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Nicoară-Farcău O, Han G, Rudler M, Angrisani D, Monescillo A, Torres F, Casanovas G, Bosch J, Lv Y, Thabut D, Fan D, Hernández-Gea V, García-Pagán JC, Abraldes JG, Nevens F, Caca K, Laleman W, Appenrodt B, Luca A, Vinel JP, Mössner J, Di Pascoli M, Zipprich A, Sauerbruch T, Martinez-Lagares F, Ruiz-del-Arbol L, Sierra A, Guevara C, Jimenez E, Marrero JM, Buceta E, Sanchez J, Castellot A, Penate M, Cruz A, Pena E, Procopeț B, Giráldez Á, Amitrano L, Villanueva C, Ibañez-Samaniego L, Silva-Junior G, Martinez J, Genescà J, Trebicka J, Llop E, Palazon JM, Castellote J, Rodrigues S, Gluud LL, Ferreira CN, Barcelo R, Cañete N, Rodríguez M, Ferlitsch A, Mundi JL, Gronbaek H, Hernández-Guerra M, Sassatelli R, Dell’Era A, Senzolo M, Romero-Gómez M, Casas M, Masnou H, Primignani M, Krag A, Calleja JL, Jansen C, Robic MA, Conejo I, Catalina MV, Albillos A, Alvarado E, Guardascione MA, Tanțău M, Zuo L, Zhu X, Zhao J, Xue H, Jiang Z, Zhuge Y, Zhang C, Sun J, Ding P, Ren W, Li Y, Zhang K, Zhang W, He C, Zhong J, Peng Q, Ma F, Luo J, Zhang M, Wang G, Sun M, Dong J, Bai W, Guo W, Wang Q, Yuan X, Wang Z, Yu T, Luo B, Li X, Yuan J, Han N, Zhu Y, Niu J, Li K, Yin Z, Nie Y, Fischer P, Horia Ștefănescu, Pop A, Laursen SB, Turon F, Baiges A, Ferrusquía-Acosta J, Magaz M, Cerda E, Tellez L, Allegretti G, Macedo G, Haldrup D, Santos P, Moura M, Reis D, Meireles L, Sousa P, Alexandrino P, Navascues C, Augustin S, La Mura V, Bañares R, Diaz R, Gómez ML, Ripoll C. Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data. Gastroenterology 2021; 160:193-205.e10. [PMID: 32980344 DOI: 10.1053/j.gastro.2020.09.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Compared with drugs plus endoscopy, placement of transjugular portosystemic shunt within 72 hours of admission to the hospital (early or preventive transjugular intrahepatic portosystemic shunt [TIPS], also called preemptive TIPS) increases the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survive for 1 year. However, the benefit of preemptive TIPS is less clear for patients with a Child-Pugh score of B and active bleeding (CP-B+AB). We performed an individual data meta-analysis to assess the efficacy of preemptive TIPS in these patients and identify factors associated with reduced survival of patients receiving preemptive TIPS. METHODS We searched publication databases for randomized controlled trials and observational studies comparing the effects of preemptive TIPS versus endoscopy plus nonselective beta-blockers in the specific population of high-risk patients with cirrhosis and acute variceal bleeding (CP-B+AB or Child-Pugh C, below 14 points), through December 31, 2019. We performed a meta-analysis of data from 7 studies (3 randomized controlled trials and 4 observational studies), comprising 1327 patients (310 received preemptive TIPS and 1017 received drugs plus endoscopy). We built adjusted models to evaluate risk using propensity score for baseline covariates. Multivariate Cox regression models were used to assess the factors associated with survival time. The primary endpoint was effects of preemptive TIPS versus drugs plus endoscopy on 1-year survival in the overall population as well as CP-B+AB and Child-Pugh C patients. RESULTS Overall, preemptive TIPS significantly increased the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survived for 1 year, compared with drugs plus endoscopy (hazard ratio [HR] 0.443; 95% CI 0.323-0.607; P < .001). This effect was observed in CP-B+AB patients (HR 0.524; 95% CI 0.307-0.896; P = .018) and in patients with Child-Pugh C scores below 14 points (HR 0.374; 95% CI 0.253-0.553; P < .001). Preemptive TIPS significantly improved control of bleeding and ascites without increasing risk of hepatic encephalopathy in Child-Pugh C and CP-B+AB patients, compared with drugs plus endoscopy. Cox analysis of patients who received preemptive TIPS showed that patients could be classified into 3 categories for risk of death, based on age, serum level of creatinine, and Child-Pugh score. In each of these risk categories, preemptive TIPS increased the proportion of patients who survived for 1 year, compared with drugs plus endoscopy. CONCLUSIONS In a meta-analysis of data from 1327 patients with cirrhosis, acute variceal bleeding, and Child-Pugh score between 10 and 13 points or CP-B+AB, preemptive TIPS increased the proportion who survived for 1 year, in both subgroups separately, compared with drugs plus endoscopy.
