127 results on '"Valla DC"'
Search Results
2. Baveno IV consensus statements noncirrhotic portal hypertension
- Author
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Valla, DC, Karin, SK, Barosi, G, Chawla, YC, Elias, E, Janssen, HLA, Primignani, M, Wanless, IR, Franchis, R., and Gastroenterology & Hepatology
- Published
- 2006
3. Etiology, Management, and Outcome of the Budd-Chiari Syndrome
- Author
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Darwish Murad, Sarwa, Plessier, A, Hernandez-Guerra, M, Fabris, F, Eapen, CE, Bahr, MJ, Trebicka, J, Morard, I, Lasser, L, Heller, J, Hadengue, A, Langlet, P, Miranda, H, Primignani, M, Elias, E, Leebeek, Frank, Rosendaal, FR, Garcia-Pagan, JC, Valla, DC, Janssen, HLA, Darwish Murad, Sarwa, Plessier, A, Hernandez-Guerra, M, Fabris, F, Eapen, CE, Bahr, MJ, Trebicka, J, Morard, I, Lasser, L, Heller, J, Hadengue, A, Langlet, P, Miranda, H, Primignani, M, Elias, E, Leebeek, Frank, Rosendaal, FR, Garcia-Pagan, JC, Valla, DC, and Janssen, HLA
- Abstract
Background: The Budd-Chiari syndrome (BCS) is hepatic venous outflow obstruction. What is known about the syndrome is based on small studies of prevalent cases. Objective: To characterize the causes and treatment of incident BCS. Design: Consecutive case series of patients with incident BCS, enrolled from October 2003 to October 2005 and followed until May 2006. Setting: Academic and nonacademic hospitals in France, Spain, Italy, Great Britain, Germany, Belgium, the Netherlands, Portugal, and Switzerland. Patients: Persons older than 16 years with definite hepatic outflow obstruction diagnosed by imaging. Persons with hepatic outflow obstruction due to heart failure, sinusoidal obstruction syndrome, cancer, or liver transplantation were excluded. Measurements: Signs and symptoms; laboratory and imaging findings; diagnosis; treatment; and overall, transplantation-free, and intervention-free survival. Results: 163 incident cases of BCS were identified. Median follow-up was 17 months (range, 0.1 to 31 months). Most patients (84%) had at least 1 thrombotic risk factor, and many (46%) had more than 1; the most common was myeloproliferative disorders (49% of 103 tested patients). Patients were mainly treated with anticoagulation (140 patients [86%]), transjugular intrahepatic porto-systemic shunting (56 patients [34%]), or liver transplantation (20 patients [12%]), and 80 patients (49%) were managed noninvasively. Only 3 patients underwent surgical shunting. The survival rate was 87% (95% CI, 82% to 93%) at 1 year and 82% (CI, 75% to 88%) at 2 years. Limitation: Treatment was not standardized across all centers, and data on important clinical variables were missing for some patients. Conclusion: Most patients with BCS have at least 1 thrombotic risk factor, and many have more than 1; myeloproliferative disorders are most common. One- and 2-year survival rates are good with contemporary management, which includes noninvasive therapies (anticoagulation and diuretics) and in
- Published
- 2009
4. Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging.
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Soussan M, Aubé C, Bahrami S, Boursier J, Valla DC, Vilgrain V, Soussan, Michael, Aubé, Christophe, Bahrami, Stéphane, Boursier, Jérôme, Valla, Dominique Charles, and Vilgrain, Valérie
- Abstract
Objective: To prospectively assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) and MR imaging in incidental solid focal liver lesions not characterised on ultrasound.Materials and Methods: Forty-seven patients with 50 lesions underwent MR imaging and CEUS: 24 focal nodular hyperplasias (FNH), 11 adenomas, 10 haemangiomas, 1 focal fatty change and 4 malignant lesions were identified. Two experienced radiologists randomly reviewed contrast-enhanced MR imaging and CEUS data, and provided the most likely diagnosis. Sensitivity (Se), specificity (Sp), likelihood ratios (LR) and kappa value were calculated.Results: A histotype diagnosis was obtained in 66-52% with MR imaging and 52-53% with CEUS, respectively, for both readers. Se, Sp and LR for haemangioma were 100-100, 100-100 and 78-78 with MR imaging and 89-89, 100-100 and 68-70 with CEUS; for FNH with MR imaging they were 88-63, 96-100 and 23-34 and 74-67, 88-96 and 6-17 with CEUS. If the diagnosis of haemangioma was uncertain with CEUS, MR imaging always confirmed the diagnosis. If the diagnosis of FNH was uncertain with either CEUS or MR imaging, the other imaging technique confirmed the diagnosis in approximately half the cases.Conclusion: Both CEUS and MR imaging have a high diagnostic performance in incidental focal liver lesions and are complementary when diagnosis is uncertain. [ABSTRACT FROM AUTHOR]- Published
- 2010
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5. Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings.
- Author
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Vilgrain V, Condat B, O'Toole D, Plessier A, Ruszniewski P, Valla DC, Vilgrain, Valérie, Condat, Bertrand, O'Toole, Dermot, Plessier, Aurélie, Ruszniewski, Philippe, and Valla, Dominique C
- Abstract
The purpose of the article was to prospectively evaluate the MR findings of pancreatic portal cavernoma in a consecutive series of patients with cavernous transformation of the portal vein. This study was approved by the review board of our institution, and informed consent was obtained. The clinical and biological data and the MR imaging for 20 patients (11 female, 9 male; median age, 49 years) with cavernous transformation of the portal vein and no evidence of previous pancreatic disease were reviewed. The presence of pancreatic portal cavernoma (defined as intra- and/or peripancreatic portal cavernoma), morphological changes in the pancreas, biliary and ductal pancreatic abnormalities, and extension of the portal venous thrombosis were qualitatively assessed. Fifteen patients (75%) had pancreatic portal cavernoma with collateral formation in the pancreas and/or collaterals around the pancreas seen on dynamic contrast-enhanced MR sequences: three patients had both intra- and peripancreatic portal cavernoma, six had intrapancreatic portal cavernoma alone and six had peripancreatic portal cavernoma only. The presence of intra- or peripancreatic portal cavernoma was significantly associated with extension of the thrombosis to the splenic and superior mesenteric veins (p = 0.05). Morphological changes in the pancreas, heterogeneity on T2-weighted sequences and main ductal pancreatic abnormalities were seen in two, four and two patients, respectively. All these patients had intrapancreatic portal cavernoma. Bile duct dilatation was observed in 13 (65%) patients: among them three had extrahepatic dilatation only and these three patients had associated intrapancreatic portal cavernoma. In patients with cavernous transformation of the portal vein, intra- or peripancreatic portal cavernoma is common. In conclusion, intra- or peripancreatic portal cavernoma was only observed in patients with extension of the thrombosis to the splenic vein and/or the superior mesenteric vein. [ABSTRACT FROM AUTHOR]
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- 2009
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6. Liver tumours in patients with Fanconi anaemia: a report of three cases.
