Pub Date : 2015-02-23DOI: 10.4172/2167-0889.1000177
Mohammed Salah Debes
Fatty liver disease is one of the common liver diseases, could be alcoholic (AFLD) when there is significant alcohol intake or non-alcoholic (NAFLD), when other causes of liver steatosis are ruled out in particular significant alcohol intake and viral hepatitis. The course of NAFLD could have one of two extremes, either benign simple steatosis or steatohepatitis known as NASH that could lead to progressive liver inflammation, cirrhosis and even hepatocellular carcinoma HCC, and is believed to be important cause for liver cirrhosis in those labeled before as cryptogenic cirrhosis. NASH represents more than 10% of liver transplant cases in the USA and unfortunately there is risk of recurrence post-transplant. The underlying cause is multifactorial, related to genetic and acquired factors, the acquired factors are mostly modifiable, related to lifestyle particularly increased calorie intake with limited consumption in people leading sedentary life, and this leads to overweight / obesity, insulin resistance and triglycerides accumulation in the liver. And so the management will mainly rely on reversal of these lifestyle negatives, so stress on the triad: Diet, exercise and weight reduction. In this review will focus on non-alcoholic fatty liver disease in adults, giving comprehensive overview including the latest recommendations about the management in clinical practice.
{"title":"Non Alcoholic Fatty Liver Overview","authors":"Mohammed Salah Debes","doi":"10.4172/2167-0889.1000177","DOIUrl":"https://doi.org/10.4172/2167-0889.1000177","url":null,"abstract":"Fatty liver disease is one of the common liver diseases, could be alcoholic (AFLD) when there is significant alcohol intake or non-alcoholic (NAFLD), when other causes of liver steatosis are ruled out in particular significant alcohol intake and viral hepatitis. The course of NAFLD could have one of two extremes, either benign simple steatosis or steatohepatitis known as NASH that could lead to progressive liver inflammation, cirrhosis and even hepatocellular carcinoma HCC, and is believed to be important cause for liver cirrhosis in those labeled before as cryptogenic cirrhosis. NASH represents more than 10% of liver transplant cases in the USA and unfortunately there is risk of recurrence post-transplant. The underlying cause is multifactorial, related to genetic and acquired factors, the acquired factors are mostly modifiable, related to lifestyle particularly increased calorie intake with limited consumption in people leading sedentary life, and this leads to overweight / obesity, insulin resistance and triglycerides accumulation in the liver. And so the management will mainly rely on reversal of these lifestyle negatives, so stress on the triad: Diet, exercise and weight reduction. In this review will focus on non-alcoholic fatty liver disease in adults, giving comprehensive overview including the latest recommendations about the management in clinical practice.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"1 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2015-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90631325","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 : 2015-02-13DOI: 10.4172/2167-0889.1000176
A. Ibrahim, H. Salem, D. Zaky, Enaam Elsayed, A. Hamed, Y. Kazem
Introduction: Over the past years, the role of nutrition as one of the most important factors that can influence overall mortality and morbidity in end stage liver disease (ESLD) has been well understood and appreciated, Our study aimed at assessment the dietary intake of the Egyptian cirrhotic patients (due to hepatitis C virus). Patients and methods: Ninety patients were included in the study were divided into three groups according their liver condition according to Child Pugh scoring system (thirty patients of each child class) and all were subjected to careful history (including medical dietary advice, appetite assessment) and thorough dietary history (including 24 hour recall and food frequency). Results: We found Predominance of unsafe intake in calories, calcium, magnesium, potassium and zinc, which was more overt in advanced patients. While predominance of over consumption in protein, sodium, iron, selenium and copper, more in Child A group patients. Using food frequency method, we found that with progress of liver disease, there are fewer variations with more restrictions and limitations regarding the intake. Conclusion: Dietary assessment is an important part of the assessment of liver disease patients and offers helpful nutrition interventions to ensure satisfactory nutrient intake and improve the overall clinical outcome of the patient.
