NEJM â Collection Updates for Liver Disease

IMAGES IN CLINICAL MEDICINE: Bleeding Esophageal Varices

Euriko Torrazza-Perez, M.D. and Norberto Carreno, M.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

A 52-year-old man with cirrhosis associated with alcohol abuse presented to the emergency department with hematemesis and lightheadedness, which had developed 3 hours earlier, after binge drinking. He had no...

IMAGES IN CLINICAL MEDICINE: Hydropneumothorax

Ping-Hsien Chen, M.D. and Xi-Zhang Lin, M.D. — Thu, 21Â JanÂ 2010 00:00:00 -05:00

A 47-year-old man with a history of cirrhosis associated with alcohol abuse presented with a 2-day history of shortness of breath. Before this symptom developed, he had been treated with...

ORIGINAL ARTICLE: Cisplatin versus Cisplatin plus Doxorubicin for Standard-Risk Hepatoblastoma

Thu, 22Â OctÂ 2009 00:00:00 -05:00

Background: Preoperative cisplatin alone may be as effective as cisplatin plus doxorubicin in standard-risk hepatoblastoma (a tumor involving three or fewer sectors of the liver that is associated with an...

EDITORIAL: Micromanaging Cancer

Judy Lieberman, M.D., Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

The discovery of RNA interference triggered a âsilentâ revolution that overturned our understanding of how gene expression is regulated.1 The previous model was that gene expression was activated during transcription,...

ORIGINAL ARTICLE: MicroRNA Expression, Survival, and Response to Interferon in Liver Cancer

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Background: Hepatocellular carcinoma is a common and aggressive cancer that occurs mainly in men. We examined microRNA expression patterns, survival, and response to interferon alfa in both men and women...

ORIGINAL ARTICLE: Recurrence of Bile Salt Export Pump Deficiency after Liver Transplantation

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Severe bile salt export pump (BSEP) deficiency is a hereditary cholestatic condition that starts in infancy and leads to end-stage liver disease. Three children who underwent orthotopic liver transplantation for...

REVIEW ARTICLE: Renal Failure in Cirrhosis

Pere GinÃ¨s, M.D., and Robert W. Schrier, M.D. — Thu, 24Â SepÂ 2009 00:00:00 -05:00

Renal failure is a challenging complication of cirrhosis12 and is one of the most important risk factors when liver transplantation is being considered. Patients with cirrhosis and renal failure are...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2009 â An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Dr. Jenica N. Upshaw (Medicine): An 81-year-old man was admitted to the hospital because of cough, weight loss, odynophagia, and failure to thrive.

The patient had been in his usual state...

CORRESPONDENCE: Persistent Carriage of Hepatitis E Virus in Patients with HIV Infection

Thu, 03Â SepÂ 2009 00:00:00 -05:00

To the Editor: Hepatitis E virus is an emerging infection in developed countries, with many clinical manifestations.1 We describe a 48-year-old bisexual white male who was infected with human immunodeficiency...

ORIGINAL ARTICLE: Peginterferon Alfa-2b or Alfa-2a with Ribavirin for Treatment of Hepatitis C Infection

Thu, 06Â AugÂ 2009 00:00:00 -05:00

Background: Treatment guidelines recommend the use of peginterferon alfa-2b or peginterferon alfa-2a in combination with ribavirin for chronic hepatitis C virus (HCV) infection. However, these regimens have not been adequately...

REVIEW ARTICLE: Alcoholic Hepatitis

Thu, 25Â JunÂ 2009 00:00:00 -05:00

Excessive alcohol consumption is the third leading preventable cause of death in the United States.12 Alcohol-associated mortality is disproportionately high among young people, and approximately 30 years of life are...

CLINICAL PRACTICE: Alpha-Antitrypsin Deficiency

Edwin K. Silverman, M.D., Ph.D., and Robert A. Sandhaus, M.D., Ph.D. — Thu, 25Â JunÂ 2009 00:00:00 -05:00

A 60-year-old white man presents for evaluation of progressive dyspnea. He is a former smoker with a 20-pack-year smoking history and a 10-year history of diagnosed chronic obstructive pulmonary disease...

IMAGES IN CLINICAL MEDICINE: Perforated Umbilical Hernia

Radheshyam Miryala, M.D. and Ryan Neilan, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

A 68-year-old man with alcoholic cirrhosis, portal hypertension, ascites, and an umbilical hernia presented to the emergency department after an episode of coughing that was followed by a rush of...

CLINICAL PROBLEM-SOLVING: Kiss of Death

Thu, 11Â JunÂ 2009 00:00:00 -05:00

A 23-year-old South African man presented to an emergency department with a 2-day history of fever, mild dyspnea, headache, nausea, and myalgias. His symptoms had begun 5 days after he...

IMAGES IN CLINICAL MEDICINE: Biliary Stones

Ping-Hsien Chen, M.D. and Chiao-Hsiung Chuang, M.D. — Thu, 11Â JunÂ 2009 00:00:00 -05:00

A 63-year-old woman presented with a 2-day history of fever, abdominal pain, and vomiting. There was no history of previous episodes. Physical examination revealed fever and moderate abdominal tenderness in...

ORIGINAL ARTICLE: Primary Biliary Cirrhosis Associated with and Variants

Thu, 11Â JunÂ 2009 00:00:00 -05:00

Background: Primary biliary cirrhosis is a chronic granulomatous cholangitis, characteristically associated with antimitochondrial antibodies. Twin and family aggregation data suggest that there is a significant genetic predisposition to primary biliary...

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection â Polling Results

Marissa B. Wilck, M.D., Mary Beth Hamel, M.D., and Lindsey R. Baden, M.D. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

In late April, we presented a case of a healthy black woman incidentally found to be infected with hepatitis C virus (HCV) in Clinical Decisions,1 an interactive feature designed to...

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 25-year-old black woman is referred to your clinic for management of an incidental positive result on a hepatitis C virus (HCV) antibody test. She had decided to donate blood...

EDITORIAL: A Step Forward in Therapy for Hepatitis C

Jay H. Hoofnagle, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

The therapy of hepatitis C began almost 25 years ago with a small trial of recombinant human interferon alfa.1 The rationale for using interferon was its broad antiviral effects and...

ORIGINAL ARTICLE: Telaprevir and Peginterferon with or without Ribavirin for Chronic HCV Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Background: In patients with chronic infection with hepatitis C virus (HCV) genotype 1, treatment with peginterferon alfa and ribavirin for 48 weeks results in rates of sustained virologic response of...

ORIGINAL ARTICLE: Telaprevir with Peginterferon and Ribavirin for Chronic HCV Genotype 1 Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Background: Current therapy for chronic hepatitis C virus (HCV) infection is effective in less than 50% of patients infected with HCV genotype 1. Telaprevir, a protease inhibitor specific to the...

CORRESPONDENCE: Ending Propylthiouracil-Induced Liver Failure in Children

Scott A. Rivkees, M.D. and Donald R. Mattison, M.D. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

To the Editor: Graves' disease is treated with antithyroid drugs, radioactive iodine, or surgery.12 Propylthiouracil and methimazole are widely used in children as first-line therapy.12 Over the past 60 years...

CLINICAL PROBLEM-SOLVING: Needle in a Haystack

Thu, 05Â FebÂ 2009 00:00:00 -05:00

A 50-year-old woman reported multiple loose bowel movements associated with mild, cramping abdominal pain. She had been well until 2 months earlier, when her bowel habits changed from one formed...

IMAGES IN CLINICAL MEDICINE: Spider Angiomas

Olivier Detry, M.D., Ph.D. and Arnaud De Roover, M.D., Ph.D. — Thu, 15Â JanÂ 2009 00:00:00 -05:00

A 55-year-old man with end-stage liver disease associated with alcohol abuse was evaluated for liver transplantation. He had a history of refractory ascites and hepatic encephalopathy. On physical examination, we...

ORIGINAL ARTICLE: Peginterferon Alfa-2a and Ribavirin in Latino and Non-Latino Whites with Hepatitis C

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Background: Race has been shown to be a factor in the response to therapy for hepatitis C virus (HCV) infection, and limited data suggest that ethnic group may be as...

CORRESPONDENCE: Glycemic Control in Patients with Insulinoma Treated with Everolimus

Matthew H. Kulke, M.D., Emily K. Bergsland, M.D., and James C. Yao, M.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

To the Editor: Management of refractory hypoglycemia due to malignant insulinoma is challenging. Currently available treatments include dietary modification, diazoxide, and, in patients with resistant disease, the use of intravenous...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Dr. Abner Louissaint (Pathology): A 58-year-old man with hemophilia was admitted to this hospital because of hepatitis C infection, hepatocellular carcinoma, and recurrent bleeding.

A diagnosis of hemophilia A (factor VIII...

EDITORIAL: Chronic Hepatitis B â New Goals, New Treatment

Ching-Lung Lai, M.D., and Man-Fung Yuen, M.D. — Thu, 04Â DecÂ 2008 00:00:00 -05:00

The hepatitis B virus (HBV) causes chronic infection in approximately 400 million people in the world. Most carriers of chronic HBV, including Asians, Africans, and a proportion of persons in...

ORIGINAL ARTICLE: Tenofovir Disoproxil Fumarate versus Adefovir Dipivoxil for Chronic Hepatitis B

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Background: Tenofovir disoproxil fumarate (DF) is a nucleotide analogue and a potent inhibitor of human immunodeficiency virus type 1 reverse transcriptase and hepatitis B virus (HBV) polymerase.

Methods: In two double-blind,...

ORIGINAL ARTICLE: Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Background: In patients with chronic hepatitis C who do not have a response to antiviral treatment, the disease may progress to cirrhosis, liver failure, hepatocellular carcinoma, and death. Whether long-term...

EDITORIAL: Recurrence of Hepatocellular Carcinoma

Morris Sherman, M.B., B.Ch., Ph.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Although the treatment of hepatocellular carcinoma is evolving, hepatic resection remains the treatment of choice for many patients. Resection is associated with a 5-year survival rate of 50% but also...

ORIGINAL ARTICLE: Gene Expression in Fixed Tissues and Outcome in Hepatocellular Carcinoma

Thu, 06Â NovÂ 2008 00:00:00 -05:00

Background: It is a challenge to identify patients who, after undergoing potentially curative treatment for hepatocellular carcinoma, are at greatest risk for recurrence. Such high-risk patients could receive novel interventional...

REVIEW ARTICLE: Hepatitis B Virus Infection

Jules L. Dienstag, M.D. — Thu, 02Â OctÂ 2008 00:00:00 -05:00

Reports of successful antiviral therapy for chronic hepatitis B virus (HBV) infection appeared three decades ago,1 and during the past decade, progress has accelerated dramatically. Along with progress, however, has...

EDITORIAL: Predicting Mortality in Cirrhosis â Serum Sodium Helps

AndrÃ©s CÃ¡rdenas, M.D., and Pere GinÃ¨s, M.D. — Thu, 04Â SepÂ 2008 00:00:00 -05:00

Liver transplantation is widely accepted as a standard method of treatment for many patients with advanced cirrhosis, and survival rates among patients who have undergone liver transplantation approach 80% at...

ORIGINAL ARTICLE: Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

Thu, 04Â SepÂ 2008 00:00:00 -05:00

Background: Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death.

Methods: Using data derived from all adult candidates for primary liver transplantation who...

ORIGINAL ARTICLE: HHV-6A in Syncytial Giant-Cell Hepatitis

Thu, 07Â AugÂ 2008 00:00:00 -05:00

Syncytial giant-cell hepatitis is a rare but severe form of hepatitis that is associated with autoimmune diseases, drug reactions, and viral infections. We used serologic, molecular, and immunohistochemical methods to...

EDITORIAL: Sorafenib in Liver Cancer â Just the Beginning

Lewis R. Roberts, M.B., Ch.B., Ph.D. — Thu, 24Â JulÂ 2008 00:00:00 -05:00

Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of death from cancer, resulting in more than 600,000 deaths per year. The major...

ORIGINAL ARTICLE: Sorafenib in Advanced Hepatocellular Carcinoma

Thu, 24Â JulÂ 2008 00:00:00 -05:00

Background: No effective systemic therapy exists for patients with advanced hepatocellular carcinoma. A preliminary study suggested that sorafenib, an oral multikinase inhibitor of the vascular endothelial growth factor receptor, the...

