The Experts below are selected from a list of 3510 Experts worldwide ranked by ideXlab platform

Marius M Hoeper - One of the best experts on this subject based on the ideXlab platform.

Michael B. Fallon - One of the best experts on this subject based on the ideXlab platform.

  • Hepatopulmonary Syndrome.
    Clinics in Liver Disease, 2014
    Co-Authors: David G Koch, Michael B. Fallon
    Abstract:

    The Hepatopulmonary Syndrome (HPS) is a pulmonary complication of cirrhosis and/or portal hypertension whereby patients develop hypoxemia as a result of alterations in pulmonary microvascular tone and architecture. HPS occurs in up to 30% of patients with cirrhosis. Although the degree of hypoxemia does not reliably correlate with the severity of liver disease, patients with HPS have a higher mortality than do patients with cirrhosis without the disorder. There has been progress into defining the mechanisms that lead to hypoxemia in HPS, but to date there are no therapeutic options for HPS aside from liver transplantation.

  • Serial Pulse Oximetry in Hepatopulmonary Syndrome
    Digestive Diseases and Sciences, 2011
    Co-Authors: Rajan Kochar, Rajasekhar Tanikella, Michael B. Fallon
    Abstract:

    Background/Aim The natural history of Hepatopulmonary Syndrome (HPS) is poorly characterized and how hypoxemia develops and progresses over time is unclear. We evaluated oxygenation over time in advanced liver disease patients with and without HPS using serial pulse oximetry.

  • Oxygen desaturation during sleep in Hepatopulmonary Syndrome
    Hepatology, 2008
    Co-Authors: David T. Palma, George M. Philips, Miguel R. Arguedas, Susan M. Harding, Michael B. Fallon
    Abstract:

    Sleep alters respiratory mechanics and gas exchange, which can adversely affect arterial oxygenation. Whether sleep affects oxygenation in Hepatopulmonary Syndrome is unknown. The aim of this study was to assess oxygen desaturation during sleep in Hepatopulmonary Syndrome. Twenty adults with cirrhosis including 10 controls and 10 patients with Hepatopulmonary Syndrome underwent home pulse-oximetry during sleep. Subjects at high risk for obstructive sleep apnea were excluded through the Berlin questionnaire. Subjects who spent more than 10% of total sleep time with arterial oxygen saturation < 90% were classified as sleep-time oxygen desaturators. Sleep-time desaturation was correlated with clinical variables. The results showed that 7 of 10 Hepatopulmonary Syndrome subjects and none of the 10 controls had sleep-time oxygen desaturation. The median percentage of total sleep time with arterial oxygen saturation < 90% was significantly higher in Hepatopulmonary Syndrome subjects than in controls (medians 25% versus 0%, P = 0.005). Hepatopulmonary Syndrome subjects had significantly lower wake-time arterial oxygen saturation level (median, 97% versus 95%; P = 0.003) and mean sleep-time arterial oxygen saturation level (median, 96% versus 91%; P = 0.0008) than did the controls. Sleep-time desaturation directly correlated with alveolar-arterial oxygen gradient (P = 0.0007) and inversely correlated with wake-time arterial oxygen tension (P = 0.0007) and oxygen saturation (P < 0.0001). Conclusion: Oxygen desaturation occurred during sleep in 70% of Hepatopulmonary Syndrome subjects, the degree of which correlated with the severity of Hepatopulmonary Syndrome. Marked hypoxemia during sleep may occur in Hepatopulmonary Syndrome patients who, according to wake-time oxygen values, have only mild to moderate hypoxemia. (HEPATOLOGY 2008.)

  • Utility of Pulse Oximetry Screening for Hepatopulmonary Syndrome
    Clinical Gastroenterology and Hepatology, 2007
    Co-Authors: Miguel R. Arguedas, Harpreet Singh, Dorothy K. Faulk, Michael B. Fallon
    Abstract:

    Background & Aims: Hepatopulmonary Syndrome is characterized by oxygenation abnormalities caused by intrapulmonary vasodilatation in the setting of liver disease and/or portal hypertension. This Syndrome occurs in approximately 15%–30% of cirrhotic patients and influences mortality and transplant candidacy. However, no specific screening guidelines are established. We evaluated pulse oximetry with contrast echocardiography in detecting Hepatopulmonary Syndrome in a cohort of patients undergoing evaluation for liver transplantation. Methods: One hundred twenty-seven consecutive patients referred for liver transplantation evaluation were prospectively enrolled and underwent pulse oximetry, contrast echocardiography, and arterial blood gas measurements on room air. Demographic, clinical, and laboratory data were recorded and analyzed. Results: Forty-one (32%) patients were found to have Hepatopulmonary Syndrome. There were no significant differences in demographic or clinical features compared with patients without Hepatopulmonary Syndrome, with the exception of pulse oximetry and oxygenation abnormalities. With a threshold value of Conclusions: Pulse oximetry is a simple, low cost, and widely available technique that reliably predicts the presence and severity of hypoxemia in patients with Hepatopulmonary Syndrome. Institution of pulse oximetry screening might enhance detection and improve management of Hepatopulmonary Syndrome in cirrhosis.

