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Quesada R, Elias E. Commentary on the prognostic impact of pre- and post- procedural renal dysfunction on late all-cause mortality outcome following transcatheter edge-to-edge repair of the mitral valve: A systematic review and meta-analysis. Cardiovascular Revascularization Medicine 2022; 42:15-16. [DOI: 10.1016/j.carrev.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
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Elias E, Ardid M, Lopez-Sanabria B, Pena C, Niberto N, Jimenez J, Quesada R. Hybrid Approach To Reshaping The Left Ventricle (bioventrix Revivent Tc System). J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Budd-Chiari syndrome (BCS) is an uncommon condition, caused by obstruction to hepatic venous outflow. It is largely underdiagnosed, and a high index of suspicion is required for any patient with unexplained portal hypertension. The understanding of its etiology and pathology is improving with advances in diagnostic techniques. Recent studies reported an identifiable etiology in > 80% of cases. Myeloproliferative neoplasm (MPN) is the most common etiology, and genetic studies help in diagnosing latent MPN. Better cross-sectional imaging helps delineate the site of obstruction accurately. The majority of BCS patients are now treated by endovascular intervention and anticoagulation which have improved survival in this disease. Angioplasty of hepatic veins/inferior vena cava remains under-utilized at present. While surgical porto-systemic shunts are no longer done for BCS, liver transplantation is reserved for select indications. Some of the unresolved issues in the current management of BCS are also discussed in this review.
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Affiliation(s)
- A Sharma
- Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - S N Keshava
- Department of Interventional Radiology, Christian Medical College, Vellore, India
| | - A Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - E Elias
- Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, India.,Liver Unit, University Hospitals Birmingham, Birmingham, UK
| | - C E Eapen
- Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, India.
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Zachariah U, Nair SC, Goel A, Balasubramanian KA, Mackie I, Elias E, Eapen CE. Targeting raised von Willebrand factor levels and macrophage activation in severe COVID-19: Consider low volume plasma exchange and low dose steroid. Thromb Res 2020; 192:2. [PMID: 32403033 PMCID: PMC7198395 DOI: 10.1016/j.thromres.2020.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/13/2023]
Affiliation(s)
- U Zachariah
- Hepatology Department, Christian Medical College, Vellore, India
| | - S C Nair
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, India
| | - A Goel
- Hepatology Department, Christian Medical College, Vellore, India
| | - K A Balasubramanian
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - I Mackie
- Research Haematology Dept., University College London, London, UK
| | - E Elias
- Liver Unit, University Hospitals Birmingham, Birmingham, UK
| | - C E Eapen
- Hepatology Department, Christian Medical College, Vellore, India.
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Elias E, Singh H, Bernstein CN, Targownik L. A246 POPULATION WIDE STUDY OF THE EPIDEMIOLOGY AND OUTCOMES OF ANTI-TNF DOSE AUGMENTATION IN INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) patients who experience loss of response to anti-tumor necrosis factor (anti-TNF) therapy are often treated with augmented doses of anti-TNF to recapture response. Despite this, factors associated with dose augmentation and treatment outcomes following dose augmentation remain largely undefined.
Aims
To examine the epidemiology of anti-TNF dose augmentation and determine the associated treatment outcomes among a province-wide cohort of anti-TNF treated IBD subjects.
Methods
The University of Manitoba Inflammatory Bowel Disease Epidemiological Database was used to identify patients receiving infliximab or adalimumab maintenance therapy for IBD in the Canadian province of Manitoba. Anti-TNF dose augmentation was defined as a ≥50% increase in anti-TNF dose or a shortening of dosing interval to ≤42 days for infliximab or ≤10 days for adalimumab. Anti-TNF failure was defined as corticosteroid use, IBD-related hospitalization, resective IBD surgery, or change in anti-TNF agent. Competing risks regression using a proportional subhazards model was used to determine the associations between dose augmentation, anti-TNF failure, anti-TNF discontinuation and a number of patient, disease, and treatment factors.
Results
871 persons (624 Crohn’s disease (CD), 247 ulcerative colitis (UC)) using anti-TNF maintenance therapy were identified. Cumulative incidence of dose augmentation among continued users was 25.7% at 90 days, 52.3% at 1 year, and 72.8% at 5 years. Anti-TNF failure occurred in 261 of 575 dose augmented subjects, with corticosteroid use the most common failure-defining event. Failure of standard dose anti-TNF in the 90 days preceding dose augmentation was strongly associated with failure of dose augmentation (HR 2.98 (2.27–3.93); p<0.0001). Persons with CD were less likely to receive corticosteroids but more likely to switch anti-TNF agents than persons with UC.
Conclusions
Rates of adverse IBD outcomes remain high after dose augmentation, particularly when dose augmentation is undertaken shortly after (or in response to) one of these adverse events. Our data suggest that dose augmentation may not be as effective as uncontrolled observational studies have indicated.
Funding Agencies
None
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Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
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Elias E, Silvester J, Graff LA, Bernstein CN, Rigaux L, Duerksen D. A107 PATIENT PERSPECTIVES ON THE LONG-TERM MANAGEMENT OF CELIAC DISEASE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Celiac disease (CD) is a common chronic gastrointestinal illness with a range of manifestations. The only available treatment is strict gluten avoidance, therefore patients are effectively self-managed. Despite the critical role patients play in their treatment, patient perspectives on long-term CD care have not been formally assessed and are therefore not represented in current clinical guidelines.
Aims
To determine the opinions of CD patients on the need for long-term CD follow-up, the utility of various aspects of CD follow-up, and the areas in which further information is desired.
Methods
The Manitoba Celiac Disease Cohort includes newly diagnosed adults with elevated TTG and/or EMA antibodies and Marsh III histology. At the 24-month follow-up visit, participants were asked to rate the utility of various aspects of CD care from 1–5 (low-high) and their desire for further information on CD-related issues from 1–6 (low-high).
