Navegando por Palavras-chave "cirrhosis"

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    Differentiating cirrhosis and chronic hepatospienic schistosorniasis using MRI
    (Amer Roentgen Ray Soc, 2008-03-01) Bezerra, Alexandre Sergio de Araujo [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Caldana, Rogerio Pedreschi [UNIFESP]; Leopoldino, Denise D.; Batista, Giovani Rodrigues [UNIFESP]; Borges, Durval Rosa [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Ahmed, Muneeb; Universidade Federal de São Paulo (UNIFESP); SARAH Network Hosp Reabilitat; Beth Israel Deaconess Med Ctr
    OBJECTIVE. the objective of our study was to identify which imaging features may be used to differentiate between cirrhosis and chronic hepatosplenic schistosomiasis and to assess image interpretation agreement for MRI findings.MATERIALS and METHODS. Retrospective review of 27 patients with alcoholic or virus-induced cirrhosis and 24 patients with chronic hepatosplenic schistosorniasis who underwent MRI (1.5 T) of the abdomen was performed. Images were interpreted independently by two radiologists evaluating the following MRI features: hepatic fissure widening, irregularity of hepatic contours, periportal fibrosis, hepatic parenchyma heterogeneity, and splenic siderotic nodules. Left, right, and caudate hepatic lobe measurements were obtained, and the splenic index was measured. the Fisher's exact test, chi-square test, and Student's t test were used to compare both groups, and regression analysis was performed. Observer agreement was measured using kappa and intraclass correlation tests.RESULTS. Periportal fibrosis, heterogeneity of hepatic parenchyma, and splenic siderotic nodules were more frequent in the group with schistosomiasis (p < 0.05), with periportal fibrosis showing the largest difference in presence and distribution (peripheral greater than central). the transverse diameter of the right hepatic lobe, caudate lobe-right lobe ratio, and splenic index were larger in patients with chronic schistosomiasis (P < 0.001). At multiple regression analysis, splenic siderotic nodules, splenic index, and caudate lobe-right lobe ratio were predictive of schistosomiasis. Observer agreement was substantial or almost perfect for almost all variables analyzed (K or r = 0.81-1.00).CONCLUSION. the presence of peripheral periportall fibrosis,heterogeneity of hepatic parenchyma, and splenic siderotic nodules, and the splenic index and caudate lobe-right lobe ratio are useful features for differentiating alcoholic or virus-induced cirrhosis from chronic schistosomiasis using MRI.
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    Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C
    (Wiley-Blackwell, 2012-04-01) Cardoso, Ana-Carolina; Carvalho-Filho, Roberto J. [UNIFESP]; Stern, Christiane; Dipumpo, Alexandrine; Giuily, Nathalie; Ripault, Marie-Pierre; Asselah, Tarik; Boyer, Nathalie; Lada, Olivier; Castelnau, Corinne; Martinot-Peignoux, Michelle; Valla, Dominique-Charles; Bedossa, Pierre; Marcellin, Patrick; Univ Paris 07; Universidade Federal de São Paulo (UNIFESP)
    Background/ Aims: Accuracy of transient elastography (TE) in hepatitis B virus (HBV) infection has not been well established. We aimed to compare the performances of TE for the assessment of liver fibrosis in patients with chronic HBV or hepatitis C virus (HCV) infection. A secondary analysis was performed to assess whether or not alanine aminotransferase (ALT) levels would impact on the accuracy of TE. Methods: This cross-sectional study, carried out in a single centre, included treatment-naive patients with compensated chronic HBV or HCV infection, consecutively admitted between 2006 and 2008 for a liver biopsy and TE measurement on the same day. Results: A total of 202 HBV patients and 363 HCV subjects were evaluated. Overall diagnostic accuracy of TE in the HBV group was comparable to that observed in HCV patients [area under the receiver-operating characteristics (AUROCs) 0.867 +/-0.026 vs. 0.868 +/-0.019 for predicting F +/-2, P = 0.975; 0.902 +/-0.029 vs. 0.894 +/-0.020 for F +/-3, P = 0.820; and 0.935 +/-0.024 vs. 0.947 +/-0.027 for F4, P = 0.740 respectively]. TE exhibited comparable accuracies, sensitivities, specificities, predictive values and likelihood ratios in HBV and HCV groups. AUROC analysis showed no influence of ALT levels on the performance of TE in HBV individuals. ALT-specific cut-off values did not exhibit significantly higher diagnostic performances for predicting fibrosis in HBV patients with elevated ALT. Conclusions: in HBV patients, TE measurement accurately predicts the absence or presence of significant fibrosis, advanced fibrosis or cirrhosis and shows similar performances as compared to HCV patients. the use of TE cut-off values adjusted to ALT level did not improve performances for estimating liver fibrosis in HBV patients.
