scholarly journals Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension

2021 ◽  
Vol 84 (1) ◽  
pp. 95-99
Author(s):  
S Raevens ◽  
A Geerts ◽  
L Devisscher ◽  
H Van Vlierberghe ◽  
C Van Steenkiste ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Negative Impact ◽  
Vascular Complications ◽  
Hepatopulmonary Syndrome ◽  
Medical Intervention ◽  
Pulmonary Vascular Disease ◽  
Portopulmonary Hypertension ◽  
Pulmonary Vasodilation ◽  
Recent Advances ◽  
Impact On Survival

Liver disease, cirrhosis and portal hypertension can be complicated by pulmonary vascular disease, which may affect prognosis and influence liver transplantation (LT) candidacy. Pulmonary vascular complications comprise hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH). Although these two conditions develop on a same background and share a common trigger, pulmonary responses are distinct and occur at different anatomical sites of the pulmonary circulation. HPS affects 10-30% of patients referred for LT, and is characterized by gas exchange abnormalities due to pulmonary vasodilation and right-to-left shunting. POPH occurs in 5%, and is defined by pulmonary arterial hypertension due to increased pulmonary vascular resistance, which leads to hemodynamic failure. Even though HPS and POPH may have a substantial negative impact on survival, both entities are clinically underrecognized and frequently misdiagnosed. Without intervention, the 5-year survival rate is 23% in HPS and 14% in POPH. Their presence should be actively sought by organized screening in patients presenting with dyspnea and in all patients on the waitlist for LT, also because clinical symptoms are commonly non-specific or even absent. LT may lead to resolution, however, advanced stages of either HPS or POPH may jeopardize safe and successful LT. This implicates the need of proper identification of HPS and POPH cases, as well as the need to be able to successfully ‘bridge’ patients to LT by medical intervention. A review article on this topic has been published in this journal in 2007 (1). This updated review focuses on recent advances in the diagnosis and management of these 2 liver-induced pulmonary vascular disorders and incorporates results from our recent work.

scholarly journals Transition from Hepatopulmonary Syndrome to Portopulmonary Hypertension: A Case Series of 3 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Radhika Zopey ◽  
Irawan Susanto ◽  
Igor Barjaktarevic ◽  
Tisha Wang
Keyword(s):  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Treatment Plan ◽  
Case Series ◽  
Vascular Complications ◽  
Subsequent Development ◽  
Hepatopulmonary Syndrome ◽  
Portopulmonary Hypertension ◽  
Pulmonary Arterial ◽  
Differential Binding

Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) are the two major pulmonary vascular complications of liver disease. While HPS is characterized by low pulmonary vascular resistance, PPHTN is defined by the presence of elevated pulmonary vascular resistance. Given these seemingly opposing pathophysiologic mechanisms, these conditions were traditionally felt to be mutually exclusive. In this series, we present three patients with severe hepatopulmonary syndrome who had spontaneous resolution of their HPS with the subsequent development of PPHTN. To our knowledge, this is the largest case series presented of this phenomenon in nontransplanted patients. One proposed mechanism for the occurrence of this phenomenon involves dysregulation of the same vascular signaling pathway, which may lead to both pulmonary vascular dilatations and pulmonary arterial remodeling in the same patient. Another theory involves the possible differential binding of endothelin-1, a vasoactive signaling peptide that induces vasoconstriction when bound to receptor A and vasodilation when bound to receptor B. Although the mechanisms for this phenomenon remain unclear, it is important to be vigilant of this phenomenon as it may change the patient's overall treatment plan, especially in regard to appropriateness and timing of liver transplant.

