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1.
Medicine (Baltimore) ; 100(6): e24425, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578535

RESUMO

ABSTRACT: In humans, thrombocytopenic patients have increased incidence of post-hepatectomy liver failure (PHLF), but existing evidence is heterogeneous. Our objective was to determine if preoperative platelet count or antiplatelet drugs were associated with PHLF.Patients who underwent hepatic resection in the University Hospitals of Geneva, Switzerland, from 01.12.2009 to 18.12.2018 were identified. Platelet count at day 0, postoperative days (POD) 1, 3, and 5 were retrieved. Occurrence of PHLF according to the ISGLS definition was determined. Logistic regression was performed to determine if platelet count or antiplatelet drug were predictors for PHLF.Five hundred ninety seven patients were included. Eighty patients (17.8%) had a preoperative platelet count <150 (G/l) and 24 patients (5.3%) had a platelet count <100 (G/l). Thirty five patients (5.9%) were under antiplatelet drug. Platelet count significantly decreased at POD 1 and POD 3 when compared to preoperative platelet count (182 ±â€Š71.61 (G/l) vs 212 ±â€Š85.26 (G/l), P < .0001; 162 ±â€Š68.5 (G/l) vs 212 ±â€Š85.26 (G/l), P < .0001). At POD 5, post-operative platelet count did not significantly differ from its preoperative value. Forty three patients (11.2%) suffered from PHLF. Their platelet count was not significantly different than patients without PHLF (211 ±â€Š89.7 (G/l) vs 211 ±â€Š83.5 (G/l), P = .671). One patient with PHLF had a platelet count <100 (G/l) and 5 had a count <150 (G/l). Univariate logistic regression did not identify preoperative thrombocytopenia (<100 (G/l) or <150 (G/l)), postoperative thrombocytopenia, or the presence of antiagregant drug, as predictors of PHLF. We did not identify preoperative or postoperative thrombocytopenia as predictor of PHLF in a cohort of 597 patients.


Assuntos
Hepatectomia/efeitos adversos , Falência Hepática/etiologia , Contagem de Plaquetas , Cuidados Pré-Operatórios/métodos , Feminino , Hepatectomia/métodos , Humanos , Falência Hepática/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Contagem de Plaquetas/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
2.
Swiss Med Wkly ; 151: w20420, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33516166

RESUMO

The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit. During his ICU stay the patient developed a variety of complications including acute respiratory distress syndrome, pulmonary embolism, right heart failure and suspected HLH leading to multiorgan failure and death. Despite the proven diagnosis of haemophagocytic lymphohistiocytosis, the excessively high ferritin levels of the patient did not seem fully explained by this diagnosis. Therefore, the authors want to highlight different causes of hyperferritinaemia in critically ill patients and underline the importance of differential diagnoses when interpreting continuously rising ferritin levels.


Assuntos
Lesão Renal Aguda/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Falência Hepática/fisiopatologia , Linfo-Histiocitose Hemofagocítica/fisiopatologia , Embolia Pulmonar/fisiopatologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Alanina Transaminase/sangue , /complicações , Creatinina/sangue , Progressão da Doença , Evolução Fatal , Insuficiência Cardíaca/etiologia , Humanos , Falência Hepática/sangue , Falência Hepática/etiologia , Linfo-Histiocitose Hemofagocítica/etiologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Embolia Pulmonar/etiologia , /fisiopatologia , /terapia
3.
Zhonghua Wai Ke Za Zhi ; 58(10): 765-769, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32993263

