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1.
Rev. argent. cir ; 113(1): 111-116, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288180

ABSTRACT

RESUMEN El riesgo de insuficiencia hepática posoperatoria es la limitante de mayor importancia para el trata miento de pacientes con tumores hepáticos malignos primarios o secundarios. Entre las diferentes técnicas para incrementar la resecabilidad de tumores hepáticos se desarrolló una estrategia para pa cientes con tumores previamente considerados como irresecables, técnica conocida como ALPPS (as sociating liver partition with portal vein ligation for staged hepatectomy). Informamos acerca de una cirugía ALPPS en terapia reversa en un hombre referido a nuestro centro con diagnóstico sincrónico de cáncer rectal con metástasis hepáticas múltiples consideradas irresecable al momento del diagnóstico.


ABSTRACT The risk for postoperative liver failure is the most important limitation for the treatment of patients with primary or secondary liver cancer. Among the different strategies used to increase resectability in liver tumors, a technique known as ALPPS (associating liver partition with portal vein ligation for staged hepatectomy) was developed for patients with tumors previously considered unresectable. We report the case of a male patient referred to our center with a diagnosis of synchronous multiple liver metastases of colorectal cancer considered unresectable who underwent ALPPS using liver-first reverse approach.


Subject(s)
Rectal Neoplasms , Methods , Neoplasm Metastasis , Patients , Therapeutics , Colorectal Neoplasms , Risk , Health Strategies , Liver Failure , Hepatic Insufficiency , Diagnosis , Research Report , Hepatectomy , Ligation , Liver
2.
Fisioter. Bras ; 22(1): 49-60, Mar 19, 2021.
Article in Portuguese | LILACS | ID: biblio-1284029

ABSTRACT

Introdução: Queda é o acidente que ocorre com maior frequência no idoso, sendo a principal causa de morte naqueles com mais de 65 anos. As fraturas do quadril ocupam um papel de grande importância, gerando grande problema de ordem clínica envolvendo pacientes e familiares e de ordem econômica para a sociedade. Objetivo: Coletar dados de questionário da admissão e correlacionar a presença de comorbidades prévias a mortalidade em 30 dias do pós-cirurgia. Métodos: Estudo retrospectivo observacional não randomizado com 216 pacientes com fraturas cirúrgicas do quadril com 61 anos ou mais de idade atendidos no setor de emergência do Centro Hospitalar São Lucas na cidade de Niterói, RJ, no período de 30/03/2016 a 20/03/2018. Resultados: A incidência de óbito após a cirurgia do quadril é igual a 6,9% no primeiro mês. O paciente com fratura no quadril tem comorbidades cardiovasculares (75,9%). O óbito está associado à comorbidade hepática em 13,3% e ao baixo peso em 33,3%. O fato de ter duas ou mais comorbidades não está significativamente associado ao óbito. Conclusão: As comorbidades hepáticas, o baixo peso e a presença de disfunções cardiovasculares são importantes preditores prognósticos na mortalidade do paciente com mais de 61 anos após cirurgia de fratura do fêmur no primeiro mês. (AU)


Introduction: Falls are the leading cause of accidents and death in those aged 65 and above. The high incidence of these injuries impact patients, their families and it represents an economic problem for society. Objective: Collect data from the admission survey and correlate previous comorbidities to mortality in 30 days after surgery. Methods: Retrospective observational non-randomized study. 216 patients were included, aged 61 years or older, who were admitted at the emergency department of the Centro Hospitalar São Lucas in Niterói city, Rio de Janeiro. All the participants were candidates of hip fracture surgery between 03/30/2016 and 03/20/2018. Results: The mortality after hip surgery was 6.9% in the first month. Patients who underwent hip surgery had, previously, cardiovascular diseases (75.9%). Death was associated with liver comorbidity in 13.3% and low weight in 33.3%. The fact of having two or more comorbidities was not associated with death. Conclusion: Liver and cardiovascular diseases and low weight are important prognostic predictors in mortality of patients over 61 years of age after femoral fracture surgery in the first month. (AU)


Subject(s)
Humans , Aged , Aged, 80 and over , Postoperative Period , Aged , Comorbidity , Mortality , Femoral Fractures , Cardiovascular Diseases , Hepatic Insufficiency
3.
Rev. colomb. anestesiol ; 48(2): 85-90, Jan.-June 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1115561

ABSTRACT

Abstract Introduction: Orthotopic liver transplantation (OLT) is a procedure characterized by high bleeding rates and a significant likelihood of exposure to blood products. Objectives: This case series shows the experience at a referral center for Jehovah's Witnesses (JW) with end-stage liver disease, undergoing OLT. Materials and methods: A search was conducted in our database of JW undergoing OLT between July 2007 and August 2012. The information about their pre-operative condition and progress up to 30 days post-transplantation. Results: Four subjects were identified (3F/1M) with an average age of 42 years (range 22-55). All of them received a multidisciplinary management which included pre-operative optimization of red cell mass, antifibrinolytic prophylaxis, and cell salvage (mean volume of 344mL [range 113-520]). The average intraoperative bleeding volume was of 625mL (range 300-1000). One of the patients presented with a primary graft dysfunction and died, while the rest had a normal postoperative course. Conclusion: It is possible to offer OLT to patients who refuse to receive allogeneic blood transfusions, through a comprehensive approach that includes perioperative hematologic optimization and the use of blood conservation measures, without a significant impact on the outcomes.


