Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 60
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
HPB (Oxford) ; 21(9): 1156-1165, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-30777695

RESUMEN

BACKGROUND: The new UK-DCD-Risk-Score has been recently developed to predict graft loss in DCD liver transplantation. Donor-recipient combinations with a cumulative risk of >10 points were classified as futile and achieved an impaired one-year graft survival of <40%. The aim of this study was to show, if hypothermic oxygenated perfusion (HOPE) can rescue such extended DCD livers and improve outcomes. METHODS: "Futile"-classified donor-recipient combinations were selected from our HOPE-treated human DCD liver cohort (01/2012-5/2017), with a minimum follow-up of one year. Main risk factors, which contribute to the classification "futile" include: elderly donors>60years, prolonged functional donor warm ischemia time (fDWIT > 30min), long cold ischemia time>6hrs, donor BMI>25 kg/m2, advanced recipient age (>60years), MELD-score>25points and retransplantation status. Endpoints included all outcome measures during and after DCD LT. RESULTS: Twenty-one donor-recipient combinations were classified futile (median UK-DCD-Risk-Score:11 points). The median donor age and fDWIT were 62 years and 36 min, respectively. After cold storage, livers underwent routine HOPE-treatment for 120 min. All grafts showed immediate function. One-year and 5-year tumor death censored graft survival was 86%. CONCLUSION: HOPE-treatment achieved excellent outcomes, despite high-risk donor and recipient combinations. Such easy, endischemic perfusion approach may open the door for an increased utilization of futile DCD livers in other countries.


Asunto(s)
Frío , Supervivencia de Injerto , Trasplante de Hígado , Preservación de Órganos/métodos , Anciano , Femenino , Rechazo de Injerto , Humanos , Masculino , Inutilidad Médica , Persona de Mediana Edad , Oxígeno , Perfusión , Estudios Retrospectivos , Factores de Riesgo , Trasplante Homólogo
2.
J Viral Hepat ; 25(2): 152-160, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29159841

RESUMEN

In order to accurately assess the burden of hepatitis C (HCV) and develop effective interventions, we must understand the magnitude and trends of mortality related to the disease. In the United States, HCV-related mortality is continuously increasing. We have no comparable data for Switzerland and other European countries, although a modelling study predicted a similar increase. We analysed time trends (1 January 1995-31 December 2014) in HCV-specific mortality rates in the Swiss general population using the death registry of the Swiss Federal Statistical Office (SFSO). We compared HCV-related mortality to HIV-related and hepatitis B (HBV)-related mortality. To determine potential under-reporting in HCV-related mortality, we probabilistically linked the SFSO data to persons who died in the Swiss Hepatitis C Cohort Study (SCCS). SFSO data showed that HCV-related mortality more than doubled between 1995 and 2003, but has since stabilized at ~2.5/100 000 person-years. Since 2000, HCV-related mortality has been higher than HIV-related mortality and was about fivefold higher in 2014. HBV-related mortality remained low at ~0.5/100 000 person-years. Of 4556 persons in the SCCS, 421 have died and 86.2% could be linked to the death registry. According to the SCCS, 133 deaths were HCV-related. HCV was not mentioned on the SFSO death certificate of 45% of these (n = 60/133). In conclusion, HCV-related mortality remained constant, possibly because quality of care was high, or because of under-reporting or because mortality has not yet increased. However, HCV-related mortality is now much higher than HIV- and HBV-related mortality, and under-reporting was common.


Asunto(s)
Hepatitis C Crónica/mortalidad , Hepatitis C/mortalidad , Sistema de Registros , Adulto , Estudios de Cohortes , Femenino , Infecciones por VIH/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Suiza/epidemiología , Estados Unidos/epidemiología
3.
J Viral Hepat ; 25(8): 920-929, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29532619

