Non invasive markers of liver fibrosis in hepatitis C.
Explore the source record for details and available documents.
Biomarkers↗
Biomedical subjects
M Adler
Publications and source records attributed to M Adler.
[Emergency intrahepatic shunt via transjugular approach].
We report the case of a cirrhotic 65 year-old woman presenting with persistent and recurrent variceal hemorrhage in spite of endoscopic sclerotherapy with bucrylate, glypressin infusion and balloon tamponade. At the time of intrahepatic shunt placement via the transjugular route, Child-Pugh score was 14 (Child C category) and surgical variceal decompression or liver transplantation were contraindicated. At the end of the procedure, which included the placement of two Palmaz stents, varices were no more opacified and the wedge hepatic venous pressure gradient had decreased from 70%. Evolution of the patient was excellent with a permeable shunt after one month. Emergency placement of intrahepatic shunt with metallic stent has certainly a place in case of failure of initial management of variceal bleeding with pharmacotherapy, sclerotherapy or balloon tamponade.
Aged↗
Report on the Belgian consensus meeting on colorectal cancer screening.
Screening and prevention of colorectal cancer must be a public health priority. It is the most frequent malignancy in Europe, the second leading cause of cancer death, including Belgium where more than 6000 new cases occur per year. Various screening modalities, from non invasive to invasive are available and currently in use and they are all cost-effective in comparison with no screening. The decision as to which screening test to use should be made by the patient and clinician. Consensus documents prepared by the Belgian scientific community appear in this issue of Acta Gastroenterologica Belgica, summarizing the scientific evidence in favour as well as the limitations of fecal occult blood tests, flexible sigmoidoscopy, videocolonoscopy and virtual colonoscopy.
Belgium↗
Colonoscopy as a screening test for colorectal cancer.
Colonoscopy is the current gold standard for the diagnosis and treatment of colorectal neoplasms. Several gastroenterological and/or endoscopical societies recommend screening by colonoscopy in high risk patients for colorectal cancer whilst for average risk patients colonoscopy remains a valid option. In some countries screening colonoscopy is now covered by medical insurance. It is also the final common pathway of all colorectal cancer screening methods. This paper addresses the advantages and also limitations of colonoscopy as the first procedure for colorectal screening and emphasizes the importance of organized training and continuous assessment of competence of gastroenterologists and the necessity to have quality control audits of the endoscopy units.
Age Factors↗
Practical use of hepatitis C and B molecular tools: Belgian guidelines.
This article discusses the use of virologic assays in the diagnosis and management of hepatitis C virus (HCV) and hepatitis B (HBV) infection. The use of virologic tests has become essential in the management of HCV and HBV infection to diagnose viral infection, guide treatment decisions, and assess the virologic response to antiviral therapy. The continuing development of test systems accompanied by new antiviral drugs and novel therapeutic approaches should lead to an optimization of the treatment of HCV infection. Molecular methods for viral testing have become an integral part of the diagnostic and therapeutic management of infections with hepatitis C virus (HCV) and hepatitis B virus (HBV).
Belgium↗
The management of patients with mild hepatitis C.
Infection with the hepatitis C virus (HCV) represents an important public health problem and is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic hepatitis C is a heterogeneous disease. Many patients have mild disease at presentation but not all of them will develop advanced liver disease. However, the identification of these patients with mild hepatitis C who will show progressive disease is difficult and is based on histological criteria and the assessment of co-factors (age, alcohol intake, steatosis). In addition, serum transaminases that are persistently normal on several occasions during 18 months may point to a more benign course. Patients with mild hepatitis C should not be excluded "a priori" from the possibility of being treated, as treatment with pegylated interferon and ribavirin is safe and effective in this group. Overall, the decision to initiate therapy should be individualized and based on the severity of the disease by liver biopsy, the potential of serious side effects, the probability of response and the motivation of the patient.
Antiviral Agents↗
[Enteroscopy: methods and results].
Recent advances in the instrumentation and techniques of enteroscopy now permit examination of the small bowel. This report is on the use of a prototypic small bowel enteroscopy to investigate patients with gastrointestinal bleeding of obscure origin. We used the sonde-type enteroscope (Olympus Corp.) that migrates distally responding to peristaltic activity. This instrument has neither tip deflection controls nor interventional capability. Small bowel enteroscopy was performed in 17 patients. Arteriovenous malformations were visualized in 5 patients but three of them suffered from Rendu-Osler disease. Small bowel enteroscopy can be useful in the evaluation of patients with gastrointestinal bleeding of obscure origin. However, patients must be well selected on basis of negative routine examinations because this method is time-consuming.