Resumen Introducción: El trasplante hepático ortotópico (THO) es un procedimiento caracterizado por índices significativos de sangrado y alta probabilidad de exposición a hemocomponentes. Objetivos: Esta serie de casos muestra la experiencia de un centro de referencia en la atención de testigos de Jehová (TJ) con enfermedad hepática terminal llevados a THO. Materiales y métodos: Se realizó una búsqueda en nuestra base de datos de TJ que hubiesen sido llevados a THO entre julio de 2007 y agosto de 2012. Se registraron datos correspondientes a su estado preoperatorio, manejo perioperatorio y evolución hasta los 30 días postrasplante. Resultados: Se encontraron cuatro sujetos (3M/1H) con una edad promedio de 42 años (rango de 22-55). Todos recibieron un manejo multidisciplinario que incluyó la optimización preoperatoria de su masa eritrocitaria, profilaxis antifibrinolítica y salvamento celular [volumen promedio de 344 ml (rango de 113-520)]. El volumen promedio de sangrado intraoperatorio fue de 625 ml (rango de 300-1000). Uno de los pacientes presentó disfunción primaria del injerto y muerte, mientras que los demás tuvieron un curso posoperatorio convencional. Conclusiones: Es posible ofrecer la posibilidad de THO para sujetos que se niegan a recibir transfusiones alogénicas, por medio de un abordaje integral que incluya la optimización hematológica perioperatoria y la utilización de medidas de conservación sanguínea, sin que esto afecte significativamente los resultados.


Subject(s)
Humans , Male , Female , Middle Aged , Liver Transplantation , Jehovah's Witnesses , Blood Transfusion , Hepatic Insufficiency , Viscoelastic Substances/chemical synthesis
4.
Rev. chil. cir ; 70(6): 571-579, dic. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-978032

ABSTRACT

Resumen Introducción: La insuficiencia hepática posoperatoria (IHP) es una causa importante de morbimortalidad posoperatoria en cirugía hepática. Un remanente hepático futuro (RHF) insuficiente es una de las principales causas IHP La asociación de bipartición hepática con ligadura portal para hepatectomía en 2 tiempos (ALPPS) es una técnica relativamente nueva que induce una rápida hipertrofia parenquimatosa reduciendo el tiempo de espera para lograr un volumen hepático adecuado. Nuestro objetivo es comunicar la experiencia y los resultados iniciales de la hepatectomía en 2 tiempos utilizando la técnica de ALLPS. Material y Método: Se incluyeron todos los pacientes en los que se ha realizado una hepatectomía en 2 tiempos utilizando la técnica de ALPPS entre el 1 de junio de 2014 y el 31 de julio de 2016 en la Unidad de Cirugía Digestiva del Hospital Regional de Talca. Resutados: Durante el periodo de estudio, se realizaron 47 hepatectomías en el Hospital Regional de Talca. En 3 casos (6.3%), se realizó una hepatectomía en 2 tiempos utilizando la técnica de ALPPS, en todos ellos se logró una hipertrofia del remanente hepático futuro (RHF) que permitió completar el segundo tiempo sin IHP clínicamente significativa. Conclusión: En nuestra experiencia inicial, la técnica de ALPPS logró aumentar el RHF permitiendo resecar pacientes que inicialmente tenían un RHF insuficiente para ser sometidos a una hepatectomía mayor.


Introduction: Postoperative liver failure (POLF) is a relevant cause of morbimortality after liver surgery. An insufficient future liver remnant (FLR) is one of the main causes of POLF. The association of hepatic bipartition with portal ligation for 2-stage hepatectomy (ALPPS) is a relatively new technique that induces rapid parenchymal hypertrophy reducing the waiting time to achieve adequate FLR. Our aim is to communicate the experience and the initial results of the hepatectomy in 2-stages using the ALLPS technique. Material and Method: All patients in whom a 2-stage hepatectomy using ALPPS technique between June 1, 2014 and July 31, 2016 in the Digestive Surgery Unit of the Hospital Regional of Talca were included. Results: There were 47 hepatectomies performed at the Hospital Regional of Talca. In 3 cases (6.3%), a 2-stage hepatectomy was performed using the ALPPS technique, in all of which a hypertrophy of the future hepatic remnant (RHF) was achieved, which allowed completing the second stage without POLF clinically significant. Conclusion: In our initial experience, the ALPPS technique successfully allowed increase FLR in patients who initially had insufficient FLR to be submitted a major liver resection.