RESUMO

Objective: To investigate the value of Gd-EOB-DTPA-enhanced MRI in evaluating liver function and predicting the risk of post-hepatoectomy liver failure in patients with major resection of liver cancer. Methods: A total number of 212 patients were included from June 2016 to June 2019 at Department of General Surgery, Peking University Third Hospital with a retrospectively collected data.All patients underwent Gd-EOB-DTPA-enhanced MRI for diagnosis and preoperative evaluation of liver function.There were 135 males and 77 females, with age of (63.1±10.3) years old (range: 18 to 86 years old) . Relative enhancement ratio (RER) of the region of interest on Gd-EOB-DTPA-enhanced MRI was acquired by two independent researcher and then conducted the comparison of RER among the patients with or without post-hepatoectomy liver failure (PHLF) .Preoperative evaluation demonstrated that 141 cases infected by hepatitis virus, 128 cases with hepatitis B alone and 11 cases with hepatitis C alone, 2 cases had both of hepatitis B and C, and all patients were grade A judged by Child-Pugh score. The relationship between RER and PHLF was evaluated by Pearson correlation analysis and the diagnostic value of RER in predicting PHLF was test by receiver operating characteristic curve. Results: PHLF occurred in 42 patients according to ISGLS standard. Among them, 31 cases had level A liver failure, 9 cases had level B liver failure and 2 had level C failure. There was a significant correlation between RER and overall level of PHLF and RER was also significantly associated with severe B to C level of PHLF (P<0.05) .The further receiver operating characteristics curve analysis showed that the diagnostic accuracy of RER on overall PHLF was 0.818 (sensitivity 72.9%, specificity 83.3%, cut-off value 73.5%, 95%CI: 0.75 to 0.887) and on severe PHLF was 0.924 (sensitivity 97.0%, specificity 90.9%, cut-off value: 61.5%, 95%CI: 0.79 to 0.90) . Conclusion: For patients who planned to undergo major resection of liver cancer, preoperative Gd-EOB-DTPA-enhanced MRI can help with the assessment of liver function and predicting the risk for post-hepatectomy liver failure.


Assuntos
Meios de Contraste , Gadolínio DTPA , Neoplasias Hepáticas , Imagem por Ressonância Magnética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatectomia/efeitos adversos , Humanos , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Adulto Jovem
4.
Surgery ; 168(4): 643-652, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32792098

RESUMO

BACKGROUND: Posthepatectomy liver failure is a worrisome complication after major hepatectomy for hepatocellular carcinoma and is the leading cause of postoperative mortality. Recommendations for hepatectomy for hepatocellular carcinoma are based on the risk of severe posthepatectomy liver failure, and accurately predicting posthepatectomy liver failure risk before undertaking major hepatectomy is of great significance. Thus, herein, we aimed to establish and validate an artificial neural network model to predict severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. METHODS: Three hundred and fifty-three patients who underwent hemihepatectomy for hepatocellular carcinoma were included. We randomly divided the patients into a development set (n = 265, 75%) and a validation set (n = 88, 25%). Multivariate logistic analysis facilitated identification of independent variables that we incorporated into the artificial neural network model to predict severe posthepatectomy liver failure in the development set and then verified in the validation set. RESULTS: The morbidity of patients with severe posthepatectomy liver failure in the development and validation sets was 24.9% and 23.9%, respectively. Multivariate analysis revealed that platelet count, prothrombin time, total bilirubin, aspartate aminotransferase, and standardized future liver remnant were all significant predictors of severe posthepatectomy liver failure. Incorporating these factors, the artificial neural network model showed satisfactory area under the receiver operating characteristic curve for the development set of 0.880 (95% confidence interval, 0.836-0.925) and for the validation set of 0.876 (95% confidence interval, 0.801-0.950) in predicting severe posthepatectomy liver failure and achieved well-fitted calibration ability. The predictive performance of the artificial neural network model for severe posthepatectomy liver failure outperformed the traditional logistic regression model and commonly used scoring systems. Moreover, stratification into 3 risk groups highlighted significant differences between the incidences and grades of posthepatectomy liver failure. CONCLUSION: The artificial neural network model accurately predicted the risk of severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. Our artificial neural network model might help surgeons identify intermediate and high-risk patients to facilitate earlier interventions.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Falência Hepática/etiologia , Neoplasias Hepáticas/cirurgia , Redes Neurais de Computação , Medição de Risco/métodos , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias
5.
Surgery ; 168(3): 419-425, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600880

