It is therefore a national imperative to train additional classes of hepatologists

and other health care providers who focus on community-based efforts to prevent, detect, and treat chronic liver disease including viral hepatitis. These will require restructuring of training in liver diseases across many specialties and nonphysician health care providers. The AASLD will use its committee structure to begin to develop an approach and work with sister societies and the American Board of Internal Medicine, family practices, etc., to actualize this recommendation of the IOM. Finally, as noted by the IOM report, hepatitis B and C remain important causes of preventable death worldwide. The implications of the IOM report are therefore global and are likely to be helpful GSK-3 inhibition to the WHO

as they respond to a proposed global resolution on viral hepatitis prevention and control at the 63rd World Health Assembly. We hope that by the synergistic activities of the federal agencies such as the CDC, NIH etc and other stakeholders such as the AASLD and WHO, we will map out the way towards global prevention and control of chronic viral hepatitis. “
“A young girl, aged 3, with bilateral nephroblastoma was being selleck products treated with chemotherapy prior to surgery. A week after the third course of actinomycin D, she developed abdominal pain with hepatomegaly and her weight increased by 7% despite the use of diuretics. Liver enzymes were markedly abnormal and her serum bilirubin peaked at 2.2 mg/dL (37 µmol/L). An ultrasound study showed free peritoneal fluid (FF) and edema of the gallbladder wall (Figure 1). The hepatic artery was highly perfused and the portal venous flow was reversed to about −20 cm/sec (Figure 2, left, Acetophenone arrowheads). A diagnosis of sinusoidal obstruction syndrome was made as Seattle and Baltimore criteria were fulfilled and other causes of acute liver disease were excluded by other investigations. In addition to supportive therapy, she was treated with defibrotide,

a mixture of single-stranded oligodeoxyribonucleotides derived from porcine intestinal DNA. Symptoms and liver function tests improved over 7 days and a repeat ultrasound study showed that portal venous flow had returned to 20 cm/sec in an antegrade direction (Figure 2, right, arrowheads). Liver complications did not recur during a further course of chemotherapy. Sinusoidal obstruction syndrome was previously known as hepatic veno-occlusive disease and is usually associated with myeloablative regimens prior to bone marrow transplantation. However, the syndrome can also occur with conventional doses of chemotherapeutic drugs and during treatment with azathioprine and 6-mercaptopurine. There is also an association with herbal teas containing pyrrolizidine alkaloids. In patients who have liver biopsies, there is obstruction of liver sinusoids by endothelial and other cells that may extend into the central veins.