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Spirometry patterns in patients with hepatic cirrhosis
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects [-~"~ EFFECT OF PERCUTANEOUS TRANSHEPATIC PORTAL VEIN EMBOLIZATION OF THE RIGHT PORTAL VEIN (PTPE) ON INTRAHEPATIC ARTERIAL RESISTANCE IN PATIENTS WITH CIRRHOSIS Massimo Bolognesi, Daniela Milazzo, David Sacerdoti, Giancarlo Bombonato, Giorgio Gerunda, Angelo Gatta. Dept. Clinical
and Experimental Medicine, University of Padua, Italy PTPE has been proposed before of an extensive liver resection in patients with hepatocellular carcinoma (HCC). The effect of PTPE on hepatic arterial resistance in cirrhotics has not been defined. Five cirrhotics with HCC in the right lobe underwent PTPE. Portal blood mean velocity (PBV) and flow (PBF) in the main trunk (MT) and left branch (LB), and right and left arterial resistance indices (RI) (Vmax-Vmin/Vmax) were measured with echo-Doppler before and 1, 7 and 14 days after PTPE. Results: PBV and PBF (MT) decreased after 1 day (from 15.3 -1- 4.3 cm/s to 8.9 4- 3.1, p < 0.03, and from 985 -4-459 ml/min to 526 -4-94, p: NS. PBF (LB) increased after 7 days: form 317 4- 129 ml/min to 378 4- 82 (day 1), to 591 4- 217, p < 0.05 (day 7). RI values did not modify. Right RI: from 0.66 4- 0.05 to 0.65 4- 0.09 (day 1) (p: NS), left RI: from 0.73 4- 0.09 to 0.77 4- 0.09 (day 1) (p: NS). Similar RI values were obtained at 7 and 14 days. In conclusion, PTPE caused an acute decrease in PBF (MT), an increase in PBF (LB) evident only after one week, and no effect on intrahepatic arterial resistance. Neither the acute decrease in PBF (right lobe), nor its increase (left lobe) modified hepatic artery resistance. In cirrhotics, arterial blood flow seems not able to balance sudden changes in PBF.
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SPIROMETRY PATTERNS IN PATIENTS WITH HEPATIC CIRRHOSIS
B. Castaneda, Y. Zamorano, G. Vazquez, S. Moran, M. Dehesa. Clinica de
Hipertension Portal, Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS Mexico Distrito Federal; Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal; Servicio de Terapia Respiratoria, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal; Laboratorio de Gastroenterologia, Hospital de Pediatria, Centro Medico Nacional IMSS, Mexico Distrito Federal; Departarnento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal, Mexico Introduction: The presence of pulmonary alterations restrict the use of drugs (betablockers) commonly employed to prevent hemorrhage in patients with liver cirrhosis. Although the presence of these alterations is seldom verified trough spirometric evaluation. Objective: To describe the frequency and patterns of respiratory alterations in patients with liver cirrhosis. Material and Methods: Cirrhotic patients were evaluated; demographical and clinical characteristics were analized; clinical, biochemical, ultrasonographic and endoscopic evaluations were also performed, as well as a spirometry and thorax radiotelegraphy. Results: One hundred and twenty two patients were included, with age range 18-70 years of which 79 were women and 43 men, 42 (34.4%) of whom smoked. The etiology of cirrhosis was HBV or HCV in 61 patients, cryptogenic in 26, alcohol in 25, hepatocarcinoma in 3 and other causes in 7 cases. According the Child-Pugh classification 60 patients were in grade A, 35 patients in grade B and 27 in grade C. Ascites was present in 25 of the patients (20.5%). Alterations were found in the thorax of 63 patients (51.6%). The spirometry pattern was normal in 48 patients (39.3%), and altered in 74 patients (60.4%) (obstructive pattern n = 15; restrictive n = 34; mixed n = 25). Conclusion: Ventilatory abnormalities were common (60.4%) in our patients. This fact justifies the inclusion of a spirometric evaluation in order to improve the treatment and decrease the risk related to the use of betablockers.
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PORTAL VEIN THROMBOSIS (PVT) IN CIRRHOTIC PATIENTS
B. Castaneda, N. Ortiz, G. Gutierrez, S. Moran, M. Dehesa. Clinica de
Hipertension Portal, Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS Mexico Distrito Federal; Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional 1MSS, Mexico Distrito Federal; Servicio de Hematologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal; Laboratorio de Gastroenterologia, Hospital de Pediatria, Centro Medico Nacional IMSS, Mexico Distrito Federal; Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal, Mexico Aim: To investigate the frequency of PVT in cirrhotic patients in the portal hypertension clinic and the factors that may predispose to its development. Methods: One hundred cirrhotic patients attending the portal hypertension clinic between June 2000 and October 2001 were studied by ultrasonografy with Doppler examination (DU). The cirrhotic patients diagnosed with PVT were evaluated clinically and special coagulation tests, anticardiolipin antibodies (Cla) and lupus anticoagulant (La) were performed. Results: Nine patients (9%) were detected with PVT (5 men, 4 women) with a mean age of 59 + 10 years, etiology of liver disease was HCV (n = 3), excessive alcohol consumption (n = 3), primary biliary cirrhosis (n = 1), non-alcoholic steatohepatitis (n = 1) and in another case the etiology could not be identified. In their clinical records bleeding associated to portal hypertension was found in 8 patients, ascites in 4, abdominal surgery in 6 and sclerotherapy in 8. All cases presented more than one altered coagulation factor. No Lupus anticoagulant and anticardiolipin antibodies could be found in these patients. Conclusions: Thrombosis frequency was similar to that reported previously. All patients with PVT had more than one predisposing factor for this condition.
