ABSTRACT
Less than 5% of patients with liver cirrhosis (LC) with portal hypertension (PH) develop atypical shunt (in regions other than the esophagus or the stomach). Within this group are varices associated with a stoma, for example the ones associated with an uretero-ileostomy which are infrequent. They are a diagnostic and therapeutic challenge, as they can cause hemorrhages due to PH. We present a clinical case about stoma varicose bleeding as the latest guidelines for the management of PH do not mention them or their treatment due to their low incidence.(AU)
Subject(s)
Humans , Male , Middle Aged , Hypertension, Portal/complications , Thrombocytopenia , Hematuria , Gastrointestinal Hemorrhage , Liver Cirrhosis , Thrombosis , Inpatients , Physical Examination , Symptom Assessment , Neoplasm Recurrence, Local , Portal VeinABSTRACT
Less than 5% of patients with liver cirrhosis (LC) with portal hypertension (PH) develop atypical shunt (in regions other than the esophagus or the stomach). Within this group are varices associated with a stoma, for example the ones associated with an uretero-ileostomy which are infrequent. They are a diagnostic and therapeutic challenge, as they can cause hemorrhages due to PH. We present a clinical case about stoma varicose bleeding as the latest guidelines for the management of PH do not mention them or their treatment due to their low incidence.
Subject(s)
Hypertension, Portal , Portasystemic Shunt, Transjugular Intrahepatic , Thrombosis , Varicose Veins , Humans , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Neoplasm Recurrence, Local , Hemorrhage/complications , Hypertension, Portal/complications , Hypertension, Portal/surgery , Varicose Veins/surgery , Thrombosis/complications , Liver Cirrhosis/complications , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Portal Vein , Treatment OutcomeABSTRACT
INTRODUCTION: Defibrotide (DF) is a polyribonucleotide with antithrombotic, pro-fibrinolytic, and anti-inflammatory effects on endothelium. These effects and the established safety of DF present DF as a strong candidate to treat viral and post-infectious syndromes involving endothelial dysfunction. AREAS COVERED: We discuss DF and other therapeutic agents that have the potential to target endothelial components of pathogenesis in viral and post-infectious syndromes. We introduce defibrotide (DF), describe its mechanisms of action, and explore its established pleiotropic effects on the endothelium. We describe the established pathophysiology of Coronavirus Disease 2019 (COVID-19) and highlight the processes specific to COVID-19 potentially modulated by DF. We also present influenza A and viral hemorrhagic fevers, especially those caused by hantavirus, Ebola virus, and dengue virus, as viral syndromes in which DF might serve therapeutic benefit. Finally, we offer our opinion on novel treatment strategies targeting endothelial dysfunction in viral infections and their severe manifestations. EXPERT OPINION: Given the critical role of endothelial dysfunction in numerous infectious syndromes, in particular COVID-19, therapeutic pharmacology for these conditions should increasingly prioritize endothelial stabilization. Several agents with endothelial protective properties should be further studied as treatments for severe viral infections and vasculitides, especially where other therapeutic modalities have failed.