  • Hepatopulmonary Syndrome.
    Clinics in Liver Disease, 2005
    Co-Authors: Miguel R. Arguedas, Michael B. Fallon
    Abstract:

    The Hepatopulmonary Syndrome is an increasingly important vascular complication of cirrhosis where microvascular dilatation impairs arterial oxygenation in the setting of liver disease. This Syndrome is identified in as many as 20% of patients evaluated for liver transplantation and results in increased mortality. No clearly effective medical therapies are available, and liver transplantation is the only established treatment. Pathophysiologic insights obtained from experimental models may lead to the development of novel and effective medical treatments.

Luiz Augusto Carneiro D'albuquerque - One of the best experts on this subject based on the ideXlab platform.

  • The Hepatopulmonary Syndrome
    ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2014
    Co-Authors: Lucas Souto Nacif, Wellington Andraus, Rafael S. Pinheiro, Liliana Ducatti, Luciana Bertocco De Paiva Haddad, Luiz Augusto Carneiro D'albuquerque
    Abstract:

    INTRODUCTION: The Hepatopulmonary Syndrome has been acknowledged as an important vascular complication in lungs developing systemic hypoxemia in patients with cirrhosis and portal hypertension. Is formed by arterial oxygenation abnormalities induced from intrapulmonary vascular dilatations with liver disease. It is present in 4-32% of patients with cirrhosis. It increases mortality in the setting of cirrhosis and may influence the frequency and severity. Initially the hypoxemia responds to low-flow supplemental oxygen, but over time, the need for oxygen supplementation is necessary. The liver transplantation is the only effective therapeutic option for its resolution. AIM: To update clinical manifestation, diagnosis and treatment of this entity. METHOD: A literature review was performed on management of Hepatopulmonary Syndrome. The electronic search was held of the Medline-PubMed, in English crossing the headings "Hepatopulmonary Syndrome", "liver transplantation" and "surgery". The search was completed in September 2013. RESULTS: Hepatopulmonary Syndrome is classically defined by a widened alveolar-arterial oxygen gradient (AaPO2) on room air (>15 mmHg, or >20 mmHg in patients >64 years of age) with or without hypoxemia resulting from intrapulmonary vasodilatation in the presence of hepatic dysfunction or portal hypertension. Clinical manifestation, diagnosis, classification, treatments and outcomes are varied. CONCLUSION: The severity of Hepatopulmonary Syndrome is an important survival predictor and determine the improvement, the time and risks for liver transplantation. The liver transplantation still remains the only effective therapeutic.

  • Myeloperoxidase activity is increased in Hepatopulmonary Syndrome in rats.
    Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 2013
    Co-Authors: Lucas Souto Nacif, Márcia Saldanha Kubrusly, Nilza A.t. Molan, Eleazar Chaib, Wellington Andraus, Luiz Augusto Carneiro D'albuquerque
    Abstract:

    BACKGROUND: Hepatopulmonary Syndrome is formed by a triad of liver disease, intrapulmonary vascular dilatation and changes in blood gases. Its pathogenesis is not well defined, but it is speculated that a combination of factors, such as the imbalance of endothelin receptor responses, pulmonary microvascular remodeling, and genetic predisposition, leads to bacterial translocation and intrapulmonary vascular dilatation. AIM: To evaluate the myeloperoxidase activity in Hepatopulmonary Syndrome in rat model. METHOD: Twenty-nine rats were divided into control, sham and experimental Hepatopulmonary Syndrome groups. Was evaluated the myeloperoxidase activity and the experimental model used to induce Hepatopulmonary Syndrome was common bile duct ligation. RESULTS: The myeloperoxidase activity levels were significantly increased in the common bile duct ligation group as compared with the other groups. Myeloperoxidase activity was higher in the common bile duct ligation group than control group (p

  • Myeloperoxidase activity is increased in Hepatopulmonary Syndrome in rats.
    ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2013
    Co-Authors: Lucas Souto Nacif, Márcia Saldanha Kubrusly, Nilza A.t. Molan, Eleazar Chaib, Wellington Andraus, Luiz Augusto Carneiro D'albuquerque
    Abstract:

    HEADINGS - Hepatopulmonary Syndrome. Animal model, experimental. Myeloperoxidase activity. ABSTRACT - Background: Hepatopulmonary Syndrome is formed by a triad of liver disease, intrapulmonary vascular dilatation and changes in blood gases. Its pathogenesis is not well defined, but it is speculated that a combination of factors, such as the imbalance of endothelin receptor responses, pulmonary microvascular remodeling, and genetic predisposition, leads to bacterial translocation and intrapulmonary vascular dilatation. Aim: To evaluate the myeloperoxidase activity in Hepatopulmonary Syndrome in rat model. Method: Twenty-nine rats were divided into control, sham and experimental Hepatopulmonary Syndrome groups. Was evaluated the myeloperoxidase activity and the experimental model used to induce Hepatopulmonary Syndrome was common bile duct ligation. Results: The myeloperoxidase activity levels were significantly increased in the common bile duct ligation group as compared with the other groups. Myeloperoxidase activity was higher in the common bile duct ligation group than control group (p

Michael Joseph Krowka - One of the best experts on this subject based on the ideXlab platform.

