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1.
World J Gastroenterol ; 30(19): 2512-2522, 2024 May 21.
Article in English | MEDLINE | ID: mdl-38817666

ABSTRACT

Hepatocellular carcinoma (HCC) is a high mortality neoplasm which usually appears on a cirrhotic liver. The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis. Notwithstanding the current deployment of treatments with curative intent (liver resection/local ablation and liver transplantation) in early and intermediate stages, a high rate of HCC recurrence persists, underscoring a pivotal clinical challenge. Emergent systemic therapies (ST), particularly immunotherapy, have demonstrate promising outcomes in terms of increase overall survival, but they are currently bound to the advanced stage of HCC. This review provides a comprehensive analysis of the literature, encompassing studies up to March 10, 2024, evaluating the impact of novel ST in the early and intermediate HCC stages, specially focusing on the findings of neoadjuvant and adjuvant regimens, aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative intent. We also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative intent. Finally, we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.


Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Neoadjuvant Therapy , Neoplasm Staging , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/mortality , Humans , Liver Neoplasms/therapy , Liver Neoplasms/pathology , Liver Neoplasms/mortality , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/trends , Neoplasm Recurrence, Local , Immunotherapy/methods , Hepatectomy , Liver Transplantation , Treatment Outcome , Chemotherapy, Adjuvant/methods , Prognosis
3.
Rev Esp Enferm Dig ; 2024 Mar 19.
Article in English | MEDLINE | ID: mdl-38501802

ABSTRACT

Alert systems are proving to be useful to increase hepatitis C virus (HCV) diagnoses and facilitating access to antiviral treatment. Since 2020, our health department has had a fully automated alert system set up at the Microbiology Department. In this study, we present the results of the 2022-2023 period to assess the current characteristics of HCV diagnosed patients. In addition, we analyzed, through a comparison, whether a limitation that we noticed during the 2020-2021 period (whose results were published) is still present. This limitation consists of that 24.2% (34/134) of those candidates for antiviral treatment were not treated because they could not be located or refused treatment. During the 2022-2023 period, 188 new cases were diagnosed, and 75% (141/188) were treated. The comparison of both periods showed that in 2022-2023, the rate of treatment rejection by the patient was significantly lower (1.4% vs 14.5%, p < 0.05) and, therefore, the rate of antiviral treatment increased (75% vs 58.9%, p < 0.05). These results suggest that our alert system is useful and efficient for the diagnosis and treatment of HCV.

4.
Rev Esp Enferm Dig ; 2024 Jan 11.
Article in English | MEDLINE | ID: mdl-38205687

ABSTRACT

Transarterial chemoembolization of hepatocellular carcinoma consists of the selective release of chemotherapeutic agents in the tumor feeding arteries (and their subsequent occlusion) and presents a low risk of extrahepatic complications. However, the presence of anatomical variants of the celiac trunk is common and facilitates these complications by connecting the hepatic arterial vascularization with that of the surrounding organs. We present three clinical cases of extrahepatic ischemia in three different organs (esophagus, stomach and gallbladder) following transarterial chemoembolization in patients who presented one of these anatomical variants.

5.
Rev Esp Enferm Dig ; 116(1): 43, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37073695

ABSTRACT

New immunosuppressive and antineoplastic drugs are becoming both more numerous and more widely used, even during several years. Most of them present a low-moderate risk of hepatitis B virus (HBV) reactivation in HBsAg-negative and anti-HBc-positive patients. However, their reactivation capacity has not been clearly studied. We present the clinical case of a patient with these serological characteristics who, after 5 years of treatment with ibrutinib for chronic lymphocytic leukaemia, developed VHB reactivation, which was controlled with tenofovir. The occurrence of this event with drugs such as ibrutinib may lead to changes in HBV reactivation prophylaxis.


Subject(s)
Adenine/analogs & derivatives , Hepatitis B virus , Hepatitis B , Humans , Hepatitis B/chemically induced , Hepatitis B Surface Antigens , Piperidines/pharmacology , Piperidines/therapeutic use , Virus Activation , Antiviral Agents/adverse effects
7.
Rev Esp Enferm Dig ; 115(4): 181-187, 2023 04.
Article in English | MEDLINE | ID: mdl-36043540

ABSTRACT

INTRODUCTION: simplification strategies for the care circuit of patients with hepatitis C virus (HCV) are key to achieve eradication. An electronic identification system was set up for HCV serology to link diagnosis to specialist management, aimed to reduce patient loss. MATERIAL AND METHODS: a retrospective, single-center study was performed in patients with HCV identified from 15/3/2020 to 15/12/2021, using an alert system from Microbiology that notified specialists of positive cases. The patient was contacted and appointed a Fibroscan® and viral load measurement, with antiviral therapy prescribed on the same day. Origin, public health data, patient location rate and antiviral therapy prescription were recorded. RESULTS: of 174 patients identified, 171 had positive viremia, with a mean age of 59.6 ± 15.9 years, 61.5 % were males and 81.2 % were Spanish nationals. Origin in the outpatient setting predominated (57.9 %, 99/171), particularly Primary Care (51/171), penitentiaries (21/171) and addiction units (14/171). Overall, 43.3 % (74/171) were aware of their diagnosis; 19.4 % (20/103) of patients had F3 fibrosis and 25.2 % (26/103) had F4 fibrosis. Also, 78.4 % (134/171) were deemed candidates for treatment. Of these, 74.6 % (100/134) were located and treatment was initiated, and all those who completed their treatment achieved a sustained viral response (96/96). This system managed 58.5 % (100/171) of the patients identified. The only association found between antiviral therapy and patient variables was comorbidities with being untreated (OR, 7.14; p ˂ 0.001). CONCLUSIONS: this alert system allows to minimize patient loss in the care circuit and provides high rates of treated patients.


