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E Cos

Publications and source records attributed to E Cos.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Orthotopic hepatic transplant in chronic hepatopathy of alcoholic origin].

Liver transplantation for alcoholic cirrhosis remains controversial at some transplantation centers. We compared resource utilization and outcome in alcoholic and non-alcoholic cirrhotic patients undergoing liver transplantation. From April 1990 to November 1994, 60 patients received orthotopic liver transplants for end-stage alcoholic liver disease, and 119 transplants were performed in 103 patients for non-alcoholic liver disease. No significant differences were noted in resource utilization of the variables examined. The outcome of liver transplantation (early graft function, frequency of sepsis, incidence of rejection, renal function, arterial hypertension...) was equivalent or better in alcoholic patients. Postoperative mortality was higher in non-alcoholic population (25.2% vs 16.7%). One-year and three year actuarial survival was not significantly different, but it was higher in the alcoholic group (77% vs 67% and 74% vs 64% respectively). The recurrence rate of alcohol in take has been 9.09%, with most patients drinking only socially. We conclude that liver transplantation for end-stage alcohol-related cirrhosis provides excellent results and resource utilization appears to be equivalent to that for patients undergoing transplantation for non-alcohol-related cirrhosis.

Female↗
PubMed1996

[Treatment with interferon alfa-2b in patients with chronic hepatitis caused by hepatitis C virus: predictive factors for the response, relapse and early development to cirrhosis after treatment].

UNLABELLED: The treatment of chronic hepatitis C is interferon (IFN). Diverse predictive factors influence a complete response. The aim of this study was to determine the response to IFN-alpha therapy and factors that may predict a sustained response before and after the first month of treatment. Likewise, it evaluates the relapse and liver cirrhosis evolution after therapy. PATIENTS AND METHODS: We have treated 155 consecutively patients with chronic hepatitis C. Nine left therapy because of severe side effects. We studied the patients who had had persistently elevated serum aminotransferase concentrations, HBsAg negative, HIV negative and antiHCV positive with polymerase chain reaction confirmation, and without any other liver disease. The schedule of IFN-alpha 2b therapy was 5 MU three times per week for 3 months, and later, 3 MU three times per week for 6 more months. There were two groups of response: A) Complete response, if serum aminotransferase levels were normal and RNA-HCV negative, B) No response, if it didn't meet these conditions. The sustained response was complete response during follow-up. The relapse described as aminotransferase increase after suppression therapy with or without positive RNA-HCV, or positive RNA-HCV only. RESULTS: A complete response was obtained in 34.9%. Ten variables were statistically significant (p < 0.05) on univariate analysis: weight, corporal surface, dosage IFN/m2, bilirubin and total protein pretreatment; polymorphonuclears/mononuclears cells, AST, ALT, AST/ALT, and gamma GT in the first therapy's month. In multivariate analysis, serum AST levels < 40 U/l (odds ratio 0.15, 95% CI 0.04-0.52), and AST/ALT ratio > 0.75 (odds ratio 3.05, 95% CI 1.04-8.9) in the first month, were correlated independently with complete response. Incidence of relapse was 47% of responders, with mean appearance period a of 2.7 +/- 2.1 months. Therefore, a sustained response was obtained in 27 patients (18.5%). Seventeen of 115 patients (14.6%) without cirrhosis initially, developed liver cirrhosis after a second biopsy. Two variables were statistically significant in multiple regression analysis: RNA-HCV positive after treatment (odds ratio 2.99, 95% CI 0.9-2.99), and platelet count < 180,000/mm3 before therapy (odds ratio 17.7, 95% CI 3.7-83.2) were correlated independently with cirrhosis development. CONCLUSIONS: A 9 months course of IFN therapy is effective in a third of patients, but almost half of them have relapsed within 6 months after treatment's suppression. The AST levels and AST/ALT ratio in the first of month therapy were correlated independently with complete response. Liver cirrhosis appears in a small percentage. Platelet count before therapy and RNA-HCV positive at the end treatment, were predictor variables of this evolution.

Adult↗
PubMed1995

Effects of transjugular intrahepatic portasystemic shunt (TIPS) on splanchnic and systemic hemodynamics, and hepatic function in patients with portal hypertension. Preliminary results.

