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Jacques Belghiti - One of the best experts on this subject based on the ideXlab platform.

  • polycystic Liver disease hepatic venous outflow obstruction lesions of the noncystic parenchyma have major consequences
    Hepatology, 2018
    Co-Authors: L Barbier, Maxime Ronot, Beatrice Aussilhou, Francois Cauchy, Claire Francoz, Valerie Vilgrain, Olivier Soubrane, Valerie Paradis, Jacques Belghiti
    Abstract:

    In patients with polycystic Liver disease (PLD), development of cysts induces hepatic venous outflow obstruction (HVOO) and parenchymal modifications, challenging the paradigm of a normal noncystic Liver parenchyma. The aims were to reappraise the pathology of the noncystic parenchyma, by focusing on HVOO lesions; and to investigate the association with outflow obstruction at imaging and perioperative course after Liver resection. This is a retrospective study conducted in one tertiary center between 1993 and 2014. PLD patients (n = 125) who underwent resection (n = 90) or transplantation (n = 35) were included. HVOO parenchymal lesions were assessed for all patients and a Liver Congestion score was built. Imaging was analysed for 45 patients with computed tomography scan, and perioperative course was assessed in resected patients. At pathology, 92% of patients had HVOO lesions, with sinusoidal dilatation being the most common feature. HVOO was more severe in patients who underwent transplantation compared to Liver resection, as assessed by the Congestion score. At imaging, all patients had HVOO with at least two hepatic veins involved. Mosaic enhancement pattern of the parenchyma was associated with the severity of hepatic vein obstruction (P = 0.045) and the compression of the inferior vena cava (P = 0.014). In case of Liver resection, intraoperative course was characterized by hemorrhage, related to HVOO at imaging. Ascites (44%) and Liver failure (9%) in the postoperative period were associated with blood losses and transfusions. Conclusion Hepatic venous outflow obstruction, including development of venous collaterality and parenchymal changes, is frequent in PLD and has major consequences on intraoperative bleeding and postoperative ascites and Liver failure. Hepatic venous outflow obstruction should be taken into account to choose the most appropriate surgical treatment. (Hepatology 2017).

Hossein Poustchi - One of the best experts on this subject based on the ideXlab platform.

  • fibroscan for assessing Liver fibrosis an acceptable alternative for Liver biopsy fibroscan an acceptable alternative for Liver biopsy
    Hepatitis Monthly, 2011
    Co-Authors: Reza Malekzadeh, Hossein Poustchi
    Abstract:

