1,721,308 research outputs found
Does Transjugular Intrahepatic Portosystemic Shunt Stent Differentially Improve Survival in a Subset of Cirrhotic Patients?
No full textAbstractDoes transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment. While TIPS does not improve survival in other situations, it improves disease management, especially in patients without TIPS contraindications but with refractory bleeding, early rebleeding, portal vein thrombosis, and hepatorenal syndrome. Experience gained at the centers and follow-up of TIPS patients are key features that improve outcome. Important factors for selection and follow-up include cardiac function, inflammation, sarcopenia, age, and early evaluation for liver transplantation.</jats:p
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Vorgehen bei gastrointestinaler Blutung – die neue Leitlinie
No full textWas ist neu?
Präendoskopisches Management Bei Verdacht auf gastrointestinale Blutung sind strukturierte Abläufe zu Risikostratifizierung, initialer Stabilisierung und Endoskopie definiert. Der Verdacht auf variköse Blutung erfordert neben dem Standard (PPI i. v., Erythromycin vor Endoskopie, ggf. Transfusion) spezifische medikamentöse Maßnahmen (Vasokonstriktoren, Antibiotika) bereits vor der Endoskopie, die bei Bestätigung für bis zu 5 bzw. 7 Tage durchgeführt werden.
Gerinnungsstatus und Antikoagulanzien Eine Notfallendoskopie zur Blutstillung soll unabhängig vom Gerinnungsstatus erfolgen.
Diagnostik Die Endoskopie ist diagnostisches und therapeutisches Verfahren der ersten Wahl bei der gastrointestinalen Blutung. Propofol ist auch im Notfall sicher zur Sedierung.
Therapie nicht variköser Blutungen Die alleinige endoskopische Injektionstherapie wird nicht empfohlen, sondern sollte mit einem mechanischen oder thermischen Verfahren kombiniert werden. Für neuere Therapieverfahren (großlumige Clips, Hämostasesprays, Stents) existieren vorläufige, gute Wirksamkeitsdaten in definierten Indikationen. Eine Biopsieentnahme ist auch während der Indexendoskopie möglich und sinnvoll zur Malignom- oder H.-pylori-Diagnostik. Bei schwerer unterer GI-Blutung verbessert eine zeitnahe Koloskopie nach intensivierter Darmvorbereitung die Detektion der Blutungsquelle.
Therapie der varikösen Blutung Bei Hochrisikopatienten mit Varizenblutung sollte die frühzeitige Anlage eines beschichteten TIPS erwogen werden. Bei refraktärer Blutung sollte ein Danis-Stent bei Ösophagusvarizen oder eine Linton-Nachlas-Sonde bei Fundusvarizen eingelegt und immer die Möglichkeit der TIPS-Implantation geprüft werden, ebenso bei Rezidivblutung bei fehlenden Kontraindikationen.</jats:p
Role of albumin in the treatment of decompensated liver cirrhosis
No full textPURPOSE OF REVIEW: Albumin has been used primarily as a plasma expander, since it leads to an increase in the circulating blood volume. Current generally recommended indications for albumin therapy in cirrhotic patients are the prevention of circulatory dysfunction after large-volume paracentesis, the prevention of hepatorenal syndrome (HRS) in patients with spontaneous bacterial peritonitis (SBP), and the management of HRS in combination with vasoconstrictors. Yet, new indications for albumin have been tested in the recent years and are outlined in this short review.RECENT FINDINGS: New data show that albumin both supports the circulation and reduces systemic inflammation. In addition, to its oncotic function, it acts as an antioxidant, radical scavenger, and immune modulator. These nononcotic properties explain why long-term albumin administration in patients with decompensated cirrhosis may be useful in the prevention of associated complications (acute-on-chronic liver failure, infections). New data show that long-term albumin therapy in patients with cirrhosis and ascites improves survival, prevents complications, simplifies ascites management, and lowers hospitalization rates. The so-called disease-modifying effects of long-term albumin therapy may have a favorable effect on the course of the disease. Nevertheless, the optimal dosage and administration intervals have not yet been finally defined.SUMMARY: Albumin therapy is effective in the indications already recommended by the guidelines. A possible extension of the indication for albumin administration in non-SBP infections and as long-term therapy is promising, but should be confirmed by further studies.</p
Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis
No full textPublisher Copyright: © 2022 The Author(s)Background & Aims: It remains unclear whether rectal colonization with multidrug-resistant organisms (MDROs) is prevalent and predisposes to infections by the same pathogens in patients with cirrhosis. Methods: Two series of critically ill patients were evaluated. In the Barcelona cohort, 486 consecutive patients were prospectively evaluated, 129 with and 357 without cirrhosis (2015-2016). Rectal swabs were performed at admission and weekly thereafter (until intensive care unit [ICU] discharge) to detect MDRO colonization. Risk factors for colonization and infection by MDROs were evaluated. A retrospective cohort from Frankfurt (421 patients with cirrhosis; 2010-2018) was investigated to evaluate MDRO rectal colonization in another epidemiological scenario. Results: In the Barcelona cohort, 159 patients were colonized by MDROs (32.7%), 102 (64.2%) at admission and 57 (35.8%) during follow-up. Patients with cirrhosis showed higher rates of rectal colonization at admission than those without cirrhosis (28.7% vs. 18.2%, p = 0.01) but similar colonization rates during ICU stay. Extended-spectrum beta-lactamase-Enterobacterales were the most frequent MDROs isolated in both groups. Colonization by MDROs independently increased the risk of infection by MDROs at admission and during follow-up. Risk of new infection by the colonizing strain was also significantly increased in patients with (hazard ratio [HR] 7.41) and without (HR 5.65) cirrhosis. Rectal colonization by MDROs was also highly prevalent in Frankfurt (n = 198; 47%; 131 at admission [66.2%] and 67 [33.8%] during follow-up), with vancomycin-resistant enterococci being the most frequent colonizing organism. Rectal colonization by MDROs was also associated with an increased risk of infection by MDROs in this cohort. Infections occurring in MDR carriers were mainly caused by the colonizing strain. Conclusion: Rectal colonization by MDROs is extremely frequent in critically ill patients with cirrhosis. Colonization increases the risk of infection by the colonizing resistant strain. Lay summary: Rectal colonization by multidrug-resistant organisms (MDROs) is a prevalent problem in patients with cirrhosis requiring critical care. The pattern of colonizing bacteria is heterogeneous with relevant differences between centers. Colonization by MDROs is associated with increased risk of infection by the colonizing bacteria in the short term. This finding suggests that colonization data could be used to guide empirical antibiotic therapy and de-escalation policies in patients with cirrhosis.The study was supported by ISCIII , PI16/00885 . Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft ( SFB TRR57 , CRC 1382 ), European Union’s Horizon 2020 Research and Innovation Programme (Galaxy, No. 668031 and MICROB-PREDICT, No. 825694) and Societal Challenges - Health, Demographic Change and Wellbeing (No. 731875 ), and Cellex Foundation (PREDICT). Javier Fernandez has received grant and research support from Grifols, speaker honorarium from MSD and educational grant from Pfizer. Jonel Trebicka has received speaking and/or consulting fees from Gore, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis, and Martin Pharmaceutical. The study was supported by ISCIII, PI16/00885. Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57, CRC 1382), European Union's Horizon 2020 Research and Innovation Programme (Galaxy, No. 668031 and MICROB-PREDICT, No. 825694) and Societal Challenges - Health, Demographic Change and Wellbeing (No. 731875), and Cellex Foundation (PREDICT).Peer reviewe
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