ABSTRACT
WHAT IS KNOWN AND OBJECTIVE: No studies have evaluated the use of sorafenib with the direct-acting antiviral ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV). CASE SUMMARY: Three hepatitis C virus genotype 1b-infected patients with well-preserved liver function were included in this prospective case series. The patients were taking sorafenib for advanced hepatocellular carcinoma and received OBV/PTV/r+DSV for 12 weeks. One patient discontinued sorafenib while concomitant treatment due to grade 2 fatigue and muscular pain. The other two patients reported only grade 1 adverse effects. Sustained virologic response at 24 weeks was achieved, and no tumour recurrences were found. WHAT IS NEW AND CONCLUSION: The concurrent use of OBV/PTV/r+DSV with sorafenib was considered safe and effective.
Subject(s)
Antineoplastic Agents/administration & dosage , Antiviral Agents/administration & dosage , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , 2-Naphthylamine , Aged , Anilides/administration & dosage , Antineoplastic Agents/adverse effects , Antiviral Agents/adverse effects , Carbamates/administration & dosage , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular/pathology , Cyclopropanes , Drug Therapy, Combination , Female , Genotype , Hepacivirus/isolation & purification , Hepatitis C, Chronic/virology , Humans , Lactams, Macrocyclic , Liver Neoplasms/drug therapy , Liver Neoplasms/pathology , Macrocyclic Compounds/administration & dosage , Male , Middle Aged , Proline/analogs & derivatives , Prospective Studies , Ritonavir/administration & dosage , Sorafenib/administration & dosage , Sorafenib/adverse effects , Sulfonamides/administration & dosage , Treatment Outcome , Uracil/administration & dosage , Uracil/analogs & derivatives , ValineABSTRACT
Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.
Subject(s)
Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/therapy , Embolization, Therapeutic/methods , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Yttrium Radioisotopes/therapeutic use , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/surgery , Liver Transplantation , Male , Microspheres , Middle Aged , Neoplasm StagingABSTRACT
BACKGROUND: Decompensated cirrhosis due to hepatitis C virus (HCV) is one of the main indications for liver transplantation (LT) in Spain. Recurrence of HCV after LT is the main cause of graft loss and death in HCV-positive recipients. Advanced donor age determines a more aggressive recurrence of HCV and a shorter survival. In this setting, in our liver unit, grafts from younger donors are allocated to HCV-positive recipients. The aim of this study was a comparative analysis of allocation of grafts in HCV-positive recipients versus other etiologies and the impact on waiting list time, Model for End-Stage Liver Disease (MELD) score progression until LT, need of admission in a hospital, survival until LT. METHODS: This was a retrospective study from the cohort of patients included in the waiting list for LT owing to decompensated cirrhosis in the Hospital Gregorio Marañón from January 2008 to June 2013. RESULTS: A total of 91 patients were included; 63 patients (69.23%) received LT; 19 (20.88%) retired from the waiting list: 6 because of improvement, 11 (12.08%) because of death. In both groups, the age of recipients was similar (HCV 52 y vs other 53 y; P = .549). HCV patients were included in the waiting list with lower MELD score than other etiologies (HCV 16.1 vs other 19.4; P = .010); nevertheless, MELD score was similar at the time of LT in both groups (HCV 18.9 vs other 19.4; P = .675). Time on waiting list was significantly longer in HCV patients (198 d vs 86 d; P = .002) and they were admitted in hospital more days (30 d vs 12 d; P = .03). Donor age in the HCV group was significantly lower (64.3 y vs 54.7 y; P = .006). The intention-to-treat survival analysis did not show differences between the groups (log rank = 0.504). CONCLUSIONS: HCV patients with decompensated cirrhosis receive grafts from younger donors. HCV patients remain waiting longer for an optimal organ and suffer MELD deterioration and more days admitted in hospital. These differences in allocation of grafts did not affect final survival. In our experience, designating younger organs to HCV-positive patients does not penalize neither HCV recipients nor recipients with other etiologies.