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    Factors associated with nutritional status in liver transplant patients who survived the first year after transplantation
    (Wiley-Blackwell, 2010-02-01) Carvalho, Luciana de [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Samuel, Didier; Universidade Federal de São Paulo (UNIFESP); Univ Paris 11
    Background and Aims: Most studies published focus on the evaluation of the impact of nutritional status on the morbidity and mortality during the immediate postoperative period or on the short-term evolution of liver transplant patients. the aim of the study was to evaluate long-term trends in nutritional status.Methods: Seventy patients consecutively submitted to liver transplantation were studied. Nutritional assessment was performed the day before transplantation and the 45, 90, 180 and 365 days after transplantation, consisting of determination of dietary intake, anthropometric and biochemical analysis.Results: Sixty-nine percent of the patients presented with malnutrition on the day before liver transplantation, decreasing to 44% at end of the first year. the prevalence of protein-calorie malnutrition (PCM) was 63% at 90 days post-transplant. A significant difference of PCM was observed between patients with cirrhosis and non-cirrhotic disease (53.6% x 100%) at 90 days post-transplant. the pre-transplant nutritional diagnosis and 90-day calorie intake were identified as variables independently associated with nutritional status at 90 days post-transplant. the variables independently associated with nutritional status in the 1-year assessment were pre-transplant PCM and 365-day calorie requirements.Conclusion: No influence on nutritional status was observed for peri- or postoperative factors after 3 or 12 months of follow up. As expected, dietary factors, especially adequate calorie intake, were always associated with nutritional status during all periods analyzed.
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    Hepatitis G virus infection in patients with hepatocellular carcinoma in Recife, Brazil
    (Oxford Univ Press, 2007-08-01) Leão-Filho, Gustavo Carneiro; Lopes, Edmundo P. A.; Ferraz, Alvaro Antonio B.; Moura, Izolda; Pernambuco, J. Ricardo; Reis, Cynthia [UNIFESP]; Silva, Antônio Eduardo B. [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Universidade Federal de Pernambuco (UFPE); Universidade Federal de São Paulo (UNIFESP)
    The evidence of a higher incidence of hepatitis G virus (HGV) infection among patients with hepatocellular carcinoma (HCC) and the relatively high prevalence of patients with primary liver carcinoma without apparent risk factors in our country motivated the present study, the objective of which was to determine the frequency of HGV-ribonucleic acid (RNA) in a series of patients with HCC. the diagnosis of HCC was established based on a-fetoprotein levels (>400 ng/ml), a compatible image and/or biopsy of the hepatic nodules. Markers of hepatitis B virus (HBV) (HBsAg and anti-HBc), hepatitis C virus (HCV) (anti-HCV) and HGV (HGVRNA) were investigated using MEIA and RT-PCR (reverse transcriptase polymerase chain reaction). There were 32 patients evaluated, including 20 males (63%), with a mean age of 58 years. Twenty-eight (88%) patients were cirrhotic (Child-Pugh: A = 8 patients, B = 14, and C = 6) and 50% reported alcohol consumption. Serological hepatitis markers were detected in 26 (81%) patients, including HBV in 19 (59%), HCV in 12 (38%) and HGV in 9 (28%). Only one (3%) patient was positive for HGV alone. the prevalence of HGV in blood donors from the same region is 10%. the findings suggest that, despite the frequent detection of HGV markers in patients with HCC, isolated infection with this agent does not seem to be a relevant factor in the etiology of this carcinoma.
