Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
1.
J Gastrointest Cancer ; 50(1): 48-53, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29127665

RESUMEN

PURPOSE: For patients at high-risk of developing hepatocellular carcinoma (HCC), biannual ultrasound surveillance has long been recommended, in order to detect the tumor in the early, potentially curative stages. However, globally reported HCC surveillance rates vary greatly, ranging from as low as 1.7 to as high as 80%. Our aim was to assess the utilization of surveillance with biannual ultrasound in high-risk Croatian patients and to identify the factors that impact the implementation of the recommended protocol. METHODS: This retrospective study included 145 newly diagnosed HCC patients in the period from January 2010 to September 2015. We identified low-risk and high-risk patients. The latter were further subdivided into the regular biannual ultrasound surveillance group and the non-surveillance group. The groups were compared according to demographic characteristics and BCLC stage at the time of HCC diagnosis. RESULTS: Among 145 patients, 80 patients were classified as high-risk according to EASL criteria. During the relevant period, 28.7% underwent regular surveillance, while 71.25% did not. Younger patients were more likely to undergo surveillance (OR 0.935 CI 0.874-0.999; p = 0.05). The patients who underwent regular surveillance had a higher chance of being diagnosed at a curative stage (BCLC 0 or A) (OR 3.701 CI 1.279-10.710; p < 0.05).Gender was not a predictor of participation in the regular surveillance protocol. Among the high-risk patients who did not undergo regular surveillance, 56.1% were not aware of the chronic liver disease prior to the HCC diagnosis. CONCLUSION: HCC surveillance is still underutilized in high-risk Croatian patients despite its obvious benefits possibly due to the untimely diagnosis of the chronic liver disease.


Asunto(s)
Carcinoma Hepatocelular/diagnóstico , Hepatopatías/diagnóstico , Neoplasias Hepáticas/diagnóstico , Vigilancia de la Población/métodos , Ultrasonografía/métodos , Anciano , Carcinoma Hepatocelular/patología , Enfermedad Crónica , Croacia , Femenino , Humanos , Hepatopatías/patología , Neoplasias Hepáticas/patología , Masculino , Estudios Retrospectivos
2.
Genet Test Mol Biomarkers ; 20(3): 112-7, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26799313

RESUMEN

AIMS: Wilson disease (WD) is an autosomal recessive disorder of copper metabolism, characterized by its accumulation in tissues which results in hepatic, neurological, and/or psychiatric symptoms. The aim of this study was to investigate the genetics of WD in Croatian patients. METHODS: Correlation of the clinical presentation subtype and the age at onset of the diagnosis of WD with the ATP7B genotype was investigated in a group of Croatian WD patients. DNA from peripheral blood samples was tested for the p.His1069Gln by direct mutational analysis and other polymorphisms were identified by sequence analysis of coding and flanking intronic regions of ATP7B gene. RESULTS: In the group of 75 WD patients of Croatian origin, 18 different mutations in ATP7B gene were detected, three of which were novel. The p.His1069Gln mutation was most frequent, being detected in 44 Croatian WD patients (58.7%). Most ATP7B mutations (90.4%) were located in exons 5, 8, 13, 14, and 15. CONCLUSIONS: Clinical diagnosis of WD was confirmed in 59 patients by detecting mutations on both ATP7B alleles. The age at onset of WD and the type of WD clinical presentation showed no significant correlation with the ATP7B genotype.


Asunto(s)
Adenosina Trifosfatasas/genética , Proteínas de Transporte de Catión/genética , Degeneración Hepatolenticular/genética , Adenosina Trifosfatasas/sangre , Adulto , Alelos , Proteínas de Transporte de Catión/sangre , ATPasas Transportadoras de Cobre , Croacia , Análisis Mutacional de ADN , Exones , Femenino , Estudios de Asociación Genética , Degeneración Hepatolenticular/enzimología , Humanos , Masculino , Persona de Mediana Edad , Mutación , Polimorfismo Genético , Polimorfismo de Longitud del Fragmento de Restricción
3.
Lijec Vjesn ; 138(9-10): 272-81, 2016.
Artículo en Croata | MEDLINE | ID: mdl-30148556