RESUMEN

It remains unclear whether hepatitis B virus (HBV) infection may modify the severity of viral steatosis in patients coinfected with chronic hepatitis C virus (HCV). We examined the influence of coinfection with HBV on prevalence of steatosis in chronic hepatitis C in a multi-centre cohort of HBV-HCV subjects, and by performing a systematic review and meta-analysis of the literature. We centrally and blindly assessed steatosis prevalence and severity in a cohort of HBV-HCV coinfected subjects compared to HCV and HBV monoinfected controls and we performed a systematic review of studies addressing the prevalence of steatosis in HBV-HCV subjects compared to HCV controls. In the clinical cohort, we included 85 HBV-HCV, 69 HBV and 112 HCV subjects from 16 international centres. There was no significant difference in steatosis prevalence between the HBV-HCV and the HCV groups (33% vs 45%, P = .11). In subgroup analysis, lean HBV-HCV subjects with detectable HBV DNA had less steatosis than lean HCV subjects matched for HCV viremia (15% vs 45%, P = .02). Our literature search identified 5 additional studies included in a systematic review. Overall, prevalence of steatosis > 5% was similar in HBV-HCV infection compared to HCV (pooled odds ratio [OR] 0.91, 95% CI 0.53-1.6) although there was significant heterogeneity (I2 69%, P = .007). In conclusion, although the prevalence of steatosis is similar in HBV-HCV compared to HCV subjects, our analysis suggests that there may be an inhibitory effect of HCV-induced steatogenesis by HBV in certain subgroups of patients.


Asunto(s)
Coinfección/complicaciones , Hígado Graso/epidemiología , Hígado Graso/patología , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos
4.
Am J Transplant ; 17(4): 1050-1063, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-27676319

RESUMEN

Allocation of liver grafts triggers emotional debates, as those patients, not receiving an organ, are prone to death. We analyzed a high-Model of End-stage Liver Disease (MELD) cohort (laboratory MELD score ≥30, n = 100, median laboratory MELD score of 35; interquartile range 31-37) of liver transplant recipients at our center during the past 10 years and compared results with a low-MELD group, matched by propensity scoring for donor age, recipient age, and cold ischemia time. End points of our study were cumulative posttransplantation morbidity, cost, and survival. Six different prediction models, including donor age x recipient MELD (D-MELD), Difference between listing MELD and MELD at transplant (Delta MELD), donor-risk index (DRI), Survival Outcomes Following Liver Transplant (SOFT), balance-of-risk (BAR), and University of California Los Angeles-Futility Risk Score (UCLA-FRS), were applied in both cohorts to identify risk for poor outcome and high cost. All score models were compared with a clinical-oriented decision, based on the combination of hemofiltration plus ventilation. Median intensive care unit and hospital stays were 8 and 26 days, respectively, after liver transplantation of high-MELD patients, with a significantly increased morbidity compared with low-MELD patients (median comprehensive complication index 56 vs. 36 points [maximum points 100] and double cost [median US$179 631 vs. US$80 229]). Five-year survival, however, was only 8% less than that of low-MELD patients (70% vs. 78%). Most prediction scores showed disappointing low positive predictive values for posttransplantation mortality, such as mortality above thresholds, despite good specificity. The clinical observation of hemofiltration plus ventilation in high-MELD patients was even superior in this respect compared with D-MELD, DRI, Delta MELD, and UCLA-FRS but inferior to SOFT and BAR models. Of all models tested, only the BAR score was linearly associated with complications. In conclusion, the BAR score was most useful for risk classification in liver transplantation, based on expected posttransplantation mortality and morbidity. Difficult decisions to accept liver grafts in high-risk recipients may thus be guided by additional BAR score calculation, to increase the safe use of scarce organs.


Asunto(s)
Enfermedad Hepática en Estado Terminal/cirugía , Rechazo de Injerto/mortalidad , Trasplante de Hígado/efectos adversos , Donadores Vivos , Complicaciones Posoperatorias/mortalidad , Índice de Severidad de la Enfermedad , Adulto , Anciano , Femenino , Rechazo de Injerto/etiología , Rechazo de Injerto/patología , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento
5.
J Viral Hepat ; 23(9): 697-707, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27006320

RESUMEN

Socio-demographic and behavioural characteristics are associated with delayed diagnosis and disease progression in HCV-infected persons. However, many analyses focused on single variables rather than groups defined by several variables. We used latent class analysis to study all 4488 persons enrolled in the Swiss Hepatitis C Cohort Study. Groups were identified using predefined variables at enrolment. The number of groups was selected using the Bayesian information criterion. Mortality, loss to follow-up, cirrhosis, treatment status and response to antivirals were analysed using Laplace and logistic regressions. We identified five groups and named them according to their characteristics: persons who inject drugs, male drinkers, Swiss employees, foreign employees and retirees. Two groups did not conform to common assumptions about persons with chronic hepatitis C and were already in an advanced stage of the disease at enrolment: 'male drinkers' and 'retirees' had a high proportion of cirrhosis at enrolment (15% and 16% vs <10.3%), and the shortest time to death (adjusted median time 8.7 years and 8.8 years vs >9.0). 'Male drinkers' also had high substance use, but they were well educated and were likely to be employed. This analysis may help identifying high-risk groups which may benefit from targeted interventions.


