Trasplante en la enfermedad hepática por alcohol / Transplantation for alcohol-related liver disease

La enfermedad hepática por alcohol es una de las enfermedades hepáticas más prevalentes en todo el mundo, y una de las principales causas de morbilidad y mortalidad. La enfermedad puede progresar desde estadios leves, como el hígado graso alcohólico, hasta condiciones severas que incluyen cirrosis y, en algunos casos, carcinoma hepatocelular. A su vez, la esteatohepatitis alcohólica grave es una presentación aguda de la enfermedad hepática por alcohol asociada con una alta mortalidad. A pesar del tratamiento, entre el 30% y el 50% de los pacientes con hepatitis alcohólica grave finalmente fallecen. En los casos de enfermedad avanzada, el trasplante hepático puede ser la única opción para la supervivencia del paciente. El trasplante por hepatitis alcohólica ha sido un tema controvertido, y algunos países todavía aplican la "regla de los 6 meses", en la que se requiere este tiempo de abstinencia de alcohol antes de la cirugía. Estudios recientes recomiendan el trasplante de hígado en casos de hepatitis alcohólica grave que no responden a las terapias médicas, incluso sin el período de abstinencia requerido, ya que la mayoría de estos pacientes fallecen antes de 6 meses. Se requieren más estudios para apoyar la selección de los pacientes idóneos para trasplante hepático con un periodo de abstinencia menor de 6 meses. La prevención y el tratamiento de la enfermedad hepática alcohólica debe ser integral, con un abordaje multidisciplinario que incluya el manejo de la dependencia al consumo de alcohol, al igual que el manejo farmacológico o quirúrgico, de acuerdo con la necesidad de cada paciente.

Alcoholic liver disease is one of the most prevalent liver diseases worldwide, and a major cause of morbidity and mortality. The disease can progress from mild stages, such as alcoholic fatty liver, to severe conditions including cirrhosis, and in some cases hepatocellular carcinoma. Furthermore, severe alcohol steatohepatitis and alcoholic cirrhosis can lead to alcoholic hepatitis, which is an acute presentation of alcoholic liver disease associated with high mortality. Despite treatment, between 30% and 50% of patients with severe alcoholic hepatitis eventually die. In the case of advanced disease, liver transplantation may be the only option for patient survival. Transplantation for alcoholic hepatitis has been a controversial topic, and some countries still apply the "6-month rule", in which this time of alcohol abstinence is required prior to surgery. Emerging studies are recommending liver transplantation in severe alcoholic hepatitis not responding to medical therapies even without the required abstinence period, since the majority of these patients would die within 6 months. Further studies are needed to help refine the selection of suitable patients who have been abstinent for less than 6 months. Prevention and treatment of alcoholic liver disease must be comprehensive, with a multidisciplinary approach that includes the management of alcohol dependence, as well as pharmacological or surgical options according to the needs of each patient.

The prophylactic varices ligation has been applied to patients with liver cirrhosis, cirrhosis accompanied by hepatocellular carcinoma

75 patients were diagnosed with liver cirrhosis (LC) and hepato cellular carcinoma (HCC) are divided into 3 groups: Group 1: 30patients of LC together HCC with digestive bleeding; Group 2: 30 parients of LC with digestive bleeding; Group 3: 15 patients of LC with high risk of digestive bleeding from oesophageal varices. The haemostasis success in Group 1 (LC accompanied by HCC) and Group 2 (LC with digestive bleeding due to oesophageal varices) are 73.3% and 93.3%, respectively. The success of breaking the cluster of oesophageal varices in Group 2 (LC) and Group 3 (LC with high risk of digestive bleeding and treated by prophylactic ligation) are 73.3% and 80%, respectively. The rate of rebleeding in Group 2 and 3 after a year is 20% and 13.3%, respectively.

Nodular Lesions of Cirrhotic Liver: Imaging Manifestations with Pathologic Correlation / 中国普外基础与临床杂志

Objective To introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.Methods Ultrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.Results Many of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, low grade dysplastic nodule, high grade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.Conclusion Modern state of the art medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.

Effect of helicobacter pylori infection on hyperdynamic circulatory state and portal hypertensive gastrropathy in liver cirrhotic patients / 中国免疫学杂志

Objective:To evaluate the effect of Helicobacter pylori infection on hyperdynamic circulatory state and portal hypertensive gastrropathy in liver cirrhotic patients.Methods:Helicobacter pylori infection,IL-1,IL-8,TNF-?,Endotoxin,NO,ET,anti-VacA and anti-CagA levels were determined in cirrhotic patients by using rapid urease test,()~(14)C-urea expiratory test,immunoimpression test,nitrite colorimetric test and ELISA.The parameters of portal venous system flow were determined by doppler ultrasonography.Results:HP prevalence in patients with liver cirrhosis was 77.1%,anti-VacA and antiCagA positive rate was 60.4% in common.IL-1,IL-8,TNF-?,Endotoxin,NO and ET levels in anti-VacA and anti-CagA positive group were significantly higher than in anti-VacA and anti-CagA negtive group.The amount of splenic venous flow(SVF) and superior mesenteric venous flow(SMVF)in anti-VacA and anti-CagA positive group was greater and the amount of portal venous flow(PVF) was smaller than those in negtive group.Conclusion:There was the effect of Helicobacter pylori infection on hyperdynamic circulatory state and portal hypertensive gastrropathy in liver cirrhotic patients.

The Research on Natural Killer(NK) Activity of Peripheral Blood Mononuclear Cells in Patients with Liver Diseases / 中国免疫学杂志

Using ~(125)IUdR Release test, the NK activity of peripheral blood Mononuclear cells in patients with different types of B viral hepatitis (54 cases), Liver cirrhosis (LC,42 cases) and hepatocellular carcinoma (HCC,38 cases) in vitro against k562target cells was detected. In comparison with normal controls,the NK activity was signific- antly increased (P