CLINICAL THERAPEUTICS: Acetylcysteine for Acetaminophen Poisoning

Kennon J. Heard, M.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

A 25-year-old man presents to the emergency department with a toothache. During the evaluation, the physician determines that the patient has been taking large doses of over-the-counter acetaminophen along with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

Thu, 26Â JunÂ 2008 00:00:00 -05:00

Dr. Allyson K. Bloom (Medicine): A 57-year-old woman was admitted to this hospital because of abdominal pain and weakness. One month earlier, a laparoscopic Roux-en-Y gastric bypass and cholecystectomy were...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2008 â A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation

Thu, 12Â JunÂ 2008 00:00:00 -05:00

A 68-year-old man was admitted to the hospital because of headache and loss of vision in the right eye. Orthotopic allogeneic liver transplantation had been performed 3 1/2 months earlier...

REVIEW ARTICLE: Hepatopulmonary Syndrome â A Liver-Induced Lung Vascular Disorder

Roberto RodrÃguez-Roisin, M.D., and Michael J. Krowka, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

The hepatopulmonary syndrome is characterized by a defect in arterial oxygenation induced by pulmonary vascular dilatation in the setting of liver disease1; patients of all ages can be affected. 08052930.xml...

IMAGES IN CLINICAL MEDICINE:

Do Hyun Park, M.D., Ph.D. and Hyun-Young Son, M.D. — Thu, 17Â AprÂ 2008 00:00:00 -05:00

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2008 â A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation

Thu, 10Â AprÂ 2008 00:00:00 -05:00

A 45-year-old man was admitted to this hospital for orthotopic liver transplantation. The patient had been well until the age of 18 years, when a diagnosis of non-A, non-B hepatitis...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Dr. Robert B. Den (Medicine): A 33-year-old man was admitted to this hospital because of fever, abdominal pain, and pancytopenia.

The patient had received a cadaveric renal allograft 15 years earlier...

CLINICAL THERAPEUTICS: Phototherapy for Neonatal Jaundice

M. Jeffrey Maisels, M.B., B.Ch., and Antony F. McDonagh, Ph.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

A male infant weighing 3400 g was born at 37 weeks' gestation after an uncomplicated pregnancy. The mother is a 24-year-old primipara who has type A Rh-positive blood. The infant's...

ORIGINAL ARTICLE: Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Hepatitis E virus (HEV) is considered an agent responsible for acute hepatitis that does not progress to chronic hepatitis. We identified 14 cases of acute HEV infection in three patients...

EDITORIAL: Immunosuppressive Therapy and Tolerance of Organ Allografts

Thomas E. Starzl, M.D., Ph.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

In this issue of the Journal, three articles describe several organ-transplant recipients in whom allografts have maintained good function for up to 5 years without immunosuppressive treatment.123 In two articles...

ORIGINAL ARTICLE: Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

Thu, 24Â JanÂ 2008 00:00:00 -05:00

Complete hematopoietic chimerism and tolerance of a liver allograft from a deceased male donor developed in a 9-year-old girl, with no evidence of graft-versus-host disease 17 months after transplantation. The...

EDITORIAL: Clinical Penetrance of Hereditary Hemochromatosis

Bruce R. Bacon, M.D., and Robert S. Britton, Ph.D. — Thu, 17Â JanÂ 2008 00:00:00 -05:00

In 1996, Feder and colleagues1 showed that homozygosity for a mutation (C282Y) in the HFE gene is responsible for the majority of cases of typical phenotypic hereditary hemochromatosis. At that...

ORIGINAL ARTICLE: Iron-OverloadâRelated Disease in Hereditary Hemochromatosis

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Background: Most persons who are homozygous for C282Y, the HFE allele most commonly asssociated with hereditary hemochromatosis, have elevated levels of serum ferritin and transferrin saturation. Diseases related to iron...

IMAGES IN CLINICAL MEDICINE: Chronic BuddâChiari Syndrome and Abdominal Varices

Sanjay Sharma, M.D. and Harsh Kandpal, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

A 44-year-old man with a 20-year history of chronic liver disease presented with recurrent acute upper gastrointestinal bleeding and worsening mental status. He was emaciated, with marked abdominal distention due...

ORIGINAL ARTICLE: Telbivudine versus Lamivudine in Patients with Chronic Hepatitis B

Thu, 20Â DecÂ 2007 00:00:00 -05:00

Background: Reducing hepatitis B virus (HBV) replication to minimal levels is emerging as a key therapeutic goal for chronic hepatitis B.

Methods: In this double-blind, phase 3 trial, 1370 patients with...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Liver X Receptor and Atherosclerosis

James Scott, M.B., B.S. — Thu, 22Â NovÂ 2007 00:00:00 -05:00

Cardiovascular disease is the leading cause of death in the developed world, and it is poised to become the most widespread health problem worldwide. Atherosclerosis is the major cause of...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Hepatocellular Carcinoma and Sex

Jack Wands, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

Hepatocellular carcinoma is an important disease worldwide, with an increasing incidence in the United States. The large majority of cases occur in patients with chronic infection with hepatitis B virus...

IMAGES IN CLINICAL MEDICINE: Recanalized Umbilical Vein

Ton-Ho Young, M.D. and Herng-Sheng Lee, M.D., Ph.D. — Thu, 18Â OctÂ 2007 00:00:00 -05:00

A 72-year-old woman with a 10-year history of compensated cirrhosis due to hepatitis C infection presented with swelling of the lower leg. Physical examination showed splenomegaly, spider angiomata, and visible...

CLINICAL THERAPEUTICS: Ursodeoxycholic Acid for the Treatment of Primary Biliary Cirrhosis

Keith Lindor, M.D. — Thu, 11Â OctÂ 2007 00:00:00 -05:00

A 52-year-old woman presents with a 1-year history of fatigue and itching. Several months before presentation, her primary care physician noted abnormal liver-function tests, and levels have been persistently elevated...

ORIGINAL ARTICLE: Evidence of MEN-2 in the Original Description of Classic Pheochromocytoma

Thu, 27Â SepÂ 2007 00:00:00 -05:00

The first description of pheochromocytoma in 1886 has been attributed to Felix FrÃ¤nkel, who described an 18-year-old woman with bilateral adrenal âsarcoma and angio-sarcoma.â We reviewed the publication and then...

EDITORIAL: Shortened Therapy for Hepatitis C Virus Genotype 2 or 3 â Is Less More?

T. Jake Liang, M.D. — Thu, 12Â JulÂ 2007 00:00:00 -05:00

Infection with hepatitis C virus (HCV) is a major worldwide cause of chronic liver disease, cirrhosis, and liver cancer, which together represent a chief global public health burden. Therapy has...

ORIGINAL ARTICLE: Peginterferon Alfa-2a and Ribavirin for 16 or 24 Weeks in HCV Genotype 2 or 3

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Background: Patients infected with hepatitis C virus (HCV) genotype 2 or 3 have sustained virologic response rates of approximately 80% after receiving treatment with peginterferon and ribavirin for 24 weeks....

CLINICAL PROBLEM-SOLVING: A Hand-Carried Diagnosis â A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

Thu, 07Â JunÂ 2007 00:00:00 -05:00

A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise. Her colleagues had noticed yellowing of her eyes over the past few days. The patient...

IMAGES IN CLINICAL MEDICINE: Liver Transplantation for Polycystic Liver Disease

William J. Wall, M.D. — Thu, 12Â AprÂ 2007 00:00:00 -05:00

A 51-year-old woman with polycystic liver and kidney disease had undergone renal transplantation 21 years before presentation. She had no evidence of cerebrovascular malformations. Both her father and aunt also...

REVIEW ARTICLE: Strategies for Safer Liver Surgery and Partial Liver Transplantation

Thu, 12Â AprÂ 2007 00:00:00 -05:00

The liver possesses the unique ability to regenerate within a short period.123 This feature has led to the development of innovative strategies in liver surgery and transplantation. The anatomy of...

REVIEW ARTICLE: Viral Hepatitis in HIV Infection

Margaret James Koziel, M.D., and Marion G. Peters, M.D. — Thu, 05Â AprÂ 2007 00:00:00 -05:00

Hepatitis c virus (hcv) and hepatitis b virus (hbv) infections are common among patients with human immunodeficiency virus (HIV) infection because of shared routes of viral transmission. Liver disease due...

EDITORIAL: Hepatitis E Vaccine â Ready for Prime Time?

Krzysztof Krawczynski, M.D., Ph.D. — Thu, 01Â MarÂ 2007 00:00:00 -05:00

Large outbreaks of hepatitis E virus (HEV) infection were first recognized as a distinct clinical entity in the early 1980s.12 Outbreaks continue and involve thousands of patients in certain geographic...

ORIGINAL ARTICLE: Safety and Efficacy of a Recombinant Hepatitis E Vaccine

Thu, 01Â MarÂ 2007 00:00:00 -05:00

Background: Hepatitis E virus (HEV) is an important cause of viral hepatitis. We evaluated the safety and efficacy of an HEV recombinant protein (rHEV) vaccine in a phase 2, randomized,...

IMAGES IN CLINICAL MEDICINE: Hepatosplenic Candidiasis

Nermin Halkic, M.D. and Riadh Ksontini, M.D. — Thu, 25Â JanÂ 2007 00:00:00 -05:00

A 19-year-old woman underwent five cycles of chemotherapy for acute myelomonocytic leukemia that had been diagnosed 7 months earlier. During the last cycle of chemotherapy, neutropenia developed, lasting 22 days,...

CLINICAL PROBLEM-SOLVING: Sum of the Parts

Thu, 07Â DecÂ 2006 00:00:00 -05:00

A 36-year-old Pakistani woman presented to the emergency room with a 10-day history of a nonproductive cough, dyspnea, and fever. She reported having no night sweats and no contact with...

CLINICAL THERAPEUTICS: Peginterferon and Ribavirin for Chronic Hepatitis C

Jay H. Hoofnagle, M.D., and Leonard B. Seeff, M.D. — Thu, 07Â DecÂ 2006 00:00:00 -05:00

A 44-year-old woman with chronic hepatitis C has intermittent fatigue and persistent elevations in serum alanine aminotransferase levels. She has had hepatitis C for 10 years. The diagnosis was made...

EDITORIAL: Thiazolidinediones for Nonalcoholic Steatohepatitis â Promising but Not Ready for Prime Time

Arthur J. McCullough, M.D. — Thu, 30Â NovÂ 2006 00:00:00 -05:00

Mostly unrecognized before 1980, nonalcoholic fatty liver disease now affects all fields of clinical medicine and is the most common form of chronic liver disease in the United States.1 The...

ORIGINAL ARTICLE: A Placebo-Controlled Trial of Pioglitazone in Subjects with Nonalcoholic Steatohepatitis

Thu, 30Â NovÂ 2006 00:00:00 -05:00

Background: No pharmacologic therapy has conclusively proved to be effective for the treatment of nonalcoholic steatohepatitis, which is characterized by insulin resistance, steatosis, and necroinflammation with or without centrilobular fibrosis....

CLINICAL PROBLEM-SOLVING: Ring around the Diagnosis

Thu, 04Â MayÂ 2006 00:00:00 -05:00

A 71-year-old retired schoolteacher from rural Ohio presented to his local hospital with a two-week history of malaise, fever, anorexia, chills, and sweats. He had not had a cough or...

ORIGINAL ARTICLE: Variant of Hepatitis B Virus with Primary Resistance to Adefovir

Thu, 27Â AprÂ 2006 00:00:00 -05:00

The reverse-transcriptase inhibitor lamivudine (Zeffix, GlaxoSmithKline) is often used to treat chronic infection with hepatitis B virus (HBV) until resistance develops. Treatment may then be switched to the reverse-transcriptase inhibitor...

IMAGES IN CLINICAL MEDICINE: Talc Retinopathy

Fayssal El-Jabali, B.S. and Steven Cohen, M.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

A 37-year-old woman with chronic hepatitis C presented with blurred vision after losing her eyeglasses. Her corrected visual acuity was 20/30 in both eyes. On questioning, she reported intravenous use...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2006 â A 35-Year-Old Woman with Recurrent Right-Upper-Quadrant Pain

RocÃo M. Hurtado, M.D., Dushyant V. Sahani, M.D., and Richard L. Kradin, M.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

Dr. Amanda F. Peppercorn (Infectious Diseases): A 35-year-old woman was admitted to this hospital because of recurrent abdominal pain in the right upper quadrant. One year earlier, abdominal pain developed...

EDITORIAL: Hepatitis B â Preventable and Now Treatable

Jay H. Hoofnagle, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

Chronic infection with hepatitis B virus (HBV) accounts for an enormous burden of disease worldwide, including up to half of all cases of cirrhosis, end-stage liver disease, and hepatocellular carcinoma.1...

