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Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities

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World Journal of Gastrointestinal Pathophysiology 2022年第3期13卷 96-106页

作者： Kouichi Miura Hiroshi Maeda Naoki Morimoto Shunji Watanabe Mamiko Tsukui Yoshinari Takaoka Hiroaki Nomoto Rie Goka Kazuhiko Kotani Hironori Yamamoto Department of Medicine Division of GastroenterologyJichi Medical University School of Medicine3311-1 YakushijiShimotsuke 329-0498TochigiJapan Division of Community and Family Medicine Center for Community MedicineJichi Medical University3311-1 YakushijiShimotsuke 329-0498Japan

BACKGROUND Vibration-controlled transient elastography(VCTE)is proposed as a second step of examination to assess liver fibrosis in patients with nonalcoholic fatty liver disease(NAFLD)after triaging by the fibrosis-4(FIB-4)***,VCTEbased scoring systems,including FibroScan-AST(FAST),Agile 3+,and Agile 4,emerged to determine the status of ***,the significance of these scoring systems remains unknown in narrowing the high-risk group of NAFLD patients with comorbidities,including hepatocellular carcinoma(HCC)and esophagogastric varices(EGV).AIM To clarify the significance of VCTE-based scoring systems to narrow the high-risk group of NAFLD patients with *** We performed a cross-sectional study to investigate the usefulness of VCTE-based scoring systems and other fibrosis markers to narrow the high-risk group of patients with ***-4 index was used for the first *** groups of FAST,Agile 3+,and Agile 4 were stratified according to the published *** the 191 patients with NAFLD,there were 26(14%)and 25 patients(13%)with HCC and EGV,*** When 1.3 was used as a cutoff value,the FIB-4 index narrowed the risk group to 120 patients,in which all patients with HCC and/or EGV were *** risk group of Agile 3+could subsequently narrow the risk *** prevalence of HCC and EGV at this step were 33%(26/80)and 31%(25/80),*** further narrowing of EGV,Agile 4 aggregated the patients with EGV into 43 patients,of whom 23(53%)had *** failed to narrow the risk group of patients with *** 2.6 was used as a cutoff value of the FIB-4 index,three patients with HCC and two patients with EGV were missed at the first *** Agile 3+and Agile 4 are useful to narrow the NAFLD patient group,in which patients may have HCC and/or EGV.

关键词： Nonalcoholic fatty liver disease Vibration controlled transient elastography Non-invasive test Hepatocellular carcinoma varix

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Evaluation of a Possible Effect of In-House Cryoprecipitate Transfusion on Outcome of Severe Upper Gastrointestinal Bleeding: A Retrospective Cohort Study

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Open Journal of Blood Diseases 2019年第1期9卷 20-29页

作者： Hiroshi Fujita Shigeko Nishimura Kazuhiro Sugiyama Department of Transfusion Medicine Tokyo Metropolitan Bokutoh Hospital Tokyo Japan Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Tokyo Japan

Purposes: Hypofibrinogenemia is usually complicated with severe and massive upper gastrointestinal (GI) bleeding, especially in liver cirrhosis. In Japan, neither fibrinogen concentrate nor cryoprecipitate (CRYO) is available for cases of acquired hypofibrinogenemia to recover the hemostatic level of fibrinogen rapidly. We prepared and produced in-house CRYO from fresh frozen plasma, and compared mortality between pre-implementation and post-implementation of CRYO. Methods: We performed a retrospective cohort study of patients admitted to our single tertiary medical center with upper GI bleeding from January 2011 to December 2016. The observational control period was from January 2011 to February 2013. From March 2013 to December 2016, we implemented the transfusion of CRYO, which was prepared and produced in our hospital. Clinical outcomes were compared between the patients in the two periods. Patients: Eleven patients in the control period and 10 in the intervention period were eligible for analysis. Results: In-hospital mortality (55% vs. 20%, P = 0.238) and mortality within 24 hour after admission (27% vs. 0%, P = 0.246) tended to be lower in the intervention period than in the control period, although the patients had more severe coagulation on admission than those in the control period. The plasma fibrinogen level before the treatment of hemostasis in the intervention period was higher than that in the control period (80 ± 9 mg/dL vs. 127 ± 15 mg/dL, P Conclusion: Implementation of in-house CRYO transfusion may reduce the rate of mortality due to severe upper GI bleeding.

