- Email: [email protected]
Usefulness of two prognostic scores in patients with cirrhosis
Papers read by title
c0 ,,
]
MORPHO-CLINICAL ASPECTS IN PORTAL HYPERTENSION IN A COHORT OF CIRRHOTIC PATIENTS D. Georgescu t, C. Georgescu2, 13. Cocarla 3, L. Vasile4, I.A. Rivis 1 Semiological Clinic, University of Medeeine and Pharmacy, Timisoara, Romania. 2Clinic of Neurology, University of Medecine and Pharmacy, Timisoara, Romania. 3Department of Physiology, University of Medecine and Pharmacy, Timisoara, Romania. 4Department of Histology, University of Medecine and Pharmacy, Timisoara, Romania. There are many factors involved in the pathoganesis of portal hypertension. This paper wishes to study the presence of the different morphological aspects in order to state the possible morphoelinieal correlation in the process of portal hypertension. We have studied a number of 25 cirrhotic patients , of different etiologies with median age=61,7 years, 14 men, 11 women ,Child's grade A=12%, B=20%, C=68%., with portal hypertension proven by EchoDoppler and upper digestive endoscopy, who have been followed-up in our clinic for a period of 1-3 years and died mainly by upper digestive bleeding (rapture of eso-gastric verices). They undertook an autoptic procedure and.many samples of liver tissue (right, left and eandate lobe),were taken and histologically analised.We've made usual stains( HE, trichrome Gomori, Red Sirius), histochemieal( PAS),and tmmunohistochemical stains (antiSMA, LCA, CD3, von Willebrand factor) niDAKO-EPOS system, in order to assess following aspects: presence of the stromal and perenchimal injueies:inereasing number of Kupffer , endotelinl and Ito cells, presennce of inflammatorycells, evolution of the liver stromal populations related to the stage of the cirrhotic liver disease.We have showed an important fibrogenetic process with large amounts of collagen deposition in Disse spaces resulting in marked increasing exlxacelhilar matrix and increase of the resistence of portal vein flow, well correlated to liver stage disease and portal hypertensiongrading.
11
[
C02/51
]
USEFULNESS OF TWO PROGNOSTIC SCORES IN PATIENTS WITH CIRRHOSIS J. Sgouros, S. Siasiakou, I. Sideri, Ch. Kolettas, P. Tsiodra, A. Efstratopoulos 3rd Medical Dept. of General Hospital of Athens, Athens, Greece.
Prognostic evaluation ofpts with cirrhosis is very important in
selecting in time candidates for liver transplantation. We examined retrospectively the utility and prognostic significance of the Diseriminant Score(DS) as described by M. Adler et al and the Prognostic lndex(PI) as proposed by J. Bustamante et al in predicting mortality in cirrhotic pts. A DS>0 and a PI>0.4175 predicts death in one year. 130 cirrhotic pts (M:I00, F:30) mean aged 60 (27-86), were included. 57(44%) pts had alcoholic cirrhosis, 12(9.2%) HBV(+), 12(9.2%) HCV(+), 12(9.2%) alcoholic and HBV(+), 9(7%) alcoholic and HCV(+), 2(1.5%) alcoholic and HBV(+) and HCV(+), 7(5.3%) autoimmune and 19(14.5%) cryptogenic ]'hey were classified in 3 groups. 21 pts (16.2%) in group A (Child A), 55 (42.3%) in group B (Child B) and 54 (41.5%) in group C (Child C). The DS and the PI were calculated and it was recorded the survival in one year. The results were: DS(%) PI(%) Survival in one year Group A 33.3 31.5 68.4 Group B 69.1 69.4 30.6 Group C 100 85.5 14.6 W e c o n c l u d e that t h e s e t w o p a r a m e t e r s can help in following cirrhotic pts and selecting t h e m for transplantation.
C02/50
]
FOCAL NODULAR HYPERPLASIA-LIKE AREAS IN CIRRHOSIS A. Quaglia l, N. Prasad l, P Nozza 1, S.E. Davies l, A. Grasso 2, A.K. Burroughs2, A. Dhillon l IAcademic Department of Histopathology, Royal Free and University College Medical School, London NW3 2PE UK. 2Academic Department of Medicine, Royal Free and University College Medical School, London NW3 2PE UK. A number of morphological types of nodules have been described in the setting of cirrhosis. These include regenerative nodules, macroregenerative nodules, dysplastic nodules, and hepatoeellular carcinoma. FNH is characterised by a stellate scar, abnormal blood vessels, bile ductular proliferation, and an "inactive" cirrhosis-like pattern. This sort of lesion has rarely been described in cirrhotic livers (Sugihara S e t al. Acta Pathol Japonica 40,699-703;1990). We report four cases of FNH occurring in cirrhotic livers which were detected during examination of 300 consecutive liver transplantation (explant) specimens over a 5 year period. Pretransplant radiological studies (including angiography) did not identify these lesions. The patients (3 female) were all adults (age range= 44-53) and were transplanted for chronic liver disease (patient 1= alcoholic liver disease; patient 2 = primary sclerosing cholangitis; patient 3= primary biliary cirrhosis; patient 4 = cryptogenic chronic liver disease). In patient 1 a single 10-mm FNH-like nodule was present, with thrombosis of adjacent blood vessels. Patient 2 had one 10 mm diameter nodule. Patient 3 had 3 nodules (4, 10 and 11 mm diameter) as well as a haemangioma in the adjacent liver. Patient 4 had 4 nodules up to 20-mm diameter. All of these nodules showed histological features suggestive of FNH including stellate scars, mildly inflamed vascular fibrous septa, and ductules. They were morphologically indistinguishable from FNH occurring in non cirrhotic livers. We describe four cases of unusual FNH-like nodules in cirrhotic livers. Improved recognition could avoid their confusion with other parenchymal lesions.
