scholarly journals Severe alcoholic hepatitis: why do we know a lot, but can do so little?

2018 ◽  
Vol 96 (5) ◽  
pp. 401-410
Author(s):  
A. O. Buyeverov ◽  
V. E. Syutkin ◽  
P. O. Bogomolov
Keyword(s):  
Liver Failure ◽  
Alcoholic Hepatitis ◽  
Treatment Options ◽  
Infectious Complications ◽  
Intestinal Wall ◽  
Severe Alcoholic Hepatitis ◽  
New Treatment ◽  
Cytokine Cascade ◽  
Selective Influence

Severe alcoholic hepatitis (SAH) is characterized by high both immediate and long - term mortality, caused by these patients ’ a special form of liver failure development which is acute on the background of chronic one (acute-on-chronic liver failure). Steatosis, oxidative stress, increased permeability of the intestinal wall, the formation of toxic metabolites and the cytokine cascade are considered to be the main pathogenetic elements of the SAH. The course of SAH is accompanied by the so-called liver-associated immunodeficiency, which is associated with a high risk of fatal infectious complications, causing up to А of all deaths. This variant of immunodeficiency is characterized by hyperactivation of some elements of the immune system along with suppression of the activity of others. Despite advances in the study of pathogenesis, today the only therapeutic agent affecting the survival of patients with SAH are corticosteroids. A significant improvement in prognosis in the absence of response to corticosteroid therapy can only be achieved by performing an urgent liver transplant. Currently, several new treatment options for patients with SAH are being developed. We believe that selective influence on key immunopathological processes deserves special attention.

scholarly journals Predicting long‐term prognosis in severe alcoholic hepatitis

2020 ◽  
Vol 40 (3) ◽  
pp. 511-513
Author(s):  
Felix Stickel ◽  
Marsha Y. Morgan
Keyword(s):  
Alcoholic Hepatitis ◽  
Severe Alcoholic Hepatitis ◽  
Long Term Prognosis

990 LONG-TERM SURVIVAL IN PATIENTS WITH NON SEVERE ALCOHOLIC HEPATITIS

2009 ◽  
Vol 50 ◽  
pp. S359 ◽  
Author(s):  
D. Degré ◽  
A. Lemmers ◽  
T. Gustot ◽  
R. Maréchal ◽  
S. Evrard ◽  
...  
Keyword(s):  
Alcoholic Hepatitis ◽  
Term Survival ◽  
Long Term Survival ◽  
Severe Alcoholic Hepatitis

Liver Transplantation for Alcoholic Hepatitis: Standard of Care Yet?

2020 ◽  
Vol 04 (01) ◽  
pp. 036-039
Author(s):  
Alejandro Cracco ◽  
Lisandro Montorfano ◽  
Jason M. Vanatta
Keyword(s):  
Liver Transplantation ◽  
Alcoholic Hepatitis ◽  
Alcoholic Cirrhosis ◽  
Standard Of Care ◽  
Screening Tools ◽  
Severe Alcoholic Hepatitis ◽  
Patients At Risk ◽  
Small Pool ◽  
Related Liver Disease

AbstractAlcohol-related liver disease (ALD) is one of the most common indications for liver transplantation. However, liver transplantation for alcoholic hepatitis (AH) remains controversial. The morbidity of severe alcoholic hepatitis (SAH) is extremely high, with most of the deaths occurring within the first 2 months. Multiple studies have recently demonstrated significant improvement in overall survival following liver transplantation in patients with SAH who failed medical management, with comparable rates to those transplanted electively. Concerns remain due to the small pool of donors and the high risk of alcohol relapse in this population. The traditional requirement of 6 months of abstinence prior to transplantation, or also known as “6-month rule” is controversial and has been criticized as whether it is a good predictor of long-term sobriety. Previous studies among patients with alcoholic cirrhosis have indicated that this rule poorly identifies patients who will relapse after liver transplantation. More recent studies in patients transplanted for SAH, have reported relapse rates that are comparable to those with abstinence periods >6 months. Applying stringent selection criteria appears to be key in identifying patients who are less likely to relapse after transplantation, and therefore prolonging patient and graft life. However, further research is needed to identify patients at risk and create appropriate screening tools. In this article, we present a review of currently available data on this topic.

Vascular malformations revisited

VASA ◽  
2015 ◽  
Vol 44 (1) ◽  
pp. 5-22 ◽  
Author(s):  
Robert K. Clemens ◽  
Thomas Pfammatter ◽  
Thomas O. Meier ◽  
Ahmad I. Alomari ◽  
Beatrice R. Amann-Vesti
Keyword(s):  
Gold Standard ◽  
Multidisciplinary Approach ◽  
Vascular Malformations ◽  
Treatment Options ◽  
Reduce Blood Loss ◽  
Significant Morbidity ◽  
Treatment Techniques ◽  
New Treatment ◽  
Common Understanding

Vascular malformations are congenital anomalies that can affect each part of the vasculature. Combined forms are common and they are often part of complex syndromes. Most malformations are diagnosed during infancy, but some get obvious only later in life. The field of vascular malformations is emerging with recently described new entities and treatments. Still, misdiagnosis is common in this field, leading to nosologic confusion and wrong treatment. Clinical evaluation and imaging are the gold standard for diagnostic confirmation. Sclerotherapy and embolization are the main treatment techniques but are also used preoperatively to reduce blood loss and shrink the lesion if surgery is planned. Despite new treatment options, especially if extensive in size or involving vulnerable structures, vascular malformations are still considered chronic diseases and cause significant morbidity. Common understanding and agreement on terminology and a multidisciplinary approach are the basis of successful treatment and long-term support for these patients. Continuing research in the field of vascular anomalies will improve knowledge and create further treatment options.

scholarly journals Modern combined targeted and immunotherapy of metastatic skin melanoma

2020 ◽  
pp. 54-61
Author(s):  
S. A. Protsenko ◽  
E. N. Imyanitov ◽  
A. I. Semenova ◽  
D. Kh. Latipova ◽  
A. V. Novik ◽  
...  
Keyword(s):  
Treatment Options ◽  
Survival Rates ◽  
New Drugs ◽  
Phase Iii ◽  
Immune Checkpoints ◽  
Malignant Neoplasms ◽  
Skin Melanoma ◽  
Clinical Prognosis ◽  
New Treatment

Melanoma of the skin is one of the most aggressive malignant neoplasms. Metastatic skin melanoma has an extremely poor clinical prognosis with a high mortality rate, accounting for 80% of all deaths from skin malignancies. The approaches to the treatment of metastatic skin melanoma have been dynamically developing over the past decade. New drugs and their combinations are becoming more affordable. In connection with the advances in molecular genetics and the development of new targeted drugs, treatment outcomes have significantly improved: first of all, overall survival and the time to progression of the disease, which has set new challenges for continuing research in this area. The development of new treatment options for patients with inoperable and/or metastatic melanoma with a mutation in the BRAFV600 gene is still in high demand. Emerging data from clinical and preclinical studies suggest that synergies can be observed between inhibitors of immune checkpoints and inhibitors of BRAF and MEK. Despite the fact that inhibitors of the BRAF signaling pathway have a high frequency of objective responses, in most cases their duration is short. Inhibitors of immune checkpoints provide a longer lasting effect, but the response rate is relatively low. Combining the two types of therapy can improve survival rates over the long term. This review demonstrates the results of phase III randomized trials that have allowed to determine the current standards in the treatment of metastatic skin melanoma. We also demonstrated our own experience of using a triple combination of targeted therapy with BRAF/MEK inhibitors in combination with PD-1 inhibitors.

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