The purpose of this study was to evaluate the short-term splanchnic and systemic hemodynamics and hepatic function after TIPS creation. Fifteen cirrhotics with portal hypertension underwent TIPS placement for treatment of variceal hemorrhage, and extensive hemodynamic studies including right heart catheterization, portal pressure measurement, hepatic blood flow, and indocyanine green (ICG) clearance were performed before and 1 month after the procedure. Self-expandable metal stents (Strecker 11 mm diameter) were placed in all cases. Portasystemic gradient significantly diminished (18.3 +/- 4.2 vs 8 +/- 2.8; 54% +/- 18 mm Hg) after the technique, mainly due to a decrease in portal pressure, and remained stable in the final study. Cardiac output and mean arterial pressure increased (6.2 +/- 1.4 vs 8.2 +/- 1.8 liters/min, 80.1 +/- 10.1 vs 91 +/- 11.2 mm Hg, respectively), and a decrease in systemic vascular resistance was registered (1018 +/- 211 vs 872 +/- 168 dyne/sec/cm5); the hepatic blood flow and ICG clearance also decreased significantly (1.5 +/- 0.7 vs 0.68 +/- 0.2 liters/min, 0.4 +/- 0.2 vs 0.24 +/- 0.06 liters/min, respectively). There was an increase in the preload at the final study, as evidenced by a marked increase in right atrial (3.1 +/- 1.6 vs 4.35 +/- 2.2 mmHg, +15%, P < 0.05), pulmonary arterial (12.2 +/- 2.4 vs 15.9 +/- 3.2 mm Hg, +31.8%, P < 0.001), and wedge pulmonary arterial pressures (6.9 +/- 2.4 vs 9.8 +/- 3.1 mm Hg, +53%, P < 0.001). These results suggest that TIPS worsens the hyperdynamic syndrome associated to portal hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Hemolysis associated with intrahepatic percutaneous portosystemic shunt].

Two cases of intravascular hemolysis in patients with intrahepatic percutaneous portosystemic shunt are described. This is a recently reported complication, the incidence of which currently remains unknown. Following analysis of different possible mechanisms, it is suggested that a relationship may exist between the hemolysis and the number of the inserted prosthesis and length of the intraportal segment of the stent.

Anemia, Hemolytic↗
PubMed1995

[Tracheoesophageal fistula secondary to endoscopic sclerotherapy of esophageal varices].

Over the past 15 years, endoscopic variceal sclerotherapy (EVS) has become the main therapy for patients with bleeding esophageal varices. EVS has the advantage of a low associated mortality and morbidity, but may lead to serious complications. We report a case of esophagotracheal fistula complicating sclerotherapy that resolved with nonsurgical management.

Aged↗
PubMed1995

[Hydrogen peroxide-induced lesions in the digestive tract. Apropos 4 cases].

Gastrointestinal injury caused by caustic products a are relatively infrequent, occurring mainly in the upper gastrointestinal tract. Accidental ingestion accounts for most of the cases, and the severity and extent of damage produced, depends on the composition and volume of the caustic agent ingested; endoscopy is a safe and effective diagnostic procedure. We report four unusual cases of caustic injury of the gastrointestinal tract due to hydrogen peroxide, two cases due to oral ingestion and another two due to the accidental administration of enemas, there was a good clinic and endoscopic recovery with conservative treatment.

Accidents, Occupational↗
PubMed1995

[Epithelioid hemangioendothelioma: a rare indication for liver transplantation?].

A clinical case of epithelioid hemangioendothelioma without extrahepatic involvement treated with liver transplantation is presented. The patient remains alive 42 months thereafter without tumor recurrence. A review of cases reported to date was carried out with special reference being made to the therapy undertaken and the follow-up.

Adult↗
PubMed1995

[Portacaval H-graft shunt as an alternative long-term treatment in gastrointestinal hemorrhage caused by esophagogastric varices].

From 1984 to 1991, 44 cirrhotic patients with gastrointestinal bleeding by esophagogastric varices (EGV) underwent emergency or elective calibrated portacaval shunt (CPS) with a prothesis of small diameter (8 and 10 mm) due to the impossibility of bleeding control by other conservative methods. In this series this procedure was found to be an effective alternative with acceptable operative mortality (20.4%), and a high rate of hepatic portal flow maintenance (72.2%) although a high incidence of postoperative hepatic encephalopathy (38.6%) of easy control was observed. The global probability of survival at 12 and 24 months was 74 and 64%, respectively. Survival at one and 2 years was significantly higher in patients of Child score A than those of score B (94 and 88% versus 73 and 56%). Patients of Child score C all died by the end of the first month thus suggesting that CPS should be performed in patients with good liver function (Child scores A and B).

Adult↗
PubMed1995

[Hypertensive colopathy: its endoscopic evaluation and evolution following a liver transplant].

In the last decade the association between intestinal vasculopathy and Portal Hypertension (PH) has been established on the basis of endoscopic, histological and histomorphometric examinations. We report the case of a patient with cirrhosis secondary to hepatitis C virus, in whom colonoscopy demonstrated the presence of colonic vascular lesions with cherry spots appearance in the rectum and left colon that vanished two weeks after liver transplantation. The disappearance of mucosal lesions after liver grafting suggest a relation ship among them and portal hypertension.

Colonic Diseases↗
PubMed1995

[Biliary drainage, a complication of liver transplantation].