{"title":"Dietary Patterns in Egyptian Patients with Chronic Hepatitis C Related Liver Disease: A Cross-Sectional Study","authors":"A. Ibrahim, H. Salem, D. Zaky, Enaam Elsayed, A. Hamed, Y. Kazem","doi":"10.4172/2167-0889.1000176","DOIUrl":"https://doi.org/10.4172/2167-0889.1000176","url":null,"abstract":"Introduction: Over the past years, the role of nutrition as one of the most important factors that can influence overall mortality and morbidity in end stage liver disease (ESLD) has been well understood and appreciated, Our study aimed at assessment the dietary intake of the Egyptian cirrhotic patients (due to hepatitis C virus). Patients and methods: Ninety patients were included in the study were divided into three groups according their liver condition according to Child Pugh scoring system (thirty patients of each child class) and all were subjected to careful history (including medical dietary advice, appetite assessment) and thorough dietary history (including 24 hour recall and food frequency). Results: We found Predominance of unsafe intake in calories, calcium, magnesium, potassium and zinc, which was more overt in advanced patients. While predominance of over consumption in protein, sodium, iron, selenium and copper, more in Child A group patients. Using food frequency method, we found that with progress of liver disease, there are fewer variations with more restrictions and limitations regarding the intake. Conclusion: Dietary assessment is an important part of the assessment of liver disease patients and offers helpful nutrition interventions to ensure satisfactory nutrient intake and improve the overall clinical outcome of the patient.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"38 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2015-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81607033","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 : 2015-01-19DOI: 10.4172/2167-0889.1000174
C. F. Carvalho, M. Jericó, B. Cogliati, T. Cintra, M. Chammas
The objective of this study was to document the progressive effects of fatty infiltration of the liver on hepatic veins (HVs) by measuring Doppler waveforms in groups of rats and dogs. All of the groups underwent hepatic B-mode and duplex Doppler sonography. B-mode fatty infiltration was classified into four degrees corresponding to increasing grades of hepatic echogenicity for all groups: (0) absent, (1) mild, (2) moderate and (3) severe fatty infiltration. Histograms were obtained in all dogs to standardise each grade of hepatic echogenicity and an increasing distribution of grey-levels was found according to the grade of fatty infiltration of the liver in obese dogs. The Doppler sonography spectra of HVs were classified into three groups: normal or triphasic waveforms, biphasic waveforms, and monophasic or flat waveforms. Obese dogs (60%) and rats (100%) with fatty infiltration of the liver presented biphasic or flat right HV Doppler waveforms more often than control dogs and rats, and these differences were statistically significant (p = 0.002 for dogs and p = 0.0028 for rats). None of the control dogs and rats had monophasic waveforms. These findings suggest there is an association between wave form pattern of hepatic veins and the degree of fatty liver disease.
{"title":"Association of Doppler Wave Pattern of Hepatic Veins and Fatty Liver Disease Degree","authors":"C. F. Carvalho, M. Jericó, B. Cogliati, T. Cintra, M. Chammas","doi":"10.4172/2167-0889.1000174","DOIUrl":"https://doi.org/10.4172/2167-0889.1000174","url":null,"abstract":"The objective of this study was to document the progressive effects of fatty infiltration of the liver on hepatic veins (HVs) by measuring Doppler waveforms in groups of rats and dogs. All of the groups underwent hepatic B-mode and duplex Doppler sonography. B-mode fatty infiltration was classified into four degrees corresponding to increasing grades of hepatic echogenicity for all groups: (0) absent, (1) mild, (2) moderate and (3) severe fatty infiltration. Histograms were obtained in all dogs to standardise each grade of hepatic echogenicity and an increasing distribution of grey-levels was found according to the grade of fatty infiltration of the liver in obese dogs. The Doppler sonography spectra of HVs were classified into three groups: normal or triphasic waveforms, biphasic waveforms, and monophasic or flat waveforms. Obese dogs (60%) and rats (100%) with fatty infiltration of the liver presented biphasic or flat right HV Doppler waveforms more often than control dogs and rats, and these differences were statistically significant (p = 0.002 for dogs and p = 0.0028 for rats). None of the control dogs and rats had monophasic waveforms. These findings suggest there is an association between wave form pattern of hepatic veins and the degree of fatty liver disease.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"12 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2015-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73491512","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 : 2015-01-01DOI: 10.4172/2167-0889.1000172
J. Wiederkehr, H. Wiederkehr, B. Erbano, B. Wiederkehr, C. Carvalho
Biliary anastomoses in Orthotopic liver transplantation (OLT) are considered technically arduous and are accountable for the majority of OLT surgical complications. In this ‘How I do It’ article, we present a new biliary anastomosis technique. It has been performed in our service since 2011 in more than 300 liver transplants. In our series, 5.7% of the patients submitted to duct-to-duct anastomosis with a follow-up greater of 6 months developed biliary complications. Future studies should enhance this surgical technique, in order to minimize the OLT complications.
