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Biomedical subjects

L Pagliaro

Publications and source records attributed to L Pagliaro.

At least 127 records · Page 7Linked to original sources
PubMed1986

Survival and prognostic indicators in compensated and decompensated cirrhosis.

Six-year survival of cirrhosis was assessed in a series of 1155 consecutive patients (751 men, 404 women). Among the men, 33% were alcoholics and 18% were HBsAg positive; corresponding figures for the women were 15% and 6% respectively. Features of decompensation at first presentation were observed in 63% of the patients. Six-year survival was 54% in compensated and 21% in decompensated patients. No significant differences in survival were found between alcoholics and nonalcoholics. Leading causes of death were liver failure (49%), hepatocellular carcinoma (22%), and bleeding (13%). The prognostic role of 21 variables was evaluated separately in compensated and decompensated patients by the Cox's regression model. The following variables were found to be significant predictors of death risk in compensated patients: male sex, HBsAg positivity, age, prothrombin time prolongation, and esophageal varices. In decompensated disease the significant indicators of death risk were: hepatocellular carcinoma, encephalopathy, hemorrhage, SGOT, esophageal varices, gamma globulins, prothrombin time prolongation, continued abuse of alcohol, HBsAg positivity, gamma glutamyl transpeptidase, and cholinesterase. A simple prognostic index based upon the relative risk coefficient of the significant variables is suggested.

Carcinoma, Hepatocellular↗
PubMed1986

Predictive value of ultrasonography in the screening of non-ascitic cirrhotic patients with large varices.

To evaluate the accuracy of ultrasonography in the screening of cirrhotic patients with large varices, the receiver operator characteristic (ROC) curves of the portal, mesenteric, and splenic veins of 215 consecutive non-ascitic patients were plotted in order to select the most indicative optimal threshold. The contribution of respiratory variations of splenic and mesenteric veins was also evaluated. Taking 13 mm as the limit for the normal diameter of the portal vein, 10 and 9 mm for the upper limits of the mesenteric and splenic veins, respectively, and respiratory variations being absent, the positive rates were 91, 88, and 92 per cent and the false-positive rates were 44, 38, and 42 per cent, respectively. The predictive values of a positive test were 0.34, 0.33, and 0.34, respectively, and the predictive values of a negative test were 0.96 for the portal and mesenteric veins and 0.97 for the splenic vein. Because the portal vein is always visible, the portal diameter may be employed in the screening through the presence of large varices in association with the assessment of respiratory variation in the splenic or mesenteric diameter. A cut-off point of 13 mm and the absence of respiratory variations precludes the need for endoscopy in 47 per cent of patients.

Endoscopy↗
PubMed1986

Assessment of HBV replicative status by receptors for polymerized human albumin.

Receptors for polymerized human albumin (pHSA-r) are expressed on HBsAg in larger numbers during complete viral replication. We have evaluated the usefulness of pHSA-r as a marker of high-level infection by a comparison with serum HBeAg, liver HBcAg and serum HBV-DNA. One-hundred-and-fifty-seven patients with HBsAg positive chronic liver disease were tested for HBeAg and pHSA-r titre. In 73 of them liver HBcAg was tested by immunofluorescence, while in the remaining 84 serum HBV-DNA was determined. Seventy-three subjects were HBeAg positive, 20/73 were HBcAg positive, and 60/84 had circulating HBV-DNA. The best cut-off for pHSA-r was found at 1:204,800 (sensitivity of 67.6% and specificity of 95.7% in detecting viral replication). At this cut-off the concordance rate between pHSA-r and viral replication (as assessed by HBV-DNA or liver HBcAg) was 83%, a figure similar to that of HBeAg (88%). Three HBeAg negative subjects who were actually complete replicators were identified by the pHSA-r test.

Carrier State↗
PubMed1985

Adriamycin treatment for hepatocellular carcinoma. Experience with 109 patients.

