Administration d’albumine lors de paracentèse évacuatrice dans la cirrhose : dogme ou évidence ?

Large-volume paracentesis is the procedure of choice for refractory or symptomatic ascitis. However, there is a risk for Post-paracentesis Circulatory Dysfunction (PCD) leading to hyponatremia, renal failure, or worsening portal hypertension. PCD may be effectively prevented by volume expanders, essentially albumin, administered during and after the procedure, but the data regarding the impact of this treatment on mortality are still limited. For this reason, there is a debate about the true clinical benefit of preventing PCD, explaining some variations among published guidelines. The efficacy of molecules other than albumin is still under study but none has shown real superiority so far

Severe immune-mediated drug-induced liver injury linked to ibandronate: a case report

Ibandronate is a widely used bisphosphonate with no previously well documented hepatotoxicity. We report the first case of ibandronate-related hepatotoxicity and, to our knowledge, the first case of immune-mediated drug-induced liver injury (DILI) related to bisphosphonates

Octreotide bolus injection and azygos blood flow in patients with cirrhosis: is the effect really predictable?

BACKGROUND: Octreotide (OCT) improves the management of variceal bleeding, but the pattern of administration is not clearly defined. Available data show a transient decrease in portal pressure and azygos blood flow (AzBF) after OCT bolus injection with desensitization at readministration. AIM: To explore the sustained hemodynamic effects of OCT and changes associated with readministration at 60 minutes on AzBF in patients with portal hypertension. PATIENTS AND METHODS: AzBF was measured invasively (thermodilution technique) in 12 patients at baseline and at 10 minutes intervals after OCT 50-mug IV bolus for a total of 60 minutes. Readministration of OCT was followed by AzBF measurement for another 15 minutes. Patients [age 51.4 y (30 to 69)] had cirrhosis (alcoholic in 9 patients; Pugh's score 8.8+/-0.3), portal hypertension (HVPG 19+/-1 mm Hg), and elevated AzBF (658+/-138 mL/min). RESULTS: The bolus of OCT was followed at 10 minutes by a 34% decline in AzBF as compared with baseline value. This AzBF reduction was sustained over the 60-minute study period (-36%+/-1.4%) with the values that remained decreased as compared with baseline (P<0.01). Mean arterial pressure remained stable. At 60 minutes, the repeat OCT bolus induced a further significant (P<0.01) decline in AzBF, although the response was blunted (-18%+/-1.2%). CONCLUSION: The AzBF showed a sustained decrease of value after a bolus injection of 50-mug OCT. A further hemodynamic response is detectable at OCT readministration after 60 minutes. The pattern of hemodynamic response to OCT may not be uniform among cirrhotics

Hépatite B : nouvelles recommandations de prise en charge

Hepatitis B virus (HBV) infection is a major public health concern associated with major clinical complications, notably chronic liver disease that can progress with time to cirrhosis or even to hepatocellular carcinoma. The management of HBV-infected patients is complex and requires the close collaboration between the general practitioner and the specialist. This review presents an overview of recently published guidelines, from the European Association for the Study of the Liver, and suggests strategies for initial management and referral of HBV-infected patients for the general practitioner

Clinical significance of basal ganglia alterations at brain MRI and 1H MRS in cirrhosis and role in the pathogenesis of hepatic encephalopathy

In hepatic encephalopathy, a progressive and diffuse impairment in brain function is associated with gradual alterations that can be detected by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRS). In some patients, a variety of movement disorders suggestive of extrapyramidal impairment points toward basal ganglia (BG) alterations. Accordingly, (i) hyperintensities at MRI predominant in the pallidum, an important region of BG involved in the motor control, (ii) redistribution of cerebral blood flow from cortical areas to BG structures observed using positron emission tomography studies, and (iii) the preferential pallidal location of Alzheimer astrocytosis, all support this hypothesis. In most clinical studies, little if any correlations have been found between cerebral hyperintensities and neurological manifestations. The application of a test designed to evaluate patients with Parkinson's disease (where extrapyramidal signs are typical) showed significant clinical correlations both with pallidal hyperintensity and with choline/creatine ratio at 1H MRS in BG structures. Because of complex neuronal connections between BG and many cortical areas, BG dysfunction may influence the neurocognitive manifestations of hepatic encephalopathy. Similarities between chronic Mn intoxication and cirrhosis suggest common pathophysiological mechanisms including altered dopaminergic neurotransmission, although information in chronic liver failure is limited. Clinical observations are presented regarding the evolution of parkinsonian signs in various situations

Perendoscopic variceal pressure measurement: a reliable estimation of portal pressure in patients with cirrhosis?

In patients with cirrhosis, the hepatic venous pressure gradient (HVPG) is the reference method for the assessment of portal hypertension (PHT). Variceal pressure (VP) may be measured at endoscopy, but its relationship to the HVPG remains controversial. The aim of the study was to retrospectively compare HVPG and VP values obtained in a cohort of patients with cirrhosis and PHT

Acute portal hemodynamics and cytokine changesfollowing selective transarterial chemoembolization in patients with cirrhosis and hepatocellular carcinoma

Altered portal hemodynamics and inflammation may occur following transcatheter arterial chemoembolization (TACE), but early biological and portal perfusion changes are not well characterized when this procedure is performed selectively