Adult↗
Endoscopic treatment of esophagogastric varices.
We report our current management of variceal bleeding with endoscopic sclerotherapy. We emphasize the importance of resuscitation and of recording at time zero and within the first 72 hours clinical and laboratory indicators, as these influence the management of these patients. Primary sclerotherapy using Histoacryl for active bleeding and Ethoxysclerol for recent bleeding should be performed as soon as the patient is stable hemodynamically. As we have identified factors related to the severity of hemorrhage and of liver failure degree which can predict early failure of sclerotherapy, patients presenting with these findings should be, in the future, referred quickly toward alternative therapies among which non-surgical intrahepatic shunt appears a promising modality.
Cyanoacrylates↗
Operative colonoscopic endoscopy.
There are several conditions where operative colonoscopy is useful. Acute colonic pseudo-obstruction or Ogilvie's syndrome is characterized by a acute distension of the colon. Although medical management may be sufficient in many cases, endoscopic decompression must be performed when colonic distension is greater than 12 cm. Insertion of decompression tube to avoid rapid recurrence seems to be adequate. In case of massive lower intestinal hemorrhage, colonoscopy seems to be more accurate than mesenteric angiography. Such endoscopic examination requires an experienced endoscopist. Colonoscopic polypectomy has become the standard method for removal of colonic polyps. Factors influencing the rate of complications have been studied. While the number of complications was very low, we have observed that all the major hemorrhages were immediate when the blended current was used, but delayed when the pure coagulation current was applied. Endoscopic laser photocavitation is a valuable palliative method treating rectal adenocarcinoma in well selected patients. Indeed, if the patients survive sufficiently long after initial therapy, it becomes increasingly difficult to achieve persistent palliation with laser therapy.
Adenocarcinoma↗
Function and distribution of acetyl- and butyrylcholinesterase in canine tracheal smooth muscle.
The total cholinesterase activity in canine tracheal smooth muscle was found to consist of butyrylcholinesterase and acetylcholinesterase in a ratio of 3:1. Most of the acetyl- and butyrylcholinesterase sites were distributed on the muscle surface; the remaining hydrolytic sites were associated with internal structures. Intracellular acetylcholinesterase staining was associated with the perinuclear envelope, sarcoplasmic reticulum and Golgi apparatus. Intracellular butyrylcholinesterase was associated with the perinuclear envelope, sarcoplasmic reticulum and the contractile filaments. Inhibition of acetylcholinesterase by the selective agent 1,5,bis(allyl-dimethylammoniumphenyl)-pentane-3-one dibromide (BW 284C51) led to a parallel leftward shift in the concentration-response curve for bath-applied acetylcholine. A similar shift was observed in the frequency-response curve for neurally released acetylcholine. Inhibition of butyrylcholinesterase by the selective agent tetraisopropyl-pyrophosphoramide potentiated the response to bath-applied and neurally released acetylcholine; the potentiation was limited to acetylcholine concentrations greater than or equal to 1 microM and frequencies greater than or equal to 10 Hz. It is concluded that both acetyl- and butyrylcholinesterase participate in the hydrolysis of acetylcholine in canine tracheal smooth muscle. The role of acetylcholinesterase is evident over the entire range of concentrations (1 nM to 100 microM) and frequencies (1 to 90 Hz) examined, whereas the role of butyrylcholinesterase is confined to the higher end of the concentration and frequency ranges used.
Acetylcholinesterase↗
[Acute dilatation of the colon].
Dilated colon is provoked by obstructing lesions, toxic megacolon or colonic pseudoobstruction. The obstructing lesions of the colon are colonic volvulus, inflammatory bowel disease with stenosis or colonic cancer. Toxic megacolon is more often caused by I.B.D. and rarely by infectious diseases. Etiological diagnosis is possible after clinical and radiological evaluation. Colonoscopy is always indicated, except in toxic megacolon. Balloon dilatation of strictures, palliative treatment of colonic carcinoma by Laser procedures, reduction of colonic volvulus and aspiration of colonic pseudoobstruction are the principal indications of therapeutic colonoscopy in the non surgical treatment of dilated colon.
Acute Disease↗
[Acute hepatic insufficiency: medico-surgical therapeutic approach].
Explore the source record for details and available documents.
Acute Disease↗
[Primary sclerosing cholangitis: contribution of retrograde cholangiography in follow-up: apropos of 15 case reports].