{"title":"W Technique for Biliary Anastomosis in Liver Transplantation","authors":"J. Wiederkehr, H. Wiederkehr, B. Erbano, B. Wiederkehr, C. Carvalho","doi":"10.4172/2167-0889.1000172","DOIUrl":"https://doi.org/10.4172/2167-0889.1000172","url":null,"abstract":"Biliary anastomoses in Orthotopic liver transplantation (OLT) are considered technically arduous and are accountable for the majority of OLT surgical complications. In this ‘How I do It’ article, we present a new biliary anastomosis technique. It has been performed in our service since 2011 in more than 300 liver transplants. In our series, 5.7% of the patients submitted to duct-to-duct anastomosis with a follow-up greater of 6 months developed biliary complications. Future studies should enhance this surgical technique, in order to minimize the OLT complications.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"36 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74674571","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 : 2015-01-01DOI: 10.4172/2167-0889.1000170
Félicie Sherer, G. V. Simaeys, J. Kers, Q. Yuan, G. Doumont, M. Laute, Cindy Peleman, D. Egrise, T. Lahoutte, Véronique Flam, S. Goldman
Background: In hepatic transplantation, inflammatory response related to liver ischemia-reperfusion injury is an important cause of hepatocellular damage that may lead to organ dysfunction. This project aims to develop a new method of dynamic imaging for the local analysis of hepatic function using un-metabolized 99mTc-labeled mebrofenin excretion time in the bile canaliculi as a read-out. Methods: C57BL/6 female mice underwent acute liver damage induced either by endotoxin administration or by warm ischemia-reperfusion. Liver damage intensity was assessed with a 99mTc-labeled mebrofenin dynamic planar imaging protocol, together with biological parameters of liver damage — levels of blood transaminases, liver necrosis and neutrophil infiltration. The acquisition data consisted of a series of 60-frame pinhole images performed on a gamma camera. A region of interest was drawn within the hepatic area in order to measure liver activity on each frame. Excretion rate was quantified as the time necessary for the count value to reach 50% (T0.5Exc) and 20% (T0.2Exc) of the maximum liver count value. We compared biological parameters of liver damage — levels of blood transaminases, liver necrosis and neutrophil infiltration — with 99mTc-labeled mebrofenin excretion times in both models of liver damage and in control animals. Results: 99mTc-labeled mebrofenin excretion times (T0.5Exc and T0.2Exc) were significantly increased in both models of liver damage. Conclusions: We concluded that quantification of liver function is feasible in mice using dynamic planar pinhole imaging with 99mTc-mebrofenin as tracer of the hepato-biliary function. This method is particularly suited to the noninvasive evaluation of immune and pharmacological interventions aiming at a reduction of early liver insults related to ischemic-reperfusion phenomenon.