Results
A total of 213 patients were recruited and 137 participants completed the online survey (median age 41 [interquartile range 29–57] years; 68% female). Adherence to a gluten free diet was variable, with 29% of patients having TTG antibodies above the upper limit of normal.
Two-thirds of participants felt they should be seen regularly for their celiac disease, while 79.8% of those who wished to be followed felt they should be seen every 6–12 months. Blood tests were the most highly rated component of CD care (scored ≥4 by 78% of respondents). Celiac symptom review, information on research in celiac disease, and the opportunity to ask questions about vitamins and supplements were also positively regarded. Diet review was not generally considered helpful. 79% of patients desired further information on research in CD, while approximately 60% desired information on the long-term complications of CD and the risk of nutritional deficiencies.
Conclusions
The majority of CD patients find regular specialist follow-up helpful, particularly for biochemical assessment of disease activity and its complications. Further information on CD research and the long-term complications of CD should be addressed in follow-up visits. These aspects of follow-up care should be reflected in future guidelines.
Funding Agencies
None
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Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | | | - L A Graff
- University of Manitoba, Winnipeg, MB, Canada
| | | | - L Rigaux
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
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Elias E, Oketola A, Krishnan S, Singh H, Targownik L, Bernstein CN. A40 IBD PATIENTS RECEIVING INFLIXIMAB IN COMBINATION WITH AN IMMUNOMODULATOR ARE LESS LIKELY TO DEVELOP SECONDARY LOSS OF RESPONSE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | - A Oketola
- University of Manitoba, Winnipeg, MB, Canada
| | - S Krishnan
- University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
| | - L Targownik
- University of Manitoba, Winnipeg, MB, Canada
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Elias E, Krishnan S, Oketola A, Singh H, Bernstein CN, Targownik L. A132 ANTI-TNF DOSE AUGMENTATION FREQUENTLY OCCURS IN THE ABSENCE OF OBJECTIVE EVIDENCE OF DISEASE ACTIVITY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | - S Krishnan
- University of Manitoba, Winnipeg, MB, Canada
| | - A Oketola
- University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
| | | | - L Targownik
- University of Manitoba, Winnipeg, MB, Canada
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Olds A, Eudailey K, Brinkman M, Liao M, Pentyala S, Wang C, Guaman K, Ng V, Velagapudi P, Elias E, Patel A, Vahl T, Khalique O, Lewis C, Hahn R, Bapat V, Leon M, Ahmed M, Kodali S, Nazif T, George I. TCT-395 A Propensity-Matched Comparison of Suprasternal and Transfemoral Transcatheter Aortic Valve Replacement: Inominate versus Femoral. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Padbury R, Gunson B, Dousset B, Hubscher S, Mayer A, Buckels J, Neuberger J, Elias E, McMaster P. Long-term immunosuppression after liver transplantation: are steroids necessary? Transpl Int 2018. [PMID: 14621849 DOI: 10.1111/tri.1992.5.s1.470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Elias E, Oketola A, Bernstein CN, Singh H, Targownik L. A92 ANTI-TNF DOSE AUGMENTATION FREQUENTLY OCCURS IN THE ABSENCE OF OBJECTIVE EVIDENCE OF DISEASE ACTIVITY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | - A Oketola
- University of Manitoba, Winnipeg, MB, Canada
| | | | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
| | - L Targownik
- University of Manitoba, Winnipeg, MB, Canada
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Elias E, Oketola A, Targownik L, Singh H, Bernstein CN. A93 NO INCREASE IN IMMUNOMODULATOR USE IN COMBINATION WITH ANTI-TNF THERAPY IN THE POST SONIC ERA. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | - A Oketola
- University of Manitoba, Winnipeg, MB, Canada
| | - L Targownik
- University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
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Jacobs K, Leopold A, Hendricks DJ, Sampson E, Nardone A, Lopez KB, Rumrill P, Stauffer C, Elias E, Scherer M, Dembe J. Project Career: Perceived benefits of iPad apps among college students with Traumatic Brain Injury (TBI). Work 2017; 58:45-50. [PMID: 28922175 DOI: 10.3233/wor-172596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Project Career is an interprofessional five-year development project designed to improve academic and employment success of undergraduate students with a traumatic brain injury (TBI) at two- and four-year colleges and universities. Students receive technology in the form of iPad applications ("apps") to support them in and out of the classroom. OBJECTIVE To assess participants' perspectives on technology at baseline and perceived benefit of apps after 6 and 12 months of use. METHODS This article address a component of a larger study. Participants included 50 college-aged students with traumatic brain injuries. Statistical analysis included data from two Matching Person and Technology (MPT) assessment forms, including the Survey of Technology Use at baseline and the Assistive Technology Use Follow-Up Survey: Apps Currently Using, administered at 6- and 12-months re-evaluation. Analyses included frequencies and descriptives. RESULTS Average scores at baseline indicated positive perspectives on technology. At 6 months, quality of life (67%) and academics (76%) improved moderately or more from the use of iPad apps. At 12 months, quality of life (65%) and academics (82%) improved moderately or more from the use of iPad apps. CONCLUSION Students with a TBI have positive perspectives on technology use. The results on perceived benefit of apps indicated that students with a TBI (including civilians and veterans) report that the apps help them perform in daily life and academic settings.
