Pub Date : 2016-01-01DOI: 10.4172/2167-0889.1000138
A. Alizadeh, Mohammad-taghi Mohammad Khah, Navid Saadat damghani, R. Talaee, Hasan Rajabali Nia, Aazam Erfanifar
Background: Metabolic Syndrome (MetS) is defined as a cluster of multiple cardiovascular risk factors, including central obesity, elevated fasting plasma glucose, high blood pressure, dyslipidemia. The prevalence of MetS has been increasing gradually in the world and there are many hypotheses about relationship between metabolic syndrome and others diseases. The aim of this study is evaluation of prevalence of metabolic syndrome in the patients with gallstone disease. Methods and materials: 400 patients with gallstone disease entered in a cross sectional study. Medical files were extracted and metabolic syndrome was defined by Adult Treatment Panel III (ATP III) base on clinical data. Results: Metabolic syndrome was diagnosed in 213 (53.3%) subjects. In this group, 175 (82.2%) had their gallstone both in gall bladder and biliary tract and 38 (17.85) only in biliary tract. In patients without metabolic syndrome, 127 (67.9%) had the gallstone in both gallbladder and biliary tract and 60 (32.1%) only in their biliary tract. Comparison of these ratios led to a statistically significant difference (P=0.001; Odds Ratio: 2.18; CI 95%: 1.36-3.47). Conclusions: The results showed that may be a relationship between metabolic syndrome and gallstone disease. More future study with control group for this evaluation is necessary.
背景:代谢综合征(MetS)被定义为一组多重心血管危险因素，包括中枢性肥胖、空腹血糖升高、高血压、血脂异常。代谢综合征在世界范围内的发病率逐渐上升，关于代谢综合征与其他疾病之间的关系存在许多假设。本研究的目的是评估胆结石患者代谢综合征的患病率。方法与材料:对400例胆结石患者进行横断面研究。提取医疗档案，根据临床资料采用成人治疗小组III (Adult Treatment Panel III, ATP III)对代谢综合征进行定义。结果:213例(53.3%)被诊断为代谢综合征。本组175例(82.2%)胆囊胆道合并结石，38例(17.85%)胆道合并结石。在无代谢综合征的患者中，127例(67.9%)同时发生胆囊和胆道结石，60例(32.1%)仅发生胆道结石。这些比率的比较有统计学上的显著差异(P=0.001;优势比:2.18;Ci 95%: 1.36-3.47)。结论:代谢综合征与胆结石病可能存在一定的关系。未来有必要进行更多的对照组研究。
{"title":"Metabolic Syndrome in Patients with Gallstone","authors":"A. Alizadeh, Mohammad-taghi Mohammad Khah, Navid Saadat damghani, R. Talaee, Hasan Rajabali Nia, Aazam Erfanifar","doi":"10.4172/2167-0889.1000138","DOIUrl":"https://doi.org/10.4172/2167-0889.1000138","url":null,"abstract":"Background: Metabolic Syndrome (MetS) is defined as a cluster of multiple cardiovascular risk factors, including central obesity, elevated fasting plasma glucose, high blood pressure, dyslipidemia. The prevalence of MetS has been increasing gradually in the world and there are many hypotheses about relationship between metabolic syndrome and others diseases. The aim of this study is evaluation of prevalence of metabolic syndrome in the patients with gallstone disease. Methods and materials: 400 patients with gallstone disease entered in a cross sectional study. Medical files were extracted and metabolic syndrome was defined by Adult Treatment Panel III (ATP III) base on clinical data. Results: Metabolic syndrome was diagnosed in 213 (53.3%) subjects. In this group, 175 (82.2%) had their gallstone both in gall bladder and biliary tract and 38 (17.85) only in biliary tract. In patients without metabolic syndrome, 127 (67.9%) had the gallstone in both gallbladder and biliary tract and 60 (32.1%) only in their biliary tract. Comparison of these ratios led to a statistically significant difference (P=0.001; Odds Ratio: 2.18; CI 95%: 1.36-3.47). Conclusions: The results showed that may be a relationship between metabolic syndrome and gallstone disease. More future study with control group for this evaluation is necessary.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"18 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80984949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4172/2167-0889.1000140
Takahiro Sato, Sho Kitagawa, M. Kimura
