ABSTRACT
La trombosis venosa portal es una complicación infrecuente de los pacientes con cirrosis, que habitualmente aparece en las fases más avanzadas de la enfermedad. Aunque no disponemos de una evidencia sólida, la anticoagulación está indicada en algunos grupos de pacientes en los que la gravedad de la oclusión portal o en los que su especial situación de cara al trasplante requiere intentar la recanalización portal. Más allá de la recanalización, la anticoagulación parece tener un efecto beneficioso en la historia natural de la cirrosis, lo que plantea dudas sobre la oportunidad de su retirada una vez iniciada.(AU)
Subject(s)
Humans , Male , Female , Liver Cirrhosis/complications , Venous Thrombosis/drug therapy , Hypertension, Portal , Anticoagulants/administration & dosage , Venous Thrombosis/complications , Risk Factors , Digestive System DiseasesABSTRACT
Portal vein thrombosis is an uncommon complication in patients with cirrhosis, typically manifesting in the advanced stages of the disease. Although robust evidence is lacking, anticoagulation is indicated in specific patient subgroups, either those with severe portal occlusion or those requiring attempted portal recanalization due to their unique transplant situation. Beyond recanalization, anticoagulation appears to exert a beneficial effect on the natural history of cirrhosis, which raises uncertainties about the appropriateness of discontinuing it once initiated.
Subject(s)
Anticoagulants , Venous Thrombosis , Humans , Anticoagulants/therapeutic use , Portal Vein , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Venous Thrombosis/etiology , Liver Cirrhosis/complications , Liver Cirrhosis/pathology , Treatment OutcomeABSTRACT
Gastrointestinal (GI) Endoscopy is a basic competence for the management of gastrointestinal diseases. However, it should not be regarded as an independent training technique. Rather it is a part of a continuous and accredited process that requires clinical knowledge from the gastroenterologist to keep skills up-to-date in a constantly evolving medical subspecialty. Thus, the only official accredited way for training in GI endoscopy is through the Specialized Health Training program in the Management of the Digestive Diseases administered by the Spanish Ministry of Health.
Subject(s)
Gastroenterologists , Gastrointestinal Diseases , Humans , Endoscopy, Gastrointestinal/methods , Curriculum , Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Diseases/therapy , Clinical CompetenceSubject(s)
Humans , Clinical Competence , Endoscopy, Digestive System/education , Societies, Medical , SpainABSTRACT
Introduction: despite advances in imaging diagnosticmodalities, hepatocellular carcinoma is sometimes incidentally diagnosed on histological examination of the liver explant. The objectives of the study were: a) to compare the characteristics between incidental and known hepatocellular carcinoma; and b) to estimate survival and tumor recurrence after liver transplantation.Material and methods: a retrospective, single-center study was performed. The inclusion criteria were: a) cirrhotic patients, age ≥ 18 years; b) liver transplantation between 1998 and 2018; and c) hepatocellular carcinoma diagnosed via histopathologic examination of the explanted liver. Cholangiocarcinoma and patients with early retransplantation were excluded. Multivariate analysis was performed using binomial logistic regression to assess the factors associated with incidental hepatocellular carcinoma. Kaplan-Meier curves were plotted to explore the impact on overall survival and recurrence free survival.Results: two hundred and sixty-nine patients were enrolled. The prevalence of incidental hepatocellular carcinoma was 4.18 % (95 % CI: 2.89-6.01 %) of all liver transplants performed in cirrhotic patients. The median diameter of the main nodule was smaller in incidental hepatocellular carcinoma (20 vs 27 mm, p = 0.004), although they were more likely to be beyond the Up-to-Seven criteria on explant examination (22.2 % vs 7.5 %, p = 0.001), with no differences in any other histological features. No differences were found in overall survival rates (incidental 70.2 % vs 70.4 %, p = 0.87) or recurrence-free survival (incidental 100 % vs 83.8 %, p = 0.07) at five years. Conclusion: incidental hepatocellular carcinoma are smaller in size and are more frequently found to be beyond the Up-to-Seven criteria. However, no differences were found in overall survival rates or recurrence-free survival, although there was no tumor recurrence in the incidental hepatocellular carcinoma group. (AU)
Subject(s)
Humans , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/pathology , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/surgery , Liver Cirrhosis/pathology , Liver Neoplasms/diagnosis , Liver Neoplasms/epidemiology , Liver Neoplasms/surgery , Treatment Outcome , Kaplan-Meier Estimate , Liver Transplantation , Retrospective StudiesABSTRACT
The performance of an endoscopic procedure involves introducing an endoscope through the mouth or the anus, which may potentially lead to lethal infection. The risk increases when complex and difficult-to-clean scopes are used, as in the case of duodenoscopes. Side-viewing duodenoscopes are complex in design, with the camera and working channel exit located on one side of the endoscope's distal end, and with an elevator nail also located at this point for catheter redirection. This complex design may facilitate the presence of blind areas not easy to access for cleaning, resulting in suboptimal disinfection of the duodenoscope and therefore a higher risk of bacterial infection. This is of particular importance in particularly vulnerable patients like those who are immunosuppressed (e.g., transplanted patients) or have a malignant disease and are receiving chemotherapy. Moreover, in the era of ¨superbugs¨, like carbapenem-resistant Enterobacteriaceae, infection outbreaks related to endoscopic retrograde cholangiopancreatography (ERCP) have been reported with a significant mortality rate.
