No abstract

SUMMARY We report the cases of two adult patients in whom fulminant hepatitis developed after 17 and 103 days of ketoconazole administration. Histologic administration showed massive, predominantly centrilobular necrosis. Clinical manifestations of hypersensitivity and eosinophilia were absent in both patients, which suggests that ketoconazole hepatotoxicity is not mediated through an immunoallergic mechanism.Toxicity to the liver is a recognised complication of administration of ketoconazole, an antifungal imidazole derivative. The hepatic reaction to the drug is usually limited to an asymptomatic increase in serum aminotransferases: the prevalence of this biochemical disorder would range from 3 to 5%.1 Symptomatic non-fatal hepatitis is much less common: its prevalence would be of the order of 0-01%.' Fulminant hepatitis is likely to be still less frequent: only five cases have been mentioned so far, but with no or very few details. -3 The purpose of this report is to describe in detail two additional cases of ketoconazole-induced fulminant hepatitis. Case reportsThe time and duration of ketoconazole administration, the concentrations of serum alanine aminotransferase (ALT), serum bilirubin, and prothrombin, and the time of death of our two patients are given in Figure 1. Serological markers of a recent infection with hepatitis A virus, hepatitis B virus, cytomegalovirus, Epstein-Barr virus, and herpes viruses were absent in both patients. Only specific details are given in the following reports.PATIENT 1A 38-year-old woman, suffering from a fungal infection of the toe nails ascribed to Trichophyton rubrum,

Patients who have undergone repair of aortic coarctation frequently remain asymptomatic for a long time. Late complications can be appropriately treated when diagnosed early. Consequently, all coarctation patients need careful lifelong follow-up, especially those with congenital aortic valve disease or surgery in childhood with interposition of prosthetic material.

Background: To present a 2-year follow-up regarding safety and hemodynamic performance of a new restorative vascular graft used as extracardiac cavo-pulmonary connection in patients with univentricular congenital heart malformations. Methods: The graft was implanted in five patients (aged 4-12 years) as extracardiac connection between the inferior vena cava and the pulmonary artery. The conduit consists of a bioabsorbable polymer-based implant able to generate endogenous tissue restoration leading to a fully functional neo-vessel while the polymer progressively absorbs. All patients have reached more than 24 months following surgery and underwent echocardiography and magnetic resonance imaging. Results: All patients are doing well at 24 months follow-up, with no graft-related serious adverse events.Transthoracic echocardiography demonstrated adequate function of the conduit in all patients while magnetic resonance imaging showed anatomical and functional stability of the restorative grafts. Conclusions: The new restorative conduit has been successfully used for the second step of the Fontan procedure as extracardiac total cavopulmonary connection. The results are promising because they suggest that complete transformation of a bioabsorbable polymer and replacement through endogenous tissue may represent a major advantage in the treatment of congenital heart disease patients. Further monitoring will allow to evaluate the long-term behavior of this new graft, in terms of clinical and hemodynamic performance, thrombogenicity and ability to grow.