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    Pituitary glycoprotein hormone a-subunit secretion by cirrhotic patients
    (Associação Brasileira de Divulgação Científica, 1999-01-01) Oliveira, M.c.; Pizarro, C.b.; Cassal, A.; Cremonese, R.; Vieira, J.g.h. [UNIFESP]; A01; Fundação Faculdade Federal de Ciências Médicas de Porto Alegre; Universidade Federal de São Paulo (UNIFESP)
    Secretion of the a-subunit of pituitary glycoprotein hormones usually follows the secretion of intact gonadotropins and is increased in gonadal failure and decreased in isolated gonadotropin deficiency. The aim of the present study was to determine the levels of the a-subunit in the serum of patients with cirrhosis of the liver and to compare the results obtained for eugonadal cirrhotic patients with those obtained for cirrhotic patients with hypogonadotropic hypogonadism. Forty-seven of 63 patients with cirrhosis (74.6%) presented hypogonadism (which was central in 45 cases and primary in 2), 7 were eugonadal, and 9 women were in normal menopause. The serum a-subunit was measured by the fluorimetric method using monoclonal antibodies. Cross-reactivity with LH, TSH, FSH and hCG was 6.5, 1.2, 4.3 and 1.1%, respectively, with an intra-assay coefficient of variation (CV) of less than 5% and an interassay CV of 5%, and sensitivity limit of 4 ng/l. The serum a-subunit concentration ranged from 36 to 6253 ng/l, with a median of 273 ng/l. The median was 251 ng/l for patients with central hypogonadism and 198 ng/l for eugonadal patients. The correlation between the a-subunit and basal LH levels was significant both in the total sample (r = 0.48, P<0.01) and in the cirrhotic patients with central hypogonadism (r = 0.33, P = 0.02). Among men with central hypogonadism there was a negative correlation between a-subunit levels and total testosterone levels (r = 0.54, P<0.01) as well as free testosterone levels (r = -0.53, P<0.01). In conclusion, although the a-subunit levels are correlated with LH levels, at present they cannot be used as markers for hypogonadism in patients with cirrhosis of the liver.
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    Portal hypertensive response to bradykinin in inflamed or cirrhotic rat livers is mediated by B-2-type receptors
    (Blackwell Science Asia, 2001-01-01) Loureiro-Silva, M. R.; Molina, H. M.; Borges, D. R.; Universidade Federal de São Paulo (UNIFESP)
    Background: We have shown that the portal hypertensive response to bradykinin in normal rats is mediated by B-2 receptors.Methods: By using isolated and exsanguinated rat liver perfusion, we studied the portal hypertensive response to bradykinin or des-Arg(9)-bradykinin (B-1 agonist) in inflamed or cirrhotic rat livers. Livers were perfused with bovine serum albumin Krebs-Henseleit buffer (pH 7.4; 37 degreesC) at a constant flow rate, in the absence or presence of des-Arg(9)[Leu(8)]-bradykinin or HOE 140 (B-1 and B-2 receptor antagonists, respectively). Bradykinin (140 nmol) or des-Arg(9)-bradykinin was injected as a bolus via the afferent route to the liver.Results: Basal perfusion pressure in liver-cirrhotic rats was higher than in normal rats. in normal, inflamed, or liver-cirrhotic rats, the presence of the B-1 antagonist did not change the portal hypertensive response to bradykinin, while the B-2 antagonist abolished this response. A 140-nmol dose of des-Arg(9)-bradykinin did not change the perfusion pressure; 700 nmol of this B-1 agonist produced an insignificant perfusion pressure increase. the perfusion pressure increase induced by bradykinin in cirrhotic livers was lower than in normal livers.Conclusions: the portal hypertensive response to bradykinin in inflamed or cirrhotic rat livers is mediated by B-2 receptors, but not B-1 receptors, and there is a contracting hyporeactivity to bradykinin in cirrhotic rat livers. (C) 2001 Blackwell Science Asia Pty Ltd.
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    Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers
    (Lippincott Williams & Wilkins, 2011-09-01) Tafarel, Jean Rodrigo [UNIFESP]; Lenz Tolentino, Luciano Henrique [UNIFESP]; Correa, Lucianna Motta [UNIFESP]; Bonilha, Danielle Rossana [UNIFESP]; Piauilino, Patricia [UNIFESP]; Martins, Fernanda Prata [UNIFESP]; Rodrigues, Rodrigo Azevedo [UNIFESP]; Nakao, Frank Shigeo [UNIFESP]; Della Libera, Ermelindo [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Silveira Roehr, Maria Rachel da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective To determine whether Model for End-stage Liver Disease (MELD) Child-Turcotte-Pugh (CTP) classification, AST to platelet ratio index (APRI), and laboratory tests could predict the presence of esophageal varices (EV) or varices which need prophylactic therapy (medium or large size EV).Methods Three hundred patients with cirrhosis (193 men; mean age 53.1 years; majority with chronic C hepatitis) were prospectively analyzed. the presence of EV (any size and medium or large EV) was correlated with patients' characteristics (MELD, CTP classification, APRI, platelets count, and liver tests).Results One hundred and seventy-one patients (57%) had EV, of whom 35% (105) had varices which need prophylactic therapy (VPT). the distribution of EV according to CTP classification was as follows: A, 49%; B, 75.3% and C, 80%. Independent predictors of EV were: MELD higher than 8 (P = 0.02); APRI higher than 1.64 (P = 0.01); platelet count lower than 93 000/mm(3) (P < 0.01); aspartate aminotransferase higher than 1.34 x UNL (P = 0.01), and total bilirubin higher than 1 mg/dl (P = 0.04). MELD higher than 8 had the highest discriminative value for presence of EV (sensitivity = 80.1%; specificity = 51.2%; area under receiver operating characteristics = 0.68). Factors independently associated with VPT were: thrombocytopenia (< 92 000/mm(3); P < 0.01) and aspartate aminotransferase higher than 1.47 x UNL (P = 0.03). Platelet count lower than 92 000/mm(3) had sensitivity of 65.7%, specificity of 57.9%, and an area under receiver operating characteristics of 0.62 for the presence of VPT.Conclusion High values on MELD are associated with EV and thrombocytopenia, with varices which need prophylactic therapy. As a result of their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all patients with cirhosis. Eur J Gastroenterol Hepatol 23: 754-758 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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    Role of gamma-glutamyl transferase activity in patients with chronic hepatitis C virus infection
    (Blackwell Publishing Asia, 2004-03-01) Souza e Silva, Ivonete Sandra de [UNIFESP]; Ferraz, MLCG; Perez, R. M.; Lanzoni, V. P.; Figueiredo, V. M.; Silva, AEB; Universidade Federal de São Paulo (UNIFESP)
    Background: Increased serum gamma-glutamyl transferase (GGT) levels are frequently observed in chronic hepatitis C virus (HCV) infection. However, the significance of this finding remains unclear. the purpose of the present paper was to assess the relationship between GGT levels and clinical, biochemical and histological features in chronic HCV-infected carriers.Methods: Patients with a liver biopsy presenting anti-HCV and HCV-RNA were evaluated. Age, gender, risk factors of transmission, serum alanine aminotransferase (ALT), GGT and alkaline phosphatase (ALP) levels and histological features were assessed in all. Data were analyzed statistically by the chi(2) test and multivariate logistic regression analysis.Results: Among 201 patients studied, elevated GGT levels and bile duct damage were observed in 48% and 35% of them, respectively. No association was seen between GGT level and bile duct damage or between GGT level and hepatic steatosis. Inititally, age >40 years (P=0.007), elevated ALT (P=0.01), grading of inflammatory activity (P=0.004) and staging of fibrosis (P<0.001) were found to be associated with elevated GGT levels. After multivariate regression analysis, histology grading 3 and 4 inflammation activity (P=0.01) and staging 3 and 4 fibrosis (P=0.01) remained independently associated with elevated GGT level.Conclusions: A significant number of patients with chronic HCV infection had elevated serum GGT levels. Furthermore, this enzyme seemed to be useful as an indirect marker of more advanced liver disease in chronic hepatitis C. (C) 2004 Blackwell Publishing Asia Pty Ltd.
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    Underlying mechanism of portal hypertensive gastropathy in cirrhosis: A hemodynamic and morphological approach
    (Wiley-Blackwell, 2009-09-01) Curvelo, Lilian Amorim [UNIFESP]; Brabosa, Walnei [UNIFESP]; Rhor, Rachel [UNIFESP]; Lanzoni, Valeria [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Kondo, Mario [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background and Aim:Portal hypertensive gastropathy (PHG) is an important cause of bleeding in patients with cirrhosis associated with portal hypertension. Histologically, the condition is characterized by dilation of the mucosal and submucosal vessels of the stomach; however, its mechanisms remain unclear. the aim of the present cross-sectional study was to evaluate the role of portal and systemic hemodynamic features, humoral factors and hepatocellular function in the development and severity of PHG in patients with cirrhosis.Methods:Forty-six patients with cirrhosis of different etiologies underwent endoscopy. Portal hypertension was evaluated by hepatic venous pressure gradient (HVPG). the gastric mucosa was analyzed using two diagnostic methods: endoscopy according to the McCormack criteria and histological by histomorphometric analysis.Results:The prevalence of PHG according to the endoscopic and histomorphometric methods was 93.4% and 76.1%, respectively. There were no statistically significant differences in HVPG measurements between the patients with mild (16.0 +/- 5.9 mmHg) and severe PHG (16.9 +/- 6.5 mmHg; P = 0.80) or between patients who did not have (15.2 +/- 8.0 mmHg) and those who had PHG (16.3 +/- 5.7 mmHg). No correlation was found between the presence or severity of PHG and systemic vascular resistance index (P = 0.53 and 0.34, respectively), Child-Pugh classification (P = 0.73 and 0.78, respectively) or glucagon levels (P = 0.59 and 0.62, respectively).Conclusions:The present data show no correlation between the presence or the severity of PHG and portal pressure, Child-Pugh classification or systemic hemodynamics, suggesting that other factors may be involved in the physiopathology of PHG, such as local gastric mucosal factors or other underlying factors.