ORIGINAL ARTICLE: Entecavir versus Lamivudine for Patients with HBeAg-Negative Chronic Hepatitis B

Thu, 09Â MarÂ 2006 00:00:00 -05:00

Background: Entecavir is a potent and selective antiviral agent that has demonstrated efficacy in phase 2 studies in patients with hepatitis B e antigen (HBeAg)ânegative chronic hepatitis B.

Methods: In this...

ORIGINAL ARTICLE: A Comparison of Entecavir and Lamivudine for HBeAg-Positive Chronic Hepatitis B

Thu, 09Â MarÂ 2006 00:00:00 -05:00

Background: Entecavir is a potent and selective guanosine analogue with significant activity against hepatitis B virus (HBV).

Methods: In this phase 3, double-blind trial, we randomly assigned 715 patients with hepatitis...

REVIEW ARTICLE: Drug-Related Hepatotoxicity

Victor J. Navarro, M.D., and John R. Senior, M.D. — Thu, 16Â FebÂ 2006 00:00:00 -05:00

In this review, we define hepatotoxicity as injury to the liver that is associated with impaired liver function caused by exposure to a drug or another noninfectious agent. The distinction...

CLINICAL PROBLEM-SOLVING: Empirically Incorrect

Thu, 02Â FebÂ 2006 00:00:00 -05:00

A 46-year-old Mexican immigrant presented to the hospital because of epigastric pain and the vomiting of coffee-grounds material. He had had fatigue, malaise, jaundice, and a 20-lb (9.1 kg) weight...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2006 â A 63-Year-Old Woman with Jaundice and a Pancreatic Mass

Robert H. Schapiro, M.D., Michael M. Maher, M.D., and Joseph Misdraji, M.D. — Thu, 26Â JanÂ 2006 00:00:00 -05:00

A 63-year-old woman was admitted to the hospital for evaluation of a pancreatic mass.

Four months before admission, the patient noticed dysuria and dark urine. The results of urinalysis showed 3+...

IMAGES IN CLINICAL MEDICINE: Bleeding Angiodysplasia in the Duodenum

Kuang-I Fu, M.D. and Takahiro Fujimori, M.D., Ph.D. — Thu, 19Â JanÂ 2006 00:00:00 -05:00

An 86-year-old woman with cirrhosis and esophageal varices due to chronic hepatitis C infection was referred for evaluation of anemia and fatigue. Esophagogastroduodenoscopy revealed active bleeding in the third part...

REVIEW ARTICLE: Autoimmune Hepatitis

Edward L. Krawitt, M.D. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

Autoimmune hepatitis is a generally progressive, chronic hepatitis of unknown cause that occurs in children and adults of all ages. Occasionally, it has a fluctuating course, with periods of increased...

IMAGES IN CLINICAL MEDICINE: Acanthosis Nigricans

Maria Concetta Fargnoli, M.D. and Pasquale Frascione, M.D. — Thu, 29Â DecÂ 2005 00:00:00 -05:00

A 37-year-old man was evaluated because of a two-year history of asymptomatic thickening and darkening of the skin on his axillae (Panel A), neck, face, and arms. The patient had...

IMAGES IN CLINICAL MEDICINE: Caput Medusae

Pei-Ming Yang, M.D., Ph.D. and Ding-Shinn Chen, M.D. — Thu, 24Â NovÂ 2005 00:00:00 -05:00

A 47-year-old man with a seven-year history of compensated hepatic cirrhosis due to chronic hepatitis B infection presented for routine evaluation. Physical examination revealed a firm liver and mild splenomegaly....

EDITORIAL: Beta-Blockers to Prevent Esophageal Varices â An Unfulfilled Promise

Sandeep Mukherjee, M.D., M.P.H., and Michael F. Sorrell, M.D. — Thu, 24Â NovÂ 2005 00:00:00 -05:00

Variceal bleeding is the most feared complication of portal hypertension in patients with cirrhosis and is a major cause of death. Treatments frequently include endoscopic banding or sclerotherapy of esophageal...

ORIGINAL ARTICLE: Beta-Blockers to Prevent Gastroesophageal Varices in Patients with Cirrhosis

Thu, 24Â NovÂ 2005 00:00:00 -05:00

Background: Nonselective beta-adrenergic blockers decrease portal pressure and prevent variceal hemorrhage. Their effectiveness in preventing varices is unknown.

Methods: We randomly assigned 213 patients with cirrhosis and portal hypertension (minimal hepatic...

IMAGES IN CLINICAL MEDICINE: Actinomyces Hepatic Abscess with Cutaneous Fistula

Mustafa Saad, M.D. and Jonathan Moorman, M.D., Ph.D. — Thu, 03Â NovÂ 2005 00:00:00 -05:00

A 64-year-old man with a history of colonic resection for adenocarcinoma six years earlier presented with weakness and abdominal discomfort of six months' duration. Computed tomography of the abdomen with...

REVIEW ARTICLE: Primary Biliary Cirrhosis

Marshall M. Kaplan, M.D., and M. Eric Gershwin, M.D. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

Primary biliary cirrhosis is a slowly progressive autoimmune disease of the liver that primarily affects women. Its peak incidence occurs in the fifth decade of life, and it is uncommon...

EDITORIAL: Hepatitis A â The Price of Progress

Loriana Di Giammarino, M.D., and Jules L. Dienstag, M.D. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

Hepatitis A tends to be a self-limited disease without serious sequelae and with a low case fatality rate1; unlike hepatitis B and hepatitis C, hepatitis A is not a cause...

ORIGINAL ARTICLE: An Outbreak of Hepatitis A Associated with Green Onions

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Background: In November 2003, a large hepatitis A outbreak was identified among patrons of a single Pennsylvania restaurant. We investigated the cause of the outbreak and factors that contributed to...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2005 â A 57-Year-Old Man with a Mass in the Liver

Thu, 28Â JulÂ 2005 00:00:00 -05:00

A 57-year-old man was admitted to the hospital because of a mass in the liver.

The patient had been well until approximately two years before admission, when a diagnosis of chronic...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2005 â A Four-Week-Old Male Infant with Jaundice and Thrombocytopenia

Thu, 14Â JulÂ 2005 00:00:00 -05:00

A four-week-old male infant was admitted to this hospital because of jaundice, hyperbilirubinemia, thrombocytopenia, and abdominal distention.

The patient was born at term at another hospital by spontaneous vaginal delivery to...

EDITORIAL: The Maze of Treatments for Hepatitis B

Anna Suk-Fong Lok, M.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

Worldwide, there are approximately 350 million carriers of hepatitis B virus (HBV), of whom half a million to 1 million die from liver disease each year. The goal of treatment...

ORIGINAL ARTICLE: Peginterferon Alfa-2a, Lamivudine, and the Combination for HBeAg-Positive Chronic Hepatitis B

Thu, 30Â JunÂ 2005 00:00:00 -05:00

Background: Current treatments for chronic hepatitis B are suboptimal. In the search for improved therapies, we compared the efficacy and safety of pegylated interferon alfa plus lamivudine, pegylated interferon alfa...

ORIGINAL ARTICLE: Long-Term Therapy with Adefovir Dipivoxil for HBeAg-Negative Chronic Hepatitis B

Thu, 30Â JunÂ 2005 00:00:00 -05:00

Background: Treatment with adefovir dipivoxil for 48 weeks resulted in histologic, virologic, and biochemical improvement in patients with hepatitis B e antigen (HBeAg)ânegative chronic hepatitis B. We evaluated the effect...

ORIGINAL ARTICLE: Peginterferon Alfa-2b and Ribavirin for 12 vs. 24 Weeks in HCV Genotype 2 or 3

Thu, 23Â JunÂ 2005 00:00:00 -05:00

Background: We hypothesized that in patients with hepatitis C virus (HCV) genotype 2 or 3 in whom HCV RNA is not detectable after 4 weeks of therapy, 12 weeks of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2005 â An 80-Year-Old Man with Shortness of Breath, Edema, and Proteinuria

Thu, 19Â MayÂ 2005 00:00:00 -05:00

An 80-year-old man was admitted to the hospital because of shortness of breath, pleural effusions, and edema of the legs.

Atrial fibrillation had developed seven years earlier, with bradycardia and syncope,...

CLINICAL PROBLEM-SOLVING: Clear as Mud

Daniel R. Kaul, M.D., Scott A. Flanders, M.D., and Sanjay Saint, M.D., M.P.H. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

A 17-year-old boy presented to his primary care physician, reporting four days of low back pain, a temperature as high as 40Â°C, headache, diffuse myalgias, and vomiting. The patient had...

PERSPECTIVE: Orchestration of Iron Homeostasis

Robert E. Fleming, M.D., and Bruce R. Bacon, M.D. — Thu, 28Â AprÂ 2005 00:00:00 -05:00

The number of newly identified genes participating in the regulation of iron homeostasis has increased at a remarkable pace. The characterization of these genes has led investigators to challenge previous...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Arrest in the Liver â A Genetically Defined Malaria Vaccine?

Ute Frevert, D.V.M., Ph.D., and Elizabeth Nardin, Ph.D. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

Malaria is a disease with far-reaching effects: 40 percent of the world's population is at risk for malarial infection, approximately 300 million to 400 million cases occur annually, and each...

IMAGES IN CLINICAL MEDICINE: Malposition of a SengstakenâBlakemore Tube

Jung-Yien Chien, M.D. and Chong-Jen Yu, M.D., Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

An 86-year-old woman had a history of cirrhosis associated with chronic hepatitis B infection lasting more than 16 years; she had had five episodes of esophageal variceal bleeding that had...

IMAGES IN CLINICAL MEDICINE: Blocking the Common Bile Duct

Betram G. Esser-KÃ¶chling, M.D. and Friedrich W. Hirsch, M.D. — Thu, 03Â FebÂ 2005 00:00:00 -05:00

A 63-year-old woman was admitted to the hospital with vomiting and abdominal pain. Approximately one year earlier, she had undergone a papillotomy and laparoscopic cholecystectomy for biliary colic. Laboratory examination...

EDITORIAL: Genes and the Response to Drugs

Yoseph Caraco, M.D. — Thu, 30Â DecÂ 2004 00:00:00 -05:00

The response to many drugs in common use varies greatly among patients. After the intake of identical doses of a given agent, some patients may have clinically significant adverse effects,...

CLINICAL PRACTICE: Prevention of Hepatitis B with the Hepatitis B Vaccine

Gregory A. Poland, M.D., and Robert M. Jacobson, M.D. — Thu, 30Â DecÂ 2004 00:00:00 -05:00

A 25-year-old registered nurse comes for a visit to initiate prenatal care after receiving a positive result on a pregnancy test. On review of her vaccination status, she reports that...

ORIGINAL ARTICLE: Codeine Intoxication Associated with Ultrarapid CYP2D6 Metabolism

Thu, 30Â DecÂ 2004 00:00:00 -05:00

Life-threatening opioid intoxication developed in a patient after he was given small doses of codeine for the treatment of a cough associated with bilateral pneumonia. Codeine is bioactivated by CYP2D6...

CLINICAL PROBLEM-SOLVING: Why âWhyâ Matters

Thu, 02Â DecÂ 2004 00:00:00 -05:00

A 38-year-old woman presented to the emergency room for evaluation of shortness of breath and jaundice. The previous day, she had attended a wedding, where she felt well. Several hours...

IMAGES IN CLINICAL MEDICINE: Benign Hepatic Cyst

Sandeep Garg, M.D. and Manisha Garg, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

An 88-year-old man was admitted to the hospital with a sudden onset of shortness of breath. Deep venous thrombosis and pulmonary embolism were diagnosed. During an echocardiogram, a large cystic...

PERSPECTIVE: Running Like Water â The Omnipresence of Hepatitis E

Suzanne U. Emerson, Ph.D., and Robert H. Purcell, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

Hepatitis E virus (HEV), originally identified as the culprit in massive waterborne epidemics of acute hepatitis in Asia, is now commanding attention in regions of Sudan and Iraq. And once...

ORIGINAL ARTICLE: Mutant Mitochondrial Elongation Factor G1 and Combined Oxidative Phosphorylation Deficiency

Thu, 11Â NovÂ 2004 00:00:00 -05:00

Although most components of the mitochondrial translation apparatus are encoded by nuclear genes, all known molecular defects associated with impaired mitochondrial translation are due to mutations in mitochondrial DNA. We...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2004 â A Four-Year-Old Boy with Hypoxemia

T. Bernard Kinane, M.D., and Sjirk J. Westra, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

A four-year-old boy was transferred to this hospital because of hypoxemia of unknown origin. Five days before admission, he had been taken to the emergency room of another hospital with...