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Affiliation(s)
- Oana Nicoară-Farcău
- Regional Institute of Gastroenterology and Hepatology "Octavian Fodor", Hepatology Department and "Iuliu Hatieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Marika Rudler
- Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| | - Debora Angrisani
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
| | - Alberto Monescillo
- Digestive Disease Department, Hospital Universitario Insular de Gran Canaria, Canary Islands
| | - Ferran Torres
- Medical Statistics Core Facility, Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Casanovas
- Medical Statistics Core Facility, Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
| | - Jaime Bosch
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University, Bern, Switzerland
| | - Yong Lv
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Dominique Thabut
- Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Juan Carlos García-Pagán
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
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Noronha Ferreira C, Reis D, Cortez-Pinto H, Tato Marinho R, Gonçalves A, Palma S, Leite I, Rodrigues T, Pedro AJ, Alexandrino P, Serejo F, Sobral Dias M, Ferreira P, Vasconcelos M, Damião F, Xavier Brito L, Baldaia C, Fatela N, Ramalho F, Velosa J. Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis. Dig Dis Sci 2019; 64:2671-2683. [PMID: 30852769 DOI: 10.1007/s10620-019-05572-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. AIMS We analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival. METHODS Eighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis. RESULTS Average MELD score was 15 ± 7. Portal hypertension-related complications at PVT diagnosis were present in 65 (81.3%) patients. Isolated portal vein trunk/branch thrombosis was present in 53 (66.3%) patients. AT was started in 37 patients. AT was stopped in 17 (45.9%) patients, in 4 (10.8%) due to bleeding events. No variceal bleeding occurred while on AT. Anticoagulation was restarted in 6/17 (35.2%) patients due to rethrombosis. In 67 patients with adequate follow-up imaging, AT significantly increased the rate of PVT recanalization compared with those who did not receive anticoagulation [51.4% (18/35) vs 6/32 (18.8%), p = 0.005]. OLT-free survival after a median follow-up of 25 (1-146) months was 32 (40%). Although there was no significant effect of AT on overall OLT-free survival, OLT-free survival was higher among patients with MELD ≥ 15 receiving AT compared to those who did not (p = 0.011). Baseline MELD at PVT detection independently predicted PVT recanalization (HR 1.11, 95% CI 1.01-1.21, p = 0.027) and mortality/OLT (HR 1.12, 95% CI 1.05-1.19, p < 0.001). CONCLUSIONS Although AT did not improve overall OLT-free survival, it was associated with higher survival in advanced cirrhosis. Anticoagulation increased PVT recanalization and should be maintained after PVT recanalization to avoid rethrombosis.