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Affiliation(s)
- K Jacobs
- Boston University, Boston, MA, USA
| | - A Leopold
- JBS International, Inc., Bethesda, MD, USA
| | | | - E Sampson
- West Virginia University, Morgantown, WV, USA
| | | | - K B Lopez
- Kent State University, Kent, OH, USA
| | - P Rumrill
- Kent State University, Kent, OH, USA
| | | | - E Elias
- JBS International, Inc., Bethesda, MD, USA
| | - M Scherer
- University of Rochester, Rochester, NY, USA
| | - J Dembe
- Kent State University, Kent, OH, USA
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Affiliation(s)
- S. Kaizerman
- Technion-Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
| | - E. Wacholder
- Technion-Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
| | - E. Elias
- Technion-Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
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Affiliation(s)
- E. Elias
- Technion-Israel Institute of Technology Department of Nuclear Engineering, Haifa, Israel
| | - Y. Segal
- Technion-Israel Institute of Technology Department of Nuclear Engineering, Haifa, Israel
| | - A. Notea
- Technion-Israel Institute of Technology Department of Nuclear Engineering, Haifa, Israel
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Affiliation(s)
- E. Elias
- Technion – Israel Institute of Technology Department of Nuclear Engineering, Haifa, Israel
| | - Y. Segal
- Technion – Israel Institute of Technology Department of Nuclear Engineering, Haifa, Israel
| | - A. Notea
- Technion – Israel Institute of Technology Department of Nuclear Engineering, Haifa, Israel
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Affiliation(s)
- S. Kaizerman
- Technion-Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
| | - E. Wacholder
- Technion-Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
| | - E. Elias
- Technion-Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
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Affiliation(s)
- E. Elias
- Technion - Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
| | - Y. Segal
- Technion - Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
| | - A. Notea
- Technion - Israel Institute of Technology Department of Nuclear Engineering Haifa 32000, Israel
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Gaztanaga J, Paruchuri V, Elias E, Wilner J, Islam S, Sawit S, Viles-Gonzalez J, Sanz J, Garcia MJ. Prognostic Value of Late Gadolinium Enhancement in Nonischemic Cardiomyopathy. Am J Cardiol 2016; 118:1063-8. [PMID: 27614850 DOI: 10.1016/j.amjcard.2016.06.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to determine the prognostic value of late gadolinium enhancement seen on cardiac magnetic resonance (CMR) imaging in patients with nonischemic cardiomyopathy (NICMP). Patients with NICMP are at increased risk for cardiovascular events and death. The presence of late gadolinium enhancement (LGE) in CMR may be associated with a poor prognosis, but its significance is still under investigation. We retrospectively studied 105 consecutive patients with NICMP and left ventricular ejection fraction (LVEF) ≤40% referred for CMR. The cohort was analyzed for the presence of LGE and left and right ventricular functional parameters. Patients were followed for the composite end point of hospitalization for congestive heart failure, appropriate implantable cardioverter-defibrillator therapy, or all-cause mortality. LGE was observed in 68% (n = 71) of the cohort. Both groups were similar in age, LVEF and LV end-diastolic volume. The LGE+ patients were more often men and had larger right ventricular volumes. At a mean follow-up of 806 ± 582 days, there were 26 patients (23 in the LGE+ group) who reached the primary end point. Event-free survival was significantly worse for the LGE+ patients. After adjusting for traditional risk factors (age, gender, and LVEF), patients with LGE had an increased risk of experiencing the primary end point (hazard ratio 4.47, 95% CIs 1.27 to 15.74, p = 0.02). The presence of LGE in patients with NICMP strongly predicts the occurrence of adverse events. In conclusion, this may be important in risk stratification and management.
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Affiliation(s)
| | | | - R Hermon Dowling
- MRC Intestinal Malabsorption Group, Department of Medicine, Royal Postgraduate Medical School, Ducane Road, London W12
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Elias E, Casselbrant A, Werling M, Abegg K, Vincent RP, Alaghband-Zadeh J, Olbers T, le Roux CW, Fändriks L, Wallenius V. Bone mineral density and expression of vitamin D receptor-dependent calcium uptake mechanisms in the proximal small intestine after bariatric surgery. Br J Surg 2014; 101:1566-75. [PMID: 25209438 DOI: 10.1002/bjs.9626] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/17/2013] [Accepted: 07/08/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass may lead to impaired calcium uptake. Therefore, operation-specific effects of gastric bypass and vertical banded gastroplasty on bone mineral density (BMD) were examined in a randomized clinical trial. Bone resorption markers and mechanisms of decreased calcium uptake after gastric bypass were investigated using blood and endoscopic samples from two additional patient cohorts. METHODS Total BMD and non-weight-bearing skull BMD were measured by dual-energy X-ray absorptiometry at baseline, and 1 and 6 years after gastric bypass or vertical banded gastroplasty in patients who were not receiving calcium supplements. Bone resorption markers in serum and calcium uptake mechanisms in jejunal mucosa biopsies were analysed after gastric bypass by proteomics including radioimmunoassay, gel electrophoresis and mass spectrometry. RESULTS One year after surgery, weight loss was similar after gastric bypass and vertical banded gastroplasty. There was a moderate decrease in skull BMD after gastric bypass, but not after vertical banded gastroplasty (P < 0·001). Between 1 and 6 years after gastric bypass, skull BMD and total BMD continued to decrease (P = 0·001). C-terminal telopeptide levels in serum had increased twofold by 18 months after gastric bypass. Proteomic analysis of the jejunal mucosa revealed decreased levels of heat-shock protein 90β, a co-activator of the vitamin D receptor, after gastric bypass. Despite increased vitamin D receptor levels, expression of the vitamin D receptor-regulated calcium transporter protein TRPV6 decreased. CONCLUSION BMD decreases independently of weight after gastric bypass. Bone loss might be attributed to impaired calcium absorption caused by decreased activation of vitamin D-dependent calcium absorption mechanisms mediated by heat-shock protein 90β and TRPV6.
