scholarly journals Role of TIPS in Improving Survival of Patients with Decompensated Liver Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sundeep J. Punamiya ◽  
Deepak N. Amarapurkar
Keyword(s):  
Treatment Options ◽  
Venous Pressure ◽  
Covered Stents ◽  
Decompensated Liver Disease ◽  
Portosystemic Shunts ◽  
Portal Decompression ◽  
Cirrhotic Patients ◽  
And Control ◽  
Selection Of

Liver cirrhosis is associated with higher morbidity and reduced survival with appearance of portal hypertension and resultant decompensation. Portal decompression plays a key role in improving survival in these patients. Transjugular intrahepatic portosystemic shunts are known to be efficacious in reducing portal venous pressure and control of complications such as variceal bleeding and ascites. However, they have been associated with significant problems such as poor shunt durability, increased encephalopathy, and unchanged survival when compared with conservative treatment options. The last decade has seen a significant improvement in these complications, with introduction of covered stents, better selection of patients, and clearer understanding of procedural end-points. Use of TIPS early in the period of decompensation also appears promising in further improvement of survival of cirrhotic patients.

scholarly journals Schistosomiasis: from established diagnostic assays to emerging micro/nanotechnology-based rapid field testing for clinical management and epidemiology

2019 ◽  
Vol 3 (1) ◽  
pp. 439-458 ◽  
Author(s):  
Maurice Mutro Nigo ◽  
Georgette Salieb-Beugelaar ◽  
Manuel Battegay ◽  
Peter Odermatt ◽  
Patrick Hunziker
Keyword(s):  
Point Of Care ◽  
Field Testing ◽  
Detection Methods ◽  
Low Grade ◽  
Analytical Strategy ◽  
Diagnostic Assays ◽  
And Control ◽  
Analytical Platforms ◽  
Selection Of

Schistosomiasis is a neglected invasive worm disease with a huge disease burden in developing countries, particularly in children, and is seen increasingly in non-endemic regions through transfer by travellers, expatriates, and refugees. Undetected and untreated infections may be responsible for the persistence of transmission. Rapid and accurate diagnosis is the key to treatment and control. So far, parasitological detection methods remain the cornerstone of Schistosoma infection diagnosis in endemic regions, but conventional tests have limited sensitivity, in particular in low-grade infection. Recent advances contribute to improved detection in clinical and field settings. The recent progress in micro- and nanotechnologies opens a road by enabling the design of new miniaturized point-of-care devices and analytical platforms, which can be used for the rapid detection of these infections. This review starts with an overview of currently available laboratory tests and their performance and then discusses emerging rapid and micro/nanotechnologies-based tools. The epidemiological and clinical setting of testing is then discussed as an important determinant for the selection of the best analytical strategy in patients suspected to suffer from Schistosoma infection. Finally, it discusses the potential role of advanced technologies in the setting near to disease eradication is examined.

Motives for ‘Disappearances’ in Argentina, Chile and Uruguay in the 1970s

1995 ◽  
Vol 13 (1) ◽  
pp. 51-64 ◽  
Author(s):  
Wolfgang S. Heinz
Keyword(s):  
Armed Conflict ◽  
State Violence ◽  
Civilian Control ◽  
Internal Security ◽  
And Control ◽  
The Military ◽  
Good And Evil ◽  
Point Of Departure ◽  
Selection Of

The article looks at the motives of military governments in Argentina, Chile and Uruguay to introduce ‘disappearances’ as a new method to fight ‘subversion’ and thereby commit human rights violations. Five variables are taken as a point of departure, the country's previous experience with use of state violence, the selection of victims, the role of international public opinion, the selection of methods within the state and ideological factors. Among the key elements were in two countries the shift of responsibility for the use of violence to the military before the coup (except Chile), a lack of civilian control and influence in the formulation and control of internal security policies and an overwhelming, confused ideological definition in Argentina and in Chile (to a lesser degree in Uruguay) of the armed conflict as a war between good and evil and against World Communism which endangered the survival of the nation.

scholarly journals When Does the Incremental Risk Format Aid Informed Medical Decisions? The Role of Learning, Feedback, and Number of Treatment Options

