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F Nevens

Publications and source records attributed to F Nevens.

64 records · Page 4Linked to original sources
PubMedDate not supplied

Hepatic fibrin-ring granulomas in granulomatous hepatitis: report of four cases and review of the literature.

BACKGROUND: The differential diagnosis of hepatic fibrin-ring granulomas includes infective agents (Coxiella burneti, CMV, EBV,....), hypersensitivity to medication (allopurinol) and malignancy. METHODS: During a period of 6 months, four patients presented at our university hospital with a similar clinical picture of fever and abnormal liver tests, and fibrin-ring granulomas on liver biopsy. Clinical course, laboratory and imaging findings, and histopathological features were compared. RESULTS: Clinical manifestations, and laboratory and imaging findings were similar. Histopathological assessment of the hepatic fibrin-ring granulomas appeared not to be helpful in identifying the causative agent. Other histopathological features (e.g. sinusoidal rows of lymphocytes, eosinophilic polymorphonuclear infiltrate) were suggestive for the causative agent, yet conclusive identification was obtained by either serology (Q fever, CMV, EBV), or by exclusion with concomitant stop of medication (allopurinol). CONCLUSIONS: In the differential diagnosis of hepatic fibrin-ring granulomas, serologic titers remain the determining factor, since an infective agent is the most common cause. When hepatic fibrin-ring granulomas are present, other histopathological features may be helpful in making the differential diagnosis.

Adult↗
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Hepatitis C virus: the burden of the disease.

Chronic hepatitis C infection affects approximately 3% of the world population and is responsible for a large proportion of patients with cirrhosis, end-stage liver diseases, hepatocellular carcinoma and for those who are candidates for liver transplantation or die of liver-related complications. The health care burden of this infection, whose epidemic peaked in the 1980s, is expected to significantly increase in the next 15 years in the absence of an organized national strategy. On the other hand, hepatitis C infection can be easily diagnosed with third generation enzyme immunoassay and indications for molecular biology-based assay are well defined. Composite scores and non-invasive markers of fibrosis may in the future replace liver biopsy which is still recommended in the presence of chronically elevated transaminases and indications for antiviral treatment.

Adult↗
PubMedDate not supplied

The long-term morbidity and mortality rate in a cohort of patients with liver cirrhosis and oesophageal varices.

BACKGROUND/AIMS: A long-term study and follow-up of an uniform treatment strategy for esophageal varices was evaluated to plan future strategies more effectively. MATERIAL AND METHODS: Morbidity and mortality in 101 patients with liver cirrhosis followed up for 5 years in a single center after the first detection of oesophageal varices were studied. RESULTS: Definitive hemostasis of the first variceal bleeding episode could not be obtained in 31.5%, despite emergency endoscopic sclerotherapy in combination with vasopressin and/or balloon tamponade. Mortality related to this bleeding was 26% in this cohort of patients. Overall mortality from variceal bleeding during the 5 year period was 38%. Death occurred predominantly in patients with advanced liver disease, since the Child-Pugh score of patients who bled and survived was 8 +/- 2 as compared to 11 +/- 2 (p<0.01) in those who bled and died. If fundic varices were the origin of the hemorrhage, the mortality reached 78% within 6 months. Eighty-five percent of the fatalities were related to the liver disease. Besides variceal bleeding, infection was the predominant trigger leading to liver failure; occurring in 25%. The cause of non-liver related death was malignancy of esophagus, lung and pancreas. Only 13% of the patients with liver failure had undergone an orthotopic liver transplantation. CONCLUSION: Since variceal hemorrhage still carries a high mortality rate, primary prophylaxis for patients at high risk is indicated. The systematic, concomitant use of vasoactive drugs to sclerotherapy and the early performance of TIPS in case of failure of sclerotherapy have to be evaluated. Finally patients with an advanced liver disease and increased risk factors for variceal bleeding should be considered earlier for liver transplantation.

Cohort Studies↗