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Affiliation(s)
- Carlos Noronha Ferreira
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Daniela Reis
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Helena Cortez-Pinto
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Rui Tato Marinho
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Afonso Gonçalves
- Serviço De Imagiologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Sónia Palma
- Serviço De Imagiologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Inês Leite
- Serviço De Imagiologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago Rodrigues
- Serviço De Imagiologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Júlia Pedro
- Serviço De Medicina II, Hospital De Santa Maria - Centro Hospitalar Lisboa, Lisbon, Portugal
| | - Paula Alexandrino
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Fátima Serejo
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Margarida Sobral Dias
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Paula Ferreira
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Mariana Vasconcelos
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Filipe Damião
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Leonor Xavier Brito
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Cilenia Baldaia
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Narcisa Fatela
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - Fernando Ramalho
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
| | - José Velosa
- Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal
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Noronha Ferreira C, Marinho RT, Cortez-Pinto H, Ferreira P, Dias MS, Vasconcelos M, Alexandrino P, Serejo F, Pedro AJ, Gonçalves A, Palma S, Leite I, Reis D, Damião F, Valente A, Xavier Brito L, Baldaia C, Fatela N, Ramalho F, Velosa J. Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: A prospective study. Liver Int 2019; 39:1459-1467. [PMID: 31021512 DOI: 10.1111/liv.14121] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. There are few prospective studies validating risk factors for development of PVT. We analysed the incidence, factors associated with PVT development and its influence on cirrhosis decompensations and orthotopic liver transplant (OLT)-free survival. METHODS In this prospective observational study between January 2014 and March 2019, 445 consecutive patients with chronic liver disease were screened and finally 241 with cirrhosis included. Factors associated with PVT development and its influence on cirrhosis decompensations and OLT-free survival by time dependent covariate coding were analysed. RESULTS Majority of patients belonged to Child-Pugh class A 184 (76.3%) and the average MELD score was 10 ± 5. Previous cirrhosis decompensations occurred in 125 (52.1%), 63 (26.1%) were on NSBB and 59 (27.2%) had undergone banding for bleeding prophylaxis. Median follow-up was 29 (1-58) months. Cumulative incidence of PVT was 3.7% and 7.6% at 1 and 3 years. Previous decompensation of cirrhosis and low platelet counts but not NSBB independently predicted the development of PVT. During follow-up, 82/236 (34.7%) patients developed cirrhosis decompensations. OLT-free survival was 100% and 82.8% at 3 years, with and without PVT respectively. MELD score, but not PVT, independently predicted cirrhosis decompensations (HR 1.14; 95%CI:1.09-1.19) and OLT-free survival (HR 1.16;95%CI:1.11-1.21). CONCLUSION Previous decompensations of cirrhosis and thrombocytopenia predict PVT development in cirrhosis suggesting a pathophysiologic role for severity of portal hypertension. PVT development did not independently predict cirrhosis decompensations or lower OLT-free survival.
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Affiliation(s)
- Carlos Noronha Ferreira
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisboa, Portugal
| | - Rui T Marinho
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisboa, Portugal
| | - Helena Cortez-Pinto
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisboa, Portugal
| | - Paula Ferreira
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Margarida S Dias
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Mariana Vasconcelos
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Paula Alexandrino
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Fátima Serejo
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Ana Júlia Pedro
- Serviço De Medicina II, Hospital De Santa Maria - Centro Hospitalar Lisboa, Lisboa, Portugal
| | - Afonso Gonçalves
- Serviço De Imagiologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Sónia Palma
- Serviço De Imagiologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Inês Leite
- Serviço De Imagiologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Daniela Reis
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Filipe Damião
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Ana Valente
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Leonor Xavier Brito
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Cilenia Baldaia
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Narcisa Fatela
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Fernando Ramalho
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - José Velosa
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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Noronha Ferreira C, Rodrigues T, Cortez-Pinto H, Serejo F, Ramalho F, Alexandrino P, Velosa J. The new definition of acute kidney injury in patients with cirrhosis: a critical look. Gut 2012; 61:1513. [PMID: 22287595 DOI: 10.1136/gutjnl-2011-301951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Lopes JA, Melo MJ, Costa AC, Raimundo M, Alexandrino P, Gomes da Costa A, Velosa J. Acute kidney injury and in-hospital mortality in critically ill patients with cirrhosis: a cohort study. Gut 2012; 61:955-6. [PMID: 21997555 DOI: 10.1136/gutjnl-2011-301190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Nunes J, Alexandrino P, Marinho RT. Stomal varices: a rare cause of severe bleeding in portal hypertension. J Gastrointestin Liver Dis 2009; 18:500. [PMID: 20076828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Joana Nunes
- Department of Gastroenterology and Hepatology, Hospital Santa Maria, Lisbon, Portugal.