2020 ◽  
Vol 40 (2) ◽  
pp. 212-221 ◽  
Author(s):  
Kevin E. Tiede ◽  
Felicia Ripke ◽  
Nicole Degen ◽  
Wolfgang Gaissmaier
Keyword(s):  
Medical Information ◽  
Treatment Options ◽  
Control Group ◽  
Total Risk ◽  
Medical Decisions ◽  
Medical Treatments ◽  
Multiple Trials ◽  
Number Of Treatment ◽  
And Control

Background. Informed medical decisions require understanding the benefits and risks of treatments. This entails comparing treatment outcomes to a control group. The incremental risk format has been recommended as it directly visualizes the differences between treatment and control group in 1 graph, whereas they have to be calculated from 2 separate graphs in the total risk format. We investigated when the incremental risk format aids understanding. Methods. In 2 experiments, participants received information about medical treatments, either as incremental or total risk format. We assessed verbatim knowledge (precise quantitative knowledge), gist knowledge (knowledge of essential meaning), and evaluations of the formats. Study 1 ( N = 99) consisted of only 1 trial with medical information and also assessed recall. Study 2 ( N = 222) assessed learning across multiple trials and also varied the presence of feedback and the number of treatment options. Results. In study 1, the incremental risk format (v. total risk format) led to worse knowledge, recall, and evaluations. In study 2, participants learned to understand the incremental risk format over time, resulting in comparable verbatim knowledge and evaluations as in the total risk format, as well as in even better gist knowledge. Feedback and number of treatment options did not moderate the effect of risk format. Limitations. The studies were conducted with nonpatient samples, and study 2 employed hypothetical treatments. Conclusions. The incremental risk format was initially less understandable than the total risk format. After a short learning period, however, the incremental risk format resulted in better gist knowledge and was comparable otherwise, which suggests that participants had to get used to that format. This has important implications for the study of new formats.

scholarly journals The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery

2019 ◽  
Vol 71 (5) ◽  
pp. 942-950 ◽  
Author(s):  
Enric Reverter ◽  
Isabel Cirera ◽  
Agustín Albillos ◽  
Wilma Debernardi-Venon ◽  
Juan G. Abraldes ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Prognostic Role ◽  
Cirrhotic Patients

The role of hepatic arterial flow on portal venous and hepatic venous wedged pressure in the isolated perfused CCl4-cirrhotic liver

2008 ◽  
Vol 295 (1) ◽  
pp. G197-G202 ◽  
Author(s):  
Alexander Zipprich ◽  
Mauricio R. Loureiro-Silva ◽  
Irita D'Silva ◽  
Roberto J. Groszmann
Keyword(s):  
Liver Perfusion ◽  
Venous Pressure ◽  
Arterial Flow ◽  
Hepatic Arterial Flow ◽  
Drug Induced ◽  
Arterial Perfusion ◽  
Elevated Pressures ◽  
Flow Pressure ◽  
And Control

In cirrhosis, hepatic venous pressure gradient is used to measure portal venous and sinusoidal pressures, as well as drug-induced decreases of elevated pressures. The aim of this study was to investigate the influence of hepatic arterial flow (HAF) changes on portal venous perfusion (PVPP) and wedged hepatic venous pressure (WHVP). Normal and CCl4-cirrhotic rats were subjected to a bivascular liver perfusion with continuous measurements of PVPP, WHVP, and hepatic arterial perfusion pressure. Flow-pressure curves were performed with the use of different flows either through the portal vein (PVF: 20–32 ml/min) or HAF (5–15 ml/min). Increases in HAF lead to significant absolute and relative increases in PVPP ( P = 0.002) and WHVP ( P < 0.001). Absolute changes in HAF correlated to absolute changes in PVPP (cirrhosis: r = 0.64, P < 0.001; control: r = 0.67, P < 0.001) and WHVP (cirrhosis: r = 0.71, P < 0.001; control: r = 0.82, P < 0.001). Changes in PVPP correlated to changes in WHVP due to changes in PVF only in cirrhosis ( r = 0.75, P < 0.001), whereas changes in HAF correlated in both cirrhosis ( r = 0.92, P < 0.001) and control ( r = 0.77, P < 0.001). In conclusion, increases and decreases in HAF lead to respective changes in PVPP and WHVP. This suggests a direct influence of HAF on PVPP and WHVP most likely due to changes in sinusoidal perfusion.