Subject(s)
Hepacivirus , Hepatitis C, Chronic/complications , Liver Cirrhosis/surgery , Liver Transplantation/statistics & numerical data , Tertiary Care Centers , Transplant Recipients , Waiting Lists , Female , Follow-Up Studies , Hepatitis C, Chronic/virology , Humans , Incidence , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Male , Middle Aged , Retrospective Studies , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Feline Infectious Peritonitis/complications , Feline Infectious Peritonitis/diagnosis , Listeria monocytogenes/isolation & purification , Listeria monocytogenes/pathogenicity , Ampicillin/therapeutic use , Ceftriaxone/therapeutic use , Paracentesis/methods , Fever/etiology , Paracentesis/trendsSubject(s)
Colostomy/adverse effects , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/complications , Varicose Veins/etiology , Blood Transfusion , Combined Modality Therapy , Embolization, Therapeutic , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Humans , Hypertension, Portal/diagnostic imaging , Hypertension, Portal/therapy , Male , Middle Aged , Portasystemic Shunt, Transjugular Intrahepatic/instrumentation , Portography , Stents , Tomography, X-Ray Computed , Treatment Outcome , Varicose Veins/diagnostic imaging , Varicose Veins/therapyABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Hepatitis C, Chronic/complications , Tuberculosis, Pulmonary/complications , Polyarteritis Nodosa/complications , Pancreatitis/etiology , Acute Disease , Fatal OutcomeABSTRACT
OBJECTIVE: Hepatocellular carcinoma (HCC) ablation by radiofrequency (RFA) is a novel technique with a great variety of methods whose efficacy and predictive factors have not been completely studied. Some of the main predictive factors in this type of treatment are analyzed in the present study. PATIENTS AND METHODS: Ninety-three patients with hepatocellular carcinoma over cirrhosis, and with no indication for surgical resection were treated by RFA. Two different types of electrodes were used for RFA (refrigerated-"Cool-Tip" and perfusion with saline solution, the approach was percutaneous, by laparoscopy or laparotomy. RESULTS: Overall survival at 1, 2 and 3 years was 88, 81, and 76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively. For tumors less than 3 cm, FDS at 1,2 and 3 years was 74, 44 and 30%, while for more than 3 cm in size FDS was 55, 12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36 and 22%, and for more than one nodule it decreased to 50, 17 and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly, the method employed for RFA has a main influence in FDS, with 0% at 3 years for perfusion electrodes and 26% for cool-tip electrodes at the same period. CONCLUSIONS: In this series, overall survival at three years was relatively high; however, tumoral size, number of nodules and RFS method were independent variables associated with disease-free survival.
Subject(s)
Carcinoma, Hepatocellular/therapy , Catheter Ablation , Liver Neoplasms/therapy , Aged , Carcinoma, Hepatocellular/complications , Female , Humans , Liver Cirrhosis/complications , Liver Neoplasms/complications , Male , Survival Analysis , Treatment OutcomeABSTRACT
The prevalence of systemic thromboembolic complications is higher in patients with inflammatory bowel disease than in the general population. This hypercoagulable state is due to an increased production of procoagulant substances proportionally related to the inflammatory activity of the disease, although recent reports have focused on the presence of inherited thrombophilic disorders in this entity. We present the case of a 32-year-old woman with no relevant medical history who presented with massive abdominal vein thrombosis, including suprahepatic, portal, splenic and superior mesenteric veins, and secondary acute liver failure in her first ulcerative colitis flare and who later developed toxic megacolon requiring emergency total colectomy despite steroids and cyclosporine. Anticoagulant therapy achieved complete resolution of suprahepatic thrombosis and partial resolution in the splenic and superior mesenteric veins, with final cavernous transformation of the portal vein.
