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Hendrik Vilstrup

Publications and source records attributed to Hendrik Vilstrup.

33 records · Page 2Linked to original sources
PubMed2003

[Nonalcoholic steatohepatitis--a "new" hepatic disease].

Non-alcoholic fatty liver disease (NAFLD) is one of the most common hepatic disorders in the Western world. Non-alcoholic steatohepatitis (NASH) may occur in a subset of NAFLD patients and is an increasingly recognised clinicopathologial hepatic disorder. NASH may have significant impact on the healthcare system as it is associated with the metabolic syndrome comprising insulin resistance, obesity, hypertension, and type 2 diabetes mellitus. NASH can progress to liver fibrosis, cirrhosis and chronic hepatic failure and eventually to the need for a liver transplantation. The present review deals with the epidemiological features of NASH, describes a two-step pathogenesis with hepatic lipid accumulation (NAFLD) followed by the development of steatohepatitis (NASH). A strategy for establishing a diagnosis of NASH is presented including the indication for liver biopsy. The treatment of NASH may comprise different modalities from diet, weight loss, and exercise to pharmacological treatment to improve insulin resistance and drugs with antioxidant effects.

Denmark↗
PubMed2003

[Transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of complications of portal hypertension in patients with liver cirrhosis].

Portal hypertension is a main cause for the development of esophago-gastric varices, ascites and hepatic nephropathy in liver cirrhosis. Reduction of portal pressure by a transjugular intrahepatic portosystemic shunt (TIPS) procedure has been possible for the last decade. The treatment reduces the risk for variceal bleeding, reduces ascites formation and may improve renal function in hepatic nephropathy. Improved survival, however, has not yet been documented. Complications comprise procedure related events (puncture of liver capsule, bleeding, infection, hemolysis with mortality 1-5%), shunt stenosis (30-80% during the first year but reversible), and encephalopathy (30% intermittent, 10% chronic). Indications for the procedure are primarily variceal bleeding resistant to conventional pharmacologic and endoscopic treatment. Absolute and relative contraindications are severe hepatic failure, a history of hepatic encephalopathy, infections, respiratory failure, and non-hepatic renal insufficiency.

Ascites↗
PubMed2003

[TIPS--transjugular intrahepatic portosystemic shunt. Experiences from a recently started center].

The transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous, minimally invasive, method of creating a portosystemic shunt for the treatment of portal hypertension. The results of the first 54 TIPS procedures are reported. There were no severe procedure-related complications. TIPS implantation was successful in 52 patients. Rebleeding was seen in 13% of the patients. Hepatic encephalopathy developed in 19%, but only in 11% as a chronic complication. Seven out of 9 patients with refractory ascites no longer required paracentesis after six months. The cumulative survival for the whole group was 81% after one year and 62% after three years.

Adult↗
PubMed2003

Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark.

Mortality from cirrhosis of the liver has been examined in few long-term follow-up studies. In the Danish National Registry of Patients, 1982-1989, we identified a cohort of 10,154 patients with liver cirrhosis and divided them according to the etiology of their liver disease. Causes of death were identified in the Danish Death Registry, 1982-1993. We estimated relative survival and standardized mortality ratios by comparing with the mortality in the general population. The 10-year relative survival was worse in patients with alcoholic cirrhosis (34%) or nonspecified cirrhosis (32%) than in patients with primary biliary cirrhosis (58%) or chronic hepatitis (66%). The standardized mortality ratio for all causes of death combined was 12-fold increased, 5-fold excluding cirrhosis-related causes. Mortality in all disease categories was increased, even in those not traditionally related to cirrhosis. In conclusion, patients with cirrhosis of the liver face reduced life expectancy due to several causes of death.

Cause of Death↗
PubMed2003

Thirty-day case fatality after nephrectomy in patients with liver cirrhosis--a Danish population-based cohort study.

OBJECTIVE: Previous studies have shown that patients with liver cirrhosis are at increased risk of death after a number of surgical procedures, but their risk of death after nephrectomy has not been examined. We compared the 30-day postoperative case fatality rate after nephrectomy in patients with liver cirrhosis with that of patients without liver cirrhosis using data from an established dataset. MATERIAL AND METHODS: Between 1 January, 1977 and 31 December, 1993 we followed a population-based cohort of Danish liver cirrhosis patients in order to identify those who underwent nephrectomy. A control group of patients without liver cirrhosis who underwent nephrectomy during the same period was also identified. A logistic regression model was used to estimate the odds ratio of the 30-day case fatality rate of patients with liver cirrhosis relative to those without liver cirrhosis. The model was adjusted for age, sex, comorbidity and type of admission. The study was based entirely on data from the Danish National Registry of Patients. RESULTS: A total of 29/23 133 patients with liver cirrhosis underwent nephrectomy, and the control group comprised 582 patients without liver cirrhosis. The 30-day case fatality rates were 24.1% and 8.1%, respectively, yielding an adjusted odds ratio of 3.6 (95% CI 1.2-8.9) for patients with liver cirrhosis relative to those without liver cirrhosis. Male gender, high comorbidity and emergency admission were also associated with an increased risk of postoperative death. CONCLUSIONS: Nephrectomy in patients with liver cirrhosis carries an increased risk of postoperative death, but the lack of clinical data prevents us from suggesting guidelines for clinical management.

