- End user evaluation of DG-PT L Rec, a human recombinant thromboplastin in liquid formulation. [Journal Article]
- BCBlood Coagul Fibrinolysis 2016 Oct 13
- The objective is to evaluate Grifols' DG-PT L Rec liquid reagent for prothrombin time (PT) determination in comparison to the laboratory's reference reagent (Siemens' Thromborel S). For linearity, th...
The objective is to evaluate Grifols' DG-PT L Rec liquid reagent for prothrombin time (PT) determination in comparison to the laboratory's reference reagent (Siemens' Thromborel S). For linearity, the average master curve for PT and five nominal prothrombin concentrations was obtained from five calibration curves. Within-assay precision (repeatability) was calculated after measuring 20 successive tests of normal and pathological controls. For correlation, 581 routine clinical citrated plasma samples were assessed with both reagents. The BCS XP hemostasis analyzer was used. Linearity of the DG-PT L Rec was good (P < 0.001). The coefficient of variation met the desirable imprecision of less than 2% (normal controls: 1.7%; pathological controls: 0.9%). Correlation between DG-PT L Rec and Thromborel S was high (r = 0.9795; PT in %). In subgroups of anticoagulated, low fibrinogen, lipemic, jaundice, and hemolyzed samples the correlation was more than 0.95. Performance of DG-PT L Rec was high and comparable to the reference reagent.
- Antireflux Versus Conventional Plastic Stent in Malignant Biliary Obstruction: A Prospective Randomized Study. [Journal Article]
- JLJ Laparoendosc Adv Surg Tech A 2016 Oct 18
- CONCLUSIONS: According to these results, the use of this ARS is not recommended.
- [Research advances in breast milk-acquired cytomegalovirus infection in premature infants]. [Journal Article]
- ZDZhongguo Dang Dai Er Ke Za Zhi 2016; 18(10):931-936
- Breast milk is considered ideal food for premature infants, but it can also be the main source of cytomegalovirus (CMV) infection in premature infants. CMV infection may cause serious clinical sympto...
Breast milk is considered ideal food for premature infants, but it can also be the main source of cytomegalovirus (CMV) infection in premature infants. CMV infection may cause serious clinical symptoms, such as sepsis-like syndrome, thrombocytopenia, neutropenia, jaundice, hepatitis, and pneumonitis. This article reviews the research advances in symptoms, treatment strategies, prognosis and the prevention of breast milk-acquired CMV infection in premature infants.
- Covered versus uncovered self-expandable metal stents for malignant biliary strictures: A meta-analysis and systematic review. [Review]
- IJIndian J Gastroenterol 2016 Aug 27
- Self-expandable metal stents (SEMS) are used for palliating inoperable malignant biliary strictures. It is unclear if covered metal stents are superior to uncovered metal stents in these patients. We...
Self-expandable metal stents (SEMS) are used for palliating inoperable malignant biliary strictures. It is unclear if covered metal stents are superior to uncovered metal stents in these patients. We compared clinical outcomes in patients with covered and uncovered stents. Studies using covered and uncovered metallic stents for palliation in patients with malignant biliary stricture were reviewed. Articles were searched in MEDLINE, PubMed, and Ovid journals. Fixed and random effects models were used to calculate the pooled proportions. Initial search identified 1436 reference articles, of which 132 were selected and reviewed. Thirteen studies (n = 2239) for covered and uncovered metallic stents which met the inclusion criteria were included in this analysis. Odds ratio for stent occlusion rates in covered vs. uncovered stents was 0.79 (95 % CI = 0.65 to 0.96). Survival benefit in patients with covered vs. uncovered stents showed the odds ratio to be 1.29 (95 % CI = 0.95 to 1.74). Pooled odds ratio for migration of covered vs. uncovered stents was 9.9 (95 % CI = 4.5 to 22.3). Covered stents seemed to have significantly lesser occlusion rates, increased odds of migration, and increased odds of pancreatitis compared to uncovered stents. There was no statistically significant difference in the survival benefit, overall adverse event rate, and patency period of covered vs. uncovered metal stents in patients with malignant biliary strictures.
- The role of surgery in the therapeutic approach of gastric cancer liver metastases. [Review]
- IJIndian J Gastroenterol 2016; 35(5):331-336
- Gastric cancer (GC) currently prevails as the second cause of death by malignancy worldwide. Estimations suggest that 35 % of affected patients appear with synchronous distant metastases. The vast ma...
Gastric cancer (GC) currently prevails as the second cause of death by malignancy worldwide. Estimations suggest that 35 % of affected patients appear with synchronous distant metastases. The vast majority of patients present with hepatic metastatic disease, sometimes accompanied by synchronous peritoneal and lung dissemination. The disease mostly remains asymptomatic at an early stage, with few reported cases of incidental abdominal discomfort. As the cancer advances, symptoms such as nausea or vomiting arise, along with indigestion and dysphagia, blood loss in the form of melena or hematemesis, as well as anorexia and weight loss. Having spread to the liver, it also causes jaundice due to hepatomegaly and general inanition. Despite recent research on the therapeutic strategies against GC metastatic disease, surgical resection appears the only potentially curative approach. Unfortunately, the majority of patients are not eligible to undergo surgical intervention. With regard to treatment modalities of the advanced stage disease, the role of metastasectomy is still debatable and quite unclear, while prolonged survival was succeeded only under certain specific circumstances. Systemic chemotherapy remains however another option, as well as local management in the form of cryotherapy, radiofrequency ablation, or transcatheter arterial chemoembolization. The aims of this review were to evaluate the results of surgical treatment for metastatic GC with special reference to the extent of its histological spread and to present the recent literature in order to provide an update on the current concepts of advanced surgical management of this entity. Relevant publications in the last two decades are briefly reviewed.