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Dzama K, Bessa I, Pinheiro I, Matola M, Rocha A, Alexandrino P. Genetic diversity and relationships among indigenous Mozambican cattle breeds. S AFR J ANIM SCI 2009. [DOI: 10.4314/sajas.v39i1.43548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bispo M, Valente A, Maldonado R, Palma R, Glória H, Nóbrega J, Alexandrino P. Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder. World J Gastroenterol 2009; 15:2920-2. [PMID: 19533818 PMCID: PMC2699014 DOI: 10.3748/wjg.15.2920] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the first reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.
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Bispo M, Valente A, Maldonado R, Palma R, Glória H, Nóbrega J, Alexandrino P. Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder. World J Gastroenterol 2009. [PMID: 19533818 DOI: pmid/19533818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the first reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.
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Affiliation(s)
- Miguel Bispo
- Department of Gastroenterology, Egas Moniz Hospital, Lisbon, Portugal.
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Pérez M, Branco M, Llavona A, Ribeiro PA, Santos AM, Hawkins SJ, Dávila JA, Presa P, Alexandrino P. Development of microsatellite loci for the black-footed limpet, Patella depressa, and cross-amplification in two other Patella species. CONSERV GENET 2006. [DOI: 10.1007/s10592-006-9195-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Navalho M, Pires F, Duarte A, Gonçalves A, Alexandrino P, Távora I. Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values. Clin Imaging 2006; 30:114-9. [PMID: 16500542 DOI: 10.1016/j.clinimag.2005.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 09/07/2005] [Accepted: 09/07/2005] [Indexed: 01/27/2023]
Abstract
The objective of this study was to assess the efficacy of percutaneous catheter drainage, of early infected pancreatic fluid collections, in critically ill patients with severe acute pancreatitis. The patients in our series had a mean Ranson's score of 5.4. Nineteen (63.3%) of the 30 patients were cured with percutaneous drainage. In this group, the mean C-reactive protein value at the beginning of treatment was 172.8 U/l and 102.5 U/l at the end (P<.001). Cultures yielded multiple organisms in 23 patients (76.7%). The most frequently seen organisms were Escherichia coli, Staphylococcus aureus, and Enterococcus faecium.
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Affiliation(s)
- Márcio Navalho
- Radiology Department, University Hospital of Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal.
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Faria R, Weiss S, Alexandrino P. A molecular phylogenetic perspective on the evolutionary history of Alosa spp. (Clupeidae). Mol Phylogenet Evol 2006; 40:298-304. [PMID: 16581269 DOI: 10.1016/j.ympev.2006.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 02/08/2006] [Indexed: 11/19/2022]
Affiliation(s)
- R Faria
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Campus Agrário de Vairão, 4485-661 Vairão, Portugal.