Aged↗
PubMed2003

Risk of cancer in patients hospitalized with fatty liver: a Danish cohort study.

GOALS: To examine the risk of cancer in patients with fatty liver. BACKGROUND: The relation between liver disease, including fatty liver, and cancer risk is poorly understood. STUDY: Using the population-based National Registry of Patients, we examined the incidence of cancer in 7,326 patients discharged with a diagnosis of fatty liver from a Danish hospital during 1977-1993. Patients with a prior diagnosis of liver cirrhosis were excluded. We identified cancers through the Danish Cancer Registry. The expected number of cancers was estimated from national age-, sex-, and site-specific incidence rates. RESULTS: Overall, 523 cancers were diagnosed during 47,594 person-years of follow-up, yielding a 1.7-fold increased risk (95% confidence interval, 1.6-1.9) compared with the Danish general population. The risk of primary liver cancer was markedly elevated in patients with alcoholic as well as nonalcoholic fatty liver with a standardized incidence ratio of 9.5 (95% confidence interval, 5.7-14.8) and 4.4 (95% confidence interval, 1.2-11.4), respectively. Patients with alcoholic fatty liver also had substantially increased risks of several types of cancer associated with alcohol and tobacco use (cancers of the lung, pharynx, larynx, esophagus, and stomach) and a moderately increased risk for cancers of the colon and breast. Among patients with nonalcoholic fatty liver, an increased risk of some alcohol- and tobacco-related cancers was seen, and there was also an increased risk of colon and pancreas cancer. CONCLUSIONS: Patients discharged with a diagnosis of fatty liver have an increased risk of cancer, in particular liver cancer, most prominently among patients with alcoholic fatty liver.

Age Distribution↗
PubMed2003

Cirrhosis and bacterial infections.

Half of cirrhosis patients die within two years after diagnosis, in most cases from cirrhosis related causes; most frequently variceal bleeding closely followed by infections. There seems to exist associations between infection and other complications such as malnutrition, hepatic encephalopathy and variceal bleeding. Cirrhosis patients have an acquired immune deficiency because of dyshomeostasis and malnutrition. All host defence systems are compromised, e.g. the acute phase response, and macrophage, neutrocyte, and lymphocyte functions. Simultaneously, there is increased microbiotic invasion, due to increased nosocomial exposure, intestinal translocation, aspiration, skin lesions, and trauma. Compared to the background population, the mortality of infections is more than 20 times increased in cirrhosis. The incidence of peritonitis, bacteremia, urinary tract infection, pneumonia, meningitis, tuberculosis, liver abscess is increased more than tenfold, and the mortality of each episode 3-10 times higher. The systemic response and accompanying classical symptoms are usually weakened. When positive isolates can be obtained the flora tends to be of an opportunistic nature. Infection should be suspected in any cirrhotic patient with an unexpected deterioration of clinical course. Treatment should be started on suspicion and with large dose broad-spectrum antibiotics (avoiding aminoglycosides). Antibiotic prophylaxis is efficacious at variceal bleeding, recurrent peritonitis, and at very low protein ascites, but otherwise is associated with risk of infection with multi-resistant strains.

Antibiotic Prophylaxis↗
PubMed2002

Thirty-day postoperative mortality after hysterectomy in women with liver cirrhosis: a Danish population-based cohort study.

BACKGROUND: Women with liver cirrhosis have a higher incidence of hysterectomy than the general population, generally because of abnormal bleeding. They may also have an increased risk of postoperative mortality and morbidity. METHODS: In the nationwide Danish National Patients Register (NPR) we identified all women diagnosed with liver cirrhosis from 1977 to 1993. From this cohort we selected all women undergoing hysterectomy. A random sample of women without liver cirrhosis undergoing hysterectomy was selected as controls. Outcome was defined as mortality within the first 30 days after discharge. Logistic regression analysis was used to estimate the association between liver cirrhosis and 30-day postoperative mortality, adjusted for age, comorbidity, and type of admission. RESULTS: Out of 8539 women with liver cirrhosis 105 underwent hysterectomy. We found a 30-day postoperative mortality of 7.6% (95% confidence interval (CI) 2.5-12.7%) and 0.6% (95% CI 0.5-0.7%) in women with and without liver cirrhosis, respectively. The crude odds ratio was 14 (95% CI 6.5-29) and the adjusted odds ratio was 11 (95% CI 4.8-24) for 30-day postoperative mortality in women with liver cirrhosis compared with non-cirrhotic controls. CONCLUSION: Hysterectomy in women with liver cirrhosis is associated with an 11-fold increased risk of death within the first 30 days after discharge.