Background: A few studies have investigated duodenal lesions in patients with portal hypertension. Aim is to investigate duodenal angioectasia in patients with portal hypertension. Methods: Sixty patients with duodenal angioectasia and portal hypertension were investigated between April 2009 and March 2012. The subjects were 29 males and 31 females ranging in age from 50 to 84 years (mean: 67.5). Endoscopic findings of duodenal angioectasia were investigated. We evaluated the therapeutic strategy for cases of bleeding duodenal angioectasia. Result: The underlying pathologies of portal hypertension were liver cirrhosis in 56 patients, idiopathic portal hypertension in three patients and extrahepatic portal vein obstruction in one patient. Forty-one of the 60 patients had previously received endoscopic injection sclerotherapy for esophageal varices and the other nineteen patients had a coexistent high risk of esophageal varices. Gastric antral vascular ectasia was discerned in 29 cases. The location of the duodenal angioectasia was the duodenal bulb in 30 cases, descending portion in 13 cases and both the duodenal bulb and descending portion in 17 cases. Endoscopic findings of duodenal angioectasia were classified as follows: punctulate erythema (<1 mm), with or without oozing, and patchy erythema (a few mm), with or without oozing. Endoscopically, bleeding from the duodenal angioectasia was observed in 16 of 60 (26.7%) patients: punctulate erythema in 6 cases and patchy erythema in 10 cases. Bleeding from the patchy erythema type was discerned in 10 of 16 patients (62.5%). However, there was no bleeding in 43 cases of punctulate erythema involving the bulb. Argon plasma coagulation was successfully performed for 6 of 16 cases of bleeding duodenal angioectasia and the other 10 cases were followed-up with endoscopic observations. Conclusions: Duodenal angioectasia in patients with portal hypertension is considered to be one of the lesions of portal hypertensive duodenopathy.
{"title":"Evaluation of Duodenal Angioectasia with Portal Hypertension","authors":"Takahiro Sato, Sho Kitagawa, M. Kimura","doi":"10.4172/2167-0889.1000140","DOIUrl":"https://doi.org/10.4172/2167-0889.1000140","url":null,"abstract":"Background: A few studies have investigated duodenal lesions in patients with portal hypertension. Aim is to investigate duodenal angioectasia in patients with portal hypertension. Methods: Sixty patients with duodenal angioectasia and portal hypertension were investigated between April 2009 and March 2012. The subjects were 29 males and 31 females ranging in age from 50 to 84 years (mean: 67.5). Endoscopic findings of duodenal angioectasia were investigated. We evaluated the therapeutic strategy for cases of bleeding duodenal angioectasia. Result: The underlying pathologies of portal hypertension were liver cirrhosis in 56 patients, idiopathic portal hypertension in three patients and extrahepatic portal vein obstruction in one patient. Forty-one of the 60 patients had previously received endoscopic injection sclerotherapy for esophageal varices and the other nineteen patients had a coexistent high risk of esophageal varices. Gastric antral vascular ectasia was discerned in 29 cases. The location of the duodenal angioectasia was the duodenal bulb in 30 cases, descending portion in 13 cases and both the duodenal bulb and descending portion in 17 cases. Endoscopic findings of duodenal angioectasia were classified as follows: punctulate erythema (<1 mm), with or without oozing, and patchy erythema (a few mm), with or without oozing. Endoscopically, bleeding from the duodenal angioectasia was observed in 16 of 60 (26.7%) patients: punctulate erythema in 6 cases and patchy erythema in 10 cases. Bleeding from the patchy erythema type was discerned in 10 of 16 patients (62.5%). However, there was no bleeding in 43 cases of punctulate erythema involving the bulb. Argon plasma coagulation was successfully performed for 6 of 16 cases of bleeding duodenal angioectasia and the other 10 cases were followed-up with endoscopic observations. Conclusions: Duodenal angioectasia in patients with portal hypertension is considered to be one of the lesions of portal hypertensive duodenopathy.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"70 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85690924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4172/2167-0889.1000141
T. Mizuguchi, M. Kawamoto, M. Meguro, Shigenori Ota, Masayuki Ishii, K. Okita, Y. Kimura, T. Furuhata, K. Hirata