Asunto(s)
Antivirales/uso terapéutico , Accesibilidad a los Servicios de Salud , Hepatitis C Crónica/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suiza , Resultado del Tratamiento , Adulto Joven
6.
Gut ; 64(10): 1605-15, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25214320

RESUMEN

OBJECTIVE: The natural course of chronic hepatitis C varies widely. To improve the profiling of patients at risk of developing advanced liver disease, we assessed the relative contribution of factors for liver fibrosis progression in hepatitis C. DESIGN: We analysed 1461 patients with chronic hepatitis C with an estimated date of infection and at least one liver biopsy. Risk factors for accelerated fibrosis progression rate (FPR), defined as ≥ 0.13 Metavir fibrosis units per year, were identified by logistic regression. Examined factors included age at infection, sex, route of infection, HCV genotype, body mass index (BMI), significant alcohol drinking (≥ 20 g/day for ≥ 5 years), HIV coinfection and diabetes. In a subgroup of 575 patients, we assessed the impact of single nucleotide polymorphisms previously associated with fibrosis progression in genome-wide association studies. Results were expressed as attributable fraction (AF) of risk for accelerated FPR. RESULTS: Age at infection (AF 28.7%), sex (AF 8.2%), route of infection (AF 16.5%) and HCV genotype (AF 7.9%) contributed to accelerated FPR in the Swiss Hepatitis C Cohort Study, whereas significant alcohol drinking, anti-HIV, diabetes and BMI did not. In genotyped patients, variants at rs9380516 (TULP1), rs738409 (PNPLA3), rs4374383 (MERTK) (AF 19.2%) and rs910049 (major histocompatibility complex region) significantly added to the risk of accelerated FPR. Results were replicated in three additional independent cohorts, and a meta-analysis confirmed the role of age at infection, sex, route of infection, HCV genotype, rs738409, rs4374383 and rs910049 in accelerating FPR. CONCLUSIONS: Most factors accelerating liver fibrosis progression in chronic hepatitis C are unmodifiable.


Asunto(s)
Hepacivirus/genética , Hepatitis C Crónica/complicaciones , Cirrosis Hepática/etiología , Polimorfismo de Nucleótido Simple , ARN Viral/análisis , Medición de Riesgo/métodos , Biopsia , Progresión de la Enfermedad , Femenino , Estudio de Asociación del Genoma Completo , Hepatitis C Crónica/virología , Humanos , Incidencia , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Masculino , Estudios Retrospectivos , Factores de Riesgo , Suiza/epidemiología , Factores de Tiempo
7.
Infection ; 42(4): 779-83, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24595492

RESUMEN

We describe a case of a 62-year-old diabetic woman with hepatocellular carcinoma due to chronic hepatitis B virus infection. Two weeks after orthotopic liver transplantation, endoscopy for massive upper gastrointestinal bleeding revealed a large necrotic area in the gastric fundus. The patient underwent emergency resection. Histopathologically, angioinvasive mold infection compatible with mucormycosis was diagnosed in a large area of necrosis, mimicking an atypically localized gastric ulcer. Foreign bodies originating from transarterial chemoembolization (TACE) performed 7 and 8 months earlier and 40 days before transplantation were identified in the submucosal tissue. The patient was treated with liposomal amphotericin B (LAB) for 5 weeks, followed by 7 weeks of posaconazole. Follow-up biopsies after 1 and 5 months confirmed successful treatment. Review of the radiological images of the TACE procedure showed that some of the TACE material had been diverted to the stomach via an accessory gastric branch originating from the left hepatic artery. TACE agents may be associated with chronic, refractory gastroduodenal ulcers. We hypothesize that the ischemic lesion was first colonized with presumed Mucorales mold and invasive growth was promoted by the posttransplantation immunosuppression. Careful exploration of extrahepatic collaterals during TACE may prevent this complication.


