Cases Of Cirrhosis Research Articles

A case of hepatitis C-related liver cirrhosis treated with lusutrombopag before coil embolization for splenic artery aneurysm

A case of hepatitis C-related liver cirrhosis treated with lusutrombopag before coil embolization for splenic artery aneurysm

PATTERN AND BURDEN OF ANTIMICROBIAL RESISTANCE AMONG CAUSATIVE ORGANISMS OF SPONTANEOUS BACTERIAL PERITONITIS.

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Material and Methods; All the cases (n = 183) of Cirrhosis of liver with ascities, fulfilling inclusion criteria were recruited from Department of Medicine Akhtar Saeed Trust Hospital Lahore and Nishtar Hospital, Multan. All selected patients were subjected to ascitic fluid tap, under aseptic measures by inserting a needle of 22 / 18 gauge in the left flank of abdomen. Ten ml of ascitic fluid was aspirated in a heparinised disposable syringe; which was immediately inoculated into blood culture bottle at bedside and send for bacterial culture and causative organisms was tested for their antibiotic drug resistance pattern. Data was entered and analyzed by computer program SPSS-18. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; High degree of drug resistance was observed among these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli. DOI: 10.7176/JMPB/67-07 Publication date: August 31 st 2020

A cohort study on long-term exposure to air pollution and incidence of liver cirrhosis.

We used an administrative cohort established from the 2001 census. We included all adults of 30 years of age or older who were free of cirrhosis, resulting in a study population of over 1.2 million subjects. Follow-up of the subjects ended on 31 December 2015. We ascertained incident cases of cirrhosis from regional mortality and hospital discharge registries using a validated algorithm. We assessed exposure of the subjects to PM10, PM coarse, PM2.5, PM2.5 absorbance, NO2, NOx, and PM metal components at their residential address using Land Use Regression models. We used Cox regression models, adjusted for relevant covariates, to estimate the association between air pollution exposure and cirrhosis incidence. We observed 10,111 incident cases of cirrhosis, with a crude incidence rate of 67 × 100,000 person-years. Long-term exposure to all pollutants tested was significantly associated with cirrhosis, e.g., PM10 (hazard ratios [HR], 1.05; 95% confidence interval [CI], 1.01-1.09, per 10 µg/m3 increments), PM coarse (HR, 1.11; 95% CI, 1.05-1.17, per 10 µg/m3 increments), PM2.5 (HR, 1.08; 95% CI, 1.03-1.13, per 5 µg/m3 increments), and NO2 (HR, 1.03; 95% CI, 1.02-1.05, per 10 µg/m3 increments). The associations were robust in secondary analyses. Our findings suggest a possible contribution of air pollution to the development of cirrhosis.

Non-invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh type 2 diabetes study.

The incidence of cirrhosis and hepatocellular carcinoma (HCC) is increased in Type 2 diabetes, primarily secondary to non-alcoholic fatty liver disease (NAFLD). European guidelines recommend screening for NAFLD in Type 2 diabetes. American guidelines, while not advocating a screening protocol, suggest using non-invasive markers of fibrosis for risk-stratification and guiding onward referral. To test the ability of individual fibrosis scores and the European screening algorithm to predict 11-year incident cirrhosis/HCC in an asymptomatic community cohort of older people with Type 2 diabetes. The Edinburgh Type 2 Diabetes Study investigated men and women with Type 2 diabetes (n = 1066, aged 60-75 at baseline). Liver markers were measured at baseline and year 1; steatosis and fibrosis markers were calculated according to independently published calculations. During 11 years of follow-up, cases of cirrhosis and HCC were identified. Forty-three out of 1059 participants with no baseline cirrhosis/HCC developed incident disease. All scores were significantly associated with incident liver disease by odds ratio (P < .05). The ability of the risk-stratification tools to accurately identify those who developed incident cirrhosis/HCC was poor with low-positive predictive values (5-46%) and high false-negative and -positive rates (up to 60% and 77%) respectively. When fibrosis risk scores were used in conjunction with the European algorithm, they performed modestly better than when applied in isolation. In a cohort with a moderately low incidence of cirrhosis/HCC, existing risk scores did not reliably identify participants at high risk. Better prediction models for cirrhosis/HCC in people with Type 2 diabetes are required.

Hepatitis B virus preS2Δ38-55 variants: A newly identified risk factor for hepatocellular carcinoma.