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COARSE NODULAR PATTERN AND THE RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH HDV-RELATED LIVER CIRRHOSIS
Eugenio Caturelli l, Luigi Castellano 2 S averio Fusilli 3, Bruno Palmentieri2, Grazia Niro I, Ilario De Sit 2.1Gastroenterologia,
Ospedale 'Casa Sollievo Della Sofferenza' lrccs, S. Giovanni Rotondo, Foggia; 21stituto Di Medicina Interna E Gastroenterologia, li Ateneo, Napoli; 3Anatomia E Istologia Patologica, Ospedale 'Casa Sollievo Della Sofferenza' lrccs, S. Giovanni Rotondo, Foggia, Italy Background: Coarse nodular pattern (CNP) is a major risk factor for hepatocellular carcinoma (HCC) development in HCV- and HBV-related liver cirrhosis. No data are available for patients with HDV-related cirrhosis. Purpose: To quantify the incidence of the CNP in patients with different etiologies of liver cirrhosis, and the risk of developing HCC according to the etiology and to the presence of the CNP. Patients and Methods: Liver parenchymal pattern at ultrasound (US) was examined in 100 patients with HDV-related liver cirrhosis. A cohort of 302 cirrhotic patients (94 HBV-related, 100 HCV-related, 63 alcohol-related, and 45 with primary biliary cirrhosis) served as controls. All patients were in Child-Pugh class A5 to B7; none of them presented focal liver lesions at the time of enrollment. Liver parenchymal echo patterns were classified into four groups: normal, 'bright liver pattern' (BLP), 'coarse echo pattern' (CEP), and CNP. All patients were followed up at 4-6 months intervals by US and blood test, for a mean period of 43.6 months. Results: Half about of HDV-related cirrhotics presented the CNP at diagnosis, while in the other etiologic groups the CEP was the most frequent one. The CNP was highly predictive of HCC development in HCV - (55 %), HBV - (50%), and alcohol - (28.5%) related liver cirrhosis, compared with PBC (0%) and HDV-related (4%) cirrhosis. Conclusions: The CNP is a common presentation of HDV-related liver cirrhosis, and it is not associated with a higher risk of HCC development.
and Experimental Medicine, University of Padua, Italy PTPE has been proposed before of an extensive liver resection in patients with hepatocellular carcinoma (HCC). The effect of PTPE on hepatic arterial resistance in cirrhotics has not been defined. Five cirrhotics with HCC in the right lobe underwent PTPE. Portal blood mean velocity (PBV) and flow (PBF) in the main trunk (MT) and left branch (LB), and right and left arterial resistance indices (RI) (Vmax-Vmin/Vmax) were measured with echo-Doppler before and 1, 7 and 14 days after PTPE. Results: PBV and PBF (MT) decreased after 1 day (from 15.3 -1- 4.3 cm/s to 8.9 4- 3.1, p < 0.03, and from 985 -4-459 ml/min to 526 -4-94, p: NS. PBF (LB) increased after 7 days: form 317 4- 129 ml/min to 378 4- 82 (day 1), to 591 4- 217, p < 0.05 (day 7). RI values did not modify. Right RI: from 0.66 4- 0.05 to 0.65 4- 0.09 (day 1) (p: NS), left RI: from 0.73 4- 0.09 to 0.77 4- 0.09 (day 1) (p: NS). Similar RI values were obtained at 7 and 14 days. In conclusion, PTPE caused an acute decrease in PBF (MT), an increase in PBF (LB) evident only after one week, and no effect on intrahepatic arterial resistance. Neither the acute decrease in PBF (right lobe), nor its increase (left lobe) modified hepatic artery resistance. In cirrhotics, arterial blood flow seems not able to balance sudden changes in PBF.
