Utilización y eficacia de la técnica de bombeo hepático / No disponible

Objetivo: buscar evidencias de la utilización de las técnicas de bombeo visceral en el ámbito de la osteopatía. Método: fue realizada una búsqueda de la bibliografía disponible, utilizando los métodos formales de revisión sistemática, siguiendo las recomendaciones preconizadas por el "Standard PRISMA". Las bases de datos utilizadas fueron: PubMed, MEDLINE, SciELO, Biblioteca Cochrane, LILACS, Scientific European Federation Osteopaths (S.E.F.O.) y IBECS. Los criterios de inclusión fueron publicaciones a partir de enero de 1998, artículos que discutiesen sobre el tratamiento osteopático visceral y publicaciones exclusivamente con enfoque direccionado a la utilización de las técnicas de bombeo. Resultados: Después de un total de 1.739 publicaciones recuperadas y tomándose en consideración los factores de inclusión y exclusión preconizados por el patrón "Standard PRISMA", 9 artículos fueron seleccionados. 3 son estudios experimentales en animales, 4 en humanos y 2 son revisiones de la literatura. Conclusiones: las técnicas de bombeo visceral han sido ampliamente utilizadas por profesionales de osteopatía hace más de un siglo. Su eficacia ha sido demostrada en el ámbito de los sistemas linfático e inmunológico. Hasta el momento, las publicaciones de evidencias y efectos de estas técnicas realizadas exclusivamente sobre el hígado, son prácticamente inexistentes y no dan apoyo a una afirmación basada en datos concretos y consistentes

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Occupational Therapy Home Modification Assessment and Intervention.

Evidence Connection articles describe a clinical application of a systematic review developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice (EBP) Project. This Evidence Connection provides a case report of a client referred to occupational therapy for home modification assessment and intervention, applying the evidence from the systematic review of home modifications conducted in conjunction with the EBP Project. The client received in-home occupational therapy after side effects of liver disease resulted in increased falls within her home.

The role of narrative medicine in pregnancy after liver transplantation.

UNLABELLED: Narrative medicine allows professionals from all fields of medical sciences to understand the patient's total experience of illness, and meet his/her needs in an empathetic environment. Narrative medicine helps spread holistic knowledge of a multitude of complex clinical conditions, including transplantation. OBJECTIVE: To underline the role of narrative medicine in women who become pregnant after a liver transplant by using their narrations of this very special experience. METHODS: We describe our study with narration and listening to the stories of three women expecting their first child after a liver transplant, by analysing the structure and role of narration in the context of relationships between patients and caregivers. The narrations were transcribed verbatim with the main plot analysed in order to address all the aspects of this rare clinical condition and the transition to parenthood. RESULTS: The women narrated this experience in three phases: transplantation, pregnancy and delivery, and post-partum. They described all phases of pregnancy as stressful but satisfying, whereas the fact of becoming a mother was perceived as a victory both as a woman and as a transplant patient. CONCLUSIONS: Our results suggest that narrative medicine represents a significant professional tool for caring for transplant patients during pregnancy.

[The use of mineral waters for the rehabilitative treatment of the patients with non-alcoholic lesions of the liver in the hospital environment].

A method has been developed for the correction of metabolic, hepato-biliary, and ischemic disorders in the patients with chronic nonalcoholic lesions of the liver by means of combined treatment using pharmaceutical agents (ursosan and Omega-3), Tib-2 drinking mineral water, and sinusoidal modulated currents (SMC) electrophoresis of this water in the right hypochondrial region. This therapy ensured pathogenetically sound modulation of the functional state of the liver and the biliary tract; moreover, it reduced the severity of regional ischemia, improved rheologic properties of the blood, normalized lipid metabolism and peroxidation, influenced production ofpro-inflammatory cytokines.

[Rehabilitation for digestive and metabolic diseases. Quo vadis?]. / Rehabilitation bei Verdauungs- und Stoffwechselkrankheiten. Quo vadis?

The position of rehabilitation in gastroenterology, hepatology and metabolic diseases has changed little in the last 25 years. Initial improvements in quality are oriented more to the content of rehabilitative measures and less to organizational basic conditions. Nevertheless, there is an urgent need for action if rehabilitation medicine is to achieve an equivalent and recognized position in the interaction between primary care and other medical specialties. In this article suggestions for expedient prerequisites and utilization options of rehabilitation in the fields of hepatogastroenterology and metabolism will be presented, which are also oriented to the exemplary implemented concepts from Sweden and The Netherlands.

