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Surveillance for hepatocellular carcinoma at the community level: Easier said than done

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World Journal of Gastroenterology 2021年第37期27卷 6180-6190页

作者： paolo del poggio Marzio Mazzoleni Sergio Lazzaroni Andrea D'Alessio Unitàdi Epatologia Policlinico San Marco Zingonia GSD University and Research Hospital UnitàEpatologiaOsio Sotto 24040BergamoItaly Primary Care Physician ASST BergamoOsio Sotto 24040BergamoItaly Department of Medicine Policlinico San Marco ZingoniaGSD University and Research HospitalOsio Sotto 24040BergamoItaly

Surveillance for hepatocellular carcinoma(HCC)in high-risk patients with semiannual ultrasound examinations is advocated by all international ***,as long as the identification of the population to be screened and the surveillance programs are not well implemented,the real-life impact of HCC surveillance in reducing mortality for HCC cannot be *** propose a new approach that promotes the identification of cirrhotic patients by primary care physicians(PCPs)and referral of patients to the hepatologist for *** should be incorporated,when feasible,in a hub and spoke model of comprehensive hepatology *** PCPs to identify cirrhotic patients and performing surveillance in a subspecialist setting are equally important to improve the effectiveness of real-life surveillance and to decrease HCC mortality over time.

关键词： Hepatocellular carcinoma Cirrhosis Ultrasound surveillance Primary health care

Screening in liver disease

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World Journal of Gastroenterology 2006年第33期12卷 5272-5280页

作者： paolo del poggio Marzio Mazzoleni Hepatology Unit Treviglio Hospital Treviglio (Bergamo) Italy General Practitioner Italian Society of Family Physicians (SIMG) Italy

A disease is suitable for screening if it is common, if the target population can be identifi ed and reached and if both a good screening test and an effective therapy are available. Of the most common liver diseases only viral hepatitis and genetic hemochromatosis partially satisfy these conditions. Hepatitis C is common, the screening test is good and the therapy eliminates the virus in half of the cases, but problems arise in the definition of the target population. In fact generalized population screening is not endorsed by international guidelines, although some recommend screening immigrants from high prevalence countries. Opportunistic screening (case finding) of individuals with classic risk factors, such as transfusion before 1992 and drug addiction, is the most frequently used strategy, but there is disagreement whether prison inmates, individuals with a history of promiscuous or traumatic sex and health care workers should be screened. In a real practice setting the performance of opportunistic screening by general practitioners is low but can be ameliorated by training programs. Screening targeted to segments of the population or mass campaigns are expensive and therefore interventions should be aimed to improve opportunistic screening and the detection skills of general practitioners. Regarding genetic hemochromatosis there is insufficient evidence for population screening, but individual physicians can decide to screen racial groups with a high prevalence of the disease, such as people in early middle age and of northern European origin. In the other cases opportunistic screening of high risk individu-als should be performed, with a high level of suspicion in case of unexplained liver disease, diabetes, juvenile artropathy, sexual dysfunction and skin pigmentation.

关键词：肝疾病筛选方法病毒性肝炎遗传因素

Cystic tumors of the liver:A practical approach

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World Journal of Gastroenterology 2008年第23期14卷 3616-3620页

作者： paolo del poggio Marco Buonocore Hepatology Unit Treviglio HospitalTreviglio(Bg) 24047Italy

Biliary cyst tumors(cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver,but differential diagnosis with multiloculated or complicated biliary cysts,atypical hemangiomas,hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography(CT) and magnetic resonance imaging(MRI) are often not diagnostic and in these cases fine needle aspiration(FNA) is used to confirm the presence of atypical biliary cells. FNA,however,lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma,it is important to exclude liver metastasis,of which colonic cancer is the most common primary site. Multiple biliary hamartomas(von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic,but occasionally a percutaneous biopsy may be required.

关键词：胆管肿瘤肝囊肿形成囊腺瘤囊腺癌非典型肝囊肿

Low-dose tenofovir is more potent than adefovir and is effective in controlling HBV viremia in chronic HBeAg-negative hepatitis B

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World Journal of Gastroenterology 2007年第30期13卷 4096-4099页

作者： paolo del poggio Maurizio Zaccanelli Maria Oggionni Silvia Colombo Carlo Jamoletti Vesna Puhalo Hepatology Unit Treviglio Hospital (Bg) Italy Blood Bank (Molecular Biology Section) Treviglio Hospital (Bg) Italy

AIM: To study the efficacy of tenofovir disoproxil fumarate (TDF) at low dose in a small open trial of chronic hepatitis B patients with advanced stage disease. METHODS: Eleven patients were treated with TDF 75 mg for a median period of 80 (range, 24-576) wk and then 7 cases were shifted to an adefovir 10 mg treatment group. All patients had been pre-treated with lamivudine: 5 had YMDD resistant mutants and 6 wild- type virus. When TDF was started, 4 patients had low- level viremia and 6 were PCR-negative. RESULTS: During TDF treatment, PCR remained negative in 10 patients, transaminase levels were normal and no significant viral breakthrough was observed. The drug was well tolerated in all cases. When TDF 75 mg was substituted with adefovir 10 mg, 3 out of 7 patients had a persistent viral rebound (2700-130 000 copies/mL), in whom lamivudine had to be reintroduced. CONCLUSION: Low-dose TDF monotherapy can control HBV viremia for an extended period of time without the emergence of resistance and is more potent than adefovir at the standard dosage. The use of a reduced dose of TDF could diminish the cost of therapy in low-income countries, but further studies in a larger population and in HBeAg-positive subjects are needed.

关键词：特洛福韦乙型肝炎核苷酸治疗效果