关键词： Esophageal varix Resuscitation Mortality Hypofibrinogenemia

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Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

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World Journal of Gastroenterology 2013年第34期19卷 5759-5762页

作者： Dae-Seong Myung Cho-Yun Chung Hyung-Chul Park Jong-Sun Kim Sung-Bum Cho Wan-Sik Lee Sung-Kyu Choi Young-Eun Joo Department of Internal Medicine Chonnam National University Medical School

Variceal bleeding is the most serious complication of portal hypertension,and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis ***,endoscopic treatment remains the predominant method for the prevention and treatment of variceal *** treatments include band ligation and injection *** sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal *** injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding,injection of N-butyl-2-cyanoacrylate is associated with a variety of complications,including systemic ***,we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.

关键词： Cerebrum Esophageal varix Infarction N-butyl-2-cyanoacrylate Spleen

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Endoscopic cyanoacrylate injection for the treatment of gastric varices in children

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World Journal of Gastroenterology 2015年第9期21卷 2719-2724页

作者： Seak Hee Oh Seung Jin Kim Kang Won Rhee Kyung Mo Kim Department of Pediatrics Asan Medical Center Children’s HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea

AIM:To evaluate the efficacy and safety of N-butyl-2-cyanoacrylate in treating acute bleeding of gastric varices in ***:The retrospective study included 21 children with 47 episodes of active gastric variceal bleeding who were treated by endoscopic injection of N-butyl-2-cyanoacrylate at Asan Medical Center Children's Hospital between August 2004 and December *** reduce the risk of embolism,each injection consisted of 0.1-0.5 mL of 0.5 mL N-butyl-2-cyanoacrylate diluted with 0.5 or 0.8 mL *** primary outcome was incidence of hemostasis after variceal obliteration and the secondary outcome was complication of the ***:The 21 patients experienced 47 episodes of active gastric variceal bleeding,including rebleeding,for which they received a total of 52 cyanoacrylate *** 42 bleeding episodes,hemostasis was achieved after one injection and following five bleeding episodes it was achieved after two *** mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL(range:0.1-0.5 m L).Injection achieved hemostasis in 45 of 47(95.7%) episodes of acute gastric variceal *** patients(52.4%) developed rebleeding events,with the mean duration of hemostasis being 11.1 ± 11.6 mo(range:1.0-39.2 mo).No treatment-related complications such as distal embolism were noted with the exception of abdominal pain in one patient(4.8%).Among four mortalities,one patient died of variceal ***:Endoscopic variceal obliteration using a small volume of aliquots with repeated cyanoacrylate injection was an effective and safe option for the treatment of gastric varices in children.

关键词： Cyanoacrylate Gastric varix Children Endoscopic va

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A hybrid trapping-evacuation technique for the clipping of pediatric basilar artery tip pial arteriovenous fistula

A hybrid trapping-evacuation technique for the clipping of p...

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第十三届中国医师协会神经外科医师年会

作者： Jingwei Li Zeng Gao Xinglong Zhi Jianxin Du Hongqi Zhang Feng Ling Department of Neurosurgery Xuanwu HospitalCapital Medical University

Intracranial pial arteriovenous fistulas（PAVFs）are rare cerebrovascular lesions but with high mortality *** authors report a rare case of pediatric basilar artery tip PAVF treated by surgical clipping with the aid of trapping-evacuation technique in a hybrid operation *** 18 months old boy presented with hypoevolutismus and weakness of left extremities for 4 *** magnetic resonance imaging revealed a giant aneurysm-like malformation around the midbrain and *** showed a high-flow PAVF fed by the basilar artery and bilateral P1 segments of posterior cerebral arteries,draining from deep draining veins to the transverse sinus and straight *** these intrinsic characteristics of the lesion,such as the deep location,giant fistula and varix,multiple feeding arteries,the authors successfully clipping his PAVF by hybrid operation aided by trapping-evacuation technique,which could clearly identify and block the shunting *** this report,the authors also discuss the existing literature and compare the relative merits among the endovascular embolization,surgical disconnection and hybrid technique for the treatment of PAVF.

关键词： pial arteriovenous fistula hybrid surgery trapping-evacuation technique varix pediatric

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Endovascular interventions for traumatic portal venous hemorrhage complicated by portal hypertension

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World Journal of Radiology 2013年第10期5卷 381-385页

作者： Dinesh Kumar Sundarakumar Crysela Mirta Smith Jorge Enrique Lopera Matthew Kogut Rajeev Suri Department of Radiology The University of Texas Health Science Center at San Antonio Department of Radiology University of Washington Medical Center

Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic ***,severe portal bleeding in this setting has been controlled by surgical techniques such as packing,ligation,and *** presence of portal hypertension could potentially increase the amount of hemorrhage in the setting of blunt portal vein trauma making it more difficult to *** case series describes the use of indirect carbon dioxide portography to identify portal ***,these cases illustrate attempted endovascular treatment utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other.

关键词： Trauma Portal vein Portal hypertension Transjugular Intrahepatic Portasystemic Shunt varix

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