Subject(s)
Humans , Male , Female , Middle Aged , Hepatic Insufficiency/etiology , Hepatectomy/adverse effects , Hepatectomy/methods , Liver Neoplasms/surgery , Treatment Outcome , Liver Neoplasms/complications
5.
Texto & contexto enferm ; 27(2): e3730016, 2018. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-904458

ABSTRACT

RESUMO Objetivo: avaliar a dimensão psicossocial da qualidade de vida de pacientes antes e depois do transplante hepático. Método: estudo descritivo, transversal, com abordagem quantitativa, com 150 pacientes submetidos ao transplante de fígado em seguimento a partir do sexto mês, no ambulatório de um centro de referência em transplante hepático. A coleta de dados foi realizada a partir da aplicação de um instrumento com dados sociodemográficos/clínicos e do questionário Liver Disease Quality of Life. Foi utilizada análise estatística descritiva, teste t de Student para comparação das médias dos domínios e Games-Howell para comparações múltiplas. Resultados: houve melhoria nos níveis de qualidade de vida pós-transplante nos quatro domínios avaliados (<0,0001), com maior elevação de escores para os domínios: preocupação (55,5 vs 87,9) e estigma da doença hepática (58,6 vs 93,7). Conclusão: o estudo demonstrou que os pacientes submetidos ao transplante hepático obtiveram uma melhoria significativa da percepção da qualidade de vida no que diz respeito à dimensão psicossocial, sendo mais perceptiva nos domínios preocupação e estigma da doença hepática.


RESUMEN Objetivo: evaluar la dimensión psicosocial de la calidad de vida de los pacientes antes y después del trasplante hepático. Método: estudio descriptivo, transversal y con un abordaje cuantitativo con 150 pacientes sometidos al trasplante de hígado y en seguimiento a partir del sexto mes, en el ambulatorio de un centro de referencia en trasplante hepático. La obtención de datos se realizó a partir de la aplicación de un instrumento con datos sociodemográficos/clínicos y del cuestionario Liver Disease Quality of Life. Se utilizó el análisis estadístico descriptivo, la prueba t de Student para la comparación de los promedios de los dominios y Games-Howell para las comparaciones múltiples. Resultados: hubo mejoras en los niveles de calidad de vida post-trasplante en los cuatro dominios evaluados (<0,0001), con una elevación mayor de resultados para los dominios preocupación (55,5 vs 87,9) y estigma de la enfermedad hepática (58,6 vs 93,7). Conclusión: el estudio demostró que los pacientes sometidos al trasplante hepático consiguieron una significativa mejora de la percepción de la calidad de vida en relación a la dimensión psicosocial, siendo más perceptivo en los dominios de preocupación y estigma de la enfermedad hepática.


ABSTRACT Objective: to assess the psychosocial dimension of patients' quality of life before and after a hepatic transplantation. Method: descriptive, cross-sectional study of quantitative approach, with 150 patients submitted to a liver transplantation being monitored from the sixth month, in the outpatient clinic of a reference center in hepatic transplantation. The data collection was carried out through an instrument with sociodemographic/clinical data and the Liver Disease Quality of Life questionnaire. The descriptive statistical analysis, Student's t-test for comparison of domain means, and Games-Howell for multiple comparisons have been used. Results: there was improvement in the post-transplant quality of life in the four domains evaluated (<0.0001),with higher scores for the domains: health distress (55.5 vs 87.9) and stigma of hepatic disease (58.6 vs 93.7). Conclusion: the study has demonstrated that patients submitted to a liver transplantation had a significant improvement in the perception of quality of life regarding the psychosocial dimension, being more perceptive in the areas of health distress and stigma of hepatic disease.


Subject(s)
Humans , Quality of Life , Health Evaluation , Liver Transplantation , Nursing , Psychosocial Impact , Hepatic Insufficiency
6.
Rev. méd. hondur ; 85(3/4): 136-138, jul.-dic. 2017.
Article in Spanish | LILACS | ID: biblio-970358

ABSTRACT

La hepatitis C constituye un enorme problema de salud pública mundial. Es causada por los virus de hepatitis C. Se han descrito 6 genotipos distribuidos por el Mundo, transmitidos al humano, primordialmente por vía parenteral. La infección, generalmente asintomática en 85% de los casos, en su fase crónica produce cirrosis, insuiciencia hepática, manifestaciones extrahepáticas y hepatocarcinoma en 80% de las personas; se considera la causa principal de trasplante hepático en USA. Se calcula que el mundo, existen 170-240 millones de personas infectadas, en su mayoría sin saberlo hasta que sobrevienen las complicaciones. Entre 2001 y 2011, el tratamiento estándar fue Interferon pegilado y Ribavirina durante aproximadamente 48 semanas, obteniéndose respuesta viral sostenida (RVS) entre 40% y 50%, con poca tolerabilidad y efectos adversos. Después de 2011, inició la terapia triple con Interferon pegilado, Ribavirina y Telaprevir o Boceprevir, tratamientos más cortos, con resultados de RVS entre 65% y 75%. En 2014 se utilizaron drogas antivirales orales (1 tab./dia-Sofosbuvir o Simeprivir; ambos aceptados por la FDA en 2013), y Ledipasvir, Dasabuvir-Ombitasvir, Daclastavir, Elbastavir, Grazoprevir solos o combinados con Ribavirina, durante 12-24 semanas),lográndose RVS de 90%-100%).El diagnóstico precoz y el inicio de tratamiento es la mejor estrategia para reducir el impacto de la enfermedad. La OMS tiene como objetivo global eliminar la hepatitis C para 2030, pero la ineicacia de diagnóstico oportuno y los elevados costos de las drogas, diicultarán cumplir el eslogan:"testar y tratar a la mayor brevedad posible" En conclusión, existe evidencia cientíica para declarar que: el tratamiento de la hepatitis C constituye un nuevo paradigma de que la enfermedad es curable.