Purpose: Left lateral sectionectomy is one of the best methods for laparoscopic anatomical liver resection. We have developed a three-port method for anatomical left lateral sectionectomy, in which the sectionectomy is performed via a minimal incision after hand-assisted laparoscopic mobilization. Methods: Access for the open laparotomy was obtained by making an 8 cm incision for a hand port. The other ports were used as the camera port and working port. Liver immobilization was completed under pneumoperitoneum. Fingertip tape ligation is a very simple method for encircling the hepatoduodenal ligament and does not require any special equipment. The standard open technique was then employed for liver dissection through the minilaparotomy. We compared the clinical and operative variables of the patients that underwent the open procedure (n = 6) with those of the patients that underwent the laparoscopic procedure (n = 5) at our institute between January 2005 through June 2008. Results: We developed a three-port method for left lateral sectionectomy. No technical difficulties or major complications occurred. The laparoscopy group exhibited significantly less intraoperative bleeding and a significantly shorter period of hospitalization than the open procedure group. Conclusion: The three-port method is suitable for hand-assisted left lateral sectionectomy and is easily repeatable by all liver surgeons, as it does not require any special skills.
{"title":"Left Lateral Sectionectomy Performed Under Minimal Open Access after the Completion of Hand-Assisted Laparoscopic Mobilization","authors":"T. Mizuguchi, M. Kawamoto, M. Meguro, Shigenori Ota, Masayuki Ishii, K. Okita, Y. Kimura, T. Furuhata, K. Hirata","doi":"10.4172/2167-0889.1000141","DOIUrl":"https://doi.org/10.4172/2167-0889.1000141","url":null,"abstract":"Purpose: Left lateral sectionectomy is one of the best methods for laparoscopic anatomical liver resection. We have developed a three-port method for anatomical left lateral sectionectomy, in which the sectionectomy is performed via a minimal incision after hand-assisted laparoscopic mobilization. Methods: Access for the open laparotomy was obtained by making an 8 cm incision for a hand port. The other ports were used as the camera port and working port. Liver immobilization was completed under pneumoperitoneum. Fingertip tape ligation is a very simple method for encircling the hepatoduodenal ligament and does not require any special equipment. The standard open technique was then employed for liver dissection through the minilaparotomy. We compared the clinical and operative variables of the patients that underwent the open procedure (n = 6) with those of the patients that underwent the laparoscopic procedure (n = 5) at our institute between January 2005 through June 2008. Results: We developed a three-port method for left lateral sectionectomy. No technical difficulties or major complications occurred. The laparoscopy group exhibited significantly less intraoperative bleeding and a significantly shorter period of hospitalization than the open procedure group. Conclusion: The three-port method is suitable for hand-assisted left lateral sectionectomy and is easily repeatable by all liver surgeons, as it does not require any special skills.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"33 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91545966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4172/2167-0889.1000190
Li-li Wang
In the past decade, a growing body of evidence has shown that HBsAg quantification (qHBsAg) not only is a useful marker for monitoring natural history of treatment-naïve Chronic HBV Infection (CHB) but can also predict clinical and treatment outcomes [1]. While, other study indicated that, being used alone, qHBsAg is not a suitable marker for evaluating hepatitis activity and distinguishing between cases of HBeAg-negative CHB and inactive HBV carrier state [2]. In our study, we showed that qHBsAg had high predictive value for discrimination of immune tolerance (IT) and Immune Clearance (IC) phase, and it had moderate predictive value for differentiation of low replication (LR) phase and HBeAg Negative Hepatitis (ENH) [3]. While, role of HBeAg quantification (qHBeAg) in natural phases of HBV infection has not been attracted more attention up to now. We found that in HBeAg positive phase of treatment-naïve CHB, qHBsAg and qHBeAg correlated positively (P<0.0001), and both had strong negative correlation with grade of liver inflammation (G) (P<0.0001) and Fibrosis stage (F) (P<0.0001) (unpublished data). Thus, we might speculate that qHBeAg can either be used as a marker of natural phases of HBV infection in HBeAg positive patients. Indeed, we demonstrated that qHBeAg had moderate predictive value for discriminating IT and IC phase [3]. And qHBsAg and qHBeAg had moderate predictive value for F1, F2 and F3 and for G2 and G3 in treatment-naïve HBeAg positive CHB (unpublished data). In recent years, HBcAb quantification (qHBcAb) has been indicated to be associated with HBV infection induced hepatitis [4]. We also suggested that qHBcAb are higher in IC and ENH phases than in IT and LR phases. And qHBcAb correlated positively with grade of liver inflammation. Whereas, the qHBcAb has low divisional value for the intermediate grades of inflammation (unpublished data). Next, we will determine whether qHBcAb is different with liver injury of different etiologies in HBV infection, including HBV infection merged with non-alcoholic fatty liver disease or combined with drug induced liver injury. In all, qHBsAg had high and qHBeAg had moderate predictive value for discrimination of IT and IC phase. And both had moderate predictive value for diagnosis of mild to severe liver fibrosis in treatment-naïve HBeAg positive CHB. Both qHBsAg and qHBcAb had moderate predictive value for differentiation of LR and ENH phase.
{"title":"Role of Serum Hepatitis B Virus Marker Quantitation to Differentiate Natural History","authors":"Li-li Wang","doi":"10.4172/2167-0889.1000190","DOIUrl":"https://doi.org/10.4172/2167-0889.1000190","url":null,"abstract":"In the past decade, a growing body of evidence has shown that HBsAg quantification (qHBsAg) not only is a useful marker for monitoring natural history of treatment-naïve Chronic HBV Infection (CHB) but can also predict clinical and treatment outcomes [1]. While, other study indicated that, being used alone, qHBsAg is not a suitable marker for evaluating hepatitis activity and distinguishing between cases of HBeAg-negative CHB and inactive HBV carrier state [2]. In our study, we showed that qHBsAg had high predictive value for discrimination of immune tolerance (IT) and Immune Clearance (IC) phase, and it had moderate predictive value for differentiation of low replication (LR) phase and HBeAg Negative Hepatitis (ENH) [3]. While, role of HBeAg quantification (qHBeAg) in natural phases of HBV infection has not been attracted more attention up to now. We found that in HBeAg positive phase of treatment-naïve CHB, qHBsAg and qHBeAg correlated positively (P<0.0001), and both had strong negative correlation with grade of liver inflammation (G) (P<0.0001) and Fibrosis stage (F) (P<0.0001) (unpublished data). Thus, we might speculate that qHBeAg can either be used as a marker of natural phases of HBV infection in HBeAg positive patients. Indeed, we demonstrated that qHBeAg had moderate predictive value for discriminating IT and IC phase [3]. And qHBsAg and qHBeAg had moderate predictive value for F1, F2 and F3 and for G2 and G3 in treatment-naïve HBeAg positive CHB (unpublished data). In recent years, HBcAb quantification (qHBcAb) has been indicated to be associated with HBV infection induced hepatitis [4]. We also suggested that qHBcAb are higher in IC and ENH phases than in IT and LR phases. And qHBcAb correlated positively with grade of liver inflammation. Whereas, the qHBcAb has low divisional value for the intermediate grades of inflammation (unpublished data). Next, we will determine whether qHBcAb is different with liver injury of different etiologies in HBV infection, including HBV infection merged with non-alcoholic fatty liver disease or combined with drug induced liver injury. In all, qHBsAg had high and qHBeAg had moderate predictive value for discrimination of IT and IC phase. And both had moderate predictive value for diagnosis of mild to severe liver fibrosis in treatment-naïve HBeAg positive CHB. Both qHBsAg and qHBcAb had moderate predictive value for differentiation of LR and ENH phase.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"34 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87964825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4172/2167-0889.1000195
A. Mohammad, Khairy H Morsy