    There is now adequate evidence to indicate that Liver fibrosis is a dynamic rather than a static process and as effective antiviral and other specific therapies became available, fibrosis and even cirrhosis could become reversible [1][2]. Effective and early therapy of viral and autoimmune hepatitis could result in reversibility of cirrhosis in addition to clinical cure [1][2][3]. Therefore, we urgently need to be able to follow the progression or regression of fibrosis in response to therapy in addition to initial assessment of fibrosis by Liver biopsy. Liver biopsy which was first introduced in 1923 has been used widely in the diagnosis of Liver diseases and is still the gold standard reference for the assessment of Liver fibrosis during the course of chronic Liver diseases [4][5]. But this procedure is costly, painful and runs a small risk of sever complications like hemorrhage and even death; therefore, it is unacceptable to patients and doctors alike [5]. It is also time-consuming and labor-intensive; the assessment is subjective and due to small size of the specimen in setting of heterogeneity of Liver fibrosis is prone to sampling error. There is now increasing evidence that sampling error (up to 35%), inter- and intra-observer variability (up to 20%) for a particular stage between pathologist are major problems which may preclude accurate fibrosis staging for individual patients with Liver biopsy [4][5][6]. For the said reasons and especially in chronic Liver disease where monitoring the evolution of disease or response to treatment may require repeated assessments, the discipline of hepatology need to find a reliable and noninvasive alternative method to replace this old procedure. Finding a noninvasive method for assessment of Liver fibrosis has become a real challenge for hepatologists during the last two decades. This is especially true given that chronic Liver diseases affect hundreds of millions of people worldwide, the majority of which living in Asian countries [7][8][9]. Several methods have been proposed to noninvasively stage Liver fibrosis including a variety of imaging modalities and a range of biochemical tests [10][11][12]. The blood tests or their composite scores like Fibro Test or aspartate aminotransferase to platelets ratio index (APRI) [11] or serum fibrosis marker such as hyaluronic acid [12] have been shown to be of limited diagnostic value especially in HBV-related chronic Liver disease. The imaging modalities include ultrasound-based transient elastography (TE) [10], magnetic resonance elastography [13] and fibrocomputed tomography [14]. According to available evidence fibrocomputed tomography and magnetic resonance elastography which require the involvement of a radiologist with extensive training and a lot of financial investment, do not seem to have clear advantages in staging fibrosis when compared to TE. In this issue of Hepatitis Monthly, Sporea and colleagues [15] used fibroscan to measure Liver stiffness and estimate the extent of fibrosis in subjects with active and inactive chronic HBV infection. They have shown that patients with active HBV infection and those with an elevated HBV-DNA load have significantly higher fibroscan score compared to those with inactive HBV. Although their study have several shortcomings including significantly older age of the control group patients, absence of viral markers and Liver function test measurements and sonography in the control group, absence of Liver biopsy information especially on those with a higher fibroscan score and absence of estimation for visceral adiposity by waist-to-hip ratio or waist circumference measurement, their finding was similar to a previous study particularly in Asian population which indicates that TE could be used at least as a screening test to select the chronic HBV-infected individual with normal or minimally elevated transaminase for Liver biopsy [10][16]. Using Liver biopsy in 132 chronic HBV-infected subjects in Tehran [17] with persistently normal ALT, we have shown that up to 30% of them (mean age of 32 years) had a Knodell histologic stage of ≥ 2. Further studies comparing the actual histology stage with fibroscan measurment is necessary to find out the cutoff value in different pouplations. All evidece up to now is supporting that TE using fibroscan is a reliable, noninvasive method for identification of patients with significant hepatic fibrosis. TE is readily reproducible and its score has low inter- and intra-observer variability [10][16][18]. Several factors were found to affect the accuracy of TE for the diagnosis of significant fibrosis. These included sever Liver Congestion, hyperbilirubinemia, transaminitis, and prolonged prothrombin time. These factors were found to cause a significant overestimation of TE values, leading to false-positive identification of fibrosis [10][18]. In addition, TE is impossible in patients with ascites and is difficult in obese subjects and those with very narrow intercostal spaces. But, its use especially in chronic HBV-infected subjects with normal or minimally elevated ALT-which constitutes the majority of chronic Liver disease in Asian population-to select the subject who may benefit from oral nucleoside analogue therapy is very attractive. The accuracy of fibroscan score is excellent for the diagnosis of cirrhosis; it is probably the most accurate noninvasive method for the early detection of cirrhosis. It is a user-friendly technique that can be performed without any preparation in the less than five minutes in clinic or at the bedside, with immediate results and high patient acceptance, it is very likely that in future it will become the most widely used technique for assessment of Liver fibrosis [10][18]. Further technological improvements are necessary for better application of this technique in obese patients and other specific populations along with efforts to improve and standardize the procedure and adequate operator training [19].

Hana Kocour Kroupova - One of the best experts on this subject based on the ideXlab platform.