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Affiliation(s)
- E Elias
- Departments of Gastrosurgical Research and Education, University of Gothenburg, Gothenburg, Sweden
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Shaposhnik Y, Shwageraus E, Elias E. Shutdown margin for high conversion BWRs operating in Th-233U fuel cycle. Nuclear Engineering and Design 2014. [DOI: 10.1016/j.nucengdes.2014.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Helou J, Elias E, Zhang L, Cheung P, Deabreu A, D'Alimonte L, Perakaa S, Mamedov A, Cardoso M, Loblaw A. Dosimetric and Patient Correlates of Quality of Life After Prostate Stereotactic Ablative Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tripathi D, Macnicholas R, Kothari C, Sunderraj L, Al-Hilou H, Rangarajan B, Chen F, Mangat K, Elias E, Olliff S. Commentary: TIPSS for Budd-Chiari syndrome - authors' reply. Aliment Pharmacol Ther 2014; 39:1238. [PMID: 24735140 DOI: 10.1111/apt.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 03/16/2014] [Indexed: 12/08/2022]
Affiliation(s)
- D Tripathi
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
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Tripathi D, Macnicholas R, Kothari C, Sunderraj L, Al-Hilou H, Rangarajan B, Chen F, Mangat K, Elias E, Olliff S. Good clinical outcomes following transjugular intrahepatic portosystemic stent-shunts in Budd-Chiari syndrome. Aliment Pharmacol Ther 2014; 39:864-72. [PMID: 24611957 DOI: 10.1111/apt.12668] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/24/2013] [Accepted: 01/30/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND There have been encouraging reports on transjugular intrahepatic portosystemic stent-shunt (TIPSS) for Budd-Chiari syndrome (BCS). Long-term data are lacking. AIM To assess long-term outcomes and validate prognostic scores following TIPSS for BCS. METHODS A single centre retrospective study. Patients underwent TIPSS using bare or polytertrafluoroethane (PTFE)-covered stents. RESULTS Sixty-seven patients received successful TIPSS between 1996 and 2012 using covered (n = 40) or bare (n = 27) stents. Patients included had a Male: Female ratio of 21:46, and were characterised (mean ± s.d.) by age 39.9 ± 14.3 years, Model of end stage liver disease (MELD) 16.1 ± 7.0 and Child's score 8.8 ± 2.0. Seventy-eight percent had haematological risk factors. Presenting symptoms were ascites (n = 61) and variceal bleeding (n = 6). Nine patients underwent hepatic vein dilatation or stenting prior to TIPSS. Mean follow-up was 82 months (range 0.5-184 months). Fifteen percent had post-TIPSS encephalopathy. Two have been transplanted. Primary patency rates (76% vs. 27%, P < 0.001) and shunt re-interventions (22% vs. 100%, P < 0.001) significantly favoured covered stents. Secondary patency was 99%. Six-, 12-, 24-, 60- and 120-month survival was 97%, 92%, 87%, 80% and 72% respectively. Six patients had liver related deaths. Two patients developed hepatocellular carcinoma. The BCS TIPS PI independently predicted mortality in the whole cohort, but no prognostic score was a significant predictor of mortality after subgroup validation. CONCLUSIONS Long-term outcomes following TIPSS for Budd-Chiari syndrome are very good. PTFE-covered stents have significantly better primary patency. The value of prognostic scores is controversial. TIPSS should be considered as first line therapy in symptomatic patients in whom hepatic vein patency cannot be restored.
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Affiliation(s)
- D Tripathi
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Shaposhnik Y, Shwageraus E, Elias E. Core design options for high conversion BWRs operating in Th–233U fuel cycle. Nuclear Engineering and Design 2013. [DOI: 10.1016/j.nucengdes.2013.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Elias E, Pozo E, Paruchuri V, Gaztanaga J, Narula J, Pinney S, Fuster V, Sanz J. T1 MAPPING BY CMR IN PATIENTS WITH NONISCHEMIC CARDIOMYOPATHY: RELATION TO LEFT VENTRICULAR PERFORMANCE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Elias E, Pozo E, Paruchuri V, Gaztanaga J, Kalman J, Narula J, Fuster V, Sanz J. PREDICTORS OF CARDIAC OUTCOMES BY CMRI IN PATIENTS WITH NONISCHEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liao JH, Jara H, Nadgir R, Elias E, Nowrouzi N, Saito N, Steinberg MH, Sakai O. qMRI relaxometry of mandibular bone marrow: A monomodal distribution in sickle cell disease. J Magn Reson Imaging 2012; 37:1182-8. [DOI: 10.1002/jmri.23887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 09/14/2012] [Indexed: 11/10/2022] Open
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Sanelli PC, Anumula N, Gold R, Elias E, Johnson C, Comunale J, Tsiouris AJ, Segal AZ. Outcomes-based assessment of a new reference standard for delayed cerebral ischemia related to vasospasm in aneurysmal subarachnoid hemorrhage. Acad Radiol 2012; 19:1066-74. [PMID: 22727622 PMCID: PMC3416968 DOI: 10.1016/j.acra.2012.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose is to perform outcomes-based assessment of a new reference standard for delayed cerebral ischemia (DCI) related to vasospasm. MATERIALS AND METHODS Retrospective study was performed with consecutive aneurysmal subarachnoid hemorrhage (A-SAH) patients between January 2002 and May 2009. A new reference standard for DCI was applied to the study population incorporating clinical and imaging criteria. Diagnostic accuracy was determined by chart diagnosis. Outcome measures for assessment included: permanent neurologic deficits, infarction, functional disability, treatment, and discharge status. Medical record review was performed by two blinded observers. Chi-square test calculated statistical significance between DCI and no DCI groups. RESULTS A total of 137 patients were included; 59% (81/137) classified as DCI and 41% (56/137) as no DCI by the reference standard. Overall accuracy is 96% (95% confidence interval 92-99) with 100% sensitivity, 92% specificity, 94% positive and 100% negative predictive values. Patients classified as DCI had 40% (32/81) permanent neurologic deficits and 57% (46/81) infarction compared to 0% (0/56) classified as no DCI. DCI patients had 33% (27/81) functional disability compared to 13% (7/56) classified as no DCI. Ninety-four percent (76/81) DCI patients received treatment compared to 0% (0/56) classified as no DCI. DCI group had 46% (37/81) discharged to rehabilitation facilities and 11% (9/81) mortality compared to 25% (14/56) and 2% (1/56), respectively, in no DCI group. There are statistically significant differences (P < .0001) between DCI and no DCI groups for all outcome measures. CONCLUSION This new reference standard has high diagnostic accuracy for DCI related to vasospasm. The outcomes-based assessment further supports its accuracy in correctly classifying A-SAH patients.
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Affiliation(s)
- Pina C Sanelli
- Department of Radiology, Weill Cornell Medical College/New York-Presbyterian Hospital, NY 10065, USA.