Subject(s)
Humans , Fibrosis , Public Health , Hepatitis C/diagnosis , Hepatic Insufficiency/complications
7.
HU rev ; 43(2): 179-182, abr-jun 2017.
Article in Portuguese | LILACS | ID: biblio-946513

ABSTRACT

A esteatose hepática aguda da gestação é uma patologia obstétrica rara e grave, associada a alta mortalidade materna e fetal. O seu diagnóstico é difícil devido a sobreposição clínica com outras patologias graves, como a pré-eclampsia e a síndrome HELLP. O relato de caso apresentado neste estudo descreve a ocorrência de esteatose hepática aguda da gestação em uma mulher de 40 anos, multípara, previamente hígida, que evolui com insuficiência hepática e renal. A identificação precoce desta patologia, a pronta interrupção da gestação e o suporte intensivo adequado após o parto, contribuíram para o bom prognóstico da paciente.


Acute fatty liver of pregnancy (AFLP) is a rare and serious obstetric pathology associated with maternal and fetal mortality. The diagnosis difficulty may be overlapped with other serious diseases, such as preeclampsia and HELLP syndrome. In this study, the case report described the occurrence of acute fatty liver of pregnancy in a woman, 40 years old, multiparous, previously healthy, evolving with liver and kidney failure. Early identification of this condition, the prompt termination of pregnancy and adequate intensive support after delivery contributed to the good prognosis of the patient and patient's recovery


Subject(s)
Pregnancy , Fatty Liver , HELLP Syndrome , Hepatic Insufficiency , Fetal Mortality , Renal Insufficiency , Liver
8.
Pesqui. vet. bras ; 37(1): 23-30, jan. 2017. ilus., tab.
Article in English | ID: biblio-837446

ABSTRACT

Ingestion of Enterolobium contortisiliquum pods causes digestive disturbances, secondary hepatogenous photosensitization and abortions in ruminants. Pods were administered to sheep via a ruminal cannula to characterize acute poisoning. In Experiment 1, a single dose of 12g/kg of body weight (BW) was administered to three sheep in one experiment. One sheep died, and the other two recovered after presenting clinical signs. In Experiment 2, 10g/kg BW were administered daily to 15 sheep until the onset of clinical signs or for three consecutive days. Fourteen sheep showed mild to severe signs after the ingestion of 1-3 doses. Two sheep died, and the others recovered. Clinical signs in both experiments were diarrhea, anorexia, rumen atony, apathy, dehydration and tachypnea. The main macroscopic findings were an orange, frothy ruminal content witch contained pods fragments. The intestinal content was liquid. Detachment of the mucosa from the submucosa and ballooning degeneration of mucosal cells were observed histologically in the forestomachs. Evaluation of ruminal contents revealed acute lactic ruminal acidosis (ALRA). Bromatological analysis of E. contortisiliquum pods revealed 537.8g/kg DM (dry matter) of non-fibrous carbohydrates, which is sufficient to cause ALRA. Only one sheep in Experiment 2 had liver failure, characterized by jaundice, elevated serum activity of liver enzymes and histological lesions in liver biopsies. It is concluded that the administration of E. contortisiliquum pods in forage-fed sheep at doses of 10g/kg BW or higher may cause ALRA. The induction of liver failure in one sheep suggests that liver damage may occur in those sheep that do not develop acidosis.(AU)


A ingestão das favas de Enterolobium contortisiliquum causa distúrbios digestivos, fotossensibilização hepatógena e abortos em ruminantes. Para caracterizar a intoxicação aguda, favas de E. contortisiliquum foram administradas a ovinos por meio de cânula ruminal. No Experimento 1, uma dose única de 12g/kg de peso corporal (pc) foi administrada a três ovinos. Um dos ovinos morreu e os outros dois se recuperaram após mostrar sinais clínicos. No experimento 2, 10g/kg/pc foram administradas diariamente a 15 ovinos, por três dias consecutivos ou até o parecimento dos sinais clínicos. Catorze ovinos mostraram sinais clínicos leves a acentuados após ingestão de 1-3 doses. Dois ovinos morreram e os outros se recuperaram. Observou-se nos ovinos dos experimentos 1 e 2, diarreia, anorexia, atonia ruminal, apatia, desidratação e taquipneia. Os principais achados macroscópicos incluíram conteúdo ruminal espumoso e alaranjado em meio ao qual se observavam fragmentos das favas de E. contortisiliquum, e conteúdo intestinal líquido. Histologicamente, havia degeneração balonosa e desprendimento do epitélio de revestimento dos pré-estomagos. A avaliação do conteúdo ruminal revelou acidose ruminal láctica aguda (ARLA). Análise bromatológica das favas de E. contortisiliquum revelou 537.8g/kg de matéria seca de carboidratos não fibrosos, quantidade suficiente para causar ARLA. Um ovino do Experimento 2 teve insuficiência hepática aguda, caracterizada por icterícia, elevação da atividade sérica das enzimas hepáticas e alterações histológicas observadas em biópsia hepática. Concluiu-se que a administração de favas de E. contortisiliquum na alimentação de ovinos, nas doses de 10g/kg pc ou maiores, pode causar ARLA. A ocorrência de insuficiência hepática num dos ovinos deste experimento sugere que a lesão hepática pode se desenvolver em ovinos que não apresentam ARLA.(AU)


