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Biomedical subjects

M Cocciolo

Publications and source records attributed to M Cocciolo.

18 recordsLinked to original sources
PubMed2001

Renovascular impedance and esophageal varices in patients with Child-Pugh class A cirrhosis.

PURPOSE: To evaluate the frequency of increased renovascular impedance and its relationship with the presence of esophageal varices in patients with Child-Pugh class A cirrhosis without ascites. MATERIALS AND METHODS: The intraparenchymal renal resistive index (RI) (reference value, <0.7) and portal congestive index (ie, the ratio between the portal cross-sectional area and mean flow velocity; reference value, <0.07) were measured by using duplex Doppler ultrasonography in 50 consecutive patients. The frequency of varices was assessed endoscopically. The data were analyzed with the Fisher exact test. RESULTS: The renal RI was consistent with increased impedance (ie, >0.7) in 18 (36%) patients and was normal in 32 (64%). The proportion of patients with varices was significantly higher in the former group: 14 (78%) versus 10 (31%) (P =.002). In detection of the presence of varices, the renal RI was uniformly better than the portal congestive index in terms of sensitivity (58% vs. 48%), specificity (84% vs 54%), and positive (3.60 vs 1.04) and negative (0.50 vs. 0.96) likelihood ratios. RI determination improved the ability to exclude the presence of varices from a basal pretest probability of 52% (26 of 50 patients) to a final one of 69% (22 of 32 patients) and that of predicting the presence of varices from 48% (24 of 50 patients) to 78% (14 of 18 patients). CONCLUSION: A substantial proportion of patients with Child-Pugh class A cirrhosis without ascites have increased renovascular impedance; this significantly correlates with the presence of varices.

Esophageal and Gastric Varices↗
PubMed2000

Adult syncytial giant cell chronic hepatitis due to herbal remedy.

Syncytial giant cell hepatitis is an uncommon form of chronic hepatitis in adults, although it has been reported in association with viral infection (including HCV and HIV infection), drug reactions and autoimmune disorders. We here report a very unusual case of giant cell chronic hepatitis in a 26-old-woman, who had been taking a herbal remedy (ISABGOL) for chronic constipation. The presence of viral and metabolic diseases has been excluded; an autoimmune etiology was very unlikely as the autoimmunity test remained negative during the year of follow-up and the total disease score normalized (from 13 to 8) without corticosteroid treatment. The causative role of the herbal remedy was further supported by the spontaneous and dramatic clinical, biochemical and histologic improvement observed following its withdrawal, despite the absence of any treatment.

Adult↗
PubMed1998

Hepatic artery resistance in alcoholic liver disease.

Patency and direction of flow in portal veins and their branches are generally assessed by duplex Doppler ultrasonography (DDUS), whereas few data are available on hepatic arterial hemodynamics. In this study, resistive (RI) and pulsatility indexes (PI) were calculated at DDUS in 21 controls, 22 chronic alcoholic patients without evidence of liver damage, 19 patients with acute alcoholic hepatitis (AAH), 30 patients with chronic viral hepatitis (CVH), 23 patients with alcoholic cirrhosis, and 22 patients with viral-related cirrhosis. Diagnosis was based on clinical and histological findings. Mean +/- SD RI was similar in controls and CVH patients (0.64 +/- 0. 02 and 0.66 +/- 0.04, respectively), significantly decreased in alcoholic patients without liver damage and AAH patients (0.61 +/- 0. 07 and 0.60 +/- 0.07) (P < .05), and significantly increased in patients with alcoholic (0.72 +/- 0.04) and viral-related cirrhosis (0.74 +/- 0.04) (P < .05). It was <0.60 in 9 of the 19 AAH patients (47%) and 11 of the 22 alcoholic patients without liver damage (50%), and >0.70 in 39 of the 45 cirrhotic patients (87%) and 12 of the 71 noncirrhotic patients pooled together (17%). A significant correlation was observed between RI and PI (r = .83; P < .05). The coefficients of variation for intraobserver variability were 6.3% +/- 5.1% for RI and 10.1% +/- 6.2% for PI, and the corresponding figures for interobserver variability were 5.2% +/- 3.5% and 9.3% +/- 4.6%. These findings support the existence of ethanol-related hepatic arterial vasodilation in AAH and alcoholic patients without liver damage. Progression of liver damage from AAH to cirrhosis profoundly impairs the hepatic responsiveness as a consequence of fibrosis with vascular distortion.