{"title":"Dynamic Molecular Imaging for Hepatic Function Assessment in Mice: Evaluation in Endotoxin-Induced and Warm Ischemia-Reperfusion Models of Acute Liver Failure","authors":"Félicie Sherer, G. V. Simaeys, J. Kers, Q. Yuan, G. Doumont, M. Laute, Cindy Peleman, D. Egrise, T. Lahoutte, Véronique Flam, S. Goldman","doi":"10.4172/2167-0889.1000170","DOIUrl":"https://doi.org/10.4172/2167-0889.1000170","url":null,"abstract":"Background: In hepatic transplantation, inflammatory response related to liver ischemia-reperfusion injury is an important cause of hepatocellular damage that may lead to organ dysfunction. This project aims to develop a new method of dynamic imaging for the local analysis of hepatic function using un-metabolized 99mTc-labeled mebrofenin excretion time in the bile canaliculi as a read-out. Methods: C57BL/6 female mice underwent acute liver damage induced either by endotoxin administration or by warm ischemia-reperfusion. Liver damage intensity was assessed with a 99mTc-labeled mebrofenin dynamic planar imaging protocol, together with biological parameters of liver damage — levels of blood transaminases, liver necrosis and neutrophil infiltration. The acquisition data consisted of a series of 60-frame pinhole images performed on a gamma camera. A region of interest was drawn within the hepatic area in order to measure liver activity on each frame. Excretion rate was quantified as the time necessary for the count value to reach 50% (T0.5Exc) and 20% (T0.2Exc) of the maximum liver count value. We compared biological parameters of liver damage — levels of blood transaminases, liver necrosis and neutrophil infiltration — with 99mTc-labeled mebrofenin excretion times in both models of liver damage and in control animals. Results: 99mTc-labeled mebrofenin excretion times (T0.5Exc and T0.2Exc) were significantly increased in both models of liver damage. Conclusions: We concluded that quantification of liver function is feasible in mice using dynamic planar pinhole imaging with 99mTc-mebrofenin as tracer of the hepato-biliary function. This method is particularly suited to the noninvasive evaluation of immune and pharmacological interventions aiming at a reduction of early liver insults related to ischemic-reperfusion phenomenon.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"75 2 Pt 2 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89213749","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 : 2015-01-01DOI: 10.4172/2167-0889.1000169
K. Ueda, H. Omori
It is near a half century since hepatitis B virus (HBV) was identified. HBV receptor molecules and the entry mechanism of HBV into hepatocytes have not been elucidated completely, though there are some reports on infection systems and on the receptor molecules. Thus, we still have not reached finding a real HBV receptor and there have been no useful and convenient infection system in vitro and in vivo for HBV, which makes it impossible for us to understand a precise HBV life cycle and HBV involved related diseases. An HBV infection system is really needed to explore ways and means of treatment of HBV related diseases based on evidence as well. Here, we designed and tried to generate an HBV pseudotype, which has a viral particle containing a retrovirus capsid and a genome inside surrounded by HBV membrane proteins. We proved successful generation of this pseudotype by immunoprecipitation with anti-HBVs antibodies and by CsCl density gradient ultracentrifugation, followed by RT-PCR targeting a retroviral gene, an EGFP gene in this case, respectively. Though our established system is constructed on growth dependent integration of retroviral genomes and thus was very hard to observe its infection in a primary human hepatocytes culture system, successful generation of the HBV pseudotype will make it possible for us to perform a biological assay to clone an HBV receptor based on infectivity and will facilitate its separation and identification