Background & AimsAlthough HBV is a major cause of death in Africa, its genetic variability has been poorly documented. This study aimed to address whether HBV genotype and surface gene variants are associated with HBV-related liver disease in The Gambia.MethodsWe conducted a case-control study nested in the Prevention of Liver Fibrosis and Cancer in Africa programme. Consecutive treatment-naive patients with chronic HBV infection and detectable viral load were recruited: 211 controls with no significant liver disease and 91 cases (56 cirrhosis and 35 HCC cases). HBV genotypes and surface gene variants were determined by Sanger sequencing or next-generation sequencing (NGS) in serum DNA. Aflatoxin B1 (AFB1)-specific codon 249 TP53 mutation was determined by NGS in circulating cell-free plasma DNA.ResultsIn phylogenetic analysis, 85% of individuals carried HBV genotype E, 14% genotype A, and 1% A/E recombinant viruses. Surface gene variants were more frequently observed in cases (43% and 57% in cirrhosis and HCC cases, respectively) than controls (25%; p <0.001), with preS2 deletions between nucleotides 38–55 (preS2Δ38–55) being the main genetic variant detected. In multivariable analysis, HBeAg seropositivity, low HBsAg levels, and HDV seropositivity were significantly associated with cirrhosis and HCC, whilst older age, higher viral load, genotype A, preS2Δ38–55, and AFB1 exposure were only associated with HCC. There was a multiplicative joint effect of preS2Δ38–55 variants with HBeAg seropositivity (odds ratio [OR] 43.1 [10.4–177.7]), high viral load >2,000 IU/ml (OR 22.7 [8.0–64.9]), HBsAg levels <10,000 IU/ml (OR 19.0 [5.5–65.3]), and AFB1 exposure (OR 29.3 [3.7–230.4]) on HCC risk.ConclusionsThis study identified a hotspot for HBV preS2 deletions as a strong independent factor for HCC in The Gambia, with HBV genotypes and AFB1 exposure contributing to the high liver cancer risk.Lay summaryAlthough HBV-related liver disease is highly prevalent in sub-Saharan Africa, the associated virological characteristics are poorly studied. Using clinical data from African patients chronically infected with HBV, an assessment of the virological variability (genotypes and mutations) and exposure to AFB1, a toxin often contaminating food, was carried out. Our results show that HBV genotypes, the presence of a highly prevalent mutant form of HBV, and AFB1 exposure contribute to the high liver cancer risk in this population.

Serous effusions: A clinicopathological study

This study is a prospective, observational study done for two years, comprising of 267 cases. Their episodes were while tapping pleural cavity, peritoneal cavity and pericardial sac, pleural, ascitic and pericardial fluids were collected. Majority of the samples received were from our hospital (98%) while 2% (5 samples) were obtained from outside. The male cases (55%) outnumbered the females (45%). And, a maximum number of instances in quinquagenarian among males and sexagenarian among females. In peritoneal fluids, females (29/30) outnumbered males. Fifty-nine (22%) samples showed the presence of clot with the majority being in pleural fluid (35/59). Few of the cases of TB showed neutrophilic (10%) or eosinophilic (2.5%) exudate instead of lymphocytic effusion. In contrast, a few cases of liver cirrhosis showed exudative effusion instead of transudative because of bacterial peritonitis. Majority cases were exudates (58.2%) excluding the peritoneal fluids, out of 71 cases of known malignancy. Out of these, 50% of the malignant effusions were nonhemorrhagic. Common microorganisms were gram-negative bacilli and grampositive cocci. There were three unusual cases in this study, viz: Eosinophilic effusion, Parasite (Ascaris) in pleural fluid and an example of a second malignancy. If the effusion is suspected for malignancy, the fluid typing of exudate or transudate may be done. Also, wet mount preparation for abnormal cells may be done before Examination of fixed smears for cancerous cells, as we did not find any transudate fluid positive for malignancy. Diagnostic effusion tapping, followed by immediate processing of fluid in a laboratory may improve cytological outcome. Malignant effusions may not be hemorrhagic in appearance. Rarely effusion may be the first manifestation of malignancy.