Subject(s)
Disinfection , Duodenoscopes , Cholangiopancreatography, Endoscopic Retrograde , Costs and Cost Analysis , Delivery of Health Care , Duodenoscopes/microbiology , HumansABSTRACT
INTRODUCTION: despite advances in imaging diagnostic modalities, hepatocellular carcinoma is sometimes incidentally diagnosed on histological examination of the liver explant. The objectives of the study were: a) to compare the characteristics between incidental and known hepatocellular carcinoma; and b) to estimate survival and tumor recurrence after liver transplantation. MATERIAL AND METHODS: a retrospective, single-center study was performed. The inclusion criteria were: a) cirrhotic patients, age ≥ 18 years; b) liver transplantation between 1998 and 2018; and c) hepatocellular carcinoma diagnosed via histopathologic examination of the explanted liver. Cholangiocarcinoma and patients with early retransplantation were excluded. Multivariate analysis was performed using binomial logistic regression to assess the factors associated with incidental hepatocellular carcinoma. Kaplan-Meier curves were plotted to explore the impact on overall survival and recurrence free survival. RESULTS: two hundred and sixty-nine patients were enrolled. The prevalence of incidental hepatocellular carcinoma was 4.18 % (95 % CI: 2.89-6.01 %) of all liver transplants performed in cirrhotic patients. The median diameter of the main nodule was smaller in incidental hepatocellular carcinoma (20 vs 27 mm, p = 0.004), although they were more likely to be beyond the Up-to-Seven criteria on explant examination (22.2 % vs 7.5 %, p = 0.001), with no differences in any other histological features. No differences were found in overall survival rates (incidental 70.2 % vs 70.4 %, p = 0.87) or recurrence-free survival (incidental 100 % vs 83.8 %, p = 0.07) at five years. CONCLUSION: incidental hepatocellular carcinoma are smaller in size and are more frequently found to be beyond the Up-to-Seven criteria. However, no differences were found in overall survival rates or recurrence-free survival, although there was no tumor recurrence in the incidental hepatocellular carcinoma group.
Subject(s)
Bile Duct Neoplasms , Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Adolescent , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/pathology , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/surgery , Cohort Studies , Humans , Kaplan-Meier Estimate , Liver Cirrhosis/pathology , Liver Neoplasms/diagnosis , Liver Neoplasms/epidemiology , Liver Neoplasms/surgery , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Retrospective Studies , Treatment OutcomeABSTRACT
Chronic intestinal pseudo-obstruction (CIPO) is characterized by symptoms and signs of bowel obstruction in the absence of an anatomical cause. Almost 50 % of cases are secondary to systemic diseases of neurological, paraneoplastic, autoimmune, metabolic, or infectious origin.
Subject(s)
Chondrosarcoma , Intestinal Pseudo-Obstruction , Chondrosarcoma/complications , Chronic Disease , Humans , Intestinal Pseudo-Obstruction/diagnostic imaging , Intestinal Pseudo-Obstruction/etiology , Neoplasms, Connective and Soft TissueABSTRACT
A 54-year-old male was admitted due to painless jaundice to our hospital four weeks after undergoing liver transplantation. Magnetic resonance imaging cholangiography demonstrated the presence of an anastomotic biliary stenosis.
