The molecular adsorbent recirculating system as a liver support system: summary of Mexican experience.

AIM: The aim of this study was to assess the effects of the molecular absorbent recirculating system (MARS) on patients with acute liver failure (ALF) and liver failure with cirrhosis (AoCLF) as well as in cholestatic patients with intractable pruritus in a Mexican population. MATERIAL AND METHODS: From August 2003 to December 2011, MARS was used in 38 patients with ALF, 15 patients with AoCLF, and 17 cholestatic patients with intractable pruritus. The patients were examined using a standard liver function test and for vital signs, presence of ascites and encephalopathy before and after each treatment. The therapeutic response, patient status, follow-up status, and need for liver transplantation were determined. RESULTS: Seventy-nine MARS procedures were performed. MARS was used for ALF in 54.3% of patients, AoCLF in 24.2%, and cholestatic disease in 21.5%. There were significant improvements in serum bilirubin (p = 0.000), aspartate aminotransferase (p = 0.000), alanine aminotransferase (p = 0.030), gamma-glytamyl transpeptidase (p = 0.044), alkaline phosphatase (p = 0.006), and encephalopathy grade (p = 0.000). Thirty-eight ALF patients were listed for emergency liver transplantation and treated with MARS; 20 of these patients died on a waiting list, 18 survived. only four underwent liver transplantation and 14 (37%) recovered without transplantation after the MARS procedure. CONCLUSION: MARS is a safe and effective procedure, especially for ALF patients. Our results suggest that MARS therapy can contribute to native liver recovery in ALF patients.

An update on the management of hepatitis C: guidelines for protease inhibitor-based triple therapy from the Latin American Association for the Study of the Liver.

Hepatitis C is a common cause of end-stage liver disease, and the main indication for liver transplantation in Latin America. Treatment of hepatitis C infected patients improves important long-term outcomes as mortality. Sustained viral response is reached in near 50% of patients with the previous management based in pegylated interferon and ribavirin. Recently new drugs were available increasing sustained viral response significantly, changing the standard of care to triple therapy. This guidelines provides a framework for practitioner in Latin America, to the management of patients with hepatitis C chronic infection. 

Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis.

Chronic liver disease (CLD) may be associated with pleural effusions (PEs). This article prospectively evaluates whether detection of PEs on thoracic ultrasound (TUS) at the bedside independently predicts mortality and length of stay (LOS) in hospitalized patients with a decompensated CLD. A total of 116 consecutive inpatients with decompensated cirrhosis underwent antero-posterior chest radiographs (CXR) and TUS to detect PEs. Their median age was 54 y (interquartile range, 47-62), 90 (70.6%) were male, and 61 (52.6%) fell into the Child-Pugh class C categorization. TUS identified PEs in 58 (50%) patients, half of which were small enough to preclude thoracentesis. CXR failed to recognize approximately 40% of PEs seen on TUS. The identification of PEs by TUS was associated with a longer LOS (10 vs. 5.5 d, p < 0.001) and double mortality (39.7% vs. 20.7%, p = 0.021). In multivariate analysis, PEs were independently related to poor survival (hazard ratio 2.08, 95% confidence interval [CI] 1.02-4.25; p = 0.044). Patients with both Child-Pugh C stage and PEs had the lowest survival rate (70 vs. 317 d, p = 0.001). In conclusion, PEs identified by TUS in hospitalized patients with decompensated CLD independently predict a poor outcome and portend a longer LOS.

D-dimer from central and peripheral blood samples in asymptomatic central venous catheter-related thrombosis in patients with cancer.

OBJECTIVES: To evaluate the usefulness of a negative D-dimer in peripheral or central venous blood to screen for asymptomatic catheter-related thrombosis in cancer patients. METHODS: D-dimer was measured in blood from central venous catheter and peripheral venous samples in 48 patients with cancer. Asymptomatic catheter-related thrombosis was identified via Doppler ultrasound. Bland and Altman's limits of agreement analysis was used to compare sample sites. Sensitivity and specificity of D-dimer was calculated. RESULTS: Overall, 33 of the central samples and 32 of the peripheral samples had D-dimer levels below the cutoff (≥0.3 mg/l). Mean central D-dimer was 0.31 ± 0.35 mg/l; peripheral 0.24 ± 0.22 mg/l (p = 0.5). Bland-Altman plot showed that the two sample sites were not equivalent. Catheter-related thrombosis was demonstrated in five patients, and there were three false negatives. Peripheral D-dimer had a negative predictive value of 90.9%. CONCLUSIONS: A negative D-dimer may be useful for screening asymptomatic catheter-related thrombosis in patients with cancer, but the central and peripheral sample sites are not equivalent.

Cáncer hepático primario: características epidemiológicas, clínicas y bioquímicas / Primary hepatic cancer: epidemiological, clinical and biochemical characteristics

En este trabajo se revisaron retrospectiva y prospectivamente algunos aspectos clínicos, epidemiológicos, bioquímicos y de gabinete del cáncer hepático primario (CHP) en pacientes internados en nuestro hospital. Este estudio comprende 76 pacientes estudiados de 1971 a 1990. 49 hombres y 27 mujeres. La edad promedio fue de 67.1 ñ 11.7 años. El carcinoma hepatocelular (CHC) fue el tipo histológico más frecuente (84.1 por ciento), seguido por el colangiocarcinoma (CC) con 8.7 por ciento, el carcinoma mixto (CM) con 4.4 por ciento y finalmente el hepatoblastoma (HB) con 2.9 por ciento. A parte, se revisó material de 1485 autopsias, encontrándose que la prevalencia de CHP fue de 0.74 por ciento y los sitios más frecuentes de metástasis fueron los pulmones (66 por ciento) y la vena porta (50 por ciento). El 80 por ciento de los casos de CHC diagnosticado por autopsia presentaban concomitantemente cirrosis hepática. Los síntomas generales y el dolor abdominal fueron las manifestaciones clínicas más comunes (72.5 por ciento). Además, se observó la fosfatasa alcalina elevada en el 77 por ciento de los casos, hiperbilirrubinemia en el 62 por ciento y anemia en el 62 por ciento. En el 61.7 por ciento el tumor fue bilateral o difuso. Todos los tumores solitarios medían más de 5 cms de diámetros por ecografía al momento del diagnóstico. La AFP fue normal en el 18 por ciento de los casos de CHC y el 40 por ciento de estos pacientes tuvo al menos un marcador positivo para el virus de la hepatitis B