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De Rubens-Figueroa J, Granda-Jiménez J, Hoyos-Apodaca A, Zárate-Mondragón F. Contrast echocardiogram for diagnosis to pulmonary arterio-venous fistulas in hepato-pulmonary syndrome. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:107-110. [PMID: 38507306 PMCID: PMC11160529 DOI: 10.24875/acm.22000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/26/2023] [Indexed: 03/22/2024] Open
Affiliation(s)
| | | | | | - Flora Zárate-Mondragón
- Servicio de Gastroenterología. Instituto Nacional de Pediatría, Ciudad de México, México
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Rose SCP, Cunha DV, Medeiros SDBC, Trevizoli JE, Carneiro MDV, Freitas WMD, Mendes LSC. Correlation between hepatopulmonary syndrome and oxygen saturation pulse oximetry in cirrhotic patients. Rev Assoc Med Bras (1992) 2020; 66:1577-1582. [PMID: 33295413 DOI: 10.1590/1806-9282.66.11.1577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/13/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Hepatopulmonary Syndrome (HPS) is a complication of cirrhosis that worsens the disease's prognosis, pre and post liver transplant. The objective of this study is to analyze the prevalence of HPS in cirrhotic patients at our service and to correlate it with oxygen saturation (SatO2) using a pulse oximeter to evaluate if this is useful as a screening test for HPS. A prospective study was conducted in patients with hepatic cirrhosis conventionally selected from 2014 to 2016. All the patients underwent an echocardiogram with microbubbles and oxygen saturation measurement by pulse oximetry. Those with intrapulmonary shunt were submitted to arterial blood gas analysis. The relationship between oxygen saturation and HPS was assessed by the multivariate model of binary logistic regression. We analyzed 77 patients, and 23.3% (18 patients) had all criteria for HPS. The relationship between HPS and SatO2 did not show statistical significance, even after the variables were adjusted for sex, age, and smoking. Oxygen saturation alone was not able to detect HPS in the sample of cirrhotic patients. More accurate methods for screening and diagnosis of the syndrome should be used.
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Affiliation(s)
- Sara Cardoso Paes Rose
- Serviço de Gastroenterologia do Instituto Hospital de Base, Faculdade de Medicina, Universidade Católica de Brasília, Brasília, DF, Brasil
| | - Débora Vilela Cunha
- Serviço de Gastroenterologia do Instituto Hospital de Base, Faculdade de Medicina, Universidade Católica de Brasília, Brasília, DF, Brasil
| | | | - José Eduardo Trevizoli
- Serviço de Gastroenterologia, Instituto Hospital de Base do Distrito Federal, Brasília, DF, Brasil
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Nacif LS, Torres EKD, Alvarez PSE, Pereira JM, Pinheiro RS, Rocha-Santos V, Martino RB, Waisberg DR, Macedo RA, Ducatti L, Rocha Filho JA, Galvão FH, Andraus W, Carneiro D´Albuquerque L. Hepatopulmonary syndrome in waiting list and liver transplant. TRANSPLANTATION REPORTS 2020. [DOI: 10.1016/j.tpr.2020.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Terto SV, Araújo ST, Negreiros FDDS, Brasil BMBL, da Cunha GH, Rodrigues AB, de Carvalho MMD, Gadelha DD, Carioca AAF, Oliveira Fernandes V, Montenegro Júnior RM. Risk Factors Associated With New-Onset Diabetes After Liver Transplant: A Case Control Study. Transplant Proc 2019; 51:1956-1961. [PMID: 31303408 DOI: 10.1016/j.transproceed.2019.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND New-onset diabetes after transplant is a severe complication that can present in liver transplant recipients, negatively impacting quality of life and graft survival. It also contributes to increased risk of infection, cardiovascular disease, and rejection, which are the main causes of death among liver transplant recipients. The aim of the present study was to assess the risk factors associated with new-onset diabetes after transplant. METHOD This was a case control study based on the data from 146 liver transplant patients at a reference hospital. The data from the charts were collected using a 2-part form: Part I (sociodemographic variables) and Part II (clinical variables). RESULTS Multiple analysis showed that pre-existing systemic arterial hypertension (odds ratio [OR], 2.65; 95% CI, 1.12-6.28) and the use of sodium mycophenolate associated with tacrolimus (OR, 2.68; 95% CI, 1.02-7.06) increased the risk of new-onset diabetes after transplant. On comparing the anthropometric variables, lipid panel, and blood glucose levels of liver transplant patients with and without diabetes, higher glycemic levels were found in the group with diabetes (P < .001). CONCLUSION Pre-existing systemic arterial hypertension and the associated use of sodium mycophenolate and tacrolimus increased the risk of new-onset diabetes after transplant.