Objectives: To find the most accurate, suitable and applicable scoring system used for prediction of outcome in cirrhotic patients with bleeding varices. Methods: This prospective study included 120 cirrhotic patients with acute variceal bleeding, admitted at Department of Tropical Medicine and Gastroenterology in Sohag University Hospital over a one-year period (1/2015 to 1/2016). Clinical, laboratory and endoscopic parameters were studied, Child–Pugh (CTP) classification score, Model for end-stage liver disease (MELD) score, Acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and AIMS65 score were calculated for all patients, univariate, multivariate analysis and performance was performed for all taken parameters and the scores. Results: The 120 patients (92 male, 28 female) admitted during the study period, eight patients (6.67%) died in hospital. Higher age, presence of encephalopathy, rebleeding, and higher serum bilirubin were independent factors associated with higher hospital mortality. The largest area under the receiver operator curve (AUROC) was for AIMS65 score and SOFA score followed by MELD score and APACHEII score then Child score all of which achieved very good performance (AUROC > 0.8). AIMS 65 score has the best sensitivity, specificity negative and positive predictive values. Although AIMS65 score was not significantly different from MELD, SOFA, and APACHEII scores, it was the best among them in prediction of mortality. Conclusions: AIMS65 score is best simple and applicable scoring system to independently predict mortality in those patients.
{"title":"Scoring Systems and Risk Stratification in Cirrhotic Patients with Acute Variceal Bleeding \"Scoring in Variceal Bleeding\"","authors":"A. Mohammad, Khairy H Morsy","doi":"10.4172/2167-0889.1000195","DOIUrl":"https://doi.org/10.4172/2167-0889.1000195","url":null,"abstract":"Objectives: To find the most accurate, suitable and applicable scoring system used for prediction of outcome in cirrhotic patients with bleeding varices. Methods: This prospective study included 120 cirrhotic patients with acute variceal bleeding, admitted at Department of Tropical Medicine and Gastroenterology in Sohag University Hospital over a one-year period (1/2015 to 1/2016). Clinical, laboratory and endoscopic parameters were studied, Child–Pugh (CTP) classification score, Model for end-stage liver disease (MELD) score, Acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and AIMS65 score were calculated for all patients, univariate, multivariate analysis and performance was performed for all taken parameters and the scores. Results: The 120 patients (92 male, 28 female) admitted during the study period, eight patients (6.67%) died in hospital. Higher age, presence of encephalopathy, rebleeding, and higher serum bilirubin were independent factors associated with higher hospital mortality. The largest area under the receiver operator curve (AUROC) was for AIMS65 score and SOFA score followed by MELD score and APACHEII score then Child score all of which achieved very good performance (AUROC > 0.8). AIMS 65 score has the best sensitivity, specificity negative and positive predictive values. Although AIMS65 score was not significantly different from MELD, SOFA, and APACHEII scores, it was the best among them in prediction of mortality. Conclusions: AIMS65 score is best simple and applicable scoring system to independently predict mortality in those patients.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87984571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-25DOI: 10.4172/2167-0889.1000189
Hiroto Tanaka, H. Sasaki, M. Arita
A 51-year-old female with chronic hepatitis B treated by Lamivudine (LAM) and Adefovir Dipivoxil (ADV) because of breakthrough hepatitis developed hypophosphatemia. She was diagnosed with Fanconi’s syndrome caused by the long-term administration of ADV. Since her symptoms did not improve after decreasing the ADV dosage and administering vitamin D, she was given L-carnitine. This led to a gradual improvement of her symptoms and the hypophosphatemia. These results indicate that a decrease in the ADV dose combined with supplementation with L-carnitine led to an improvement of Fanconi’s syndrome acquired by a patient with chronic hepatitis B while taking ADV.