Asunto(s)
Quimioembolización Terapéutica/efectos adversos , Trasplante de Hígado/efectos adversos , Mucorales/aislamiento & purificación , Mucormicosis/diagnóstico , Mucormicosis/patología , Gastropatías/diagnóstico , Gastropatías/patología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Carcinoma Hepatocelular/cirugía , Complicaciones de la Diabetes , Femenino , Hepatitis B Crónica/complicaciones , Histocitoquímica , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Neoplasias Hepáticas/cirugía , Microscopía , Persona de Mediana Edad , Triazoles/uso terapéutico
8.
Inn Med (Heidelb) ; 65(4): 318-324, 2024 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-38483554

RESUMEN

Non-viral infections of the liver are rare to very rare compared to viral infections. They can be caused by various bacteria, helminths, protozoa, and fungi, often leading to liver involvement during dissemination. Some of these infections affect in particular immunocompromised individuals, while others need to be considered in the differential diagnostic work-up in patients returning from tropical countries. In cases where the infection occurs through oral ingestion of eggs, such as in cystic and alveolar echinococcosis, the liver is often the most commonly affected organ. Due to the diversity of non-viral liver infections and their varied clinical manifestations, a comprehensive discussion of all potential pathogens and their effects is not within the scope of this article. Therefore, only a few of these conditions will be discussed in more detail.


Asunto(s)
Equinococosis , Virosis , Humanos , Hígado
9.
Infection ; 40(2): 139-52, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22076692

RESUMEN

PURPOSE: Human alveolar (AE) and cystic echinococcosis (CE) caused by the metacestode stages of Echinococcus multilocularis and E. granulosus, respectively, lack pathognomonic clinical signs. Diagnosis therefore relies on the results of imaging and serological studies. The primary goal of this study was to evaluate the efficacy of several easy-to-produce crude or partially purified E. granulosus and E. multilocularis metacestode-derived antigens as tools for the serological diagnosis and differential diagnosis of patients suspicious for AE or CE. METHODS: The sera of 51 treatment-naïve AE and 32 CE patients, 98 Swiss blood donors and 38 patients who were initially suspicious for echinococcosis but suffering from various other liver diseases (e.g., liver neoplasia, etc.) were analysed. RESULTS: According to the results of enzyme-linked immunosorbent assays (ELISA), metacestode-derived antigens of E. granulosus had sensitivities varying from 81 to 97% and >99.9% for the diagnosis of CE and AE, respectively. Antigens derived from E. multilocularis metacestodes had sensitivities ranging from 84 to 91% and >99.9% for the diagnosis of CE and AE, respectively. Specificities ranged from 92 to >99.9%. Post-test probabilities for the differential diagnosis of AE from liver neoplasias, CE from cystic liver lesions, and screening for AE in Switzerland were around 95, 86 and 2.2%, respectively. Cross-reactions with antibodies in sera of patients with other parasitic affections (fasciolosis, schistosomosis, amebosis, cysticercosis, and filarioses) did occur at variable frequencies, but could be eliminated through the use of confirmatory testing. CONCLUSIONS: Different metacestode-derived antigens of E. granulosus and E. multilocularis are valuable, widely accessible, and cost-efficient tools for the serological diagnosis of echinococcosis. However, confirmatory testing is necessary, due to the lack of species specificity and the occurrence of cross-reactions to other helminthic diseases.


Asunto(s)
Anticuerpos Antihelmínticos/sangre , Antígenos Helmínticos/inmunología , Equinococosis Hepática/diagnóstico , Echinococcus granulosus/inmunología , Echinococcus multilocularis/inmunología , Adulto , Anciano , Animales , Reacciones Cruzadas/inmunología , Diagnóstico Diferencial , Equinococosis/diagnóstico , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suiza
10.
J Viral Hepat ; 18(11): 768-78, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20723035