{"title":"Successful Generation of Hepatitis B virus (HBV) Pseudotype Particle; A Versatile Tool for Identification of the HBV Receptor and Investigation of HBV Infectivity","authors":"K. Ueda, H. Omori","doi":"10.4172/2167-0889.1000169","DOIUrl":"https://doi.org/10.4172/2167-0889.1000169","url":null,"abstract":"It is near a half century since hepatitis B virus (HBV) was identified. HBV receptor molecules and the entry mechanism of HBV into hepatocytes have not been elucidated completely, though there are some reports on infection systems and on the receptor molecules. Thus, we still have not reached finding a real HBV receptor and there have been no useful and convenient infection system in vitro and in vivo for HBV, which makes it impossible for us to understand a precise HBV life cycle and HBV involved related diseases. An HBV infection system is really needed to explore ways and means of treatment of HBV related diseases based on evidence as well. Here, we designed and tried to generate an HBV pseudotype, which has a viral particle containing a retrovirus capsid and a genome inside surrounded by HBV membrane proteins. We proved successful generation of this pseudotype by immunoprecipitation with anti-HBVs antibodies and by CsCl density gradient ultracentrifugation, followed by RT-PCR targeting a retroviral gene, an EGFP gene in this case, respectively. Though our established system is constructed on growth dependent integration of retroviral genomes and thus was very hard to observe its infection in a primary human hepatocytes culture system, successful generation of the HBV pseudotype will make it possible for us to perform a biological assay to clone an HBV receptor based on infectivity and will facilitate its separation and identification","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"41 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74292935","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 : 2014-10-28DOI: 10.4172/2167-0889.1000167
W. Otto, M. Krol, Maciej Maciaszczyk, B. Najnigier, J. Sierdziński, M. Krawczyk
Objective: Development of HCC is associated with the process of angiogenesis and leads to the increment of the number of stem cells in the peripheral blood circulation. This study evaluated whether the level of hematopoietic stem cells and endothelial progenitor cells (HSCs & EPCs) could indicate the unfavorable tumour biology and the progress of disease in HCC. Methods: The study covered 146 HCC patients; 53 selected for liver resection, 49 for liver transplantation, 44 for palliation. Control consisted of 42 patients with liver cirrhosis and 43 healthy individuals. The cells were enumerated with CD45, CD34, CD133, CD309 markers. The cell rates were measured by phenotypic analysis of 2 ml fresh blood in a flow cytometer. The data were evaluated statistically. Results: There were significant differences in the levels of HSCs and EPCs between patients with HCC, with liver cirrhosis and healthy volunteers (Chisq = 45.92, p<0.001, Chisq = 16.22, p<0.001), as well as between the groups of patients with HCC selected for liver resection, liver transplantation and palliation (Chisq=40.86, p<0.001, Chisq=18.81, p<0.001), respectively. The multivariate analysis of regression indicated the rates of hematopoietic stem cells and the endothelial progenitor cells as the factor predicting poor tumour differentiation (W=3.95, p<0.04 and W=7.11, p<0.008). Conclusions: Liver cirrhosis and the development of hepatocellular carcinoma cause significant changes in the levels of circulating hematopoietic and endothelial progenitor cells. The cell levels correlate with the advances of liver pathology and allow anticipating the unfavorable biology of the tumour.
{"title":"Levels and Values of Circulating Hematopoietic and Endothelial Progenitor Cells in Patients with Hepatocellular Carcinoma","authors":"W. Otto, M. Krol, Maciej Maciaszczyk, B. Najnigier, J. Sierdziński, M. Krawczyk","doi":"10.4172/2167-0889.1000167","DOIUrl":"https://doi.org/10.4172/2167-0889.1000167","url":null,"abstract":"Objective: Development of HCC is associated with the process of angiogenesis and leads to the increment of the number of stem cells in the peripheral blood circulation. This study evaluated whether the level of hematopoietic stem cells and endothelial progenitor cells (HSCs & EPCs) could indicate the unfavorable tumour biology and the progress of disease in HCC. Methods: The study covered 146 HCC patients; 53 selected for liver resection, 49 for liver transplantation, 44 for palliation. Control consisted of 42 patients with liver cirrhosis and 43 healthy individuals. The cells were enumerated with CD45, CD34, CD133, CD309 markers. The cell rates were measured by phenotypic analysis of 2 ml fresh blood in a flow cytometer. The data were evaluated statistically. Results: There were significant differences in the levels of HSCs and EPCs between patients with HCC, with liver cirrhosis and healthy volunteers (Chisq = 