Influence of the primary disease on rehabilitation results in the early postoperative period in patients after orthotopic liver transplantation.

BACKGROUND: Rehabilitation after orthotropic liver transplantation (OLT) is a difficult clinical problem due to severe comorbidities and complications. We evaluated the rehabilitation progress in the early postoperative period of patients after OLT depending on the reason for liver transplantation. MATERIALS AND METHODS: We retrospectively evaluated 309 OLT recipients transplanted between 2003 and 2006, including 161 women and 148 men. We analyzed the results of early postoperative rehabilitation measured by the time to full, active, erection upright after surgery. We divided the patients into 5 groups due to etiology of liver failure: group A (n = 89; mean age, 46.7 years) consisted of patients with liver cirrhosis due to hepatitis B, C, or both; group B (n = 70; mean age, 43.8 years) included patients with primary biliary cirrhosis and primary sclerosing cholangitis; group C (n = 44; mean age, 46 years) conprised patients with postalcoholic liver cirrhosis; group D (n = 23; mean age, 29.7 years) had experienced acute or subacute liver failure; and group E (n = 83; mean age, 37.4 years) had other reasons of liver failure. All patients were included in an identical rehabilitation program. RESULTS: The mean time to full, active, erection upright was dependent on the reason for liver failure. The best result was observed in groups A and E (4.51 and 4.6 days, respectively), medium in groups B and C (5.3 and 5.02, respectively), and worst in group D (8.5 days). The differences between groups A, E, and D were significant. CONCLUSION: The best results were obtained in groups A and E, where full, active, erection upright was achieved at 4.51 and 4.60 days respectively, and worst in group D, where it was achieved on day 8.50. These results need to be taken into account in planning the rehabilitation process for OLT patients. When analyzing the correlation between full, active, erection upright and primary diseases, one of the factors contributing to the delay needs to be assumed to be the inability to develop compensating mechanisms in the cases of acute and subacute hepatic failures, resulting from the sudden development of the disease.

Chronic liver disease--an increasing problem: a study of hospital admission and mortality rates in England, 1979-2005, with particular reference to alcoholic liver disease.

AIMS: To determine time trends in hospital admissions for chronic liver disease in England between 1989/1990 and 2002/2003, mortality rates in England and Wales between 1979 and 2005, and the influence of alcohol-related disease on these trends. METHODS: Hospital episode statistics for admissions in England were obtained from the Information Center for Health and Social Care and mortality data for England and Wales from the Office for National Statistics. RESULTS: Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females over the study period. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. While there was a smaller rise for chronic viral hepatitis B and C, admission rates declined for hepatitis A, autoimmune hepatitis, and primary biliary cirrhosis. Mortality rates for chronic liver disease more than doubled between 1979 and 2005. Two thirds of these deaths were attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver disease mortality was in the 45-64 age group, and the largest percentage increase between 1979 and 2005 occurred in the 25-34 age group. CONCLUSIONS: Hospital admissions and mortality in England from chronic liver disease are increasing. The underlying reasons are complex, but alcohol-induced liver disease makes a major contribution. There are clear social and health implications if the trend continues and addressing alcohol-related liver disease should be a public health priority.

Disease characteristics as determinants of the labour market position of adolescents and young adults with chronic digestive disorders.

BACKGROUND: Job prospects can be problematic for young patients with chronic digestive disorders. OBJECTIVES: To compare the employment status and disease burden in young adult patients with several chronic digestive disorders with healthy controls, and to determine whether labour participation depends on disease characteristics, such as type of diagnosis and burden of disease. PARTICIPANTS: In total 622 patients categorized into five diagnostic groups--inflammatory bowel disease (IBD) (n=274), chronic liver diseases (n=78), congenital digestive disorders (n=104), food allergy (n=77), celiac disease (n=89)--and a population-based control group (n=248), age 15-24 years. METHODS: Labour participation and burden of disease (i.e. consequences of the disease in daily life) were assessed by a postal questionnaire. Multivariate statistics were computed to investigate the relationship between disease characteristics and labour participation. RESULTS: Patients with IBD or chronic liver diseases were found to have limited job prospects. Patients with chronic liver diseases, IBD and food allergy reported more disease burden regarding several indicators compared with controls. Logistic regression analyses including background characteristics revealed socio-economic status (educational level of parents) and nocturnal toilet use as important determinants of employment. In addition, gender and medication intake were found to be most determinative for a full-time position. CONCLUSIONS: The possible impact of IBD and chronic liver diseases on the labour participation of young adults should be recognized and deserves extra attention from gastroenterologists so that young patients can be supported to increase their job opportunities.