- Author
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Ozenne V, Paradis V, Vullierme MP, Vilgrain V, Leblanc T, Belghiti J, Imbert A, Valla DC, Degos F, Ozenne, Violaine, Paradis, Valérie, Vullierme, Marie-Pierre, Vilgrain, Valérie, Leblanc, Thierry, Belghiti, Jacques, Imbert, Audrey, Valla, Dominique C, and Degos, Françoise
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- 2008
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7. Etiology, Management, and Outcome of the Budd-Chiari Syndrome
- Author
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DARWISH MURAD, S, Plessier, A, HERNANDEZ GUERRA, M, Fabris, F, Eapen, Ce, Bahr, Mj, Trebicka, J, Morard, I, Lasser, L, Heller, J, Hadengue, A, Langlet, P, Miranda, H, Primignani, M, Elias, E, Leebeek, Fw, Rosendaal, Fr, GARCIA PAGAN JC, Valla, Dc, Janssen, Hl, DE SANTIS, Adriano, Gastroenterology & Hepatology, and Hematology
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Budd-Chiari Syndrome/*etiology/mortality/*therapy ,Myeloproliferative Disorders/complications ,Gene mutation ,Budd-Chiari Syndrome ,Inferior vena cava ,Young Adult ,SDG 3 - Good Health and Well-being ,Risk Factors ,Ascites ,Internal Medicine ,medicine ,Thrombophilia ,Humans ,Protein S deficiency ,Prospective Studies ,Angioplasty, Balloon, Coronary ,Aged ,ddc:616 ,Aged, 80 and over ,Myeloproliferative Disorders ,Thrombophilia/complications ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Liver Transplantation ,Europe ,Treatment Outcome ,medicine.vein ,Budd–Chiari syndrome ,Etiology ,Female ,medicine.symptom ,Liver Transplantation/methods ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Background: The Budd-Chiari syndrome (BCS) is hepatic venous outflow obstruction. What is known about the syndrome is based on small studies of prevalent cases. Objective: To characterize the causes and treatment of incident BCS. Design: Consecutive case series of patients with incident BCS, enrolled from October 2003 to October 2005 and followed until May 2006. Setting: Academic and nonacademic hospitals in France, Spain, Italy, Great Britain, Germany, Belgium, the Netherlands, Portugal, and Switzerland. Patients: Persons older than 16 years with definite hepatic outflow obstruction diagnosed by imaging. Persons with hepatic outflow obstruction due to heart failure, sinusoidal obstruction syndrome, cancer, or liver transplantation were excluded. Measurements: Signs and symptoms; laboratory and imaging findings; diagnosis; treatment; and overall, transplantation-free, and intervention-free survival. Results: 163 incident cases of BCS were identified. Median follow-up was 17 months (range, 0.1 to 31 months). Most patients (84%) had at least 1 thrombotic risk factor, and many (46%) had more than 1; the most common was myeloproliferative disorders (49% of 103 tested patients). Patients were mainly treated with anticoagulation (140 patients [86%]), transjugular intrahepatic porto-systemic shunting (56 patients [34%]), or liver transplantation (20 patients [12%]), and 80 patients (49%) were managed noninvasively. Only 3 patients underwent surgical shunting. The survival rate was 87% (95% CI, 82% to 93%) at 1 year and 82% (CI, 75% to 88%) at 2 years. Limitation: Treatment was not standardized across all centers, and data on important clinical variables were missing for some patients. Conclusion: Most patients with BCS have at least 1 thrombotic risk factor, and many have more than 1; myeloproliferative disorders are most common. One- and 2-year survival rates are good with contemporary management, which includes noninvasive therapies (anticoagulation and diuretics) and invasive techniques. Transjugular intrahepatic portosystemic shunting seems to have replaced surgical shunting as the most common invasive therapeutic procedure. Primary Funding Source: Fifth Framework Programme of the European Commission.
8. High-b-Value Diffusion-weighted MR Imaging of Benign Hepatocellular Lesions: Quantitative and Qualitative Analysis
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Bernard E. Van Beers, Francesco Agnello, Ralph Sinkus, Valérie Vilgrain, Maxime Ronot, Dominique Valla, Agnello, F, Ronot, M, Valla, DC, Sinkus, R, Van Beers, BE, and Vilgrain, V
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Adenoma ,Sensitivity and Specificity ,Adenoma, Liver Cell ,hepatocellular lesions ,Young Adult ,Qualitative analysis ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Water diffusion ,Aged ,Retrospective Studies ,High-B-Value Diffusion-Weighted MR Imaging ,business.industry ,Liver cell ,Liver Neoplasms ,Reproducibility of Results ,Middle Aged ,Image enhancement ,Image Enhancement ,medicine.disease ,Diffusion Magnetic Resonance Imaging ,Female ,Signal intensity ,business ,Algorithms ,Liver parenchyma - Abstract
PURPOSE:To analyze the signal intensity (SI) of benign hepatocellular lesions in high-b-value diffusion-weighted (DW) magnetic resonance (MR) images and to compare the apparent diffusion coefficient (ADC) values of focal nodular hyperplasias (FNHs) with those of hepatocellular adenomas (HCAs). MATERIALS AND METHODS: This retrospective study was approved by institutional review board, with waiver of informed consent. Inclusion criteria were consecutive patients with diagnosed FNH or HCA who underwent MR imaging with a DW sequence of the liver at three b values, 0, 150, and 600 sec/mm2. The final study population included 67 patients (seven men, 60 women) with 90 hepatocellular lesions (54 FNHs, 36 HCAs). The mean ADC was compared between the lesions and the liver. Receiver operating characteristic analysis was performed to evaluate the diagnostic value of ADC for differentiating HCAs and FNHs. RESULTS: The mean ADC value of all FNHs and HCAs was significantly lower than that of the liver (P=.004). An ADC ratio below 15% was observed in 50 of 54 (93%) FNHs and in 29 of 36 (81%) HCAs. The mean ADC value of FNHs was significantly higher than that of HCAs (P
- Published
- 2012
9. Hepatic vein thrombosis and PVT: A personal view on the contemporary development of ideas.
- Author
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Valla DC
- Abstract
Competing Interests: The author has no conflicts to report.
- Published
- 2024
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10. Primary Budd-Chiari Syndrome. Reply.
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Valla DC and Garcia-Pagán JC
- Subjects
- Humans, Budd-Chiari Syndrome complications
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- 2023
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11. Primary Budd-Chiari Syndrome.
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Garcia-Pagán JC and Valla DC
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- Humans, Budd-Chiari Syndrome
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- 2023
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12. Contrast-enhanced CT and liver surface nodularity for the diagnosis of porto-sinusoidal vascular disorder: A case-control study.
- Author
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Valainathan SR, Sartoris R, Elkrief L, Magaz M, Betancourt F, Pellegrino S, Nivolli A, Dioguardi Burgio M, Flattet Y, Terraz S, Drilhon N, Lazareth M, Herrou J, Bruno O, Payance A, Plessier A, Durand F, Ronot M, Valla DC, Paradis V, Garcia-Pagan JC, Vilgrain V, and Rautou PE
- Subjects
- Case-Control Studies, Fibrosis, Humans, Liver diagnostic imaging, Liver pathology, Liver Cirrhosis complications, Liver Cirrhosis diagnostic imaging, Liver Cirrhosis pathology, Retrospective Studies, Tomography, X-Ray Computed methods, Hypertension, Portal complications, Vascular Diseases complications
- Abstract
Background and Aims: Porto-sinusoidal vascular disorder (PSVD) is a rare and commonly overlooked cause of portal hypertension. The interest of CT analysis, including quantification of liver surface nodularity (LSN) for PSVD diagnosis has not been established. This study aimed at assessing the performance of LSN and CT features for a PSVD diagnosis in patients with signs of portal hypertension., Approach and Results: This retrospective case-control study included a learning cohort consisting of 50 patients with histologically proven PSVD, according to VALDIG criteria, and 100 control patients with histologically proven cirrhosis, matched on ascites. All patients and controls had at least one sign of portal hypertension and CT available within 1 year of liver biopsy. Principal component analysis of CT features separated patients with PSVD from patients with cirrhosis. Patients with PSVD had lower median LSN than those with cirrhosis (2.4 vs. 3.1, p < 0.001). Multivariate analysis identified LSN < 2.5 and normal-sized or enlarged segment IV as independently associated with PSVD. Combination of these two features had a specificity of 90% for PSVD and a diagnostic accuracy of 84%. Even better results were obtained in an independent multicenter validation cohort including 53 patients with PSVD and 106 control patients with cirrhosis (specificity 94%, diagnostic accuracy 87%)., Conclusions: This study that included a total of 103 patients with PSVD and 206 patients with cirrhosis demonstrates that LSN < 2.5 combined with normal-sized or enlarged segment IV strongly suggests PSVD in patients with signs of portal hypertension., (© 2022 American Association for the Study of Liver Diseases.)
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- 2022
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13. Paroxysmal nocturnal hemoglobinuria and vascular liver disease: Eculizumab therapy decreases mortality and thrombotic complications.