  • the sub lethal effects and tissue concentration of the human pharmaceutical atenolol in rainbow trout oncorhynchus mykiss
    Science of The Total Environment, 2014
    Co-Authors: Christoph Steinbach, Viktoriia Burkina, Ganna Fedorova, Katerina Grabicova, Alzbeta Stara, Josef Velisek, Vladimir Zlabek, Heike Schmidtposthaus, Roman Grabic, Hana Kocour Kroupova
    Abstract:

    Atenolol is a highly prescribed anti-hypertensive pharmaceutical and a member of the group of β-blockers. It has been detected at concentrations ranging from ng L(-1) to low μg L(-1) in waste and surface waters. The present study aimed to assess the sub-lethal effects of atenolol on rainbow trout (Oncorhynchus mykiss) and to determine its tissue-specific bioconcentration. Juvenile rainbow trout were exposed for 21 and 42 days to three concentration levels of atenolol (1 μg L(-1) - environmentally relevant concentration, 10 μg L(-1), and 1000 μg L(-1)). The fish exposed to 1 μg L(-1) atenolol exhibited a higher lactate content in the blood plasma and a reduced haemoglobin content compared with the control. The results show that exposure to atenolol at concentrations greater than or equal to 10 μg L(-1) significantly reduces both the haematocrit value and the glucose concentration in the blood plasma. The activities of the studied antioxidant enzymes (catalase and superoxide dismutase) were not significantly affected by atenolol exposure, and only the highest tested concentration of atenolol significantly reduced the activity of glutathione reductase. The activities of selected CYP450 enzymes were not affected by atenolol exposure. The histological changes indicate that atenolol has an effect on the vascular system, as evidenced by the observed Liver Congestion and changes in the pericardium and myocardium. Atenolol was found to have a very low bioconcentration factor (the highest value found was 0.27). The bioconcentration levels followed the order Liver>kidney>muscle. The concentration of atenolol in the blood plasma was below the limit of quantification (2.0 ng g(-1)). The bioconcentration factors and the activities of selected CYP450 enzymes suggest that atenolol is not metabolised in the Liver and may be excreted unchanged.

Sebastian Mueller - One of the best experts on this subject based on the ideXlab platform.

Kyungsuk Suh - One of the best experts on this subject based on the ideXlab platform.

  • hepatic venous Congestion in living donor grafts in Liver transplantation is there an effect on hepatocellular carcinoma recurrence
    Liver Transplantation, 2014
    Co-Authors: Sukwon Suh, Jeongmoo Lee, Tae You, Youngrok Choi, Kwangwoong Lee, Kyungsuk Suh
    Abstract:

    A certain degree of graft Congestion in living donor Liver transplantation (LDLT) using a right Liver graft may be inevitable because of the mismatch between the inflow and outflow structures of the Liver. The subsequent inflammatory reaction and rapid regeneration of the graft have been suggested as causes of tumor recurrence. Therefore, we investigated the influence of graft Congestion on hepatocellular carcinoma (HCC) recurrence after LDLT. Two hundred eighty-nine LDLT patients for HCC within the University of California San Francisco criteria between November 1999 and February 2012 were investigated. Patients were assigned to groups on the basis of the degree of Congestion (≤10% for group A and >10% for group B), which was determined by 3-dimensional reconstruction of posttransplant multidetector helical computed tomography within 2 weeks. Perioperative characteristics, regeneration rates after 6 months, and recurrence rates were compared between the groups, and a multivariate analysis of the influence of Congestion on tumor recurrence was subsequently completed. No significant difference in demographics was found. Group B had more elevated peak posttransplant levels of aspartate aminotransferase (296.26 versus 227.53, P = 0.05), alanine aminotransferase (382.91 versus 276.98, P = 0.04), and highly selective C-reactive protein (5.41 versus 3.55, P   10% [hazard ratio (HR) = 3.10, 95% confidence interval (CI) = 1.15-8.35, P = 0.03], microvascular invasion (HR = 5.43, 95% CI = 2.04-14.44, P   200 IU/L (HR = 2.98, 95% CI = 1.10-8.03, P = 0.03) were significantly related to tumor recurrence. Liver Congestion may promote the recurrence of HCC after LDLT; therefore, it should be minimized.