https://ninho.inca.gov.br/jspui/handle/123456789/5104 Coleção voltada para a inserção de documentos da área de Pronto Atendimento Interno 2026-02-04T18:00:38Z https://ninho.inca.gov.br/jspui/handle/123456789/9698 Title: Treatment of Severe Hepatic Veno-Occlusive Disease after Bone Marrow Transplantation by Trans Jugular Intrahepatic Portosystemic Stent-Shunt (TIPS) Authors: Gouveia, Hugo Rodrigues; Araújo Neto, João Marcello de; Arcuri, Leonardo Javier Abstract: Severe Veno-Occlusive Disease (VOD) of the liver is an important cause of mortality after bone marrow transplantation. This paper reports the case of a child that underwent Transjugular Intrahepatic Portosystemic Shunt (TIPS) for life-threatening VOD after following haploidentical bone marrow transplantation for acute lymphatic leukemia. TIPS permitted regression of the hepatic symptoms as decreased aminotransferase levels and resolution of ascites. TIPS were an effective method for portal decompression. Description: p. 1-3.: tab. p&b. 2018-01-01T00:00:00Z https://ninho.inca.gov.br/jspui/handle/123456789/9696 Title: Transient hepatic elastography has the best performance to evaluate liver fibrosis in non-alcoholic fatty liver disease (NAFLD) Authors: Nogueira, Cristiane Alves Villela; Leite, Nathalie Carvalho; Panke, Carine Luíze; Tovo, Cristiane Valle; Coral, Gabriela Perdomo; Fernandes, Sabrina; Buss, Caroline; Port, Gabriela Zanatta; Cardoso, Ana Carolina; Barroso, Cláudia Cravo Moreira; Calçado, Fernanda Luiza Valladares; Rezende, Guilherme Ferreira da Motta; Campos, Carlos Frederico Ferreira; Araújo Neto, João Marcello de; Perez, Renata de Mello; Coelho, Henrique Sérgio Moraes; Mattos, Angelo Alves de Abstract: The gold-standard for fibrosis diagnosis in non-alcoholic fatty liver disease (NAFLD) is liver biopsy, despite its invasive approach, sampling limitations and variability among observers. The objective was to validate the performance of non-invasive methods (FibroscanTM; APRI, FIB4 and NAFLD score) comparing with liver biopsy in the evaluation of liver fibrosis in patients with NAFLD. Material and methods: NAFLD patients ≥18 years of age who were submitted to liver biopsy were included and evaluated at two reference tertiary hospitals in Brazil with transient hepatic elastography (THE) assessment through FibroscanTM, APRI, FIB4 and NAFLD scores were determined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of advanced fibrosis were calculated to evaluate the performance of these non-invasive methods in NAFLD patients, adopting liver biopsy as the gold standard. Results: A total of 104 patients were studied. At three different cutoff values (7.9, 8.7 and 9.6 kPa) THE presented the highest sensitivity values (95%, 90% and 85% respectively), and the highest NPV (98%, 96.4% and 95.1% respectively) for the diagnosis of advanced fibrosis. It also presented the highest AUROC (0.87; CI 95% 0.78–0.97). Conclusion: When compared to the gold standard, transient hepatic elastography presented the best performance for the diagnosis and exclusion of advanced fibrosis in patients with NAFLD, overcoming APRI, FIB4 and NAFLD score. Description: p. 445–449.: il. color. 2019-01-01T00:00:00Z https://ninho.inca.gov.br/jspui/handle/123456789/9694 Title: The performance of M and XL probes of FibroScan for the diagnosis of steatosis and fibrosis on a Brazilian nonalcoholic fatty liver disease cohort Authors: Cardoso, Ana Carolina; Cravo, Claudia; Calçado, Fernanda Luiza Valladares; Rezende, Guilherme Ferreira da Motta; Campos, Carlos Frederico Ferreira; Araújo Neto, João Marcello de; Luz, Rodrigo Pereira; Soares, Jorge André Segadas; Coelho, Henrique Sérgio Moraes; Leite, Nathalie Carvalho; Perez, Renata de Mello; Nogueira, Cristiane Alves Villela Abstract: Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate. Aim Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard. Methods NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2). Results Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64–0.84) and 0.76 (0.65–0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73–0.90) and 0.82 (0.71–0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71–0.93) and 0.80 (0.69–0.92) (P = 0.66). Conclusion Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD. Eur J Gastroenterol Hepatol 2020: 231–238 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Description: p. 231-238.: il. p&b. 2020-01-01T00:00:00Z https://ninho.inca.gov.br/jspui/handle/123456789/9688 Title: Schistosomiasis: Clinical Management of Liver Disease Authors: Cavalcanti, Marta Guimarães; Araújo Neto, João Marcello de; Peralta, José Mauro Abstract: Schistosoma infection is one of the most important causes of noncirrhotic portal hypertension in Latin America, Africa, and Asia.1 Schistosomiasis is a waterborne disease caused by a blood fluke of the genus Schistosoma. Schistosoma man soni and S. japonicum are the species most commonly involved in liver disease. Schistosoma intercalatum, S. mekongi, and, occasionally, S. haematobium may also induce liver disease.2 Despite some species-specific variations in inflammatory/fibrotic responses, Schistosoma-induced liver injury results from a granulomatous inflammatory reaction around trapped Schistosoma eggs in the presinusoidal peri portal spaces. In early phases of infection, a predominantly hypercellular nonfibrotic granuloma response produces liver dysfunction that is not clinically detectable. Imaging studies may reveal enlargement of the left liver lobe without changes in the liver parenchyma or splenomegaly. Revers ibility of these findings is expected in 12 months following chemotherapy.3 Development of chronicity results in colla gen deposition in the periportal spaces, which is the basis of the pathognomonic pathological feature of schistosomal associated liver fibrosis known as ‘‘Symmers’ pipestem fibro sis’’. In addition, fibrosis is accompanied by angiogenesis. Vascular disturbances include severe reduction and distor tion of the portal venous system and hyperplasia and hyper trophy of the arterial system.4 The occlusion of the portal veins is associated with portal hypertension marked by splenomegaly, portocaval shunting, and gastrointestinal vari ces. Ultrasonography (US) may reveal periportal fibrosis around periportal spaces, liver parenchymal heterogeneity, splenomegaly, enhanced portal vein dimensions, and the presence of collateral vessels. Despite successful parasite elimination, the effect of chemotherapy on the inflammatory response within the liver is negligible. As the fibrosis pro gresses, with or without active infection, repeated episodes of variceal bleeding may be accompanied by hepatic deteri oration that can lead to a fatal outcome. Worsening of liver function might also be provoked by Schistosoma-associated coinfections or other comorbidities. Viral hepatitis, malaria, HIV infection, mixed Schistosoma species, alcoholism, or nonalcoholic steatohepatitis each may enhance tissue dam age and/or inflammatory/fibrotic responses, thus promoting disease progression. Description: p. 59-62.: il. color. 2015-01-01T00:00:00Z