RESUMEN

The outcome of hepatitis C virus (HCV) infection and the likelihood of a sustained virological response (SVR) to antiviral therapy depends on both viral and host characteristics. In vitro studies demonstrated that bile acids (BA) interfere with antiviral interferon effects. We investigate the influence of plasma BA concentrations and an ABCB11 polymorphism associated with lower transporter expression on viral load and SVR. Four hundred and fifty-one Caucasian HCV-patients treated with PEG-interferon and ribavirin were included in the study. ABCB11 1331T>C was genotyped, and plasma BA levels were determined. The 1331C allele was slightly overrepresented in HCV-patients compared to controls. In HCV-patients, a significant difference between patients achieving SVR vs non-SVR was observed for HCV-2/3 (5 vs 9 µm; P=0.0001), while median BA levels in HCV-1 were marginally elevated. Normal BA levels <8 µm were significantly associated with SVR (58.3%vs 36.3%; OR 2.48; P=0.0001). This difference was significant for HCV-2/3 (90.7%vs 67.6%; P=0.002) but marginal in HCV-1 (38.7%vs 27.8%; P=0.058). SVR rates were equivalent between ABCB11 genotypes for HCV-1, but increased for HCV-2/3 (TT 100%vs CC 78%; OR 2.01; P=0.043). IL28B genotype had no influence on these associations. No correlation between BA levels and HCV RNA was detected for any HCV genotype. The higher allelic frequency of ABCB11 1331C in HCV-patients compared to controls may indirectly link increased BA to HCV chronicity. Our data support a role for BA as host factor affecting therapy response in HCV-2/3 patients, whereas a weaker association was found for HCV-1.


Asunto(s)
Transportadoras de Casetes de Unión a ATP/genética , Antivirales/uso terapéutico , Ácidos y Sales Biliares/sangre , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Polimorfismo de Nucleótido Simple , Miembro 11 de la Subfamilia B de Transportador de Casetes de Unión al ATP , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Femenino , Genotipo , Hepatitis C Crónica/genética , Hepatitis C Crónica/virología , Humanos , Interferón-alfa/antagonistas & inhibidores , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Proteínas Recombinantes/antagonistas & inhibidores , Proteínas Recombinantes/uso terapéutico , Ribavirina/administración & dosificación , Ribavirina/uso terapéutico , Resultado del Tratamiento
11.
Transpl Infect Dis ; 13(4): 416-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21615846

RESUMEN

Diarrhea in a transplant recipient may be caused by infection, metabolic problems, or adverse drug effects. The immunosuppressive drug most frequently associated with diarrhea in transplant recipients is mycophenolate mofetil (MMF). We present the case of a patient with 2 potential explanations for diarrhea lasting several weeks, which occurred years after liver transplantation. Whereas stool samples were positive for cryptosporidia, the histopathological findings were compatible with MMF colitis. However, diarrhea resolved after treatment of cryptosporidial infection, despite continued MMF medication. This case shows that histopathological findings of MMF colitis may be misleading and do not prove that diarrhea is drug induced.


Asunto(s)
Criptosporidiosis/tratamiento farmacológico , Cryptosporidium/aislamiento & purificación , Diarrea/tratamiento farmacológico , Inmunosupresores/efectos adversos , Trasplante de Hígado/efectos adversos , Ácido Micofenólico/análogos & derivados , Adulto , Animales , Criptosporidiosis/diagnóstico , Criptosporidiosis/parasitología , Cryptosporidium/efectos de los fármacos , Diarrea/inducido químicamente , Diarrea/parasitología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/uso terapéutico , Paromomicina/uso terapéutico , Resultado del Tratamiento
12.
J Viral Hepat ; 17(12): 845-50, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20070503

RESUMEN

Hepatocellular apoptosis plays a major role in the pathogenesis of chronic hepatitis C. It can be measured noninvasively by determining the circulating levels of cytokeratin-18 fragments. We hypothesized that the effect of antiviral therapy on this parameter will be different in patients with a sustained virological response, relapse (REL) and nonresponse (NR). We quantified cytokeratin-18 fragments in plasma of patients participating in the Swiss Hepatitis C cohort, who received antiviral therapy without stopping because of sides effects. A total of 315 patients were included, 183 with a sustained response, 64 with NR and 68 who relapsed. Mean levels ±SD of circulating cytokeratin-18 fragments before therapy were 174 ± 172 U/L for responsders, 188 ± 145 for nonresponders and 269 ± 158 U/L for patients who relapsed. The values were significantly higher in the REL group (ANOVA P < 0.006). A sustained response was associated with a significant improvement of the plasma levels (94 ± 92 U/L, paired test P < 0.000001), whereas there was no improvement in the nonresponder group (183 ± 158 U/L) and in the relapser group (158 ± 148 U/L). There was a weak correlation between alanine aminotransferase (ALT) and cytokeratin-18 fragment levels (r² = 0.35, P < 0.000001) before therapy but not after therapy and none with hepatitis C virus (HCV) viremia. Successful antiviral therapy results in a significant decrease in circulating levels of cytokeratin-18 fragments arguing for a reduction in hepatocellular apoptosis after clearance of the HCV. Baseline cytokeratin-18 fragment levels are higher in relapsers. Correlations with ALT are weak, suggesting that these two tests measure different but related processes.


Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Queratina-18/sangre , Carga Viral/efectos de los fármacos , Alanina Transaminasa/sangre , Apoptosis , Estudios de Cohortes , Hepacivirus/genética , Hepacivirus/fisiología , Hepatitis C Crónica/virología , Hepatocitos/fisiología , Humanos , ARN Viral/sangre , Recurrencia , Suiza , Resultado del Tratamiento , Viremia/tratamiento farmacológico , Viremia/virología
13.
Transpl Infect Dis ; 12(1): 54-9, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19804583

RESUMEN

The growing need for organs and the scarcity of donors has resulted in an increased use of extended criteria donors. We report a case where a recipient of a cardiac graft was used as an organ donor. Death of the recipient occurred 9 days after transplantation and was attributed to presumed cerebral hemorrhage, which post mortem was diagnosed as invasive aspergillosis of the brain. One recipient of a kidney transplant lost the graft due to infection with Aspergillus fumigatus, whereas prompt initiation of therapy successfully prevented disseminated aspergillosis in the other recipients. Despite the pressure to extend the use of organs by lowering the acceptance criteria, organs should only be accepted if the cause of death of the donors is unequivocally explained.


Asunto(s)
Aspergilosis/transmisión , Aspergillus fumigatus/aislamiento & purificación , Trasplante de Islotes Pancreáticos/efectos adversos , Trasplante de Órganos/efectos adversos , Donantes de Tejidos , Adulto , Anciano , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Femenino , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Hígado/efectos adversos , Trasplante de Pulmón/efectos adversos , Masculino , Persona de Mediana Edad , Adulto Joven
14.
Br J Surg ; 96(9): 975-81, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19672926

RESUMEN

BACKGROUND: A combined antiviral and tumoricidal effect of interferon (IFN) is assumed to occur after resection or ablation of hepatocellular carcinoma (HCC). METHODS: An electronic search of the Medline, Embase and Central databases from January 1998 to October 2007 was conducted to identify randomized controlled trials evaluating adjuvant effects of IFN after curative treatment of HCC. A meta-analysis was performed to estimate the effects of IFN on 2-year outcome. RESULTS: Seven trials enrolling a total of 620 patients were included in the meta-analysis. Adjuvant treatment with IFN significantly reduced the 2-year mortality rate after curative treatment of HCC, with a pooled risk ratio of 0.65 (95 per cent confidence interval 0.52 to 0.80); P < 0.001) in absence of any significant heterogeneity (I(2) = 0 per cent, P = 0.823 for chi(2)). The effect on reduction of tumour recurrence was less pronounced but still significant (pooled risk ratio 0.86 (95 per cent c.i. 0.76 to 0.97); P = 0.013). IFN had to be discontinued in 8-20 per cent of patients. CONCLUSION: IFN has a significant beneficial effect after curative treatment of HCC in terms of both survival and tumour recurrence.


Asunto(s)
Antineoplásicos/uso terapéutico , Antivirales/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Hepatitis C Crónica/tratamiento farmacológico , Interferones/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Carcinoma Hepatocelular/cirugía , Quimioterapia Adyuvante , Humanos , Inmunoterapia/métodos , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/prevención & control
15.
Transpl Infect Dis ; 11(1): 33-9, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19144096

RESUMEN

Hepatitis C virus (HCV) infection invariably recurs after liver transplantation (LT), leading to significant morbidity and mortality. Although the combination of pegylated interferon-alpha (IFN-alpha)/ribavirin is the preferred treatment for these patients, the optimal schedule remains undetermined. In an uncontrolled trial, 19 patients with HCV infection recurring after LT received pegylated IFN-alpha(2a), 180 mug weekly, and ribavirin, 10 mg/kg body weight daily, for 48 weeks. The proportion of patients with undetectable HCV RNA in their serum after 12 weeks of treatment was 53%. Five patients (26%) dropped out of the study due to intolerance (in 2 cases), depression (in 1), or infectious complications (in 2). A sustained virological response (SVR), defined as undetectable serum HCV RNA 24 weeks after the end of treatment, was observed in 9/19 patients (47%). SVR was associated with an early virological response after 12 weeks of therapy (P<0.001) and a treatment duration >80% (P=0.02), but not with baseline HCV RNA level or a cumulative dose of pegylated IFN-alpha(2a) or ribavirin >80% of the scheduled dose. All 4 patients with genotype 2 or 3 reached SVR, as compared with 33% of patients with genotype 1 or 4 (P=0.03). A 48-week course of pegylated IFN-alpha(2a)/ribavirin therapy is effective in patients with recurrent HCV infection after LT.