Subject(s)
Animals , Acidosis/veterinary , Fabaceae/toxicity , Plant Poisoning/veterinary , Sheep , Hepatic Insufficiency/veterinary , Photosensitivity Disorders/veterinary
9.
Rev. colomb. gastroenterol ; 32(4): 349-357, 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-900713

ABSTRACT

Resumen La insuficiencia hepática es un estado patológico que condiciona la síntesis y metabolismo de diversas biomoléculas, siendo las alteraciones a la hemostasia una de las primeras consecuencias a nivel sistémico que se hacen presentes; debido a esto y por la dimensión de los riesgos de esta situación, no es raro que las pruebas de coagulación sean indispensables para formular las escalas pronósticas en pacientes hepatópatas. Los conocimientos sobre hemostasia han avanzado en la última década; la clásica cascada de activación de los factores de la coagulación ha sido perfeccionada hasta conformarse el ahora vigente modelo celular que considera la valiosa e indispensable participación del endotelio y las plaquetas. Gracias a esto es posible comprender que, en pacientes con insuficiencia hepática, el riesgo de sangrado no obedece únicamente a la deficiencia en la producción de los factores de la coagulación y, por tanto, es cuestionable la administración de vitamina K. Más relevante aún es que, gracias a estos conocimientos, se puede comprender el a veces contradictorio riesgo de trombosis en estos pacientes, complicación potencialmente mortal.


Abstract Hepatic insufficiency is a pathology that conditions synthesis and metabolism of various biomolecules. Alterations of hemostasis is one of its first systemic consequences. Because of this and the size of the risks, it is not uncommon for clotting tests to be indispensable for formulating prognostic scales in patients with liver disease. Knowledge about hemostasis has advanced in the last decade, and the classic cascade of activation of coagulation factors has been perfected until it has become the now-current cellular model that considers the valuable and indispensable participation of the endothelium and platelets. Thanks to this, it is possible to understand that the risk of bleeding in patients who have hepatic insufficiency is not only due to deficiencies in production of coagulation factors, and that for this reason administration of vitamin K is questionable. Even more relevant, is the fact that, thanks to this this knowledge, we can understand the sometimes contradictory and potentially life-threatening complication of thrombosis in these patients.


Subject(s)
Blood Coagulation , Hepatic Insufficiency , Thrombosis , Vitamin K
10.
Evid. actual. práct. ambul ; 20(4): 102-104, 2017. ilus
Article in Spanish | LILACS | ID: biblio-1097209

ABSTRACT

Si bien los niveles bajos de vitamina D se han asociado con varios resultados de interés en salud, aún resulta motivo de controversia qué significa un nivel bajo, cual es la utilidad de su suplementación y cuales son sus potenciales efectos adversos. En ese contexto, se realizó en el Servicio de Medicina Familiar y Comunitaria del Hospital Italiano un taller de discusión denominado "Actividad ECCO" (Evidencia Científica en la Clínica Cotidiana) en la que fueron presentados los resulta-dos de estudios identificados que hubieran comparado el uso de vitamina D (con o sin suplementación de calcio) ver-sus placebo, con el objetivo de discutir cuál es la evidencia actual para el rastreo de deficiencia de vitamina D y para, eventualmente, recomendar o no su suplementación. Este artículo resume la evidencia identificada y las conclusiones consensuadas en dicha actividad. (AU)


Although low levels of vitamin D have been associated with several health outcomes, it is controversial what a low level means, the usefulness of its supplementation and its potential adverse effects. In this context, a workshop called "ECCO Activity" (Scientific Evidence in the Daily Clinic) was held in the Family and Community Medicine Division of Hospital Italiano de Buenos Aires, where the results of identified studies that compared the use of vitamin D (with or without calcium supplementation) versus placebo, with the aim of discussing what is the current evidence for screening of vitamin D deficiency and to, eventually, recommend or not its supplementation. This article summarizes the identified evidence and the agreed conclusions in that activity. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Avitaminosis/diagnosis , Vitamin D/adverse effects , Osteoporosis/drug therapy , Exocrine Pancreatic Insufficiency/complications , Phenobarbital/adverse effects , Phenytoin/adverse effects , Sunscreening Agents/adverse effects , Vitamin D/administration & dosage , Vitamin D/blood , Vitamin D/therapeutic use , Accidental Falls/prevention & control , Accidental Falls/statistics & numerical data , Biomarkers , Gastric Bypass/adverse effects , Inflammatory Bowel Diseases/complications , Celiac Disease/complications , Calcium/administration & dosage , Calcium/therapeutic use , Risk , Adrenal Cortex Hormones/adverse effects , Irritable Bowel Syndrome/complications , Anti-Retroviral Agents/adverse effects , Hepatic Insufficiency/complications , Renal Insufficiency, Chronic/complications
11.
Article in English | WPRIM | ID: wpr-180607

ABSTRACT

The information on mortality from echinococcosis is important not only for a better understanding of the severity of the disease, but also for evaluating the effectiveness of public health interventions. The aim of this research was to study the causes of mortality from echinococcosis. We have collected and analyzed the materials of 1,470 patients in 10 age - groups in the Republic of Armenia (from 2000 to 2016). To find out the causes of mortality from echinococcosis, we have analyzed the medical histories and protocols of postmortem examinations of 19 deaths from echinococcosis and 17 deaths due to other indirect causes not associated with the parasite. The average annual death rate from echinococcosis is 0.007 per 10,000 population, and the mortality is 1.29 (per 100 patients). The highest mortality occurs in people aged 70–79. Mortality from echinococcosis is also recorded among the unoperated children. The rupture of the parasitic cyst and hepatic insufficiency are major among the direct causes of mortality. Sometimes the hydatid cysts unrecognized during the life were first diagnosed at autopsy. Insufficient qualification of doctors in the field of helminthology, as well as the latent course of the disease or manifestation of minor symptoms in echinococcosis over a long period often led to medical errors. Further decline in mortality can be achieved by early diagnosis, timely hospitalization and treatment before the development of severe complications worsening the prognosis and outcomes of surgical intervention.


