Pulmonary complications in patients with liver cirrhosis

AbstractPatients with advanced chronic liver diseases, particularly with decompensated liver cirrhosis, can develop specific pulmonary complications independently of any pre-existing lung disease. Especially when dyspnea occurs in combination with liver cirrhosis, patients should be evaluated for hepato-pulmonary syndrome (HPS), porto-pulmonary hypertension (PPHT), hepatic hydrothorax and spontaneous bacterial empyema, which represent the clinically most relevant pulmonary complications of liver cirrhosis. Importantly, the pathophysiology, clinical features, diagnosis and the corresponding therapeutic options differ between these entities, highlighting the role of specific diagnostics in patients with liver cirrhosis who present with dyspnea. Liver transplantation may offer a curative therapy, including selected cases of HPS and PPHT. In this review article, we summarize the pathogenesis, clinical features, diagnostic algorithms and treatment options of the 4 specific pulmonary complications in patients with liver cirrhosis.

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From Liver Cirrhosis to Cancer: The Role of Micro-RNAs in Hepatocarcinogenesis

International Journal of Molecular Sciences ◽

10.3390/ijms22031492 ◽

2021 ◽

Vol 22 (3) ◽

pp. 1492

Author(s):

Raphael Mohr ◽

Burcin Özdirik ◽

Joeri Lambrecht ◽

Münevver Demir ◽

Johannes Eschrich ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Diseases ◽

Treatment Options ◽

Significant Risk ◽

Significant Risk Factor ◽

Chronic Liver ◽

Chronic Liver Diseases ◽

Micro Rnas ◽

Almost All

In almost all cases, hepatocellular carcinoma (HCC) develops as the endpoint of a sequence that starts with chronic liver injury, progresses to liver cirrhosis, and finally, over years and decades, results in liver cancer. Recently, the role of non-coding RNA such as microRNA (miRNA) has been demonstrated in the context of chronic liver diseases and HCC. Moreover, data from a phase II trial suggested a potential role of microRNAs as therapeutics in hepatitis-C-virus infection, representing a significant risk factor for development of liver cirrhosis and HCC. Despite progress in the clinical management of chronic liver diseases, pharmacological treatment options for patients with liver cirrhosis and/or advanced HCC are still limited. With their potential to regulate whole networks of genes, miRNA might be used as novel therapeutics in these patients but could also serve as biomarkers for improved patient stratification. In this review, we discuss available data on the role of miRNA in the transition from liver cirrhosis to HCC. We highlight opportunities for clinical translation and discuss open issues applicable to future developments.

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The Role of the Gut Microbiome in Liver Cirrhosis Treatment

International Journal of Molecular Sciences ◽

10.3390/ijms22010199 ◽

2020 ◽

Vol 22 (1) ◽

pp. 199

Author(s):

Na Young Lee ◽

Ki Tae Suk

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Liver Fibrosis ◽

Gut Microbiota ◽

Gut Microbiome ◽

Liver Diseases ◽

Sclerosing Cholangitis ◽

Chronic Liver ◽

Chronic Liver Diseases

Liver cirrhosis is one of the most prevalent chronic liver diseases worldwide. In addition to viral hepatitis, diseases such as steatohepatitis, autoimmune hepatitis, sclerosing cholangitis and Wilson’s disease can also lead to cirrhosis. Moreover, alcohol can cause cirrhosis on its own and exacerbate chronic liver disease of other causes. The treatment of cirrhosis can be divided into addressing the cause of cirrhosis and reversing liver fibrosis. To this date, there is still no clear consensus on the treatment of cirrhosis. Recently, there has been a lot of interest in potential treatments that modulate the gut microbiota and gut-liver axis for the treatment of cirrhosis. According to recent studies, modulation of the gut microbiome by probiotics ameliorates the progression of liver disease. The precise mechanism for relieving cirrhosis via gut microbial modulation has not been identified. This paper summarizes the role and effects of the gut microbiome in cirrhosis based on experimental and clinical studies on absorbable antibiotics, probiotics, prebiotics, and synbiotics. Moreover, it provides evidence of a relationship between the gut microbiome and liver fibrosis.