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SPIROMETRY PATTERNS IN PATIENTS WITH HEPATIC CIRRHOSIS
B. Castaneda, Y. Zamorano, G. Vazquez, S. Moran, M. Dehesa. Clinica de
Hipertension Portal, Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS Mexico Distrito Federal; Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal; Servicio de Terapia Respiratoria, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal; Laboratorio de Gastroenterologia, Hospital de Pediatria, Centro Medico Nacional IMSS, Mexico Distrito Federal; Departarnento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal, Mexico Introduction: The presence of pulmonary alterations restrict the use of drugs (betablockers) commonly employed to prevent hemorrhage in patients with liver cirrhosis. Although the presence of these alterations is seldom verified trough spirometric evaluation. Objective: To describe the frequency and patterns of respiratory alterations in patients with liver cirrhosis. Material and Methods: Cirrhotic patients were evaluated; demographical and clinical characteristics were analized; clinical, biochemical, ultrasonographic and endoscopic evaluations were also performed, as well as a spirometry and thorax radiotelegraphy. Results: One hundred and twenty two patients were included, with age range 18-70 years of which 79 were women and 43 men, 42 (34.4%) of whom smoked. The etiology of cirrhosis was HBV or HCV in 61 patients, cryptogenic in 26, alcohol in 25, hepatocarcinoma in 3 and other causes in 7 cases. According the Child-Pugh classification 60 patients were in grade A, 35 patients in grade B and 27 in grade C. Ascites was present in 25 of the patients (20.5%). Alterations were found in the thorax of 63 patients (51.6%). The spirometry pattern was normal in 48 patients (39.3%), and altered in 74 patients (60.4%) (obstructive pattern n = 15; restrictive n = 34; mixed n = 25). Conclusion: Ventilatory abnormalities were common (60.4%) in our patients. This fact justifies the inclusion of a spirometric evaluation in order to improve the treatment and decrease the risk related to the use of betablockers.
•
0
-
199
•
PORTAL VEIN THROMBOSIS (PVT) IN CIRRHOTIC PATIENTS
B. Castaneda, N. Ortiz, G. Gutierrez, S. Moran, M. Dehesa. Clinica de
Hipertension Portal, Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS Mexico Distrito Federal; Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional 1MSS, Mexico Distrito Federal; Servicio de Hematologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal; Laboratorio de Gastroenterologia, Hospital de Pediatria, Centro Medico Nacional IMSS, Mexico Distrito Federal; Departamento de Gastroenterologia, Hospital de Especialidades, Centro Medico Nacional IMSS, Mexico Distrito Federal, Mexico Aim: To investigate the frequency of PVT in cirrhotic patients in the portal hypertension clinic and the factors that may predispose to its development. Methods: One hundred cirrhotic patients attending the portal hypertension clinic between June 2000 and October 2001 were studied by ultrasonografy with Doppler examination (DU). The cirrhotic patients diagnosed with PVT were evaluated clinically and special coagulation tests, anticardiolipin antibodies (Cla) and lupus anticoagulant (La) were performed. Results: Nine patients (9%) were detected with PVT (5 men, 4 women) with a mean age of 59 + 10 years, etiology of liver disease was HCV (n = 3), excessive alcohol consumption (n = 3), primary biliary cirrhosis (n = 1), non-alcoholic steatohepatitis (n = 1) and in another case the etiology could not be identified. In their clinical records bleeding associated to portal hypertension was found in 8 patients, ascites in 4, abdominal surgery in 6 and sclerotherapy in 8. All cases presented more than one altered coagulation factor. No Lupus anticoagulant and anticardiolipin antibodies could be found in these patients. Conclusions: Thrombosis frequency was similar to that reported previously. All patients with PVT had more than one predisposing factor for this condition.
~-~
COARSE NODULAR PATTERN AND THE RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH HDV-RELATED LIVER CIRRHOSIS
Eugenio Caturelli l, Luigi Castellano 2 S averio Fusilli 3, Bruno Palmentieri2, Grazia Niro I, Ilario De Sit 2.1Gastroenterologia,
Ospedale 'Casa Sollievo Della Sofferenza' lrccs, S. Giovanni Rotondo, Foggia; 21stituto Di Medicina Interna E Gastroenterologia, li Ateneo, Napoli; 3Anatomia E Istologia Patologica, Ospedale 'Casa Sollievo Della Sofferenza' lrccs, S. Giovanni Rotondo, Foggia, Italy Background: Coarse nodular pattern (CNP) is a major risk factor for hepatocellular carcinoma (HCC) development in HCV- and HBV-related liver cirrhosis. No data are available for patients with HDV-related cirrhosis. Purpose: To quantify the incidence of the CNP in patients with different etiologies of liver cirrhosis, and the risk of developing HCC according to the etiology and to the presence of the CNP. Patients and Methods: Liver parenchymal pattern at ultrasound (US) was examined in 100 patients with HDV-related liver cirrhosis. A cohort of 302 cirrhotic patients (94 HBV-related, 100 HCV-related, 63 alcohol-related, and 45 with primary biliary cirrhosis) served as controls. All patients were in Child-Pugh class A5 to B7; none of them presented focal liver lesions at the time of enrollment. Liver parenchymal echo patterns were classified into four groups: normal, 'bright liver pattern' (BLP), 'coarse echo pattern' (CEP), and CNP. All patients were followed up at 4-6 months intervals by US and blood test, for a mean period of 43.6 months. Results: Half about of HDV-related cirrhotics presented the CNP at diagnosis, while in the other etiologic groups the CEP was the most frequent one. The CNP was highly predictive of HCC development in HCV - (55 %), HBV - (50%), and alcohol - (28.5%) related liver cirrhosis, compared with PBC (0%) and HDV-related (4%) cirrhosis. Conclusions: The CNP is a common presentation of HDV-related liver cirrhosis, and it is not associated with a higher risk of HCC development.