RESUMEN

Until the beginning of the 90ies, it was believed that patients with liver cirrhosis were auto-anticoagulated and thus protected from thromboembolic events. However, new discoveries have broken the longstanding paradigm. In deranged hepatic function there is a reduced synthesis of procoagulants and endogenous anticoagulants, however, extrahepatally synthesized hemostatic and fibrinolytic factors are disproportionately affected. In stable disease hemostatic system is "rebalanced'' but fragile, therefore, even a minimal stress can promote bleeding or thrombosis. Also, there are many concomitant factors, such as hemodynamic changes, other organ affection, namely kidney, and predisposition to infection, that shift the balance towards either bleeding or thrombosis. Conventional laboratory tests are not sufficient for evaluation of the bleeding risk, prothrombotic risk factors are not clearly identified, and safety profile of antithrombotic drugs is not precisely evaluated since cirrhotic patients are mainly excluded from big clinical trials. For all that is said, the diagnostic and therapeutic approach in this context is complex and requires teamwork of a hepatologist, hematologist and in a phase of operative treatment, the anesthesiologist. In this review article, we will discuss mechanisms of hemostatic and fibrinolytic abnormalities of liver cirrhosis, the incidence of thromboembolic events as well as prophylactic and therapeutic options in the setting of conservative treatment.


Asunto(s)
Fármacos Hematológicos/farmacología , Hemorragia , Cirrosis Hepática , Trombosis , Coagulación Sanguínea/efectos de los fármacos , Coagulación Sanguínea/fisiología , Tratamiento Conservador/métodos , Fibrinólisis/efectos de los fármacos , Fibrinólisis/fisiología , Hemorragia/sangre , Hemorragia/etiología , Hemorragia/prevención & control , Hemostasis/efectos de los fármacos , Hemostasis/fisiología , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Cirrosis Hepática/fisiopatología , Trombosis/sangre , Trombosis/etiología , Trombosis/prevención & control
4.
BMC Gastroenterol ; 11: 113, 2011 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-22014337

RESUMEN

BACKGROUND: Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. METHODS: A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's disease patients endoscopy was performed to assess disease activity in the rectum. RESULTS: Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001). CONCLUSION: Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound elastography in inflammatory bowel disease.


Asunto(s)
Colitis Ulcerosa/diagnóstico por imagen , Enfermedad de Crohn/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad , Recto/diagnóstico por imagen , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Adulto Joven
6.
Basic Clin Pharmacol Toxicol ; 106(1): 62-5, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19906050

RESUMEN

Vanishing bile duct syndrome is a severe cholestatic disease associated with toxic effects of medications. Stevens-Johnson syndrome is a hypersensitivity disorder that may also be caused by medications. We present a case of a 62-year-old male patient who developed vanishing bile duct syndrome a month after Stevens-Johnson syndrome. These adverse drug reactions were associated with the use of azithromycin (500 mg daily for 3 days). The patient was initially treated for Stevens-Johnson syndrome with steroids, antihistamines and proton pump inhibitors and fully recovered. However, a month after the beginning of Stevens-Johnson syndrome, he developed vanishing bile duct syndrome and was treated with steroids, ursodeoxycholic acid, antihistamines and tacrolimus. Unfortunately, the treatment was unsuccessful and he was listed for liver transplantation which was performed 7 months after the beginning of jaundice. This is the first case of vanishing bile duct syndrome associated with the use of azithromycin and one of few that reports vanishing bile duct syndrome and Stevens-Johnson syndrome co-occurrence.