The Keloid Intervention Benefit Inventory 21: A New Assessment Tool for the Quality of Life of Patients with Auricular Keloids

2021 ◽  
Author(s):  
Daniel Häussler ◽  
Stefanie Hüttemann ◽  
Christel Weiß ◽  
Nicole Karoline Rotter ◽  
Haneen Sadick
Keyword(s):  
Quality Of Life ◽  
Internal Consistency ◽  
Social Impact ◽  
Assessment Tool ◽  
Clinical Symptoms ◽  
Physical Symptoms ◽  
Medical Intervention ◽  
Medical Interventions ◽  
Before And After

Abstract Purpose The assessment of the quality of life (QoL) of patients with chronic diseases before and after medical interventions has gained increasing importance in recent decades. Particularly for patients with visible keloid scars in the head and neck region, standardized measurement tools are either absent or have been shown to be insufficient. The aim of the present study was to create a new standardized questionnaire that is specific to auricular keloid patients and reflects their clinical symptoms and QoL. Methods The Keloid Intervention Benefit Inventory 21 (KIBI-21) questionnaire was developed in two stages. First, a group of experts identified a pool of 26 questions and modified and supplemented the items through a comparison with existing QoL assessments so that they related to keloid-specific clinical symptoms and the QoL of patients with auricular keloids before and after a medical intervention. This questionnaire was distributed to 27 outpatients who had undergone medical interventions for visible auricular keloids. Second, a sequential statistical analysis was conducted. This included a single-item assessment and reduction, analysis for internal consistency, construct validity, and divergence validity as well as a factor analysis. The analyses were performed for the entire questionnaire and for the items in the subcategories General Health, Physical Symptoms, Self-Esteem, and Social Impact. Results The final version of this newly validated and standardized KIBI questionnaire consisted of 21 items, of which each item was assigned to only one subscale. The questionnaire showed a Cronbach's α of 0.84 with a good internal consistency. In the item correlation validity, strong associations were found in all subscales, except for the Social Impact Subscale. Conclusion The keloid-specific QoL questionnaire KIBI-21 proved to be a reliable and reproducible instrument to assess the QoL and clinical symptoms in patients suffering from auricular keloids before and after a medical treatment.

scholarly journals DIAGNOSIS OF ORAL MUCOSAL PATHOLOGY IN PATIENTS WITH VARIOUS MANIFESTATIONS OF GROUP B VITAMIN IMBALANCE

2021 ◽  
Vol 16 (4) ◽  
pp. 77-83
Author(s):  
Anna Yatsenko ◽  
Lidiya Trankovskaya ◽  
Olga Artyulova
Keyword(s):  
Oral Cavity ◽  
Oral Mucosa ◽  
Human Body ◽  
Clinical Symptoms ◽  
Negative Impact ◽  
Vitamin B12 Deficiency ◽  
Vitamin Deficiency ◽  
The Body ◽  
B Vitamins ◽  
Group B

Subject. The scientific works of recent years show an increase in the degree of negative impact of vitamin deficiency and vitamin-like substances on the state of health of the population. With the deficiency of most vitamins, synthetic processes and regeneration of oral tissues are reduced, so often the initial signs of hypovitaminosis are stomatitis, gingivitis, glossitis, and therefore, it is dentists who are the first to diagnose deviations in the body associated with vitamin deficiency. This justifies the relevance and practical value of studying and describing clinical cases of manifestations of deficient vitamin conditions in the oral cavity. The object – is to study the effect of B vitamins on the oral mucosa in order to increase the effectiveness of diagnosis of vitamin-deficient conditions of the human body. Methodology. These clinical examples illustrate the management experience of patients with manifestations of deficient vitamin conditions on the oral mucosa. Clinical and laboratory methods of diagnosing the analysed conditions of the organism were applied. Statistical processing of materials was carried out using the STATISTICA 10 software (StatSoft, Inc., USA). Results. The deficient condition of the organism in relation to vitamins B2, B6, B12 in patients 18-75 years old has been studied. Characteristic clinical changes on the oral mucosa of the examined patients were established. So, in most patients with vitamin B2 deficiency, the classic Sebrel triad was found: dermatitis, glossitis, cheilitis. In those examined with a lack of vitamin B6, language desquamations (smoothed, polished language) were determined in the 83.6%, often combined with glossodinia. Patients with vitamin B12 deficiency were characterized by a lesion in the form of Meller-Gunter glossitis in 74.9% of cases, moreover, 67.6% of patients showed paresthesia in the area of tongue and oral mucosa. Conclusions. The study found that the first clinical symptoms of deficient conditions of the presented vitamins of group B were found from the oral cavity. Thus, it is the dentist who is the first to diagnose the pathological states of lack of group B vitamins in the human body, which emphasizes the importance and relevance of continuing to study these states of the body.

