5 research outputs found
Sarcoidosis-induced pericarditis in a patient with portopulmonary hypertension: a case report
Portopulmonary hypertension is a rare and severe complication of patients with cirrhosis. Sarcoidosis, a disease of unknown etiology, is also a cause of pulonary hypertension and right heart dysfunction. We report the case of a 51-year-old male patient, suffering from cirrhosis due to Wilson’s disease, portal hypertension and pulmonary hypertension (PH), who developed severe pericarditis. Wilson’s disease was diagnosed 8 years before his last admission to our hospital and was being successfully treated with D-penicillamine. PH was recognized 2 years before admission and being treated with bosentan. The patient complained for dyspnea at rest and the 2D echocardiogram revealed a significant amount of pericardial fluid. All other causes of acute pericarditis were excluded and his laboratory, imaging and histopathological investigation showed evidence of sarcoidosis. He underwent a therapy with corticosteroids (methylprednisolone) and his follow-up examination showed remarkable decrease of the levels of mean pulmonary artery pressure and pericardial fluid
Severe dysphagia due to a huge epiphrenic diverticulum: long-term treatment with balloon dilation and botulinum toxin injection: a case report
We herein describe the first case of a high elderly patient with severe dysphagia in solids and liquids, caused by a huge epiphrenic diverticulum, who was treated with combined therapy of balloon dilation and botulinum toxin injection. Due to comorbid associated diseases the patient was unsuitable to withstand surgical or laparoscopic intervention. Treatment with botulinum toxin injection at the region of lower esophageal sphincter was unsuccessful. Combined therapy with balloon dilatation and botulinum toxin injection at the compressed part of esophageal lumen by the diverticulum resulted in improvement in dysphagia and malnutrition. During the long-term follow-up the patient developed symptomatic relapses, successfully treated by subsequent combined therapy resulting in longer-lasting symptom relief
Relative Adrenal Insufficiency in Cirrhotic Patients
Relative adrenal insufficiency (RAI) was demonstrated in patients with cirrhosis and liver failure. A relationship appears to exist between the severity of the liver disease and the presence of RAI. Neither the mechanism nor the exact prevalence of RAI is fully understood. There is though a hypothesis that low high-density lipoprotein (HDL) levels in this group of patients may be responsible for the insufficiency of cortisol. Several questions also arise about the way and the kind of cortisol (total cortisol, free cortisol, or even salivary cortisol) that should be measured. The presence of RAI in patients with cirrhosis is unquestionable, but still several studies should come up in order to properly define it and fully understand it
A Hybrid Parallel Implementation of the Aho–Corasick and Wu–Manber Algorithms Using NVIDIA CUDA and MPI Evaluated on a Biological Sequence Database
Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: results of the nationwide HEPNET. Greece cohort study
Objective To evaluate the risk and predictors of hepatocellular
carcinoma (HCC) in HBeAg-negative chronic hepatitis B patients of the
large HEPNET. Greece cohort study who received long-term oral antivirals
starting with lamivudine monotherapy.
Design Retrospective analysis of HCC incidence in HBeAg-negative chronic
hepatitis B patients from a retrospective-prospective cohort who were
treated with nucleos(t)ide analogue(s) starting with lamivudine
monotherapy for >= 12 months.
Setting A nationwide network of liver centres.
Patients 818 patients were included: 517 with chronic hepatitis B only;
160 with compensated cirrhosis; 56 with decompensated cirrhosis; 85 with
unclassified disease severity.
Interventions All patients were treated with nucleos(t)ide analogue(s)
starting with lamivudine monotherapy.
Main outcome measures Development of HCC.
Results During a median follow-up of 4.7 years, HCC developed in 49
(6.0%) patients. The 5-year cumulative incidence of HCC was higher in
patients with cirrhosis than in those with chronic hepatitis B only
(11.5% vs 3.2%, respectively; p<0.001). HCC developed in 0.7%, 6.7%
and 11.7% of patients <50, 50-60 and >60 years old, respectively
(p<0.001). Virological on-therapy remission did not significantly affect
the incidence of HCC in all patients or those with cirrhosis, but it
showed a trend for lower HCC incidence in patients with chronic
hepatitis B only (p=0.076). In multivariate analysis, age, gender and
cirrhosis were independently associated with HCC risk regardless of
virological remission.
Conclusions Long-term therapy with nucleos(t) ide analogue(s) starting
with lamivudine monotherapy does not eliminate HCC risk in
HBeAg-negative chronic hepatitis B. The risk of HCC is particularly high
in patients with cirrhosis, who should remain under HCC surveillance
even during effective therapy. Older age and male gender remain
independent risk factors for HCC, while virological on-therapy remission
does not seem to significantly reduce the overall incidence of HCC