Adult↗
PubMed1998

Peripheral intrahepatic cholangiocarcinoma: ultrasound findings and differential diagnosis from hepatocellular carcinoma.

OBJECTIVE: Peripheral cholangiocarcinoma may be more frequent than expected, and is usually asymptomatic until it is well advanced. Our purpose was to assess the accuracy of ultrasound in differential diagnosis. METHODS: We compared the sonographic findings of ten consecutive patients with histologically proven peripheral cholangiocarcinoma with those obtained in 26 consecutive patients with hepatocarcinoma detected in the same period. In every patient we performed an ultrasound-guided biopsy with a fine (22 gauge) cutting needle. RESULTS: In all patients with a final diagnosis of peripheral cholangiocarcinoma, the ultrasound scan disclosed multiple well-defined nodules with a hypoechoic or target pattern. Two patients had dilated intrahepatic bile ducts and suspected infiltration of the common duct. No patient had ascites. Only minimal alterations in laboratory examinations were found. Ultrasound-guided fine cutting needle biopsy yielded diagnostic material and allowed the definitive differential diagnosis. CONCLUSION: Peripheral cholangiocarcinoma even in Western countries may represent a significant proportion of all primary liver cancers. Due to non-specific symptomatology only intractable and far advanced cases were detected by means of sonography. Ultrasound findings did not differ from those found in cases of metastases from extrahepatic adenocarcinomas or hepatocarcinoma with multinodular pattern (10/26 in our series).

Bile Duct Neoplasms↗
PubMed1998

Iron-related indexes in chronic alcoholics. Effect of alcohol withdrawal.

BACKGROUND: Increased serum transferrin saturation and ferritin levels have been reported in chronic alcoholics. AIM: To evaluate modifications in serum iron-related indexes in chronic alcohol abusers with and without cirrhosis, at enrolment and after complete alcohol withdrawal. PATIENTS: Fifty-one consecutive chronic alcohol abusers, 33 without and 18 with cirrhosis. METHODS: Liver function tests were performed and transferrin saturation percent and serum ferritin levels measured at time 0 and after 7 and 14 days of complete alcohol withdrawal. RESULTS: Duration of alcohol abuse was significantly longer in patients with cirrhosis than in those without (24 +/- 13 SD vs 18 +/- 13 SD years, p < 0.01). A concomitant increase in transferrin saturation percent and serum ferritin was found in 60% of the cirrhotics and 45% of the non cirrhotic group. During the observation period, transferrin saturation percent and serum ferritin fell significantly in both groups (from 59 +/- 33 SD to 36 +/- 22% SD, p < 0.05, and from 900 +/- 933 SD to 469 +/- 457 SD ng/ml, p < 0.01, in cirrhotics, and from 46 +/- 30 SD to 27 +/- 12% SD, p < 0.01, and from 702 +/- 602 SD to 340 +/- 29 SD ng/ml, p < 0.01, in non cirrhotics). CONCLUSIONS: Iron-related indexes increase with chronic alcohol abuse and return to normal rapidly after complete alcohol withdrawal. In chronic alcoholics the timing of determinations of iron-related indexes is crucial, and screening for possible concomitant genetic haemochromatosis must be postponed.

Adult↗
PubMed1997

Kaposi's sarcoma in severe alcoholic hepatitis.

We report a case of Kaposi's sarcoma, in a woman with alcoholic hepatitis requiring steroid therapy, which healed completely after withdrawal of the therapy and improvement of the hepatitis.

Female↗
PubMed1994

Abnormalities of Doppler waveform of the hepatic veins in patients with chronic liver disease: correlation with histologic findings.

