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1.
Acta Gastroenterol Belg ; 85(1): 29-33, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35304991

RESUMO

Background: PEG (percutaneous endoscopic gastrostomy) is a well established endoscopic procedure for enteral feeding. However, patients with a shorter life expectancy will not benefit from PEG tube placement. Furthermore, some specific evolving diseases will never benefit from PEG. The aim of the study focuses on short and long term mortality rates after PEG tube placement in a referral gastroenterology centre (Geneva University Hospital). 219 patients were enrolled in this study. Patients and methods: All patients scheduled for a PEG procedure between January 2011 and December 2014 were included. Nine patient parameters were collected for further analysis as well as the main underlying disease requiring PEG tube placement. Patients were subsequently divided into 4 groups according to underlying disease: Group 1) swallowing disorders of neurologic origin; Group 2) swallowing disorders associated with upper digestive tract neoplasia ; Group 3) nutritional support for a non GI reason ; Group 4) Other. Results: 219 patients had undergone a PEG tube placement. 33 patients died within 60 days after the procedure. After one year, 71 patients died. Global survival was 870 days. The nutritional support group had the better survival rate with 1276 days compared to the swallowing groups and others. The multivariate analysis has highlighted the underlying disease as the only associated parameter with short and long term mortality. Conclusions: PEG tube placement is associated with high short and long term mortality depending on the underlying disease. We outlined the potential role of PEG tube insertion as a supportive transient approach for nutritional support.


Assuntos
Transtornos de Deglutição , Gastrostomia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Nutrição Enteral , Gastroscopia , Gastrostomia/métodos , Humanos , Intubação Gastrointestinal
2.
Vaccine ; 39(26): 3459-3466, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34023135

RESUMO

BACKGROUND: Solid organ transplantation (SOT) candidates and recipients are highly vulnerable to invasive pneumococcal diseases (IPD). Data on which to base optimal immunization recommendations for this population is scant. The national distribution of IPD serotypes led the Swiss Health Authorities to recommend in 2014 one dose of pneumococcal-13-valent-conjugate-vaccine (PCV13), without any subsequent dose of the 23-valent-polysaccharide-pneumococcal-vaccine (PPV23). METHODS: This is a retrospective analysis of pneumococcal immunity using a multiplex binding assay, to assess seroprotection rates against a selection of seven PCV13- and seven PPV23-serotypes in SOT-candidates and recipients evaluated and/or transplanted in 2014/2015 in the University Hospitals of Geneva. Seroprotection was defined as serotype-specific antibody concentration greater than 0.5 mg/l and overall seroprotection when this was achieved for ≥ 6/7 serotypes. RESULTS: Pre-vaccination and at time of transplant sera were available for 35/43 (81%), and 43/43 (100%) SOT-candidates respectively. At listing, 17/35 (49%) SOT-candidates were seroprotected against PCV13 and 21/35 (60%) against PPV23 serotypes. Following one systematic dose of PCV13 at listing, 35/43 (81%) SOT-recipients were seroprotected at day of transplant against PCV13-serotypes and 34/43 (79%) against PPV23 serotypes, compared to 21/41 (51%) and 28/41 (68%) respectively in the controls transplanted in 2013, before the systematic PCV13-vaccination. CONCLUSIONS: The systematic vaccination with PCV13 of all SOT candidates without additional PPV23 is a good strategy as it confers seroprotection against a wide range of pneumococcal serotypes. Indeed, one of five PCV13-vaccinated SOT-candidates was nevertheless not seroprotected at time of transplant, reflecting their partial immune competence, and indicating the need for additional dose of pneumococcal vaccines before transplant.


Assuntos
Transplante de Órgãos , Infecções Pneumocócicas , Humanos , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Estudos Retrospectivos , Streptococcus pneumoniae , Vacinas Conjugadas
3.
Am J Transplant ; 16(8): 2473-8, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27109874

RESUMO

Most countries exclude human immunodeficiency virus (HIV)-positive patients from organ donation because of concerns regarding donor-derived HIV transmission. The Swiss Federal Act on Transplantation has allowed organ transplantation between HIV-positive donors and recipients since 2007. We report the successful liver transplantation from an HIV-positive donor to an HIV-positive recipient. Both donor and recipient had been treated for many years with antiretroviral therapy and harbored multidrug-resistant viruses. Five months after transplantation, HIV viremia remains undetectable. This observation supports the inclusion of appropriate HIV-positive donors for transplants specifically allocated to HIV-positive recipients.