scholarly journals Pregnancy-related lumbopelvic pain: classification and diagnostics according to European guidelines and a review of literature

2017 ◽  
Vol 21 (3) ◽  
pp. 58-63
Author(s):  
Małgorzata Starzec ◽  
Aleksandra Truszczyńska-Baszak
Keyword(s):  
Lumbar Spine ◽  
Clinical Symptoms ◽  
Negative Impact ◽  
Mechanical Load ◽  
Pelvic Girdle ◽  
Pelvic Girdle Pain ◽  
Lumbar Pain ◽  
Foreign Literature ◽  
European Guidelines ◽  
Pain Syndromes

Lumbopelvic pain associated with pregnancy may originate from the lumbar spine, the pelvic girdle or may be mixed. According to European guidelines, individual subtypes of pain require different procedures, for which a detailed differential diagnosis is necessary. These ailments arouse a lot of controversy. The aim of the work was to present the current state of knowledge on the aforementioned ailments, including European guidelines and the latest trends in foreign literature. The diagnosis of lumbopelvic pain, with particular emphasis on the pathophysiology and methods of differentiation of both pain syndromes, was discussed. Lumbar spine pain is mainly related to the mechanical load caused by a pregnant uterus. In the case of pelvic girdle pain, the main cause is the disorder of optimal stability, which depends on the correct mechanisms of force and form closure. Pelvic girdle pain is characterized by other clinical symptoms and risk factors, it also often remains after pregnancy, having negative impact on the daily functioning of a woman even years after giving birth. Depending on the location (one or both sacroiliac joints, pubic symphysis), several types of this pain syndrome are distinguished. The worst prognosis is pelvic pain associated with the involvement of all three joints at the same time. Until now, this term has not been more widely used in the Polish-language literature. The complexity of chronic pain syndromes, in which the discomforts of the pregnancy period may develop, entails the necessity of early identifi cation and deliberate action. Knowledge of the etiopathogenesis of these ailments is a prerequisite for therapeutic success. Introduction of terminology popular in foreign literature will improve treatment of these diseases, adapting it to current standards and will also enable better exchange of experience between professionals. pelvic girdle pain, lumbar pain, pregnancy

scholarly journals Prevalence and impact of allergic rhinitis in school going children

2021 ◽  
Vol 7 (5) ◽  
pp. 760
Author(s):  
Sucheta Gupta ◽  
Vinod Gupta ◽  
Akhil Gupta
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Negative Impact ◽  
Community Health Center ◽  
Medical Intervention ◽  
House Dust Mites ◽  
Inflammatory Disorder ◽  
Chronic Inflammatory Disorder ◽  
Co Morbidity

<p><strong>Background:</strong> Allergic rhinitis (AR) is a chronic inflammatory disorder affecting the nasal mucosa. There is negative impact of AR on several aspects of day to day living and quality of life (QoL), which include: daily functioning, sleep, absenteeism, school productivity and academic performance. Almost 40% of children are being affected by AR.</p><p><strong>Method:</strong> An observational study was conducted on randomly selected 100 parents of school going children aging 2 to 15 years, attending OPD in community health center, Chenani, district Udhampur, J and K, for a period of one year from June 2018 to Nov 2018. Children having frequent episodes of allergic rhinitis were enquired about their history of sneezing, runner itchy nose and eyes, thick mucus, nasal blockage or breathless with associated symptoms were selected.</p><p><strong>Results:</strong> 81% of subjects had a worse problem during specific months of the year; and 67% had itchy-watery eyes. In 15% of subjects, AR impacted daily activities. A prevalence of 28% for nasal symptoms and 14% for allergic rhino-conjunctivitis was found. Study also showed significantly higher proportion of blockers (61%) than sneeze runners (39%). 56% children had one or more co morbidity, whereas 44% had ‘nil’ co-morbidities. The most common allergens were: pollens (grass, trees and weeds), house dust mites, pets, molds, fungi and food.</p><p><strong>Conclusions:</strong> AR adversely affects quality of life of patients and furthermore studies should be conducted for more clarity on the subject, besides a timely medical intervention and treatment could possibly avoid the rising morbidity associated with the disease.</p>