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Elias E, Mukherji D, Faraj W, Alameddine R, Saleh A, El Saghir N, Shamseddine A. 43 Effect of Nodal Status in Triple Negative Breast Cancer – Survival Outcomes From a Tertiary Center. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elias E, Benrick A, Behre CJ, Ekman R, Zetterberg H, Stenlöf K, Wallenius V. Central nervous system lipocalin-type prostaglandin D2-synthase is correlated with orexigenic neuropeptides, visceral adiposity and markers of the hypothalamic-pituitary-adrenal axis in obese humans. J Neuroendocrinol 2011; 23:501-7. [PMID: 21438929 DOI: 10.1111/j.1365-2826.2011.02128.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lipocalin-type prostaglandin D2-synthase (L-PGDS) is the main producer of prostaglandin D2 (PGD2) in the central nervous system (CNS). Animal data suggest effects of central nervous L-PGDS in the regulation of food intake and obesity. No human data are available. We hypothesised that a role for CNS L-PGDS in metabolic function in humans would be reflected by correlations with known orexigenic neuropeptides. Cerebrospinal fluid (CSF) and serum samples were retrieved from 26 subjects in a weight loss study, comprising a 3-week dietary lead-in followed by 12-weeks of leptin or placebo treatment. At baseline, CSF L-PGDS was positively correlated with neuropeptide Y (NPY) (ρ = 0.695, P < 0.001, n = 26) and galanin (ρ = 0.651, P < 0.001) as well as visceral adipose tissue (ρ = 0.415, P = 0.035). Furthermore, CSF L-PGDS was inversely correlated with CSF leptin (ρ = -0.529, P = 0.005) and tended to correlate inversely with s.c. adipose tissue (ρ = -0.346, P = 0.084). As reported earlier, leptin treatment had no effect on weight loss and did not affect CSF L-PGDS or NPY levels compared to placebo. After weight loss, the change of CSF L-PGDS was significantly correlated with the change of CSF NPY levels (ρ = 0.604, P = 0.004, n = 21). Because of the correlation between baseline CSF L-PGDS levels and visceral adipose tissue, we examined associations with hypothalamic-pituitary-adrenal (HPA) axis components. Baseline CSF L-PGDS was correlated with corticotrophin-releasing hormone (ρ = 0.764, P < 0.001) and β-endorphin (ρ = 0.491, P < 0.001). By contrast, serum L-PGDS was not correlated with any of the measured variables either at baseline or after treatment. In summary, CSF L-PGDS was correlated with orexigenic neuropeptides, visceral fat distribution and central HPA axis mediators. The importance of these findings is unclear but could suggest a role for CSF L-PGDS in the regulation of visceral obesity by interaction with the neuroendocrine circuits regulating appetite and fat distribution. Further interventional studies will be needed to characterise these interactions in more detail.
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Affiliation(s)
- E Elias
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy at Sahlgrenska University Hospital, University of Gothenburg, Sweden
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Wallenius V, Elias E, Bergstrom GML, Zetterberg H, Behre CJ. The lipocalins retinol-binding protein-4, lipocalin-2 and lipocalin-type prostaglandin D2-synthase correlate with markers of inflammatory activity, alcohol intake and blood lipids, but not with insulin sensitivity in metabolically healthy 58-year-old Swedish men. Exp Clin Endocrinol Diabetes 2010; 119:75-80. [PMID: 21104585 DOI: 10.1055/s-0030-1265212] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The lipocalins retinol-binding protein (RBP)-4, lipocalin-2 and lipocalin-type prostaglandin D-synthase (L-PGDS) have been suggested to mediate obesity-associated insulin resistance and other metabolic co-morbidities. The role of lipocalins is however controversial and it is unclear whether they have a physiological role in regulation of insulin sensitivity and metabolic function in clinically healthy humans. Therefore, we examined the correlations between serum levels of RBP-4, L-PGDS and lipocalin-2 and insulin sensitivity and other metabolic parameters in non-diabetic subjects selected to display variations in insulin sensitivity. 100 clinically healthy 58-year-old Swedish men were selected by stratified sampling among 818 screened subjects to represent quintiles of varying degrees of insulin sensitivity. Insulin sensitivity was measured by the euglycaemic hyperinsulinaemic clamp method. Serum levels of lipocalins and cytokines were determined using antibody-based techniques. Serum lipids were measured by standardized laboratory methods. None of the measured lipocalins showed any correlations with insulin sensitivity. However, we found that lipocalin-2 and L-PGDS were correlated with each other, but not with RBP-4. Lipocalin-2 and L-PGDS were positively correlated with soluble TNF- receptors 1 and 2 and negatively with alcohol consumption and serum HDL. Further, lipocalin-2 was correlated with interleukin-6 whereas RBP-4 was negatively correlated with TNF-α. □These results suggest that RBP-4, lipocalin-2 and L-PGDS do not regulate insulin sensitivity in healthy men. Rather the expression levels of lipocalin-2 and L-PGDS, but not RBP-4, seemed to reflect inflammatory activity and were inversely correlated with alcohol intake and serum HDL levels.
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Affiliation(s)
- V Wallenius
- Department of Gastrosurgical Research, Sahlgrenska Academy at Sahlgrenska University Hospital, Gothenburg, Sweden.
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Gold R, Reichman M, Greenberg E, Ivanidze J, Elias E, Tsiouris AJ, Comunale JP, Johnson CE, Sanelli PC. Developing a new reference standard: is validation necessary? Acad Radiol 2010; 17:1079-82. [PMID: 20692619 DOI: 10.1016/j.acra.2010.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 10/30/2009] [Accepted: 05/25/2010] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES A gold standard is often an imperfect diagnostic test, falling short of achieving 100% accuracy in clinical practice. Using an imperfect gold standard without fully comprehending its limitations and biases can lead to erroneous classification of patients with and without disease. This will ultimately affect treatment decisions and patient outcomes. Therefore, validation is essential before implementing a reference standard into practice. Performing a comprehensive validation process is discussed, along with its advantages and challenges. The different types of validation methods are reviewed. An example from our work in developing a new reference standard for vasospasm diagnosis in aneurysmal subarachnoid hemorrhage patients is provided. CONCLUSION Employing a new reference standard may result in a definitional shift of the disease and classification scheme of patients; therefore, it is important to also assess the impact of a new reference standard on patient outcomes and its clinical effectiveness.