EDITORIAL: Prevention of Hepatocellular Carcinoma

Jack R. Wands, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

Hepatocellular carcinoma is a significant problem worldwide, and the incidence is increasing in the United States.1 Approximately 90 to 95 percent of these tumors result from the biologic consequences of...

ORIGINAL ARTICLE: Lamivudine for Patients with Chronic Hepatitis B and Advanced Liver Disease

Thu, 07Â OctÂ 2004 00:00:00 -05:00

Background: The effectiveness of antiviral therapy in preventing disease progression in patients with chronic hepatitis B and advanced fibrosis or cirrhosis is unknown.

Methods: 04100729.xml Patients with chronic hepatitis B who...

ORIGINAL ARTICLE: Peginterferon Alfa-2a Alone, Lamivudine Alone, and the Two in Combination in Patients with HBeAg-Negative Chronic Hepatitis B

Thu, 16Â SepÂ 2004 00:00:00 -05:00

Background: Available treatments for hepatitis B e antigen (HBeAg)ânegative chronic hepatitis B are associated with poor sustained responses. As a result, nucleoside and nucleotide analogues are typically continued indefinitely, a...

IMAGES IN CLINICAL MEDICINE: Detection of Liver Abscesses by T-Weighted Magnetic Resonance Imaging

Masanori Nakagawara, M.D., Hiroyuki Hanai, M.D., and Masayoshi Kajimura, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

A 68-year-old man presented with pain in the right upper abdomen and a temperature above 39Â°C. Although he had recently undergone a five-day course of treatment with broad-spectrum antibiotics at...

ORIGINAL ARTICLE: Peginterferon Alfa-2a plus Ribavirin versus Interferon Alfa-2a plus Ribavirin for Chronic Hepatitis C in HIV-Coinfected Persons

Thu, 29Â JulÂ 2004 00:00:00 -05:00

Background: Chronic hepatitis C virus (HCV) infection is a cause of major complications in persons who are also infected with the human immunodeficiency virus (HIV). However, the treatment of HCV...

ORIGINAL ARTICLE: Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus Infection in HIV-Infected Patients

Thu, 29Â JulÂ 2004 00:00:00 -05:00

Background: Hepatitis C virus (HCV) infection is highly prevalent and is associated with substantial morbidity and mortality among persons infected with the human immunodeficiency virus (HIV). We compared the efficacy...

PERSPECTIVE: Treating Hepatitis C in âDifficult-to-Treatâ Patients

Jean-Michel Pawlotsky, M.D., Ph.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

The current standard treatment for chronic hepatitis C is the combination of pegylated interferon alfa and ribavirin, a synthetic guanosine analogue. In the pegylated form of interferon, the interferon alfa...

IMAGES IN CLINICAL MEDICINE: A Cystic Mass in the Liver

Nermin Halkic, M.D. and Michel Gillet, M.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

A 44-year-old woman presented with a 10-month history of intermittent discomfort in the right upper abdomen. On physical examination, a mass filling the epigastrium and the right subcostal region was...

REVIEW ARTICLE: Hereditary Hemochromatosis â A New Look at an Old Disease

Antonello Pietrangelo, M.D., Ph.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

For much of the 20th century, hereditary hemochromatosis was regarded as a clinically and genetically unique entity. The classic findings on presentation â diabetes, bronze pigmentation of the skin, and...

ORIGINAL ARTICLE: Peginterferon Alfa-2b and Ribavirin for the Treatment of Chronic Hepatitis C in Blacks and Non-Hispanic Whites

Thu, 27Â MayÂ 2004 00:00:00 -05:00

Background: Several small studies have reported a lower response rate to interferon alfa among black patients with chronic hepatitis C infection than among white patients. The increased prevalence of infection...

REVIEW ARTICLE: Management of Cirrhosis and Ascites

Thu, 15Â AprÂ 2004 00:00:00 -05:00

Cirrhosis, most frequently caused by hepatitis C or alcoholism, was the 12th leading cause of death in the United States in 2000, accounting for more than 25,000 deaths.1 Ascites is...

REVIEW ARTICLE: Hepatitis B Virus Infection â Natural History and Clinical Consequences

Don Ganem, M.D., and Alfred M. Prince, M.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

In the past 10 years, remarkable strides have been made in the understanding of the natural history and pathogenesis of hepatitis B virus (HBV) infection. In this article we will...

REVIEW ARTICLE: The BuddâChiari Syndrome

K.V. Narayanan Menon, M.D., Vijay Shah, M.D., and Patrick S. Kamath, M.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

The BuddâChiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the inferior vena cava,...

CLINICAL PRACTICE: Prevention of Hepatitis A with the Hepatitis A Vaccine

Allen S. Craig, M.D., and William Schaffner, M.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

A 34-year-old man presented to the emergency department two weeks after returning from a trip to India, reporting a six-day history of anorexia, vomiting, malaise, fatigue, and dark urine. His...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Hepatic Diseases â Hitting the Target with Inhibitory RNAs

Beverly L. Davidson, Ph.D. — Thu, 11Â DecÂ 2003 00:00:00 -05:00

What is all the noise about RNA silencing? And how does silencing, or impairing translation of target RNAs, help us develop effective therapies for chronic and acute liver diseases? As...

CLINICAL PROBLEM-SOLVING: Step by Step

Thu, 04Â DecÂ 2003 00:00:00 -05:00

A 63-year-old man presented to the emergency department for an evaluation of acute, mild rectal bleeding. He reported a two-week history of exertional dyspnea and generalized weakness, as well as...

IMAGES IN CLINICAL MEDICINE: Giant Hepatic Hemangioma

Toshimi Kaido, M.D. and Masayuki Imamura, M.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

A 46-year-old woman had a one-year history of abdominal distention. Physical examination showed an upper-abdominal mass extending from the right hypochondrium to 10 cm below the umbilicus. Laboratory studies disclosed...

CLINICAL PROBLEM-SOLVING: A Window of Opportunity

Thu, 06Â NovÂ 2003 00:00:00 -05:00

A 62-year-old woman presented to her local emergency department because of pain in the epigastrium and right upper quadrant. The pain had begun insidiously five days earlier and was constant,...

CLINICAL PROBLEM-SOLVING: Mind the Gap

Alexander Turchin, M.D., Julian L. Seifter, M.D., and Ellen W. Seely, M.D. — Thu, 09Â OctÂ 2003 00:00:00 -05:00

A 62-year-old woman was admitted to the hospital because of abnormal liver-function tests. She had a history of acute myelogenous leukemia and had undergone transplantation of T-cellâdepleted allogeneic bone marrow...

REVIEW ARTICLE: Drug-Induced Hepatotoxicity

William M. Lee, M.D. — Thu, 31Â JulÂ 2003 00:00:00 -05:00

In the past five years, two drugs have been withdrawn from the market by the Food and Drug Administration (FDA) for causing severe liver injury, a potential danger that had...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2003 â A Nine-Year-Old Girl with Hepatosplenomegaly and Pain in the Thigh

Eric C. Larsen, M.D., Susan A. Connolly, M.D., and Andrew E. Rosenberg, M.D. — Thu, 26Â JunÂ 2003 00:00:00 -05:00

A nine-year-old girl was admitted to the hospital because of hepatosplenomegaly and pain in the thigh.

The patient had been well until three years earlier, when she began to have frequent...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2003 â A 14-Month-Old Boy with Hepatomegaly, Perianal Lesions, and a Bony Lump on the Forehead

G. Naheed Usmani, M.D., Sjirk J. Westra, M.D., and Souhad Younes, M.D. — Thu, 24Â AprÂ 2003 00:00:00 -05:00

A 14-month-old boy was admitted to the hospital because of hepatomegaly, left-sided ptosis, and a bony lump on the forehead.

The patient had been constipated for several months, passing one hard...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2003 â A 14-Year-Old Boy with Ulcerative Colitis, Primary Sclerosing Cholangitis, and Partial Duodenal Obstruction

Albert M. Ross IV, M.D., Sudha A. Anupindi, M.D., and Ulysses J. Balis, M.D. — Thu, 10Â AprÂ 2003 00:00:00 -05:00

A 14-year-old boy with a history of ulcerative colitis was admitted to the hospital because of vomiting and abdominal pain.

Ulcerative colitis had been diagnosed at the age of three years...

EDITORIAL: Suppressing Hepatitis B without Resistance â So Far, So Good

Mark E. Mailliard, M.D., and John L. Gollan, M.D., Ph.D. — Thu, 27Â FebÂ 2003 00:00:00 -05:00

Clinicians caring for patients with chronic viral hepatitis face complex challenges. The ultimate goal of therapy for chronic hepatitis is to heal hepatic inflammation and necrosis, thereby halting progression to...

SPECIAL ARTICLE: A Survey of Liver Transplantation from Living Adult Donors in the United States

Thu, 27Â FebÂ 2003 00:00:00 -05:00

Background: The transplantation of the right lobe of a liver from a living adult donor into an adult recipient has been performed increasingly frequently in the United States. Although the...

ORIGINAL ARTICLE: Adefovir Dipivoxil for the Treatment of Hepatitis B e AntigenâPositive Chronic Hepatitis B

Thu, 27Â FebÂ 2003 00:00:00 -05:00

Background: In preclinical and phase 2 studies, adefovir dipivoxil demonstrated potent activity against hepatitis B virus (HBV), including lamivudine-resistant strains.

Methods: We randomly assigned 515 patients with chronic hepatitis B who...

ORIGINAL ARTICLE: Adefovir Dipivoxil for the Treatment of Hepatitis B e AntigenâNegative Chronic Hepatitis B

Thu, 27Â FebÂ 2003 00:00:00 -05:00

Background: Adefovir dipivoxil, a nucleotide analogue, demonstrated clinically significant antiviral activity in patients with chronic hepatitis B in phase 1 and 2 clinical trials.

Methods: We randomly assigned 185 patients with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2003 â A 42-Year-Old Woman with Cough, Fever, and Abnormalities on Thoracoabdominal Computed Tomography

Lindsey R. Baden, M.D., and Danielle D. Elliott, M.D. — Thu, 30Â JanÂ 2003 00:00:00 -05:00

A 42-year-old woman was admitted to the hospital because of a productive cough, chills, and fever.

The patient had been well until seven months earlier, when an intermittent, generally nonproductive cough...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2002 â A 54-Year-Old Man with Hypercalcemia, Renal Dysfunction, and an Enlarged Liver

John K. Erban and Zuoquin Tang — Thu, 12Â DecÂ 2002 00:00:00 -05:00

A 54-year-old man was admitted to the hospital because of possible metastatic carcinoma with hypercalcemia and renal dysfunction.

The patient had been in good health until about six weeks earlier. At...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2002 â A 61-Year-Old Man with Headache and Multiple Infarcts

Martin A. Samuels, Mary Etta King, and Ulysses Balis — Thu, 10Â OctÂ 2002 00:00:00 -05:00

A 61-year-old man was admitted to the hospital because of right hemiplegia, aphasia, and obtundation.

According to the patient's family, he had been well at his home in Haiti until about...

ORIGINAL ARTICLE: Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus Infection

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Background: Treatment with peginterferon alfa-2a alone produces significantly higher sustained virologic responses than treatment with interferon alfa-2a alone in patients with chronic hepatitis C virus (HCV) infection. We compared the...

EDITORIAL: Hepatitis B e Antigen â The Dangerous Endgame of Hepatitis B

Thu, 18Â JulÂ 2002 00:00:00 -05:00

Just as traditional Chinese medicine teaches us to respect the external forces that may affect the liver, modern Western medicine continues to uncover the maleficence of these influences in the...

ORIGINAL ARTICLE: Hepatitis B e Antigen and the Risk of Hepatocellular Carcinoma

Thu, 18Â JulÂ 2002 00:00:00 -05:00

Background: The presence of hepatitis B e antigen (HBeAg) in serum indicates active viral replication in hepatocytes. 02071823.xml HBeAg is thus a surrogate marker for the presence of hepatitis B...

ORIGINAL ARTICLE: Clinical Trial of Lamivudine in Children with Chronic Hepatitis B

Thu, 30Â MayÂ 2002 00:00:00 -05:00

Background: Lamivudine therapy is effective for chronic hepatitis B infection in adults. We evaluated the efficacy and tolerability of lamivudine as a treatment for chronic infection with hepatitis B virus...