{"title":"The Efficacy of L-Carnitine for Fanconis Syndrome caused by Long-TermAdministration of Adefovir Dipivoxil(Adv) in a Patient with Chronic Hepatitis B: A Case Report","authors":"Hiroto Tanaka, H. Sasaki, M. Arita","doi":"10.4172/2167-0889.1000189","DOIUrl":"https://doi.org/10.4172/2167-0889.1000189","url":null,"abstract":"A 51-year-old female with chronic hepatitis B treated by Lamivudine (LAM) and Adefovir Dipivoxil (ADV) because of breakthrough hepatitis developed hypophosphatemia. She was diagnosed with Fanconi’s syndrome caused by the long-term administration of ADV. Since her symptoms did not improve after decreasing the ADV dosage and administering vitamin D, she was given L-carnitine. This led to a gradual improvement of her symptoms and the hypophosphatemia. These results indicate that a decrease in the ADV dose combined with supplementation with L-carnitine led to an improvement of Fanconi’s syndrome acquired by a patient with chronic hepatitis B while taking ADV.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"24 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74981631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-17DOI: 10.4172/2167-0889.1000188
H. Rajekar
Portal hypertension is responsible for most of the complications that mark the transition from compensated to decompensated cirrhosis, namely variceal hemorrhage, ascites and hepatic encephalopathy. Gastroesophageal varices result almost solely from portal hypertension, although the hyperdynamic circulation contributes to variceal growth and rupture. Ascites results from sinusoidal hypertension (portal hypertension) and sodium retention, which is, in turn, secondary to vasodilatation and activation of neurohumoral systems. The hepatorenal syndrome results from extreme vasodilatation with extreme decrease in effective blood volume and maximal activation of vaso constrictive systems, renal vasoconstriction and renal failure, which is probably an indirect effect of the changes in splanchnic circulation. Spontaneous bacterial peritonitis, a frequent precipitant of the hepatorenal syndrome, most probably results from deficient immunity, resulting in pathological gut bacterial translocation. Hepatic encephalopathy results from portosystemic shunting and hepatic insufficiency leading to accumulation of neurotoxins, mainly ammonia, in the brain. As for any illness, prediction of death in cirrhosis is essential in its management; and the development of portal hypertension and its complications have important prognostic value.
{"title":"Complication of Cirrhosis Portal Hypertension: A Review","authors":"H. Rajekar","doi":"10.4172/2167-0889.1000188","DOIUrl":"https://doi.org/10.4172/2167-0889.1000188","url":null,"abstract":"Portal hypertension is responsible for most of the complications that mark the transition from compensated to decompensated cirrhosis, namely variceal hemorrhage, ascites and hepatic encephalopathy. Gastroesophageal varices result almost solely from portal hypertension, although the hyperdynamic circulation contributes to variceal growth and rupture. Ascites results from sinusoidal hypertension (portal hypertension) and sodium retention, which is, in turn, secondary to vasodilatation and activation of neurohumoral systems. The hepatorenal syndrome results from extreme vasodilatation with extreme decrease in effective blood volume and maximal activation of vaso constrictive systems, renal vasoconstriction and renal failure, which is probably an indirect effect of the changes in splanchnic circulation. Spontaneous bacterial peritonitis, a frequent precipitant of the hepatorenal syndrome, most probably results from deficient immunity, resulting in pathological gut bacterial translocation. Hepatic encephalopathy results from portosystemic shunting and hepatic insufficiency leading to accumulation of neurotoxins, mainly ammonia, in the brain. As for any illness, prediction of death in cirrhosis is essential in its management; and the development of portal hypertension and its complications have important prognostic value.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"47 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90646219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-23DOI: 10.4172/2167-0889.1000187
P. Bhattacharya, A. Roy
