1,721,042 research outputs found
Nonalcoholic fatty liver disease: an update
No full textPurpose of reviewWe discuss two recent controversial issues in the research field of fatty liver: the proposal to replace nonalcoholic fatty liver disease (NAFLD) with metabolically associated fatty liver disease (MAFLD) and the suggestion to extend to primary care the noninvasive testing for liver fibrosis that was developed for secondary care.Recent findingsThere is preliminary evidence that MAFLD-only patients are at greater risk of fibrosis than NAFLD-only patients. There are a large number of false positives associated with the downshift of noninvasive testing for liver fibrosis from secondary to primary care.More studies are needed to compare the MAFLD and NAFLD operational definitions. Noninvasive testing of liver fibrosis also needs further evaluation before it can be used in primary care or in the general population
Fatty liver, cardiometabolic disease and mortality
No full textPurpose of review We discuss the findings of the most recent metanalyses on the association between nonalcoholic fatty liver disease (NAFLD), cardiometabolic disease and mortality. Recent findings Recent metanalyses have shown that NAFLD is associated with incident type 2 diabetes mellitus (T2DM) and incident cardiovascular disease (CVD). Nonalcoholic steatohepatitis, which can be diagnosed by liver biopsy only in tertiary care centers, is often associated with liver fibrosis, which has been shown by metanalyses to increase both cardiovascular and liver-related mortality. Hyperlipidemia, lipotoxicity and impaired insulin secretion are among the possible mechanisms underlying the association of NAFLD with T2DM and CVD. Metanalyses of the association between NAFLD and mortality in the general population, where risk stratification cannot be performed on the basis of liver biopsy, have given contradictory results. To establish conclusively whether NAFLD adds to known prognostic factors of death in the general population will require a shared operational definition of NAFLD, purposefully designed cohort studies, and the use of clinically relevant measures of effect size
Cryoglobulinemia in elderly patients with HCV-related chronic hepatitis
No full textHepatitis C virus (HCV) infection affects about 3% of
the world’s population and often leads to chronic liver
disease. In some industrialized countries, HCV prevalence
increases with age, but the optimal management of older
patients has not been accurately defined. HCV infection
can also lead to lymphoproliferative disorders, the most
common being mixed cryoglobulinemia (MC), and also
for this condition that frequently affects elderly patients,
the optimal therapeutic strategy is still debated. We report
the case of a 77-year-old Caucasian woman with
HCV-related chronic hepatitis and cutaneous manifestations
consisting of urticaria and pruritus related to MC resistant
to antihistamines. The patient underwent a treatment
with interferon and ribavirin. Such a treatment led
to early biochemical and virological response associated
with the resolution of cryoglobulinemia and cutaneous
symptoms. After the end of treatment, HCV replication relapsed, but cryoglobulinemia and cutaneous symptoms
did not recur. In the absence of definite treatment guidelines
in this particular context, our experience suggests
that the presence of symptoms related to HCV-infection
that deeply affect patient quality of life warrants antiviral
therapy even beyond the age limits that currently exclude
patients from treatment
Cryoglobulinemia in elderly patients with HCV-related chronic hepatitis.
No full textHepatitis C virus (HCV) infection affects about 3% of
the world’s population and often leads to chronic liver
disease. In some industrialized countries, HCV prevalence
increases with age, but the optimal management of older
patients has not been accurately defined. HCV infection
can also lead to lymphoproliferative disorders, the most
common being mixed cryoglobulinemia (MC), and also
for this condition that frequently affects elderly patients,
the optimal therapeutic strategy is still debated. We report
the case of a 77-year-old Caucasian woman with
HCV-related chronic hepatitis and cutaneous manifestations
consisting of urticaria and pruritus related to MC resistant
to antihistamines. The patient underwent a treatment
with interferon and ribavirin. Such a treatment led
to early biochemical and virological response associated
with the resolution of cryoglobulinemia and cutaneous
symptoms. After the end of treatment, HCV replication relapsed, but cryoglobulinemia and cutaneous symptoms
did not recur. In the absence of definite treatment guidelines
in this particular context, our experience suggests
that the presence of symptoms related to HCV-infection
that deeply affect patient quality of life warrants antiviral
therapy even beyond the age limits that currently exclude
patients from treatment
Calcineurin inhibitors levels reduction during treatment with Sofosbuvir in liver transplanted patients.
Full text linkIn liver transplant, during anti-viral therapy for
hepatitis C virus (HCV) recurrence, the immunosuppressant
levels should be monitored to prevent both toxicity
and rejection.
Sofosbuvir (SOF) has been used within compassionate
programs for HCV recurrence and, according to pharmacokinetic
analyses, is not supposed to have significant
pharmacological interactions with tacrolimus (Tac) or
ciclosporin.1 This was reported in the review article by
Koff recently published.2 We treated eight transplant
recipients with SOF/ribavirin (RBV) for a severe HCV
recurrence, and observed unexpected Tac/ciclosporin
reduction during SOF
DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN HCV CIRRHOTIC PATIENTS TREATED WITH DIRECT ACTING ANTIVIRALS
No full textChemoembolization versus chemotherapy in elderly patients with unresectable hepatocellular carcinoma and contrast uptake as prognostic factor
No full textBackground. Age is considered one of the important contraindications to surgery for hepatocellular carcinoma (HCC) in cirrhosis patients. We therefore evaluated the safety and prevalence of side effects in endoarterial therapy (EAT) in subjects aged over 65 years compared with younger treated patients.
Methods. Thirty-eight patients with HCC aged 65 years and over underwent transcatheter arterial chemoembolization (TACE) (n = 28) or intraarterial chemotherapy (IAC) (n = 10). The survival rate was calculated using Kaplan-Meier's method with respect to a control group consisting of younger treated subjects (44 TACE; 21 IAC) comparable for stage of HCC and severity of the underlying cirrhosis.
Results. The comparison between the two groups regarding side effects, procedure-related death, and survival did not show any difference considering the whole EAT procedure. TACE in elderly subjects reached a statistically lower outcome with respect to younger patients (p < .025) but remained statistically superior in survival versus both older and younger patients treated with IAC (p < .05, respectively). Stratifying the patients following the degree of Lipiodol uptake of tumor mass in the three groups (Group I, > 75%; Group II, 50-75%; Group III, < 50%), in the young subjects a higher probability of survival was strictly correlated to a degree of uptake over 75%, while in the elderly patients an impregnation over 50% was sufficient to obtain a satisfactory survival curve.
Conclusions. EAT is a reliable and safe therapeutic option for the geriatric patient with HCC, with TACE showing a better efficacy than IAC, requiring a lesser degree of Lipiodol uptake to achieve an improvement of outcome
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