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Froufe E, Sefc KM, Alexandrino P, Weiss S. Isolation and characterization of Brachymystax lenok microsatellite loci and cross-species amplification in Hucho spp. and Parahucho perryi. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1471-8286.2004.00594.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Froufe E, Alekseyev S, Knizhin I, Alexandrino P, Weiss S. Comparative phylogeography of salmonid fishes (Salmonidae) reveals late to post-Pleistocene exchange between three now-disjunct river basins in Siberia. DIVERS DISTRIB 2003. [DOI: 10.1046/j.1472-4642.2003.00024.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Costa Macedo T, Maldonado R, Valente A, Palma R, Raimundo M, Liberato M, Távora I, Alexandrino P, Carneiro de Moura M. Hemobilia in hereditary hemorrhagic telangiectasia: an unusual complication of endoscopic retrograde cholangiopancreatography. Endoscopy 2003; 35:531-3. [PMID: 12783354 DOI: 10.1055/s-2003-39659] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 12/10/2022]
Abstract
Hepatobiliary manifestations of hereditary hemorrhagic telangiectasia (HHT) are rare, but often involve cholestasis. We report here a case of HHT associated with cholestasis due to common bile duct stenosis. Attempted balloon dilation of the stenosis during endoscopic retrograde cholangiopancreatography (ERCP) resulted in hemobilia. Hemostasis was achieved by adjusting the nasobiliary drain. The aim of this report is to highlight the biliary manifestations of HHT and draw attention to an unusual complication of ERCP in this setting.
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Affiliation(s)
- T Costa Macedo
- Gastrenterology and Hepatology Intensive Care Unit, Dept. of Medicine II, Santa Maria Hospital, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal.
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16
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Beja-Pereira A, Alexandrino P, Bessa I, Carretero Y, Dunner S, Ferrand N, Jordana J, Laloe D, Moazami-Goudarzi K, Sanchez A, Cañon J. Genetic characterization of southwestern European bovine breeds: a historical and biogeographical reassessment with a set of 16 microsatellites. J Hered 2003; 94:243-50. [PMID: 12816965 DOI: 10.1093/jhered/esg055] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [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: 11/14/2022] Open
Abstract
The origin of Iberian cattle has been suggested by some authors to be the product of European and north African cattle entrances during the last few thousands of years. However, these hypotheses were mainly based on morphological similarities. This study analyzed 889 unrelated individuals from 15 representative Iberian breeds and 3 French breeds for 16 microsatellite loci. Statistical tests were used to calculate interpopulation genetic distances (D(A)) and principal components analysis (PCA). To visualize the geographical distribution of the genetic differentiation between Iberian cattle breeds, data from the PCA analysis were used to construct synthetic maps. Genetic similarity among neighboring Iberian breeds is mainly caused by gene flow. However, recent demographic fluctuations and reproductive isolation in Alistana, Mirandesa, and Tudanca has increased genetic drift, which may be the main cause for the relatively high differentiation of these populations. The synthetic maps constructed with the first and second PCs revealed (1) a large differentiation between Northern Iberian breeds rather than between more geographically distant breeds, and (2) a clear east-west gradient that may be related with the model of demic diffusion of agriculture. Finally, we detected no strong evidence for an African genetic influence in the Iberian cattle breeds analyzed in this study.
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Affiliation(s)
- A Beja-Pereira
- Centro de Investigação em Biodiverdidade e Recursos Geneticos CIBIO-UP, Universidade do Porto, Campus Agrário de Vairão, Rua Monte-Crasto, Pt-4485-661 Vairão, Portugal.
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17
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Jordana J, Alexandrino P, Beja-Pereira A, Bessa I, Canon J, Carretero Y, Dunner S, Laloe D, Moazami-Goudarzi K, Sanchez A, Ferrand N. Genetic structure of eighteen local south European beef cattle breeds by comparative F-statistics analysis. J Anim Breed Genet 2003. [DOI: 10.1046/j.1439-0388.2003.00384.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Dinis-Ribeiro M, Cortez-Pinto H, Marinho R, Valente A, Raimundo M, Salgado MJ, Ramalho F, Alexandrino P, Carneiro-de-Moura M. Spontaneous bacterial peritonitis in patients with hepatic cirrhosis: evaluation of a treatment protocol at specialized units. Rev Esp Enferm Dig 2002; 94:473-81. [PMID: 12486852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy. AIM To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution. MATERIAL AND METHODS Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C. RESULTS First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. Although 24% of fatal cases (only two related to infection), we noted a 73% clinical and laboratorial response. Five patients (72%) that died, showed renal failure by the time of death. Second, in all cases with positive culture of ascitic fluid (n = 21), 42% of which with PMN > 250/mm3 and 9 monobacterial nonneutrocytic bacterascites' cases, one only agent was found: E. coli in 36%, Streptococci (37%), Staphylococci (14%), and other (14%): Klebsiella oxytoca, n = 1; Salmonella enteritidis, n = 1; Enterococcus faecium, n = 1, Acinectobacter anitratus, n = 1. Only one of the agents, E. faecium (3%) showed in vitro sensitivity exclusively to ampiciline; all other were cefotaxime sensitivite. CONCLUSIONS Our protocol will be modified, to treat patients with spontaneous bacterial peritonitis with cefotaxime, as monotherapy. Albumin infusion will also be added to the protocol, as, we found renal failure to be an important negative prognosis factor.