Application of pancreaticojejunostomy with pancreatic duct binding external drainage in laparoscopic pancreatoduodenectomy

Objective: To examine the effect of pancreaticojejunostomy with pancreatic duct binding external drainage in laparoscopic pancreatoduodenectomy. Methods: The data of 21 patients who underwent laparoscopic pancreaticoduodenectomy in the same treatment group from January 2017 to October 2019 in Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University were analyzed retrospectively.All patients underwent pancreaticojejunostomy with external drainage of pancreatic ducts.There were 12 males and 9 females, aged (63.1±8.1)years old (range: 46 to 77 years old), body mass index (24.8±3.2)kg/m(2)(range: 18.8 to 29.1 kg/m(2)).There were 3 cases of hypertension, 5 cases of diabetes, 3 cases of hypertension and diabetes, 3 cases of liver cirrhosis. Results: Laparoscopic pancreatoduodenectomy was successfully performed in all 21 patients.The operation time was (359.3±71.0)minutes, the pancreaticojejunostomy time was (23.8±7.4)minutes, the diameter of pancreatic duct was(3.3±0.6)mm, the intraoperative blood loss was (247.6±90.1)ml, the postoperative hospital stay was(13.7±4.9)days, the leakage of B-level fistula occurred in 1 case(4.8%), and there was no C-level pancreatic fistula.There were 3 cases of bile leakage, 1 case of incision infection, 2 cases of gastroparesis, 1 case of hydrops abdominis, no death and secondary operation. Conclusion: It is a simple and easy method of pancreatoenterostomy with pancreatic duct binding external drainage, which can reduce the incidence of pancreatic fistula and related complications after laparoscopic pancreatoduodenectomy for patients with high risk pancreatic fistula.

Evaluation of Serum Midkine as a Marker of Hepatocellular Carcinoma in Cirrhotic Patients

Background: Hepatocellular carcinoma (HCC) is the fifth most common malignancy. Midkine (MK) is a cytokine or a growth factor belongs to the carbohydrate-binding proteins. MK is over expressed in hepatocellular carcinoma. Furthermore, patients with high MK expression in the tumor frequently have a worse prognosis than those with low MK expression. Objectives: The aim of the work was to evaluate serum midkine as a marker for Hepatocellular carcinoma in cirrhotic patients. Patients and Methods: This study was conducted on 90 subjects who were divided into three groups: group I included 40 patients with liver cirrhosis and hepatocellular carcinoma, group II included 40 patients with HCV related liver cirrhosis without HCC and group III with 10 healthy subjects as controls. Plasma level of midkine was measured for all subjects. Results: Serum levels of midkine were highest in patients of group I with HCC compared to those with liver cirrhosis and the control groups (p value< 0.001). Also midkine values increased with tumor number and overall size. According to the ROC curve, the best cutoff value for midkine differentiating HCC from liver cirrhosis cases was 8500pg/mL, above which the sensitivity to discriminate HCC = 100% and below which the specificity to discriminate liver cirrhosis = 87.5% with 94.5% accuracy. Conclusion: Serum midkine level was significantly elevated in HCC patients, so it can be used as a diagnostic marker for HCC. Also, it was directly correlated to the tumor number and overall size so it has a good prognostic value.

Evaluation of Serum Midkine as a Marker of Hepatocellular Carcinoma in Cirrhotic Patients

Background: Hepatocellular carcinoma (HCC) is the fifth most common malignancy. Midkine (MK) is a cytokine or a growth factor belongs to the carbohydrate-binding proteins. MK is over expressed in hepatocellular carcinoma. Furthermore, patients with high MK expression in the tumor frequently have a worse prognosis than those with low MK expression. Objectives: The aim of the work was to evaluate serum midkine as a marker for Hepatocellular carcinoma in cirrhotic patients. Patients and Methods: This study was conducted on 90 subjects who were divided into three groups: group I included 40 patients with liver cirrhosis and hepatocellular carcinoma, group II included 40 patients with HCV related liver cirrhosis without HCC and group III with 10 healthy subjects as controls. Plasma level of midkine was measured for all subjects. Results: Serum levels of midkine were highest in patients of group I with HCC compared to those with liver cirrhosis and the control groups (p value< 0.001). Also midkine values increased with tumor number and overall size. According to the ROC curve, the best cutoff value for midkine differentiating HCC from liver cirrhosis cases was 8500pg/mL, above which the sensitivity to discriminate HCC = 100% and below which the specificity to discriminate liver cirrhosis = 87.5% with 94.5% accuracy. Conclusion: Serum midkine level was significantly elevated in HCC patients, so it can be used as a diagnostic marker for HCC. Also, it was directly correlated to the tumor number and overall size so it has a good prognostic value.

Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study

BackgroundThe opioid epidemic has been associated with an increase in hepatitis C virus (HCV) infections. Federally qualified health centers (FQHCs) have a high burden of hepatitis C disease and could serve as venues to enhance testing and treatment. MethodsWe estimated clinical outcomes and the cost-effectiveness of hepatitis C testing and treatment at US FQHCs using individual-based simulation modeling. We used individual-level data from 57 FQHCs to model 9 strategies, including permutations of HCV antibody testing modality, person initiating testing, and testing approach. Outcomes included life expectancy, quality-adjusted life-years (QALY), hepatitis C cases identified, treated and cured; and incremental cost-effectiveness ratios. ResultsCompared with current practice (risk-based with laboratory-based testing), routine rapid point-of-care testing initiated and performed by a counselor identified 68% more cases after (nonreflex) RNA testing in the first month of the intervention and led to a 17% reduction in cirrhosis cases and a 22% reduction in liver deaths among those with cirrhosis over a lifetime. Routine rapid testing initiated by a counselor or a clinician provided better outcomes at either lower total cost or at lower cost per QALY gained, when compared with all other strategies. Findings were most influenced by the proportion of patients informed of their anti-HCV test results. ConclusionsRoutine anti-HCV testing followed by prompt RNA testing for positives is recommended at FQHCs to identify infections. If using dedicated staff or point-of-care testing is not feasible, then measures to improve immediate patient knowledge of antibody status should be considered.

Morbidity, mortality and case fatality rate from liver cirrhosis in the age aspect in Kyrgyzstan for the period 2010–2017

The purpose is to study the dynamics of morbidity, mortality and case fatality ratefrom liver cirrhosis in the age aspect from 2010–2017 in Kyrgyzstan. Materials and methods : Analyzed state reporting forms No. 12 “Report on morbidity and preventive work (family medicine center, dispensary)” and “C51 — Distribution of deaths by sex, age groups and causes of death” from 2010–2017. Data processed by Microsoft Office Excel. Results : The average cumulative prevalence of liver cirrhosis (K 74) in persons older than 15 years for the period 2010–2017 was 50.9 0 / 0000 , the average incidence is 12.3 0 / 0000 , the mortality is 45.2 0 / 0000 . Persons over 75 years old had the highest mortality rate — 160, 7 0 / 0000 , the age group “45–59 years old” occupied the third position (92.8 0 / 0000 ) after the persons “60–74 years old” (140.9 0 / 0000 ). It is necessary to emphasize the presence of mortality among children and individuals 15–24 years old, although the incidence rates (0.2 0 / 0000 and 2.5 0 / 0000 , respectively) and the proportion (0.2 % and 1.6 %, respectively) were low. In the period 2015–2017 were registered 47 children with “K 74”, of which 15 were fi rst identifi ed, and for 2011–2017 yy. 32 children with a fatal outcome. Over the past 3 years there has been a tendency for the growth of all three indicators in children. For 2010–2017 yy. the average cumulative case fatality ratein persons over 15 years of age prevailed over children in 2,069.9 cases per 10,000 patients (8878.4 0 / 000 and 6808.5 0 / 000 , respectively). The case fatality rateamong adults decreased 1.6 times (11176.8 0 / 000 and 6815.2 0 / 000 , 2010 and 2017, respectively), and among children 1.5 times(4285.7 0 / 000 and 2857.1 0 / 000 , 2015 and 2017, respectively). Conclusion : On the basis of the obtained data, in order to improve the K 74 accounting system, an emergency notifi cation (Form No. 58u) was introduced in the country for newly detected and lethal cases of cirrhosis and liver cancer in the outcome of hepatitis B and C. To develop specifi c prevention measures and control strategies in general, the country needs a register of patients with cirrhosis and liver cancer with etiological interpretation.