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Plessier A, Esposito-Farèse M, Baiges A, Shukla A, Garcia Pagan JC, De Raucourt E, Ollivier-Hourmand I, Cervoni JP, De Ledinghen V, Tazi Z, Nousbaum JB, Bun R, Bureau C, Silvain C, Tournilhac O, Gerfaud-Valentin M, Durand F, Goria O, Tellez L, Albillos A, Gioia S, Riggio O, De Gottardi A, Payance A, Rautou PE, Terriou L, Charbonnier A, Elkrief L, de la Tour RP, Valla DC, Gault N, and de Fontbrune FS
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- Adult, Antibodies, Monoclonal, Humanized, Female, Humans, Male, Retrospective Studies, Hemoglobinuria, Paroxysmal complications, Hemoglobinuria, Paroxysmal drug therapy, Liver Diseases complications, Thrombosis complications
- Abstract
A total of 2%-10% of patients with vascular liver disease (VLD) have paroxysmal nocturnal hemoglobinuria (PNH). Eculizumab reduces complement-mediated haemolytic activity in PNH. This study was aimed at assessing the impact of eculizumab on VLD outcome. Retrospective cohort of PNH patients, in Valdig registry, who had VLD diagnosed between 1997 and 2019 is considered. Eculizumab was the exposure of interest. Studied outcomes were death, venous thrombosis, bleeding, arterial ischemic event, infection, and liver-related complications. We compared survival and new thrombotic events from PNH/VLD cohort to Envie2 non-PNH cohort. Sixty-two patients (33 women), median age 35 years (28-48) and median follow-up VLD diagnosis 4.7 years (1.2-9.5), were included. Clone size was 80% (70-90), median hemoglobin concentration was 10.0 g/dl (8-11), and lactate dehydrogenase (LDH) was 736 IU (482-1744). Forty-two patients (68%) had eculizumab; median exposure time was 40.1 [9.3-72.6] months. Mortality was significantly lower in exposed versus nonexposed period: 2.6 versus 8.7 per 100 (PY), incidence rate ratio (IRR) was 0.29, 95% CI (0.1-0.9), p = .035. Thrombosis recurrence occurred less frequently during the exposure to eculizumab: 0.5 versus 2.8 per 100 PY, IRR 0.22 (0.07-0.64). Other secondary end points (i.e., bleeding, arterial ischemic lesions, infection, and liver complications) were less common during the exposure to eculizumab, although not reaching statistical significance. Six-year thrombosis-free survival was 70%, 95% CI [0.60-0.83] for PNH cohort and 83%, 95% CI [0.70-1.00] for non-PNH Envie 2 patients, (p < .001). In conclusion, patients with PNH and VLD are at higher risk of recurrent thrombosis than non-PNH patients. Eculizumab is significantly associated with a lower mortality and less thrombotic recurrence in patients with PNH and VLD., (© 2022 Wiley Periodicals LLC.)
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- 2022
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14. Recommendations for management of portal vein thrombosis in cirrhosis.
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Valla DC
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- Humans, Liver Cirrhosis complications, Liver Cirrhosis pathology, Portal Vein diagnostic imaging, Portal Vein pathology, Liver Diseases pathology, Venous Thrombosis etiology, Venous Thrombosis therapy
- Published
- 2021
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15. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases.
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Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, and Valla DC
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- Disease Management, Esophageal and Gastric Varices pathology, Esophageal and Gastric Varices surgery, Gastrointestinal Hemorrhage pathology, Gastrointestinal Hemorrhage prevention & control, Humans, Portal Vein pathology, Risk Assessment, Societies, Medical, United States, Esophageal and Gastric Varices etiology, Gastrointestinal Hemorrhage etiology, Liver Cirrhosis complications, Liver Cirrhosis pathology, Varicose Veins
- Published
- 2021
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16. Recent developments in the field of vascular liver diseases.
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Valla DC
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- Adult, Anticoagulants therapeutic use, Humans, Liver Cirrhosis complications, Liver Cirrhosis pathology, Portal Vein pathology, Venous Thrombosis drug therapy, Venous Thrombosis pathology
- Abstract
Knowledge in the field of vascular liver disease is continuously expanding. The present update will discuss recent data on i) the Abernethy malformation in adults; ii) portal vein thrombosis in cirrhosis; iii) advancing expertise in recanalization of the portal vein and iv) experience in using direct oral anticoagulants in the field of vascular liver disease., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2020
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17. Anticoagulation in the cirrhotic patient.
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Turco L, de Raucourt E, Valla DC, and Villa E
- Abstract
In the past, patients with liver cirrhosis were thought to be prone to increased bleeding risk. However, those with compensated liver cirrhosis actually have normal coagulative balance, which can become altered when liver function worsens, or infection, bleeding, or acute kidney insufficiency occur. When this happens, it is now recognized that patients with liver cirrhosis are at higher risk of thrombotic rather than haemorrhagic complications. Anticoagulation plays a favourable role both when used therapeutically or prophylactically. Successful anticoagulation is associated with a lower rate of decompensation and with improved survival. To date, treatment has involved the use of low molecular weight heparins and vitamin K antagonists. Preliminary data suggest that novel non-vitamin K antagonist oral anticoagulants can be used safely in patients with liver cirrhosis., (© 2019 The Author(s).)
- Published
- 2019
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18. Understanding the Similarities and Differences between Hepatic and Pulmonary Veno-Occlusive Disease.
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Günther S, Perros F, Rautou PE, Girerd B, Ghigna MR, Cazals-Hatem D, Lau EM, Dorfmüller P, Sitbon O, Valla DC, Humbert M, and Montani D
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- Animals, Diagnosis, Differential, Disease Models, Animal, Genetic Predisposition to Disease, Hepatic Veno-Occlusive Disease diagnosis, Hepatic Veno-Occlusive Disease etiology, Hepatic Veno-Occlusive Disease therapy, Humans, Prognosis, Pulmonary Veno-Occlusive Disease diagnosis, Pulmonary Veno-Occlusive Disease etiology, Pulmonary Veno-Occlusive Disease therapy, Rats, Risk Factors, Hepatic Veno-Occlusive Disease pathology, Pulmonary Veno-Occlusive Disease pathology
- Abstract
Hepatic veno-occlusive disease (HVOD), alias sinusoidal obstruction syndrome, may develop as a complication of chemotherapy in the setting of hematopoietic stem cell transplantation. HVOD is less frequently described after exposure to chemotherapy in the nontransplant setting and can also be a complication after ingestion of toxins, such as pyrrolizidine alkaloids. Veno-occlusive disease may also affect the lungs, and it is therefore termed pulmonary veno-occlusive disease (PVOD). Similarly, PVOD can develop after exposure to chemotherapeutic agents in the treatment of solid and hematological malignancies. In addition, PVOD has also been linked to autoimmune disorders and occupational solvent exposure. Finally, the heritable form of PVOD is due to biallelic mutations of the EIF2AK4 gene. Both HVOD and PVOD share common histopathological features and pathophysiologic mechanisms. Both clinical disorders are rare complications that can appear after exposure to the common inciting trigger of chemotherapeutic agents. The present review aims to summarize the current knowledge of HVOD and PVOD and to describe both similarities as well as differences regarding both conditions., (Copyright © 2019 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)
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- 2019
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19. Vascular liver diseases on the clinical side: definitions and diagnosis, new concepts.
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Valla DC and Cazals-Hatem D
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- Budd-Chiari Syndrome pathology, Humans, Liver blood supply, Liver Diseases pathology, Budd-Chiari Syndrome diagnosis, Hepatic Artery pathology, Liver pathology, Liver Diseases diagnosis, Portal Vein pathology
- Abstract
The components of the hepatic vascular system (hepatic arteries, portal and hepatic veins, sinusoids, and lymphatics) can be damaged by various types of injury. Each of the resulting conditions is rare, which has limited knowledge and awareness. In the last two decades, international collaborations have allowed to reach critical masses of data, which has driven significant progresses in understanding and management of vascular disorders of the liver. The present paper discusses definitions, denominations, and diagnosis of such vascular disorders with the exception of those affecting hepatic arteries. Evolving pathogenic or pathophysiologic views relevant to the clinical aspects are also overviewed.
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- 2018
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20. Transient portal vein thrombosis in liver cirrhosis.
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Qi X, Guo X, Yoshida EM, Méndez-Sánchez N, De Stefano V, Tacke F, Mancuso A, Sugawara Y, Yang SS, Teschke R, Arora A, and Valla DC
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- Adult, Anticoagulants pharmacology, Female, Humans, Liver Cirrhosis pathology, Male, Prognosis, Treatment Outcome, Venous Thrombosis mortality, Venous Thrombosis pathology, Anticoagulants therapeutic use, Liver Cirrhosis complications, Portal Vein abnormalities, Venous Thrombosis etiology
- Abstract
In real-world clinical practice, the acceptance of anticoagulation therapy in the management of portal vein thrombosis (PVT) in patients with cirrhosis is limited by the fear of an increased bleeding risk. Additionally, accumulating evidence indicates that spontaneous recanalization of PVT may occur in the absence of antithrombotic treatment. Therefore, risk stratification based on outcomes in such patients is crucial for determining a therapeutic strategy. In this paper, we draw attention to the distinct clinical entity, "transient PVT" by introducing two cases with PVT that spontaneously recanalized in the absence of antithrombotic treatment. We reviewed the available data regarding the probability of and predictors for spontaneous recanalization of PVT. Available data suggest singling out transient thrombosis in the natural history of PVT in patients with cirrhosis because of its prognostic and management implications.