Asunto(s)
Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Enfermedades de los Conductos Biliares/inducido químicamente , Colestasis/inducido químicamente , Síndrome de Stevens-Johnson/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad
7.
Eur J Gastroenterol Hepatol ; 22(6): 748-53, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19494783

RESUMEN

OBJECTIVES: Currently, magnetic resonance cholangiography is being used for establishing the diagnosis of primary sclerosing cholangitis, whereas endoscopic retrograde cholangiography is reserved for therapeutic interventions. The aim of this study was to determine the role of endoscopic ultrasound elastography in the detection of inflammatory and fibrotic lesions of the common bile duct. METHODS: Linear endoscopic ultrasound elastography of the common bile duct was performed in 41 patients. The patients were divided into two groups: disease group (20 patients with both, primary sclerosing cholangitis and inflammatory bowel disease) and control group (21 patients). Main outcome measurements were diameter, wall thickness and wall qualitative Elasto Score of the common bile duct. RESULTS: The disease group consisted of nine females and 11 males, whereas the control group consisted of 13 females and eight males, with no sex differences observed (chi = 0.6, d.f. = 1, P = 0.443). There was no significant difference in the diameter of common bile duct between the studied groups: 4.67+/-1.83 mm in the disease group and 5.88+/-2.47 mm in controls (t = -1.77, d.f. = 39, P = 0.085). Hard or mixed Elasto Score was found in 16 patients and four controls, being significantly different compared with the soft Elasto Score found in four patients and 17 controls (chi = 1.8, d.f. = 1, P<0.001). A significant difference was observed in the common bile duct wall thickness: 0.89+/-0.59 mm in the disease group and 0.39+/-0.14 mm in controls (t = 3.75, d.f. = 39, P<0.001). CONCLUSION: Endoscopic ultrasound elastography might be a useful noninvasive method in diagnosing primary sclerosing cholangitis.


Asunto(s)
Colangitis Esclerosante/diagnóstico por imagen , Conducto Colédoco/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad , Endosonografía , Adulto , Anciano , Colangitis Esclerosante/patología , Conducto Colédoco/patología , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Enfermedades Inflamatorias del Intestino/patología , Masculino , Persona de Mediana Edad , Adulto Joven
8.
Eur J Gastroenterol Hepatol ; 18(8): 895-9, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16825909

RESUMEN

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with variations in localization and behaviour. Mutations in the NOD2/CARD15 gene on chromosome 16q have been implicated in the pathogenesis of the disease and three main sequence variants, all single nucleotide polymorphisms (SNPs), have been identified in North American and European populations. AIMS AND METHODS: As no data exist in the Croatian population, we consecutively collected a cohort of 136 CD patients and 91 healthy controls to determine the prevalence of NOD2/CARD15 mutations and their association with phenotypic expression of the disease. All patients and controls were genotyped for Arg702Trp (Hugot SNP8), Gly908Arg (Hugot SNP12), and Leu1007fsinsC (Hugot SNP13) and allele frequencies were compared between the Crohn's patients and controls. The correlation of NOD2/CARD15 genotypes with the phenotypic expression of Crohn's disease was further assessed by logistic regression analysis. RESULTS: NOD2/CARD15 variants were found in 38/136 CD patients (27.9%) compared to 10/91 (10.9%) healthy controls (P = 0.0022). Allele frequencies in patients with CD were 13.97%, 4.4% and 11.76%, respectively, for SNP8, 12 and 13, compared to 5.49%, 1.12% and 4.40% in controls (P = 0.041, P = 0.162, P = 0.055). Six CD patients carried double mutations and, remarkably, we identified two homozygous mutants amongst the healthy control group. Surgery over the course of the disease and a younger age at onset of the disease were significantly more frequent in patients who were carriers of NOD2/CARD15 mutations. CONCLUSIONS: This report on NOD2/CARD15 mutations in Croatian patients with CD demonstrates that this gene is also implicated in susceptibility to CD in the Croatian population. Phenotypic association showed a younger age at diagnosis and a higher need for surgery in patients carrying NOD2/CARD15 mutations. However, the prevalence is somewhat lower compared to other reports, likely due to a more prominent colonic inflammation.


Asunto(s)
Enfermedad de Crohn/etnología , Enfermedad de Crohn/genética , Mutación , Proteína Adaptadora de Señalización NOD2/genética , Adolescente , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Croacia/etnología , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Prevalencia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...