PERSPECTIVE: Chronic Hepatitis B

Thu, 30Â MayÂ 2002 00:00:00 -05:00

Chronic hepatitis B remains a major public health problem, affecting more than 350 million people worldwide. Cirrhosis, liver failure, or hepatocellular carcinoma will develop in approximately 15 to 40 percent...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2002 â A 50-Year-Old Man with Eosinophilia and Fluctuating Hepatic Lesions

J. Dick MacLean and Fiona M. Graeme-Cook — Thu, 18Â AprÂ 2002 00:00:00 -05:00

A 50-year-old man was admitted to the Tropical and Geographic Medicine Center of this hospital because of eosinophilia and fluctuating hepatic lesions.

The patient had been well until 10 months earlier,...

REVIEW ARTICLE: Nonalcoholic Fatty Liver Disease

Paul Angulo, M.D. — Thu, 18Â AprÂ 2002 00:00:00 -05:00

Nonalcoholic fatty liver disease is an increasingly recognized condition that may progress to end-stage liver disease. The pathological picture resembles that of alcohol-induced liver injury, but it occurs in patients...

REVIEW ARTICLE: Adult-to-Adult Transplantation of the Right Hepatic Lobe from a Living Donor

Thu, 04Â AprÂ 2002 00:00:00 -05:00

Transplantation of the right hepatic lobe from an adult living donor to an adult recipient is rapidly emerging as an effective treatment for selected patients with end-stage liver disease.1234 The...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2002 â A 17-Year-Old Boy with Biliary Obstruction

M. Susan Moyer and Fiona M. Graeme-Cook — Thu, 24Â JanÂ 2002 00:00:00 -05:00

A 17-year-old boy was admitted to the hospital because of evidence of biliary obstruction.

Seventeen months before admission, the patient was admitted to another hospital because of bloody diarrhea. The serum...

REVIEW ARTICLE: Alpha-Antitrypsin Deficiency â A Model for Conformational Diseases

Robin W. Carrell, Ph.D., F.R.C.P., and David A. Lomas, Ph.D., F.R.C.P. — Thu, 03Â JanÂ 2002 00:00:00 -05:00

Many biologic processes require a balance between the proteases that initiate the proteolytic pathways essential to life and the inhibitors that limit excessive protease activity. There are many different families...

IMAGES IN CLINICAL MEDICINE: Liver Abscess Due to from a Fishbone

Alexander Tkeshelashvili Kessler, M.D. and Athena P. Kourtis, M.D., Ph.D. — Thu, 06Â DecÂ 2001 00:00:00 -05:00

Figure 1. A 53-year-old man presented with a four-week history of abdominal pain and a tender, nonerythematous mass (5 by 5 cm) in the right upper quadrant. He had a...

EDITORIAL: Oral Anticoagulant Therapy for the Prevention of Stroke

Thu, 15Â NovÂ 2001 00:00:00 -05:00

This year in the United States, 450,000 people will have a first ischemic stroke.123 For these patients (including those receiving thrombolytic therapy), the primary therapeutic goals will be rehabilitation and...

ORIGINAL ARTICLE: Treatment of Acute Hepatitis C with Interferon Alfa-2b

Thu, 15Â NovÂ 2001 00:00:00 -05:00

Background: In people who are infected with the hepatitis C virus (HCV), chronic infection often develops and is difficult to eradicate. We sought to determine whether treatment during the acute...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2001 â A 44-Year-Old Woman with Chills, Fever, Jaundice, and Hepatic Abscesses

Raymond T. Chung, M.D., and Eric C. Sheffer, M.D> — Thu, 13Â SepÂ 2001 00:00:00 -05:00

A 44-year-old woman was admitted to this hospital because of abdominal pain, chills, fever, and jaundice.

The patient, a native of southern China, had been treated for intrahepatic stones by lithotripsy...

SOUNDING BOARD: Is It Justifiable to Withhold Treatment for Hepatitis C from Illicit-Drug Users?

Thu, 19Â JulÂ 2001 00:00:00 -05:00

Approximately 3 million Americans are thought to be infected with hepatitis C virus (HCV).1 HCV causes chronic infection in about 85 percent of infected persons, and cirrhosis may develop in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2001 â A 25-Year-Old Woman with Fever and Abnormal Liver Function

Eric J. Rubin, M.D., Ph.D., and Fiona M. Graeme-Cook, M.B.B.C. — Thu, 19Â JulÂ 2001 00:00:00 -05:00

A 25-year-old woman was admitted to the hospital because of persistent fever.

The patient was a resident of the Philippines who had flown to the United States 11 days before admission...

REVIEW ARTICLE: Hepatitis C Virus Infection

Georg M. Lauer, M.D., and Bruce D. Walker, M.D. — Thu, 05Â JulÂ 2001 00:00:00 -05:00

Hepatitis C virus (HCV) infects an estimated 170 million persons worldwide and thus represents a viral pandemic, one that is five times as widespread as infection with the human immunodeficiency...

ORIGINAL ARTICLE: Keratin 8 Mutations in Patients with Cryptogenic Liver Disease

Thu, 24Â MayÂ 2001 00:00:00 -05:00

Background: About 10 percent of patients who undergo liver transplantation have cryptogenic liver disease. In animal models, the absence of heteropolymeric keratins 8 and 18 or the presence of mutant...

CLINICAL PROBLEM-SOLVING: Less is More

C. Christopher Smith, M.D., Jess Mandel, M.D., and Booker Bush, M.D. — Thu, 05Â AprÂ 2001 00:00:00 -05:00

A 63-year-old woman presented to her physician with fatigue, weakness, anorexia, and an unintentional weight loss of 14.5 kg (32 lb) during the previous four months. She reported increased constipation...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2001 â A 17-Year-Old Girl with Marked Jaundice and Weight Loss

Maureen M. Jonas, Fiona M. Graeme-Cook — Thu, 22Â FebÂ 2001 00:00:00 -05:00

A 17-year-old girl was admitted to the hospital because of progressive jaundice and weight loss.

The patient had been well until four months earlier, when she experienced the onset of malaise,...

REVIEW ARTICLE: Neonatal Hyperbilirubinemia

Phyllis A. Dennery, M.D., Daniel S. Seidman, M.D., and David K. Stevenson, M.D. — Thu, 22Â FebÂ 2001 00:00:00 -05:00

Icterus neonatorum, or neonatal jaundice, has long been recognized.1 The term âkernicterusâ was introduced in the early 1900s to refer to the yellow staining of the basal ganglia observed in...

REVIEW ARTICLE: Liver Biopsy

Arturo A. Bravo, M.D., Sunil G. Sheth, M.D., and Sanjiv Chopra, M.D. — Thu, 15Â FebÂ 2001 00:00:00 -05:00

Paul Ehrlich is credited with performing the first percutaneous liver biopsy in 1883 in Germany.1 After Menghini reported a technique for âone-second needle biopsy of the liverâ in 1958, the...

IMAGES IN CLINICAL MEDICINE: Neonatal Necrotizing Enterocolitis

Husam Salama, M.D. and Orlando da Silva, M.D. — Thu, 11Â JanÂ 2001 00:00:00 -05:00

Figure 1. A baby required active resuscitation when he was born at 26 weeks of gestation weighing 918 g. The Apgar scores were 2, 3, and 7 at 1, 5,...

ORIGINAL ARTICLE: Early Administration of Vapreotide for Variceal Bleeding in Patients with Cirrhosis

Thu, 04Â JanÂ 2001 00:00:00 -05:00

Background: In patients with cirrhosis, pharmacologic or endoscopic treatment may control variceal bleeding. However, the effects of early administration of a somatostatin analogue followed by endoscopic treatment are unknown.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Alpha-Antitrypsin Deficiency

Sandra J. Shin, M.D. and Gary Meininger, M.D. — Thu, 28Â DecÂ 2000 00:00:00 -05:00

Figure 1. A 77-year-old woman with cirrhosis was admitted with a one-week history of altered sensorium. A prior evaluation of her liver disease disclosed only a serum alpha1-antitrypsin level of...

ORIGINAL ARTICLE: Transmission of Hepatitis C Virus from a Patient to an Anesthesiology Assistant to Five Patients

Thu, 21Â DecÂ 2000 00:00:00 -05:00

Prevention and treatment of infections with hepatitis C virus (HCV) remain a major challenge.1 The main source of HCV infection in developed countries was formerly transfusion of contaminated blood and...

EDITORIAL: Conquering Hepatitis C, Step by Step

Thu, 07Â DecÂ 2000 00:00:00 -05:00

Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States.1 In most of the estimated 2.7 million people who have the infection it has...

ORIGINAL ARTICLE: Peginterferon Alfa-2a in Patients with Chronic Hepatitis C and Cirrhosis

Thu, 07Â DecÂ 2000 00:00:00 -05:00

Background: Chronic hepatitis C virus (HCV) infection in patients with cirrhosis is difficult to treat. In patients with chronic hepatitis C but without cirrhosis, once-weekly administration of interferon modified by...

ORIGINAL ARTICLE: Peginterferon Alfa-2a in Patients with Chronic Hepatitis C

Thu, 07Â DecÂ 2000 00:00:00 -05:00

Background: Covalent attachment of a 40-kd branched-chain polyethylene glycol moiety to interferon alfa-2a results in a compound (peginterferon alfa-2a) that has sustained absorption, a slower rate of clearance, and a...

ORIGINAL ARTICLE: Disease-Related Conditions in Relatives of Patients with Hemochromatosis

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Hemochromatosis occurs in approximately 5 white people per 1000 and is usually due to homozygosity for mutations in the HLA-linked HFE gene. Although screening has been proposed, the proportion...

REVIEW ARTICLE: Cytokines in Alcoholic and Nonalcoholic Steatohepatitis

Herbert Tilg, M.D., and Anna Mae Diehl, M.D. — Thu, 16Â NovÂ 2000 00:00:00 -05:00

Cytokines are pleiotropic regulatory peptides that can be produced by virtually every nucleated cell in the body, including most types of liver cells.12 The cytokine family consists of several subfamilies:...

ORIGINAL ARTICLE: Liver Disease in Patients with Hereditary Hemorrhagic Telangiectasia

Thu, 28Â SepÂ 2000 00:00:00 -05:00

Background: Hereditary hemorrhagic telangiectasia, or RenduâOslerâWeber disease, is an autosomal dominant disorder characterized by angiodysplastic lesions (telangiectases and arteriovenous malformations) that affect many organs. Liver involvement in patients with this...

EDITORIAL: The Role of Transjugular Portosystemic Shunting in Patients with Ascites

Thu, 08Â JunÂ 2000 00:00:00 -05:00

Ascites is one of the most important complications of cirrhosis. It predisposes patients to several additional complications, including spontaneous bacterial peritonitis, the hepatorenal syndrome, and hepatic hydrothorax, and it is...

ORIGINAL ARTICLE: A Comparison of Paracentesis and Transjugular Intrahepatic Portosystemic Shunting in Patients with Ascites

Thu, 08Â JunÂ 2000 00:00:00 -05:00

Background: In patients with cirrhosis and ascites, creation of a transjugular intrahepatic portosystemic shunt may reduce the ascites and improve renal function. However, the benefit of this procedure as compared...

REVIEW ARTICLE: Evaluation of Abnormal Liver-Enzyme Results in Asymptomatic Patients

Daniel S. Pratt, M.D., and Marshall M. Kaplan, M.D. — Thu, 27Â AprÂ 2000 00:00:00 -05:00

Now that routine laboratory testing is automated and is frequently part of an annual checkup, physicians are often faced with the problem of a patient with one abnormal result on...

IMAGES IN CLINICAL MEDICINE: Hepatic Hemangioma

Michael Landor, M.D. and Paul Petrozzo, M.D. — Thu, 16Â MarÂ 2000 00:00:00 -05:00

Figure 1. A 45-year-old man with asymptomatic human immunodeficiency virus infection presented with abdominal distention. Examination revealed an enlarged, soft liver extending 20 cm below the costal margin in the...

ORIGINAL ARTICLE: Correction of the Hyper-IgM Syndrome after Liver and Bone Marrow Transplantation

Thu, 03Â FebÂ 2000 00:00:00 -05:00

The hyper-IgM syndrome, a rare form of combined primary immunodeficiency, is characterized by neutropenia and defective B-cell isotype switching, which results in elevated or normal levels of serum IgM and...

