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Objectives: The purpose of this clinical trial was to examine the efficacy and safety of electroacupuncture on liver cirrhosis patients suffering from muscle cramps. Methods: Fourteen patients with liver cirrhosis who experienced muscle cramps at least once a week, regardless of cramp location, were enrolled and randomly allocated to an experimental group (n=12) or a control group (n=12). The experimental patients were treated with electroacupuncture at an electrical stimulation frequency of 100 Hz three times a week for four weeks (12 times in total). Muscle cramps were evaluated by a questionnaire that probed subjective symptoms. We analyzed the frequency of muscle cramps 3 times (at screening, 14 th visit, 15 th visit) during 8 weeks. Results: The number of patients with cramps occurring 'more than once a week' was reduced and the proportion of patients decreased in response to electroacupuncture. The number of patients with cramps occurring 'less than once every two weeks' increased and the proportion of patients also increased in response to eletroacupunture. Conclusions: The results of this study suggest that electroacupuncture treatment will be beneficial for improving muscle cramps in patients with liver cirrhosis. Electroacupuncture is considered a safe and efficacious treatment for patients with liver cirrhosis who complain of muscle cramps.
저자 등은 레이노 현상이 있던 23세 여자 환자가 위장관 가성폐쇄를 주증상으로 나타내어 내원한 뒤 Systemic sclesosis sine scleroderma로 진단된 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Systemic sclerosis (SSc) is a generalized connective tissue disorder of unknown etiology. Clinically, there is a broad spectrum of disease ranging from widespread severe skin thickening to skin thickening limited to the distal extremities. In rare cases of systemic sclerosis, no cutaneous change only with internal organ involvement has been reported, which is called `systemic sclerosis sine scleroderma (ssSSc)`. We describe a patient with Raynaud`s phenomenon, who showed intestinal pseudoobstruction as a presenting symptom but did not show any skin change. She had also an esophageal motility disorder, but other organ involvement was not evident. Antinuclear antibody was positive. Her obstruction symptoms were improved by decompression by nasogastric tube and pharmaceutical treatment with erythromycin and octreotide.
Liver cirrhosis and portal hypertension may present with distinct clinitcal entities such as portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS). The pathophysiology of these two conditions is not fully understood. HPS leads to progressive hypoxiema secondary to intrapulmonary vasodilatation. Imbalance in the pulmonary circulation between vasodilators and vasoconstrictors, intestinal endotoxemia, and activation of alveolar macrophage system may play a roles in pathogenesis of HPS. In POPH, there is excessive pulmonary vasoconstriction and vascular remodeling that cause an increase in pulmonary vascular resistance. Both diseases have a substantial negative impact on survival. There is no evidence for any pharmacologic modalities to successfully treat HPS. Liver transplantation, although associated with increased mortality, is a clear and definitive treatment for HPS. Liver transplantation may be beneficial in only highly carefully selected patients with POPH and is definite contraindication for severe POPH due to high perioperative and postoperative mortality rate. New and evolving medical therapies might change the natural course of POPH, but randomized, controlled multicenter trials are urgently needed.