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Schramm B, Elias E, Kern L, Natour G, Schmitt A, Weber C. Precise Measurements of Second Virial Coefficients of Simple Gases and Gas Mixtures in the Temperature Range Below 300 K. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19910950513] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vatter K, Schmidt HJ, Elias E, Schramm B. Measurements of Interaction Second Virial Coefficients of Binary Mixtures of Inert Gases and Gases. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19961000114] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Elias E, Hoang N, Sommer J, Schramm B. Die zweiten Virialkoeffizienten von Helium-Gasmischungen im Bereich unterhalb Zimmertemperatur. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19860900406] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Talbot-Smith A, Syn WK, MacQuillan G, Neil D, Elias E, Ryan P. Familial idiopathic pulmonary fibrosis in association with bone marrow hypoplasia and hepatic nodular regenerative hyperplasia: a new "trimorphic" syndrome. Thorax 2009; 64:440-3. [PMID: 19401489 DOI: 10.1136/thx.2008.099796] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is the first report of familial idiopathic pulmonary fibrosis associated with hepatic nodular regenerative hyperplasia and bone marrow hypoplasia. Four members of one family presented with this triad of organ dysfunction. The response to immunosuppressive treatment was poor and all four members succumbed to the disease processes. The current literature is reviewed and mechanisms that could have been involved in the development of this new syndrome are proposed.
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Affiliation(s)
- A Talbot-Smith
- Department of Respiratory Medicine, Hereford County Hospital, UK.
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Owen BM, Van Mil SWC, Boudjelal M, McLay I, Cairns W, Elias E, White R, Williamson C, Dixon PH. Sequencing and functional assessment of hPXR (NR1I2) variants in intrahepatic cholestasis of pregnancy. Xenobiotica 2008; 38:1289-97. [PMID: 18800312 DOI: 10.1080/00498250802426114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
1. The purpose of this study was to evaluate the role of coding variation in hPXR (NR1I2) in intrahepatic cholestasis of pregnancy (ICP) and to functionally asses the response of PXR variants to ligands of interest in ICP. 2. The coding region of hPXR was sequenced in a cohort of 121 Caucasian ICP patients and exon 2 was sequenced in an additional 226 cases. Reporter assays were used to evaluate the function of all known hPXR variants in response to the secondary bile acid lithocholic acid and therapeutic agents rifampicin, ursodeoxycholic acid and dexamethasone. 3. Two coding single nucleotide polymorphisms (C79T and G106A) were detected in the ICP cohort at frequencies consistent with healthy populations. These do not alter hPXR function in response to ligands of interest to ICP. Analysis of all known coding hPXR variants demonstrates that while subtle changes in experimental design mask or may unveil the functional effects of genetic variation, these are not maintained in a standard functional assay. 4. Coding genetic variation in hPXR does not contribute to the aetiology of ICP in Caucasian populations.
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Affiliation(s)
- B M Owen
- Maternal and Fetal Disease Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
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Ladoyanni E, Pereira M, Struthers K, Chen K, Haydon G, Mutimer D, Elias E, Ilchyshyn A. DisseminatedCryptococcusinfection in a liver-transplant recipient presenting with a chronic scalp eruption. Clin Exp Dermatol 2008; 33:655-6. [DOI: 10.1111/j.1365-2230.2008.02781.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geberhiwot T, Alger S, McKiernan P, Packard C, Caslake M, Elias E, Cramb R. Serum lipid and lipoprotein profile of patients with glycogen storage disease types I, III and IX. J Inherit Metab Dis 2007; 30:406. [PMID: 17407002 DOI: 10.1007/s10545-007-0485-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 03/02/2007] [Accepted: 03/02/2007] [Indexed: 10/23/2022]
Abstract
With current dietary therapy, life expectancy in glycogen storage disease (GSD) has improved considerably and more children reach adulthood. Notwithstanding intensive dietary therapy, moderate to severe hyperlipidaemia is still observed frequently. There is limited information about the type and extent of hyperlipidaemia. We studied the lipid profile in 20 patients, aged 8-54 years, of the three (types I, III and IX) most common forms of adult GSD. Hyperlipidaemia was shown to be type-specific, affecting predominantly patients with GSD type Ia, who showed marked combined hypercholesterolaemia and hypertriglyceridaemia. By contrast, a heterogeneous distribution of HDL was found in patients with GSD I and III. There was no significant difference in Apo Al and Apo B concentrations between groups. In addition, mass measurements of the fractions of VLDL1, VLDL2 and IDL were raised in all patients with GSD Ia by comparison with all other patients with GSD. Patients with GSD type Ia have lipid concentrations and individual mass measurements that are consistent with ranges found in patients who have a significant risk of atherosclerosis. Accumulated evidence, however, suggest GSD type Ia patients do not have an increased risk of atherosclerotic cardiovascular disease (CVD) but the reason remains unknown. Intervention to reduce their lipid levels could therefore be on the basis of seeking to prevent the risk of pancreatitis rather than that of CVD.