Cohort Studies↗
PubMed2002

Cancer risk in persons receiving prescriptions for paracetamol: a Danish cohort study.

The use of paracetamol has been associated with increased risks for urinary tract cancers and decreased risk for ovarian cancer, although results have been inconsistent. We conducted a population-based cohort study using data from the Prescription Database of North Jutland County and the Danish Cancer Registry. Cancer incidence among 39,946 individuals receiving prescriptions for paracetamol was compared with expected incidence based on the North Jutland population who did not receive paracetamol prescriptions, during a 9-year follow-up period. Standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (95% CIs) were calculated for cancers overall and at selected sites. Overall, 2,173 cancers were observed with 1,973 expected, yielding a SIR of 1.10 (95% CI, 1.06-1.15). Significantly elevated SIRs were found for cancers of the esophagus (1.9; 95% CI, 1.3-2.8) and lung (1.6; 95% CI, 1.4-1.7). Nonsignificantly increased SIRs were observed for cancers of the liver (1.5; 95% CI, 0.96-2.2), renal parenchyma (1.3; 95% CI, 0.9-1.7) and renal pelvis/ureter (1.6; 95% CI, 0.96-2.6), whereas the SIR for cancer of the urinary bladder was close to unity (1.1; 95% CI, 0.9-1.4). For ovarian cancer, the SIR was close to expectation (0.9; 95% CI, 0.6-1.2) with no evidence of trends with duration of follow-up or number of prescriptions. A similar risk pattern was observed after exclusion of person-time experience following prescription for aspirin or other nonsteroidal antiinflammatory drugs in the study cohort and reference population. Our results do not support a major role for paracetamol in the development of cancers of the urinary tract, and we found little evidence of a protective effect of paracetamol against ovarian cancer. The elevated risks for cancers of the esophagus, lung and liver are most likely a result of confounding variables, but may warrant further investigation.

Acetaminophen↗
PubMed2002

Human insulin release processes measured by intraportal sampling.

Insulin is secreted as a series of punctuated secretory bursts superimposed on variable basal insulin release. The contribution of these secretory bursts to overall insulin secretion has been estimated on the basis of peripheral vein sampling in humans to encompass > or =75% of overall insulin release. A similar contribution of the pulsatile mode of release was inferred in a canine model by use of portal vein sampling. The primary regulation of insulin secretion is through perturbation of the mass and frequency of these secretory bursts. The mode of delivery of insulin into the circulation seems important for insulin action; therefore, physiological conditions that alter the pattern of insulin release may affect insulin action through this mechanism. Transhepatic intraportal shunt in humans may provide access to portal vein samples, thus potentially improving the sensitivity of detecting and quantitating the frequency, mass, and amplitude of secretory bursts along with basal release and the regularity of these variables. To establish the insulin-secretory mechanism in nondiabetic humans by the use of portal vein sampling, we here assessed the mass, frequency, amplitude, and overall contribution of pulsatile insulin secretion by deconvolution analysis of portal vein insulin profiles. We find that, in nondiabetic humans fasted overnight, the portal vein insulin concentration oscillates at a periodicity of 4.1 +/- 0.2 min/pulse and with secretory peak amplitudes averaging 660% of basal (interpulse) release. The frequency was confirmed by spectral and autocorrelation analyses. The punctuated insulin-secretory bursts partially overlap and are responsible for the majority (70 +/- 4%) of insulin release. After ingestion of a mixed meal, the insulin release was increased through amplification of the secretory burst mass (507 +/- 104 vs. 1,343 +/- 211 pmol x l(-1) x min(-1), P < 0.001), whereas frequency (4.4 +/- 0.2 vs. 4.3 +/- 0.2, P = 0.86) and basal secretion (62 +/- 14 vs. 91 +/- 22 pmol x l(-1) x min(-1), P = 0.33) were unaffected. One subject with diabetes and cirrhosis had a similar insulin-secretory pattern, whereas a subject with insulin-dependent diabetes mellitus and minimal insulin release had preserved pulsatile release. A single subject was entrained to show agreement between entrained frequency and portal vein insulin oscillations. We conclude that insulin release in the human portal vein occurs at a mean periodicity of 4.4 +/- 0.2 min with a high signal-to-noise ratio (pulse amplitude 660% of basal). The impact of noise on the detected high frequency cannot be excluded.

