RESUMO
INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n=43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n=37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n=37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95%CI: 0.666-0.959; P=.001), sensitivity was 76.2% (95%CI: 54.9-89.4) and specificity was 90% (95%CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison.
Assuntos
Capilares/diagnóstico por imagem , Síndrome Hepatopulmonar/diagnóstico por imagem , Cirrose Hepática/complicações , Circulação Pulmonar , Ultrassonografia Doppler Transcraniana , Idoso , Área Sob a Curva , Capilares/patologia , Meios de Contraste , Estudos Transversais , Dilatação Patológica , Ecocardiografia , Feminino , Síndrome Hepatopulmonar/epidemiologia , Síndrome Hepatopulmonar/etiologia , Humanos , Masculino , Microbolhas , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Sensibilidade e Especificidade , Método Simples-Cego , Manobra de ValsalvaAssuntos
Degeneração Hepatolenticular/complicações , Falência Hepática Aguda/cirurgia , Transplante de Fígado , Adolescente , Biomarcadores , Ceruloplasmina/análise , Cobre/análise , ATPases Transportadoras de Cobre/genética , Diagnóstico Tardio , Emergências , Feminino , Transtornos Hemorrágicos/etiologia , Degeneração Hepatolenticular/diagnóstico , Degeneração Hepatolenticular/genética , Homozigoto , Humanos , Achados Incidentais , Falência Hepática Aguda/etiologia , Mutação de Sentido Incorreto , Índice de Gravidade de DoençaRESUMO
BACKGROUND AND OBJECTIVES: celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. METHODS: we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. RESULTS: we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. CONCLUSION: in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications.
Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/genética , Antígenos HLA-DQ/genética , Adolescente , Adulto , Idade de Início , Idoso , Alelos , Estudos de Casos e Controles , Doença Celíaca/epidemiologia , Criança , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Espanha/epidemiologia , Adulto JovemAssuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Anticorpos Monoclonais/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , Resultado do TratamentoAssuntos
Antivirais/efeitos adversos , Doença Celíaca/etiologia , Vírus da Hepatite B/patogenicidade , Interferons/efeitos adversos , Antivirais/uso terapêutico , Doença Celíaca/induzido quimicamente , Doença Celíaca/virologia , Diabetes Mellitus Tipo 2/induzido quimicamente , Diabetes Mellitus Tipo 2/etiologia , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Humanos , Interferons/uso terapêutico , RecidivaAssuntos
Ar , Cáusticos/intoxicação , Esofagite/induzido quimicamente , Gastrite/induzido quimicamente , Intubação Gastrointestinal/efeitos adversos , Veia Porta , Adulto , Queimaduras Químicas/etiologia , Procedimentos Cirúrgicos Eletivos , Emergências , Estenose Esofágica/induzido quimicamente , Feminino , Humanos , Jejuno , Fígado/irrigação sanguínea , Veia Porta/diagnóstico por imagem , Baço/irrigação sanguínea , Tentativa de Suicídio , Tomografia Computadorizada por Raios XRESUMO
INTRODUCCIÓN: Las dilataciones vasculares intrapulmonares (DVIPu) están consideradas una complicación de la cirrosis. La ecocardiografía con contraste (ETTc) es la técnica de elección para su diagnóstico. El objetivo de este estudio es demostrar que el doppler transcraneal con contraste (DTCc) puede servir para el diagnóstico de las DVIPu. MÉTODO: Se incluyeron consecutivamente pacientes evaluados para trasplante hepático. Estudio transversal con enmascaramiento de la prueba de referencia (ETTc) para quien interpreta la prueba a valorar (DTCc). Analizamos la exactitud de la prueba diagnóstica mediante los valores de sensibilidad, especificidad, valor predictivo positivo y negativo, y razón de verosimilitud. RESULTADOS: Por DTCc (n = 43) existía shunt derecha-izquierda en 23 pacientes (62,2%): 4 precoces, 2 indeterminados y 17 tardíos. Diecinueve (51,4%) casos fueron clasificados DVIPu. Con ETTc (n = 37) 10 estudios (27%) fueron negativos para shunt y 27 (73%) positivos, 21 (56,8%) fueron compatibles con DVIPu. Los pacientes con y sin DVIPu no diferían en edad, sexo, etiología, gravedad o índice de MELD, independientemente del método diagnóstico. En el estudio de validez diagnóstica (n = 37) del DTCc frente a la ETTc, el rendimiento diagnóstico fue AUC = 0,813% (IC 95%: 0,666-0,959; p = 0,001), sensibilidad: 76,2% (IC 95%: 54,9-89,4) y especificidad: 90% (IC 95%: 63,9-96,5). Razón de verosimilitud positiva: 6,095. CONCLUSIONES: Demostramos una alta prevalencia de DVIPu en candidatos a trasplante hepático. La probabilidad que tiene el DTCc en detectar DVIPu cuando se observa shunt derecha-izquierda tardío con recirculación es muy elevada, y con pocos falsos positivos. Al ser una técnica previamente no descrita en este contexto, deben llevarse a cabo estudios similares con fin comparativo
INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n = 43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n = 37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n = 37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95% CI: 0.666-0.959; P = .001), sensitivity was 76.2% (95% CI: 54.9-89.4) and specificity was 90% (95% CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison
Assuntos
Humanos , Cirrose Hepática/complicações , Ultrassonografia Doppler Transcraniana/métodos , Síndrome Hepatopulmonar , Dilatação Patológica/fisiopatologia , Transplante de Fígado , Reprodutibilidade dos Testes , Estudos TransversaisRESUMO
No disponible
Assuntos
Humanos , Feminino , Adolescente , Falência Hepática Aguda/complicações , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Degeneração Hepatolenticular/complicações , Anemia Hemolítica/complicações , Ascite/complicações , Esplenomegalia/complicações , Cobre/sangue , Cobre/urina , Ceruloplasmina/análiseRESUMO
Background and objectives: celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. Methods: we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. Results: we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. Conclusion: in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications (AU)
Assuntos
Humanos , Masculino , Feminino , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Doença Celíaca/genética , Autoimunidade/genética , Autoimunidade/imunologia , Antígenos HLA/análise , Teste de Histocompatibilidade/métodos , Estudos Retrospectivos , GenótipoAssuntos
Humanos , Feminino , Adulto , Tromboembolia/complicações , Tromboembolia/diagnóstico , Tromboembolia Venosa/complicações , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , /métodos , Paracentese/métodos , Trombofilia/complicações , Colite Ulcerativa/patologia , Colite Ulcerativa/cirurgia , Colite Ulcerativa , Heparina/uso terapêutico , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari , Dor Abdominal/complicações , Dor Abdominal/etiologiaRESUMO
No disponible