Subject(s)
COVID-19/complications , Endothelium, Vascular/drug effects , Polydeoxyribonucleotides/pharmacology , Blood Coagulation Disorders/drug therapy , Blood Coagulation Disorders/etiology , COVID-19/physiopathology , COVID-19/virology , Endothelium, Vascular/physiopathology , Humans , Polydeoxyribonucleotides/therapeutic use , SARS-CoV-2/isolation & purification , Post-Acute COVID-19 SyndromeSubject(s)
COVID-19/complications , Endothelial Cells/virology , Endothelium, Vascular/virology , Pandemics , SARS-CoV-2/pathogenicity , Vasculitis/etiology , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/physiopathology , Anticoagulants/therapeutic use , Apoptosis , Bone Marrow Transplantation/adverse effects , COVID-19/epidemiology , Endothelial Cells/pathology , Glucuronidase/antagonists & inhibitors , Graft vs Host Disease/etiology , Graft vs Host Disease/physiopathology , Heparin/therapeutic use , Hepatic Veno-Occlusive Disease/etiology , Hepatic Veno-Occlusive Disease/physiopathology , Humans , Idiopathic Interstitial Pneumonias/etiology , Idiopathic Interstitial Pneumonias/physiopathology , Interleukin-6/physiology , Multiple Organ Failure/etiology , Multiple Organ Failure/physiopathology , Organ Specificity , Polydeoxyribonucleotides/therapeutic use , SARS-CoV-2/isolation & purification , Stem Cell Transplantation/adverse effects , Thrombophilia/drug therapy , Thrombophilia/etiology , Thrombotic Microangiopathies/etiology , Thrombotic Microangiopathies/physiopathology , Vasculitis/drug therapy , Vasculitis/virology , Viral TropismSubject(s)
Acute Coronary Syndrome/surgery , Aspirin/adverse effects , Coronary Artery Bypass/adverse effects , Platelet Aggregation Inhibitors/adverse effects , Platelet Function Tests , Point-of-Care Testing , Postoperative Hemorrhage/chemically induced , Purinergic P2Y Receptor Antagonists/adverse effects , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/diagnosis , Aged , Aspirin/administration & dosage , Clinical Decision-Making , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Patient Selection , Platelet Aggregation Inhibitors/administration & dosage , Predictive Value of Tests , Prospective Studies , Purinergic P2Y Receptor Antagonists/administration & dosage , Reproducibility of Results , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Serum concentrations of ST2 (interleukin-1 receptor-like 1) represent a meaningful prognostic marker in cardiac diseases. Production of soluble ST2 (sST2) may be partially extracardiac. Identification of sST2 sources is relevant to design strategies for modulating its signaling. METHODS AND RESULTS: An experimental model of ischemic heart failure was used. sST2, membrane-bound ST2 (ST2L), and IL-33 were measured in lungs, heart, kidney, and liver by quantifying mRNA and protein expression in tissue samples obtained at different times (1, 2, 4, and 24 weeks). Primary human type II pneumocyte cell cultures were subjected to strain. sST2 was measured in samples of bronchial aspirate and serum obtained from patients treated with invasive respiratory support. In the experimental model, sST2 increased significantly from the first week in both lungs and myocardium, whereas ST2L/IL-33 response was unfavorable in lungs (decrease) and favorable in myocardium (increase). No changes were observed in liver and kidneys. ST2 immunostaining was intensely observed in alveolar epithelium, and sST2 was secreted by primary human type II pneumocytes in response to strain. sST2 levels in lung aspirates were substantially higher in the presence of cardiogenic pulmonary edema (median, 228 [interquartile range, 28.4-324.0] ng/mL; P<0.001) than bronchopneumonia (median, 5.5 [interquartile range, 1.6-6.5]) or neurological disorders (median, 2.9 [interquartile range, 1.7-10.1]), whereas sST2 concentrations in serum did not differ. CONCLUSIONS: The lungs are a relevant source of sST2 in heart failure. These results may have implications for the progression of disease and the development of therapies targeting the ST2 system in patients with heart failure.
Subject(s)
Alveolar Epithelial Cells/metabolism , Heart Failure/metabolism , Interleukin-1 Receptor-Like 1 Protein/metabolism , Lung/metabolism , Receptors, Interleukin-1/metabolism , Animals , Cells, Cultured , Disease Models, Animal , Heart Failure/blood , Heart Failure/genetics , Humans , Interleukin-1 Receptor-Like 1 Protein/blood , Interleukin-33/genetics , Interleukin-33/metabolism , Male , Rats, Wistar , Receptors, Interleukin-1/genetics , Time FactorsABSTRACT
Upper gastrointestinal bleeding is one of the most frequent complications after cardiac surgery and endoscopic treatment (ET) is often the first-choice procedure. When it fails, surgery can be an option but has significant mortality and morbidity. We propose arterial embolization (TAE: transcatheter arterial embolization) as an alternative treatment in selected cases.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Duodenal Ulcer/complications , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Postoperative Complications/therapy , Angiography , Duodenal Ulcer/diagnostic imaging , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Recurrence , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Embolization, Therapeutic , Gastrointestinal Hemorrhage/therapy , Peptic Ulcer/complications , Peptic Ulcer , Thoracic Surgery/methods , Postoperative Complications , Angiography , Celiac Artery/pathology , Celiac ArteryABSTRACT
No disponible