Validation of the German version of the Chronic Liver Disease Questionnaire.

OBJECTIVE: The Chronic Liver Disease Questionnaire is an instrument for the assessment of health-related quality of life in patients with chronic liver diseases. So far it has not been validated for German speaking countries. METHODS: Two hundred and three consecutive patients with chronic liver diseases (age, 52.7 +/- 13.9 years; 47% female; 45% no cirrhosis, 21% Child's class A, 15% Child's class B and 17% Child's class C cirrhosis; 52% with chronic viral hepatitis, 32% with alcoholic and 16% with other liver diseases) of a liver centre completed the German version of the Chronic Liver Disease Questionnaire (CLDQ-D), the Short Form Health Survey SF-36, the Hospital Anxiety and Depression Scale (HADS) and the Giessener Symptom List GBB-24. Fifty stable patients filled in the CLDQ-D a second time within 3 - 8 days. RESULTS: With 97.7% completed items the acceptance by the patients was high. The internal consistency (Cronbach alpha) for the subscales ranged from 0.69 to 0.95, the test-retest reliability ranged from 0.79 to 0.88. The correlation coefficients with similar subscales of the instruments used for validation ranged between 0.5 and 0.9 (convergent validity). Patients with liver cirrhosis Child-Pugh stage C scored significantly lower in the subscales 'Abdominal Symptoms', 'Activity' and 'Worry', indicating a reduced health-related quality of life than in patients without cirrhosis (P < 0.05) (discriminant validity). CONCLUSION: The CLDQ-D is well accepted by patients with chronic liver diseases and has good reliability and satisfactory discriminant validity.

[Social-medical aspects of chronic liver diseases]. / Sozialmedizinische Aspekte chronischer Lebererkrankungen.

In our country liver diseases are frequent and have many different causes. They can often develop into cirrhosis of the liver with mortality beetween 13.5% and 24.5%. Hepatitis B and C-viral infections frequently play a significant role in the recognition of an occupational disease in the case of medical staff, with histological criteria of major importance in this respect. A consequence of cirrhosis of the liver may be the development of hepatoencephalopathia of varying degrees of severity. As it is then likely that a patient will no longer be able to drive motor vehicles, it is important that attending physicians inform their patients accordingly. Liver transplants are an acknowledged method of treatment in the therapy of advanced liver cirrhosis. Rehabilitation shortly after transplantation is highly important to help ensure a speedy return to work. Surprisingly, reintegration is more difficult in patients suffering from alcohol related liver disease than in those with non-alcohol-related liver disease.

Bayesian multiple testing for two-sample multivariate endpoints.

In clinical studies involving multiple variables, simultaneous tests are often considered where both the outcomes and hypotheses are correlated. This article proposes a multivariate mixture prior on treatment effects, that allows positive probability of zero effect for each hypothesis, correlations among effect sizes, correlations among binary outcomes of zero versus nonzero effect, and correlations among the observed test statistics (conditional on the effects). We develop a Bayesian multiple testing procedure, for the multivariate two-sample situation with unknown covariance structure, and obtain the posterior probabilities of no difference between treatment regimens for specific variables. Prior selection methods and robustness issues are discussed in the context of a clinical example.

Colestasis hepática en neonatos asociada a nutrición parenteral / Cholestasis associated parenteral nutrition in neonates

La administración de nutrición parenteral total (NPT) se asocia en un porcentaje elevado de pacientes a una alteración de los parámetros indicadores de la función hepática. En estos casos se aconseja retirar la nutrición parenteral e iniciar nutrición enteral lo antes posible. Entre los factores nutricionales que predisponen a colestasis hepática se encuentran: aporte calórico excesivo de lípidos, tipo de mezcla lipídica aportada en la NPT (los de cadena larga LCT mayor que los de cadena corta MCT) y duración de la NPT. En pacientes neonatos, además, la taurina juega un papel muy importante en la prevención y reducción de colestasis asociada con NPT prolongada (AU)

High-performance liquid chromatography improves diagnostic efficiency of carbohydrate-deficient transferrin.