Subject(s)
Armenia , Autopsy , Child , Early Diagnosis , Echinococcosis , Echinococcus granulosus , Echinococcus multilocularis , Hepatic Insufficiency , Hospitalization , Humans , Medical Errors , Mortality , Parasites , Prognosis , Public Health , Rupture
12.
Int. j. cardiovasc. sci. (Impr.) ; 29(2): 139-148, mar.-abr. 2016. tab
Article in English, Portuguese | LILACS | ID: biblio-831105

ABSTRACT

A cardiomiopatia cirrótica (CMC) é uma disfunção cardíaca crônica que acomete pacientes cirróticos sem doença cardíaca prévia. Trata-se de uma doença inicialmente assintomática que se manifesta em situações de maior demanda metabólica, devido a menor capacidade cardíaca em aumentar seu inotropismo. O diagnóstico é pautado em alterações eletrocardiográficas e ecocardiográficas. Ainda não há tratamento específico para a CMC, sendo instituídas medicações sintomáticas semelhantes ao tratamento da insuficiência cardíaca. Esta revisão tem por objetivo descrever os aspectos fisiopatológicos, clínicos e diagnósticos da CMC, evidenciando as características clínicas, laboratoriais e eletro e ecocardiográficas no rastreio da disfunção cardíaca nos pacientes cirróticos.


Cirrhotic cardiomyopathy (CCM) is a chronic cardiac dysfunction that affects cirrhotic patients without history of heart disease. It is an initially asymptomatic disease that appears in situations of increased metabolic demand due to lower cardiac capacity to increase inotropism. Diagnosis is based on disorders revealed by electrocardiography and echocardiography. There is no specific treatmentfor CCM. Similar symptomatic medications are established to treat heart failure. This review aims to describe the pathophysiological, clinical and diagnostic aspects of CCM, showing the clinical, laboratory, electrocardiographic and echocardiographic characteristics in assessing cardiac dysfunction in cirrhotic patients.


Subject(s)
Humans , Cardiomyopathies/physiopathology , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Heart Failure/complications , Heart Failure/physiopathology , Hepatic Insufficiency/physiopathology , Chronic Disease , Echocardiography/methods , Electrocardiography/methods , Magnetic Resonance Spectroscopy/methods , Renin-Angiotensin System , Risk Factors
13.
Article in English | WPRIM | ID: wpr-81486

ABSTRACT

The incidence of complications after liver resection is closely related to functional future liver remnant (FLR). The standard approach to augment FLR is surgical or radiological occlusion of the artery or portal vein on the tumor side. Associated liver partition and portal vein ligation for staged hepatectomy (ALLPS) has been introduced as an alternative method to augment FLR. It offers rapid and effective hypertrophy for resecting liver metastases. However, data regarding its application in patients with hepatocellular carcinoma (HCC) with a background of chronic liver disease are limited. Here we describe the use of ALPPS procedure to manage a large solitary HCC with a background of chronic liver disease. The rising incidence of HCC has increased the number of surgical resections in patients with advanced stage liver disease not considered for liver transplantation. We reviewed reported experience of ALPPS in established chronic liver disease and current therapeutic modalities for HCC on a background of chronic liver disease in patients with potential liver insufficiency where tumor burden is beyond liver transplant criteria.


Subject(s)
Arteries , Carcinoma, Hepatocellular , Hepatectomy , Hepatic Insufficiency , Humans , Hypertrophy , Incidence , Ligation , Liver Cirrhosis , Liver Diseases , Liver Transplantation , Liver , Neoplasm Metastasis , Portal Vein , Tumor Burden
14.
Rev. chil. obstet. ginecol ; 80(6): 481-485, dic. 2015. ilus
Article in Spanish | LILACS | ID: lil-771636

ABSTRACT

ANTECEDENTES: La sepsis por Clostridios es una entidad poco frecuente que conlleva una mortalidad del 8090% a pesar del tratamiento antibiótico y quirúrgico. A pesar de que la mayoría de los casos de septicemia secundaria a Clostridios se originan en el aparato genital femenino tras un aborto séptico, solo un pequeño porcentaje de abortos sépticos (1%) se siguen de septicemia. CASO CLÍNICO: Gestante de 15 semanas que acude a urgencias por rotura prematura de membranas pretérmino. Ante el deseo de la paciente se mantiene actitud conservadora con antibioterapia iv, produciéndose a las pocas horas el aborto de forma espontánea junto con aparición de signos de infección. Rápidamente la paciente evoluciona a sepsis grave, y ante la sospecha de aborto séptico se efectúa histerectomía. Tras la intervención ingresa en situación de shock séptico con insuficiencia renal, hepática y respiratoria. Durante el ingreso se confirma Clostridium perfringens como agente responsable del proceso séptico. Finalmente la paciente es dada de alta definitiva tras seis meses, una vez resueltas las alteraciones derivadas del proceso séptico.