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Affiliation(s)
- T Geberhiwot
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Kondili LA, Lala A, Gunson B, Hubscher S, Olliff S, Elias E, Bramhall S, Mutimer D. Primary hepatocellular cancer in the explanted liver: outcome of transplantation and risk factors for HCC recurrence. Eur J Surg Oncol 2007. [PMID: 17258882 DOI: 10.1016/s0168-8278(04)90255-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM To evaluate the risk of recurrence of hepatocellular cancer (HCC) after liver transplantation (LT). METHODS The clinical records of 104 patients with HCC in the explanted liver were examined. RESULTS HCC recurrence occurred in 12 patients. Recurrence was observed in all patients with a single nodule greater than 5 cm. Among the 5 patients with more than 3 tumours with a maximum diameter of 4.5 cm, no recurrence occurred. The survival rates were 81% and 64% at 1 and 5 years, respectively; the recurrence-free survival at 1 and 5 years was, respectively, 93% and 82%. Pre-LT alpha-fetoprotein (AFP) increased at a greater magnitude in patients who experienced recurrence, compared to those who did not. Tumour diameter, differentiation, satellitosis, AFP and the magnitude of AFP increase were predictive of recurrence. The 1- and 5-year recurrence-free survival for the 68 patients who had a single nodule up to 5 cm, or up to 3 nodules all less than 4.5 cm and with a maximum cumulative diameter of 8 cm, or more than 3 nodules all less than 2.5 cm, were 95% and 92%, respectively. For the 13 patients not meeting these criteria, the 1- and 5-year recurrence-free survival was, respectively, 75% and 54% (log Rank test p=0.019). CONCLUSIONS Patients with more than 3 small HCC nodules before LT could still have a good outcome without recurrence. A rapid increase in AFP could be useful in identifying patients with a greater risk of post-LT HCC recurrence.
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Affiliation(s)
- L A Kondili
- Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Kondili LA, Lala A, Gunson B, Hubscher S, Olliff S, Elias E, Bramhall S, Mutimer D. Primary hepatocellular cancer in the explanted liver: outcome of transplantation and risk factors for HCC recurrence. Eur J Surg Oncol 2007; 33:868-73. [PMID: 17258882 DOI: 10.1016/j.ejso.2006.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 10/03/2006] [Indexed: 12/23/2022] Open
Abstract
AIM To evaluate the risk of recurrence of hepatocellular cancer (HCC) after liver transplantation (LT). METHODS The clinical records of 104 patients with HCC in the explanted liver were examined. RESULTS HCC recurrence occurred in 12 patients. Recurrence was observed in all patients with a single nodule greater than 5 cm. Among the 5 patients with more than 3 tumours with a maximum diameter of 4.5 cm, no recurrence occurred. The survival rates were 81% and 64% at 1 and 5 years, respectively; the recurrence-free survival at 1 and 5 years was, respectively, 93% and 82%. Pre-LT alpha-fetoprotein (AFP) increased at a greater magnitude in patients who experienced recurrence, compared to those who did not. Tumour diameter, differentiation, satellitosis, AFP and the magnitude of AFP increase were predictive of recurrence. The 1- and 5-year recurrence-free survival for the 68 patients who had a single nodule up to 5 cm, or up to 3 nodules all less than 4.5 cm and with a maximum cumulative diameter of 8 cm, or more than 3 nodules all less than 2.5 cm, were 95% and 92%, respectively. For the 13 patients not meeting these criteria, the 1- and 5-year recurrence-free survival was, respectively, 75% and 54% (log Rank test p=0.019). CONCLUSIONS Patients with more than 3 small HCC nodules before LT could still have a good outcome without recurrence. A rapid increase in AFP could be useful in identifying patients with a greater risk of post-LT HCC recurrence.
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Affiliation(s)
- L A Kondili
- Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Eapen CE, Velissaris D, Heydtmann M, Gunson B, Olliff S, Elias E. Favourable medium term outcome following hepatic vein recanalisation and/or transjugular intrahepatic portosystemic shunt for Budd Chiari syndrome. Gut 2006; 55:878-84. [PMID: 16174658 PMCID: PMC1856218 DOI: 10.1136/gut.2005.071423] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We report our experience with management of patients with Budd Chiari syndrome over the past two decades. In 1996 we described a novel approach involving recanalisation of hepatic veins by combined percutaneous and transvenous approaches. This was incorporated into an algorithm published in 1999 in which our preferred treatment for all cases of Budd Chiari syndrome with short segment occlusion or stenosis of the hepatic veins involves recanalisation of the hepatic veins by transvenous or combined percutaneous-transvenous approaches. In symptomatic Budd Chiari syndrome where recanalisation is not possible, we perform transjugular intrahepatic portosystemic shunts (TIPS) because TIPS decompresses the portal circulation directly in an adjustable way. In this series of patients with Budd Chiari syndrome treated with radiological interventions alone, we assess their medium term outcome using two independent objective prognostic indices. METHODS We retrospectively studied 61 patients with non-malignant Budd Chiari syndrome treated by radiological intervention alone in our centre. RESULTS Actuarial survival for the entire cohort at one year and five years was 94% and 87%, respectively. Survival of our patients with mild disease (according to the Murad classification) was 100% at one year and at five years, with intermediate disease severity 94% at one year and 86% at five years, and with severe disease 85% at one year and 77% at five years. CONCLUSION Management of Budd Chiari syndrome by interventional radiology resulted in excellent medium term survival for patients in all categories of disease severity.
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Affiliation(s)
- C E Eapen
- Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
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Abstract
INTRODUCTION Because of the tendency for preexisting diseases to recur following liver transplantation, studying the course of patients who were transplanted for their cryptogenic cirrhosis may reveal features of the original cause. We examined the clinicopathological posttransplant progression of patients transplanted due to cryptogenic cirrhosis with emphasis on the detection of posttransplant steatosis and steatohepatitis. METHODS The data on all patients transplanted for cryptogenic cirrhosis and their routine 1-year posttransplant liver biopsies were compared to a control group of a randomized sample of patients transplanted for other indications matched for length of follow-up. The posttransplant histological diagnosis was based on the latest available biopsy. RESULTS Among 1710 patients, 39 present with cryptogenic etiology survived at least 1 year after transplantation. The control group consisted of 78 patients. The mean ages of the two groups were 50.7 and 49.3 years and the mean follow-up periods 6.2 and 5.7 years, both of which were similar. There was a significantly greater prevalence of posttransplant steatosis and steatohepatitis among the cryptogenic group (37.5 vs 16.7%, P = .048). The difference in patients with at least moderate steatosis was more pronounced (18.8 vs 3.3%, P = .035). Half of these cases progressed to fibrosis and cirrhosis after 48 months. CONCLUSIONS This study found a greater incidence of allograft steatosis and steatohepatitis among patients transplanted for cryptogenic cirrhosis compared with a control group. A significant proportion of these patients developed a picture resembling nonalcoholic steatohepatitis, which progressed to fibrosis and cirrhosis.