Liver Cirrhosis in Forensic Autopsies in Moscow

Introduction: There has been an increase in the number of liver cirrhosis worldwide. Liver cirrhosis in forensic practice is common enough. Medical experts diagnose liver cirrhosis according to morphological data. At the same time this problem in medicolegal analytical reports and publications are still small. The purpose of our research consisted in characteristic of liver cirrhoses by forensic medical examinations for the 12-year period from 2007 to 2018 in the city of Moscow. Materials and methods. We studied 3.371 case of death from liver cirrhosis in proportion to the number of non-violent deaths. We analyzed the acts of forensic autopsies and histological studies performed at the Bureau of Forensic Medicine of the Department of Health of Moscow during 2007-2018. We calculated the frequency of occurrence, gender and age, annual changes and the overall trend of mortality from liver cirrhosis. we determined the liver cirrhosis form and liver failure stage.We determined the liver cirrhosis form and liver failure stage by the results of the section and histologic morphological signs. Results. We found that forensic examination of corpses diagnosed a significant number of liver cirrhosis. Their annual number averaged 1.15% of total non-violent deaths. During the studied period, the annual incidence of liver cirrhosis changed significantly: it increased in 2009, 2015, 2017, 2018 and decreased in 2013 and 2016. Change difference reached 20.5%. We determined that the highest number of liver cirrhosis were diagnosed between 2009 and 2012, the lowest in 2016. In the last 2 years, the number of liver cirrhosis cases tends to increase. Over a 12-year liver cirrhosis study period we were a steady trend in the decline established. We found that liver cirrhosis during forensic examination of corpses in Moscow were more likely in young and middle-aged men detected. The morphological structure was dominated by small and mixed morphological forms. We found that in histological forensic examination the terminal (48.9%) and decompensated (43.4%) stages of hepatic failure was most often diagnosed. Conclusion: According to traditional perceptions liver cirrhosis can rarely be the cause of sudden death and is therefore more likely to be the subject of an autopsy by anatomists rather than forensic experts. On the one hand we established that high (1/100) incidence of liver cirrhosis correlates with the prevalence of this disease among the population of the city of Moscow and on the other indicates a significant number of cases of non-violent death in the total volume of forensic autopsies. We have calculated that the number of annually diagnosed deaths from liver cirrhosis were proportional to the total number of non-violent deaths. During the period 2007-2018 a marked dynamics of decline in the frequency of forensic detection of liver cirrhosis, which is consistent with the general trend of reduction of cirrhosis incidence in Moscow. However, in the last 2 years there was some increase in the number of the liver cirrhosis. The young and middle-aged men in mixed and small-node morphological form at the terminal and decompensated stage of the disease were diagnosed.

Outcomes of patients with cardiac cirrhosis undergoing heart transplantation.

Cardiac cirrhosis is common in patients with advanced heart failure and can limit heart transplant eligibility. We examined the outcomes of patients with cardiac cirrhosis following orthotopic heart transplantation. A retrospective matched cohort study of adult patients with cirrhosis undergoing heart transplantation at an Australian hospital from 2009 to 2017 was performed. Cirrhosis was established by either (a) histopathology or (b) combination of radiological features of cirrhosis and portal hypertension plus clinical features of portal hypertension. Primary objectives were to assess mortality, perioperative, and long-term complications. Matching was performed with non-cirrhotic patients undergoing heart transplantation in a 4:1 ratio. Five patients with biopsy-proven cirrhosis or portal hypertension and 20 matched controls without cirrhosis were included. Additionally, 5 patients with clinical and radiological evidence of cirrhosis were assessed separately. The groups were well-matched for age at transplant, year of transplant, gender, and comorbidities. Mortality was more frequent but not significantly greater in the cirrhosis group with 2 deaths within 4months of transplant compared to 1 death each in the no cirrhosis and suspected cirrhosis groups (40%, 5%, 20% P=.40). The median duration of intensive care unit stay was longer in the cirrhosis group compared to the suspected cirrhosis group (8 vs 6days, P=.03); however, there was no difference in total hospitalization (P=.56) or in median duration of admission (0.64) compared to the no cirrhosis group. These findings suggest that there is greater mortality associated with cases of definite cirrhosis compared to suspected or matched controls following orthotopic heart transplantation; however, statistical significance was not reached. Admission length and complication rates were similar compared to those without cirrhosis. Future studies are warranted to further evaluate mortality risk in a larger population.

Development of an Algorithm to Identify Cases of Nonalcoholic Steatohepatitis Cirrhosis in the Electronic Health Record.