Subject(s)
Colitis, Ulcerative/complications , Liver Failure, Acute/complications , Megacolon, Toxic/etiology , Portal System , Venous Thrombosis/complications , Adult , Colitis, Ulcerative/diagnosis , Female , Humans , Liver Failure, Acute/diagnosis , Megacolon, Toxic/diagnosis , Venous Thrombosis/diagnosisABSTRACT
Hepatoportal sclerosis is characterized by fibrosis of the intima of the portal vein and its branches leading to the development of presinusoidal portal hypertension. We describe the case of a 58-year-old woman with idiopathic hepatoportal sclerosis, who was admitted to our service due to impairment of liver function, with rapid clinical worsening and finally the development of multiorgan failure. Autopsy showed a diffuse liver angiosarcoma with splenic metastases. The patient had no history of domestic or occupational exposure to substances involved in the development of hepatoportal sclerosis or liver angiosarcoma. The development of liver angiosarcoma in a patient with hepatoportal sclerosis is exceptional, even though both diseases may have a common etiology.
Subject(s)
Hemangiosarcoma/complications , Hepatic Veno-Occlusive Disease/complications , Liver Neoplasms/complications , Multiple Organ Failure/etiology , Portal Vein/pathology , Autopsy , Fatal Outcome , Female , Hemangiosarcoma/secondary , Humans , Hypertension, Portal/etiology , Liver Failure/etiology , Liver Neoplasms/pathology , Middle Aged , Sclerosis , Splenic Neoplasms/secondaryABSTRACT
Los pacientes con enfermedad inflamatoria intestinal (EII) presentan una prevalencia superior de complicaciones tromboembólicas sistémicas que la población general. Este estado de hipercoagulabilidad se debe a una producción excesiva de sustancias procoagulantes relacionada proporcionalmente con la actividad de la enfermedad, aunque ciertas publicaciones recientes han revelado un número creciente de mutaciones genéticas predisponentes a la trombofilia en estos enfermos. Se presenta el caso de una mujer de 32 años, sin antecedentes patológicos de interés, en la que su primer brote de EII se presentó clínicamente como una trombosis venosa masiva abdominal (que afectaba a las venas suprahepáticas, porta, esplénica y mesentérica superior), con una insuficiencia hepática aguda y el desarrollo posterior de un megacolon tóxico, a pesar de la administración de esteroides y ciclosporina, por lo que se realizó a la paciente una colectomía total urgente. La anticoagulación consiguió la resolución completa de la trombosis de las venas suprahepáticas y parcial de la esplénica y mesentérica superior, con transformación cavernomatosa de la porta
The prevalence of systemic thromboembolic complications is higher in patients with inflammatory bowel disease than in the general population. This hypercoagulable state is due to an increased production of procoagulant substances proportionally related to the inflammatory activity of the disease, although recent reports have focused on the presence of inherited thrombophilic disorders in this entity. We present the case of a 32-year-old woman with no relevant medical history who presented with massive abdominal vein thrombosis, including suprahepatic, portal, splenic and superior mesenteric veins, and secondary acute liver failure in her first ulcerative colitis flare and who later developed toxic megacolon requiring emergency total colectomy despite steroids and cyclosporine. Anticoagulant therapy achieved complete resolution of suprahepatic thrombosis and partial resolution in the splenic and superior mesenteric veins, with final cavernous transformation of the portal vein
Subject(s)
Female , Adult , Humans , Colitis, Ulcerative/complications , Megacolon, Toxic/etiology , Portal System , Venous Thrombosis/complications , Liver Failure, Acute/complications , Colitis, Ulcerative/diagnosis , Megacolon, Toxic/diagnosis , Venous Thrombosis/diagnosis , Liver Failure, Acute/diagnosisABSTRACT
La esclerosis hepatoportal es una enfermedad caracterizada por la fibrosis de la íntima de la vena porta y de sus ramas, que conduce al desarrollo de hipertensión portal presinusoidal. A continuación describimos el caso de una paciente de 58 años de edad, diagnosticada de esclerosis hepatoportal idiopática, que ingresó en nuestro servicio por presentar un deterioro de la función hepática, con un rápido empeoramiento clínico y el desarrollo de un fallo multiorgánico. El estudio de la necropsia demostró la presencia de un angiosarcoma hepático difuso con metástasis esplénicas. La paciente no presentaba antecedentes de exposición a sustancias de riesgo para el desarrollo de esclerosis hepatoportal ni angiosarcoma hepático en su entorno laboral y doméstico. El desarrollo de un angiosarcoma hepático sobre una esclerosis hepatoportal es un hecho excepcional a pesar de que ambas enfermedades poseen una posible etiología común