RESUMO

BACKGROUND: Recent evidence suggests that gadolinium ethoxybenzyl diethylenetriamine penta acetic acid-enhanced (Gd-EOB-DTPA) magnetic resonance imaging may be used to evaluate liver function. The aim of this study was to assess whether the signal intensity of Gd-EOB-DTPA magnetic resonance imaging may be used to predict functional liver reserve and posthepatectomy liver failure in patients undergoing hepatectomy for liver tumors. METHODS: This is an observational retrospective study on 137 preoperative Gd-EOB-DTPA magnetic resonance imaging of patients undergoing hepatectomy between 2015 and 2018. Mean signal intensity of liver (L20) and spleen (S20) were measured on T1-weighted single-breath-hold 3-dimensional fat-saturated gradient echo sequences acquired 20 minutes after Gd-EOB-DTPA administration. The hepatocellular uptake index of liver volume (VL) was calculated with the formula VL([L20/S20] - 1) and was tested with several score systems for liver diseases and to the occurrence of post-hepatectomy liver failure. RESULTS: Patients with diseased liver had significantly lower values of hepatic uptake index in comparison with those with normal function. This was found for a Model for End-Stage Liver Disease score ≤9 versus >9 (P = .04), combination of bilirubin and cholinesterases levels score ≤2 versus >2 (P = .02), albumin to bilirubin grades (P = .03), and Humanitas score ≤6 versus >6 (P = .03). Twenty-two patients (16%) developed posthepatectomy liver failure, and 2 (1.4%) died within 90 days. The hepatocellular uptake index was significantly lower in those patients with posthepatectomy liver failure (P < .01). Receiver operating characteristics curve analysis revealed valuable hepatocellular uptake index ability in predicting post-hepatectomy liver failure (area under the curve = 0.84; 95% confidence interval, 0.71-0.92; P < .01), with a cutoff value of 574.33 (98% sensitivity; 83% specificity). CONCLUSION: The hepatocellular uptake index hepatocellular uptake index measured on preoperative Gd-EOB-DTPA magnetic resonance imaging identifies patients with diseased liver and predicts posthepatectomy liver failure. This index could be used to discern those patients at higher risk of complications after hepatectomy.


Assuntos
Meios de Contraste/farmacocinética , Gadolínio DTPA/farmacocinética , Hepatectomia/efeitos adversos , Falência Hepática/epidemiologia , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Incidência , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Falência Hepática/diagnóstico , Falência Hepática/etiologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Estudos Retrospectivos
6.
Int J Hematol ; 112(6): 900-905, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32710432

RESUMO

Anaplastic large cell lymphoma (ALCL) accounts for 10-15% of childhood non-Hodgkin lymphoma cases; it is generally chemo-sensitive and is one of the most curable pediatric cancers. We report here a case of pediatric ALCL complicated with acute liver failure due to the aggravation of pre-existing biliary hepatopathy by lymphoma-associated hemophagocytic lymphohistiocytosis (HLH). Although the initial treatment response against ALCL was very good, poor and irreversible liver function due to biliary cirrhosis worsening by lymphoma-associated HLH prevented the patient from receiving further consolidation chemotherapies. To make matters worse, his condition was accompanied with intrahepatic fungal pseudoaneurysm and invasive fungal infection. Thus, we decided to perform an urgent living-donor liver transplantation from his father to correct the patient's liver function and make it possible to proceed with further ALCL therapy. After the living-donor liver transplantation, the patient successfully received consolidation therapy with brentuximab vedotin. To our knowledge, this may be an early reported case of a pediatric patient undergoing liver transplantation during treatment for ALCL. In most patients with HLH-associated ALCL, liver function improves when ALCL is controlled. However, acute liver failure is occasionally observed in HLH cases with pre-existing liver dysfunction. In such cases, liver transplantation should be considered to correct liver dysfunctions if the disease control of HLH is satisfactory.