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- 2018
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21. Budd-Chiari syndrome/hepatic venous outflow tract obstruction.
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Valla DC
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- Adolescent, Adult, Aged, Aged, 80 and over, Angioplasty methods, Anticoagulants therapeutic use, Budd-Chiari Syndrome epidemiology, Budd-Chiari Syndrome etiology, Budd-Chiari Syndrome therapy, Diuretics therapeutic use, Female, Hepatic Veins diagnostic imaging, Humans, Incidence, Liver Transplantation methods, Magnetic Resonance Imaging, Male, Middle Aged, Portasystemic Shunt, Transjugular Intrahepatic methods, Prognosis, Risk Factors, Survival Rate, Thrombophilia complications, Tomography, X-Ray Computed, Ultrasonography, Doppler, Vena Cava, Inferior pathology, Venous Thrombosis pathology, Young Adult, Budd-Chiari Syndrome diagnosis, Hepatic Veins pathology, Myeloproliferative Disorders complications, Vena Cava, Inferior diagnostic imaging
- Abstract
Background: Budd-Chiari syndrome (BCS) is a rare disease characterized by hepatic venous outflow tract obstruction (HVOTO)., Methods: Recent literature has been analyzed for this narrative review., Results: Primary BCS/HVOTO is a result of thrombosis. The same patient often has multiple risk factors for venous thrombosis and most have at least one. Presentation and etiology may differ between Western and certain Eastern countries. Myeloproliferative neoplasms are present in 40% of patients and are usually associated with the V617F-JAK2 mutation in myeloid cells, in particular peripheral blood granulocytes. Presentation and symptoms vary, thus this diagnosis must be considered in any patient with acute or chronic liver disease. Doppler ultrasound, computed tomography, or magnetic resonance imaging of the hepatic veins and inferior vena cava usually successfully provide noninvasive identification of the obstruction or its consequences in the collaterals of hepatic veins or the inferior vena cava. The reported life expectancy in these patients is 3 years after the first symptoms. The therapeutic strategy includes first, anticoagulation, correction of risk factors, diuretics, and prophylaxis for portal hypertension, then angioplasty for short-length venous stenosis followed by transjugular intrahepatic portosystemic shunt (TIPS) and finally liver transplantation. The progression of treatment is based on the response to therapy at each step. This strategy results in a 5-year survival rate of nearly 85%. The medium-term prognosis depends upon the severity of liver disease, and the long-term outcome can be jeopardized by transformation of underlying conditions and hepatocellular carcinoma., Conclusion: BCS/HVOTO hepatic manifestations of BCS/HVOTO can be controlled in most patients with medical or radiological interventions. Underlying disease has become the major determinant of patient outcome.
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- 2018
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22. Anticoagulation for Portal Vein Thrombosis in Cirrhosis: Selection of Appropriate Patients.
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Qi X, Valla DC, and Guo X
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- Anticoagulants, Blood Coagulation, Humans, Hypertension, Portal, Liver Cirrhosis, Thrombosis, Portal Vein, Venous Thrombosis
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- 2018
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23. Cholangiopathy in critically ill patients surviving beyond the intensive care period: a multicentre survey in liver units.
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Laurent L, Lemaitre C, Minello A, Plessier A, Lamblin G, Poujol-Robert A, Gervais-Hasenknopf A, Pariente EA, Belenotti P, Mostefa-Kara N, Sogni P, Legrand M, Cournac JM, Tamion F, Savoye G, Bedossa P, Valla DC, Vilgrain V, and Goria O
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bile Ducts, Intrahepatic, Cholangiography, Critical Care, Female, Humans, Liver Function Tests, Male, Middle Aged, Retrospective Studies, Surveys and Questionnaires, Young Adult, Bile Duct Diseases mortality, Critical Illness mortality, Intensive Care Units statistics & numerical data, Liver Diseases mortality
- Abstract
Background: The outcome of cholangiopathy developing in intensive care unit (ICU) is not known in patients surviving their ICU stay., Aim: To perform a survey in liver units, in order to clarify the course of cholangiopathy after surviving ICU stay., Methods: The files of the liver units affiliated to the French network for vascular liver disease were screened for cases of ICU cholangiopathy developing in patients with normal liver function tests on ICU admission, and no prior history of liver disease., Results: Between 2005 and 2015, 16 cases were retrieved. Extensive burns were the cause for admission to ICU in 11 patients. Serum alkaline phosphatase levels increased from day 11 (2-46) to a peak of 15 (4-32) × ULN on day 81 (12-511). Magnetic resonance cholangiography showed irregularities or frank stenosis of the intrahepatic ducts, and proximal extrahepatic ducts contrasting with a normal aspect of the distal common bile duct. Follow-up duration was 20.6 (4.7-71.8) months. Three patients were lost to follow-up; 2 patients died from liver failure and no patient was transplanted. One patient had worsening strictures of the intrahepatic bile ducts with jaundice. Nine patients had persistent but minor strictures of the intrahepatic bile ducts on MR cholangiography, and persistent cholestasis without jaundice. One patient had normal liver function tests., Conclusions: In patients surviving their ICU stay, ICU cholangiopathy is not uniformly fatal in the short term or clinically symptomatic in the medium term. Preservation of the distal common bile duct appears to be a finding differentiating ICU cholangiopathy from other diffuse cholangiopathies., (© 2017 John Wiley & Sons Ltd.)
- Published
- 2017
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24. Reply to: "Calreticulin mutations and their importance in Budd-Chiari syndrome".
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Poisson J, Turon F, Marzac C, Valla DC, Garcia-Pagan JC, and Rautou PE
- Subjects
- Humans, Mutation, Budd-Chiari Syndrome, Calreticulin
- Published
- 2017
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25. Selective testing for calreticulin gene mutations in patients with splanchnic vein thrombosis: A prospective cohort study.
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Poisson J, Plessier A, Kiladjian JJ, Turon F, Cassinat B, Andreoli A, De Raucourt E, Goria O, Zekrini K, Bureau C, Lorre F, Cervantes F, Colomer D, Durand F, Garcia-Pagan JC, Casadevall N, Valla DC, Rautou PE, and Marzac C
- Subjects
- Adult, Female, Humans, Janus Kinase 2 genetics, Male, Middle Aged, Myeloproliferative Disorders genetics, Prospective Studies, Calreticulin genetics, Mutation, Venous Thrombosis genetics
- Abstract
Background and Aims: Myeloproliferative neoplasms (MPN) are the leading cause of splanchnic vein thrombosis (SVT). Janus kinase 2 gene (JAK2)
V617F mutations are found in 80 to 90% of patients with SVT and MPN. Mutations of the calreticulin (CALR) gene have also been reported. However, as their prevalence ranges from 0 to 2%, the utility of routine testing is questionable. This study aimed to identify a group of patients with SVT at high risk of harboring CALR mutations and thus requiring this genetic testing., Methods: CALR, JAK2V617F and thrombopoietin receptor gene (MPL) mutations were analysed in a test cohort that included 312 patients with SVT. Criteria to identify patients at high risk of CALR mutations in this test cohort was used and evaluated in a validation cohort that included 209 patients with SVT., Results: In the test cohort, 59 patients had JAK2V617F , five had CALR and none had MPL mutations. Patients with CALR mutations had higher spleen height and platelet count than patients without these mutations. All patients with CALR mutations had a spleen height ⩾16cm and platelet count >200×109 /L. These criteria had a positive predictive value of 56% (5/9) and a negative predictive value of 100% (0/233) for the identification of CALR mutations. In the validation cohort, these criteria had a positive predictive value of 33% (2/6) and a negative predictive value of 99% (1/96)., Conclusion: CALR mutations should be tested in patients with SVT, a spleen height ⩾16cm, platelet count >200×109 /L, and no JAK2V617F . This strategy avoids 96% of unnecessary CALR mutations testing. Lay summary: Mutations of the CALR gene are detected in 0 to 2% of patients with SVT, thus the utility of systematic CALR mutation testing to diagnose MPN is questionable. This study demonstrates that CALR mutations testing can be restricted to patients with SVT, a spleen height ⩾16cm, a platelet count >200×109 /L, and no JAK2V617F . This strategy avoids 96% of unnecessary CALR mutations testing., (Copyright © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)- Published
- 2017
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26. Review article: the aetiology of primary Budd-Chiari syndrome - differences between the West and China.