Current genetic research of nonalcoholic steatohepatitis (NASH) cirrhosis is limited by our ability to accurately identify cases on a large scale. Our objective was to develop and validate an electronic health record (EHR) algorithm to accurately identify cases of NASH cirrhosis in the EHR. We used Clinical Query 2, a search tool at Beth Israel Deaconess Medical Center, to create a pool of potential NASH cirrhosis cases (n = 5415). We created a training set of 300 randomly selected patients for chart review to confirm cases of NASH cirrhosis. Test characteristics of different algorithms, consisting of diagnosis codes, laboratory values, anthropomorphic measurements, and medication records, were calculated. The algorithms with the highest positive predictive value (PPV) and the highest F score with a PPV ≥ 80% were selected for internal validation using a separate random set of 100 patients from the potential NASH cirrhosis pool. These were then externally validated in another random set of 100 individuals using the research patient data registry tool at Massachusetts General Hospital. The algorithm with the highest PPV of 100% on internal validation and 92% on external validation consisted of ≥ 3 counts of "cirrhosis, no mention of alcohol" (571.5, K74.6) and ≥ 3 counts of "nonalcoholic fatty liver" (571.8-571.9, K75.81, K76.0) codes in the absence of any diagnosis codes for other common causes of chronic liver disease. We developed and validated an EHR algorithm using diagnosis codes that accurately identifies patients with NASH cirrhosis.

Liver cirrhosis in a patient with hepatic hereditary hemorrhagic telangiectasia and Budd\u2013Chiari syndrome: a case report

BackgroundHereditary hemorrhagic telangiectasia (HHT) often involves the liver, and belongs to abnormal blood vessel disease. The etiology of Budd–Chiari syndrome (BCS) is not clear, but congenital vascular dysplasia is considered to be one of the causes. Liver cirrhosis due to hepatic hereditary hemorrhagic telangiectasia concomitant with BCS has not been reported. Here, we report a case of cirrhosis with hepatic hereditary hemorrhagic telangiectasia (HHHT) and BCS.Case presentationA 58-year-old woman with hepatic hereditary hemorrhagic telangiectasia showed decompensated liver cirrhosis, and abdominal imaging revealed Budd–Chiari syndrome. Disease has progressed considerably during 2.5 years after hospital discharge despite subsequent transjugular intrahepatic portosystemic shunting (TIPS). One hypothesis that might explain the coexistence of hepatic hereditary hemorrhagic telangiectasia and Budd–Chiari syndrome in this patient is ischemia and thrombosis of hepatic veins.ConclusionsFurther studies are required to evaluate the relationship between HHHT and BCS. Our observations already challenged the TIPS therapeutic strategy in BCS secondary to HHHT patients.

A case of alcoholic liver cirrhosis treated with nalmefene and abstinence from alcohol

A case of alcoholic liver cirrhosis treated with nalmefene and abstinence from alcohol

Аутоиммунный гепатит на фоне описторхозной инвазии (клинический случай)

The article describes the case of liver cirrhosis of autoimmune origin on the background of opisthorchiasis. The relevancy of the problem is justified by complexity of early diagnosis of autoimmune liver diseases on the background of opisthorchiasis, lack of data on the characteristics of the course of the combined pathology, and probable comorbidity of these diseases. These and many other questions still need to be addressed in future researches. The article shows the difficulty of differential diagnosis of autoimmune diseases of the liver and hepatitis of parasitic etiology, which leads to untimely, inadequate treatment and disease progression.

Health-Related Quality of Life and Frailty in Chronic Liver Diseases.

We sought to examine the relationship between frailty and health-related quality of life as evaluated using the 36-item Short-Form Health Survey (SF-36) questionnaire in Japanese chronic liver disease (CLD) patients (n = 341, 122 liver cirrhosis cases, median age = 66 years). Frailty was defined as a clinical syndrome in which three or more of the following criteria were met (frailty score 3, 4, or 5): unintentional body weight loss, self-reported exhaustion, muscle weakness (grip strength: <26 kg in men and <18 kg in women), slow walking speed (<1.0 m/s), and low physical activity. Robust (frailty score 0), prefrail (frailty score 1 or 2), and frailty were found in 108 (31.7%), 187 (54.8%), and 46 (13.5%) patients, respectively. In all eight scales of the SF-36 (physical functioning, role physical, bodily pain, general health perception, vitality, social functioning, role emotion, and mental health), and the physical component summary score and mental component summary score, each score was well stratified according to the frailty status (all p < 0.0001). In the multivariate analysis, age (p = 0.0126), physical functioning (p = 0.0005), and vitality (p = 0.0246) were independent predictors linked to the presence of frailty. In conclusion, Japanese CLD patients with frailty displayed poorer conditions, both physically and mentally.