One hundred nine patients with hepatocellular carcinoma were treated with intravenous (IV) Adriamycin (doxorubicin). Cumulative survival rate was 34% at 6 months and 13% at 1 year. Survival was positively related to a good performance status and to alpha-fetoprotein less than 50 ng/ml, not influenced by hepatitis B surface antigen (HBsAg) and by presence of clear cells in the tumor. Partial response (alpha-fetoprotein decrease by greater than or equal to 50% of the initial value) was observed in 10 patients and complete response in 1 patient, always within the fourth dose, with a 10% response rate. Twenty of 75 symptomatic patients (27%) achieved improvement in performance and/or pain reduction. Withdrawal of treatment became necessary for side effects in six patients. In conclusion, IV Adriamycin in hepatocellular carcinoma has only limited efficacy. Because of its early activity, treatment can be stopped after three doses if there is no evidence of response.

Aged↗
PubMed1985

Polyalbumin receptors, hepatitis B surface antigen (HBsAg), and HBsAg/IgM complexes in HBsAg positive patients with and without delta superinfection.

Receptors for polymerized human albumin are found at high titres during high-level hepatitis B virus (HBV) replication and in small amounts in chronic low-level infection. Complexes between hepatitis B surface antigen (HBsAg) and IgM without specificity for HbsAg are expressed in a pattern similar to that of receptors. Anti-albumin antibodies could be involved in their formation. Delta infection depresses the synthesis of gene products of HBV. To assess whether delta modifies the expression of receptors on HBsAg and the level of HBsAg/IgM complexes, and if anti-albumin antibodies are actually part of the complex, we tested sera from 86 subjects with acute and chronic HBV infection. Our findings show that the amounts of circulating receptors and HBsAg/IgM are proportional to the concentration of HBsAg and thus probably to the degree of viral replication. We did not find any correlation between circulating anti-albumin antibodies of the IgM class and HBsAg/IgM complexes. Delta infection depresses HBsAg synthesis and causes a related decrease in receptors and HBsAg/IgM titres if superimposed on the more active stage of HBV infection. When HBsAg, receptors, and HBsAg/IgM are at low levels, no further depression is caused by delta infection. HBsAg/IgM titre is not enhanced by presence of anti-delta antibodies, thus excluding a role of the latter in forming these complexes.

Acute Disease↗
PubMed1985

The clinical value of serum ferritin in hepatocellular carcinoma.

Serum ferritin is often elevated in patients with hepatocellular carcinoma (HCC). Its use as a disease marker has been proposed. We have measured serum ferritin levels in 85 patients with HCC and in 62 comparable subjects with cirrhosis. Abnormal values (greater than or equal to 300 ng/ml) were found in 54% of the patients with HCC and in 35% of those with cirrhosis (median 323 and 204 ng/ml, respectively). The overlap of the range of concentration in HCC and cirrhosis was so great that no discriminant level could be chosen. No relationship was found between alpha-fetoprotein and ferritin concentrations. Among 61 patients who received Adriamycin treatment, no discernible fall in ferritin levels was observed, while alpha-fetoprotein increased progressively during the follow-up. Serum ferritin has no role in diagnosing and/or monitoring the response to treatment of patients with HCC.

Adult↗
PubMed1984

Ultrasonographic and radionuclide detection of hepatocellular carcinoma in cirrhotics with low alpha-fetoprotein levels.

A total of 67 cirrhotic patients with clinically suspected neoplastic degeneration and low alpha-fetoprotein levels were assessed prospectively with ultrasound and gold (198Au) scintigraphy. Ultrasound showed space-occupying lesions in 22 of the 24 patients who had a final diagnosis of hepatocellular carcinoma (HCC) (sensitivity, 95.8%) and excluded the presence of HCC in 37 of the 43 patients with cirrhosis only (specificity, 86.0%; efficiency, 90.8%). Scintigraphy demonstrated a cold defect in 22 of the 24 patients who had a final diagnosis of HCC (sensitivity, 95.8%) and excluded the presence of HCC in 22 of the 43 patients with cirrhosis only (specificity, 51.1%; efficiency, 69.8%). It was concluded that the most accurate screening plain in cirrhotic patients suspected of having HCC with alpha-fetoprotein values below 500 ng/ml would consist of ultrasonography followed, as clinically indicated, by ultrasonographic or laparoscopic guided biopsy.

Carcinoma, Hepatocellular↗
PubMed1984

Delta agent infection in acute hepatitis and chronic HBsAg carriers with and without liver disease.