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Liu JW, Chen DQ. Correlations of MMP-2 and MMP-9 gene polymorphisms with the risk of hepatopulmonary syndrome in cirrhotic patients: A case-control study. Kaohsiung J Med Sci 2018; 34:634-642. [DOI: 10.1016/j.kjms.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/21/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022] Open
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Abbas N, Makker J, Abbas H, Balar B. Perioperative Care of Patients With Liver Cirrhosis: A Review. Health Serv Insights 2017; 10:1178632917691270. [PMID: 28469455 PMCID: PMC5398291 DOI: 10.1177/1178632917691270] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022] Open
Abstract
The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients. Perioperative management of patients with cirrhosis warrants special attention to nutritional status, fluid and electrolyte balance, control of ascites, excluding preexisting infections, correction of coagulopathy and thrombocytopenia, and avoidance of nephrotoxic and hepatotoxic medications. Transjugular intrahepatic portosystemic shunt may improve the CTP class, and semielective surgeries may be feasible. Emergency surgery, whenever possible, should be avoided.
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Affiliation(s)
- Naeem Abbas
- Divisions of Gastroenterology and Hepatology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Naeem Abbas, Divisions of Gastroenterology and Hepatology, Department of Medicine, Bronx-Lebanon Hospital Center, 1650 Selwyn Ave, Suite 10C, Bronx, NY 10457, USA.
| | - Jasbir Makker
- Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - Hafsa Abbas
- Department of Internal Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - Bhavna Balar
- Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Severe Hepatopulmonary Syndrome in a Child with Caroli Syndrome. Case Rep Pediatr 2017; 2017:2171974. [PMID: 28884036 PMCID: PMC5572614 DOI: 10.1155/2017/2171974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022] Open
Abstract
Hepatopulmonary Syndrome (HPS) is a potential complication of chronic liver disease and is more commonly seen in the adult population. Caroli Syndrome is a rare inherited disorder characterized by intrahepatic ductal dilation and liver fibrosis that leads to portal hypertension. In children with liver disease, HPS should be considered in the differential diagnosis of prolonged, otherwise unexplained, hypoxemia. The presence of HPS can improve patient priority on the liver transplantation wait list, despite their Pediatric End-Stage Liver Disease (PELD) score. We present a 6-year-old girl with Caroli Syndrome and End-Stage Renal Disease who presented with persistent hypoxemia. The goal of this report is to increase awareness of HPS in children.
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Inhibition of autophagy ameliorates pulmonary microvascular dilation and PMVECs excessive proliferation in rat experimental hepatopulmonary syndrome. Sci Rep 2016; 6:30833. [PMID: 27480323 PMCID: PMC4969600 DOI: 10.1038/srep30833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/11/2016] [Indexed: 02/08/2023] Open
Abstract
Hepatopulmonary syndrome (HPS) is a defective liver-induced pulmonary vascular disorder with massive pulmonary microvascular dilation and excessive proliferation of pulmonary microvascular endothelial cells (PMVECs). Growing evidence suggests that autophagy is involved in pulmonary diseases, protectively or detrimentally. Thus, it is interesting and important to explore whether autophagy might be involved in and critical in HPS. In the present study, we report that autophagy was activated in common bile duct ligation (CBDL) rats and cultured pulmonary PMVECs induced by CBDL rat serum, two accepted in vivo and in vitro experimental models of HPS. Furthermore, pharmacological inhibition of autophagy with 3-methyladenine (3-MA) significantly alleviated pathological alterations and typical symptom of HPS in CBDL rats in vivo, and consistently 3-MA significantly attenuated the CBDL rat serum-induced excessive proliferation of PMVECs in vitro. All these changes mediated by 3-MA might explain the observed prominent improvement of pulmonary appearance, edema, microvascular dilatation and arterial oxygenation in vivo. Collectively, these results suggest that autophagy activation may play a critical role in the pathogenesis of HPS, and autophagy inhibition may have a therapeutic potential for this disease.
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