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Affiliation(s)
- D S Sutedja
- Singapore Liver Transplant Program, National University Hospital, Singapore.
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Abstract
Nodular regenerative hyperplasia (NRH) of the liver is a rare disorder that is often associated with connective tissue disorders, haematological malignancy, or drugs, and is a cause of non-cirrhotic portal hypertension. We describe two cases of NRH in individuals with adult coeliac disease and IgA anticardiolipin antibodies. We discuss the potential impact of this observation on the understanding of the pathogenesis of NRH.
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Affiliation(s)
- A Austin
- The Liver Unit, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK
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Sharma S, Texeira A, Texeira P, Elias E, Wilde J, Olliff SP. Pharmacological thrombolysis in Budd Chiari syndrome: a single centre experience and review of the literature. J Hepatol 2004; 40:172-80. [PMID: 14672630 DOI: 10.1016/j.jhep.2003.09.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIMS To review our experience of thrombolytic therapy in patients with acute Budd Chiari syndrome (BCS). METHODS Records of 10 patients with BCS, treated by thrombolysis over a 12-year period were retrospectively analysed for demographics, clinical presentation/duration, primary disease, thrombolytic regimen, and follow-up. The same characteristics were also studied in previously reported patients. The agent used was recombinant tissue plasminogen activator (tPA) in all patients. RESULTS Thrombolysis was used 12 times in 10 patients. Infusion was made systemically in three patients, into the hepatic artery in one patient, locally into a hepatic vein and/or IVC in four patients and locally within TIPS/portal vein in two patients. Only one infusion made systemically was partially successful. Adjunctive balloon angioplasty and/or stent insertion was undertaken for all eight procedures (in six patients) where local infusion was into the hepatic vein or TIPS. Six of these were ultimately successful (in five patients) and two were unsuccessful. Thrombolysis was more likely to be successful in the presence of a short history of thrombosis, when the thrombolytic agent was locally infused and when it was combined with a successful radiological procedure. Mean follow-up was 4.5 years (range 1-10 years). No serious bleeding complication occurred. CONCLUSIONS We observed no benefit from thrombolysis when delivered systemically or arterially except in one case. Thrombolysis was useful in adjunctive management of BCS when the drug was infused locally into recently thrombosed veins that had appreciable flow following partial recanalisation. Thrombolysis was clearly of benefit in the repermeation of occluded/partially occluded hepatic veins/TIPS when early detection of new thrombus followed interventional procedures such as balloon angioplasty or stenting of hepatic veins.
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Affiliation(s)
- S Sharma
- Department of Radiology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, The Liver Unit, Birmingham B15 2TH, UK
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Cabrera-Abreu J, Crabtree NJ, Elias E, Fraser W, Cramb R, Alger S. Bone mineral density and markers of bone turnover in patients with glycogen storage disease types I, III and IX. J Inherit Metab Dis 2004; 27:1-9. [PMID: 14970741 DOI: 10.1023/b:boli.0000016632.13234.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with glycogen storage disease (GSD) types I, III and IX show reduced bone mineral content, but there is scarce data on new serum and urine markers of bone turnover or their relationship to bone densitometry. Six GSD I, four GSD III and four GSD IX patients underwent bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry. Free pyridinoline (fPYD):creatinine and free deoxypyridinoline (fDPD):creatinine ratios were analysed on random urines. Procollagen type I C-terminal propeptide, procollagen type I N-terminal propeptide (PINP), carboxyterminal telopeptide of type I collagen and bone-specific alkaline phosphatase were analysed in serum. Some GSD I and GSD III patients had low or very low BMD. There was no difference in total body BMD z-score between the GSD types after adjusting for height (p=0.110). Bone marker analysis showed no consistent pattern. Urine fPYD:creatinine ratio was raised in four GSD I and two GSD III patients, while serum PINP was inappropriately low in some of these patients. There was no clear correlation between any markers of bone destruction and total body z-score, but the patient with the lowest total body z-score showed the highest concentrations of both urinary fPYD:creatinine and fDPD:creatinine ratios. We conclude that some GSD I and GSD III patients have very low bone mineral density. There is no correlation between mineral density and bone markers in GSD patients. The inappropriately low concentration of PINP in association with the raised urinary fPYD:creatinine and fDPD:creatinine ratios seen in two GSD I patients reflect uncoupling of bone turnover. All these findings taken together suggest that some GSD I and GSD III patients may be at an increased risk of osteoporosis.
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Affiliation(s)
- J Cabrera-Abreu
- Department of Clinical Chemistry, Birmingham Children's Hospital, Birmingham, UK
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Padbury RT, Gunson BK, Dousset B, Hubscher SG, Mayer AD, Buckels JA, Neuberger JM, Elias E, McMaster P. Long-term immunosuppression after liver transplantation: are steroids necessary? Transpl Int 2003; 5 Suppl 1:S470-2. [PMID: 14621849 DOI: 10.1007/978-3-642-77423-2_137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Steroid therapy was withdrawn in 85% of 152 orthotopic liver transplant recipients with grafts surviving for more than 3 months, and 87% of these remained steroid-free. Steroid therapy was restarted in 8% for reasons other than rejection. The most common was conversion of immunosuppression because of cyclosporine nephrotoxicity. The incidence of rejection after steroid withdrawal was low: 3.8% for chronic rejection (CR) and 4.5% for acute rejection. Only 3 grafts (1.9%) were lost because of CR. No risk factors have been identified for the development of CR after steroid withdrawal, but a protective role for azathioprine has been suggested.
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Affiliation(s)
- R T Padbury
- The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
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