158
] C02/52
]
NON INVASIVE ESTIMATION OF THE LEVELS OF HEPATIC FIBROSIS USING PULSE DOPPLER ULTRASONOGRAPHY M. Hirata, S.M.E Akbar, N. Horiike. M. Onii Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan.
As an approach to make a non invasive estimation of the
levels of hepatic fibrosis in patients with chronic liver diseases, we studied hepatic hemodynamics in 62 patients with chronic hepatitis (CH), 19 patients with cirrhosis of liver (LC) and 20 healthy normal controls (NC). Maximum velocities of blood in the left and right portal veins (LPV and RPV), and left and fight hepatic arteries (LHA and RHA) were calculated using pulse Doppler ultrasonography. Left and right artery/portal (A/P) ratios were calculated by dividing LHA with LPV and RHA with RPV, respectively. The levels of LPV and RPV were significantly lower and the levels of LHA and RHA were significantly higher in LC compared with CH and normal controls (p<0.05). Probit analysis revealed that A/P ratio of 3.5 may be used as a line to assess the progression of liver diseases, and clinically 95% patients with A/P ratios of more than 3.5 had LC. Both left and right A/P ratios increased significantly along with the increased levels of hepatic fibrosis. Levels o f Fibrosis Mild Moderate Severe Left A/P ratio 3.20+-1.19 4.79o-1.34 6.21-+2.31 Right A/P ratio 2.14,-0.52 3.22±1.27 5.19±1.84 These data show the utility of A/P ratio as an non invasive approach to estimate hepatic fibrosis in chronic liver diseases.
c0 ,,
]
MORPHO-CLINICAL ASPECTS IN PORTAL HYPERTENSION IN A COHORT OF CIRRHOTIC PATIENTS D. Georgescu t, C. Georgescu2, 13. Cocarla 3, L. Vasile4, I.A. Rivis 1 Semiological Clinic, University of Medeeine and Pharmacy, Timisoara, Romania. 2Clinic of Neurology, University of Medecine and Pharmacy, Timisoara, Romania. 3Department of Physiology, University of Medecine and Pharmacy, Timisoara, Romania. 4Department of Histology, University of Medecine and Pharmacy, Timisoara, Romania. There are many factors involved in the pathoganesis of portal hypertension. This paper wishes to study the presence of the different morphological aspects in order to state the possible morphoelinieal correlation in the process of portal hypertension. We have studied a number of 25 cirrhotic patients , of different etiologies with median age=61,7 years, 14 men, 11 women ,Child's grade A=12%, B=20%, C=68%., with portal hypertension proven by EchoDoppler and upper digestive endoscopy, who have been followed-up in our clinic for a period of 1-3 years and died mainly by upper digestive bleeding (rapture of eso-gastric verices). They undertook an autoptic procedure and.many samples of liver tissue (right, left and eandate lobe),were taken and histologically analised.We've made usual stains( HE, trichrome Gomori, Red Sirius), histochemieal( PAS),and tmmunohistochemical stains (antiSMA, LCA, CD3, von Willebrand factor) niDAKO-EPOS system, in order to assess following aspects: presence of the stromal and perenchimal injueies:inereasing number of Kupffer , endotelinl and Ito cells, presennce of inflammatorycells, evolution of the liver stromal populations related to the stage of the cirrhotic liver disease.We have showed an important fibrogenetic process with large amounts of collagen deposition in Disse spaces resulting in marked increasing exlxacelhilar matrix and increase of the resistence of portal vein flow, well correlated to liver stage disease and portal hypertensiongrading.
11
[
C02/51
]
USEFULNESS OF TWO PROGNOSTIC SCORES IN PATIENTS WITH CIRRHOSIS J. Sgouros, S. Siasiakou, I. Sideri, Ch. Kolettas, P. Tsiodra, A. Efstratopoulos 3rd Medical Dept. of General Hospital of Athens, Athens, Greece.