ORIGINAL ARTICLE: The Effect of the Volume of Procedures at Transplantation Centers on Mortality after Liver Transplantation

Thu, 30Â DecÂ 1999 00:00:00 -05:00

Background: For many complex surgical procedures there is an association between a low volume of procedures and an increased risk of death for the patients who undergo the procedures.

Methods: We...

ORIGINAL ARTICLE: Hepatic Arterial Infusion of Chemotherapy after Resection of Hepatic Metastases from Colorectal Cancer

Thu, 30Â DecÂ 1999 00:00:00 -05:00

Background: Two years after undergoing resection of liver metastases from colorectal cancer, about 65 percent of patients are alive and 25 percent are free of detectable disease. We tried to...

ORIGINAL ARTICLE: Lamivudine as Initial Treatment for Chronic Hepatitis B in the United States

Thu, 21Â OctÂ 1999 00:00:00 -05:00

Background: Although the nucleoside analogue lamivudine has shown promise in patients with chronic hepatitis B, long-term data on patients from the United States are lacking.

Methods: We randomly assigned previously untreated...

EDITORIAL: Hepatitis C Infection in Children

Thu, 16Â SepÂ 1999 00:00:00 -05:00

Recent data indicate that an estimated 2.7 million people in the United States are chronically infected with hepatitis C virus (HCV).1 Hepatitis C has become the most common reason for...

ORIGINAL ARTICLE: Donor-Derived Acute Promyelocytic Leukemia in a Liver-Transplant Recipient

Thu, 09Â SepÂ 1999 00:00:00 -05:00

The long-term survival of donor lymphoid cells in recipients of solid-organ transplants or of fetal lymphocytes that cross the placenta and enter the maternal circulation has been established,123 but the...

ORIGINAL ARTICLE: The Prevalence of Hepatitis C Virus Infection in the United States, 1988 through 1994

Thu, 19Â AugÂ 1999 00:00:00 -05:00

Background: Because many persons with chronic hepatitis C virus (HCV) infection are asymptomatic, population-based serologic studies are needed to estimate the prevalence of the infection and to develop and evaluate...

EDITORIAL: Intravenous Albumin for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Patients with cirrhosis and ascites are often on the brink of renal failure. Their renal function is vulnerable because of the poorly understood, complex hemodynamic abnormalities that occur in advanced...

IMAGES IN CLINICAL MEDICINE: Caput Medusae

Stanley M. Cohen, M.D. — Thu, 05Â AugÂ 1999 00:00:00 -05:00

Figure 1. A 43-year-old man known to have hepatitis C infection and a long history of alcohol abuse was admitted to the hospital with ascites and edema. For the previous...

ORIGINAL ARTICLE: Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Background: In patients with cirrhosis and spontaneous bacterial peritonitis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated...

IMAGES IN CLINICAL MEDICINE: Successful Treatment of Severe Thalassemia

Pietro Muretto, M.D. and Emanuele Angelucci, M.D. — Thu, 08Â JulÂ 1999 00:00:00 -05:00

Figure 1. A six-year-old girl underwent successful allogeneic bone marrow transplantation for severe Î²-thalassemia in 1985. Before transplantation, the serum ferritin concentration was 4044 Î¼g per liter and the serum...

ORIGINAL ARTICLE: Occult Hepatitis B Virus Infection in Patients with Chronic Hepatitis C Liver Disease

Thu, 01Â JulÂ 1999 00:00:00 -05:00

Background: Hepatitis B virus (HBV) infections in patients who lack detectable hepatitis B surface antigen (HBsAg) are called occult infections. Although such infections have been identified in patients with chronic...

ORIGINAL ARTICLE: A Fetal Fatty-Acid Oxidation Disorder as a Cause of Liver Disease in Pregnant Women

Thu, 03Â JunÂ 1999 00:00:00 -05:00

Background: Acute fatty liver of pregnancy and the HELLP syndrome (hemolysis, elevated liver-enzyme levels, and a low platelet count) are serious hepatic disorders that may occur during pregnancy in women...

IMAGES IN CLINICAL MEDICINE: Madelung's Disease: Inherited from an Ancient Mediterranean Population?

Claudio Feliciani, M.D. and Pierluigi Amerio, M.D. — Thu, 13Â MayÂ 1999 00:00:00 -05:00

Figure 1. A 44-year-old man was evaluated for symmetric deposits of fat on his arms and legs. At the age of 26 years, he had been hospitalized because of axonal...

EDITORIAL: The Disappearance of Reye's Syndrome â A Public Health Triumph

Thu, 06Â MayÂ 1999 00:00:00 -05:00

Today, few young parents in the United States recognize the name Reye's syndrome or react strongly to it. A short time ago the response was far different. In the 1970s...

ORIGINAL ARTICLE: Reye's Syndrome in the United States from 1981 through 1997

Thu, 06Â MayÂ 1999 00:00:00 -05:00

Background: Reye's syndrome is characterized by encephalopathy and fatty degeneration of the liver, usually after influenza or varicella. Beginning in 1980, warnings were issued about the use of salicylates in...

ORIGINAL ARTICLE: Clinical Outcomes after Hepatitis C Infection from Contaminated Anti-D Immune Globulin

Elizabeth Kenny-Walsh, M.D., for the Irish Hepatology Research Group — Thu, 22Â AprÂ 1999 00:00:00 -05:00

Background: and Methods: In February 1994, batches of anti-D immune globulin used in Ireland during 1977 and 1978 to prevent Rh isoimmunization were found to be contaminated with hepatitis C...

EDITORIAL: The Increasing Incidence of Hepatocellular Carcinoma

Thu, 11Â MarÂ 1999 00:00:00 -05:00

Primary hepatocellular carcinoma, one of the most common tumors in the world today, is occurring with increasing frequency in the United States, as shown in the study by El-Serag and...

ORIGINAL ARTICLE: Rising Incidence of Hepatocellular Carcinoma in the United States

Hashem B. El-Serag, M.D., M.P.H., and Andrew C. Mason, M.D. — Thu, 11Â MarÂ 1999 00:00:00 -05:00

Background: and Methods: Clinical observations have suggested that the number of cases of hepatocellular carcinoma has increased in the United States. We analyzed data from the Surveillance, Epidemiology, and End...

EDITORIAL: The Case for Routine Childhood Vaccination against Hepatitis A

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Although its incidence has declined in the past decade, hepatitis A is still responsible for nearly 60 percent of the cases of acute viral hepatitis in the United States. In...

ORIGINAL ARTICLE: A Multistate, Foodborne Outbreak of Hepatitis A

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Background: We investigated a large, foodborne outbreak of hepatitis A that occurred in February and March 1997 in Michigan and then extended the investigation to determine whether it was related...

ORIGINAL ARTICLE: A Randomized, Controlled Trial of a Behavioral Intervention to Prevent Sexually Transmitted Disease among Minority Women

Thu, 14Â JanÂ 1999 00:00:00 -05:00

Background: African-American and Hispanic women are disproportionately affected by sexually transmitted diseases, including the acquired immunodeficiency syndrome (AIDS). In the effort to reduce infection rates, it is important to create...

ORIGINAL ARTICLE: A Defect in the Transport of Long-Chain Fatty Acids Associated with Acute Liver Failure

Thu, 10Â DecÂ 1998 00:00:00 -05:00

Fatty-acid oxidation has a major role in energy production during periods of fasting. When body glucose is depleted, fatty acids are mobilized from adipose tissue, taken up by the liver,...

EDITORIAL: Combination Therapy for Hepatitis C Infection

Thu, 19Â NovÂ 1998 00:00:00 -05:00

About 4 million people in the United States and probably more than 100 million people worldwide are infected with the hepatitis C virus (HCV).1 The majority have no symptoms, although...

ORIGINAL ARTICLE: Interferon Alfa-2b Alone or in Combination with Ribavirin for the Treatment of Relapse of Chronic Hepatitis C

Thu, 19Â NovÂ 1998 00:00:00 -05:00

Background: Interferon alfa is the only effective treatment for patients with chronic hepatitis C. Forty percent of patients have an initial response to this therapy, but most subsequently relapse. We...

ORIGINAL ARTICLE: Interferon Alfa-2b Alone or in Combination with Ribavirin as Initial Treatment for Chronic Hepatitis C

Thu, 19Â NovÂ 1998 00:00:00 -05:00

Background: Only 15 to 20 percent of patients with chronic hepatitis C have a sustained virologic response to interferon therapy. We compared the efficacy and safety of recombinant interferon alfa-2b...

REVIEW ARTICLE: Molecular Pathogenesis of Cholestasis

Michael Trauner, M.D., Peter J. Meier, M.D., and James L. Boyer, M.D. — Thu, 22Â OctÂ 1998 00:00:00 -05:00

The formation of bile is a vital function, and its impairment by drugs or infectious, autoimmune, metabolic, or genetic disorders results in the syndrome commonly known as cholestasis.1 The secretion...

IMAGES IN CLINICAL MEDICINE: Biliary Sludge Extruding into the Duodenum

Akira Hokama, M.D. and Fukunori Kinjo, M.D. — Thu, 22Â OctÂ 1998 00:00:00 -05:00

Figure 1. A 77-year-old man presented with fever, jaundice, and pain in the right upper quadrant. In the past, he had had a permanent pacemaker implanted and had undergone a...

REVIEW ARTICLE: Nitric Oxide as a Mediator of Hemodynamic Abnormalities and Sodium and Water Retention in Cirrhosis

Pierre-Yves Martin, M.D., Pere GinÃ¨s, M.D., and Robert W. Schrier, M.D. — Thu, 20Â AugÂ 1998 00:00:00 -05:00

A decade ago, it was proposed that peripheral arterial vasodilation was an important event in the pathophysiology of ascites formation in patients with cirrhosis.1 At the same time, nitric oxide...

EDITORIAL: Iron-Chelation Therapy with Oral Deferiprone â Toxicity or Lack of Efficacy?

Thu, 13Â AugÂ 1998 00:00:00 -05:00

Red-cell transfusion therapy in patients with homozygous Î²-thalassemia (thalassemia major) decreases the complications of severe anemia and prolongs survival.1 However, the effectiveness of transfusions is limited by the tissue damage...

REVIEW ARTICLE: Diuretic Therapy

D. Craig Brater, M.D. — Thu, 06Â AugÂ 1998 00:00:00 -05:00

Diuretic drugs are widely used for the treatment of patients with edema. Among these drugs, loop diuretics such as furosemide are perhaps the most frequently prescribed, and their clinical pharmacology...

ORIGINAL ARTICLE: A One-Year Trial of Lamivudine for Chronic Hepatitis B

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Background: and Methods: In preliminary trials, lamivudine, an oral nucleoside analogue, has shown promise for the treatment of chronic hepatitis B. We conducted a one-year, double-blind trial of lamivudine in...

EDITORIAL: Treatment of Chronic Hepatitis B Infection

Thu, 09Â JulÂ 1998 00:00:00 -05:00

In this issue of the Journal, Lai et al.1 report the results of a one-year trial of lamivudine, an oral nucleoside analogue, in patients with chronic hepatitis B infection. The...

EDITORIAL: Hepatocyte Transplantation

Thu, 14Â MayÂ 1998 00:00:00 -05:00

Attempts to treat a variety of conditions, including type I diabetes mellitus and fulminant liver failure, with epithelial-cell transplantation have been disappointing. In this issue of the Journal, Fox and...

ORIGINAL ARTICLE: Treatment of the CriglerâNajjar Syndrome Type I with Hepatocyte Transplantation

Thu, 14Â MayÂ 1998 00:00:00 -05:00

CriglerâNajjar syndrome type I is a recessively inherited disorder characterized by severe unconjugated hyperbilirubinemia beginning at birth. The syndrome results from an absence of hepatic uridine diphosphoglucuronate (UDP) glucuronosyltransferase activity,...

ORIGINAL ARTICLE: Liver Failure and Death after Exposure to Microcystins at a Hemodialysis Center in Brazil

Thu, 26Â MarÂ 1998 00:00:00 -05:00

Background: Hemodialysis is a common but potentially hazardous procedure. From February 17 to 20, 1996, 116 of 130 patients (89 percent) at a dialysis center (dialysis center A) in Caruaru,...

ORIGINAL ARTICLE: Fulminant Hepatitis Associated with Hepatitis A Virus Superinfection in Patients with Chronic Hepatitis C

Thu, 29Â JanÂ 1998 00:00:00 -05:00

Background: Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients...

