Lamivudine is a nucleoside analog with activity against human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Patients coinfected with HIV and HBV may have hepatitis flares when lamivudine therapy is discontinued or when resistance of HBV to lamivudine emerges. This retrospective, descriptive study conducted in three tertiary care medical centers describes patients coinfected with HIV type 1 and HBV who presented with a spectrum of clinical and subclinical hepatitic responses to lamivudine withdrawal or resistance. One patient had fulminant hepatic failure and a second patient had subclinical hepatitis when lamivudine therapy was discontinued and a more efficacious antiretroviral regimen was substituted. Three patients had flares of hepatitis after 13 to 18 months of lamivudine therapy. Lamivudine withdrawal or emergence of lamivudine-resistant mutants in patients coinfected with HIV and HBV may result in severe hepatitis. Clinicians caring for patients with coinfection with HIV and HBV should be aware of the possibility that a hepatitis B flare may occur in previously asymptomatic carrier patients.

The diagnosis of primary sclerosing cholangitis in association with autoimmune hepatitis was made in this case after the discovery of inflammatory bowel disease prompted a cholangiogram. Immunosuppressive therapy with cyclosporine prior to ERCP resulted in a significant decrease in serum aminotransferase. Liver histology and autoimmune serologies favored a diagnosis of AIH, while cholangiographic findings suggested PSC. A review of similar cases describing the simultaneous occurrence of AIH and PSC is presented. The shared autoimmune characteristics of the two diseases, such as serum autoantibodies, peripheral lymphocyte subsets and HLA haplotypes, raises the question of whether similar mechanisms of immune dysfunction can result in both processes. The existence of a PSC-AIH overlap syndrome may help provide the linkage between the two diseases.

Thrombocytopenia associated with chronic liver disease presents a difficult management issue. Most reports conclude that portocaval and distal splenorenal shunts do not improve platelet counts in this setting. The response of thrombocytopenia after transjugular intrahepatic portosystemic shunt placement has not been studied. All platelet counts of 21 patients undergoing intrahepatic shunt placement were determined retrospectively to accumulate values at one month prior to procedure, weekly for the first month after the procedure, and monthly thereafter to six months. Comparison of pre- and postshunt platelet means showed a significant increase in counts in patients with a postshunt portal pressure gradient < 12 mm Hg, with the increment evident by one week after the procedure. This response was not seen when preshunt thrombocytopenia was used as the lone variable. This study suggests that the transjugular intrahepatic portosystemic shunt may improve the thrombocytopenia associated with liver cirrhosis when these pressure gradients are attained.

This study evaluated the intrapatient correlation for gastric emptying times with instant oatmeal and scrambled egg meals. In addition, this study evaluated the degree of overlap between the stomach and the colon or jejunum in the anterior (AP) and left anterior oblique (LAO) projections in CT studies of the abdomen. Methods: Fifteen patients were studied twice, 1 d apart, with instant oatmeal and scrambled egg meals, both of which were labeled with 99m Tc-sulfur colloid. Imaging was performed in the upright position with the LAO projection. One-minute digital images acquired every 15 min were used to calculate a simple half-time of emptying. The correlation coefficient between the oatmeal and egg meals was calculated. In addition, the degree of overlap between the stomach and the colon or jejunum in the AP and LAO projections in 100 CT studies of the abdomen was categorized as none, mild (up to 25%), moderate (25%250%), or marked (.50%). Results: One pair of gastric emptying studies was eliminated as an outlier because the distribution of the meals in the stomach, as determined by imaging, was very different for the 2 studies. In the remaining 14 patients, the correlation coefficient for half-times of emptying for the oatmeal and egg meals was 0.77 (P , 0.01). The stomach overlapped the colon 74% of the time in the AP projection and 82% of the time in the LAO projection (P 5 not significant). The stomach overlapped the jejunum 77% of the time in the AP projection but only 52% of the time in the LAO projection (P , 0.05). Conclusion: The significant correlation between the instant oatmeal and scrambled egg gastric emptying times suggests that similar information is provided by the 2 meals. The frequent overlap of the stomach and the colon in both the AP and the LAO projections suggests that imaging at delayed times, such as 4 h, is likely to be problematic because of colonic activity within the stomach region of interest. In addition, the frequent overlap of the stomach and the jejunum has implications for calculation of the lag time; the less frequent overlap of the stomach and the jejunum in the LAO projection than in the AP projection may be an advantage for imaging in the LAO projection.