Prognostic evaluation ofpts with cirrhosis is very important in
selecting in time candidates for liver transplantation. We examined retrospectively the utility and prognostic significance of the Diseriminant Score(DS) as described by M. Adler et al and the Prognostic lndex(PI) as proposed by J. Bustamante et al in predicting mortality in cirrhotic pts. A DS>0 and a PI>0.4175 predicts death in one year. 130 cirrhotic pts (M:I00, F:30) mean aged 60 (27-86), were included. 57(44%) pts had alcoholic cirrhosis, 12(9.2%) HBV(+), 12(9.2%) HCV(+), 12(9.2%) alcoholic and HBV(+), 9(7%) alcoholic and HCV(+), 2(1.5%) alcoholic and HBV(+) and HCV(+), 7(5.3%) autoimmune and 19(14.5%) cryptogenic ]'hey were classified in 3 groups. 21 pts (16.2%) in group A (Child A), 55 (42.3%) in group B (Child B) and 54 (41.5%) in group C (Child C). The DS and the PI were calculated and it was recorded the survival in one year. The results were: DS(%) PI(%) Survival in one year Group A 33.3 31.5 68.4 Group B 69.1 69.4 30.6 Group C 100 85.5 14.6 W e c o n c l u d e that t h e s e t w o p a r a m e t e r s can help in following cirrhotic pts and selecting t h e m for transplantation.
C02/50
]
FOCAL NODULAR HYPERPLASIA-LIKE AREAS IN CIRRHOSIS A. Quaglia l, N. Prasad l, P Nozza 1, S.E. Davies l, A. Grasso 2, A.K. Burroughs2, A. Dhillon l IAcademic Department of Histopathology, Royal Free and University College Medical School, London NW3 2PE UK. 2Academic Department of Medicine, Royal Free and University College Medical School, London NW3 2PE UK. A number of morphological types of nodules have been described in the setting of cirrhosis. These include regenerative nodules, macroregenerative nodules, dysplastic nodules, and hepatoeellular carcinoma. FNH is characterised by a stellate scar, abnormal blood vessels, bile ductular proliferation, and an "inactive" cirrhosis-like pattern. This sort of lesion has rarely been described in cirrhotic livers (Sugihara S e t al. Acta Pathol Japonica 40,699-703;1990). We report four cases of FNH occurring in cirrhotic livers which were detected during examination of 300 consecutive liver transplantation (explant) specimens over a 5 year period. Pretransplant radiological studies (including angiography) did not identify these lesions. The patients (3 female) were all adults (age range= 44-53) and were transplanted for chronic liver disease (patient 1= alcoholic liver disease; patient 2 = primary sclerosing cholangitis; patient 3= primary biliary cirrhosis; patient 4 = cryptogenic chronic liver disease). In patient 1 a single 10-mm FNH-like nodule was present, with thrombosis of adjacent blood vessels. Patient 2 had one 10 mm diameter nodule. Patient 3 had 3 nodules (4, 10 and 11 mm diameter) as well as a haemangioma in the adjacent liver. Patient 4 had 4 nodules up to 20-mm diameter. All of these nodules showed histological features suggestive of FNH including stellate scars, mildly inflamed vascular fibrous septa, and ductules. They were morphologically indistinguishable from FNH occurring in non cirrhotic livers. We describe four cases of unusual FNH-like nodules in cirrhotic livers. Improved recognition could avoid their confusion with other parenchymal lesions.
158
] C02/52
]
NON INVASIVE ESTIMATION OF THE LEVELS OF HEPATIC FIBROSIS USING PULSE DOPPLER ULTRASONOGRAPHY M. Hirata, S.M.E Akbar, N. Horiike. M. Onii Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan.
As an approach to make a non invasive estimation of the
levels of hepatic fibrosis in patients with chronic liver diseases, we studied hepatic hemodynamics in 62 patients with chronic hepatitis (CH), 19 patients with cirrhosis of liver (LC) and 20 healthy normal controls (NC). Maximum velocities of blood in the left and right portal veins (LPV and RPV), and left and fight hepatic arteries (LHA and RHA) were calculated using pulse Doppler ultrasonography. Left and right artery/portal (A/P) ratios were calculated by dividing LHA with LPV and RHA with RPV, respectively. The levels of LPV and RPV were significantly lower and the levels of LHA and RHA were significantly higher in LC compared with CH and normal controls (p<0.05). Probit analysis revealed that A/P ratio of 3.5 may be used as a line to assess the progression of liver diseases, and clinically 95% patients with A/P ratios of more than 3.5 had LC. Both left and right A/P ratios increased significantly along with the increased levels of hepatic fibrosis. Levels o f Fibrosis Mild Moderate Severe Left A/P ratio 3.20+-1.19 4.79o-1.34 6.21-+2.31 Right A/P ratio 2.14,-0.52 3.22±1.27 5.19±1.84 These data show the utility of A/P ratio as an non invasive approach to estimate hepatic fibrosis in chronic liver diseases.