Assuntos
Sobrevivência de Enxerto/imunologia , Infecções por HIV/cirurgia , Soropositividade para HIV , HIV-1/imunologia , Transplante de Fígado , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos , Idoso , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
4.
Rev Med Suisse ; 9(396): 1577-80, 1582-3, 2013 Sep 04.
Artigo em Francês | MEDLINE | ID: mdl-24066465

RESUMO

Liver tests abnormalities during pregnancy should encourage the clinician to seek liver diseases of pregnancy. The liver diseases of pregnancy are those proper to pregnancy including hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, all the "hypertensive" related diseases and acute fatty liver of pregnancy. These pathologies can involve the vital prognosis of the mother and the child. An adequate management reduces maternal-fetal complications. Close monitoring of pregnancy with sometimes induction of labour and verification of the normalization of liver tests after childbirth are essential.


Assuntos
Hepatopatias/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Colestase Intra-Hepática/complicações , Colestase Intra-Hepática/fisiopatologia , Colestase Intra-Hepática/terapia , Fígado Gorduroso/fisiopatologia , Fígado Gorduroso/terapia , Feminino , Humanos , Hiperêmese Gravídica/fisiopatologia , Hiperêmese Gravídica/terapia , Hipertensão Induzida pela Gravidez/fisiopatologia , Hipertensão Induzida pela Gravidez/terapia , Hepatopatias/complicações , Hepatopatias/fisiopatologia , Testes de Função Hepática , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Prognóstico
6.
Rev Med Interne ; 33(8): 439-45, 2012 Aug.
Artigo em Francês | MEDLINE | ID: mdl-22284952

RESUMO

Long-term treatment with proton pump inhibitors (PPI) is becoming more prevalent. Although they are well tolerated in the short term, serious concerns about long-term use have arisen. Recent data suggest that the latter is associated with an increased risk for osteoporotic fracture (especially vertebral), Clostridium difficile infection and rebound acid hypersecretion after treatment discontinuation. Acute interstitial nephritis is rare but may progress to chronic renal failure. An increased risk of community-acquired pneumonia has not been established in the general population and seems limited to the most vulnerable patients. Consistent data are still missing to correctly assess the risk of iron deficiency, vitamin B12 deficiency or hypomagnesaemia and the risk of digestive malignant diseases, despite the pathophysiological basis that exists concerning gastric malignancy. Many drug interactions can occur on long-term treatment, including some that imply the cytochrome P450 enzymes. Finally, the risk-benefit balance for a chronic PPI use in children seems unfavorable in most cases.


Assuntos
Inibidores da Bomba de Prótons/efeitos adversos , Adenocarcinoma/induzido quimicamente , Adenocarcinoma/epidemiologia , Antiulcerosos/administração & dosagem , Antiulcerosos/efeitos adversos , Antiulcerosos/uso terapêutico , Interações Medicamentosas , Neoplasias Gastrointestinais/induzido quimicamente , Neoplasias Gastrointestinais/epidemiologia , Humanos , Infecções/induzido quimicamente , Infecções/epidemiologia , Nefrite/induzido quimicamente , Nefrite/epidemiologia , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/uso terapêutico , Medição de Risco , Fatores de Tempo , Deficiência de Vitamina B 12/induzido quimicamente , Deficiência de Vitamina B 12/epidemiologia
8.
Case Rep Gastroenterol ; 5(1): 217-22, 2011 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-21552449

RESUMO

Lenalidomide is a recent thalidomide analog used for the treatment of refractory multiple myeloma. The main toxicity of this drug consists in severe neutropenia and thrombocytopenia. Lenalidomide-associated liver injury is rare, manifesting itself as elevated liver enzymes and hyperbilirubinemia reversible upon weeks after drug withdrawal. We report here in detail the clinical course as well as the biological and histological alterations of an acute lenalidomide-induced liver injury. Findings on liver biopsy allowed us to discriminate acute inflammatory changes due to the drug and minor associated lesions of graft-versus-host disease in this patient with recurrent myeloma after allogeneic bone marrow transplantation.