- Author
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Qi X, Han G, Guo X, De Stefano V, Xu K, Lu Z, Xu H, Mancuso A, Zhang W, Han X, Valla DC, and Fan D
- Subjects
- Antibodies, Antiphospholipid blood, Asian People genetics, Budd-Chiari Syndrome blood, Budd-Chiari Syndrome epidemiology, China, Factor V genetics, Female, Hematologic Diseases epidemiology, Humans, Hyperhomocysteinemia epidemiology, Methylenetetrahydrofolate Reductase (NADPH2) genetics, Mutation, Poverty, Pregnancy, Prothrombin genetics, Budd-Chiari Syndrome etiology
- Abstract
Background: China may have the largest number of Budd-Chiari syndrome (BCS) cases in the world (at least 1914 original papers were published, and at least 20 191 BCS patients were reported). Considering the discrepancy in the clinical profiles and preferred treatment selection of primary BCS between the West and China, understanding its aetiology in these two different regions is very important., Aim: To review the data from large cohort studies and meta-analyses to illustrate the epidemiology of risk factors for BCS in the West and China., Methods: Relevant papers were identified by major English- and Chinese-language databases, conference abstracts, and by manual search., Results: Risk factors reviewed include myeloproliferative neoplasms (MPNs) and their related gene mutations, anti-phospholipid syndrome, paroxysmal nocturnal haemoglobinuria (PNH), hyperhomocysteinaemia and 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T mutation, factor V Leiden (FVL) and prothrombin G20210A mutations, inherited anti-thrombin, protein C and protein S deficiencies, pregnancy and puerperium, poverty, and family history., Conclusions: We examined the differences in the aetiological distribution of BCS between the West and China. Several recommendations should be considered in Chinese BCS patients: (i) screening for hyperhomocysteinaemia and MTHFR mutation should be regularly performed; (ii) screening for MPNs, PNH, and anti-phospholipid syndrome should be selectively performed; (iii) inherited anti-thrombin, protein C, and protein S deficiencies should be actively explored; (iv) screening for FVL and prothrombin G20210A mutations may be unnecessary; and (v) the clinical significance of pregnancy and puerperium, poverty with bacterial infections and unsanitary environments, and family history as possible risk factors should never be neglected., (© 2016 John Wiley & Sons Ltd.)
- Published
- 2016
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27. Toward a Comprehensive New Classification of Portal Vein Thrombosis in Patients With Cirrhosis.
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Sarin SK, Philips CA, Kamath PS, Choudhury A, Maruyama H, Nery FG, and Valla DC
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- Humans, Venous Thrombosis etiology, Venous Thrombosis pathology, Liver Cirrhosis complications, Portal Vein, Venous Thrombosis classification
- Published
- 2016
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28. Sinusoidal obstruction syndrome.
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Valla DC and Cazals-Hatem D
- Subjects
- Antineoplastic Agents adverse effects, Hematopoietic Stem Cell Transplantation adverse effects, Humans, Liver Neoplasms drug therapy, Pyrrolizidine Alkaloids adverse effects, Hepatic Veno-Occlusive Disease etiology
- Abstract
Sinusoidal obstruction syndrome (SOS) is characterized by damage to small hepatic vessels affecting particularly sinusoidal endothelium. Damaged sinusoids can be associated with a partial or complete occlusion of small hepatic veins, hence the previous denomination of hepatic veno-occlusive disease (VOD). Exposure to certain exogenous toxins appears to be specific to this condition and is frequently included in its definition. Typical histopathological features of SOS in a liver biopsy specimen are presented in the text. The purpose of this article is to provide an overview on the different entities corresponding to this general definition. Such entities include: (i) liver disease related to pyrrolizidine alcaloids; (ii) liver injury related to conditioning for hematopoietic stem cell transplantation; (iii) vascular liver disease occurring in patients treated with chemotherapy for liver metastasis of colorectal cancer; and (iv) other liver diseases related to toxic agents., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)
- Published
- 2016
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29. Acute extrahepatic infectious or inflammatory diseases are a cause of transient mosaic pattern on CT and MR imaging related to sinusoidal dilatation of the liver.
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Ronot M, Kerbaol A, Rautou PE, Brancatelli G, Bedossa P, Cazals-Hatem D, Valla DC, and Vilgrain V
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Biopsy, Contrast Media, Dilatation, Pathologic pathology, Female, Hepatic Veins pathology, Humans, Infections pathology, Inflammation pathology, Magnetic Resonance Imaging methods, Male, Middle Aged, Portal Vein pathology, Tomography, X-Ray Computed methods, Young Adult, Liver Neoplasms pathology
- Abstract
Purpose: To report the association of a mosaic enhancement pattern on contrast-enhanced CT or MR imaging and hepatic sinusoidal dilatation (SD) with acute inflammatory conditions affecting extrahepatic organs., Methods: From 2007 to 2012, patients with acute inflammatory diseases who underwent contrast-enhanced CT and/or MRI of the liver with a mosaic enhancement pattern were selected. Clinico-biological and other imaging features were collected at diagnosis and during follow-up., Results: Sixteen patients were included (15 women, median age 27 years; range 18-68). Five women (33 %) were receiving oral contraceptives. Acute inflammatory diseases included pyelonephritis (n = 10), pancreatitis (n = 2), pneumonia (n = 1), septicemia (n = 1), active Crohn's disease (n = 1), and infectious colitis (n = 1). Median white blood cell count was 13,250 cells/μL (range 11,500-18,000 cells/μL) and CRP level 94 mg/L (range 60-121 mg/L). Mosaic enhancement pattern was present in the whole liver and was prominent in the subcapsular areas. Four patients underwent liver biopsy confirming SD. Eleven patients underwent follow-up imaging showing normalized aspect in 9/11 patients after a median of 2 months., Conclusion: Acute diseases of extrahepatic organs, associated with a marked systemic inflammatory syndrome should be added to the list of conditions causing a reversible hepatic sinusoidal dilatation as manifested by a mosaic enhancement pattern on contrast-enhanced CT or MR imaging., Key Points: • Acute extrahepatic infectious/inflammatory diseases are a cause of transient MP. • In most patients, MP was seen during both arterial and portal venous phase. • In all patients, the mosaic enhancement pattern was diffuse, but more conspicuous in subcapsular areas. • MP was no longer seen after resolution of the acute disease. • No liver biopsy should be performed.
- Published
- 2016
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30. Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension.
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Bissonnette J, Garcia-Pagán JC, Albillos A, Turon F, Ferreira C, Tellez L, Nault JC, Carbonell N, Cervoni JP, Abdel Rehim M, Sibert A, Bouchard L, Perreault P, Trebicka J, Trottier-Tellier F, Rautou PE, Valla DC, and Plessier A
- Subjects
- Adult, Europe epidemiology, Female, Humans, Hypertension, Portal complications, Hypertension, Portal mortality, Male, Middle Aged, Quebec epidemiology, Retrospective Studies, Hypertension, Portal therapy, Portasystemic Shunt, Transjugular Intrahepatic
- Abstract
Unlabelled: Idiopathic noncirrhotic portal hypertension is a heterogeneous group of diseases characterized by portal hypertension in the absence of cirrhosis. The efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in this population are unknown. The charts of patients with idiopathic noncirrhotic portal hypertension undergoing TIPS in seven centers between 2000 and 2014 were retrospectively reviewed. Forty-one patients were included. Indications for TIPS were recurrent variceal bleeding (n = 25) and refractory ascites (n = 16). Patients were categorized according to the presence (n = 27) or absence (n = 14) of significant extrahepatic comorbidities. Associated conditions were hematologic, prothrombotic, neoplastic, immune, and exposure to toxins. During follow-up (mean 27 ± 29 months), variceal rebleeding occurred in 7/25 (28%), including three with early thrombosis of the stent. Post-TIPS overt hepatic encephalopathy was present in 14 patients (34%). Eleven patients died, five due the liver disease or complications of the procedure and six because of the associated comorbidities. The procedure was complicated by hemoperitoneum in four patients (10%), which was fatal in one case. Serum creatinine (P = 0.005), ascites as indication for TIPS (P = 0.04), and the presence of significant comorbidities (P = 0.01) at the time of the procedure were associated with death. Mortality was higher in patients with significant comorbidities and creatinine ≥100 μmol/L (P < 0.001)., Conclusion: In patients with idiopathic noncirrhotic portal hypertension who have normal kidney function or do not have severe extrahepatic conditions, TIPS is an excellent option to treat severe complications of portal hypertension. (Hepatology 2016;64:224-231)., (© 2016 by the American Association for the Study of Liver Diseases.)
