infections that have been implicated to enable early diagnosis,rapid treatment initiation when possible,and optimal management,which may include liver transplantation.This review aims to provide a summary of viral causes of ALF,diagnostic approaches,treatment options,and expected outcomes.展开更多
Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions....Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions.However,these patients form a vulnerable group,who are at risk for developing side effects and complications.Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients.Artificial intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare settings.ICUs produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of AI.However,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.展开更多
Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated fields.Machine learning(ML)refers to a model that learns from past data to predict future data.Medicine and particularly gastro...Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated fields.Machine learning(ML)refers to a model that learns from past data to predict future data.Medicine and particularly gastroenterology and hepatology,are data-rich fields with extensive data repositories,and therefore fruitful ground for AI/ML-based software applications.In this study,we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application.Specifically,we refer to the applications of AI/ML-based models in prevention,diagnosis,management,and prognosis of gastrointestinal bleeding,inflammatory bowel diseases,gastrointestinal premalignant and malignant lesions,other nonmalignant gastrointestinal lesions and diseases,hepatitis B and C infection,chronic liver diseases,hepatocellular carcinoma,cholangiocarcinoma,and primary sclerosing cholangitis.At the same time,we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them.Notably,we elaborate on the concerns regarding intrinsic biases,data protection,cybersecurity,intellectual property,liability,ethical challenges,and transparency.Even at a slower pace than anticipated,AI is infiltrating the healthcare industry.AI in healthcare will become a reality,and every physician will have to engage with it by necessity.展开更多
After three rounds of rigorous evaluation of core journals in gastroenterology andhepatology conducted by the Reference Citation Analysis (RCA) editorial team ofBaishideng Publishing Group (Baishideng), the RCA databa...After three rounds of rigorous evaluation of core journals in gastroenterology andhepatology conducted by the Reference Citation Analysis (RCA) editorial team ofBaishideng Publishing Group (Baishideng), the RCA database of Baishidengofficially released the 2022 Journal Article Influence Index (2022 JAII) of 101 corejournals in gastroenterology and hepatology, for the first time. The list of 101 corejournals can be found at: https://www.referencecitationanalysis.com/Search-Journal. Among them, the highest 2022 JAII is 48.014 and the lowest is 3.900. Thisarticle highlights the top 20 journals, describes the calculation method for the 2022JAII, the evaluation process, and the inclusion principles for journals in the RCA.These steps are the underpinning of the RCA’s empirical journal academicevaluation service by which the digital platform addresses the needs of authors toselect reliable journals for submission, readers to select high-quality literature forreading, and editors to track their own journal citation performance. As such, theRCA core journal list will serve as a useful Find-a-Journal tool. Any interestedparty is welcome to use this journal list and recommend it to their peers.展开更多
Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicil...Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.展开更多
基金Supported by(In part)grant funding from the National Institutes of Health(Grant 5T32DK007769-15)NIH-Surgical Oncology grant(T32 CA163177)
文摘AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations(variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis.METHODS: We identified original articles reported through February 2015 in MEDLINE, Scopus, Science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%CI.RESULTS: A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality(OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites(OR = 2.52, 95%CI: 1.63-3.89, P < 0.001). There was insufficient data available to determine the pooled effect on other markers of decompensation including gastroesophageal variceal bleeding or hepatic encephalopathy. CONCLUSION: Portal vein thrombosis appears to increase mortality and ascites, however, the relatively small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.