OBJECTIVE: Changes in the Doppler waveform of the hepatic veins are associated with chronic liver disease, particularly cirrhosis. We correlated abnormalities in Doppler waveforms of hepatic veins with histologic findings in the liver to determine the accuracy of Doppler imaging in the detection of cirrhosis. SUBJECTS AND METHODS: Fifty-two patients with chronic hepatitis C were examined prospectively and blindly by two sonographers. In the same session, a liver biopsy specimen was obtained from each patient and submitted to three independent pathologists for conventional interpretation and for grading of severity according to a predetermined scoring system. Duplex sonography of the hepatic veins was also performed in 50 control subjects. RESULTS: Abnormal hepatic vein waveforms were detected in 12 of 16 patients with cirrhosis and in eight of 36 patients without cirrhosis. However, histologic examination of the biopsy specimens showed that only two of the eight patients without cirrhosis had no significant abnormalities, other than mild portal inflammation. Abnormal waveforms were seen in no control subjects. We found a correlation between fibrosis and steatosis and abnormalities in the Doppler waveform of the hepatic veins (r = .50, p < .001). Portal inflammation, intralobular degeneration, and necrosis did not correlate with an abnormal waveform. CONCLUSION: Duplex sonography of the hepatic veins may be useful for studying liver disease associated with fibrosis and steatosis. In patients with well-compensated liver disease, flattening of the Doppler waveform of the hepatic vein suggests the presence of cirrhosis.

Female↗
PubMed1993

Ascitic fluid analysis in hepatocellular carcinoma.

BACKGROUND: Ascites in patients with hepatocellular carcinoma (HCC) is a poorly characterized subgroup of malignancy-related ascites. Not only the underlying liver disease, but also the tumor growth and spread contributes to the ascites formation. The authors differentiated ascites in HCC from other types of ascites. METHODS: The authors analyzed the ascitic fluid of 185 consecutive patients (89 liver cirrhosis, 33 HCC, 31 peritoneal carcinomatosis, 22 liver metastases, 10 spontaneous bacterial peritonitis). RESULTS: Each subgroup showed a typical pattern. Compared with the cirrhotic patients, those with HCC showed a higher frequency of positive cytologic findings (4 of 33 versus 0/89, P < 0.004), elevated fibronectin concentration (10/33 versus 8/89, P < 0.004), and elevated polymorphonuclear cell count (10/33 versus 5/89 P < 0.004). CONCLUSIONS: A significant number of patients with ascites and HCC patients showed signs of peritoneal infiltration with positive cytologic findings and increased concentration of fibronectin. Moreover, neutrocytic ascites without signs of superinfection is relatively common (30%).

Albumins↗
PubMed1993

Abnormal renovascular impedance in patients with hepatic cirrhosis: detection with duplex US.

The purpose of this study was to determine whether duplex ultrasound (US) can allow detection of early impairment of renal function in patients with hepatic cirrhosis. The authors calculated the pulsatility index (PI) and resistive index (RI) by using duplex US in 17 patients with cirrhosis and ascites but with normal renal function (group A), in 16 patients with cirrhosis but no ascites (group B), in 20 with chronic hepatitis (group C), in six with peritoneal carcinomatosis (group D), and in 16 healthy control subjects (group E). All patients had normal renal function on the basis of blood urea nitrogen and serum creatinine values. PI and RI were higher (P < .001) in group A patients than in others. Cirrhotic patients with ascites had renal vasoconstriction even in the absence of clinically apparent renal impairment and full-blown hepatorenal syndrome. Impaired renal perfusion plays a key role in sodium and fluid accumulation in patients with liver disease. On the basis of these results, duplex US is useful in pathophysiologic and clinical studies in such patients.

Ascites↗
PubMed1989

Diagnostic accuracy of sialic acid in the diagnosis of malignant ascites.

The authors evaluated the diagnostic accuracy of sialic acid and its lipid-bound fraction in ascites and compared these tests with others (fibronectin, cholesterol) recently claimed as valuable in the differential diagnosis of ascites. Fibronectin yielded the best diagnostic accuracy (85%) with no false-positive and 37% of false-negative (10/27). The authors also found higher concentration of sialic acid in malignant ascites than in nonmalignant ascites (P less than 0.001) and, taking 300 mg/l as the cutoff value, the false-positive rate was 10% (four of 40), the false-negative rate 30% (eight of 27), and the overall diagnostic accuracy 82%, comparable to that of the fibronectin. The authors conclude that both fibronectin and sialic acid determinations in ascites may be regarded as accurate markers of neoplastic involvement of the peritoneum, although no test is useful in the ascites with hepatocellular carcinoma and cirrhosis of the liver.

