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Ian R Wanless - One of the best experts on this subject based on the ideXlab platform.
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the Laennec staging system for histological sub classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis
Journal of Hepatology, 2012Co-Authors: Seung Up Kim, Ian R Wanless, Sarah Lee, Kwang Hyub Han, Young Nyun ParkAbstract:Backgrounds & Aims The clinical severity of cirrhosis varies widely. We investigated whether histological sub-classification of cirrhosis using the Laennec system can discriminate different outcomes among patients with cirrhosis. Methods One hundred and seventy-five patients with chronic liver disease who underwent liver biopsy and showed stage 3 or 4 fibrosis between January 2001 and December 2008 were prospectively enrolled. Cirrhosis was sub-classified into three groups (4A, 4B, and 4C) according to the Laennec system. The end point was liver-related event (LRE) occurrence, including decompensation, hepatocellular carcinoma, and liver-related death. Results The median age of the patients (110 men, 65 women) was 55years. Stages 3, 4A, 4B, and 4C were identified in 46 (26.3%), 16 (9.1%), 82 (46.9%), and 31 (17.7%) patients, respectively. During the follow-up period, LREs occurred in 32 (18.3%) patients: 4 (8.7%) with stage 3, 2 (12.5%) with stage 4A, 17 (20.7%) with stage 4B, and 9 (29.0%) with stage 4C. In a multivariate analysis, histological sub-classification of cirrhosis independently predicted LRE occurrence. While patients with stage 4A tended to be at higher risk of LRE occurrence than those with stage 3, patients with stages 4B and 4C had significantly higher risks of LRE occurrence, with hazard ratios of 6.158 ( p =0.016) and 8.945 ( p =0.004), respectively. Conclusions Histological sub-classification of cirrhosis using the Laennec system can be used to assess the risk of LRE occurrence among patients with cirrhosis. Our study provides a solid basis for further studies of non-invasive methods for monitoring the risk of LRE occurrence and will help physicians to establish optimum treatment strategies.
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lack of progressive hepatic fibrosis during long term therapy with deferiprone in subjects with transfusion dependent beta thalassemia
Blood, 2002Co-Authors: Ian R Wanless, Rita M Gamberini, G D Sweeney, Amar P. Dhillon, Maria Guido, Antonio Piga, Elias SchwartzAbstract:Patients with thalassemia major require lifelong chelation therapy to prevent iron-induced organ damage. The orally active chelator deferiprone has been proposed as an alternative for patients unable or unwilling to use deferoxamine. One report has concluded that deferiprone may worsen hepatic fibrosis in patients with thalassemia, whereas others have found no detrimental effect. A panel of 3 pathologists evaluated 112 coded liver biopsies obtained from 56 patients before and after deferiprone therapy. Fibrosis was scored with the Laennec and Ishak systems. The mean interval between liver biopsies was 3.1 years (range, 1.2-4.9 years). In 11 patients seronegative for hepatitis C, fibrosis scores before and after therapy were 1.12 ± 1.07 and 0.97 ± 0.84 ( P = .42) with the use of the Ishak system, and 0.71 ± 0.65 and 0.70 ± 0.53 ( P = .91) with the Laennec system. Among 45 patients seropositive for hepatitis C, fibrosis scores before and after therapy were 1.91 ± 1.13 and 2.04 ± 1.30 ( P = .43) with the use of the Ishak system and 1.26 ± 0.73 and 1.35 ± 0.90 ( P = .41) with the Laennec system. When the data set was limited to biopsies that each contained 6 or more portal tracts (31 patients), analysis still showed no significant change in fibrosis with time. With the use of the Laennec system, the fibrosis score did not increase by more than one level in any patients without hepatitis C; it increased by more than one level in 1 patient with hepatitis C; and it did not decrease by more than one level in any of the 56 patients. This analysis of the largest collection of liver biopsies reported to date in patients receiving deferiprone demonstrates no evidence of deferiprone-induced progression of hepatic fibrosis during long-term therapy.
Saraví F.d. - One of the best experts on this subject based on the ideXlab platform.