文摘近年来，食物过敏在世界范围内受到广泛关注。自2010年来，世界上很多学术团体发布了关于食物过敏，特别是牛奶蛋白过敏（cow's milk protein allergy，CMPA）的指南、共识或建议。包括2010年世界过敏组织（World Allergy Organization，WAO）发布的《牛奶蛋白过敏诊断和理论依据》[1]，2012年8月欧洲儿科肠胃病学、肝病和营养学会（European Society for Paediatric Gastroenterology,Hepatology,and Nutrition，ESPGHAN）发布的《婴幼儿和儿童牛奶蛋白过敏的诊断方法和治疗原则》[2]，中华医学会2013年发布的《中国婴幼儿牛奶蛋白过敏诊治循证建议》[3]和2017年发布的《食物过敏相关消化道疾病诊断与管理专家共识》[4]，2017年英国牵头发布的《国际MAP指南（international MAP Milk Allergy in Primary Care guideline）》，以下简称《iMAP指南》[5]。
文摘肝细胞癌（hepatocellular carcinoma，HCC）是原发性肝癌的最常见病理类型，占85%~90%。目前，全球各国和地区均积极制定适合自身国情的HCC临床实践指南，主要包括美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）指南、美国肝病研究学会（American Association for the Study of Liver Diseases，AASLD）指南、欧洲肝病研究学会（European Association for the Study of the Liver，EASL）指南、亚太肝病研究学会（Asian Pacific Association for the Study of the Liver，APASL）指南、日本肝病学会（Japan Society of Hepatology，JSH）指南、韩国肝癌研究组（Korean Liver Cancer Study Group，KLCSG）和国立癌症中心（National Cancer Center，NCC）指南等。2011年，中国卫生和计划生育委员会（原卫生部）颁布了原发性肝癌诊疗规范（以下简称规范），并于2017年修订更新。这些指南和规范均由多学科专家团队结合最新循证医学证据经充分讨论而建立，并定期更新，对规范和指导HCC的临床实践起到了积极推动作用。影像检查是高危人群中HCC筛查及诊断的主要方法。全球不同地区HCC发病率不一，基础肝病背景也显著不同，导致筛查方案、检查技术及诊断流程均有很大差异。笔者通过深入解读我国2017年版规范相关内容，并与国际诊断指南进行对比，旨在提高对HCC的诊断水平。
文摘The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA), also called ecstasy, is a neurotoxin widely consumed among young people that has increased in recent years because it is a recreational drug, of which immediate effects are known such as a greater sensation of well-being, extroversion, increased sensory perception. However, its long-term effects have been described very little in the medical literature, including damage to the heart, central nervous system, kidney, etc. One of its little-known effects is hepatotoxicity, of which few cases are known associated with fulminant hepatitis, which is a rapidly deteriorating condition that is generally associated with a syndrome of multiple organ dysfunction and death. Therefore, it is very important to know this type of damage in the short and long term. The following case is of a 39-year-old man who came to our service due to jaundice syndrome and the only history of MDMA consumption, who as the days went by met the criteria for fulminant liver failure, with damage to multiple organs (organ dysfunction syndrome).
文摘BACKGROUND Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites,esophageal/gastric varices or encephalopathy.The most common sequelae associated with liver cirrhosis are neurologic and neuropsychiatric impairments labeled as hepatic encephalopathy(HE).Well established triggers for HE include infection,gastrointestinal bleeding,constipation,and medications.Alterations to the gut microbiome is one of the leading ammonia producers in the body,and therefore may make patients more susceptible to HE.AIM To investigate the relationship between the use of proton pump inhibitors(PPIs)and HE in patients with cirrhosis.METHODS This is a single center,retrospective analysis.Patients were included in the study with an admitting diagnosis of HE.The degree of HE was determined from subjective and objective portions of hospital admission notes using the West Haven Criteria.The primary outcome of the study was to evaluate the grade of HE in PPI users versus non-users at admission to the hospital and throughout their hospital course.Secondary outcomes included rate of infection,gastrointestinal bleeding within the last 12 mo,mean ammonia level,and model for end-stage liver disease scores at admission.RESULTS The HE grade at admission using the West Haven Criteria was 2.3 in the PPI group compared to 1.7 in the PPI nonuser group(P=0.001).The average length of hospital stay in PPI group was 8.3 d compared to 6.5 d in PPI nonusers(P=0.046).Twenty-seven(31.8%)patients in the PPI user group required an Intensive Care Unit admission during their hospital course compared to 6 in the PPI nonuser group(16.7%)(P=0.138).Finally,10(11.8%)patients in the PPI group expired during their hospital stay compared to 1 in the PPI nonuser group(2.8%)(P=0.220).CONCLUSION Chronic PPI use in cirrhotic patients is associated with significantly higher average West Haven Criteria for HE compared to patients that do not use PPIs.