Subject(s)
Cholestasis , Liver Transplantation , Cholangiography/methods , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Duodenoscopes , Humans , Male , Middle Aged , Postoperative ComplicationsABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Gastrointestinal Hemorrhage/etiology , Esophagitis/complications , Herpes Simplex/complications , Cytomegalovirus Infections/complications , Anemia/complications , Hematemesis/complications , Esophagus/injuries , Biopsy , Mouth/injuries , Gastroscopy , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Gastrointestinal Hemorrhage/complications , Endosonography , Duodenal Ulcer/diagnostic imaging , Embolization, Therapeutic/adverse effects , Gastrointestinal Hemorrhage/diagnostic imaging , Carcinoma, Hepatocellular/pathology , Cholecystostomy/methods , Cholangiography , Angiography , Duodenal Ulcer/complications , Celiac Artery/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Epidermal Cyst/diagnosis , Epidermal Cyst/pathology , Adenocarcinoma/diagnosis , Appendicitis/surgery , Gardner Syndrome/diagnosis , Polyps/diagnosis , Colonoscopy , Appendicitis/radiotherapy , Metastasectomy/methods , Fluorouracil/administration & dosage , Diagnosis, Differential , Cell Nucleus/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Adrenal Gland Neoplasms/etiology , Adrenal Gland Neoplasms/secondary , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/diagnostic imaging , Neoplasm Metastasis , Immunohistochemistry , Adrenal Glands/diagnostic imaging , Adrenal Glands/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Antiviral Agents/therapeutic use , Hepatitis E/drug therapy , Ribavirin/therapeutic use , Acute Disease , Hepatitis E/complications , Kidney Diseases/etiology , Severity of Illness IndexABSTRACT
Introducción: La epistaxis en los pacientes cirróticos es un hecho frecuente. No obstante, la literatura publicada hasta la fecha es muy escasa. Material y métodos: Serie de casos retrospectiva de pacientes con cirrosis que presentaron una epistaxis significativa, entre los años 2006 y 2016. Resultados: Se recogieron datos de 39 pacientes cirróticos con una edad media de 61,4 (±14) años, 75% varones. Las principales comorbilidades fueron la hipertensión arterial (33%) y la diabetes mellitus (26%). Siete (18%) pacientes tomaban antiagregantes y 3 (8%) anticoagulantes. Un tercio de los pacientes tenían antecedentes de epistaxis y 6 presentaban alguna patología ORL previa. La principal etiología de la cirrosis fue el alcohol en el 46% de los casos, siendo 15 (38%) pacientes Child A, 12 (31%) Child B y 12 (31%) Child C. La mediana de MELD al ingreso fue de 16 [12-21]. Treinta y cinco (97%) pacientes presentaban hipertensión portal. Al ingreso, la mediana de plaquetas fue de 89.000 [60.000-163.000] y la media de INR de 1,52 (±0,37). Clínicamente, en 8 (21%) pacientes la epistaxis se presentó simulando una hemorragia digestiva como hematemesis o melenas al ser la sangre deglutida. En 10 (26%) pacientes la epistaxis fue considerada como el probable desencadenante de una encefalopatía hepática. Dos pacientes requirieron ingreso en UCI por el sangrado y 8 (21%) fallecieron durante el ingreso, por causas no directamente relacionadas con la epistaxis. Conclusiones: La epistaxis es una complicación a tener en cuenta, pudiendo actuar como desencadenante de encefalopatía o simular un episodio de hemorragia digestiva
Introduction: Epistaxis in cirrhotic patients is a common issue. However, the literature published to date is very scarce. Material and methods: Retrospective case series of patients with cirrhosis who presented with a significant epistaxis, between 2006 and 2016. Results: Data were collected from 39 cirrhotic patients with a mean age of 61.4 (±14) years, 75% of which were males. The main comorbidities were hypertension (33%) and diabetes mellitus (26%). Seven (18%) patients were taking antiplatelet drugs and 3 (8%) anticoagulants. One third of patients had a previous history of epistaxis and 6 had a previous ENT pathology. The main aetiological factor of cirrhosis was alcohol in 46% of cases, with 15 (38%) patients presenting with Child A, 12 (31%) Child B and 12 (31%) Child C class. The median MELD score upon admission was 16 [12-21]. Thirty-five (97%) patients had portal hypertension. At admission, the median platelet count was 89,000 [60,000-163,000] and mean INR was 1.52 (±0.37). Clinically, epistaxis presented as haematemesis or melaena in 8 (21%) patients, simulating gastrointestinal bleeding due to swallowing of blood. In 10 (26%) patients, epistaxis was considered as the probable trigger of an episode of hepatic encephalopathy. Two patients required ICU admission due to bleeding and 8 (21%) died during hospitalisation due to causes not directly related to epistaxis. Conclusions: Epistaxis is a complication to be taken into account in cirrhotic patients, as it can act as an encephalopathy trigger or simulate an episode of gastrointestinal bleeding
