Ludendorff, Erich - Das Marne-Drama - Der Fall Moltke-Hentsch (1934, 31 S., Scan-Text, Fraktur)
45 1 - St. Marianna University School of...
Transcript of 45 1 - St. Marianna University School of...
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Table 1. Laboratory Data on Admission
Figure 1. Abdominal US findings on admission: Fatty
liver is seen with focal spared lesion. Note
slight splenomegaly.
Figure 2. Abdominal CT on admission: In addition to
fatty liver, slight splenomegaly is seen.
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Figure 3. Heart rate is 52 �min and sinus bradycardia�3a�. T wave is inverted in V1�5, and myocar-dial injury was suspected. QT prolongation is
also seen. QT time was 533 ms �3a�. QT pro-longation which was seen on admission
dis-appeared just before dischage from our
hospital. QT time was 435 ms �3b�.
Figure 4. Clinical course
Figure 5. a: Masson staining �10�� Although P-C bridg-ing necrosis was seen in a small portion, the
lobular structure was maintained �5a�. b: HEstaining �10��. Bridging necrosis and focalnecrosis were found dispersively. Furthermore,
there were regeneration of small hepatocytes
and numerous eosinophilic bodies �5b�. c: HEstaining �10 ��. Note fibrotic expansion ofportal area. Inflammatory infiltration was
composed primarily of monocytes and neutro-
phils �5c�. d: a: HE staining �40�� Eosinofilicinfiltration is seen �5d�.
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Abstract
A Case of Drug induced Liver Injury Caused by
“Super Slender”, a Chinese Dietary Supplement
for Weight Loss
Hideaki Takahashi1, Hiroshi Yotsuyanagi1, Mayu Orita1, Yoshihiko Nagase1,
Yuka Suzuki1, Yoshiki Katakura1, Noriaki Okuse1, Yutaro Kobayashi1,
Junki Koike2, Yasuhito Takahashi1, Takeshi Hayashi1, Mchihiro Suzuki1,
Shiro Maeyama2, Toshiyuki Uchikoshi2, and Fumio Itoh1
The patient was a 48-year-old woman who had visited the Division of Metabolism and Endocrinology
in our hospital regularly since she was 46-years-old for the treatment of diabetes, hypertension, hyperlipide-
mia, fatty liver, and obesity. She had been taking the dietary supplement “Super Slender 45” from July 10,
2002 to August 12, 2002 in an e#ort to lose weight. She was admitted to our hospital for the treatment of liver
injury �AST, 663 IU�L; ALT, 1117 IU�L; g-GTP, 569 IU�L� that was noted during the course of a regularcheck-up. Electrocardiography on admission revealed QT interval prolongation. Viral hepatitis, autoim-
mune hepatitis, alcoholic liver disease, and metabolic liver disease were excluded, and drug-induced liver
injury was considered the most probable diagnosis. Since liver function did not improve even after
terminating administration of the dietary supplement, 50 mg�day of predonisolone were given just after liverbiopsy. Histological findings from the liver biopsy specimen were compatible with drug-induced liver injury.
Liver function improved immediately, and the patient was discharged after predonisolone dose was tapered
to 5 mg�day. QT interval prolongation, which gradually normalized without treatment, was presumablycaused by the dietary supplement. Although lymphocyte stimulation testing for the dietary supplement
yielded negative results, liver dysfunction was diagnosed as drug-induced liver injury due to Super Slender
45 based on clinical course and liver biopsy findings.
1 Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University
2 Department of Pathology, St. Marianna University
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