Hepatitis B virus (HBV) is a major cause of chronic liver disease in southern Italy. In the same area superinfection with the delta agent is endemic. To assess the prevalence of delta infection in a large population of patients with acute and chronic HBV related liver disease and to look for differential features among delta infected and uninfected subjects sera from 592 consecutive HBsAg positive patients were tested for the delta/anti-delta system by RIA. In no case was delta Ag found in serum. The prevalence of anti-delta was low in acute hepatitis (6.6%) and in asymptomatic carriers (6.4%) but raised in chronic active hepatitis with or without cirrhosis (52.3%). A decrease in frequency of anti-delta was seen in inactive cirrhosis (38.8%) and in hepatocellular carcinoma (11.9%). A younger mean age of delta-infected subjects was observed in each type of chronic liver disease. Our data confirm that delta agent superinfection is definitely associated with severe chronic active liver disease. The difference in age between anti-delta positive and negative patients suggests that delta infection accelerates the natural history of HBV related liver disease.

Acute Disease↗
PubMed1984

Tissue markers of hepatitis B virus infection in hepatocellular carcinoma and cirrhosis.

In order to assess the prevalence of tissue markers of HBV infections (HBsAg and HBcAg) in HBsAg seropositive and seronegative hepatocellular carcinoma (HCC) as compared with other advanced liver diseases (inactive cirrhosis, IC, and active cirrhosis, AC), we studied 49 patients with HCC (13 HBsAg+), 52 patients with IC (5 HBsAg+) and 53 patients with AC (14 HBsAg+). Among HBsAg seropositive patients, intrahepatic HBsAg was frequently found (26/32 cases), while HBcAg was present more rarely (5/32 cases) and correlated with serological features of high-level viral replication. HBsAg seronegative, anti-HBc +/- anti-HBs positive subjects had intrahepatic HBsAg in 8/34 cases, and HBcAg in liver cell nuclei in 14/34 cases. HBcAg was more frequent in cirrhosis than in HCC. No other differences in the intrahepatic display of HBV markers was observed, nor was a specific pattern identified for HCC. Viral components were never found in the liver in the absence of serum HBsAg or anti-HBc. Neoplastic hepatocytes did not usually support the synthesis of HBsAg or HBcAg.

Antibodies, Monoclonal↗
PubMed1983

Percutaneous blind biopsy versus laparoscopy with guided biopsy in diagnosis of cirrhosis. A prospective, randomized trial.

A prospective controlled study of the diagnostic accuracy of blind percutaneous liver biopsy in comparison to laparoscopy plus guided biopsy for the recognition or exclusion of cirrhosis has been performed. One hundred twenty-six patients with a clinical diagnosis of chronic, diffuse, well-compensated liver disease were randomized into two groups and submitted either to percutaneous blind liver biopsy (PB: 64 patients) or to laparoscopy with guided biopsy (LB: 62 patients), in order to assess the accuracy of either procedure in diagnosing cirrhosis. PB correctly recognized or ruled out cirrhosis in 52 patients (82%). Inconclusive results were mostly false negative, as demonstrated by the presence on endoscopy of esophageal varices or by subsequent LB. LB demonstrated presence or absence of cirrhosis in all patients. The difference between the rate of accurate results of the two procedures is statistically significant. It is concluded that in patients without esophageal varices, LB should be the investigation of choice for the assessment of liver structure since the presence of cirrhosis can be missed in up to 20% of cases by PB.

Adult↗
PubMed1983

Ultrasound in the diagnosis of hepatocellular carcinoma associated with cirrhosis.

A total of 100 cirrhotic patients with clinically suspected neoplastic transformation was assessed prospectively with ultrasound. Ultrasound was diagnostic in 27/30 patients who had a final diagnosis of hepatocellular carcinoma (sensitivity 90%); there were five false-positive examinations (specificity 93%). The positive predictive value of the test was 84.4%; negative predictive value was 95%. Three different ultrasound patterns were observed in hepatocellular carcinoma: increased reflectivity, decreased reflectivity, and mixed echo pattern. Ultrasound can be used as a safe, effective first-line screening test for cirrhotic patients with clinically suspected neoplastic transformation.

Carcinoma, Hepatocellular↗