- Published
- 2016
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31. Safety of supramesocolic surgery in patients with portal cavernoma without portal vein decompression. Large single centre experience.
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Dokmak S, Aussilhou B, Sauvanet A, Lévy P, Plessier A, Ftériche FS, Farges O, Vilgrain V, Valla DC, and Belghiti J
- Subjects
- Adult, Aged, Cholestasis diagnostic imaging, Cholestasis etiology, Cholestasis physiopathology, Collateral Circulation, Computed Tomography Angiography, Drainage instrumentation, Female, France, Humans, Hypertension, Portal diagnostic imaging, Hypertension, Portal etiology, Hypertension, Portal physiopathology, Liver Circulation, Male, Middle Aged, Phlebography methods, Portal Pressure, Portal Vein diagnostic imaging, Portal Vein physiopathology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Stents, Time Factors, Treatment Outcome, Biliopancreatic Diversion adverse effects, Cholecystectomy adverse effects, Cholestasis surgery, Decompression, Surgical, Hypertension, Portal surgery, Portal Vein surgery
- Abstract
Background: Supra-mesocolic surgery (SMS) is complicated in patients with portal vein cavernoma (PC) and portal decompression is recommended. The aim of this study was to report a large single centre of SMS in patients with PC without portal decompression., Methods: Between 2006 and 2013, all patients who met inclusion criteria were analyzed retrospectively. The primary endpoint was the feasibility rate, surgical and postoperative outcome. The secondary endpoints were the long-term outcome of patients who underwent biliary bypass for cholangitis. Risk factors for complications were studied., Results: Thirty patients underwent 51 procedures. Pancreatitis was the main etiology of PC (19/30) and biliary obstruction was mainly related to the underlying disease and not to portal cholangiopathy (12/14). All planned procedures were successfully completed. Fourteen patients underwent biliary bypass. Median blood loss (250 ml), transfusion (n = 7), mortality (n = 0), overall morbidity (n = 12) and the median hospital stay (10 days). Good long-term control of cholangitis was achieved in the 9 patients alive with available follow-up. Significant risk factors for complications were a previous abdominal wall scar, previous intra-abdominal surgical field and liver fibrosis., Conclusion: SMS can be safely performed in patients with PC. In patients with risk factors for complications, portal decompression should be discussed., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2016
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32. Editorial: short-length stenoses of hepatic venous outflow tract - an Asian specificity?
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Valla DC and Payancé A
- Subjects
- Constriction, Pathologic, Humans, Hepatic Veins, Liver Transplantation
- Published
- 2016
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33. [Idiopathic non-cirrhotic portal hypertension: An update].
- Author
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Bissonnette J, Rautou PE, and Valla DC
- Subjects
- Esophageal and Gastric Varices complications, Esophageal and Gastric Varices epidemiology, Esophageal and Gastric Varices therapy, Gastrointestinal Hemorrhage complications, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage therapy, Humans, Hypertension, Portal epidemiology, Hypertension, Portal etiology, Liver Cirrhosis complications, Liver Cirrhosis epidemiology, Liver Cirrhosis therapy, Portal Vein pathology, Practice Patterns, Physicians' trends, Hypertension, Portal therapy
- Abstract
Idiopathic non-cirrhotic portal hypertension is an under-estimated cause of portal hypertension. The diagnosis requires the exclusion of cirrhosis, common causes of chronic liver disease and venous obstruction of the portal and hepatic veins. It has been associated with various extra-hepatic conditions that are most frequently immunologic, prothrombotic, hematologic and toxic. The most frequent clinical complications are variceal hemorrhage and portal vein thrombosis. Complications of portal hypertension should be managed as in patients with cirrhosis., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Published
- 2015
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34. Interplay of Inflammation and Endothelial Dysfunction in Bone Marrow Transplantation: Focus on Hepatic Veno-Occlusive Disease.
- Author
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Vion AC, Rautou PE, Durand F, Boulanger CM, and Valla DC
- Subjects
- Angiogenic Proteins metabolism, Animals, Anticoagulants therapeutic use, Capillary Leak Syndrome etiology, Capillary Leak Syndrome physiopathology, Cardiovascular Diseases etiology, Cardiovascular Diseases physiopathology, Cell Adhesion Molecules metabolism, Cell-Derived Microparticles, Endothelium, Vascular drug effects, Endothelium, Vascular radiation effects, Fever etiology, Fever physiopathology, Graft vs Host Disease etiology, Graft vs Host Disease physiopathology, Hematologic Diseases physiopathology, Hematologic Diseases therapy, Hematopoietic Stem Cell Transplantation adverse effects, Hepatic Veno-Occlusive Disease drug therapy, Hepatic Veno-Occlusive Disease pathology, Humans, Immunosuppressive Agents adverse effects, Nitric Oxide metabolism, Polydeoxyribonucleotides therapeutic use, Pulmonary Veno-Occlusive Disease etiology, Pulmonary Veno-Occlusive Disease physiopathology, Radiation Injuries physiopathology, Syndrome, Thrombotic Microangiopathies etiology, Transplantation Conditioning adverse effects, Bone Marrow Transplantation adverse effects, Endothelium, Vascular physiopathology, Hepatic Veno-Occlusive Disease etiology, Inflammation blood
- Abstract
Endothelial cells are unique multifunctional cells with basal and inducible metabolic and synthetic functions. Various stimuli can induce physiological or pathological changes in endothelial cell biology. Hematopoietic stem cell transplantation (HSCT) requires high-dose irradiation and/or chemotherapy and is associated with increased risk of bacterial infections and immune reactions. These factors can affect endothelial cells. This review provides an overview of the effects of HSCT on endothelial cells, based on findings observed in cultured cells as well as in patients. We first describe to what extent irradiation and chemotherapy constitute direct and indirect triggers for endothelial cell activation and injury. Then, we highlight the role of the endothelium in several complications of HSCT, including capillary leak syndrome, engraftment syndrome, transplant-associated microangiopathy, graft-versus-host disease, and diffuse alveolar hemorrhages. We also analyze in detail available data on sinusoidal obstruction syndrome, previously known as veno-occlusive disease of the liver, where liver sinusoidal endothelial cells are first injured and eventually lead to sinusoid occlusion and liver cell damage. Finally, we open the question of the possible contribution of endothelial damage to cardiovascular events occurring long after HSCT., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Published
- 2015
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35. The significance of nonobstructive sinusoidal dilatation of the liver: Impaired portal perfusion or inflammatory reaction syndrome.
- Author
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Marzano C, Cazals-Hatem D, Rautou PE, and Valla DC
- Subjects
- Animals, Female, Humans, Hypertension, Portal physiopathology, Interleukin-6 metabolism, Liver Circulation physiology, Male, Mice, Organoplatinum Compounds therapeutic use, Prognosis, Pyridines therapeutic use, Risk Assessment, Vascular Endothelial Growth Factor A metabolism, Hepatic Veno-Occlusive Disease etiology, Hepatic Veno-Occlusive Disease physiopathology, Organoplatinum Compounds adverse effects, Portal System physiopathology, Pyridines adverse effects, Systemic Inflammatory Response Syndrome physiopathology
- Abstract
Unlabelled: Sinusoidal dilatation found in the absence of an impaired sinusoidal blood outflow has been so far of unclear significance. Sinusoidal dilatation may actually be a nonspecific feature of impaired portal venous blood inflow, whatever the cause, or a feature of severe systemic inflammatory reaction syndrome, whatever the cause. Sinusoidal dilatation is mainly located in the centrilobular area even in the absence of an outflow block. A predominantly periportal location is specifically found in oral contraceptive users, associated with an inflammatory condition. There is strong evidence for the association of sinusoidal dilatation and oxaliplatin-based chemotherapy but not for estroprogestative steroids or thiopurine derivatives. Exposure to anabolic androgen steroids appears to cause sinusoidal changes different from a mere sinusoidal dilatation., Conclusion: There is evidence of activation of the interleukin-6 and vascular endothelial growth factor pathways in sinusoidal dilatation, but the mechanisms linking the activation of these pathways with the microvascular changes must be identified., (© 2015 by the American Association for the Study of Liver Diseases.)
- Published
- 2015
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36. Somatic calreticulin mutations in patients with Budd-Chiari syndrome and portal vein thrombosis.