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Affiliation(s)
- M Dinis-Ribeiro
- Liver Unit and Hepatology and Gastroenterology Intensive Care Unit, Department of Medicine II, University Hospital of Santa Maria, Lisbon, Portugal
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Cortez-Pinto H, Alexandrino P, Camilo ME, Gouveia-Oliveira A, Santos PM, Alves MM, Moura MC. Lack of effect of colchicine in alcoholic cirrhosis: final results of a double blind randomized trial. Eur J Gastroenterol Hepatol 2002; 14:377-81. [PMID: 11943949 DOI: 10.1097/00042737-200204000-00007] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Colchicine, an inhibitor of collagen synthesis, has been suggested as potentially beneficial in cirrhosis. OBJECTIVE This long-term, randomized, double blind, placebo controlled trial was conducted in order to evaluate the efficacy of colchicine in alcoholic cirrhosis. METHODS Ambulatory patients with biopsy proven alcoholic cirrhosis, presenting from 1989 to 1997, with no exclusion criteria (e.g. Child-Pugh C, bilirubin > 10 mg/dl and gastrointestinal bleeding in the previous 15 days), were randomized to receive orally, 5 days/week, 1 mg/day of colchicine or placebo. MAIN OUTCOME MEASURES Results were analysed on an intention to treat basis, for survival, incidence of complications, biochemical liver tests and safety. RESULTS Twenty-nine patients received colchicine and 26 placebo; characteristics of both groups were similar. The median follow-up was 40.6 (1.4-126.3) months in the colchicine versus 42.4 (5.7-118.2) months in the placebo group (NS). No significant side effects were reported. During follow-up, there were no significant differences in compliance and alcohol abstinence (86% vs 85%). Overall survival was not statistically different (P = 0.38). Cumulative 3-year survival rates were 74.9% in the colchicine versus 91.4% in placebo group (NS). The annual incidence rate of complications was similar with colchicine or placebo: gastrointestinal bleeding, 1.5% vs 1.2%; ascites, 3.7% vs 3.7%; and encephalopathy, 1.0% vs 0.9%. The comparison of changes in biochemical parameters between groups did not show any significant difference. CONCLUSIONS Although well tolerated, colchicine does not appear to overcome the progression and natural history of long-established alcoholic cirrhosis.
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Affiliation(s)
- Helena Cortez-Pinto
- Department of Medicine 2, University Hospital of Santa Maria, Lisbon Medical School, Avenida Prof. Egas Moriz, 1669 Lisbon, Portugal.
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Affiliation(s)
- E Barjas
- Serviço de Medicina II, Unidade de Cuidados Intensivos de Gastroenterologia e Hepatologia (UCIGE-H), Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal.