Subject(s)
Hepatitis C, Chronic , Hepatitis C , Male , Humans , Adult , Middle Aged , Aged , Female , Hepacivirus , Retrospective Studies , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/complications , Antiviral Agents/therapeutic use , Antiviral Agents/adverse effects , Fibrosis , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/complications
8.
Rev. esp. enferm. dig ; 115(4): 181-187, 2023. tab
Article in Spanish | IBECS | ID: ibc-218577

ABSTRACT

Introducción: las estrategias de simplificación del circuitoasistencial para pacientes con virus de la hepatitis C (VHC)son fundamentales para lograr su erradicación. Para ello,introdujimos un sistema electrónico de detección de serología VHC con el objetivo de ligar diagnóstico y asistenciaespecializada para disminuir la pérdida de pacientes.Material y métodos: estudio retrospectivo unicéntrico depacientes VHC detectados del 15/3/2020 al 15/12/2021 mediante un sistema de alertas desde Microbiología que notificaba los casos positivos a facultativos especialistas. Se contactaba con el paciente concertando una cita donderealizaban Fibroscan® y determinación de carga viral y sepautaba tratamiento antiviral el mismo día. Registramosprocedencia, datos sociosanitarios, tasa de localización delpaciente y prescripción de tratamiento antiviral.Resultados: de 174 pacientes detectados, 171 presentaronviremia positiva, con edad media de 59,6 ± 15,9 años, un61,5 % varones y el 81,2 % españoles. Predominó la procedencia del ámbito extrahospitalario (57,9 %, 99/171), destacando Atención Primaria (51/171), centro penitenciario(21/171) y unidades de adicción (14/171). El 43,3 % (74/171)conocía el diagnóstico. Registramos un 19,4 % (20/103) depacientes con fibrosis F3 y un 25,2 % (26/103) con F4. Consideramos candidatos a tratamiento al 78,4 % (134/171). Deestos, fueron localizados e iniciaron tratamiento el 74,6 %(100/134) y lograron respuesta viral sostenida todos los quelo completaron (96/96). Con este sistema hemos tratado al58,5 % (100/171) de los pacientes detectados. La única asociación detectada entre tratamiento antiviral y variablesdel paciente fue que presentar comorbilidades se asociócon no ser tratado (OR 7,14, p < 0,001).Conclusiones: este sistema de alerta permite minimizar lapérdida de pacientes en el circuito asistencial y presentatasas elevadas de pacientes tratados. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Antiviral Agents/therapeutic use , Retrospective Studies
9.
Rev Esp Enferm Dig ; 113(12): 825-832, 2021 12.
Article in English | MEDLINE | ID: mdl-34157846

ABSTRACT

INTRODUCTION: abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. The aim of this study was to determine whether ALB is a risk factor for unfavorable clinical outcome and involvement. MATERIALS AND METHODS: a retrospective, single-center study in confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as any elevation of total bilirubin, AST, ALT, alkaline phosphatase, and/or GGT above the upper limit of normal. First, an assessment was made of the correlation between ALB and need for hospitalization. This was followed by an assessment of the correlation of ALB in hospitalized patients with demographic variables, comorbidities, and treatment for COVID-19, and with clinical involvement and outcome. The statistical analysis was performed using an age-adjusted multiple logistic regression with a p-value < 0.05. RESULTS: of 1,277 confirmed cases, 346 required hospitalization and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9 % vs. 10.3 %, p ˂ 0.001). Among hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities, or treatment for COVID-19, except for low molecular weight heparin. There was a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation of ALB with longer hospital stay and admission to the intensive care unit, but this did not imply increased mortality. CONCLUSIONS: ALB correlates with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.


Subject(s)
COVID-19 , Hospitalization , Humans , Liver , Prognosis , Retrospective Studies , SARS-CoV-2
11.
Rev Esp Enferm Dig ; 113(1): 69-70, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33207899

ABSTRACT

Hepatic hemangioendothelioma is a rare tumor which has malignant potential and a difficult radiological differential diagnosis that includes many others liver tumors as metastasic carcinoma, cholangiocarcinoma and, especially, angiosarcoma. Thus, it is an entity that is usually not diagnosed in an accurate way by radiology and further histolopathological study is needed. However, hemangioendothelioma can present certain specificied patterns in contrast-enhanced imaging. In this regard, we present the case of a patient with an epithelioid hemangioendothelioma that shows these radiological features.