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El estetoscopio revoluciona la obstetricia
Universidad Nacional de Cuyo. Facultad de Ciencias Médicas, 2014Co-Authors: Saraví F.d.Abstract:Con el estetoscopio inventado por su amigo Laennec, el médico francés Kergaradec descubrió en 1821 que podía auscultar el corazón fetal. Él respondió adecuadamente los cuestionamientos sobre la factibilidad y utilidad del descubrimiento. La auscultación obstétrica se desarrolló precozmente en Alemania e Irlanda. En Francia, se revalorizó desde 1835; allí también Pinard inventó el estetoscopio obstétrico en uso hasta hoy. La auscultación del corazón fetal devino el primer signo seguro para diagnosticar el embarazo y evaluar la vitalidad fetal. También hizo tomar conciencia de la responsabilidad del obstetra de cuidar tanto del feto tanto como de la madre.Using the stethoscope invented by his friend Laennec, Kergaradec, a French physician, discovered in 1821 that he was able to hear the fetal heartbeat. He answered appropriately the objections raised about the feasibility and utility of his findings. Obstetric auscultation was early developed in Germany and Ireland. In France it was generally appreciated since 1835; in the same country, Pinard invented the obstetric stethoscope still in use. Fetal heart auscultation became the first certain sign for the diagnosis of pregnancy and a method to assess fetal well-being. The discovery also generated an awareness of the obstetrician’s responsibility to care for both the mother and the fetus.Fil: Saraví, F.D.. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Departamento de Morfofisiologí
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Laennec, el método anatomoclínico y la invención del estetoscopio : parte 2 : la auscultación, de la controversia a la aceptación
Universidad Nacional de Cuyo. Facultad de Ciencias Médicas, 2013Co-Authors: Saraví F.d.Abstract:En la primera parte relaté la vida de René Laennec hasta su crucial descubrimiento de la auscultación mediata. En esta segunda parte, me ocuparé de su tratado sobre la auscultación, su contribución al diagnóstico físico, la pneumonología y la cardiología, y su recepción en Francia y en el extranjero. Luego trataré de la retirada de Laennec de París y su regreso glorioso, su controversia con Broussais, sus actividades clínicas y docentes, la preparación de la segunda edición de su tratado, su matrimonio y su prematuro deceso. Laennec siempre será recordado por sus múltiples contribuciones a las ciencias médicas, y sobre todo por la auscultación mediata, por la cual con justicia se lo ha considerado uno de los más influyentes inventores de todos los tiempos.In the first part of this work, I gave an account of the life of René Laennec until his momentous discovery of mediate auscultation. In this second part, I will deal first with his treatise on auscultation, its contribution to physical diagnosis, pneumology and cardiology, and its reception in France and abroad. Next, I will address Laennec’s retreat from Paris and his glorious return, his controversy with Broussais, his clinical and teaching activities, the preparation of the second edition of his treatise, his marriage and his untimely death. Laennec will be always remembered by his many contributions to medical sciences, and above all by mediate auscultation, for which he has been rightly regarded as one of the most influential inventors of all times.Fil: Saraví, F.D.. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Departamento de Morfofisiologí
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Laennec, el método anatomoclínico y la invención del estetoscopio : parte 1 : de Bretaña a París, hasta la gran invención
Universidad Nacional de Cuyo. Facultad de Ciencias Médicas, 2012Co-Authors: Saraví F.d.Abstract:Hasta comienzos del siglo XIX, el examen físico del paciente tenía un lugar secundario en el diagnóstico médico. El enfoque diagnóstico comenzó a cambiar a partir del método anátomo-clínico desarrollado principalmente en la Escuela de Medicina de París. En la revolución allí iniciada tuvo un papel muy destacado la invención del estetoscopio por René Théophile Hyacinthe Laennec (1781-1826). Este es un relato de la vida y circunstancias de Laennec desde su nacimiento hasta el descubrimiento de la auscultación mediata por medio del estetoscopio. En la segunda parte me referiré a la obra principal de Laennec y su impacto en la práctica de la medicina desde esta invención hasta el fallecimiento de su inspirado autor.Until the early nineteenth Century, the physical examination of the patient had a secondary role in medical diagnosis. The diagnostic approach began to change starting with the anatomo-clinical method developed mainly in the School of Medicine of Paris. In the revolution that was started there, the invention of the stethoscope by René Théophile Hyacinthe Laennec (1781-1826) had an outstanding role. This is an account of the life and circumstances of Laennec since his birth to the discovery of mediate auscultation by means of the stethoscope. In the second part, I will address Laennec’s main work and its impact on the practice of medicine since this invention to the demise of its inspired author.Fil: Saraví, F.D.. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Departamento de Morfofisiologí
Elias Schwartz - One of the best experts on this subject based on the ideXlab platform.