Hepatitis C, a leading cause of chronic liver disease globally, is caused by Hepatitis C Virus (HCV), a hepatotropic RNA virus. HCV infection starts with an acute infection, mostly subclinical, which ultimately leads to chronic hepatitis in about 80% of the infected cases. HCV is classified into 6 major genotypes and numerous subtypes. The global prevalence of HCV infection is about 1.6% with a majority of these infections being in adults. There is widespread heterogeneity in the prevalence of different genotypes of HCV in different geographical regions of the world. While genotype 1 is the most common worldwide, different regions of the world report variations in the prevalence of the other genotypes. Genotype 3 is the commonest genotype in India, but there is a wide variation in the distribution of the other genotypes in different parts of the country; genotype 6, a comparatively rarer genotype, has been reported frequently from the northeast part of India. With the introduction of new oral drugs, the Directly Acting Antivirals (DAA), the management protocols of hepatitis C has undergone dramatic transformation, with a paradigm shift towards an all-oral interferon-free regimen. However, developing countries like India still face a challenge with respect to accessibility and affordability of such newer regimens. Furthermore, the differences in genotypic distributions in India, with a higher prevalence of genotype 3, which is more difficult to treat, makes the situation even more challenging. As newer antivirals are being universally used to manage HCV infection, economically weaker countries like India should incorporate these changes in treatment guidelines soon. However, till substantial evidence on the efficacy of the newer regimens is accrued in the Indian population, and issues on cost and accessibility are addressed, it may not yet be prudent enough to altogether discard the existing conventional modes of HCV therapy.
{"title":"Management of Hepatitis C in the Indian Context: An Update","authors":"P. Bhattacharya, A. Roy","doi":"10.4172/2167-0889.1000187","DOIUrl":"https://doi.org/10.4172/2167-0889.1000187","url":null,"abstract":"Hepatitis C, a leading cause of chronic liver disease globally, is caused by Hepatitis C Virus (HCV), a hepatotropic RNA virus. HCV infection starts with an acute infection, mostly subclinical, which ultimately leads to chronic hepatitis in about 80% of the infected cases. HCV is classified into 6 major genotypes and numerous subtypes. The global prevalence of HCV infection is about 1.6% with a majority of these infections being in adults. There is widespread heterogeneity in the prevalence of different genotypes of HCV in different geographical regions of the world. While genotype 1 is the most common worldwide, different regions of the world report variations in the prevalence of the other genotypes. Genotype 3 is the commonest genotype in India, but there is a wide variation in the distribution of the other genotypes in different parts of the country; genotype 6, a comparatively rarer genotype, has been reported frequently from the northeast part of India. With the introduction of new oral drugs, the Directly Acting Antivirals (DAA), the management protocols of hepatitis C has undergone dramatic transformation, with a paradigm shift towards an all-oral interferon-free regimen. However, developing countries like India still face a challenge with respect to accessibility and affordability of such newer regimens. Furthermore, the differences in genotypic distributions in India, with a higher prevalence of genotype 3, which is more difficult to treat, makes the situation even more challenging. As newer antivirals are being universally used to manage HCV infection, economically weaker countries like India should incorporate these changes in treatment guidelines soon. However, till substantial evidence on the efficacy of the newer regimens is accrued in the Indian population, and issues on cost and accessibility are addressed, it may not yet be prudent enough to altogether discard the existing conventional modes of HCV therapy.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"37 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2015-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79274145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-15DOI: 10.4172/2167-0889.1000186
T. Shizuma
Backgrounds: Cases of Pernicious Anemia (PA) with Autoimmune Liver Diseases (ALDs) or chronic viral hepatitis have been uncommon. There have been few articles regarding the associations between these diseases. Methods: A review of concomitant cases of PA in patients with ALDs, such as Auto Immune Hepatitis (AIH) or Primary Biliary Cirrhosis (PBC), and patients with chronic viral hepatitis with or without Interferon (IFN) treatment were conducted. Results: Six cases of concomitant PA and ALDs (five were PBC and one was AIH) and seven cases of chronic viral hepatitis (six were due to HCV, one was due to HBV; five cases were of IFN-induced PA and two were of PA without IFN treatment) have been reported. In these concomitant cases, serum vitamin B12 deficiency was documented in all 13 cases and serum Intrinsic Factor Antibodies (IFA) were positive in 11 of 12 cases, excluding one case in which detection of IFA was not mentioned. Conclusions: Although concomitant cases of PA in patients with ALDs or chronic viral hepatitis have been rarely reported, PA should be considered in cases of progressive macrocytic anemia in these patients.