REVIEW ARTICLE: Hepatitis B Virus Infection

William M. Lee, M.D. — Thu, 11Â DecÂ 1997 00:00:00 -05:00

The hepatitis B virus (HBV), discovered in 1966, infects more than 350 million people worldwide.1 Hepatitis B is a leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma, accounting for...

IMAGES IN CLINICAL MEDICINE: Peliosis Hepatis

Eike Walter, M.D. and Jochen MÃ¶ckel, M.D. — Thu, 27Â NovÂ 1997 00:00:00 -05:00

Figure 1. A 69-year-old woman was treated for aplastic anemia with a high dose of androgens (2 mg of methenolone acetate per kilogram of body weight) for nearly two years,...

ORIGINAL ARTICLE: Acetaminophen Toxicity in an Urban County Hospital

Thu, 16Â OctÂ 1997 00:00:00 -05:00

Background: The prevalence and characteristics of acetaminophen-associated liver injury in hospitalized patients are not well defined.

Methods: We identified patients hospitalized for excessive acetaminophen ingestion at an urban county hospital over...

ORIGINAL ARTICLE: Percutaneous Drainage Compared with Surgery for Hepatic Hydatid Cysts

Thu, 25Â SepÂ 1997 00:00:00 -05:00

Background: In recent years percutaneous drainage has been used successfully to treat the hepatic hydatid cysts of echinococcal disease. We performed a controlled trial to compare the safety and efficacy...

REVIEW ARTICLE: Treatment of Hepatic Encephalopathy

Stephen M. Riordan, M.D., and Roger Williams, M.D. — Thu, 14Â AugÂ 1997 00:00:00 -05:00

Hepatic encephalopathy is a complex neuropsychiatric syndrome that may occur in such diverse clinical situations as inherited errors of the urea cycle, acute or chronic liver disease, and spontaneous or...

ORIGINAL ARTICLE: Patient-to-Patient Transmission of Hepatitis C Virus during Colonoscopy

Thu, 24Â JulÂ 1997 00:00:00 -05:00

Invasive diagnostic or therapeutic procedures may be a route for the transmission of the hepatitis C virus (HCV).12345 In a study of patients in a gastrointestinal-disease unit, endoscopic biopsies were...

EDITORIAL: Prevention of Primary Liver Cancer by Immunization

Thu, 26Â JunÂ 1997 00:00:00 -05:00

The most common form of primary liver cancer is hepatocellular carcinoma. The other forms of primary liver cancer, including cholangiocarcinoma, angiosarcoma, and several others, are quite rare. Hepatocellular carcinoma is...

REVIEW ARTICLE: Imaging of the Hepatobiliary Tract

Sanjay Saini, M.D. — Thu, 26Â JunÂ 1997 00:00:00 -05:00

Over the past two decades, ultrasonography and computed tomography (CT) have emerged as the principal imaging methods for diagnostic examination of the liver and biliary tree. The other noninvasive imaging...

ORIGINAL ARTICLE: Universal Hepatitis B Vaccination in Taiwan and the Incidence of Hepatocellular Carcinoma in Children

Thu, 26Â JunÂ 1997 00:00:00 -05:00

Background: A nationwide hepatitis B vaccination program was implemented in Taiwan in July 1984. To assess the effect of the program on the development of hepatocellular carcinoma, we studied the...

IMAGES IN CLINICAL MEDICINE: Liver Abscess with Septic Pulmonary Emboli

Herbert L. Fred, M.D. and Shehzad Basaria, M.D. — Thu, 15Â MayÂ 1997 00:00:00 -05:00

Figure 1. A previously healthy 52-year-old man presented with right-sided pleurisy, fever, and shaking chills for three days. On examination he was febrile and had marked tenderness to percussion over...

EDITORIAL: Power Failure, Liver Failure

Thu, 17Â AprÂ 1997 00:00:00 -05:00

The literature on fulminant hepatic failure is studded with exotica. Hepatic failure has been caused by mushrooms, overheated hot tubs, and the infamous unripe ackee fruit that is associated with...

ORIGINAL ARTICLE: Fulminant Liver Failure in Association with the Emetic Toxin of

Thu, 17Â AprÂ 1997 00:00:00 -05:00

Background: A 17-year-old boy and his father had acute gastroenteritis after eating spaghetti and pesto that had been prepared four days earlier. Within two days, fulminant liver failure and rhabdomyolysis...

ORIGINAL ARTICLE: Hepatitis-Associated Aplastic Anemia

Thu, 10Â AprÂ 1997 00:00:00 -05:00

Background: Hepatitis-associated aplastic anemia is a variant of aplastic anemia in which aplastic anemia follows an acute attack of hepatitis. The aplastic anemia, however, is often fatal if untreated. To...

ORIGINAL ARTICLE: Simultaneous Transmission of Human Immunodeficiency Virus and Hepatitis C Virus from a Needle-Stick Injury

Thu, 27Â MarÂ 1997 00:00:00 -05:00

Human immunodeficiency virus type 1 (HIV) and hepatitis C virus (HCV) are blood-borne viruses that pose occupational hazards to health care workers exposed to the blood of infected patients. As...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Heinrich Kremer, M.D. — Thu, 20Â MarÂ 1997 00:00:00 -05:00

Figure 1. A single diagnosis explains the unusual findings in this 79-year-old woman....

ORIGINAL ARTICLE: Idiopathic Biliary Ductopenia in Adults without Symptoms of Liver Disease

Thu, 20Â MarÂ 1997 00:00:00 -05:00

Background: Idiopathic adulthood ductopenia is a severe cholestatic liver disease of unknown cause characterized by loss of the interlobular bile ducts in more than 50 percent of the portal tracts....

EDITORIAL: Hepatitis G Virus â A True Hepatitis Virus or an Accidental Tourist?

Thu, 13Â MarÂ 1997 00:00:00 -05:00

Over the past 30 years, five hepatitis viruses have been identified and named A, B, C, D, and E.1 Hepatitis A and E viruses are transmitted enterically and induce acute...

ORIGINAL ARTICLE: The Incidence of Transfusion-Associated Hepatitis G Virus Infection and Its Relation to Liver Disease

Thu, 13Â MarÂ 1997 00:00:00 -05:00

Background: The role of hepatitis G virus (HGV) in transfusion-associated infection and its relation to liver disease are not well understood.

Methods: Serum samples collected between 1972 and 1995 from 357...

ORIGINAL ARTICLE: Acute Non-AâE Hepatitis in the United States and the Role of Hepatitis G Virus Infection

Thu, 13Â MarÂ 1997 00:00:00 -05:00

Background: Little is known about the relation of the newly discovered hepatitis G virus (HGV) to the cause and clinical course of acute and chronic viral hepatitis.

Methods: We selected patients...

EDITORIAL: Toward Better Treatment of Primary Sclerosing Cholangitis

Thu, 06Â MarÂ 1997 00:00:00 -05:00

Primary sclerosing cholangitis is a chronic, progressive cholestatic liver disease characterized by continuing inflammation, necrosis, and obliteration of intrahepatic and extrahepatic bile ducts.1 The pathognomonic finding on liver biopsy, albeit...

ORIGINAL ARTICLE: Ursodiol for Primary Sclerosing Cholangitis

Thu, 06Â MarÂ 1997 00:00:00 -05:00

Background: There is no satisfactory medical therapy for patients with primary sclerosing cholangitis. Ursodiol (ursodeoxycholic acid) benefits patients with primary biliary cirrhosis, another cholestatic liver disease.

Methods: From May 1989 to...

REVIEW ARTICLE: The Treatment of Chronic Viral Hepatitis

Jay H. Hoofnagle, M.D., and Adrian M. Di Bisceglie, M.D. — Thu, 30Â JanÂ 1997 00:00:00 -05:00

Chronic viral hepatitis is the principal cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma in the world and now ranks as the chief reason for liver transplantation in adults.123...

REVIEW ARTICLE: Vaccines to Prevent Viral Hepatitis

Stanley M. Lemon, M.D., and David L. Thomas, M.D., M.P.H. — Thu, 16Â JanÂ 1997 00:00:00 -05:00

At least five different viruses cause hepatitis in humans. Two â hepatitis A virus (HAV) and hepatitis E virus (HEV) â are nonenveloped RNA viruses that are spread predominantly by...

REVIEW ARTICLE: Primary Biliary Cirrhosis

Marshall M. Kaplan, M.D. — Thu, 21Â NovÂ 1996 00:00:00 -05:00

Primary biliary cirrhosis is a chronic, progressive cholestatic liver disease of unknown cause that usually affects middle-aged women and eventually leads to liver failure and the need for liver transplantation....

ORIGINAL ARTICLE: Hepatitis C VirusâAssociated Fulminant Hepatic Failure

Thu, 29Â AugÂ 1996 00:00:00 -05:00

Fulminant hepatic failure is a dramatic clinical syndrome characterized by massive necrosis of liver cells.1 It is most often caused by hepatitis A virus and hepatitis B virus (HBV)2; whether...

REVIEW ARTICLE: Liver Disease in Pregnancy

Tamsin A. Knox, M.D., M.P.H., and Lori B. Olans, M.D., M.P.H. — Thu, 22Â AugÂ 1996 00:00:00 -05:00

Liver disease is a rare complication of pregnancy, but when it occurs it may do so in a dramatic and tragic fashion for both mother and infant. Diseases such as...

ORIGINAL ARTICLE: Routes of Infection, Viremia, and Liver Disease in Blood Donors Found to Have Hepatitis C Virus Infection

Thu, 27Â JunÂ 1996 00:00:00 -05:00

Background: For many people infected with the hepatitis C virus (HCV), the route of exposure, risk of transmission, and severity of associated liver disease are unknown. We studied these variables...

ORIGINAL ARTICLE: Nadolol plus Isosorbide Mononitrate Compared with Sclerotherapy for the Prevention of Variceal Rebleeding

Thu, 20Â JunÂ 1996 00:00:00 -05:00

Background: Patients who have bleeding from esophageal varices are at high risk for rebleeding and death. We compared the efficacy and safety of endoscopic sclerotherapy with the efficacy and safety...

EDITORIAL: Synthetic Retinoids for the Secondary Prevention of Hepatocellular Carcinoma

Thu, 13Â JunÂ 1996 00:00:00 -05:00

In this issue of the Journal, Muto et al.1 report a decrease in the incidence of second primary hepatocellular carcinomas in patients treated with polyprenoic acid, an acyclic retinoid, after...

ORIGINAL ARTICLE: Prevention of Second Primary Tumors by an Acyclic Retinoid, Polyprenoic Acid, in Patients with Hepatocellular Carcinoma

Thu, 13Â JunÂ 1996 00:00:00 -05:00

Background: In patients with hepatocellular carcinoma (hepatoma), the rate of recurrent and second primary hepatomas is high despite surgical resection and percutaneous ethanol-injection therapy. We developed an acyclic retinoid, polyprenoic...

EDITORIAL: The Cloning and Clinical Implications of HGV and HGBV-C

Thu, 06Â JunÂ 1996 00:00:00 -05:00

The cloning of the hepatitis C virus (HCV)1 established that important human pathogens, which could not be seen microscopically, grown in cell culture, or detected serologically, could nonetheless be discovered...

ORIGINAL ARTICLE: Infection with Hepatitis GB Virus C in Patients on Maintenance Hemodialysis

Thu, 06Â JunÂ 1996 00:00:00 -05:00

Background: A recently discovered non-AâE hepatitis virus has been designated hepatitis GB virus C (HGBV-C), but little is known about its mode of transmission and its clinical manifestations. We studied...

EDITORIAL: Chronic Viral Hepatitis â Benefits of Current Therapies

Thu, 30Â MayÂ 1996 00:00:00 -05:00

Interferon alfa was approved as therapy for chronic hepatitis C in the United States in 1991 and for chronic hepatitis B in 1992. These approvals were based on the results...

ORIGINAL ARTICLE: Long-Term Follow-up of HBeAg-Positive Patients Treated with Interferon Alfa for Chronic Hepatitis B

Thu, 30Â MayÂ 1996 00:00:00 -05:00

Background: In patients with chronic hepatitis B, treatment with interferon alfa and the consequent loss of hepatitis B e antigen (HBeAg) from the blood leads to a reduction in inflammatory...

ORIGINAL ARTICLE: Hepatic Dysfunction as a Complication of Adenosine Deaminase Deficiency

Thu, 23Â MayÂ 1996 00:00:00 -05:00

Complete deficiency of adenosine deaminase causes severe combined immunodeficiency that is inherited as an autosomal recessive trait. The patients present in infancy with recurrent infections, lymphopenia, defective proliferative responses to...