45.92, p<0.001, Chisq = 16.22, p<0.001), as well as between the groups of patients with HCC selected for liver resection, liver transplantation and palliation (Chisq=40.86, p<0.001, Chisq=18.81, p<0.001), respectively. The multivariate analysis of regression indicated the rates of hematopoietic stem cells and the endothelial progenitor cells as the factor predicting poor tumour differentiation (W=3.95, p<0.04 and W=7.11, p<0.008). Conclusions: Liver cirrhosis and the development of hepatocellular carcinoma cause significant changes in the levels of circulating hematopoietic and endothelial progenitor cells. The cell levels correlate with the advances of liver pathology and allow anticipating the unfavorable biology of the tumour.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"41 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2014-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83167041","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 : 2014-10-27DOI: 10.4172/2167-0889.1000168
Kian Makipour, Alexandra N. Modiri, H. Makipour
Objective: To discuss a rare cause of obstructive jaundice. Methods: A case report is presented with emphasis on diagnosis and management. Six month follow up is also presented. Results: A 42 year old African-American male presented with one week of painless jaundice. He underwent imaging via CT abdomen pancreatic protocol and MRCP demonstrating a massively dilated common bile duct of 12 cm and diffuse intrahepatic ductal dilation. He subsequently developed pruritus, RUQ abdominal pain, and cholangitis thus necessitating an endoscopic retrograde cholangiopancreatography (ERCP). ERCP was performed but not useful in delineating the biliary tree anatomy or relieving biliary obstruction. Later percutaneous transhepatic cholangiography (PTC) was performed to provide drainage and was also not useful in delineating his biliary tree anatomy. Shortly thereafter he underwent laparotomy, choledochal cyst and bile duct resection, Roux en Y pancreaticojejunostomy and hepaticojejunostomy. A review of the pathologic specimen indicates the presence of intrapapillary neoplasm of the bile duct (IPNB) which is a rare variant of a bile duct tumor. The specimen was positive for MUC1 and CEA which indicates a high possibility of recurrence. Conclusions: Invasive carcinoma has been found to be present in 70-80% of cases of resected IPNB. However, survival has been shown to be better in patients with IPNB compared to those with conventional bile duct tumors. Given the difficulty of preoperative diagnosis of these lesions and their high predisposition for invasion all IPNB should be surgically resected.
目的:探讨梗阻性黄疸的一种罕见病因。方法:本文报告1例，重点介绍诊断和治疗。6个月的随访也被提出。结果:一个42岁的非裔美国男性提出了一个星期的无痛性黄疸。经CT腹部胰腺成像和MRCP显示胆总管大量扩张12厘米，肝内弥漫性管扩张。他随后出现瘙痒、RUQ腹痛和胆管炎，因此需要内窥镜逆行胆管胰胆管造影(ERCP)。ERCP在描述胆道树解剖或缓解胆道梗阻方面没有作用。后来进行了经皮经肝胆道造影(PTC)以提供引流，但也不能用于描绘他的胆道解剖结构。此后不久，他接受了开腹手术，胆总管囊肿和胆管切除术，Roux en Y胰空肠吻合术和肝空肠吻合术。病理标本的回顾表明存在的胆管乳头内肿瘤(IPNB)，这是一种罕见的胆管肿瘤的变体。标本MUC1和CEA阳性，提示复发可能性高。结论:在70-80%的IPNB切除病例中发现浸润性癌。然而，与传统胆管肿瘤患者相比，IPNB患者的生存率更高。考虑到这些病变术前诊断的困难及其侵袭性的高易感性，所有IPNB都应手术切除。
{"title":"A Rare Cause of Biliary Obstruction","authors":"Kian Makipour, Alexandra N. Modiri, H. Makipour","doi":"10.4172/2167-0889.1000168","DOIUrl":"https://doi.org/10.4172/2167-0889.1000168","url":null,"abstract":"Objective: To discuss a rare cause of obstructive jaundice. Methods: A case report is presented with emphasis on diagnosis and management. Six month follow up is also presented. Results: A 42 year old African-American male presented with one week of painless jaundice. He underwent imaging via CT abdomen pancreatic protocol and MRCP demonstrating a massively dilated common bile duct of 12 cm and diffuse intrahepatic ductal dilation. He subsequently developed pruritus, RUQ abdominal pain, and cholangitis thus necessitating an endoscopic retrograde cholangiopancreatography (ERCP). ERCP was performed but not useful in delineating the biliary tree anatomy or relieving biliary obstruction. Later percutaneous transhepatic cholangiography (PTC) was performed to provide drainage and was also not useful in delineating his biliary tree anatomy. Shortly thereafter he underwent laparotomy, choledochal cyst and bile duct resection, Roux en Y pancreaticojejunostomy and hepaticojejunostomy. A review of the pathologic specimen indicates the presence of intrapapillary neoplasm of the bile duct (IPNB) which is a rare variant of a bile duct tumor. The specimen was positive for MUC1 and CEA which indicates a high possibility of recurrence. Conclusions: Invasive carcinoma has been found to be present in 70-80% of cases of resected IPNB. However, survival has been shown to be better in patients with IPNB compared to those with conventional bile duct tumors. Given the difficulty of preoperative diagnosis of these lesions and their high predisposition for invasion all IPNB should be surgically resected.