{"title":"Pernicious Anemia in Patients with Primary Biliary Cirrhosis, Autoimmune Hepatitis, and Chronic Viral Hepatitis","authors":"T. Shizuma","doi":"10.4172/2167-0889.1000186","DOIUrl":"https://doi.org/10.4172/2167-0889.1000186","url":null,"abstract":"Backgrounds: Cases of Pernicious Anemia (PA) with Autoimmune Liver Diseases (ALDs) or chronic viral hepatitis have been uncommon. There have been few articles regarding the associations between these diseases. Methods: A review of concomitant cases of PA in patients with ALDs, such as Auto Immune Hepatitis (AIH) or Primary Biliary Cirrhosis (PBC), and patients with chronic viral hepatitis with or without Interferon (IFN) treatment were conducted. Results: Six cases of concomitant PA and ALDs (five were PBC and one was AIH) and seven cases of chronic viral hepatitis (six were due to HCV, one was due to HBV; five cases were of IFN-induced PA and two were of PA without IFN treatment) have been reported. In these concomitant cases, serum vitamin B12 deficiency was documented in all 13 cases and serum Intrinsic Factor Antibodies (IFA) were positive in 11 of 12 cases, excluding one case in which detection of IFA was not mentioned. Conclusions: Although concomitant cases of PA in patients with ALDs or chronic viral hepatitis have been rarely reported, PA should be considered in cases of progressive macrocytic anemia in these patients.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"41 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85705397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-30DOI: 10.4172/2167-0889.1000184
Rin Iraha, M. Okada, Shimpei Kuniyoshi, Shingo Arakaki, T. Iraha, Ryo Kinoshita, M. Saio, N. Yoshimi, Yuko Iraha, M. Tanabe, K. Numata, S. Murayama
Primary Hepatic Epithelioid Hemangioendothelioma (HEH) is a rare, low-grade, malignant hepatic neoplasm. Here we present the typical CT and MRI features of HEH in a 35 year old young woman, which were confirmed by needle biopsy. The most significant CT and MRI imaging findings were capsular retraction and peripheral location with slow progression. In addition, there were multiple hypermetabolic liver tumors seen on FDG-PET/CT and hepatic arterial penetration of the tumor on Dynamic CT (DCT), which may be useful in the diagnosis of HEH.
{"title":"Hepatic Epithelioid Hemangioendothelioma: Vascular Penetration in the Tumor as a Characteristic Imaging Finding","authors":"Rin Iraha, M. Okada, Shimpei Kuniyoshi, Shingo Arakaki, T. Iraha, Ryo Kinoshita, M. Saio, N. Yoshimi, Yuko Iraha, M. Tanabe, K. Numata, S. Murayama","doi":"10.4172/2167-0889.1000184","DOIUrl":"https://doi.org/10.4172/2167-0889.1000184","url":null,"abstract":"Primary Hepatic Epithelioid Hemangioendothelioma (HEH) is a rare, low-grade, malignant hepatic neoplasm. Here we present the typical CT and MRI features of HEH in a 35 year old young woman, which were confirmed by needle biopsy. The most significant CT and MRI imaging findings were capsular retraction and peripheral location with slow progression. In addition, there were multiple hypermetabolic liver tumors seen on FDG-PET/CT and hepatic arterial penetration of the tumor on Dynamic CT (DCT), which may be useful in the diagnosis of HEH.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"1 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2015-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77387632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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