Perfusion and Infusion for Melanoma In-Transit Metastases in the Era of Effective Systemic Therapy

2015 ◽  
pp. e528-e534 ◽  
Author(s):  
Dirk J. Grünhagen ◽  
Hidde M. Kroon ◽  
Cornelis Verhoef
Keyword(s):  
Systemic Therapy ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Limb Perfusion ◽  
Effective Delivery ◽  
In Transit ◽  
And Control ◽  
Systemic Agents ◽  
Necrosis Factor

The management of melanoma in-transit metastases (IT-mets) is challenging. For many years, the absence of effective systemic therapy has prompted physicians to focus on regional therapies for melanoma confined to the limb. The introduction of isolated limb perfusion (ILP) and isolated limb infusion (ILI) has enabled effective delivery of cytotoxic drugs in an isolated circuit, so as to overcome systemic toxicity and maximize local response. Both techniques have evolved over years and both tumor necrosis factor (TNF)-alpha–based ILP and ILI have distinct indications. The development of new systemic treatment options for patients with melanoma in the past decade has shed a new light on melanoma therapy. The present manuscript focuses on the modern role of ILI and ILP in the treatment of patients with melanoma with in-transit metastases in the era of effective systemic therapy. The response and control rates of ILI/ILP are still superior to rates achieved with systemic agents. The extent of disease in patients with stage III disease, however, warrants effective systemic treatment to prolong survival. There is great potential in combining rapid response therapy such as ILI/ILP with systemic agents for sustainable response. Trial results are eagerly awaited.

POSSIBLE ROLE OF HYPERAMMONAEMIA AND/OR OF PORTOSYSTEMIC SHUNTS ON THE VARIABILITY OF THE TSH RESPONSE TO TRH IN CIRRHOTIC PATIENTS

1978 ◽  
Vol 89 (2) ◽  
pp. 284-295 ◽  
Author(s):  
J. L. Schlienger ◽  
M. Hasselmann ◽  
M. Imler
Keyword(s):  
Liver Disease ◽  
Disease Group ◽  
Portosystemic Shunts ◽  
Advanced Cirrhosis ◽  
Free Thyroxine Index ◽  
Group A ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Group B

ABSTRACT Serum concentrations of thyroid hormones (T3, T4) and the TSH response to TRH administered iv were measured by radioimmunoassay in 21 patients with advanced cirrhosis and compared to 20 control patients without liver disease (group A). While the mean T4 values (8.6±0.3 μg/100 ml) were similar for the two groups, the mean T3 values were significantly lower in patients with liver disease (123 ± 12 vs. 156 ± 10 ng/100 ml). The mean baseline TSH levels and the magnitude of the peak were normal but very scattered in these patients. The TSH response to TRH appeared independant of nutritional status, T4 and T3, anaemia, hypoalbuminaemia, transaminasaemia and bilirubinaemia. The TSH release after TRH injection seemed however to be markedly elevated in cirrhotic patients with hyperammonaemia. Therefore, patients with liver disease were separated into two groups according to the absence (group B; n = 11) or the presence (group C; n = 10) of hyperammonaemia. Mean T4 values and the free thyroxine index were lower in group C (7.2 ± 0.6 vs. 9 ± 0.6 μg/100 ml and 1.87 ± 0.16 vs. 2.49 ± 0.15) but mean T3 and basal TSH values did not differ in group B and C. The TSH response was slightly dispersed in B and lower than that observed in A or in C (P < 0.01). A hyperresponsiveness in 4 patients and a hyperresponsiveness in 2 other patients was noted in group C without any correlation with the basal TSH value or T3 or T4 Since hyperammonaemia has been considered as a biological parameter of hepatic encephalopathy, it is suggested that the THS release which is neuraminergic controlled may be altered by this situation resulting in a cerebral aminergic mediators depletion.

