• Clinical Endoscopy
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• 제55권2호
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• pp.287-291
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• 2022

Acute liver failure due to malignant melanoma is uncommon. We presents a case of acute liver failure secondary to hepatic infiltration of a malignant melanoma. An 86-year-old man was admitted with elevated liver enzymes and an increased lactate dehydrogenase level. His condition progressed to acute liver failure, but the etiology of liver failure was unclear. Esophagogastroduodenoscopy was performed to evaluate dyspepsia, which showed signs indicative of malignant melanoma. Based on the endoscopy findings and elevated liver enzyme levels, liver biopsy was performed to confirm the presence of malignant melanoma. Hepatic infiltration of malignant melanoma was observed histologically. However, massive and diffuse liver metastasis is very rare and difficult to identify on imaging studies. If the etiology of liver failure is unclear, diffuse metastatic melanoma infiltration should be considered as differential diagnosis. Early liver biopsy can help to clarify the diagnosis.

• Clinical and Experimental Pediatrics
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• 제50권9호
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• pp.841-847
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• 2007

Acute liver failure (ALF) is a very rare but devastating illness in children. Specific treatment to recovery is often not available, and the underlying cause of the liver failure is often unknown and diverse especially in children. Liver transplantation has increased the chance of survival; however it needs an optimal timing to reach the best result which is not familiar to pediatrician. This article discusses the current knowledge of the epidemiology, backgrounds and factors to be considered before establishing the treatment of ALF in children.

• 대한한방내과학회지
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• 제31권1호
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• pp.11-24
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• 2010

Objectives : This study was carried out to investigate the hepatoprotective effects of mixture with Hovenia dulcis Thunb (HDT) and Acer tegmentosum Maxim(ATM) on D-galactosamine-induced liver failure in rats. Methods : The animals were divided into 4 groups: control, with liver failure and no treatment; H1A1, with liver failure and oral treatment with HDT 1 and ATM 1; H1A2, with liver failure and oral treatment with HDT 1 and ATM 2; H1A4, with liver failure and oral treatment with HDT 1 and ATM 4. The animals were treated for 3 weeks and then examinations of change of body weight, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase ($\gamma$-GTP), total cholesterol, triglyceride, total bilirubin, superoxide dismutase (SOD), catalase, histopathologic change, and complete blood count (CBC) were performed. Results : All experimental groups had significantly decreased AST in serum and markedly increased activity of SOD as compared with the control group. H1A1, and H1A4 significantly decreased ALT in serum and H1A4 at 2 weeks was significantly higher on the change of body weight as compared with the control group. In histopathologic change of liver tissue by light microscopy, all experimental groups showed recovery effects of liver cells which were damaged by D-galactosamine. Conclusions : Based upon these results, it could be assumed that a mixture of HDT and ATM has hepatoprotective and antioxidative effects on D-galactosamine-induced liver failure. Therefore, a mixture of HDT and ATM might be utilized as a protective agent in therapy for liver diseases.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권sup2호
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• pp.50-58
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• 2008

급성 간부전은 여러 분야의 전문가 및 이식 센터의 협조가 필요한 질환으로 급성 간염을 보이는 모든 환자에서 급성 간부전으로 진행할 가능성에 대해 고려하여야 한다. 소아에서 급성 간부전은 원인 미상인 경우가 가장 흔하며, 영아기에는 대사성 간질환도 염두에 두어야 한다. 급성 간부전의 예후는 간이식이 도입된 이후 획기적으로 향상되었으나, 간성 뇌증, 혈액응고 장애, 감염, 신부전 등 주요 합병증에 대한 치료는 여전히 예후를 좌우하는 중요한 부분이며, 여기에 더하여 간이식의 여부 및 시기에 대한 결정이 소아과 의사의 중요한 역할 중 하나가 되었다. 원인이 밝혀진 경우에는 예후 예측에 도움이 되고, 원인에 대한 치료를 시도해볼 수 있으나 소아 환자는 원인 미상인 경우가 많아 예후 예측이 어렵고, 주 사망 원인인 간성 뇌증에 대한 평가가 어려워 특히 세심한 모니터가 필요하다.

• 대한치과마취과학회지
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• 제2권2호
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• pp.114-117
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• 2002

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권6호
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• pp.481-488
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• 2022

Purpose: Liver transplantation (LT) is the only curative treatment for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). In high-volume therapeutic plasma exchange (HV-TPE), extracorporeal liver support filters accumulate toxins and improve the coagulation factor by replacing them. In this study, we aimed to evaluate the effectiveness of HV-TPE in pediatric patients with ALF and ACLF. Methods: We reviewed the records of children waiting for LT at Severance Hospital who underwent HV-TPE between 2017 and 2021. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), total and direct bilirubin (TB and DB), gamma-glutamyl transferase (GGT), ammonia, and coagulation parameter-international normalized ratio (INR) were all measured before and after HV-TPE to analyze the liver function. The statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Co., Armonk, NY, USA). Results: Nine patients underwent HV-TPE with standard medical therapy while waiting for LT. One had neonatal hemochromatosis, four had biliary atresia, and the other four had ALF of unknown etiology. Significant decreases in AST, ALT, TB, DB, GGT, and INR were noted after performing HV-TPE (930.38-331.75 IU/L, 282.62-63.00 IU/L, 11.75-5.59 mg/dL, 8.10-3.66 mg/dL, 205.62-51.75 IU/L, and 3.57-1.50, respectively, p<0.05). All patients underwent LT, and two expired due to acute complications. Conclusion: HV-TPE could remove accumulated toxins and improve coagulation. Therefore, we conclude that HV-TPE can be regarded as a representative bridging therapy before LT.

