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Abstract
SummaryPatients with liver disease are at risk of bleeding due to abnormalities of the clotting system although they must be anticoagulated if they require haemodialysis or haemoperfusion. The anticoagulant of choice is heparin.In this study we have investigated heparin kinetics in patients with fulminant hepatic failure (FHF) after a single intravenous dose of heparin (2,500 units) and found there was an increased clearance of heparin whether measured by its anti-Xa effect (t1/2 = 27.8 ± 2.9 min compared to t1/2 = 50.2 ± 2.7 min in normal controls p <0.001) or by the whole blood activated clotting time (t1/2 = 23.7 ± 2.2 min compared to t1/2 = 37.0 ± 2.0 min p <0.001). There was a decreased peak level of heparin measured by anti-Xa effect (peak level in FHF = 0.48 ± 0.05 u/ml and in controls = 0.69 ± 0.04 u/ml, p <0.02), but an increased sensitivity to heparin (sensitivity in FHF = 0.072 ± 0.011 sec/unit, in controls 0.033 ± 0.003 sec/unit, p <0.001). Patients with FHF had very low levels of antithrombin III (AT III), but there was no correlation between this and any parameters of heparin effect or clearance. In a group of patients with chronic liver disease heparin kinetics did not differ from controls despite low levels of AT III.The changes in heparin kinetics in FHF are likely to be complex with the balance between the proteins that act as cofactors, (e.g. AT III) and the proteins that have heparin neutralising activity, controlling the response of added heparin.
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Affiliation(s)
- H Sette
- The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
| | - R D Hughes
- The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
| | - P G Langley
- The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
| | - A E S Gimson
- The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
| | - R Williams
- The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
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Berg C, Goncales FL, Bernstein DE, Sette H, Rasenack J, Diago M, Jensen DM, Graham P, Cooksley G. Re-treatment of chronic hepatitis C patients after relapse: efficacy of peginterferon-alpha-2a (40 kDa) and ribavirin. J Viral Hepat 2006; 13:435-40. [PMID: 16792536 DOI: 10.1111/j.1365-2893.2006.00727.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 12/09/2022]
Abstract
We conducted a randomized multinational study to determine whether 48 weeks of re-treatment with peginterferon-alpha-2a (40 kDa) plus ribavirin would induce a sustained virological response (SVR) in relapsed chronic hepatitis C patients. Patients who had previously relapsed during 24 weeks of untreated follow-up, after having achieved an end-of-treatment virological response with 24 weeks of peginterferon-alpha-2a (40 kDa)/ribavirin combination therapy, within a phase III trial, were studied. Although the recommended dosage was the same as that used at the end of the initial trial, adjustments were permitted. Data on serious adverse events, or adverse events that resulted in dose reductions or discontinuations, were collected. Following re-treatment, the overall SVR rate in the 64 patients was 55%. The SVR rates in patients infected with hepatitis C virus (HCV) genotype 1 and non-1 genotypes were 51% and 63%, respectively. Early (week 12) virological responses were seen in 39 patients (61%) and were predictive of an SVR. Re-treatment was well tolerated. The most frequent adverse events recorded were fatigue (5%) and abdominal pain (3%). Dosages of peginterferon-alpha-2a (40 kDa) and/or ribavirin were modified because of adverse events in 3% and 13% of patients, and because of laboratory abnormalities in 23% and 5% of patients, respectively. Thus, a 48-week course of peginterferon-alpha-2a (40 kDa) plus ribavirin induces an SVR in 55% of patients who relapsed during follow-up after 24 weeks of combination therapy. Physicians should not hesitate to offer re-treatment to patients who relapse after an initial, 24-week course of combination therapy, or who have prematurely stopped treatment because, for example, of laboratory abnormalities.
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Affiliation(s)
- C Berg
- University of Virginia Health Science Center, Charlottesville, VA 22908, USA.
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Parise E, Cheinquer H, Crespo D, Meirelles A, Martinelli A, Sette H, Gallizi J, Silva R, Lacet C, Correa E, Cotrim H, Fonseca J, Paraná R, Spinelli V, Amorim W, Tatsch F, Pessoa M. Peginterferon alfa-2a (40KD) (PEGASYS) plus ribavirin (COPEGUS) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy. Braz J Infect Dis 2006; 10:11-6. [PMID: 16767309 DOI: 10.1590/s1413-86702006000100003] [Citation(s) in RCA: 20] [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] [Indexed: 01/16/2023] Open
Abstract
Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18% in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa-2a (40KD) 180mg/qw and ribavirin 800 mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of follow-up (SVR - Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72% were genotype 1 and 34% were cirrhotic. In an intention-to-treat analysis, relapser patients showed 78% EoT response and 51% SVR. Nonresponders showed 57% EoT response and 26% SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45% had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.
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Affiliation(s)
- E Parise
- Federal University of São Paulo, São Paulo, SP, Brazil.