scholarly journals Serum Levels of Kisspeptin Are Elevated in Patients with Pancreatic Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Sven H. Loosen ◽  
Mark Luedde ◽  
Georg Lurje ◽  
Martina Spehlmann ◽  
Pia Paffenholz ◽  
...  
Keyword(s):  
Performance Status ◽  
Treatment Options ◽  
Tumor Resection ◽  
Serum Levels ◽  
Ecog Performance Status ◽  
Related Factors ◽  
Suitable Treatment ◽  
Novel Biomarkers ◽  
Selection Of

Pancreatic adenocarcinoma (PDAC) still represents a devastating disease associated with a very limited survival. Novel biomarkers allowing an early diagnosis as well as an optimal selection of suitable treatment options for individual patients are urgently needed to improve the dismal outcome of PDAC patients. Recently, alterations of Kisspeptin serum levels, a member of the adipokine family, were described in various types of cancers. However, the role of circulating Kisspeptin as a biomarker in PDAC patients is poorly defined. In this study, we measured Kisspeptin serum levels in a cohort of 128 prospectively enrolled PDAC patients undergoing surgical resection as well as 36 healthy controls. Kisspeptin concentrations were elevated in PDAC patients compared to control samples. Nevertheless, Kisspeptin serum levels were independent of tumor-related factors such as the tumor grading, TNM stage, or clinical features such as the ECOG performance status. Finally, in our analysis, neither preoperative nor postoperative Kisspeptin levels turned out as a significant predictor of overall survival after tumor resection. In conclusion, our data suggest that Kisspeptin concentrations are altered in PDAC patients but do not allow to predict patients’ outcome after resection of PDAC.

Cerebral Venous Thrombosis

2018 ◽  
pp. 253-264
Author(s):  
Juan Ramos-Canseco ◽  
Maxim Mokin
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Heart Association ◽  
Diagnostic Value ◽  
Surgical Interventions ◽  
Evidence Based Guidelines ◽  
And Control

Establishing the diagnosis of cerebral venous thrombosis (CVT) can often be challenging to physicians. CVT presents with variable symptoms, resulting in delay in establishing the correct diagnosis and treatment. This chapter provides practical recommendations on the currently available diagnostic and treatment options in patients with suspected acute CVT. The diagnostic value of computed tomography, magnetic resonance imaging, and catheter angiography are also discussed. This chapter also includes recommendations for medical treatment with systemic anticoagulation, the role of endovascular therapy, and indications for surgical interventions including hemicraniectomy and control of intracranial pressure. Formal evidence-based guidelines released by the American Heart Association in 2011 are also outlined in this chapter.

scholarly journals Implications of asymptomatic carriers for infectious disease transmission and control

2018 ◽  
Vol 5 (2) ◽  
pp. 172341 ◽  
Author(s):  
Rebecca H. Chisholm ◽  
Patricia T. Campbell ◽  
Yue Wu ◽  
Steven Y. C. Tong ◽  
Jodie McVernon ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Model Parameters ◽  
Model Structure ◽  
Infectious Disease Transmission ◽  
Asymptomatic Carriers ◽  
Effective Interventions ◽  
History Of ◽  
And Control ◽  
Selection Of

For infectious pathogens such as Staphylococcus aureus and Streptococcus pneumoniae , some hosts may carry the pathogen and transmit it to others, yet display no symptoms themselves. These asymptomatic carriers contribute to the spread of disease but go largely undetected and can therefore undermine efforts to control transmission. Understanding the natural history of carriage and its relationship to disease is important for the design of effective interventions to control transmission. Mathematical models of infectious diseases are frequently used to inform decisions about control and should therefore accurately capture the role played by asymptomatic carriers. In practice, incorporating asymptomatic carriers into models is challenging due to the sparsity of direct evidence. This absence of data leads to uncertainty in estimates of model parameters and, more fundamentally, in the selection of an appropriate model structure. To assess the implications of this uncertainty, we systematically reviewed published models of carriage and propose a new model of disease transmission with asymptomatic carriage. Analysis of our model shows how different assumptions about the role of asymptomatic carriers can lead to different conclusions about the transmission and control of disease. Critically, selecting an inappropriate model structure, even when parameters are correctly estimated, may lead to over- or under-estimates of intervention effectiveness. Our results provide a more complete understanding of the role of asymptomatic carriers in transmission and highlight the importance of accurately incorporating carriers into models used to make decisions about disease control.

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