文摘The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent of machine learning provides a unique opportunity to harness vast datasets,identifying subtle patterns and factors that elude conventional prognostic methods.Machine learning models,equipped with the ability to analyse intricate relationships within datasets,have shown promise in predicting outcomes in various medical disciplines.In the context of HCC,the application of machine learning to predict early recurrence holds potential for personalized postoperative care strategies.This editorial comments on the study carried out exploring the merits and efficacy of random survival forests(RSF)in identifying significant risk factors for recurrence,stratifying patients at low and high risk of HCC recurrence and comparing this to traditional COX proportional hazard models(CPH).In doing so,the study demonstrated that the RSF models are superior to traditional CPH models in predicting recurrence of HCC and represent a giant leap towards precision medicine.
文摘Acute liver failure(ALF)is a rare cause of liver-related mortality worldwide,with an estimated annual global incidence of more than one million cases.While drug-induced liver injury,including acetaminophen toxicity,is the leading cause of ALF in the Western world,viral infections remain a significant cause of ALF and the most common cause in many developing nations.Given the high mortality rates associated with ALF,healthcare providers should be aware of the broad range of viral infections that have been implicated to enable early diagnosis,rapid treatment initiation when possible,and optimal management,which may include liver transplantation.This review aims to provide a summary of viral causes of ALF,diagnostic approaches,treatment options,and expected outcomes.
文摘Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions.However,these patients form a vulnerable group,who are at risk for developing side effects and complications.Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients.Artificial intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare settings.ICUs produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of AI.However,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.
文摘Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated fields.Machine learning(ML)refers to a model that learns from past data to predict future data.Medicine and particularly gastroenterology and hepatology,are data-rich fields with extensive data repositories,and therefore fruitful ground for AI/ML-based software applications.In this study,we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application.Specifically,we refer to the applications of AI/ML-based models in prevention,diagnosis,management,and prognosis of gastrointestinal bleeding,inflammatory bowel diseases,gastrointestinal premalignant and malignant lesions,other nonmalignant gastrointestinal lesions and diseases,hepatitis B and C infection,chronic liver diseases,hepatocellular carcinoma,cholangiocarcinoma,and primary sclerosing cholangitis.At the same time,we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them.Notably,we elaborate on the concerns regarding intrinsic biases,data protection,cybersecurity,intellectual property,liability,ethical challenges,and transparency.Even at a slower pace than anticipated,AI is infiltrating the healthcare industry.AI in healthcare will become a reality,and every physician will have to engage with it by necessity.
文摘After three rounds of rigorous evaluation of core journals in gastroenterology andhepatology conducted by the Reference Citation Analysis (RCA) editorial team ofBaishideng Publishing Group (Baishideng), the RCA database of Baishidengofficially released the 2022 Journal Article Influence Index (2022 JAII) of 101 corejournals in gastroenterology and hepatology, for the first time. The list of 101 corejournals can be found at: https://www.referencecitationanalysis.com/Search-Journal. Among them, the highest 2022 JAII is 48.014 and the lowest is 3.900. Thisarticle highlights the top 20 journals, describes the calculation method for the 2022JAII, the evaluation process, and the inclusion principles for journals in the RCA.These steps are the underpinning of the RCA’s empirical journal academicevaluation service by which the digital platform addresses the needs of authors toselect reliable journals for submission, readers to select high-quality literature forreading, and editors to track their own journal citation performance. As such, theRCA core journal list will serve as a useful Find-a-Journal tool. Any interestedparty is welcome to use this journal list and recommend it to their peers.
文摘Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.