We report a case of 49-years-old man with hepatocellular carcinoma treated by hepatic transplantation. In the early post-transplant period severe hepatic dysfunction was detected. Because of the possible vascular origin of the graft lesion, an angiography procedure was performed and hepatic artery thrombosis was identified cholangiography through a T tube showed a large biliary cavity. We analyze the biliary tract reconstruction after liver transplantation, its risk factors and the management.

Carcinoma, Hepatocellular↗
PubMed1995

[Hepato-cholangiocarcinoma with diffuse metastases and hypercalcemia].

The combined hepatocellular-cholangiocarcinoma (C-HCC) is a very uncommon neoplasm, its diagnosis is difficult and its course is usually very rapid. We report the case of a patient with CHCC type II or transitional tumor, which shows two cellular types in certain zones. Our patient had tumoral hypercalcemia as well, which was very difficult to control. There was a metastatic spread with cholangiolar features almost from the beginning, that made impossible any sort of therapy. It seems that dissemination followed lymphatic pathways.

Aged↗
PubMed1995

[Elastic band ligation: preliminary experience in esophagogastric varices].

Endoscopic ligation is a new technique that shows an efficacy for acute hemorrhage and prevention similar to sclerotherapy. Its principal advantage is the smaller number of complications (2%), which seem to be related to the presence of post-treatment ulcers which are indeed more extensive but more superficial. In our preliminary study on 8 patients, eradication of varices in 62.5% was obtained. The mean number of bands placed at each ligation session was of 2.4 +/- 0.96 and the mean number of treatment sessions to achieve the eradication was 3.4 +/- 1.5. The complications that appear during the positioning of bands, a minimum bleeding was observed during the polyp formation, and in one occasion, the partial detachment of an eschar followed the bleeding was also observed. Rebleeding occurred in two patients (25%), and in other patient, spontaneous bacterial peritonitis was observed. The two patients who presented recurrent variceal bleeding, received a transjugular intrahepatic portosystemic shunt to control their hemorrhage.

Adult↗
PubMed1995

[Spontaneous bacterial peritonitis caused by Listeria monocytogenes].

Listeria monocytogenes is a gram-positive coccobacillus that produces infections in both the normal and the compromised host. Symptomatic bacteremia and pulmonary infection or meningitis are the most common clinical presentations in adults. According to a current review of the literature, Listeria is a rare bacteria that may produce spontaneous bacterial peritonitis (23 cases reported). Listeria peritonitis occurs in more than two-thirds of the cases in patients with chronic liver disease, but may also occur in patients with malignancy or undergoing peritoneal dialysis. We describe two cases of SBP in cirrhotic patients, one with alcoholic cirrhosis and other due to HCV infection. One patient also presented with acute meningitis. Peritonitis due to Listeria was clinically and analytically similar to any SBP. Third-generation cephalosporins commonly used in the therapy of SBP, are ineffective in this infection. Ampicillin is the drug of choice, although it should be used in combination therapy usually with an aminoglycoside. The mortality from Listeria peritonitis is similar to that of other SBP (17%).

Adult↗
PubMed1994

[Chemoembolization and posterior liver transplantation as therapeutic strategy for hepatocarcinoma].

Orthotopic Liver Transplantation (OLT) is the only surgical approach to non-resectable hepatocellular carcinoma (HCC) but, so far its results has been poor. During 41 months 112 patients underwent 123 OLT, nine of them had HCC over cirrhosis with a mean age 60 years. The etiology of cirrhosis was: alcohol in 1 and viral hepatitis in 8. Child's grade: A in 4, B in 5. HCC was: 5 cm or less in 5 and more in 4. According pTNM staging: I in one, II in 5, II in 2 and IVb in 1. Differentiation degree: low in 1, moderate in 4, and well in 3 (one case with complete necrosis after embolization). Eight patients were previously embolized with lipiodol, adriamycin and gelfoam, obtaining central necrosis without viable features in periphery. There were no postoperative deaths, and all the patients were discharged from the hospital. During follow up, 3 recurrences were observed, one massive with death of the patient after 6 months, and the other was surgically removed (segmentectomy V, VI) after 4 months after OLT without recurrence at 18 months of resection. In the third case a focal lesions was detected in the U.S. and T.C. study, 4 months after OLT, but in wasn't possible to obtain a biopsy because its posterior location; no treatment was made, and she's alive today. In conclusion, OLT is a good surgical option for non resectable HCC complicating cirrhosis if the patient is adequately selected. Chemoembolization has a good local effect, obtaining tumoral necrosis, but it does not decrease the posterior growth of the tumor in other localizations.

Aged↗
PubMed1993

[Post-radiation enteritis: double jejuno-colic stenosis].

Radiation enteritis is a common complication in patients receiving radiotherapy as a part of the treatment of abdominal malignancies. We report the case of a 57 year male patient with a renal carcinoma, who received radiotherapy and developed a double stenosis of the jejunum and the colon ten years later. He had to be treated surgically with resection of the affected segments. We would like to stress the possibility of this complication in patients who are to be treated with radiotherapy.

Colonic Diseases↗