REVIEW ARTICLE: Autoimmune Hepatitis

Edward L. Krawitt, M.D. — Thu, 04Â AprÂ 1996 00:00:00 -05:00

Autoimmune hepatitis is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. Since the first descriptions of the disorder in the...

ORIGINAL ARTICLE: Long-Term Outcome of Hepatitis C Infection after Liver Transplantation

Thu, 28Â MarÂ 1996 00:00:00 -05:00

Background: End-stage cirrhosis related to hepatitis C virus (HCV) is a common reason for liver transplantation, although viremia is known to persist in most cases. We investigated the impact of...

EDITORIAL: Treating Small Hepatocellular Carcinomas

Thu, 14Â MarÂ 1996 00:00:00 -05:00

Many factors influence the survival of patients with hepatocellular carcinoma, quite apart from treatment, the most important being the size of the tumor at the time of diagnosis and the...

ORIGINAL ARTICLE: Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis

Thu, 14Â MarÂ 1996 00:00:00 -05:00

Background: The role of orthotopic liver transplantation in the treatment of patients with cirrhosis and hepatocellular carcinoma is controversial, and determining which patients are likely to have a good outcome...

ORIGINAL ARTICLE: Mutations in the Nonstructural Protein 5a Gene and Response to Interferon in Patients with Chronic Hepatitis C Virus 1b Infection

Thu, 11Â JanÂ 1996 00:00:00 -05:00

Background: A region associated with sensitivity to interferon has been identified in the nonstructural protein 5A (NS5A) of hepatitis C virus (HCV) genotype 1b. The region spans amino acid residues...

ORIGINAL ARTICLE: Biliary Cryptosporidiosis in HIV-Infected People after the Waterborne Outbreak of Cryptosporidiosis in Milwaukee

Thu, 04Â JanÂ 1996 00:00:00 -05:00

Background: In March 1993, the municipal water supply in Milwaukee became contaminated with cryptosporidium and a widespread outbreak of cryptosporidiosis occurred.

Methods: We retrospectively studied the relations among the clinical presentation,...

NEJM â Collection Updates for Liver Disease

IMAGES IN CLINICAL MEDICINE: Bleeding Esophageal Varices

IMAGES IN CLINICAL MEDICINE: Hydropneumothorax

ORIGINAL ARTICLE: Cisplatin versus Cisplatin plus Doxorubicin for Standard-Risk Hepatoblastoma

EDITORIAL: Micromanaging Cancer

ORIGINAL ARTICLE: MicroRNA Expression, Survival, and Response to Interferon in Liver Cancer

ORIGINAL ARTICLE: Recurrence of Bile Salt Export Pump Deficiency after Liver Transplantation

REVIEW ARTICLE: Renal Failure in Cirrhosis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2009 â An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

CORRESPONDENCE: Persistent Carriage of Hepatitis E Virus in Patients with HIV Infection

ORIGINAL ARTICLE: Peginterferon Alfa-2b or Alfa-2a with Ribavirin for Treatment of Hepatitis C Infection

REVIEW ARTICLE: Alcoholic Hepatitis

CLINICAL PRACTICE: Alpha-Antitrypsin Deficiency

IMAGES IN CLINICAL MEDICINE: Perforated Umbilical Hernia

CLINICAL PROBLEM-SOLVING: Kiss of Death

IMAGES IN CLINICAL MEDICINE: Biliary Stones

ORIGINAL ARTICLE: Primary Biliary Cirrhosis Associated with and Variants

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection â Polling Results

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection

EDITORIAL: A Step Forward in Therapy for Hepatitis C

ORIGINAL ARTICLE: Telaprevir and Peginterferon with or without Ribavirin for Chronic HCV Infection

ORIGINAL ARTICLE: Telaprevir with Peginterferon and Ribavirin for Chronic HCV Genotype 1 Infection

CORRESPONDENCE: Ending Propylthiouracil-Induced Liver Failure in Children

CLINICAL PROBLEM-SOLVING: Needle in a Haystack

IMAGES IN CLINICAL MEDICINE: Spider Angiomas

ORIGINAL ARTICLE: Peginterferon Alfa-2a and Ribavirin in Latino and Non-Latino Whites with Hepatitis C

CORRESPONDENCE: Glycemic Control in Patients with Insulinoma Treated with Everolimus

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

EDITORIAL: Chronic Hepatitis B â New Goals, New Treatment

ORIGINAL ARTICLE: Tenofovir Disoproxil Fumarate versus Adefovir Dipivoxil for Chronic Hepatitis B

ORIGINAL ARTICLE: Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon

EDITORIAL: Recurrence of Hepatocellular Carcinoma

ORIGINAL ARTICLE: Gene Expression in Fixed Tissues and Outcome in Hepatocellular Carcinoma

REVIEW ARTICLE: Hepatitis B Virus Infection

EDITORIAL: Predicting Mortality in Cirrhosis â Serum Sodium Helps

ORIGINAL ARTICLE: Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

ORIGINAL ARTICLE: HHV-6A in Syncytial Giant-Cell Hepatitis

EDITORIAL: Sorafenib in Liver Cancer â Just the Beginning

ORIGINAL ARTICLE: Sorafenib in Advanced Hepatocellular Carcinoma

CLINICAL THERAPEUTICS: Acetylcysteine for Acetaminophen Poisoning

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2008 â A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation

REVIEW ARTICLE: Hepatopulmonary Syndrome â A Liver-Induced Lung Vascular Disorder

IMAGES IN CLINICAL MEDICINE:

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2008 â A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

CLINICAL THERAPEUTICS: Phototherapy for Neonatal Jaundice

ORIGINAL ARTICLE: Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients

EDITORIAL: Immunosuppressive Therapy and Tolerance of Organ Allografts

ORIGINAL ARTICLE: Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

EDITORIAL: Clinical Penetrance of Hereditary Hemochromatosis

ORIGINAL ARTICLE: Iron-OverloadâRelated Disease in Hereditary Hemochromatosis

IMAGES IN CLINICAL MEDICINE: Chronic BuddâChiari Syndrome and Abdominal Varices

ORIGINAL ARTICLE: Telbivudine versus Lamivudine in Patients with Chronic Hepatitis B

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Liver X Receptor and Atherosclerosis

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Hepatocellular Carcinoma and Sex

IMAGES IN CLINICAL MEDICINE: Recanalized Umbilical Vein

CLINICAL THERAPEUTICS: Ursodeoxycholic Acid for the Treatment of Primary Biliary Cirrhosis

ORIGINAL ARTICLE: Evidence of MEN-2 in the Original Description of Classic Pheochromocytoma

EDITORIAL: Shortened Therapy for Hepatitis C Virus Genotype 2 or 3 â Is Less More?

ORIGINAL ARTICLE: Peginterferon Alfa-2a and Ribavirin for 16 or 24 Weeks in HCV Genotype 2 or 3

CLINICAL PROBLEM-SOLVING: A Hand-Carried Diagnosis â A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

IMAGES IN CLINICAL MEDICINE: Liver Transplantation for Polycystic Liver Disease

REVIEW ARTICLE: Strategies for Safer Liver Surgery and Partial Liver Transplantation

REVIEW ARTICLE: Viral Hepatitis in HIV Infection

EDITORIAL: Hepatitis E Vaccine â Ready for Prime Time?

ORIGINAL ARTICLE: Safety and Efficacy of a Recombinant Hepatitis E Vaccine

IMAGES IN CLINICAL MEDICINE: Hepatosplenic Candidiasis

CLINICAL PROBLEM-SOLVING: Sum of the Parts

CLINICAL THERAPEUTICS: Peginterferon and Ribavirin for Chronic Hepatitis C

EDITORIAL: Thiazolidinediones for Nonalcoholic Steatohepatitis â Promising but Not Ready for Prime Time

ORIGINAL ARTICLE: A Placebo-Controlled Trial of Pioglitazone in Subjects with Nonalcoholic Steatohepatitis

CLINICAL PROBLEM-SOLVING: Ring around the Diagnosis

ORIGINAL ARTICLE: Variant of Hepatitis B Virus with Primary Resistance to Adefovir

IMAGES IN CLINICAL MEDICINE: Talc Retinopathy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2006 â A 35-Year-Old Woman with Recurrent Right-Upper-Quadrant Pain

EDITORIAL: Hepatitis B â Preventable and Now Treatable

ORIGINAL ARTICLE: Entecavir versus Lamivudine for Patients with HBeAg-Negative Chronic Hepatitis B

ORIGINAL ARTICLE: A Comparison of Entecavir and Lamivudine for HBeAg-Positive Chronic Hepatitis B

REVIEW ARTICLE: Drug-Related Hepatotoxicity

NEJM â Collection Updates for Liver Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2009 â An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection â Polling Results

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2008 â A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

EDITORIAL: Chronic Hepatitis B â New Goals, New Treatment

EDITORIAL: Predicting Mortality in Cirrhosis â Serum Sodium Helps

EDITORIAL: Sorafenib in Liver Cancer â Just the Beginning

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2008 â A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation

REVIEW ARTICLE: Hepatopulmonary Syndrome â A Liver-Induced Lung Vascular Disorder

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2008 â A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

ORIGINAL ARTICLE: Iron-OverloadâRelated Disease in Hereditary Hemochromatosis

IMAGES IN CLINICAL MEDICINE: Chronic BuddâChiari Syndrome and Abdominal Varices

EDITORIAL: Shortened Therapy for Hepatitis C Virus Genotype 2 or 3 â Is Less More?

CLINICAL PROBLEM-SOLVING: A Hand-Carried Diagnosis â A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

EDITORIAL: Hepatitis E Vaccine â Ready for Prime Time?

EDITORIAL: Thiazolidinediones for Nonalcoholic Steatohepatitis â Promising but Not Ready for Prime Time

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2006 â A 35-Year-Old Woman with Recurrent Right-Upper-Quadrant Pain

EDITORIAL: Hepatitis B â Preventable and Now Treatable

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2006 â A 63-Year-Old Woman with Jaundice and a Pancreatic Mass

EDITORIAL: Beta-Blockers to Prevent Esophageal Varices â An Unfulfilled Promise

EDITORIAL: Hepatitis A â The Price of Progress

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2005 â A 57-Year-Old Man with a Mass in the Liver

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2005 â A Four-Week-Old Male Infant with Jaundice and Thrombocytopenia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2005 â An 80-Year-Old Man with Shortness of Breath, Edema, and Proteinuria

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Arrest in the Liver â A Genetically Defined Malaria Vaccine?

IMAGES IN CLINICAL MEDICINE: Malposition of a SengstakenâBlakemore Tube

CLINICAL PROBLEM-SOLVING: Why âWhyâ Matters

PERSPECTIVE: Running Like Water â The Omnipresence of Hepatitis E

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2004 â A Four-Year-Old Boy with Hypoxemia

PERSPECTIVE: Treating Hepatitis C in âDifficult-to-Treatâ Patients

REVIEW ARTICLE: Hereditary Hemochromatosis â A New Look at an Old Disease

REVIEW ARTICLE: Hepatitis B Virus Infection â Natural History and Clinical Consequences

REVIEW ARTICLE: The BuddâChiari Syndrome

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Hepatic Diseases â Hitting the Target with Inhibitory RNAs

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2003 â A Nine-Year-Old Girl with Hepatosplenomegaly and Pain in the Thigh

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2003 â A 14-Month-Old Boy with Hepatomegaly, Perianal Lesions, and a Bony Lump on the Forehead

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2003 â A 14-Year-Old Boy with Ulcerative Colitis, Primary Sclerosing Cholangitis, and Partial Duodenal Obstruction

EDITORIAL: Suppressing Hepatitis B without Resistance â So Far, So Good

ORIGINAL ARTICLE: Adefovir Dipivoxil for the Treatment of Hepatitis B e AntigenâPositive Chronic Hepatitis B

ORIGINAL ARTICLE: Adefovir Dipivoxil for the Treatment of Hepatitis B e AntigenâNegative Chronic Hepatitis B

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2003 â A 42-Year-Old Woman with Cough, Fever, and Abnormalities on Thoracoabdominal Computed Tomography

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2002 â A 54-Year-Old Man with Hypercalcemia, Renal Dysfunction, and an Enlarged Liver

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2002 â A 61-Year-Old Man with Headache and Multiple Infarcts

EDITORIAL: Hepatitis B e Antigen â The Dangerous Endgame of Hepatitis B

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2002 â A 50-Year-Old Man with Eosinophilia and Fluctuating Hepatic Lesions