- Author
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Plompen EP, Valk PJ, Chu I, Darwish Murad SD, Plessier A, Turon F, Trebicka J, Primignani M, Garcia-Pagán JC, Valla DC, Janssen HL, and Leebeek FW
- Subjects
- Adult, Case-Control Studies, Cohort Studies, Female, Humans, Male, Middle Aged, Mutation genetics, Prospective Studies, Venous Thrombosis diagnosis, Venous Thrombosis genetics, Budd-Chiari Syndrome diagnosis, Budd-Chiari Syndrome genetics, Calreticulin genetics, Internationality, Portal Vein pathology
- Published
- 2015
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37. Aetiological factors of Budd-Chiari syndrome in Algeria.
- Author
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Afredj N, Guessab N, Nani A, Faraoun SA, Ouled Cheikh I, Kerbouche R, Hannoun D, Amir ZC, Ait Kaci H, Bentabak K, Plessier A, Valla DC, Cazals-Hatem V, Denninger MH, Boucekkine T, and Debzi N
- Abstract
Aim: To study the clinical presentation of Budd-Chiari syndrome (BCS) and identify the aetiologies of this disease in Algeria., Methods: Patients with BCS, hospitalised in our unit from January 2004 until June 2010 were included and the aetiological factors were assessed. Patients presenting a BCS in the setting of advanced-stage cirrhosis or a liver transplantation were excluded from the study. The diagnosis was established when an obstruction of hepatic venous outflow (thrombosis, stenosis or compression) was demonstrated. We diagnosed myeloproliferative disease (MPD) by bone marrow biopsy and V617F JAK2 mutation. Anti-phospholipid syndrome (APLS) was detected by the presence of anticardiolipin antibodies, anti-β2 glycoprotein antibodies and Lupus anticoagulant. We also detected paroxysmal nocturnal haemoglobinuria (PNH) by flow cytometry. Celiac disease and Behçet disease were systematically investigated in our patients. Hereditary anticoagulant protein deficiencies were also assessed. We tested our patients for the G20210A mutation at Beaujon Hospital. Imaging procedures were performed to determine a local cause of BCS, such as a hydatid cyst or a liver tumour., Results: One hundred and fifteen patients were included. Mean follow up: 32.12 mo. Mean age: 34.41 years, M/F = 0.64. Chronic presentation was frequent: 63.5%. The revealing symptoms for the BCS were ascites (74.8%) and abdominal pain (42.6%). The most common site of thrombosis was the hepatic veins (72.2%). Involvement of the inferior vena cava alone was observed in 3 patients. According to the radiological investigations, BCS was primary in 94.7% of the cases (n = 109) and secondary in 5.2% (n = 6). An aetiology was identified in 77.4% of the patients (n = 89); it was multifactorial in 27% (n = 31). The predominant aetiology of BCS in our patients was a myeloproliferative disease, observed in 34.6% of cases. APLS was found in 21.7% and celiac disease in 11.4%. Other acquired conditions were: PNH (n = 4), systemic disease (n = 6) and inflammatory bowel disease (n = 5). Anticoagulant protein deficiency was diagnosed in 28% of the patients (n = 18), dominated by protein C deficiency (n = 13). Secondary BCS was caused by a compressing hydatic cyst (n = 5) and hepatocellular carcinoma (n = 1)., Conclusion: The main aetiologic factor of BCS in Algeria is MPD. The frequency of celiac disease justifies its consideration when BCS is diagnosed in our region.
- Published
- 2015
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38. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study.
- Author
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Nery F, Chevret S, Condat B, de Raucourt E, Boudaoud L, Rautou PE, Plessier A, Roulot D, Chaffaut C, Bourcier V, Trinchet JC, and Valla DC
- Subjects
- Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Liver Cirrhosis complications, Portal Vein, Venous Thrombosis etiology
- Abstract
Unlabelled: In cirrhosis, portal vein thrombosis (PVT) could be a cause or a consequence of the progression of liver disease. We analyzed data from a prospective trial of ultrasound screening for hepatocellular carcinoma in order to identify risk factors for and the impact of PVT in patients with cirrhosis. In all, 1,243 adults with cirrhosis without PVT were enrolled from 43 liver units in France and Belgium between June 2000 and March 2006. The mean follow-up was 47 months. Doppler ultrasonography was used to check the portal vein. Progression of liver disease was defined by the development of: ascites, hepatic encephalopathy, variceal bleeding, prothrombin <45%, serum bilirubin >45 μmol/L, albumin <28 g/L, and/or creatinine >115 μmol/L. G20210A prothrombin and factor V gene mutations were assessed in sera stored at three large centers. The 5-year cumulative incidence of PVT was 10.7%. PVT was mostly partial and varied over time. The development of PVT was independently associated with baseline esophageal varices (P = 0.01) and prothrombin time (P = 0.002), but not with disease progression before PVT, or prothrombotic mutations. Disease progression was independently associated with baseline age (hazard ratio [HR] 1.55; 95% confidence interval [CI]: 1.11-2.17), body mass index (HR 1.40; 95% CI: 1.01-1.95), prothrombin time (HR 0.79; 95% CI: 0.70-0.90), serum albumin (HR 0.97; 95% CI: 0.94-0.99), and esophageal varices (HR 1.70; 95% CI: 1.21-2.38) but not with the prior development of PVT (HR 1.32; 95% CI: 0.68-2.65)., Conclusion: In patients with cirrhosis, the development of PVT is associated with the severity of liver disease at baseline, but does not follow a recent progression of liver disease. There is no evidence that the development of PVT is responsible for further progression of liver disease., (© 2014 by the American Association for the Study of Liver Diseases.)
- Published
- 2015
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39. The coagulation system in patients with end-stage liver disease.
- Author
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Valla DC and Rautou PE
- Subjects
- End Stage Liver Disease etiology, Hemostasis physiology, Humans, Liver Cirrhosis complications, Platelet Count, Prothrombin Time, Blood Coagulation physiology, End Stage Liver Disease drug therapy, End Stage Liver Disease physiopathology, Hypertension, Portal physiopathology, Liver Cirrhosis drug therapy, Liver Cirrhosis physiopathology, Thrombosis prevention & control
- Abstract
In patients with cirrhosis, routine laboratory tests for primary hemostasis and coagulation usually show anomalies that are associated with excess bleeding in other settings, in particular low platelet counts and prolonged prothrombin time. However, under conditions similar to those in vivo, primary hemostasis and thrombin production do not appear to be decreased in patients with cirrhosis, particularly when the platelet count is above 75,000/μl. Furthermore, there is laboratory and epidemiological evidence of a mild procoagulant and prothrombotic state in patients with cirrhosis. Bleeding is mainly because of portal hypertension rather than defective hemostasis. There is some evidence that anticoagulation therapy is not associated with an excess of severe bleeding and that it could improve the outcome in patients without portal vein thrombosis. At present, there is no clear evidence that portal vein thrombosis is responsible for the progression of liver disease and that anticoagulation therapy would improve the outcome of patients with portal vein thrombosis., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2015
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40. Small hepatic veins Budd-Chiari syndrome.
- Author
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Riggio O, Marzano C, Papa A, Pasquale C, Gasperini ML, Gigante A, Valla DC, Plessier A, and Amoroso A
- Subjects
- Adolescent, Adult, Female, Humans, Liver blood supply, Male, Budd-Chiari Syndrome pathology, Hepatic Veins pathology, Liver pathology
- Abstract
Budd-Chiari syndrome is a rare disorder characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atrio-caval junction, in the absence of heart failure or constrictive pericarditis. Various imaging modalities are available for investigating the gross hepatic vascular anatomy but there are rare forms of this disease where the obstruction is limited to the small intrahepatic veins, with normal appearance of the large hepatic veins at imaging. In this cases only a liver biopsy can demonstrate the presence of a small vessels outflow block. We report two cases of small hepatic veins Budd-Chiari syndrome.
- Published
- 2014
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41. Portal cavernoma cholangiopathy: consensus statement of a working party of the Indian national association for study of the liver.