scholarly journals Traumatic Brain Injury as a Disorder of Brain Connectivity

2016 ◽  
Vol 22 (2) ◽  
pp. 120-137 ◽  
Author(s):  
Jasmeet P. Hayes ◽  
Erin D. Bigler ◽  
Mieke Verfaellie
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Functional Connectivity ◽  
Negative Impact ◽  
Axonal Injury ◽  
Resting State Functional Connectivity ◽  
Post Injury ◽  
Recent Advances

AbstractObjectives:Recent advances in neuroimaging methodologies sensitive to axonal injury have made it possible to assess in vivo the extent of traumatic brain injury (TBI) -related disruption in neural structures and their connections. The objective of this paper is to review studies examining connectivity in TBI with an emphasis on structural and functional MRI methods that have proven to be valuable in uncovering neural abnormalities associated with this condition.Methods:We review studies that have examined white matter integrity in TBI of varying etiology and levels of severity, and consider how findings at different times post-injury may inform underlying mechanisms of post-injury progression and recovery. Moreover, in light of recent advances in neuroimaging methods to study the functional connectivity among brain regions that form integrated networks, we review TBI studies that use resting-state functional connectivity MRI methodology to examine neural networks disrupted by putative axonal injury.Results:The findings suggest that TBI is associated with altered structural and functional connectivity, characterized by decreased integrity of white matter pathways and imbalance and inefficiency of functional networks. These structural and functional alterations are often associated with neurocognitive dysfunction and poor functional outcomes.Conclusions:TBI has a negative impact on distributed brain networks that lead to behavioral disturbance. (JINS, 2016,22, 120–137)

scholarly journals Pulmonary hypertension and severe right heart failure following lumbar spinal surgery

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984780
Author(s):  
Geeshath Jayasekera ◽  
Martin Johnson ◽  
Keith Hussey ◽  
Colin Church
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Spinal Surgery ◽  
Vascular Complications ◽  
Disease Process ◽  
Right Heart Failure ◽  
Pulmonary Vascular Disease ◽  
Right Heart ◽  
Arteriovenous Fistulae ◽  
Right Heart Catheterisation

Pulmonary hypertension is a disease process affecting the pulmonary circulation and is defined by an increase in pulmonary artery pressure subsequently causing right ventricular failure. Vascular complications, including arteriovenous fistulae, are recognised, but are uncommon complications of spinal surgery. Arteriovenous fistulae increase venous return to the right heart and can induce a high-output cardiac state, mimicking pulmonary arterial hypertension and right heart failure. We present a 47-year-old man with a 1 year history of worsening dyspnoea, exertional pre-syncope and leg swelling presenting with severe right heart failure. The previous year, he had complex spinal surgery, which included discectomy, laminectomy and bilateral nerve reconstruction at L5-S1 level. Initial non-invasive investigations including echocardiography and chest imaging raised the possibility of right heart failure presumed secondary to pulmonary vascular disease. Clinical examination and right heart catheterisation were in keeping with a high cardiac output state, and invasive saturation monitoring was suggestive of a sub-diaphragmatic shunt. Subsequent imaging confirmed the presence of an iatrogenic ilio-iliac arteriovenous fistula. The patient underwent urgent endovascular repair, which resulted in resolution of his symptoms and haemodynamics. We describe the case and present a review of the relevant literature.

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