11.
Acta Gastroenterol Belg ; 73(1): 52-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20458851

RESUMO

Liver stiffness values in transient elastography (TE) have to be interpreted with caution. Steatosis, congestion, acute inflammation and extrahepatic cholestasis can indeed influence measurements. Obtained stiffness values in the cirrhotic range can also be present in the absence of fibrosis as in hepatic amyloidosis. Here we report two cases of systemic amyloidosis with hepatic involvement where high stiffness values were measured at TE. In fact, deposits of amyloid may increase the rigidity of the liver parenchyma resulting in higher liver stiffness values. Therefore, results of TE should always be interpreted in their clinical context and if inconsistent, the performance of a liver biopsy might be necessary.


Assuntos
Amiloidose/diagnóstico , Técnicas de Imagem por Elasticidade , Hepatopatias/diagnóstico , Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Rev Med Suisse ; 6(233): 198-202, 2010 Jan 27.
Artigo em Francês | MEDLINE | ID: mdl-20214192

RESUMO

Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide and its incidence has increased over the last years in most developed countries. The majority of HCCs occur in the context of liver cirrhosis. Therefore, patients with cirrhosis and those with hepatitis B virus infection should enter a surveillance program. Detection of a focal liver lesion by ultrasound should be followed by further investigations to confirm the diagnosis and to permit staging. A number of curative and palliative treatment options are available today. The choice of treatment will depend on the tumor stage, liver function and the presence of portal hypertension as well as the general condition of the patient. A multidisciplinary approach is mandatory to offer to each patient the best treatment.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica , Humanos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Transplante de Fígado , Fatores de Risco
13.
Transplant Proc ; 41(10): 4425-7, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20005415

RESUMO

Acute primary Toxoplasma gondii infection is usually considered to be a contraindication for solid organ transplantation. Recent reports of acute T. gondii infection have highlighted the need to include T. gondii serology in the pretransplant screening of solid-organ transplant recipients. However such serology might be misleading. We describe the case of a 25-year-old woman who received a liver transplantation for life-threatening liver failure due to hepatitis B virus infection. The presence of high IgM titers against T. gondii, as detected by membrane immunoassay, immunofluorescence, and mu-capture ELISA tests, together with the absence of IgG antibodies in the immediate pretransplant serology screening suggested acute primary T. gondii infection at the time of transplantation. We initiated a preemptive therapy with intravenous clindamycin and cotrimoxazole. However, negative PCR and IgA capture assays, together with the absence of a sustained IgG response finally excluded the initial diagnosis of primary toxoplasmosis, leading to discontinuation of antitoxoplasmosis therapy. This case illustrates the problem that, in the context of fulminant hepatitis B, serologic markers for acute primary toxoplasmosis can be falsely positive. Confirmation by PCR and IgA antibody determinations is required to confirm this diagnosis.


Assuntos
Hepatite B/cirurgia , Complicações Intraoperatórias/diagnóstico , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Toxoplasmose/cirurgia , Adulto , Animais , Autoanticorpos/análise , Cadáver , Feminino , Hepatite B/complicações , Antígenos E da Hepatite B/análise , Humanos , Imunoglobulina G/imunologia , Falência Hepática Aguda/sangue , Falência Hepática Aguda/imunologia , Transplante de Fígado/imunologia , Doadores de Tecidos , Toxoplasma
14.
Transpl Infect Dis ; 11(1): 33-9, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19144096