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21
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Cañón J, Alexandrino P, Bessa I, Carleos C, Carretero Y, Dunner S, Ferran N, Garcia D, Jordana J, Laloë D, Pereira A, Sanchez A, Moazami-Goudarzi K. Genetic diversity measures of local European beef cattle breeds for conservation purposes. Genet Sel Evol 2001; 33:311-32. [PMID: 11403750 PMCID: PMC2705410 DOI: 10.1186/1297-9686-33-3-311] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study was undertaken to determine the genetic structure, evolutionary relationships, and the genetic diversity among 18 local cattle breeds from Spain, Portugal, and France using 16 microsatellites. Heterozygosities, estimates of Fst, genetic distances, multivariate and diversity analyses, and assignment tests were performed. Heterozygosities ranged from 0.54 in the Pirenaica breed to 0.72 in the Barrosã breed. Seven percent of the total genetic variability can be attributed to differences among breeds (mean F(st) = 0.07; P<0.01). Five different genetic distances were computed and compared with no correlation found to be significantly different from 0 between distances based on the effective size of the population and those which use the size of the alleles. The Weitzman recursive approach and a multivariate analysis were used to measure the contribution of the breeds diversity. The Weitzman approach suggests that the most important breeds to be preserved are those grouped into two clusters: the cluster formed by the Mirandesa and Alistana breeds and that of the Sayaguesa and Tudanca breeds. The hypothetical extinction of one of those clusters represents a 17% loss of diversity. A correspondence analysis not only distinguished four breed groups but also confirmed results of previous studies classifying the important breeds contributing to diversity. In addition, the variation between breeds was sufficiently high so as to allow individuals to be assigned to their breed of origin with a probability of 99% for simulated samples.
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Affiliation(s)
- J Cañón
- Laboratorio de Genética, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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Abstract
Genetic polymorphism of an unidentified plasma protein (PX) is described for the first time in Salmo trutta (L.) by means of isoelectric focusing. The analysis of 414 individuals from different geographic origins in Portugal allowed the identification of nine alleles. Heterozygosity in natural populations is generally above 0.60, thus giving similar values to those reported for brown trout microsatellite loci. Substructuring of Portuguese brown trout is evident between northern and southern basins. Genetic affinities between the southernmost rivers and the hatchery stock were detected, suggesting the existence of recent stocking influences.
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Affiliation(s)
- A Antunes
- Departamento de Zoologia-Antropologia, Faculdade de Ciências, Universidade do Porto, Praça Gomes Teixeira, 4050 Porto, Portugal.
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23
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Weiss S, Antunes A, Schlötterer C, Alexandrino P. Mitochondrial haplotype diversity among Portuguese brown trout Salmo trutta L. populations: relevance to the post-pleistocene recolonization of northern Europe. Mol Ecol 2000; 9:691-8. [PMID: 10849285 DOI: 10.1046/j.1365-294x.2000.00910.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [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: 11/20/2022]
Abstract
Mitochondrial haplotype diversity in seven Portuguese populations of brown trout, Salmo trutta L., was investigated by sequencing the 5' end of the mitochondrial DNA (mtDNA) control region. Five new haplotypes were described for this species, each two to three mutational steps distant from the common north Atlantic haplotype. Significant population subdivision of mtDNA haplotypes was also apparent. Based on these results, as well as on published data describing the distribution of both mtDNA haplotypes and allozyme alleles throughout Europe, the postglacial recolonization of northern Europe was re-evaluated. It is argued that the available data do not support the contribution of two major glacial refugia (southwest Atlantic and Ponto-Caspian Basin) to this postglacial recolonization, as proposed in a recently published model. The unique genetic architecture of Portuguese brown trout within the Atlantic-basin clade of this species represents a highly valuable genetic resource that should be protected from introgression with nonendemic strains of hatchery fish.
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Affiliation(s)
- S Weiss
- Abteilung für Hydrobiologie, Universität für Bodenkultur, Max Emanuel Strasse 17, 1180 Vienna.
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24
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Abstract
Genetic polymorphism of acid phosphatases was investigated in 11 populations of the two European Alosa species using isoelectric focusing after sample treatment with neuraminidase. Two distinct loci, ACP1 and ACP2, were detected being ACP2 polymorphic. The observed genetic diversity between the species at the ACP2 locus supports other studies which indicate that A. alosa is the less polymorphic species of the two. This locus shows a higher geographic than interspecific pattern of differentiation and the ACP*2 allele is essentially confined to the Mediterranean.