Asunto(s)
Antivirales/administración & dosificación , Hepatitis C/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Trasplante de Hígado/efectos adversos , Polietilenglicoles/uso terapéutico , Ribavirina/uso terapéutico , Adulto , Anciano , Antivirales/uso terapéutico , Femenino , Rechazo de Injerto , Supervivencia de Injerto , Hepacivirus/efectos de los fármacos , Hepatitis C/mortalidad , Humanos , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Masculino , Persona de Mediana Edad , Polietilenglicoles/administración & dosificación , Proteínas Recombinantes , Recurrencia , Ribavirina/administración & dosificación , Tasa de Supervivencia , Resultado del Tratamiento
16.
Gut ; 57(11): 1597-603, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18625696

RESUMEN

BACKGROUND: Hepatitis C virus (HCV) infection is associated with decreased health-related quality of life (HRQOL). Although HCV has been suggested to directly impair neuropsychiatric functions, other factors may also play a role. PATIENTS AND METHODS: In this cross-sectional study, we assessed the impact of various host-, disease- and virus-related factors on HRQOL in a large, unselected population of anti-HCV-positive subjects. All individuals (n = 1736) enrolled in the Swiss Hepatitis C Cohort Study (SCCS) were asked to complete the Short Form 36 (SF-36) and the Hospital Anxiety Depression Scale (HADS). RESULTS: 833 patients (48%) returned the questionnaires. Survey participants had significantly worse scores in both assessment instruments when compared to a general population. By multivariable analysis, reduced HRQOL (mental and physical summary scores of SF-36) was independently associated with income. In addition, a low physical summary score was associated with age and diabetes, whereas a low mental summary score was associated with intravenous drug use. HADS anxiety and depression scores were independently associated with income and intravenous drug use. In addition, HADS depression score was associated with diabetes. None of the SF-36 or HADS scores correlated with either the presence or the level of serum HCV RNA. In particular, SF-36 and HADS scores were comparable in 555 HCV RNA-positive and 262 HCV RNA-negative individuals. CONCLUSIONS: Anti-HCV-positive subjects have decreased HRQOL compared to controls. The magnitude of this decrease was clinically important for the SF-36 vitality score. Host and environmental, rather than viral factors, seem to impact on HRQOL level.


Asunto(s)
Estado de Salud , Hepatitis C Crónica/psicología , Calidad de Vida/psicología , Adulto , Estudios Transversales , Trastorno Depresivo/etiología , Femenino , Encuestas Epidemiológicas , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Masculino , Índice de Severidad de la Enfermedad , Perfil de Impacto de Enfermedad , Factores Socioeconómicos , Encuestas y Cuestionarios
17.
Aliment Pharmacol Ther ; 26(2): 305-11, 2007 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-17593076

RESUMEN

BACKGROUND: The (13)C-methacetin breath test (MBT) has been proposed for the non-invasive evaluation of hepatic microsomal activity. AIM: To test a new continuous breath analysis system (BreathID) in comparison with gold-standard isotopic ratio mass spectrometry (IRMS) in patients with chronic hepatitis C infection and to assess the diagnostic performance of these validation data compared with liver biopsy for the quantification of liver fibrosis. METHODS: Fifty patients at different METAVIR stages received 75 mg of (13)C-methacetin. Breath isotopic ratio was analysed over 90 min by BreathID (one sample/3 min; BreathID) and IRMS (one sample/10 min). Results were expressed as delta over baseline [DOB (%)] at each time interval and maximal DOB [DOB(max)(%)]. RESULTS: A high linear association between both methods was observed (R(2) = 0.95, P < 0.001). For all DOB and DOB(max), the limits of agreement by Bland-Altman analysis were within the predefined maximal width of s.d. <2.5%. MBT parameters in patients with high-grade fibrosis were different from patients with low-grade fibrosis (P < 0.001). CONCLUSION: The MBT obtained by an easy to operate, automated BreathID provides results comparable with standard IRMS and differentiates fibrosis grades in patients with chronic hepatitis C infection.