RESUMO

Hepatitis C virus (HCV) infection invariably recurs after liver transplantation (LT), leading to significant morbidity and mortality. Although the combination of pegylated interferon-alpha (IFN-alpha)/ribavirin is the preferred treatment for these patients, the optimal schedule remains undetermined. In an uncontrolled trial, 19 patients with HCV infection recurring after LT received pegylated IFN-alpha(2a), 180 mug weekly, and ribavirin, 10 mg/kg body weight daily, for 48 weeks. The proportion of patients with undetectable HCV RNA in their serum after 12 weeks of treatment was 53%. Five patients (26%) dropped out of the study due to intolerance (in 2 cases), depression (in 1), or infectious complications (in 2). A sustained virological response (SVR), defined as undetectable serum HCV RNA 24 weeks after the end of treatment, was observed in 9/19 patients (47%). SVR was associated with an early virological response after 12 weeks of therapy (P<0.001) and a treatment duration >80% (P=0.02), but not with baseline HCV RNA level or a cumulative dose of pegylated IFN-alpha(2a) or ribavirin >80% of the scheduled dose. All 4 patients with genotype 2 or 3 reached SVR, as compared with 33% of patients with genotype 1 or 4 (P=0.03). A 48-week course of pegylated IFN-alpha(2a)/ribavirin therapy is effective in patients with recurrent HCV infection after LT.


Assuntos
Antivirais/administração & dosagem , Hepatite C/tratamento farmacológico , Interferon-alfa/uso terapêutico , Transplante de Fígado/efeitos adversos , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Idoso , Antivirais/uso terapêutico , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Hepacivirus/efeitos dos fármacos , Hepatite C/mortalidade , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/administração & dosagem , Proteínas Recombinantes , Recidiva , Ribavirina/administração & dosagem , Taxa de Sobrevida , Resultado do Tratamento
15.
Br J Surg ; 96(1): 95-103, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19109800

RESUMO

BACKGROUND: Bilobar colorectal metastases are a therapeutic challenge and require a multidisciplinary approach. The aim of this study was to describe the clinical and histological outcomes of patients having neoadjuvant chemotherapy and two-step hepatectomy with right portal vein occlusion for advanced bilateral colorectal metastases. METHODS: A series of 23 consecutive patients treated with curative intent according to a standardized multidisciplinary management protocol was reviewed. RESULTS: Of 23 patients, 22 completed the programme. There was no mortality and no Clavien grade III morbidity. Median survival from the start of treatment was 45 months, and 1-, 3- and 5-year Kaplan-Meier estimates were 95, 73 and 27 per cent respectively. On histology at the first operation, ten patients had a dangerous halo of proliferating tumour cells infiltrating the surrounding liver parenchyma, of variable importance (six focal and four diffuse), regardless of the response to chemotherapy of the metastases. The dangerous halo increased in prevalence and importance (six focal and seven diffuse) between the first and second operation. CONCLUSION: Neoadjuvant chemotherapy followed by two-step hepatectomy with right portal vein occlusion is feasible, safe and may be advantageous to the patient. The appearance of a dangerous halo around the liver metastases may require adaptation of the surgical technique to decrease the risk of local recurrence.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais , Hepatectomia/métodos , Neoplasias Hepáticas/terapia , Adulto , Idoso , Quimioterapia Adjuvante/efeitos adversos , Embolização Terapêutica/métodos , Embolização Terapêutica/mortalidade , Estudos de Viabilidade , Feminino , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Veia Porta , Cuidados Pós-Operatórios/mortalidade , Reoperação/mortalidade , Análise de Sobrevida , Resultado do Tratamento
16.
Ann Oncol ; 18(2): 299-304, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17060484