- [Acute kidney injury in liver failure]. [Journal Article]
- DMDtsch Med Wochenschr 2016; 141(21):1559
- History and admission findings: We report on a 76-year-old man presenting with painless jaundice who developed dialysis-dependent acute kidney injury. Investigations: Biliary tract was examined with ...
History and admission findings: We report on a 76-year-old man presenting with painless jaundice who developed dialysis-dependent acute kidney injury. Investigations: Biliary tract was examined with endoscopy, in addition kidney biopsy was performed. Diagnosis, treatment and course: A stenosing process could be seen in the biliary tract, leading to stent implantation. However, jaundice did not resolve. Kidney biopsy revealed bile casts indicating cholemic nephropathy. After switch of concomitant medication, hyperbilirubinemia resolved and kidney function was completely restored. Conclusion: Cholestatic liver disease can cause acute kidney injury by formation of bile casts in the tubuli defining cholemic nephropathy. Resolution of cholestasis can restore kidney function.
- Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy: A meta-analysis (a prisma-compliant study). [Journal Article]
- MMedicine (Baltimore) 2016; 95(40):e4949
- CONCLUSIONS: UDCA is effective and safe to improve pruritus and liver function in ICP. UDCA also reduced adverse maternal and fetal outcomes in pregnant women with ICP.
- Yellow Feet in a Patient with Breast and Thyroid Carcinoma, Due to Oral Intake of Turmeric. [Journal Article]
- DSDrug Saf Case Rep 2015; 2(1):4
- Yellow discoloration of the skin may be caused by several etiologies, including jaundice, hypervitaminosis, drug reaction or chemical exposure. Herein we describe a 68-year-old woman with a history o...
Yellow discoloration of the skin may be caused by several etiologies, including jaundice, hypervitaminosis, drug reaction or chemical exposure. Herein we describe a 68-year-old woman with a history of breast and thyroid carcinoma, presenting with a yellow discoloration of her soles, after ingestion of one capsule a day of turmeric root extract (Bluebonnet Turmeric Root, 500 mg, Vcap), taken for its anti-cancer properties, for 4 months. After drug cessation, the yellow hue disappeared completely. A Naranjo assessment score of 5 was obtained, indicating a probable relationship between the patient's symptom and her use of the drug. Curcumin, a mixture of diferuloymethane derivatives known as curcuminoids, is a yellow pigment present in the spice turmeric. Topical application of curcumin to the human skin is joined by orange-yellow discoloration. To the best of our knowledge, yellow skin discoloration after oral intake of turmeric is not mentioned in the medical literature.
- Acute-on-chronic Liver Failure. [Review]
- CGCurr Gastroenterol Rep 2016; 18(12):61
- Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease,...
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame. ACLF is characterized by a state of deregulated inflammation. Initial cytokine burst presenting as SIRS, progression to CARS and associated immunoparalysis leads to sepsis and multi-organ failure. Early identification of the acute insult and mitigation of the same, use of nucleoside analogue in HBV-ACLF, steroid in severe alcoholic hepatitis, steroid in severe autoimmune hepatitis and/or bridging therapy lead to recovery, with a 90-day transplant-free survival rate of up to 50 %. First-week presentation is crucial concerning SIRS/sepsis, development, multiorgan failure and consideration of transplant. A protocol-based multi-disciplinary approach including critical care hepatology, early liver transplant before multi-organ involvement, or priority for organ allocation may improve the outcome. Presentation with extrahepatic organ involvement or inclusion of sepsis as an acute insult in definition restricts the therapy, i.e., liver transplant or bridging therapy, and needs serious consideration. Augmentation of regeneration, cell-based therapy, immunotherapy, and gut microbiota modulation are the emerging areas and need further research.
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- Treatment of Hepatitis E. [Journal Article]
- AEAdv Exp Med Biol 2016; 948:211-221
- Hepatitis E virus (HEV) infections are the most common cause of acute hepatitis, but they can also take a chronic course. There is no specific therapy for acute hepatitis, and current treatment is su...
Hepatitis E virus (HEV) infections are the most common cause of acute hepatitis, but they can also take a chronic course. There is no specific therapy for acute hepatitis, and current treatment is supportive. Choosing ribavirin as the first-line therapy for chronic HEV is advisable, especially in solid organ transplant patients. Pegylated interferon-α has been used successfully for treatment of hepatitis E but is associated with major side effects. Cholestasis is one of the most common, but devastating, manifestations in hepatitis E. Current therapy for HEV aims to treat symptoms. Therapy generally involves several measures, such as vitamins for adequate nutrition, albumin and plasma for supporting treatment, symptomatic treatment for cutaneous pruritus, and ursodeoxycholic acid and S-adenosylmethionine, and Traditional Chinese medicine for removing jaundice. Patients with underlying liver disease may develop liver failure. For these patients, supportive treatment is the foundation. Ribavirin has successfully been used to prevent liver transplantation. Prevention and treatment of complications are important for treatment of liver failure. Liver support devices are intended to support liver function until such time as native liver function recovers or until liver transplantation. Liver transplantation is widely considered as irreplaceable and definitive treatment for acute-on-chronic liver failure, particularly for patients who do not improve with supportive measures to sustain life.