BACKGROUND: Clostridial sepsis is a rare condition which carries a mortality of 80-90% despite antibiotic and surgical treatment. Although most cases of septicemia due to Clostridium are originated in female genital tract after septic abortion, only a small percentage of septic abortions (1%) are followed by septicemia. CLINICAL CASE: Our case is about a 15 weeks pregnant woman attended the emergency room for preterm premature rupture of membranes. Due to the desire of the patient we proceed conservative treatment with antibiotics iv, in the following few hours the abortion develops spontaneously along with signs of infection. Rapidly the patient progresses into a severe sepsis, due to suspected septic abortion, the patient is intervened urgently by hysterectomy. After the intervention she enters into septic shock state with respiratory, kidney and liver failure. During the admission Clostridium perfringens is confirmed as a causative agent for septic process. Finally the patient is discharge after six months once resolved all complications arising from septic process.


Subject(s)
Humans , Female , Pregnancy , Adult , Shock, Septic/microbiology , Clostridium Infections/complications , Clostridium Infections/diagnosis , Abortion, Septic/physiopathology , Shock, Septic/surgery , Clostridium perfringens , Abortion, Septic/surgery , Hepatic Insufficiency/microbiology , Renal Insufficiency/microbiology , Hysterectomy
15.
Rev. colomb. radiol ; 26(3): 4246-4251, 2015. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-987941

ABSTRACT

Introducción: En la actualidad, el número de pacientes con insuficiencia hepática secundaria a hipertensión portal ha aumentado por diversos factores. Las modalidades de imagen han permitido realizar procedimientos mínimamente invasivos para producir un impacto benéfico en pacientes con hepatopatía y disminuir las complicaciones derivadas del deterioro del flujo intrahepático. Objetivo: Dar a conocer las consideraciones generales sobre los procedimientos guiados por imagen en el tratamiento de la hipertensión portal y sus complicaciones, teniendo en cuenta diversos factores clínicos particulares. Métodos: Se realizó una revisión de la literatura reciente con el fin de describir los diferentes procedimientos guiados por imagen que permitan disminuir la presión venosa en el sistema venoso portal. Conclusión: Existen múltiples procedimientos guiados por imagen que permiten mejorar la dinámica del flujo venoso hepático; es pertinente estar familiarizados con cada uno de ellos y seleccionar el más apropiado para cada paciente, teniendo en cuenta su disponibilidad, grado de experiencia y características propias de cada paciente.


Introduction: At present, the number of patients with liver failure secondary to portal hypertension has increased by several factors. Imaging modalities have allowed minimally invasive procedures to produce a beneficial impact in patients with liver disease and reduce complications resulting from deterioration of intrahepatic flow. Objective: Introduce the general considerations on imageguided procedures in the treatment of portal hypertension and its complications, taking into account several particular clinical factors. Methods: A review of recent literature was conducted to describe the different image-guided procedures that help decrease the venous pressure in the portal venous system. Conclusion: There are many image-guided procedures that improve the dynamics of hepatic venous flow. It is important to be familiar with these procedures to select the most appropriate for each patient, according their availability, level of experience and some specific features.


Subject(s)
Humans , Hypertension, Portal , Portography , Portasystemic Shunt, Transjugular Intrahepatic , Hepatic Insufficiency
16.
Article in Korean | WPRIM | ID: wpr-111030

ABSTRACT

We report a case of a 34-year-old woman who was in temporary delirium and hyperammonemia during treatment of bipolar affective disorder with valproate. Patient showed delirium after 20 days of treatment, while the serum valproate level was within the therapeutic range without any sign of hepatic insufficiency. However, the patient had increased serum ammonia level (121 microg/mL), and valproate was discontinued due to suspicion of valproate-induced hyperammonemic encephalopathy (VHE). Serum valproate level was normalized with reduced delirium after valproate has been discontinued. Few VHE in psychiatric literature has been documented, because of possible confusion between VHE and preexisting psychiatric symptoms. Clinicians should be cautious about the potential risk for hyperammonemic encephalopathy caused by valproate medication.


Subject(s)
Adult , Ammonia , Delirium , Female , Hepatic Insufficiency , Humans , Hyperammonemia , Mood Disorders , Valproic Acid
18.
Braz. j. morphol. sci ; 31(1): 33-41, 1/3/2014. ilus, tab
Article in English | LILACS | ID: biblio-912339

