Clinical medicine (London, England)
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Standardised mortality rates for liver disease in the UK have increased 400% since 1970. However, evidence from a large number of animal models and clinical trials indicates that liver fibrosis and even cirrhosis are potentially reversible if the underlying cause can be successfully removed. ⋯ Points of attack in the fibrotic cascade include promoting the loss of hepatic myofibroblasts, inhibiting profibrogenic properties of myofibroblasts, stimulating degradation of accumulated liver scar tissue, targeting the immune response, and cell-based therapies. Therapeutic candidates are now being evaluated in early-phase human trials but translation into the clinic will require careful patient selection and stratification, and the definition and validation of clinically meaningful endpoints.
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This study evaluates the efficacy of low-fat dietary interventions in the management of gastrointestinal (GI) symptoms due to bile acid malabsorption. In total, 40 patients with GI symptoms and a 7-day (75)selenium homocholic acid taurine (SeHCAT) scan result of <20%, were prospectively recruited and then advised regarding a low-fat dietary intervention. ⋯ Mean dietary fat intake reduced to 42 g fat after intervention (p ≥: 0.01). Low-fat dietary interventions in patients with a SeHCAT scan result of <20% leads to clinically important improvement in GI symptoms and should be widely used.
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Case Reports
Lesson of the month 2: Non-uraemic calciphylaxis - an unexpected differential diagnosis for a necrotic ulcer.
Calciphylaxis is an uncommon cause of skin necrosis seen almost exclusively in patients with end-stage renal disease. We present an unexpected diagnosis of calciphylaxis in a patient with normal renal and parathyroid function. The patient presented with a month-long history of painful bilateral necrotic leg ulcers, resistant to conventional treatment. ⋯ A biopsy confirmed a diagnosis of calciphylaxis. We suspect that warfarin therapy may have contributed to the development of this condition. Through this case we aim to raise awareness of calciphylaxis as a differential diagnosis of non-healing necrotic skin ulcers, especially in patients with known risk factors including established warfarin therapy.
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A 55-year-old man presented with acute ST-elevation myocardial infarction. He received rescue angioplasty with one drug eluting stent. He developed marked breathlessness and haemoptysis two days later. ⋯ Pneumonitis and pulmonary haemorrhage is rarely reported with acute myocardial infarction, but poses serious challenge to the patient and the clinician. Diagnosis may be delayed as breathlessness can occur due to myriad causes after myocardial infarction. Interrupting dual anti-platelet therapy after angioplasty could lead to devastating stent thrombosis.