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"99 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2014-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83470688","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 : 2014-10-07DOI: 10.4172/2167-0889.1000166
C. Riediger, Jeannine Bachmann, A. Hapfelmeier, J. Kleeff, H. Friess, Michael W Mueller
Objective: Platelets play an important role in liver regeneration. One major problem after liver surgery represents the impaired postoperative liver function and delayed recovery. The aim of this study was to evaluate the association of platelet counts to liver regeneration and postoperative outcome after liver surgery for colorectal metastases. Methods: This study included 84 patients without chronic liver disease (such as viral hepatitis or liver cirrhosis) who received partial liver resection between July 2007 and July 2012 for colorectal liver metastases in our hospital. 65% received preoperative chemotherapy. All patients presented with normal liver function before surgery. Platelet counts were obtained between day -1 and day 12 to surgery and correlated with postoperative morbidity and mortality. Comparative analysis between patients with platelet counts ≤ 100/nl and >100/nl one day after liver surgery was performed in regard to postoperative outcome and liver regeneration. Results: Postoperative low platelet counts are associated with significant higher morbidity (p=0.003) and need of re-operation (p=0.004). Furthermore, thrombocytopenic patients showed impaired liver function with significantly higher bilirubin levels (p=0.001; p=0.005) and lower prothrombin time (p=0.015; 0.006) between day 1 and day 7. Conclusion: Postoperative low platelet counts are associated with higher morbidity after liver surgery. Low platelet counts lead to impaired liver function with delayed recovery after liver surgery.
{"title":"Low Postoperative Platelet Count is Associated with Higher Morbidity after Liver Surgery for Colorectal Metastase","authors":"C. Riediger, Jeannine Bachmann, A. Hapfelmeier, J. Kleeff, H. Friess, Michael W Mueller","doi":"10.4172/2167-0889.1000166","DOIUrl":"https://doi.org/10.4172/2167-0889.1000166","url":null,"abstract":"Objective: Platelets play an important role in liver regeneration. One major problem after liver surgery represents the impaired postoperative liver function and delayed recovery. The aim of this study was to evaluate the association of platelet counts to liver regeneration and postoperative outcome after liver surgery for colorectal metastases. Methods: This study included 84 patients without chronic liver disease (such as viral hepatitis or liver cirrhosis) who received partial liver resection between July 2007 and July 2012 for colorectal liver metastases in our hospital. 65% received preoperative chemotherapy. All patients presented with normal liver function before surgery. Platelet counts were obtained between day -1 and day 12 to surgery and correlated with postoperative morbidity and mortality. Comparative analysis between patients with platelet counts ≤ 100/nl and >100/nl one day after liver surgery was performed in regard to postoperative outcome and liver regeneration. Results: Postoperative low platelet counts are associated with significant higher morbidity (p=0.003) and need of re-operation (p=0.004). Furthermore, thrombocytopenic patients showed impaired liver function with significantly higher bilirubin levels (p=0.001; p=0.005) and lower prothrombin time (p=0.015; 0.006) between day 1 and day 7. Conclusion: Postoperative low platelet counts are associated with higher morbidity after liver surgery. Low platelet counts lead to impaired liver function with delayed recovery after liver surgery.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"60 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2014-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76574960","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 : 2014-09-24DOI: 10.4172/2167-0889.1000165
Khairy H Morsy, Mohamed A. A. Ghaliony, H. Mohamed, Tarek T Hanafy