Subject(s)
Bile Duct Neoplasms , Cholangiocarcinoma , Hemangioendothelioma, Epithelioid , Hemangioendothelioma , Liver Neoplasms , Bile Duct Neoplasms/diagnostic imaging , Bile Ducts, Intrahepatic , Cholangiocarcinoma/diagnostic imaging , Diagnosis, Differential , Hemangioendothelioma, Epithelioid/diagnostic imaging , Humans , Liver Neoplasms/diagnostic imaging
12.
Rev Esp Enferm Dig ; 112(6): 508-509, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32496112

ABSTRACT

The presence of congenital portosystemic shunts in adult patients is an uncommon entity that can manifests itself with hepatic encephalopathy symptoms. However, its clinical presentation can be very diverse and varied, hence it is essential to bear it in mind to be able to diagnose it. In this manuscript we exemplify this variability by presenting a patient with complex long-standing neurological syndrome of uncertain origin, that was finally diagnosed of portosystemic shunt. To perform a percutaneous shunt closure is recommended to achieve resolution of the clinical manifestations, as happened in our patient.


Subject(s)
Hepatic Encephalopathy , Portasystemic Shunt, Transjugular Intrahepatic , Vascular Malformations , Hepatic Encephalopathy/etiology , Humans , Portal Vein/diagnostic imaging , Vascular Malformations/complications , Vascular Malformations/diagnostic imaging , Vascular Malformations/surgery
14.
Rev Esp Enferm Dig ; 110: 675-676, 2018 09 03.
Article in English | MEDLINE | ID: mdl-30338690

ABSTRACT

There has been an increase in the incidence rates in recent years of sexually transmitted diseases within the cohort of males who have sex with other men (MSM). An outbreak of acute hepatitis due to the hepatitis A virus was reported in 2017, both nationally and internationally. The sexual practices of this cohort are strongly implicated as a mechanism of infection. This situation was assessed in our health district and the incidence rate of this disease in 2017 was higher than usual. MSM practices are the potential cause of transmission in 52% of the cases (12/23). This situation triggers a change in the contagion risk factors for this disease. Therefore, we believe that we must provide health education and act within the MSM group to avoid new outbreaks in the future.


Subject(s)
Disease Outbreaks , Hepatitis A/epidemiology , Hepatitis A/transmission , Acute Disease , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Risk Factors , Sexual Behavior , Spain/epidemiology , Young Adult
16.
Rev Gastroenterol Peru ; 37(1): 96-99, 2017.
Article in Spanish | MEDLINE | ID: mdl-28489846

ABSTRACT

Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates.The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.


Subject(s)
Gastrointestinal Hemorrhage/microbiology , Liver Failure, Acute/microbiology , Weil Disease/diagnosis , Fatal Outcome , Gastrointestinal Hemorrhage/diagnosis , Humans , Liver Failure, Acute/diagnosis , Male , Middle Aged , Weil Disease/complications
17.
Rev. gastroenterol. Perú ; 37(1): 96-99, ene.-mar. 2017. ilus
Article in Spanish | LILACS | ID: biblio-991233

ABSTRACT

La leptospirosis es una enfermedad causada por la espiroqueta Leptospira. Se trata de una zoonosis de distribución mundial, con predominio en los trópicos. En España no es frecuente pero sí se observan casos en zonas más húmedas o con presencia de ríos, lagos o estanques, como son Cataluña, Andalucía o la Comunidad Valenciana, donde se relaciona con los arrozales. Los transmisores son múltiples animales como vacas o ratas, contagiándose el ser humano mediante contacto directo con estos animales o su orina, o bien de forma indirecta al consumir o estar en contacto con agua contaminada por la orina de éstos. Las manifestaciones clínicas son muy variables, siendo asintomática o poco sintomática en la mayoría de los pacientes. Aunque no ocurre siempre, la leptospirosis cursa con una primera fase con fiebre, mialgias, afectación renal o hemorragia de distintos órganos, seguida de una segunda fase con presencia de ictericia por afectación hepática. La enfermedad de Weil es una forma de leptospirosis grave caracterizada por afectación hepática con ictericia e insuficiencia renal aguda, asociada a una considerable mortalidad. El diagnóstico se basa en técnicas serológicas y detección de DNA mediante PCR. El tratamiento consta de medidas de soporte y antibioticoterapia. Presentamos un paciente con enfermedad de Weil y hemorragia digestiva por leptospirosis, con una evolución clínica fulminante, y hacemos hincapié en la necesidad de tener presente esta entidad, especialmente en ambientes epidemiológicos favorables como el de este paciente, con el fin de lograr un diagnóstico precoz.


Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates. The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.


Subject(s)
Humans , Male , Middle Aged , Weil Disease/diagnosis , Liver Failure, Acute/microbiology , Gastrointestinal Hemorrhage/microbiology , Weil Disease/complications , Liver Failure, Acute/diagnosis , Fatal Outcome , Gastrointestinal Hemorrhage/diagnosis
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