1,721,045 research outputs found
Encefalopatia epatica
No full textL’encefalopatia epatica (EE) costituisce una frequente complicanza della malattia cronica del fegato, che si può manifestare con un ampio spettro di anomalie neurologiche/psichiatriche che vanno da alterazioni subcliniche al coma. In accordo con le più recenti linee-guida, l’EE può essere classificata in differenti tipi, a seconda della severità dell’insufficienza epatica, della presenza di shunt porto-sistemici e del numero di episodi pregressi o della persistenza del quadro clinico. Da un punto di vista clinico, i quadri di EE posso essere definiti come non alterato, nascosto (che comprende due condizioni, l’EE minima e quella di grado 1, secondo la classificazione che valuta il grado di coinvolgimento mentale) e quello manifesto (che presenta tre gradi di impegno mentale). I meccanismi patogenetici alla base delle differenti forme di EE sono complessi e numerosi, per es. il ruolo dell’ammonio, di citochine pro-infiammatorie, di composti simil-benzodiazepine e l’accumulo di manganese. Nel tempo sono state proposte e attuate differenti strategie terapeutiche per l’EE, in particolare per la forma manifesta, dal momento che la gestione dell’EE nascosta richiede una valutazione caso per caso. Momento fondamentale della gestione del paziente con EE è rappresentato dalla ricerca e dall’eventuale riconoscimento con conseguente trattamento dei fattori scatenanti. I trattamenti più efficaci, che possono essere effettuati singolarmente o in combinazione, sono rappresentati dai disaccaridi lattulosio e lattitolo e dall’antibiotico topico rifaximina. Ulteriori composti utilizzati nel trattamento della EE, in particolare nei casi non responsivi, sono rappresentati dagli aminoacidi ramificati e da composti in grado di favorire l’eliminazione dell’ammonioHepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4). Different and only partially known pathogenic mechanisms have been identified, comprising ammonia, inflammatory cytokines, benzodiazepine-like compounds and manganese deposition. Different therapeutic strategies are available for treating HE, in particular the overt HE, since covert HE needs to be managed case by case. Recognition and treatment of precipitating factors represent fundamental part of the management. The more effective treatments, which can be performed separately or combined, are represented by non-absorbable disaccharides (lactulose and lactitol) and the topic antibiotic rifaximin; other possible therapies, mainly used in patients non responders to previous treatments, are represented by branched chain amino acids and metabolic ammonia scavengers
Ruolo e significato clinico dei metodi non invasivi nella valutazione dell’ipertensione portale nel paziente affetto da epatopatia cronica
No full textSummary. Portal hypertension (PH) is the main driver of complications in patients with advanced chronic liver disease (ACLD). Correctly identifying the presence and severity of PH is crucial for the management and prognosis of compensated ACLD (cACLD) patients. Over the last 20 years, several non-invasive tests (NITs) have been proposed for PH assessment; among these, liver (LSM) and spleen (SSM) stiffness measurement by transient elastography are the most validated and accurate predictors of clinically significant PH (CSPH) and its complications, such as gas-troesophageal varices, clinical decompensation and hepatocellular carcinoma. The inclusion of NITs in the official recommendations of the Baveno VI Consensus, as valid and trustworthy tools to assess PH in cACLD patients, represents one of the major advances in hepatology of the last years. For instance, the recently proposed Baveno VI Criteria (LSM150×109/L) have proven to be a valid strategy to rule out the presence of high-risk varices (HRV) and identify patients that can safely avoid screening upper endoscopy (EGD). In conclusion, further studies are necessary to fully explore the potential of NITs and maximize their use in everyday clinical practice
Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness
Full text linkBackground & Aims: Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We aimed to evaluate the role of spleen stiffness measurement (SSM) in the prediction of HCC risk in a cohort of patients with advanced chronic liver disease (ACLD) treated with DAAs.Methods: This is a retrospective cohort study of 140 patients with HCV-related ACLD successfully treated with DAAs in our centre between 2015 and 2017. Patients with available liver stiffness (LSM) and SSM before treatment and 6 months after (SVR24) were included. A Cox regression model investigated the association between SSM and HCC development.Results: During a median follow-up of 41.5 (IQR 32-49) months, 20 patients presented with HCC. SSM at SVR24 predicted HCC development in univariate and adjusted multivariate analysis (hazard ratio: 1.025; 95% CI: 1.001-1.050); the best cut-off was 42 kPa. Patients with LSM-SVR24 10 kPa, HCC incidence was not further influenced by LSM values (10-20 kPa vs. >20 kPa), but only by SSM-SVR24 values (42 kPa).Conclusions: Portal hypertension, as evaluated by SSM, plays a significant role in liver carcinogenesis after DAA treatment. We proposed a new algorithm based on post-treatment values of LSM and SSM for the stratification of HCC risk after SVR achievement.Lay summary: Spleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals. (C) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL)
Reply: AGILE 3+ score, enhancing the diagnostic accuracy of advanced fibrosis in patients with nonalcoholic fatty liver disease
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Spleen stiffness by ultrasound elastography
No full textThis chapter reviews the use of spleen stiffness measurements (SSM) by ultrasound elastography technique. SSM represents a new, useful, non-invasive tool able to help the hepatologist in the management of the patient with liver diseases and different clinical presentations. In recent years, spleen parameters have been taken more and more into consideration in order to provide additional information for the evaluation of liver diseases; indeed, SSM has been demonstrated to correlate with the presence and degree of portal hypertension (PH) both in cirrhotic and non-cirrhotic patients, as well as with the presence and degree of esophageal varices, and as a predictor of clinical decompensation and even of mortality in cirrhotic patients. We first discuss the physiopathological rationale which led to the use of ultrasound elastography (routinely employed in assessing liver stiffness) in the context of spleen stiffness. We also review the different ultrasound elastography techniques currently available, and we discuss clinical applications of SSM in cirrhotic and non-cirrhotic portal hypertension and its associated complications
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
Reply: Diagnostic accuracy of AGILE3+ score for advanced fibrosis in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis
No full textClinical outcomes after treatment with direct-acting antivirals: not all concern hepatocellular carcinoma risk.
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