Assuntos
Brentuximab Vedotin/uso terapêutico , Cirrose Hepática Biliar/complicações , Falência Hepática/tratamento farmacológico , Falência Hepática/etiologia , Falência Hepática/cirurgia , Transplante de Fígado , Doadores Vivos , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma Anaplásico de Células Grandes/complicações , Criança , Terapia Combinada , Quimioterapia de Consolidação , Progressão da Doença , Humanos , Masculino , Resultado do Tratamento
7.
Infez Med ; 28(suppl 1): 96-103, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532945

RESUMO

Liver injury has been reported to occur during the disease in severe cases. Therefore, this meta-analysis study aims to investigate the incidence of liver injury among published literature from 2019-Jan-01 to 2020-April-03 to provide an outline for further studies on the liver injury of COVID-19. Four databases including Pubmed, Embase, Web of Science, and the Scopus were searched for studies published from 2019-Jan-01 to 2020-April-03. Data analysis and drawing of charts were performed using the Comprehensive Meta-Analysis Software Version 2.2 (Biostat, USA). The search yielded 450 publications, of which 64 potentially eligible studies were identified for full-text review and 21 studies fulfilling the inclusion criteria remained. A total of 4191 COVID-19 patients were included in our meta-analysis. The pooled prevalence of liver injury was 19.5% (95% CI: 14.3-26.1). According to our results, there was significant heterogeneity among the 19 studies (X2 = 738.5; p < 0.001; I2 = 94.34%). Among 288 death cases, the pooled prevalence of liver injury was 22.8% (95% CI: 11.7-39.8). In summary, the COVID-19 disease itself can result in severe and even fatal respiratory diseases and even may lead to ARDS and multiple organ failure. The results of this systematic review highlight the importance of liver injury that may assist clinicians anywhere in the globe in controlling COVID-19-related infection and complications. Moreover, the prevalence of liver injury can be higher in severe cases than in mild cases.


Assuntos
Infecções por Coronavirus/complicações , Falência Hepática/etiologia , Pneumonia Viral/complicações , Adulto , Idoso , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/etiologia , Humanos , Irã (Geográfico)/epidemiologia , Falência Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , RNA Viral/sangue , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Risco , Tamanho da Amostra
8.
AJR Am J Roentgenol ; 215(1): 215-222, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32432911

RESUMO

OBJECTIVE. The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. RESULTS. Mortality rates within 30, 90, and 365 days after TIPS placement were 2.3% (5/219), 8.2% (17/207), and 21.7% (41/189), respectively. Logistic regression showed that the MELD score predicted 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.00-1.27; p = 0.04) and trended toward predicting 90-day mortality (OR, 1.09; 95% CI, 1.00-1.18; p = 0.06), whereas the MELD-Na score did not predict 30-day mortality (OR, 1.02; 95% CI, 0.97-1.06; p = 0.51) or 90-day mortality (OR, 1.01; 95% CI, 0.98-1.15; p = 0.44). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality (p = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality (p = 0.80 and p = 0.76, respectively). When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6; 95% CI, 1.5-29.1; p = 0.01) and MELD-Na (OR, 3.3; 95% CI, 1.1-9.6; p = 0.03). MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement (p = 0.005 and p = 0.01, respectively). CONCLUSION. MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score.