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Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521.2015.1017834 ◽

2015 ◽

Vol 50 (7) ◽

pp. 875-883 ◽

Cited By ~ 25

Author(s):

Konstantina Sargenti ◽

Hanne Prytz ◽

Emma Nilsson ◽

Evangelos Kalaitzakis

Keyword(s):

Liver Cirrhosis ◽

Liver Failure ◽

Bacterial Infections ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Decompensated Liver Cirrhosis ◽

Predictors Of Mortality

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Application of Contrast-Enhanced Ultrasound to Detect Hepatic Hydrothorax in Patients with Liver Cirrhosis

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1189-2937 ◽

2020 ◽

Author(s):

Victoria Therese Mücke ◽

Daniel Fitting ◽

Georg Dultz ◽

Philipp de Leuw ◽

Nina Weiler ◽

...

Keyword(s):

Liver Cirrhosis ◽

Pleural Effusion ◽

Contrast Medium ◽

Peritoneal Cavity ◽

Hepatic Hydrothorax ◽

Decompensated Liver Cirrhosis ◽

Ultrasound Contrast ◽

Ultrasound Contrast Medium ◽

Short Term Mortality ◽

Real Time Visualization

Abstract Purpose Hepatic hydrothorax (HH) is defined as transudate in the pleural cavity in patients with decompensated liver cirrhosis (DC) without concomitant cardiopulmonary or pleural disease. It is associated with high short-term mortality. HH can evolve via translocation through diaphragmatic gaps. The aim of this study was to evaluate the feasibility and safety of injecting ultrasound contrast medium into the peritoneal cavity to detect HH. Materials and Methods This study included patients with concomitant ascites and pleural effusion who were admitted to our hospital between March 2009 and February 2019. A peritoneal catheter was inserted and ultrasound contrast medium was injected into the peritoneal cavity. In parallel, the peritoneal and pleural cavities were monitored for up to 10 minutes. Results Overall, 43 patients were included. The median age was 60 years and the majority of patients were male (n = 32, 74 %). Most patients presented with right-sided pleural effusion (n = 32, 74 %), 3 (7 %) patients with left-sided and 8 (19 %) patients had bilateral pleural effusion. In 12 (28 %) patients ascites puncture was not safe due to low volume ascites. Thus, the procedure could be performed in 31 (72 %) patients. No adverse events occurred. In 16 of 31 (52 %) patients we could visualize a trans-diaphragmic flow of microbubbles. The median time until transition was 120 seconds. Conclusion Our clinical real-world experience supports the safety and feasibility of intraperitoneal ultrasound contrast medium application to detect HH in patients with DC, as a non-radioactive real-time visualization of HH. Our study comprises the largest cohort and longest experience using this method to date.

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How I treat prolymphocytic leukemia

Blood ◽

10.1182/blood-2012-01-380139 ◽

2012 ◽

Vol 120 (3) ◽

pp. 538-551 ◽

Cited By ~ 98

Author(s):

Claire Dearden

Keyword(s):