Introduction: Differential diagnosis of ascites is a common clinical problem. Aim of the work: To study the value of Serum Ascites Lipid Gradients (SALG) of total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol in the diagnosis of ascites. Materials and methods: The study was conducted on patients with ascites admitted to Tropical Medicine and Gastroenterology Department, Assiut University. The study included 115 patients with ascites of different etiologies (liver cirrhosis, tuberculosis, and malignant ascites). Clinical evaluation, abdominal ultrasonography, and laboratory investigations were conducted as follows: Serum Ascites Albumin Gradient (SAAG), serum lipid profile, and SALG of total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol. Results: SAAG values were 1.87 ± 0.537 (>1.1), 0.58 ± 0.112 (<1.1), and 0.69 ± 0.201 (<1.1) gm/dL respectively for patients with liver cirrhosis, tuberculosis, and malignancy. The SALG levels for differentiating high SAAG (cirrhosis) from low SAAG (tuberculosis and malignancy) were 97.9 ± 28.6 versus 52.7 ± 32.35 and 49.4 ± 28.64 for SALG- total cholesterol, 74.7 ± 28.2 versus 56.9 ± 48.0 and 48.3 ± 29.23 for SALG- triglyceride, 28.67 ± 9.11 versus 18.53 ± 15.7 and 14.7 ± 14.8 for SALG- HDL cholesterol, 55.7 ± 26.1 versus 17.93 ± 38.5 and 28.5 ± 13.65 for SALGLDL cholesterol respectively. These values are significantly higher in cirrhosis than tuberculosis or malignancy. The cut-off SALG values being 67 mg%, 66 mg%, 26 and 49 mg% in cholesterol, triglyceride, HDL cholesterol, LDL cholesterol respectively in differentiating cirrhotic ascites from tuberculosis or malignant ascites A close relationship between the levels of SALG and severity of cirrhosis is found but it is not significant. Conclusion: SALG has important value in differentiation cirrhotic ascites from tuberculosis or malignant ascites but cannot differentiate tuberculosis ascites from malignant ascites.
{"title":"Diagnostic Value of Serum Ascites Lipid Gradients in Patients with Ascites","authors":"Khairy H Morsy, Mohamed A. A. Ghaliony, H. Mohamed, Tarek T Hanafy","doi":"10.4172/2167-0889.1000165","DOIUrl":"https://doi.org/10.4172/2167-0889.1000165","url":null,"abstract":"Introduction: Differential diagnosis of ascites is a common clinical problem. Aim of the work: To study the value of Serum Ascites Lipid Gradients (SALG) of total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol in the diagnosis of ascites. Materials and methods: The study was conducted on patients with ascites admitted to Tropical Medicine and Gastroenterology Department, Assiut University. The study included 115 patients with ascites of different etiologies (liver cirrhosis, tuberculosis, and malignant ascites). Clinical evaluation, abdominal ultrasonography, and laboratory investigations were conducted as follows: Serum Ascites Albumin Gradient (SAAG), serum lipid profile, and SALG of total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol. Results: SAAG values were 1.87 ± 0.537 (>1.1), 0.58 ± 0.112 (<1.1), and 0.69 ± 0.201 (<1.1) gm/dL respectively for patients with liver cirrhosis, tuberculosis, and malignancy. The SALG levels for differentiating high SAAG (cirrhosis) from low SAAG (tuberculosis and malignancy) were 97.9 ± 28.6 versus 52.7 ± 32.35 and 49.4 ± 28.64 for SALG- total cholesterol, 74.7 ± 28.2 versus 56.9 ± 48.0 and 48.3 ± 29.23 for SALG- triglyceride, 28.67 ± 9.11 versus 18.53 ± 15.7 and 14.7 ± 14.8 for SALG- HDL cholesterol, 55.7 ± 26.1 versus 17.93 ± 38.5 and 28.5 ± 13.65 for SALGLDL cholesterol respectively. These values are significantly higher in cirrhosis than tuberculosis or malignancy. The cut-off SALG values being 67 mg%, 66 mg%, 26 and 49 mg% in cholesterol, triglyceride, HDL cholesterol, LDL cholesterol respectively in differentiating cirrhotic ascites from tuberculosis or malignant ascites A close relationship between the levels of SALG and severity of cirrhosis is found but it is not significant. Conclusion: SALG has important value in differentiation cirrhotic ascites from tuberculosis or malignant ascites but cannot differentiate tuberculosis ascites from malignant ascites.","PeriodicalId":16145,"journal":{"name":"Journal of Liver","volume":"1 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2014-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88492884","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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