Adult↗
PubMed2002

Mortality and causes of death in patients with "lupoid hepatitis." A long-term follow-up study in Denmark.

BACKGROUND: The mortality and causes of death in patients with "lupoid hepatitis", corresponding to the recent term autoimmune hepatitis, have rarely been reported. METHODS: We identified all patients discharged from hospital with a diagnosis of "lupoid hepatitis" from 1 January 1977 until 31 December 1993 in the Danish National Registry of Patients. The causes of death for the cohort were determined by linkage of the personal identification number with the Danish Death Registry. The cohort was followed until 31 December 1996. The expected number of deaths was estimated from the national age, sex, calendar period and cause-specific death rates; and the standardised mortality ratio was calculated. RESULTS: We identified a total of 96 patients. The mean age was 50 years, and 71% of the patients were female. The mean follow-up period was 7.5 years, and after 12 years of follow-up, 50% of the patients were still alive. The overall standardised mortality ratio was 3.7 (95% CI, 2.7-5.0). The risk of dying from liver cirrhosis was increased 51.2-fold (95% CI, 22.1-100.9) compared with the general population. CONCLUSIONS: Patients with "lupoid hepatitis" have a reduced life expectancy, mainly caused by excess deaths from liver cirrhosis, malignancy and heart disease.

Cause of Death↗
PubMedDate not supplied

Prognosis of patients with a diagnosis of fatty liver--a registry-based cohort study.

BACKGROUND/AIMS: There are very limited data available regarding the prognosis of patients with fatty liver. We examined the overall and cause-specific mortality of fatty liver patients in a large Danish cohort. METHODOLOGY: In the Danish National Registry of Patients, we identified 7,372 patients discharged with a diagnosis of fatty liver from a Danish hospital between 1977 and 1993. Causes of death were identified in the Danish Death Registry. We estimated the standardized mortality ratio by comparing with the general population. RESULTS: Most patients (76%) had alcoholic fatty liver. During follow-up, 2,914 (40%) died. The commonest cause of death was hepatobiliary disease (25% of deaths). Mortality was increased 5.4-fold (95% CI 5.2-5.6) in patients with alcoholic fatty liver, and 2.6-fold (95% CI 2.4-2.9) in patients with non-alcoholic or unspecified fatty liver. Overall, in the first year of follow-up, mortality was increased more than 7-fold, almost 5-fold in the second to fifth years, and more than 3-fold after that. Mortality was similar among genders and among diabetics and non-diabetics, and remained increased after censoring patients upon diagnosis of liver cirrhosis. CONCLUSIONS: The mortality of patients with a hospital discharge diagnosis of fatty liver was higher than that of the general population.

Cause of Death↗
PubMedDate not supplied

Prognosis of patients with liver cirrhosis and spontaneous bacterial peritonitis.

BACKGROUND/AIMS: Patients with liver cirrhosis and ascites have a high risk of spontaneous bacterial peritonitis, but the prognostic impact of spontaneous bacterial peritonitis has not been well examined. METHODOLOGY: Patients with liver cirrhosis and ascites were included at the time of their first paracentesis during hospitalization in the Department of Hepatology, Aarhus University Hospital, Denmark, between September 1992 and September 2000. Cox regression was used to estimate the mortality of patients with spontaneous bacterial peritonitis (ascites leukocyte count > or = 250 per mm3) relative to controls without spontaneous bacterial peritonitis. Furthermore, we used Cox regression to estimate the change in mortality when controls developed spontaneous bacterial peritonitis during follow-up. RESULTS: Of 286 patients, 76 (27%) had spontaneous bacterial peritonitis at the first paracentesis. The mortality ratio of patients with spontaneous bacterial peritonitis relative to controls was 1.0 (95% confidence interval 0.7-1.5) after adjustment for age, gender, comorbidity, and alcohol abuse. Of the 210 controls, 42 (20%) were found to have spontaneous bacterial peritonitis at a later paracentesis. Their mortality rate more than doubled with the onset of spontaneous bacterial peritonitis. CONCLUSIONS: Spontaneous bacterial peritonitis at the first paracentesis did not affect the prognosis of patients with liver cirrhosis, whereas development of spontaneous bacterial peritonitis during follow-up doubled the mortality risk. This may be due to a longer diagnostic delay in those who developed spontaneous bacterial peritonitis during follow-up.

Adolescent↗