Assuntos
Falência Hepática/etiologia , Falência Hepática/mortalidade , Derivação Portossistêmica Transjugular Intra-Hepática/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
J Surg Oncol ; 122(3): 469-479, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32424895

RESUMO

BACKGROUND: Surgery for perihilar cholangiocarcinoma (PHCC) is associated with high morbidity. This study aimed to investigate the clinical value of the future liver remnant volume-to-body weight (FLRV/BW) and propose a risk score for predicting the risk of patients with PHCC developing posthepatectomy liver failure (PHLF). METHODS: This study included 348 patients who underwent major hepatectomy with bile duct resection for PHCC during 2008-2015 at a single center in Korea and they were retrospectively analyzed. RESULTS: Clinically relevant PHLF was noted in 40 patients (11.4%). The area under the curve (AUC) for FLRV/BW was not significantly different from that for FLRV/total liver volume (P = .803) or indocyanine green clearance of the future liver remnant (P = .629) in terms of predicting PHLF. On multivariate analysis, predictors of PHLF (P < .05) were male sex, albumin less than 3.5 g/dL, preoperative cholangitis, portal vein resection, FLRV/BW less than 0.5%, and FLRV/BW 0.5% to 0.75%. These variables were included in the risk score that showed good discrimination (AUC, 0.853; 95% CI, 0.802-0.904). It will help rank patients into three risk subgroups with a predicted liver failure incidence of 4.75%, 18.73%, and 51.58%, respectively. CONCLUSIONS: FLRV/BW is a comparable risk prediction factor of PHLF and the proposed risk score can help to predict the risk of planned surgery in PHCC.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Hepatectomia/efeitos adversos , Tumor de Klatskin/cirurgia , Falência Hepática/etiologia , Idoso , Ductos Biliares/cirurgia , Peso Corporal , Feminino , Hepatectomia/métodos , Humanos , Fígado/anatomia & histologia , Fígado/cirurgia , Masculino , Curva ROC , Estudos Retrospectivos , Fatores de Risco
10.
Khirurgiia (Mosk) ; (3): 5-12, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271731

RESUMO

AIM: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.


Assuntos
Hepatectomia/efeitos adversos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Algoritmos , Doenças Biliares/etiologia , Doenças Biliares/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Protocolos Clínicos , Dissecação/efeitos adversos , Dissecação/métodos , Hepatectomia/instrumentação , Hepatectomia/mortalidade , Humanos , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Tamanho do Órgão , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Técnicas de Sutura/instrumentação
11.
Rev Cardiovasc Med ; 21(1): 119-122, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32259910

RESUMO

Arteriovenous fistula (AVF) is a rare complication of the abdominal aortic aneurysm (AAA) with complex clinical features. However, AVF and AAA usually cause no symptoms except when they rupture. This case study demonstrated that ultrasonography was a rapid and non-invasive method for the initial assessment of AAA and AVF. A 65-year-old man was admitted to the intensive care unit with hepatic and renal dysfunction. Physical examination revealed an abdominal vascular murmur and bilateral toe discoloration. Ultrasonic examination revealed an AAA and right common iliac artery aneurysm with an AVF located between the right common iliac artery and inferior vena cava. A computed tomography scan confirmed the sonographic findings. We propose that ultrasound should be used more commonly as part of the initial evaluation of the potential and established vascular diseases.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Síndrome Hepatorrenal/etiologia , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Falência Hepática/etiologia , Insuficiência Renal/etiologia , Ultrassonografia Doppler em Cores , Veia Cava Inferior/diagnóstico por imagem , Idoso , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Evolução Fatal , Síndrome Hepatorrenal/diagnóstico por imagem , Humanos , Aneurisma Ilíaco/complicações , Falência Hepática/diagnóstico , Masculino , Flebografia , Valor Preditivo dos Testes , Insuficiência Renal/diagnóstico
13.
Am J Case Rep ; 21: e921236, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32063601