RESUMO

BACKGROUND: The purpose of the study was to characterize histological response to chemotherapy of hepatic colorectal metastases (HCRM), evaluate efficacy of different chemotherapies on histological response, and determine whether tumor regression grading (TRG) of HCRM predicts clinical outcome. PATIENTS AND METHODS: TRG was evaluated on 525 HCRM surgically resected from 181 patients, 112 pretreated with chemotherapy. Disease-free survival (DFS) and overall survival (OS) were correlated to TRG. RESULTS: Tumor regression was characterized by fibrosis overgrowing on tumor cells, decreased necrosis, and tumor glands (if present) at the periphery of HCRM. With irinotecan/5-fluorouracil (5-FU), major (MjHR), partial (PHR), and no (NHR) histological tumor regression were observed in 17%, 13%, and 70% of patients, respectively. With oxaliplatin/5-FU, MjHR, PHR, and NHR were observed in 37%, 45%, and 18% of patients, respectively. Five patients, treated with oxaliplatin, had complete response in all their metastases. MjHR was associated with an improved 3-year DFS compared with PHR or NHR. MjHR and PHR were associated with an improved 5-year OS compared with NHR. CONCLUSION: Histological tumor regression of HCRM to chemotherapy corresponds to fibrosis overgrowth and not to increase of necrosis. TRG should be considered when evaluating efficacy of chemotherapy for HCRM. Histological tumor regression was most common among oxaliplatin-treated patients and associated with better clinical outcome.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Terapia Neoadjuvante , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Quimioterapia Adjuvante , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Fibrose/etiologia , Fluoruracila/administração & dosagem , Humanos , Irinotecano , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Taxa de Sobrevida , Resultado do Tratamento
17.
Rev Med Suisse ; 2(77): 1952-4, 1957-9, 2006 Sep 06.
Artigo em Francês | MEDLINE | ID: mdl-17007450

RESUMO

The success of liver transplantation essentially depends on the prevention and treatment of long term complications, which may be due to surgery, opportunistic infections, organ rejection and relapse of the initial liver disease. The side effects of immunosuppressive drugs--arterial hypertension, glucose intolerance and diabetes, dyslipidemia and obesity, renal failure, osteoporosis, malignancy, and anaemia--should be regularly screened and treated without delay. Surgical procedures in transplanted patients are safe and rarely followed by complications. Although pregnancy in this setting is considered at risk, because of prematurity and low birth weight, overall outcomes are favourable. The yearly influenza vaccination is strongly recommended. The survival and the quality of life of liver transplant patients also depend on a good communication between the general practitioner and the transplantation centre.


Assuntos
Transplante de Fígado/efeitos adversos , Seguimentos , Humanos , Imunossupressores/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
19.
Am J Transplant ; 6(6): 1430-7, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16686767

RESUMO

Hepatopulmonary syndrome (HPS) is a frequent pulmonary complication of patients with end-stage liver diseases. HPS is diagnosed by hypoxemia and pulmonary vascular dilatation and is an independent risk factor of mortality. Orthotopic liver transplantation (OLT) is the only factor that modifies the natural course of HPS. Once patients with HPS have been transplanted, their long-term survival rate is similar to transplanted patients without HPS. Consequently, HPS is an indication of OLT whatever the severity of hypoxemia. However, besides the favorable long-term survival of HPS patients with OLT, a high postoperative mortality (mostly within 6 months) has been suggested. The aim of our study was to analyze the incidence of HPS and postoperative outcome after OLT in 90 consecutive patients. All patients were prospectively included and had blood gas analysis to detect HPS. Patients with hypoxemia had contrast echocardiography to confirm HPS. Nine patients had HPS with a 50 50 mmHg in all HPS patients transplanted.


Assuntos
Síndrome Hepatopulmonar/cirurgia , Transplante de Fígado/mortalidade , Adulto , Idoso , Gasometria , Feminino , Seguimentos , Síndrome Hepatopulmonar/sangue , Síndrome Hepatopulmonar/diagnóstico por imagem , Síndrome Hepatopulmonar/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo , Ultrassonografia
20.
Endoscopy ; 38(3): 282-4, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16528658

RESUMO

Esophageal squamous-cell carcinoma is relatively common in alcohol and tobacco abusers, and it can develop rapidly after liver transplantation. We report the early detection of an esophageal squamous-cell carcinoma in a patient with alcoholic cirrhosis, diagnosed during the pre-enlistment work-up that he was undergoing before liver transplantation. This lesion had not been detected at standard endoscopy, but was well characterized using in vivo staining and microscopic examination with an "endocytoscopy" system.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Esofágicas/diagnóstico , Esofagoscópios , Esofagoscopia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Carcinoma de Células Escamosas/complicações , Corantes , Neoplasias Esofágicas/complicações , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico , Humanos , Cirrose Hepática Alcoólica/complicações , Masculino , Azul de Metileno , Microscopia , Pessoa de Meia-Idade
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