From 1975 to 1989, primary sclerosing cholangitis (PSC) was diagnosed in 15 patients especially based on cholangiographic features associated with clinical, biological and histological findings. 93 p. cent of patients had altered liver enzymes at the diagnosis time but only 26% was asymptomatic. 33 p. cent had a concomittant inflammatory bowel disease. Retrograde cholangiography showed injuries of the intrahepatic ducts in 93 p. cent; the more frequently observed lesions were short and multifocal strictures, associated with irregularities of the biliary wall or decreased arborization of intrahepatic bile ducts, but without marked dilatation. Mean follow-up was 44 months (3 to 120). Actuarial survival was 48 p. cent at 5 years. In 4 patients, because of poor clinical and biological (serum bilirubin greater than or equal to 4 mg/dl) evolution, a second retrograde cholangiography was performed showing in all cases apparition of marked ductal dilatation in extra-hepatic (one case) or in intra-hepatic bile ducts (three cases). We diagnosed one benign extra-hepatic stricture, two cholangiocarcinoma and one biliary cirrhosis complicating PSC. We concluded that retrograde cholangiography is necessary if jaundice appears to diagnose every complications of PSC. Apparition of marked ductal dilatation should be the witness of pejorative evolution, especially apparition of cholangiocarcinoma that must be excluded.
Adult↗
[Intake of essential trace elements (selenium, copper and iron) in the nutrition of patients hospitalized with liver cirrhosis].
Dietary intake for three essential trace elements: selenium, copper and iron was studied in hospitalized patients receiving either ordinary meals or regimens adapted for liver cirrhosis. The aim of the study was to assess the effects of dietary manipulations: reduction in sodium intake for uncomplicated disease and protein restriction to 40 g per day in patients with hepatic encephalopathy. The meals proposed to these three groups were collected during fourteen days and daily intake for three elements was estimated by direct analysis of the assembled meals of the day. Dietary selenium was greatly affected by the restriction in protein intake contrary to copper and iron which were not significantly reduced. Moreover, overall daily trace element intake was rather low and clearly less than the most recent recommended allowances for these essential elements. Relationships between deficiency in some of these trace elements and worsening of the liver disease have been partly documented. They should encourage studies on the correction of dietary intake.
Copper↗
[Use of diuretics in the treatment of ascites in patients with cirrhosis].
The cirrhotic patient with ascites has an increased tubular reabsorption of sodium. Diuretic therapy allows an urinary loss of sodium. The strongest diuretics which inhibit sodium reabsorption in the ascending limb of the loop of Henle (like furosemide) are not the most effective in cirrhotic patients; indeed the increased load of sodium arriving in the distal part of the tubule is reabsorbed because of hyperaldosteronism. Potassium-sparing diuretics, like spironolactone, which act beyond the sites of reabsorption of most of the filtered sodium, are mostly effective when combined with other diuretics which impair sodium reabsorption more proximally. We propose to treat ascites by: 1. Sodium restriction (maximum: 60 mmol per day); 2. Spironolactone 100 to 500 mg per day, combined with furosemide 40 to 200 mg per day if spironolactone does not induce a natriuretic effect.
Ascites↗
[Selection of patients with parenchymal cirrhosis for hepatic transplantation].
The aim of our study was to design simple and practical quantitative scores or indices suitable for deciding a pre-liver transplantation work-up in patients with parenchymal cirrhosis. A Pugh score (combining five variables) superior to 8 or a p value inferior to 0.7 of a logistic regression equation containing only two variables (score of ascites and result of 14C aminopyrine breath test) were found to be highly effective for making this decision.
Aminopyrine↗
Endoscopic Nd:YAG laser therapy. A safe and effective form of palliative treatment for rectal adenocarcinoma.
Explore the source record for details and available documents.
Adenocarcinoma↗
[Non-invasive methods for assessing the small intestines].
Non-invasive methods investigating small bowel functions are critically reviewed. For intestinal absorption, we discuss the value of fecal fat determination, D-xylose testing and breath tests. Intestinal bacterial overgrowth may be assessed by breath hydrogen test or 14C-D-Xylose breath test. Small intestinal transit time can be measured by a scintigraphy method or by a breath hydrogen technique. Intestinal clearance of alpha-1 antitrypsin is now the method of choice for the detection of protein-losing enteropathy. Intestinal permeability can be assessed by 51Cr-EDTA/14C-mannitol ratio or PEG 900 method.
Breath Tests↗