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Cheinquer H, Sette H, Pessoa M, Paraná R, Parise E, Tatsch F. P.276 Influence of genotype, viral load and fibrosis on the sustained virologic response rate to pegylated interferon alpha-2a plus ribavirin, with or without amantadine, in chronic hepatitis C patients relapsers to alpha interferferon plus ribavirin. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80456-7] [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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Medeiros DM, Oliveira AC, Barros MFA, Cury RA, Sette H, Abdala E, Canedo LF, Makdissi FF, Andraus W, Martino RB, Rocha-Santos V, Figueira ERR, Machado MAC, Carrilho FJ, Cançado ELR, Bacchella T, Machado MCC. Early mortality in liver transplantation: bilirubin as predictor of outcome. Transplant Proc 2005; 36:931-2. [PMID: 15194321 DOI: 10.1016/j.transproceed.2004.03.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/26/2022]
Abstract
The shortage of donor organs and the long waiting lists have increased the need to better select liver transplant candidates using predictors of success. We reviewed the results of 29 liver transplantations performed from January 2002 to February 2003 analyzing the correlations with early mortality (30 days) of patient data, pretransplant laboratory data, warm ischemia time, intraoperations blood unit transfusions, and postoperative complications of prolonged mechanical ventilation, dialysis, and infection. Overall early mortality was 27.6% and 44% in fulminant hepatic failure (n = 9), there were four retransplants with one death, and two intraoperative deaths. Only pretransplant bilirubin (P =.045) and postoperative lactate levels (P =.002) were significantly different between alive versus dead patients. In this small population bilirubin was more related to death than the MELD score. Lactate levels, nonspecific predictor of death in shock syndromes were probably related to septic complications.
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Affiliation(s)
- D M Medeiros
- Liver Transplantation Unit, Hospital das Clínicas, Medical School, University of São Paulo, Sao Paulo, Brazil.
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Milanez de Campos JR, Filho LO, de Campos Werebe E, Sette H, Fernandez A, Filomeno LT, Jatene FB. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax. Chest 2000; 118:13-7. [PMID: 10893352 DOI: 10.1378/chest.118.1.13] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [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: 12/18/2022] Open
Abstract
STUDY OBJECTIVE To determine indications, limitations, morbidity and mortality of surgical thoracoscopy for management of hepatic hydrothorax, a rare, but often recurrent, complication in cirrhotic patients. PATIENTS AND METHODS From May 1985 through May 1999, 10 men and 8 women, with a mean age of 57.6 years (range, 26 to 76 years), underwent 21 therapeutic thoracoscopies to achieve pleurodesis by application of talc. RESULTS The procedure was effective in 10 of 21 procedures. There were four recurrences (19. 1%) that were retreated, with only one being successful. In this specific group, we detected high morbidity (57.1%) and mortality (38.9%) during the follow-up period of 3 months. Diaphragmatic defects were localized and closed five times (23.8%). Hospital stay was approximately 15 days (range, 5 to 41 days). CONCLUSION The procedure appears to be indicated for these fragile patients, especially when medical therapy fails. Immediate efficacy was 47.6%, increasing to 60% with videothoracoscopy and suture of the diaphragmatic defect. However, morbidity and mortality were high.
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Affiliation(s)
- J R Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein and Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil.
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Sakai P, Boaventura S, Ishioka S, Mies S, Sette H, Pinotti HW. Sclerotherapy of bleeding esophageal varices in schistosomiasis. Comparative study in patients with and without previous surgery for portal hypertension. Endoscopy 1990; 22:5-7. [PMID: 2106436 DOI: 10.1055/s-2007-1012777] [Citation(s) in RCA: 28] [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: 12/30/2022]
Abstract
Ninety-seven patients with bleeding esophageal varices due to mansonic schistosomiasis were treated with endoscopic sclerotherapy. Seventy-five patients (Group I) had previously undergone surgery for portal hypertension and presented with bleeding recurrence. Twenty-two patients (Group II) had not undergone surgical treatment. The sclerotherapy technique employed was intravascular (IV) injections of ethanolamine in 40 patients and paravascular (PV) in 57 patients. Of a total of 38 (39%) patients who had bleeding recurrence, 27 (36%) were from Group I and 11 (50%) from Group II (p less than 0.005). Over a follow-up period of 48 to 132 months, 367 sessions of sclerotherapy were carried out in the 72 remaining patients from Group I (4.93 +/- 2.05). The remaining 16 patients from Group II needed 121 (7.56 +/- 2.70) sessions of sclerotherapy (p less than 0.001). Thus, sclerotherapy was effective in the control of rebleeding in 73 (97.3%) patients from Group I and 16 (72.7%) from Group II (p less than 0.05). We conclude that previous surgical treatment for portal hypertension in patients with mansonic schistosomiasis, greatly benefits treatment of rebleeding esophageal varices by endoscopic sclerotherapy. This is probably due to the lower portal pressure after splenectomy.
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Affiliation(s)
- P Sakai
- Department of Gastrointestinal Endoscopy and Digestive Surgery, Hospital das Clínicas de Faculdade de Medicina da Universidade de São Paulo, Brazil
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Sette H, Hughes RD, Langley PG, Gimson AE, Williams R. Heparin response and clearance in acute and chronic liver disease. Thromb Haemost 1985; 54:591-4. [PMID: 4089794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with liver disease are at risk of bleeding due to abnormalities of the clotting system although they must be anticoagulated if they require haemodialysis or haemoperfusion. The anticoagulant of choice is heparin. In this study we have investigated heparin kinetics in patients with fulminant hepatic failure (FHF) after a single intravenous dose of heparin (2,500 units) and found there was an increased clearance of heparin whether measured by its anti-Xa effect (t 1/2 = 27.8 +/- 2.9 min compared to t 1/2 = 50.2 +/- 2.7 min in normal controls p less than 0.001) or by the whole blood activated clotting time (t 1/2 = 23.7 +/- 2.2 min compared to t 1/2 = 37.0 +/- 2.0 min p less than 0.001). There was a decreased peak level of heparin measured by anti-Xa effect (peak level in FHF = 0.48 +/- 0.05 u/ml and in controls = 0.69 +/- 0.04 u/ml, p less than 0.02), but an increased sensitivity to heparin (sensitivity in FHF = 0.072 +/- 0.011 sec/unit, in controls 0.033 +/- 0.003 sec/unit, p less than 0.001). Patients with FHF had very low levels of antithrombin III (AT III), but there was no correlation between this and any parameters of heparin effect or clearance. In a group of patients with chronic liver disease heparin kinetics did not differ from controls despite low levels of AT III. The changes in heparin kinetics in FHF are likely to be complex with the balance between the proteins that act as cofactors, (e.g. AT III) and the proteins that have heparin neutralising activity, controlling the response of added heparin.
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Levy S, Santos LM, Kopersztych S, Musatti CC, da Silva LC, Sette H, Mendes NF. [Cellular immunity in Schistosomiasis mansoni]. Rev Inst Med Trop Sao Paulo 1978; 20:323-8. [PMID: 751169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Silva LC, Sette H, Antonácio F, Lopes JD. Commercial gammaglobulin (CGG) as a possible vehicle of transmission of HBsAg in familial clustering. Rev Inst Med Trop Sao Paulo 1977; 19:352-4. [PMID: 76328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Monsalve MV, Frota-Pessoa O, Campos AM, Sette H. A study of chromosomes of schistosomiasis patients under oxaminiquine (UK 4271) treatment. J Toxicol Environ Health 1976; 1:1023-6. [PMID: 966313 DOI: 10.1080/15287397609529405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Blood samples from 24 patients infested with Schistosoma mansoni were drawn immediately before and 2 days after the administration of a single therapeutic dose of 12-15 mg/kg oral oxaminiquine. Two-day lymphocyte cultures were obtained and about 100 mitoses from each blood sample were analyzed for chromosome aberrations. No significant differences were observed between the "before" and "after" cultures in the frequencies of aberrations resulting from spindle, chromatidic, or chromosome events. It is concluded that there is no reason to fear harmful effects on the chromosomes of patients from treatment with oxaminiquine.
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da Silva LC, Hoshino-Shimizu S, Kanamura H, Strassmann PG, Camargo ME, Sette H, Lopes JD, Chamone DA, Raia S, da Silva GR. Serum antibody changes after repeated chemotherapic series in "parasitologically cured" patients with schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 1976; 18:206-10. [PMID: 951564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Campos R, Moreira AA, Sette H, Chamone DA, Da Silva LC. Hycanthone resistance in a human strain of Schistosoma mansoni. Trans R Soc Trop Med Hyg 1976; 70:261-2. [PMID: 982527 DOI: 10.1016/0035-9203(76)90061-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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da Silva LC, Hoshino-Shimizu S, Kanamura H, Strassmann PG, Camargo ME, Sette H, Lopes JD, Chamone DA, Raia S, da Silva GR. Serum antibody changes after chemotherapy of patients with schistosomiasis mansoni. A statistical analysis. Rev Inst Med Trop Sao Paulo 1975; 17:344-9. [PMID: 769138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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da Silva LC, Sette H, Chamone DA, Sáez-Alquezar A, Punskas JA, Raia S. Further clinical trials with oxamniquine (UK 4271), a new anti-schistosomal agent. Rev Inst Med Trop Sao Paulo 1975; 17:307-11. [PMID: 1198006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Caetano da Silva L, Sette H, Fischer Chamone DA, Saez-Alquezar A. Letter: Clinical trials with oxamniquine in the treatment of human mansonian schistosomiasis. Trans R Soc Trop Med Hyg 1975; 69:288-9. [PMID: 1166499 DOI: 10.1016/0035-9203(75)90174-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Candeias JA, Antonácio F, Sette H, da Silva LC. Occurrence of hepatitis-associated-antigen (HAA) subdeterminants ad and ay in blood donors, acute and chronic liver disease. Rev Inst Med Trop Sao Paulo 1974; 16:226-31. [PMID: 4549270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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da Silva LC, Sette H, Chamone DA, Alquezar AS, Punskas JA, Raia S. Clinical trials with oral oxamniquine (UK 4271) for the treatment of mansonian schistosomiasis. Rev Inst Med Trop Sao Paulo 1974; 16:103-9. [PMID: 4845456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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