RESUMO

BACKGROUND This is a case report validating our previous studies showing clinical benefit of balloon-occluded retrograde transvenous obliteration (BRTO) in improving hepatic function and outcomes in patients with a low liver stiffness (LS) and with procedural indication of encephalopathy. Here, we present the case of a woman in her late 60s suffering from hepatitis C virus-related decompensated liver cirrhosis with refractory encephalopathy. CASE REPORT The patient presented with a Child-Pugh score of 11, Model for End-Stage Liver Disease-Sodium (MELD-Na) score of 16, and LS of 21.5 kPa. BRTO was expected to improve both the intractable encephalopathy and hepatic function and prolong her vital prognosis. Portosystemic shunt (PSS) occlusion induced drastic changes in the portal-splenic vein hemodynamics, resulting in dramatically improved Child-Pugh and MELD-Na scores. This status was maintained for 1 year postoperatively. However, her LS increased 1 month postoperatively and declined steadily thereafter. The postoperative levels of hepatic fibrosis markers, including Mac-2 binding protein glycosylation isomer, decreased markedly. No ascites, pleural effusion, esophagogastric varices, or relapse of encephalopathy were observed during a 1-year postoperative follow-up period. CONCLUSIONS Liver failure caused mainly by the advanced development of PSSs (as in our case), rather than hepatic parenchymal cell dysfunction, is considered reversible and controllable via PSS occlusion. We herein propose a novel concept, "portal-systemic liver failure," to describe liver failure with a non-stiff liver and giant PSSs, as in the present case. In patients with "portal-systemic liver failure," BRTO could potentially improve the prognosis in association with improved hepatic reserve and fibrosis.


Assuntos
Oclusão com Balão , Cirrose Hepática/cirurgia , Falência Hepática/cirurgia , Derivação Portossistêmica Cirúrgica , Idoso , Feminino , Hepatite C Crônica/complicações , Humanos , Cirrose Hepática/etiologia , Falência Hepática/etiologia
14.
J Gastroenterol Hepatol ; 35(9): 1628-1635, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32048317

RESUMO

BACKGROUND AND AIM: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) account for a large and growing proportion of liver disease burden globally. The burden of NAFLD/NASH manifests in increasing levels of advanced liver disease and primary liver cancer in Australia. A Markov model was used to forecast NAFLD burden in Australia through 2030. METHODS: A model was used to estimate fibrosis progression, primary liver cancer, and liver deaths among the Australian NAFLD population, with changes in incident NAFLD cases based on long-term trends for changes in the prevalence of obesity. Published estimates and surveillance data were applied to build and validate the model projections, including surveillance data for the incidence of liver cancer. RESULTS: Prevalent NAFLD cases were projected to increase 25% from the current burden (5 551 000 [4 748 000-6 306 000] cases in 2019) to 7 024 000 [5 838 000-7 886 000] cases in 2030. The projected increase in the number of NASH cases (40%) was greater than that of NAFLD cases. Incident cases of advanced liver disease are projected to increase up to 85% by 2030, and incident NAFLD liver deaths are estimated to increase 85% from 1900 (1100-3300) deaths in 2019 to 3500 (2100-6100) deaths in 2030. CONCLUSIONS: Restraining growth of the obese and diabetic populations, along with potential therapeutic options, will be essential for mitigating disease burden.


Assuntos
Efeitos Psicossociais da Doença , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália , Criança , Pré-Escolar , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Lactente , Falência Hepática/epidemiologia , Falência Hepática/etiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Transplante de Fígado , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Estatísticos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/mortalidade , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/epidemiologia , Prevalência , Fatores de Tempo , Adulto Jovem
16.
J Gastroenterol Hepatol ; 35(9): 1610-1618, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32032974

