Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Antibodies, Monoclonal/therapeutic use , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/therapy , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/pathology , Neoplasm Staging , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Female , Adolescent , Liver Failure, Acute/complications , Liver Failure, Acute/surgery , Liver Transplantation/methods , Hepatolenticular Degeneration/complications , Anemia, Hemolytic/complications , Ascites/complications , Splenomegaly/complications , Copper/blood , Copper/urine , Ceruloplasmin/analysisSubject(s)
Hepatolenticular Degeneration/complications , Liver Failure, Acute/surgery , Liver Transplantation , Adolescent , Biomarkers , Ceruloplasmin/analysis , Copper/analysis , Copper-Transporting ATPases/genetics , Delayed Diagnosis , Emergencies , Female , Hemorrhagic Disorders/etiology , Hepatolenticular Degeneration/diagnosis , Hepatolenticular Degeneration/genetics , Homozygote , Humans , Incidental Findings , Liver Failure, Acute/etiology , Mutation, Missense , Severity of Illness IndexABSTRACT
INTRODUCCIÓN: Las dilataciones vasculares intrapulmonares (DVIPu) están consideradas una complicación de la cirrosis. La ecocardiografía con contraste (ETTc) es la técnica de elección para su diagnóstico. El objetivo de este estudio es demostrar que el doppler transcraneal con contraste (DTCc) puede servir para el diagnóstico de las DVIPu. MÉTODO: Se incluyeron consecutivamente pacientes evaluados para trasplante hepático. Estudio transversal con enmascaramiento de la prueba de referencia (ETTc) para quien interpreta la prueba a valorar (DTCc). Analizamos la exactitud de la prueba diagnóstica mediante los valores de sensibilidad, especificidad, valor predictivo positivo y negativo, y razón de verosimilitud. RESULTADOS: Por DTCc (n = 43) existía shunt derecha-izquierda en 23 pacientes (62,2%): 4 precoces, 2 indeterminados y 17 tardíos. Diecinueve (51,4%) casos fueron clasificados DVIPu. Con ETTc (n = 37) 10 estudios (27%) fueron negativos para shunt y 27 (73%) positivos, 21 (56,8%) fueron compatibles con DVIPu. Los pacientes con y sin DVIPu no diferían en edad, sexo, etiología, gravedad o índice de MELD, independientemente del método diagnóstico. En el estudio de validez diagnóstica (n = 37) del DTCc frente a la ETTc, el rendimiento diagnóstico fue AUC = 0,813% (IC 95%: 0,666-0,959; p = 0,001), sensibilidad: 76,2% (IC 95%: 54,9-89,4) y especificidad: 90% (IC 95%: 63,9-96,5). Razón de verosimilitud positiva: 6,095. CONCLUSIONES: Demostramos una alta prevalencia de DVIPu en candidatos a trasplante hepático. La probabilidad que tiene el DTCc en detectar DVIPu cuando se observa shunt derecha-izquierda tardío con recirculación es muy elevada, y con pocos falsos positivos. Al ser una técnica previamente no descrita en este contexto, deben llevarse a cabo estudios similares con fin comparativo
INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n = 43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n = 37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n = 37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95% CI: 0.666-0.959; P = .001), sensitivity was 76.2% (95% CI: 54.9-89.4) and specificity was 90% (95% CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison
Subject(s)
Humans , Liver Cirrhosis/complications , Ultrasonography, Doppler, Transcranial/methods , Hepatopulmonary Syndrome , Dilatation, Pathologic/physiopathology , Liver Transplantation , Reproducibility of Results , Cross-Sectional StudiesABSTRACT
INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n=43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n=37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n=37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95%CI: 0.666-0.959; P=.001), sensitivity was 76.2% (95%CI: 54.9-89.4) and specificity was 90% (95%CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison.
Subject(s)
Capillaries/diagnostic imaging , Hepatopulmonary Syndrome/diagnostic imaging , Liver Cirrhosis/complications , Pulmonary Circulation , Ultrasonography, Doppler, Transcranial , Aged , Area Under Curve , Capillaries/pathology , Contrast Media , Cross-Sectional Studies , Dilatation, Pathologic , Echocardiography , Female , Hepatopulmonary Syndrome/epidemiology , Hepatopulmonary Syndrome/etiology , Humans , Male , Microbubbles , Middle Aged , Predictive Value of Tests , Prevalence , Prospective Studies , Sensitivity and Specificity , Single-Blind Method , Valsalva ManeuverABSTRACT
BACKGROUND AND OBJECTIVES: celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. METHODS: we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. RESULTS: we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. CONCLUSION: in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications.
Subject(s)
Celiac Disease/diagnosis , Celiac Disease/genetics , HLA-DQ Antigens/genetics , Adolescent , Adult , Age of Onset , Aged , Alleles , Case-Control Studies , Celiac Disease/epidemiology , Child , Female , Genotype , Humans , Male , Middle Aged , Risk Assessment , Spain/epidemiology , Young AdultABSTRACT
Background and objectives: celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. Methods: we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. Results: we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. Conclusion: in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications (AU)
Subject(s)
Humans , Male , Female , Celiac Disease/complications , Celiac Disease/diagnosis , Celiac Disease/genetics , Autoimmunity/genetics , Autoimmunity/immunology , HLA Antigens/analysis , Histocompatibility Testing/methods , Retrospective Studies , GenotypeSubject(s)
Colitis, Ulcerative/complications , Thromboembolism/etiology , Adult , Female , Humans , Severity of Illness IndexSubject(s)
Humans , Female , Adult , Thromboembolism/complications , Thromboembolism/diagnosis , Venous Thromboembolism/complications , Colitis, Ulcerative/complications , Colitis, Ulcerative/diagnosis , /methods , Paracentesis/methods , Thrombophilia/complications , Colitis, Ulcerative/pathology , Colitis, Ulcerative/surgery , Colitis, Ulcerative , Heparin/therapeutic use , Budd-Chiari Syndrome/complications , Budd-Chiari Syndrome , Abdominal Pain/complications , Abdominal Pain/etiologySubject(s)
Humans , Antiviral Agents/adverse effects , Celiac Disease/etiology , Hepatitis B virus/pathogenicity , Interferons/adverse effects , Antiviral Agents/therapeutic use , Celiac Disease/chemically induced , Celiac Disease/virology , Diabetes Mellitus, Type 2/chemically induced , Diabetes Mellitus, Type 2/etiology , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/drug therapy , Interferons/therapeutic use , RecurrenceSubject(s)
Antiviral Agents/adverse effects , Celiac Disease/etiology , Hepatitis B virus/pathogenicity , Interferons/adverse effects , Antiviral Agents/therapeutic use , Celiac Disease/chemically induced , Celiac Disease/virology , Diabetes Mellitus, Type 2/chemically induced , Diabetes Mellitus, Type 2/etiology , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/drug therapy , Hepatitis C/complications , Hepatitis C/drug therapy , Humans , Interferons/therapeutic use , RecurrenceSubject(s)
Air , Caustics/poisoning , Esophagitis/chemically induced , Gastritis/chemically induced , Intubation, Gastrointestinal/adverse effects , Portal Vein , Adult , Burns, Chemical/etiology , Elective Surgical Procedures , Emergencies , Esophageal Stenosis/chemically induced , Female , Humans , Jejunum , Liver/blood supply , Portal Vein/diagnostic imaging , Spleen/blood supply , Suicide, Attempted , Tomography, X-Ray ComputedABSTRACT
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