Serum Zinc Level Is Associated with Frailty in Chronic Liver Diseases.

We sought to examine the serum zinc (Zn) level and frailty in patients with chronic liver diseases (CLDs, n = 285, 107 liver cirrhosis cases, median age = 66 years). Frailty was defined as a clinical syndrome in which three or more of the following criteria were met (frailty score 3, 4, or 5): unintentional body weight loss, self-reported exhaustion, muscle weakness (grip strength: <26 kg in men and <18 kg in women), slow walking speed (<1.0 m/s), and low physical activity. Robust (frailty score 0), prefrail (frailty score 1 or 2), and frailty were found in 90 (31.6%), 157 (55.1%), and 38 (13.3%), respectively. The median serum Zn levels in patients with frailty, prefrailty, and robust were 59.7 μg/dL, 72.8 μg/dL, and 76.9 μg/dL, respectively (p-values: frailty vs. prefrail, p < 0.0001; prefrail vs. robust, p = 0.0063; frailty vs. robust, p < 0.0001; overall p < 0.0001). For all cases, variables with absolute values of correlation coefficient with frailty score (0–5) ≥ 0.3 were age (rs = 0.3570, p < 0.0001), serum albumin (rs = −0.3212, p < 0.0001), extracellular water to total body water ratio using bioimpedance analysis (rs = 0.4386, p < 0.0001), and serum Zn level (rs = −0.3406, p < 0.0001). In conclusion, decreased serum Zn level in patients with CLDs can be closely associated with the presence of frailty.

Initial report of treatment of uveal melanoma with hepatic metastases with yttrium90 internal radiation followed by ipilimumab and nivolumab.

10025 Background: Hepatic metastases from uveal melanoma have no established therapy, with a median survival of only 6-12 months. To date therapy with checkpoint inhibitors has yielded minimal results. To take advantage of possible synergy between radiation and immunotherapy we treated patients with yttrium90 internal radiation followed by immunotherapy. Methods: Patients received yttrium90 (Sir-Spheres) via hepatic artery infusion in two treatments, one to each lobe 3-4 weeks apart, followed in 3-6 weeks by ipilimumab and nivolumab for 4 doses, then nivolumab maintenance. Results: We are presenting interim results because of the excessive toxicity seen when these FDA-approved modalities were used in sequence with the FDA-approved dosages. Initially dosing of yttrium90 (Y90) followed the package insert “BSA method” but after 8 patients we had 5 cases of grade 3-4 hepatic toxicity; in 4 cases the toxicity was observed after just the Y90. One case of cirrhosis occurred in a patient whose liver received 40-45Gy; her cirrhosis was felt most likely due to the Y90. Y90 dosing was then reduced to limit dosage to normal liver to 35Gy, and none of the next 5 patients have had more than grade 2 hepatic toxicity. Dosage to the normal liver is approximated by the MIRD formula: Actual delivered liver dose [Gy] = 50 * Administered activity [GBq] * (1 – Lung shunt fraction) / kg of treated liver. If calculated dose was &gt; 35GY, dosage in GBq is reduced proportionally. Toxicity in the first 5 patients to receive immunotherapy included one grade 4, two grade 3 and two grade 2 hepatic toxicities, and only 3 of the 5 patients received more than one dose of ipilimumab. We then reduced dosing of ipilimumab from 3mg/kg x 4 to 1mg/kg x 4 because of this excessive autoimmune toxicity. Of 13 patients, 10 received both Y90 and immunotherapy, and 3 had responses (1 CR, 2 PR) with 3 patients stable &gt; 5months. Median progression-free survival for all patients is 27 weeks and median overall survival is greater than 48 weeks. Treatment with Y90 produced an over 50% fall in peripheral blood lymphocytes which was reversed in most patients by the immunotherapy. Conclusions: With dose modifications this therapy appears feasible and objective tumor responses were seen. Sequential therapy with Y90 and immunotherapy appears tolerable if radiation to normal liver is limited to 35Gy and ipilimumab dose is 1mg/kg. Clinical trial information: NCT02913417.