RESUMO

BACKGROUND AND AIMS: Improvement in Model for End-Stage Liver Disease (MELD) score during antiviral treatment is associated with reduced hepatic decompensation and death in patients with chronic hepatitis B (CHB)-related cirrhosis. We aimed to identify factors associated with transplant-free survival and on-treatment MELD score improvement. METHODS: We identified patients with CHB-related cirrhosis and MELD score ≥ 15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment between 2005 and 2017. The primary endpoint was transplant-free survival at month 6. The secondary endpoints at month 6 were transplant-free survival with > 5-point improvement in MELD score and transplant-free survival with MELD score < 15. RESULTS: Of 999 cirrhotic CHB patients, 605 (60.6%) achieved transplant-free survival at month 6. Proportion of transplant-free survival at month 6 stabilized at 10% in patients with high MELD. Patients who achieved transplant-free survival at month 6 were younger, had lower MELD score, lower alanine aminotransferase (ALT), and higher albumin at baseline. Of 605 patients with transplant-free survival, 276 (45.6%) achieved > 5-point improvement in MELD score; 183 (30.2%) had 1-point to 5-point improvement in MELD score; 146 (24.1%) had no improvement or a worsened MELD score. Also, 321 (53.1%) patients with transplant-free survival had a MELD score < 15 at month 6. CONCLUSION: On top of lower MELD score, patients with CHB-related cirrhosis who are younger, have higher albumin, and lower ALT are more likely to achieve transplant-free survival after 6 months of antiviral treatment.


Assuntos
Antivirais/uso terapêutico , Guanina/análogos & derivados , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/mortalidade , Projetos de Pesquisa , Tenofovir/uso terapêutico , Fatores Etários , Idoso , Alanina Transaminase/sangue , Feminino , Guanina/uso terapêutico , Hepatite B Crônica/complicações , Humanos , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/etiologia , Cirrose Hepática/mortalidade , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Albumina Sérica , Taxa de Sobrevida , Resultado do Tratamento
17.
Transplant Proc ; 52(2): 625-629, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32029313

RESUMO

BACKGROUND: Erythropoietic protoporphyria is a rare disease of heme biosynthesis resulting in excessive accumulation of protoporphyrin in various organs. The most typical symptom is photosensitivity caused by activated protoporphyrins (wavelength ~400 nm). Accumulated protoporphyrin in the liver also causes liver failure, and liver transplantation is the only life-saving treatment. Phototoxic injury to abdominal organs has been reported during liver transplantation. Thus, to avoid phototoxic injury during liver transplantation, it has previously been conducted with only shadowless lights and ceiling lights off in the operating theater. Here, we report a case of a safe and successful liver transplantation in a patient with erythropoietic protoporphyria where the operating theater lights were covered with polyimide film. CASE PRESENTATION: A 50-year-old man presented with hepatic failure owing to erythropoietic protoporphyria. Before liver transplantation, the shadowless lights and ceiling lights in the operating theater were covered entirely with polyimide film. This filter completely blocked the harmful wavelength of light (400-470 nm). Orthotopic liver transplantation was safely and successfully performed with adequate illumination and patient monitoring. The patient followed a normal postoperative course without phototoxic injuries or protoporphyrin re-accumulation. CONCLUSION: Covering not only shadowless lights but also all ceiling lights in the operating theater with the polyimide film allowed safe surgery, safe anesthesia, and safe monitoring of the patient who underwent liver transplantation for severe liver failure owing to erythropoietic protoporphyria.


Assuntos
Iluminação/métodos , Transplante de Fígado/métodos , Salas Cirúrgicas/métodos , Transtornos de Fotossensibilidade/prevenção & controle , Protoporfiria Eritropoética/cirurgia , Humanos , Falência Hepática/etiologia , Falência Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/etiologia , Protoporfiria Eritropoética/complicações
18.
Sci Rep ; 10(1): 2006, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029840

RESUMO

The prognostic factors of patients who undergo radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is not fully elucidated. We aimed to investigate the role of liver stiffness (LS) and spleen stiffness (SS) measured by acoustic radiation force impulse (ARFI) elastography in determining the prognoses of patients with HCC after RFA. We prospectively enrolled 173 patients with HCC who underwent ARFI elastography for measurement of LS and SS on the same day of RFA. Overall survival (OS), recurrence-free survival (RFS) after adjusting for competing mortality, and presence of hepatic decompensation were investigated. Patients with LS > 1.5 m/s had significantly shorter OS and RFS than their counterparts. Anti-viral treatment (hazard ratio [HR]: 0.396, p = 0.015) and LS > 1.5 m/s (HR 4.105, p = 0.028) correlated with OS by a multivariate analysis. Besides, serum alpha fetoprotein >10 ng/mL and LS > 1.5 m/s independently predicted poorer RFS. On the other hand, anti-viral treatment (HR: 0.315, p = 0.010), creatinine > 1.5 mg/dL (HR: 9.447, p = 0.006), and SS > 2.7 m/s (HR: 2.869, p = 0.044) predicted a higher risk of hepatic decompensation. In conclusion, LS but not SS measured by ARFI elastography predicted tumor recurrence and OS in RFA-treated HCC; whereas, SS predicted development of hepatic decompensation in these patients.