• 한국간담췌외과학회지
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• 제28권3호
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• pp.283-290
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• 2024

Hepatic compartment syndrome (HCS) is a rare but life-threatening entity that consists of a decreased portal flow due to intraparenchymal hypertension secondary to subcapsular liver hematoma. Lethal liver failure can be observed. We report three cases, and review the literature. A 54-year-old male was admitted for extensive hepatic subcapsular hematoma after blunt abdominal trauma. Initially, he underwent embolization of the hepatic artery's right branch, after which he presented clinical deterioration, major cytolysis (310 times the upper limit of normal [ULN]), and liver failure with a prothrombin time (PT) at 31.0%. A 56-year-old male underwent liver transplantation for acute alcoholic hepatitis. On postoperative day 2, he presented a hemorrhagic shock associated with deterioration of liver function (cytolysis 21 ULN, PT 39.0%) due to extensive hepatic subcapsular hematoma. A 59-year-old male presented a hepatic subcapsular hematoma five days after a cholecystectomy, revealed by abdominal pain with liver dysfunction (cytolysis 10 ULN, PT 63.0%). All patients ultimately underwent urgent surgery for liver capsule excision, hematoma evacuation, and liver packing, if needed. The international literature was screened for this entity. These three patients' outcomes were favorable, and all were alive at postoperative day 90. The literature review found 15 reported cases. HCS can occur after any direct or indirect liver trauma. Surgical decompression is the main treatment, and there is probably no place for arterial embolization, which may increase the risk of liver necrosis. A 13.3% mortality rate is reported. HCS is a rare complication of subcapsular liver hematoma that compresses the liver parenchyma, and leads to liver failure. Urgent surgical decompression is needed.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2008년도 추계학술대회A
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• pp.1419-1426
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• 2008

Fulminant hepatic failure is a clinical syndrome associated with a high mortality rate. Orthotopic liver transplantation is the only clinically proven effective treatment for patients with end-stage liver disease who do not respond to medical management. A major limitation of this treatment modality is the scarcity of donor organs available, resulting in patients dying while waiting for a donor liver. An extracorporeal bioartificial liver (BAL) device containing viable hepatocytes has the potential to provide temporary hepatic support to liver failure patients, serving as a bridge to transplantation while awaiting a suitable donor. In some patients, providing temporary hepatic support may be sufficient to allow adequate regeneration of the host liver, thereby eliminating the need for a liver transplant. Although the BAL device is a promising technology for the treatment of liver failure, there are several technical challenges that must be overcome in order to develop systems with sufficient processing capacity and of manageable size. In this overview, the authors describe the critical issues involved in developing a BAL device. They also discuss their experiences in hepatocyte culture optimization within the context of a microchannel flat-plate BAL device.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.210-213
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• 2008

저자들은 버섯 중독 후 간성 뇌증을 동반한 급성 간부전으로 발현된 소아를 Penicillin GK를 사용한 약물 요법으로 완치할 수 있었다. 소아에서 급성 간부전은 사망률이 높은 위중한 질병이며, 생존을 위하여 간이식이 필요한 경우가 많다. 그러나 일부의 경우에는 본 증례와 같이 정확한 병력 청취에 의하여 특별한 치료를 시행하면 간이식을 시행하지 않고서도 환아의 생명을 구할 수 있다.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.125-130
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• 2017

Purpose: To evaluate the clinical significance of T1 high signal intensity on the globus pallidus as a predictor of severe hepatic encephalopathy in patients with acute-on-chronic liver failure (ACLF), which is a distinct syndrome characterized by multi-organ dysfunction including cerebral failure. Materials and Methods: From January 2002 to April 2014, we retrospectively reviewed the magnetic resonance imaging (MRI) findings and clinical and magnetic resonance (MR) features of 74 consecutive patients (44 men and 30 women; mean age, 59.5 years) with liver cirrhosis. The chronic liver failure-sequential organ failure assessment score was used to diagnose ACLF. The pallidal index (PI), calculated by dividing the mean signal intensity of the globus pallidus by that of the subcortical frontal white matter were compared according to ACLF. The PI was compared with the Model for End-Stage Liver Disease (MELD) score in predicting the development of ACLF. Results: Fifteen patients who were diagnosed with ACLF had higher hepatic encephalopathy grades (initial, P = 0.024; follow-up, P = 0.002), MELD scores (P < 0.001), and PI (P = 0.048). In the ACLF group, the mean PI in patients with cerebral failure was significantly higher than that in the patients without cerebral failure (1.33 vs. 1.20, P = 0.039). In patients with ACLF, the area under the curve (AUC) for PI was 0.680 (95% confidence intervals [CI], 0.52-0.85), which was significantly lower than that for the MELD score (AUC, 0.88; 95% CI, 0.77-0.99) (P = 0.04). Conclusion: The PI can be an ancillary biomarker for predicting the development of ACLF and severe hepatic encephalopathy.