Ascites↗
PubMed1988

Disposition of a flow-limited drug (lidocaine) and a metabolic capacity-limited drug (theophylline) in liver cirrhosis.

The plasma clearance after oral administration of a completely absorbed drug that is metabolized by the liver depends on its intrinsic clearance. In cirrhosis the bioavailability of a flow-dependent drug increases because of both portosystemic shunting and hepatocyte dysfunction. A drug with a high extraction ratio, lidocaine, and a drug with a low extraction ratio, theophylline, were administered to 27 patients with cirrhosis and 16 control subjects. We found a significant impairment of both theophylline clearance (p less than 0.001) and lidocaine clearance (p less than 0.001) and an increase in the lidocaine peak concentration (p less than 0.001). The three parameters were significantly correlated with each other. The impairment of theophylline metabolism did not correlate with other indexes of disease severity, whereas lidocaine clearance was lower and lidocaine peak level higher in patients with decompensated cirrhosis and evidence of portal hypertension. Thus impairment in lidocaine disposition, which reflects both hepatocyte dysfunction and portosystemic shunting, correlated closer with the severity of liver disease than did theophylline metabolism.

Adult↗
PubMed1987

Ticlopidine-theophylline interaction.

Ticlopidine, a new antithrombotic agent, and theophylline, a widely used bronchodilator drug, are both almost completely metabolized in the liver. To evaluate an interaction between these two drugs, we studied theophylline pharmacokinetics before, after 10 days of ticlopidine administration, and 1 month later in 10 healthy volunteers. We found a highly significant increase in the theophylline elimination half-life (P less than 0.001) and a comparable reduction in its total plasma clearance (P less than 0.001) after ticlopidine treatment. Pharmacokinetic parameters returned to initial values within 30 days after ticlopidine withdrawal. Moreover, no changes in theophylline pharmacokinetic parameters were observed 3 months later, before and after 10 days of placebo administration. Our results seem to exclude direct liver toxicity and may suggest a reversible inhibition of the liver metabolic capacity of theophylline.

Adult↗
PubMed1986

Diagnostic accuracy of fibronectin in the differential diagnosis of ascites.

To evaluate the diagnostic accuracy of fibronectin levels in ascites to differentiate malignant from non-malignant ascites, the authors studied 30 patients with sterile uncomplicated ascites in chronic liver disease, 18 patients with malignant ascites and four patients with spontaneous bacterial peritonitis. Fibronectin concentration was significantly higher in malignant ascites than in sterile ascites (P less than 0.001). High values (greater than 85 mg/l) were found in four of six cases of hepatocellular carcinoma in liver cirrhosis with negative cytologic examination, and in six of seven peritoneal carcinomatoses. Low values (less than 85 mg/l) were found in four patients with liver metastases and in one patient with intrahepatic biliary duct carcinoma in cirrhosis. In four patients with infected ascites, the fibronectin level was low. Among all other parameters (total protein concentration, lactate dehydrogenase, gamma-glutamyl-transpeptidase, pH, amylase, triglycerides, leukocyte count, and cytologic examination), fibronectin yielded the best degree of discrimination (diagnostic accuracy, 79%).

Adult↗
PubMedDate not supplied

Thickening of the gallbladder wall in ascites.

The thickening of the gallbladder wall in patients with ascites is commonly related to hypoalbuminemia and/or portal hypertension. To evaluate the pathogenetic role of these two factors, we correlated gallbladder wall thickness (GBWT) with the albuminemia and the serum-ascites albumin gradient (SAAG), an index of portal hypertension, in 47 patients with ascites caused by cirrhosis of the liver or abdominal malignancy. We found a thickened gallbladder wall in 30/47 patients. The correlation between GBWT and SAAG was 0.64 (n = 47 p less than 0.001). No correlation was found between GBWT and albuminemia (r = 0.04). We suggest that the sonographic finding of ascites and gallbladder wall thickening should be considered a valuable sign of transudative ascites and of portal hypertension whatever its cause.

Abdominal Neoplasms↗