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lack of progressive hepatic fibrosis during long term therapy with deferiprone in subjects with transfusion dependent beta thalassemia
Blood, 2002Co-Authors: Ian R Wanless, Rita M Gamberini, G D Sweeney, Amar P. Dhillon, Maria Guido, Antonio Piga, Elias SchwartzAbstract:Patients with thalassemia major require lifelong chelation therapy to prevent iron-induced organ damage. The orally active chelator deferiprone has been proposed as an alternative for patients unable or unwilling to use deferoxamine. One report has concluded that deferiprone may worsen hepatic fibrosis in patients with thalassemia, whereas others have found no detrimental effect. A panel of 3 pathologists evaluated 112 coded liver biopsies obtained from 56 patients before and after deferiprone therapy. Fibrosis was scored with the Laennec and Ishak systems. The mean interval between liver biopsies was 3.1 years (range, 1.2-4.9 years). In 11 patients seronegative for hepatitis C, fibrosis scores before and after therapy were 1.12 ± 1.07 and 0.97 ± 0.84 ( P = .42) with the use of the Ishak system, and 0.71 ± 0.65 and 0.70 ± 0.53 ( P = .91) with the Laennec system. Among 45 patients seropositive for hepatitis C, fibrosis scores before and after therapy were 1.91 ± 1.13 and 2.04 ± 1.30 ( P = .43) with the use of the Ishak system and 1.26 ± 0.73 and 1.35 ± 0.90 ( P = .41) with the Laennec system. When the data set was limited to biopsies that each contained 6 or more portal tracts (31 patients), analysis still showed no significant change in fibrosis with time. With the use of the Laennec system, the fibrosis score did not increase by more than one level in any patients without hepatitis C; it increased by more than one level in 1 patient with hepatitis C; and it did not decrease by more than one level in any of the 56 patients. This analysis of the largest collection of liver biopsies reported to date in patients receiving deferiprone demonstrates no evidence of deferiprone-induced progression of hepatic fibrosis during long-term therapy.
Nick Sheron - One of the best experts on this subject based on the ideXlab platform.
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alcohol related cirrhosis early abstinence is a key factor in prognosis even in the most severe cases
Addiction, 2009Co-Authors: Clare Verrill, Hannah Markham, Alexa Templeton, Norman J Carr, Nick SheronAbstract:Aims? To determine the effect of pathological severity of cirrhosis on survival in patients with alcohol-related cirrhosis. Design? Liver biopsies from 100 patients were scored for Laennec score of severity of cirrhosis, and medical notes were reviewed to determine various clinical factors, including drinking status. Up-to-date mortality data were obtained using the National Health Service Strategic Tracing Service. Setting? Southampton General Hospital between 1 January 1995 and 31 December 2000. Participants? A total of 100 consecutive patients with biopsy proven alcohol-induced liver cirrhosis. Measurements? Laennec score of severity of cirrhosis and mortality. Findings? Most surprisingly, the severity of cirrhosis on biopsy had little impact on survival; indeed, early death was more likely in patients with the least severe cirrhosis. Abstinence from alcohol at 1 month after diagnosis of cirrhosis was the more important factor determining survival with a 7-year survival of 72% for the abstinent patients versus 44% for the patients continuing to drink. Conclusions? It is never too late to stop drinking, even with the most severe degrees of cirrhosis on biopsy. Early drinking status is the most important factor determining long-term survival in alcohol-related cirrhosis.
Bretonneau Pierre-fidèle - One of the best experts on this subject based on the ideXlab platform.
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No 128. D’Alfred Velpeau à Pierre-Fidèle Bretonneau 1823, 24 juillet. – Paris
'OpenEdition', 2018Co-Authors: Bretonneau Pierre-fidèleAbstract:A. BU de médecine de Tours : B2-22. a. Triaire (Paul), Bretonneau et ses correspondants, Paris : Félix Alcan, 1892, vol. 1, p. 458-462. b. Luthier (Jean), Trousseau et Velpeau, d’après leur correspondance avec Bretonneau, Tours : Faculté de médecine et de pharmacie, 1968, p. 28-32. Succès de l’école de Bretonneau à Tours. – Mémoire de Bretonneau : retard et projet de publication. – Concours de l’agrégation, concurrents. – Demande de recommandations auprès de Bretonneau. – Laennec, président d..
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No 143. D’Alfred Velpeau à Pierre-Fidèle Bretonneau 1825, 7 juillet. – Paris
'OpenEdition', 2018Co-Authors: Bretonneau Pierre-fidèleAbstract:A. BU de médecine de Tours : B3-20. a. Triaire (Paul), Bretonneau et ses correspondants, Paris : Félix Alcan, 1892, vol. 1, p. 498-500. Thèse de Cottereau. – Mémoire de Bretonneau. – Affaires familiales de Velpeau. – Observation d’une adynamie. – Revendication de l’idée de la cautérisation par Serres, alors qu’elle vient de Bretonneau. Cottereau vient de passer sa thèse, il s’est bien défendu, on a trouvé son latin mauvais, mais il avait M. Laennec pour soutien ; on lui a donné « très satisfa..