Asunto(s)
Acetamidas , Pruebas Respiratorias/métodos , Hepatitis C Crónica/diagnóstico , Cirrosis Hepática/diagnóstico , Adulto , Isótopos de Carbono , Femenino , Humanos , Cirrosis Hepática/etiología , Pruebas de Función Hepática/métodos , Masculino , Espectrometría de Masas/métodos , Persona de Mediana Edad , Espectrofotometría Infrarroja/métodos
18.
Adv Parasitol ; 96: 259-369, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28212790

RESUMEN

The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.


Asunto(s)
Equinococosis Hepática/diagnóstico , Equinococosis/diagnóstico , Echinococcus/aislamiento & purificación , Animales , Equinococosis/parasitología , Equinococosis Hepática/parasitología , Humanos
19.
Gene ; 250(1-2): 191-200, 2000 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-10854792

RESUMEN

Epidermal growth factor (EGF) regulates cell growth and differentiation through intracellular transduction networks activated by its tyrosine kinase receptor, EGFR. In this report we describe the structure and DNA sequence of transcriptional control regions from both human and Wistar-rat single copy EGF genes and their functional analysis in epithelial cell cultures. By sequence comparison we show these proximal gene regions have remained conserved in evolution to -640 (relative to the rodent mRNA initiation site), where similarity is interrupted by a rodent interspersed-repeat element (SINE). Transcript mapping reveals complexity in EGF initiation site selection: whereas a single rat liver initiation site (+1) appears 30bp 3' to the TTTAA element, an additional upstream site is detected in kidney RNA at -14. In contrast, in human RNA a single initiation is observed, which is displaced 12bp 3' to the rodent RNA terminus. Both promoters were defined in transient expression assays. Our results show the human promoter to be at least 20-fold more active than the equivalent rodent sequence, although both are activated during cell proliferation and negatively regulated in contact inhibited and quiescent cultures. The results indicate EGF gene expression and cell division are temporally linked, suggesting its promoter comprises a growth responsive regulatory domain.


Asunto(s)
ADN/genética , Factor de Crecimiento Epidérmico/genética , Regiones Promotoras Genéticas/genética , Células 3T3 , Animales , Secuencia de Bases , División Celular , Células Cultivadas , ADN/química , ADN/aislamiento & purificación , Regulación de la Expresión Génica , Humanos , Hígado/citología , Hígado/metabolismo , Luciferasas/genética , Luciferasas/metabolismo , Ratones , Datos de Secuencia Molecular , Ratas , Ratas Sprague-Dawley , Ratas Wistar , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/metabolismo , Secuencias Repetitivas de Ácidos Nucleicos , Alineación de Secuencia , Análisis de Secuencia de ADN , Homología de Secuencia de Ácido Nucleico , Transcripción Genética , Transfección , Células Tumorales Cultivadas
20.
Virchows Arch ; 434(1): 57-62, 1999 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-10071236

RESUMEN

DNA methylation plays an important part in the regulation of gene expression. Alterations in DNA methylation in tumours have been reported and have been used to generate hypotheses about mutagenesis and silencing of tumour suppressor genes. However, the underlying mechanism is still poorly understood, and conflicting data on the levels of overexpression of 5'-cytosine DNA methyltransferase in sporadic colon carcinoma have been published. We used a competitive RT-PCR assay for quantification of mRNA of 5'-cytosine DNA methyltransferase in colon biopsies obtained from patients with hereditary colon carcinoma syndromes and compared the results with those obtained in a control group. No significant difference was found between the flat mucosa of FAP patients and the mucosa of the control group. In FAP and HNPCC patients, the 5'-cytosine DNA methyltransferase mRNA levels of adenomas were significantly higher (P<0.05) than of flat mucosa in the same group, but both showed great variability from patient to patient. Our findings suggest that the mRNA levels of methyltransferase cannot be used as predictive marker for screening in families affected by hereditary colon carcinoma.


Asunto(s)
Poliposis Adenomatosa del Colon/enzimología , Neoplasias Colorrectales Hereditarias sin Poliposis/enzimología , ADN (Citosina-5-)-Metiltransferasas/genética , ARN Mensajero/análisis , Adolescente , Adulto , Anciano , Niño , Metilación de ADN , Humanos , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Células Tumorales Cultivadas
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA