Guevara M.,University of Barcelona |
Guevara M.,Institute dInvestigacions Biomdiques August Pi Sunyer IDIBAPS |
Guevara M.,CIBER ISCIII |
Baccaro M.E.,University of Barcelona |
And 24 more authors.
Journal of Hepatology | Year: 2011
Background & Aims: We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density in patients with cirrhosis. Methods: Forty eight patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects were matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, eight of them had minimal hepatic encephalopathy at inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy, and 21 patients had none of these features. Results: Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11 months (7-50 months) after liver transplant. At the time of liver transplantation, three patients belonged to class A of the Child-Pugh classification, five to class B and four to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter. Conclusions: These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation. The significance, physiopathology, and clinical relevance of this abnormality cannot be ascertained from the current study. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Martnllah M.,University of Barcelona |
Martnllah M.,Institute dInvestigacions Biomdiques August Pi Sunyer IDIBAPS |
Martnllah M.,CIBER ISCIII |
Guevara M.,University of Barcelona |
And 38 more authors.
Gastroenterology | Year: 2011
Background & Aims The prognostic value of the different causes of renal failure in cirrhosis is not well established. This study investigated the predictive value of the cause of renal failure in cirrhosis. Methods Five hundred sixty-two consecutive patients with cirrhosis and renal failure (as defined by serum creatinine > 1.5 mg/dL on 2 successive determinations within 48 hours) hospitalized over a 6-year period in a single institution were included in a prospective study. The cause of renal failure was classified into 4 groups: renal failure associated with bacterial infections, renal failure associated with volume depletion, hepatorenal syndrome (HRS), and parenchymal nephropathy. The primary end point was survival at 3 months. Results Four hundred sixty-three patients (82.4%) had renal failure that could be classified in 1 of 4 groups. The most frequent was renal failure associated with infections (213 cases; 46%), followed by hypovolemia-associated renal failure (149; 32%), HRS (60; 13%), and parenchymal nephropathy (41; 9%). The remaining patients had a combination of causes or miscellaneous conditions. Prognosis was markedly different according to cause of renal failure, 3-month probability of survival being 73% for parenchymal nephropathy, 46% for hypovolemia-associated renal failure, 31% for renal failure associated with infections, and 15% for HRS (P < .0005). In a multivariate analysis adjusted for potentially confounding variables, cause of renal failure was independently associated with prognosis, together with MELD score, serum sodium, and hepatic encephalopathy at time of diagnosis of renal failure. Conclusions A simple classification of patients with cirrhosis according to cause of renal failure is useful in assessment of prognosis and may help in decision making in liver transplantation. © 2011 AGA Institute.
Vidal-Sicart S.,University of Barcelona |
Vidal-Sicart S.,Institute dInvestigacions Biomdiques August Pi Sunyer IDIBAPS |
Rubello D.,Santa Maria della Misericordia Hospital |
Pons F.,University of Barcelona |
Pons F.,Institute dInvestigacions Biomdiques August Pi Sunyer IDIBAPS
PET Clinics | Year: 2011
When cutaneous melanoma recurrence is suspected, several imaging techniques can be used to confirm or rule out this possibility as well as performing an adequate follow-up of the disease. [18F]Fluorodeoxyglucose (FDG)-PET may play an important role in this setting. Ultrasonography and FDG-PET can be useful in the assessment of regional node involvement but sentinel node biopsy is the gold standard. PET/computed tomography is most useful for identifying all metastatic sites before embarking on a metastasectomy of an apparently isolated lesion or for clarifying the nature of a suspicious lesion identified by CT scan. © 2011 Elsevier Inc. All rights reserved.