Carbohydrate-deficient transferrin (CDT) is considered a useful biochemical marker of regular high alcohol intake. CDT was measured in the sera of 51 alcohol abusers, 20 patients with non-alcoholic liver disease and 30 healthy controls with an alcohol intake of < 30 g/day. The mean CDT levels of these three groups respectively were determined with high-performance liquid chromatography (HPLC; 4.6 +/- 5.2%; 0.7 +/- 0.2%; 0.7 +/- 0.2%) and with a radioimmunoassay after microcolumn anion-exchange chromatography (MAEC/RIA; 34.2 +/- 26.9 U/l; 16.9 +/- 3.8 U/l; 18.0 +/- 5.7 U/l). CDT levels in patients with severe alcohol abuse (161.6 +/- 96.4 g/day) were significantly higher than in the two other groups under investigation (P < 0.0001). In heavily drinking subjects, the mean daily alcohol intake correlated with aspartate aminotransferase levels (ASAT) but not with the CDT levels determined either with HPLC or MAEC/RIA. With both methods, the CDT levels were slightly higher in patients with an ASAT concentration > 30 U/l, which may indicate an advanced liver damage (P < 0.05). Analysis of receiver-operating characteristic (ROC) plots demonstrated that the diagnostic accuracy of the HPLC method, which determines the relative amount of CDT, was significantly higher than the established MAEC/RIA method, which measures the absolute amount of CDT (area under the ROC curve: 0.95 +/- 0.02 vs 0.73 +/- 0.05; P < 0.0001). At a specificity of > 95%, the sensitivity of CDT determined with HPLC and MAEC/RIA was 80 and 47%, respectively. In addition, HPLC may be a useful and reliable method for the determination of this important biochemical marker, since the HPLC chromatogram is a visible document of the successful isotransferrin separation and measurement.

[Gastroenterologic and hepatologic rehabilitation today--on changes in indications and contents]. / Die gastroenterologische und hepatologische Rehabilitation heute--zum Wandel der Indikationen und Inhalte.

The rehabilitation in gastrointestinal diseases has experienced the introduction of new concepts. Regional health resorts (i.e., mineral springs, climate or mud baths) do not play a role anymore. Today, rehabilitation cliniques are teaching and training centers for chronic patients with multiprofessional teams. The need for rehabilitation cannot be derived from the diagnosis alone or the duration of the illness but from the severity of the symptoms and/or additional psychosocial problems. The order of the application of different techniques during medical rehabilitation differs from patient to patient and necessitates a definition of the rehabilitation goal. Chronic inflammatory bowel disease, chronic pancreatitis, and chronic liver diseases are explained as an example. "Rehabilitation of gastrointestinal or metabolic diseases' is often better described with a model of progression than with the traditional model of disablement. Therefore, a network of clinical and ambulant rehabilitation as well as an entanglement of institutions providing hospital care and after-care is required.

Nutrición parenteral total ciclada en niños

El soporte nutricional con nutrición parenteral total (NPT) ha permitido que la sobrevida de muchos niños con disfunción intestinal sea mayor. la gama de disfunción y enfermedad hepática grave relacionada con el uso de la NPT ha emergido como consecuencia del uso de NPT por tiempo prolongado. La colestasis intrahepática, es uno de los problemas más frecuentes y ocacionalmente graves asociados con NPT prolongada. La NPT ciclada (NPT) referida también como intermitente o discontínua, disminuye la incidencia de complicaciones provocadas por NPT prolongada. Muchas ventajas teóricas y prácticas sicológicas por el uso de la NPTC han sido descritas. Este artículo describe las indicaciones, las deferencias maneras de ciclar, la monitori-zación y las complicaciones por la adminis-tración de NPTC en niños.

[Resolved and unresolved problems of liver surgery]. / Reshennye i nereshennye voprosy khirurgii pecheni.

Present-day status liver surgery is reviewed. The unsolved problems in surgical treatment of patients with focal lesions of the liver are listed. There is a deficit of modern diagnostical equipment, especially in rural regions of the country. There is a need for special training of specialists for liver surgery and a network of the regional centers for liver and biliary surgery, wider indications for liver resection.