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Affiliation(s)
- F Castro
- Centro de Estudos de Ciência Animal, ICETA, Vila do Conde, Portugal
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25
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dos Santos JN, e Silva AM, Alexandrino P, Saldanha T, Carrageta MO, Ferreira E, de Pádua F. Hereditary protein C deficiency and portal-vein thrombosis. Neth J Med 1991; 38:212-6. [PMID: 1922594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Inherited defects of the natural coagulation inhibitors predispose patients to thrombosis. These disorders have similar clinical presentations with a strong family history of thrombosis, episodes of recurrent venous thromboembolism, beginning in early adulthood. We report a case of upper gastrointestinal bleeding in a patient with portal hypertension due to portal-vein thrombosis secondary to hereditary protein C deficiency, an association that has seldom been reported.
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Affiliation(s)
- J N dos Santos
- Department IV, Santa Maria University Hospital, Lisbon, Portugal
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26
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dos Santos JN, Mello e Silva A, Alexandrino P, Saldanha T, Carreira MO, Ferreira E, de Pádua F. [Hereditary protein C deficiency and portal vein thrombosis]. ACTA MEDICA PORT 1990; 3:27-30. [PMID: 2333774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Inherited defects of the natural coagulation inhibitors predispose patients to thrombosis. These disorders have similar clinical presentations with a strong family of thrombosis, episodes of recurrent venous thromboembolism, beginning in early adulthood. We report a case of upper gastrointestinal bleeding in a patient with portal hypertension due to portal-vein thrombosis secondary to hereditary protein C deficiency, an association that has seldom been reported. We conclude that protein C deficiency should be investigated in thrombotic states, namely after more frequent causes have been excluded.
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Affiliation(s)
- J N dos Santos
- Serviço de Medicina 4, Hospital de Santa Maria, Faculdade de Medicina de Lisboa
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Abstract
In a randomized controlled trial, the effect of continuous intravenous administration of vasopressin was compared with Sengstaken-Blakemore balloon tamponade in 37 episodes of bleeding esophageal varices in patients with cirrhosis. The majority were Group A and B of Child's classification. Bleeding was controlled in 11 of 17 (65%) patients on vasopressin and in 14 of 20 (70%) patients on tamponade. The patients who failed to respond initially (6 episodes on vasopressin and 5 on tamponade) were treated successfully with the alternative method. Overall mortality was similar in both groups: 3 patients in the vasopressin group and 4 in the tamponade group died. Only one patient died of uncontrolled bleeding; 4 patients probably died of complications of treatment, 2 of cardiac ischemia after vasopressin and 2 of pulmonary infection after tamponade. The vasopressin group required significantly fewer blood transfusions than did the tamponade group.
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Alexandrino P, Baptista AS, Correia JP. Early gastric cancer. Review of 42 cases. ACTA MEDICA PORT 1980; 2:3-11. [PMID: 7446197] [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: 01/25/2023]
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29
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Correia JP, Cruz AG, Batista MR, Grima N, Carvalhinhos A, Cardoso A, Areias E, Camilo EA, Galvão HS, Fernandes JP, Alexandrino P, Peixe GR, Sanguino JA, Silveira J. Endoscopy in the upper G.I. bleedings. Arq Gastroenterol 1979; 16:119-23. [PMID: 317642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
From 388 patients with upper G.I. bleeding investigated by endoscopy, radiology or emergent surgery, one third bled from duodenal ulcer, one third oesophageal varices, and from the remain the most frequent were gastric ulcer (14%) and gastric cancer (9%). From a sample of 53 patients with liver cirrhosis, 66% bled from varices and 34% from other lesions. The proportion of patients who bled from oesophageal varices is higher under 60 yrs. The mortality was higher after 60 yrs, except when there was associated chronic liver disease or renal or cardio-respiratory failure. In this group of patients, near half in our series, the mortality is the same under and above 60 years.
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