Assuntos
Carcinoma Hepatocelular/cirurgia , Técnicas de Imagem por Elasticidade , Falência Hepática/diagnóstico , Neoplasias Hepáticas/cirurgia , Fígado/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Ablação por Cateter , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Fígado/fisiopatologia , Fígado/cirurgia , Falência Hepática/epidemiologia , Falência Hepática/etiologia , Falência Hepática/fisiopatologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Baço/diagnóstico por imagem
19.
Drug Des Devel Ther ; 14: 591-601, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32103901

RESUMO

Lysosomal acid lipase (LAL) deficiency is a metabolic (storage) disorder, encompassing a severe (Wolman disease) and attenuated (Cholesterol ester storage disease) subtype; both inherited as autosomal recessive traits. Cardinal clinical features include the combination of hepatic dysfunction and dyslipidemia, as a consequence of cholesteryl esters and triglyceride accumulation, predominately in the liver and vascular and reticuloendothelial system. Significant morbidity can arise, due to liver failure and/or atherosclerosis; in part related to the severity of the underlying gene defect and corresponding enzyme deficiency. Diagnosis is based on demonstration of decreased LAL enzyme activity, complemented by analysis of the cognate gene defects. Therapeutic options include dietary manipulation and the use of lipid-lowering drugs. Sebelipase alfa, a recombinant enzyme replacement therapy, has garnered regulatory approval, following demonstration of improvements in disease-relevant markers and clinical benefit in clinical trials, which included increased survival in the most severe cases.


Assuntos
Doença do Armazenamento de Colesterol Éster/terapia , Esterol Esterase/uso terapêutico , Doença de Wolman/terapia , Animais , Aterosclerose/etiologia , Doença do Armazenamento de Colesterol Éster/fisiopatologia , Humanos , Hipolipemiantes/uso terapêutico , Falência Hepática/etiologia , Índice de Gravidade de Doença , Doença de Wolman/fisiopatologia
20.
Clin Nucl Med ; 45(2): 133-135, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31833927

RESUMO

There is a growing interest in assessment of future remnant liver function with Tc-mebrofenin hepatobiliary scintigraphy before major hepatectomy to estimate the risk of posthepatectomy liver failure. We illustrate the case of a 42-year-old woman with liver metastasis from colorectal cancer who performed hepatobiliary scintigraphy. Tc-mebrofenin clearance rate of the total liver was considerably low. The patient recently started a treatment for active hepatitis C with a combination of 2 new direct-acting antiviral agents (grazoprevir, elbasvir). Apart from hypoalbuminemia or hyperbilirubinemia, physicians must be aware that drug interactions can interfere with Tc-mebrofenin liver uptake, thereby resulting in a dramatic underestimation of liver function.


Assuntos
Antivirais/efeitos adversos , Benzofuranos/efeitos adversos , Imidazóis/efeitos adversos , Falência Hepática/diagnóstico por imagem , Quinoxalinas/efeitos adversos , Cintilografia , Adulto , Amidas , Carbamatos , Ciclopropanos , Interações Medicamentosas , Feminino , Hepacivirus , Humanos , Iminoácidos , Falência Hepática/etiologia , Compostos de Organotecnécio , Compostos Radiofarmacêuticos , Sulfonamidas
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