ABSTRACT

Introductions: Hepatic cirrhosis is a final common pathway of all chronic liver diseases, characterized by deposit of fibrillar collagen and liver failure. Materials and Methods: In this experiment, hepatic cirrhosis was induced in 15 female Wistar rats by a 14-week period, with thioacetamide solution in a 200 mg/kg dosage, via intraperitoneal. Animals were submitted to liver biopsy, and euthanized after a 80-day post-induction period. Serum biochemical analysis was performed, in addition to histopathology by H.E., Picrosirius, Alcian Blue and P.A.S. stainings, following analysis of histological activity index and staging of fibrosis. Morphometric analysis of collagen on Picrosirius slides was also performed. Results: Mortality during experimental period was low (13.33%), and after 80-day period, liver function improved, cellular changes did not altered, and deposition of acidic mucopolysaccharides and glycogen were increased. Liver histological activity did not change significantly (7.25 ± 1.30 to 6.41 ± 1.32), but staging of fibrosis was altered (3.91 ± 0.76 to 4.70 ± 1.11). Interlobular collagen showed a significant decrease (5.14 ± 2.00 to 4.00 ± 1.20), while intralobular collagen was increased (0.23 ± 0.06 to 0.36 ± 0.08). Conclusions: These findings characterize thioacetamide as a safe experimental model for induction cirrhosis, which may be used for future therapy studies.(AU)


Subject(s)
Animals , Rats , Thioacetamide/administration & dosage , Collagen/analysis , Disease Models, Animal , Liver Cirrhosis/chemically induced , Rats, Wistar , Hepatic Insufficiency
19.
Egyptian Journal of Chest Diseases and Tuberculosis [The]. 2014; 63 (1): 81-85
in English | IMEMR | ID: emr-154297

ABSTRACT

Hepatitis C virus [HCV] infection is associated with a wide series of extra- hepatic manifestations. Pulmonary involvement is one of the extrahepatic manifestations of chronic hepatitis C virus [HCV] infection. The objective of this study was to determine the impact of HCV; infection and the degree of liver dysfunction in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted on COPD patients. They were selected from outpatient chest clinic in the Menoufia University Hospital. They were classified into 2 groups the first group COPD patients [n = 40] without hepatitis C and the second group COPD patients with chronic hepatitis C. Second group [COPD with HCV] classified into 3 subgroups according Child-Pugh classification to determine the degree of liver insufficiency. Group IIA: patients Child-Pugh [A], group IIB: patients Child-Pugh [B] and group IIC: patients Child-Pugh [C]. The following pulmonary function parameters were recorded: Forced Expiratory Volume in the first second [FEV1], Forced Expiratory Volume percent [FEV1/FVC%], Forced Expiratory Flow 25-75% [FEF 25-75%] and Maximal Voluntary Ventilation [MVV]. The study included 80 patients with COPD, 40 patients without chronic HCV infection [group I], and 40 patients with chronic HBV infection [group II].COPD patients with HCV infection have increased deterioration in pulmonary function [FEV1, FEV1/FVC, FEF 25-75% and MVV] than COPD patients without HCV infection. Also there were significant decreases in pulmonary function tests [FEV1, FEV1/FVC, FEF 25-75% and MVV] in group II subgroups IIA, IIB and IIC according to the degree of decompensation. Patients with COPD with HCV infection, have increased deterioration in pulmonary function than patients with COPD without HCV infection and the deterioration increases with hepatitis decompensation


Subject(s)
Humans , Male , Female , Hepatic Insufficiency , Chronic Disease , Liver Function Tests , Respiratory Function Tests , Spirometry/statistics & numerical data , Hospitals, University
20.
Journal of the Egyptian Society of Parasitology. 2014; 44 (1): 221-228
in English | IMEMR | ID: emr-154445

ABSTRACT

Orthotropic Liver transplantation [OLT] is a conventional management for end-stage acute or chronic liver insufficiency, but the shortage of donor organs continues to be the restrictive factor throughout the world. Hepatocyte transplantation [HCTx] might be the promising treatment for several liver diseases and can be used as a [bridge] to OLT. Hepatocytes transplantation can protect and even save human lives, its' applicability remains limited by the large deficiency of liver organs and hepatocytes [HC], and cellular loss after engraftment. Host elimination of grafted cells is called Early Graft Dysfunction. This study was developed for an efficient protocol of HCT. Several conditions have been met in order to achieve a high yield of harvested viable HC, overcome the detached-cell apoptosis, attenuation of innate immune reaction against transplanted cells and a receptive cell environment. HC were isolated from Lewis rats [n=8] weighing 250gm, by the 2 step collagen a seper fusion technique, and bone marrow cells [BMCs] were obtained from the rats tibia and femur by centrifugation in a buffer solution. The mean viability of harvested HC and BMCs were 90% and 95% respectively. To minimize the rejection of HC, Lewis rat recipients [n=14] weighing 250gm, were ir- -radiated with 6 Gy and received 0.1 mg of anti-aisle GM1 antiserum intravenously as im-munosuppressive drug. The isolated HC were intra-splenically transplanted and 107 bone marrow cells were injected in a penile vein into the recipients on the third day. Simultaneously, 70% hepatectomy and ligation of common bile duct were done. Thirty days later; the grafted spleen had areas with external appearance of a normal liver in ten out of 14surviving rats [71%]. Hematoxlin and eosin [H and E] staining of sections from these fragments showed sinusoids and portal areas, an evidence of successful hepatocyte engraftment and bile canaliculea formation. Large number of HC clusters of 15 to 20 cells and 2 to 4 distended small bile canaliculea were seen per50 HC. The intrasplenic route for transplanting freshly isolated HC in an immune-compromised animal model was found to give good results regarding cell engraftment and tissue formation


Subject(s)
Male , Animals, Laboratory , Hepatic Insufficiency/complications , Rats
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