  • portopulmonary hypertension and Hepatopulmonary Syndrome
    The Lancet, 2004
    Co-Authors: Marius M Hoeper, Michael Joseph Krowka, Christian P. Strassburg
    Abstract:

    The clinically and pathophysiologically distinct entities of portopulmonary hypertension and Hepatopulmonary Syndrome occur in a substantial proportion of patients who have advanced liver disease of different causes. These disorders are notoriously underdiagnosed, but they have a substantial impact on survival and require focused treatment. Abnormal intrapulmonary vascular dilatation, the hallmark of Hepatopulmonary Syndrome, can cause profound hypoxaemia that can be very difficult to treat. By contrast, portopulmonary hypertension results from excessive pulmonary vasoconstriction and vascular remodelling that eventually leads to right-heart failure. Insights into the pathogeneses of these Syndromes have led to novel therapeutic approaches. However, in severely affected patients, effective treatment remains a difficult task. In selected patients, liver transplantation represents the only treatment option, but the decision to do isolated liver transplantation is particularly challenging in patients who have severe pulmonary disease involvement. Data from several centres have contributed to provide criteria that allow improved prediction of which patients may, or may not, benefit from liver transplantation alone.

  • Hepatopulmonary Syndrome and portopulmonary hypertension
    Current Treatment Options in Cardiovascular Medicine, 2002
    Co-Authors: Michael Joseph Krowka
    Abstract:

    : In patients with Hepatopulmonary Syndrome, supplemental oxygen and liver transplantation are the usual treatments of choice. Pharmacologic approaches have limited success in improving hypoxemia. Interventional radiology procedures may improve arterial hypoxemia in highly selected patients. In patients with portopulmonary hypertension, continuous infusion with intravenous epoprostenol (prostaglandin I(2)) can significantly improve pulmonary hemodynamics. Outcome following liver transplantation is variable; increased cardiopulmonary mortality occurs in patients with moderate to severe pulmonary hypertension.

  • Hepatopulmonary Syndrome: A Pulmonary Vascular Complication of Liver Disease
    Clinics in Chest Medicine, 1996
    Co-Authors: Mario Castro, Michael Joseph Krowka
    Abstract:

    Hepatopulmonary Syndrome is part of the spectrum of pulmonary vascular disorders seen in advanced liver disease. The pathophysiology of these entities likely is dependent on the degree of pulmonary vasoconstriction or vasodilatation that occurs. Our understanding of Hepatopulmonary Syndrome has helped further our knowledge of the interaction of the liver and the lung. Advances in the management of this disorder, especially liver transplantation, finally have allowed us to offer some hope to patients with this disease.

Christian P. Strassburg - One of the best experts on this subject based on the ideXlab platform.

  • Pulmonary complications of liver cirrhosis: Hepatopulmonary Syndrome, portopulmonary hypertension and hepatic hydrothorax
    Der Internist, 2010
    Co-Authors: Michael Halank, Christian P. Strassburg, Marius M Hoeper
    Abstract:

    : Hepatopulmonary Syndrome, portopulmonary hypertension and hepatic hydrothorax are typical pulmonary complications in patients with liver cirrhosis. Whereas Hepatopulmonary Syndrome and portopulmonary hypertension represent pulmonary vascular diseases, the development of hepatic hydrothorax is associated with the presence of ascites and phrenic lesions. For severe Hepatopulmonary Syndrome and refractory hepatic hydrothorax, liver transplantation is the treatment of choice. In severe portopulmonary hypertension specific medical treatment is indicated. In selected patients, beside intravenous prostanoids, oral endothelin receptor antagonists and phosphodiesterase type-5 inhibitors are possible treatment options.

  • portopulmonary hypertension and Hepatopulmonary Syndrome
    The Lancet, 2004
    Co-Authors: Marius M Hoeper, Michael Joseph Krowka, Christian P. Strassburg
    Abstract:

    The clinically and pathophysiologically distinct entities of portopulmonary hypertension and Hepatopulmonary Syndrome occur in a substantial proportion of patients who have advanced liver disease of different causes. These disorders are notoriously underdiagnosed, but they have a substantial impact on survival and require focused treatment. Abnormal intrapulmonary vascular dilatation, the hallmark of Hepatopulmonary Syndrome, can cause profound hypoxaemia that can be very difficult to treat. By contrast, portopulmonary hypertension results from excessive pulmonary vasoconstriction and vascular remodelling that eventually leads to right-heart failure. Insights into the pathogeneses of these Syndromes have led to novel therapeutic approaches. However, in severely affected patients, effective treatment remains a difficult task. In selected patients, liver transplantation represents the only treatment option, but the decision to do isolated liver transplantation is particularly challenging in patients who have severe pulmonary disease involvement. Data from several centres have contributed to provide criteria that allow improved prediction of which patients may, or may not, benefit from liver transplantation alone.