B Cell ◽

Treatment Options ◽

Lymphocytic Leukemia ◽

Prolymphocytic Leukemia ◽

Curative Therapy ◽

Lymphoid Malignancies ◽

Molecular Features ◽

Improvement In Survival ◽

Very High

Abstract T- and B-cell subtypes of prolymphocytic leukemia (PLL) are rare, aggressive lymphoid malignancies with characteristic morphologic, immunophenotypic, cytogenetic, and molecular features. Recent studies have highlighted the role of specific oncogenes, such as TCL-1, MTCP-1, and ATM in the case of T-cell and TP53 mutations in the case of B-cell prolymphocytic leukemia. Despite the advances in the understanding of the biology of these conditions, the prognosis for these patients remains poor with short survival and no curative therapy. The advent of monoclonal antibodies has improved treatment options. Currently, the best treatment for T-PLL is intravenous alemtuzumab, which has resulted in very high response rates of more than 90% when given as first-line treatment and a significant improvement in survival. Consolidation of remissions with autologous or allogeneic stem cell transplantation further prolongs survival, and the latter may offer potential cure. In B-PLL, rituximab-based combination chemo-immunotherapy is effective in fitter patients. TP53 abnormalities are common and, as for chronic lymphocytic leukemia, these patients should be managed using an alemtuzumab-based therapy. The role of allogeneic transplant with nonmyeloablative conditioning needs to be explored further in both T- and B-cell PLL to broaden the patient eligibility for what may be a curative treatment.

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Study of role of common NOD2 gene polymorphisms in Indian patients with decompensated liver cirrhosis

Tropical gastrology ◽

10.7869/tg.422 ◽

2017 ◽

Vol 38 (3) ◽

Author(s):

Manish Tiwari

Keyword(s):

Liver Cirrhosis ◽

Gene Polymorphisms ◽

Decompensated Liver Cirrhosis ◽

Indian Patients

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The Role of the Gut Microbiome in Liver Fibrosis

10.20944/preprints202012.0041.v1 ◽

2020 ◽

Author(s):

Na Young Lee ◽

Ki Tae Suk

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Liver Fibrosis ◽

Gut Microbiota ◽

Gut Microbiome ◽

Liver Diseases ◽

Sclerosing Cholangitis ◽

Chronic Liver ◽

Chronic Liver Diseases

Liver cirrhosis is one of the most prevalent chronic liver diseases worldwide. In addition to viral hepatitis, genetic conditions such as steatohepatitis, autoimmune hepatitis, sclerosing cholangitis, and Wilson’s disease can also lead to cirrhosis. Moreover, alcohol can cause cirrhosis on its own and exacerbate chronic liver disease from other causes. The treatment of cirrhosis can be divided into addressing the cause of cirrhosis and reversing liver fibrosis. To this date, there is still no clear consensus on the treatment of cirrhosis. Recently, there has been a lot of interest in potential treatments that modulate the gut microbiota and gut-liver axis for the treatment of cirrhosis. According to recent studies, modulation of the gut microbiome by probiotics ameliorates the progression of liver disease. The precise mechanism for relieving cirrhosis via gut microbial modulation has not been identified. This paper summarizes the role and effects of the gut microbiome in cirrhosis based on experimental and clinical studies on absorbable antibiotics, probiotics, prebiotics, and synbiotics. Moreover, it provides evidence of a relationship between the gut microbiome and liver cirrhosis.

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Targeted endovascular treatment of haemorrhagic posterior fossa proliferative angiopathy

Interventional Neuroradiology ◽

10.1177/1591019918761640 ◽

2018 ◽

Vol 24 (4) ◽

pp. 440-443 ◽

Cited By ~ 3

Author(s):

Suresh Giragani ◽

Santhosh Kumar Pavunesan ◽

Anandh Balasubramaniam

Keyword(s):

Endovascular Treatment ◽

Posterior Fossa ◽

Clinical Features ◽

Arteriovenous Malformations ◽

Treatment Options ◽

Focal Lesion ◽

Imaging Findings ◽

Endovascular Management ◽

Vascular Abnormality

Cerebral proliferative angiopathy (CPA) is a rare vascular abnormality and separate from “classical” brain arteriovenous malformations. Haemorrhage due to proliferative angiopathy is rarely reported. We describe the clinical features, imaging findings and targeted endovascular management for a 12-year-old boy having proliferative angiopathy of the posterior fossa presenting with haemorrhage. Targeted endovascular embolisation in CPA is not previously described in the literature. The optimal treatment options for haemorrhagic CPA are debatable, and we wish to highlight the role of targeted treatment for culprit focal lesion demonstrable on imaging.

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