Hepatoportal sclerosis is characterized by fibrosis of the intima of the portal vein and its branches leading to the development of presinusoidal portal hypertension. We describe the case of a 58-year-old woman with idiopathic hepatoportal sclerosis, who was admitted to our service due to impairment of liver function, with rapid clinical worsening and finally the development of multiorgan failure. Autopsy showed a diffuse liver angiosarcoma with splenic metastases. The patient had no history of domestic or occupational exposure to substances involved in the development of hepatoportal sclerosis or liver angiosarcoma. The development of liver angiosarcoma in a patient with hepatoportal sclerosis is exceptional, even though both diseases may have a common etiology
Subject(s)
Female , Humans , Hemangiosarcoma/complications , Hepatic Veno-Occlusive Disease/complications , Multiple Organ Failure/etiology , Portal Vein/pathology , Liver Neoplasms/complications , Autopsy , Fatal Outcome , Hemangiosarcoma/secondary , Hypertension, Portal/etiology , Hepatic Insufficiency/etiology , Sclerosis , Liver Neoplasms/pathology , Splenic Neoplasms/secondaryABSTRACT
Objetivo: la ablación por radiofrecuencia del hepatocarcinoma(ARF) es una técnica de reciente adquisición, cuya eficacia yfactores predictivos no han sido suficientemente evaluados. Elpresente estudio fue diseñado para este análisis.Pacientes y métodos: se han tratado 93 pacientes con hepatocarcinomasobre hígado cirrótico sin criterios de resección nide trasplante hepático. El tratamiento se realizó mediante abordajepercutáneo, laparoscópico o mediante laparotomía con dos tiposde electrodos de radiofrecuencia, electrodo refrigerado y deperfusión respectivamente.Resultados: la supervivencia global a los 1, 2 y 3 años fue del88, 81 y 76%, con una supervivencia-libre de enfermedad (SLE)de 66, 31 y 17% respectivamente. El análisis multivariante demostrótres variables predictivas independientes: tamaño tumoral( 3 cm; SLE a 1,2 y 3 años de 74, 44 y 30%,frente a 55, 12 y 0%; HR= 2,02; IC 95% 1,10-3,70; p = 0,02),número de nódulos (uno frente a más de uno; SLE a 1,2 y 3 añosde 70, 36 y 22, frente a 50, 17 y 0%; HR= 1,92 IC 95% 0,95-3,93; p = 0,07) y tipo de electrodo (refrigerado frente a perfusión;SLE 80, 43 y 26% a 1, 2 y 3 años frente a 49, 12 y 0%;HR = 2,06; IC 95% 1,12-3,79; p = 0,02).Conclusiones: a pesar de que la ARF proporciona una supervivenciaglobal aceptable, la SLE es notablemente inferior. El tamañodel tumor, el número de nódulos y el tipo de electrodo deARF fueron variables independientes asociadas a la SLE
Objective: hepatocellular carcinoma (HCC) ablation by radiofrequency(RFA) is a novel technique with a great variety ofmethods whose efficacy and predictive factors have not beencompletely studied. Some of the main predictive factors in thistype of treatment are analyzed in the present study.Patients and methods: ninety-three patients with hepatocellularcarcinoma over cirrhosis, and with no indication for surgicalresection were treated by RFA. Two different types of electrodeswere used for RFA (refrigerated-Cool-Tip and perfusion withsaline solution, the approach was percutaneous, by laparoscopyor laparotomy.Results: overall survival at 1, 2 and 3 years was 88, 81, and76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively.For tumors less than 3 cm, FDS at 1,2 and 3 years was74, 44 and 30%, while for more than 3 cm in size FDS was 55,12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36and 22%, and for more than one nodule it decreased to 50, 17and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly,the method employed for RFA has a main influence in FDS, with0% at 3 years for perfusion electrodes and 26% for cool-tip electrodesat the same period.Conclusions: in this series, overall survival at three years wasrelatively high; however, tumoral size, number of nodules andRFS method were independent variables associated with diseasefreesurvival