- Author
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Dhiman RK, Saraswat VA, Valla DC, Chawla Y, Behera A, Varma V, Agarwal S, Duseja A, Puri P, Kalra N, Rameshbabu CS, Bhatia V, Sharma M, Kumar M, Gupta S, Taneja S, Kaman L, Zargar SA, Nundy S, Singh SP, Acharya SK, and Dilawari JB
- Abstract
Portal cavernoma cholangiopathy (PCC) is defined as abnormalities in the extrahepatic biliary system including the cystic duct and gallbladder with or without abnormalities in the 1st and 2nd generation biliary ducts in a patient with portal cavernoma. Presence of a portal cavernoma, typical cholangiographic changes on endoscopic or magnetic resonance cholangiography and the absence of other causes of these biliary changes like bile duct injury, primary sclerosing cholangitis, cholangiocarcinoma etc are mandatory to arrive a diagnosis. Compression by porto-portal collateral veins involving the paracholedochal and epicholedochal venous plexuses and cholecystic veins and ischemic insult due to deficient portal blood supply or prolonged compression by collaterals bring about biliary changes. While the former are reversible after porto-systemic shunt surgery, the latter are not. Majority of the patients with PCC are asymptomatic and approximately 21% are symptomatic. Symptoms in PCC could be in the form of long standing jaundice due to chronic cholestasis, or biliary pain with or without cholangitis due to biliary stones. Endoscopic retrograde cholangiography has no diagnostic role because it is invasive and is associated with risk of complications, hence it is reserved for therapeutic procedures. Magnetic resonance cholangiography and portovenography is a noninvasive and comprehensive imaging technique, and is the modality of choice for mapping of the biliary and vascular abnormalities in these patients. PCC is a progressive condition and symptoms develop late in the course of portal hypertension only in patients with severe or advanced changes of cholangiopathy. Asymptomatic patients with PCC do not require any treatment. Treatment of symptomatic PCC can be approached in a phased manner, coping first with biliary clearance by nasobiliary or biliary stent placement for acute cholangitis and endoscopic biliary sphincterotomy for biliary stone removal; second, with portal decompression by creating portosystemic shunt; and third, with persistent biliary obstruction by performing second-stage biliary drainage surgery such as hepaticojejunostomy or choledochoduodenostomy. Patients with symptomatic PCC have good prognosis after successful endoscopic biliary drainage and after successful shunt surgery.
- Published
- 2014
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42. Portal cavernoma cholangiopathy.
- Author
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Valla DC
- Published
- 2014
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43. Good long-term outcome of Budd-Chiari syndrome with a step-wise management.
- Author
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Seijo S, Plessier A, Hoekstra J, Dell'era A, Mandair D, Rifai K, Trebicka J, Morard I, Lasser L, Abraldes JG, Darwish Murad S, Heller J, Hadengue A, Primignani M, Elias E, Janssen HL, Valla DC, and Garcia-Pagan JC
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anticoagulants therapeutic use, Budd-Chiari Syndrome mortality, Cohort Studies, Europe, Female, Humans, Longitudinal Studies, Male, Middle Aged, Portasystemic Shunt, Transjugular Intrahepatic, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Thrombolytic Therapy, Young Adult, Budd-Chiari Syndrome diagnosis, Budd-Chiari Syndrome therapy, Disease Management
- Abstract
Unlabelled: Budd-Chiari syndrome (BCS) is a rare, life-threatening disease caused by obstruction of hepatic venous outflow. The aim of the study was to assess long-term outcome and identify prognostic factors in BCS patients managed by a step-wise approach using anticoagulation, angioplasty/thrombolysis, transjugular intrahepatic portosystemic shunting (TIPS), and orthotopic liver transplantation (OLT). We reviewed long-term data on 157 patients previously included by the European Network for Vascular Disorders of the Liver, a multicenter prospective study of newly diagnosed BCS patients in nine European countries. Patients were followed for a median of 50 months (range, 0.1-74.0). During the study, 88 patients (56%) received at least one invasive intervention (22 patients angioplasty/thrombolysis, 62 TIPS, and 20 OLT) and 36 (22.9%) died. Most interventions and/or deaths occurred in the first 2 years after diagnosis. The Rotterdam score was excellent in predicting intervention-free survival, and no other variable could significantly improve its prognostic ability. Moreover, BCS-TIPS prognostic index (PI) score (based on international normalized ratio, bilirubin, and age) was strongly associated with survival and had a discriminative capacity, which was superior to the Rotterdam score., Conclusions: The current study confirms, in a large cohort of patients with BCS recruited over a short period, that a step-wise treatment approach provides good long-term survival. In addition, the study validates the Rotterdam score for predicting intervention-free survival and the BCS-TIPS PI score for predicting survival., (Copyright © 2013 American Association for the Study of Liver Diseases.)
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- 2013
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44. MR findings of steatotic focal nodular hyperplasia and comparison with other fatty tumours.
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Ronot M, Paradis V, Duran R, Kerbaol A, Vullierme MP, Belghiti J, Valla DC, and Vilgrain V
- Subjects
- Adult, Fatty Liver complications, Focal Nodular Hyperplasia complications, Humans, Male, Middle Aged, Reproducibility of Results, Sensitivity and Specificity, Fatty Liver pathology, Focal Nodular Hyperplasia pathology, Liver Neoplasms complications, Liver Neoplasms pathology, Magnetic Resonance Imaging methods
- Abstract
Objectives: To correlate MR findings with pathology in steatotic FNHs and to compare the MR findings with those of other fatty tumours developed on noncirrhotic liver in a consecutive series of resected lesions., Methods: Our population included resected FNH with intralesional steatosis (n = 25) and other resected fatty tumours selected as controls (hepatocellular adenomas and angiomyolipomas, n = 34). Lesions were classified into three groups: those with typical FNH without (group 1) or with (group 2) fat on MR and those with atypical lesions (group 3). In group 3, diagnostic criteria for other fatty tumours were applied., Results: There were 9 lesions in group 1 (15.3 %), 4 in group 2 (16.8 %) and 46 in group 3 (77.9 %). Group 3 contained 12 FNHs (26 %) and all the other fatty tumours. In group 3, the association of lesion homogeneity, signal intensity similar to or slightly different from adjacent liver on in-phase T1- and T2-weighted sequences, and strong arterial enhancement was observed in 7/12 (58 %) of steatotic FNHs and 3/34 (9 %) of other tumours., Conclusion: On MR, fat within a typical FNH should not reduce the diagnostic confidence. We recommend further investigations including liver biopsy if necessary when fatty tumours exhibit atypical MR findings.
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- 2013
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45. Fibrinogen γ' and variation in fibrinogen gamma genes in the etiology of portal vein thrombosis.
- Author
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Smalberg JH, Koehler E, Darwish Murad S, Plessier A, Seijo S, Trebicka J, Primignani M, Rijken DC, de Maat MP, García-Pagán JC, Valla DC, Janssen HL, and Leebeek FW
- Subjects
- Alleles, Case-Control Studies, Cohort Studies, Female, Fibrinogen metabolism, Fibrinogens, Abnormal metabolism, Genotype, Haplotypes, Humans, Liver Diseases genetics, Male, Polymorphism, Single Nucleotide, Venous Thrombosis etiology, Fibrinogen genetics, Fibrinogens, Abnormal genetics, Portal Vein pathology, Venous Thrombosis genetics
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- 2013
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46. The burden of liver disease in Europe: a review of available epidemiological data.
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Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, and Roudot-Thoraval F
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- Cost of Illness, Europe epidemiology, Female, Hemochromatosis epidemiology, Hepatitis, Viral, Human epidemiology, Humans, Liver Cirrhosis epidemiology, Liver Diseases mortality, Liver Diseases, Alcoholic epidemiology, Liver Neoplasms epidemiology, Liver Transplantation, Male, Prevalence, Liver Diseases epidemiology
- Abstract
To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed. The incidence and prevalence of cirrhosis and primary liver cancer are key to understand the burden of liver disease. They represent the end-stage of liver pathology and thus are indicative of the associated mortality. About 0.1% of Hungarian males will die of cirrhosis every year compared with 0.001% of Greek females. WHO estimate that liver cancer is responsible for around 47,000 deaths per year in the EU. Harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to overweight and obesity are the leading causes of cirrhosis and primary liver cancer in Europe. Chronic hepatitis B affects 0.5-0.7% of the European population. In the last decade the prevalence of chronic hepatitis C was 0.13-3.26%. It is of great concern that about 90% of people in Europe infected by viral hepatitis are unaware of their status. Available data suggest the prevalence rate of NAFLD is 2-44% in the general European population (including obese children) and 42.6-69.5% in people with type 2 diabetes. Each of these four major causes of liver disease is amenable to prevention and treatment, reducing the burden of liver disease in Europe and saving lives. Further surveys are urgently needed to implement cost-effective prevention programmes and novel treatments to tackle this problem., (Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
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- 2013
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47. Standardized care management ensures similar survival rates in HIV-positive and HIV-negative patients with hepatocellular carcinoma.
- Author
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Lim C, Goutte N, Gervais A, Vullierme MP, Valla DC, Degos F, and Farges O
- Subjects
- Academic Medical Centers, Adult, Aged, Carcinoma, Hepatocellular mortality, Case-Control Studies, Cohort Studies, Female, France, HIV Infections drug therapy, HIV Infections mortality, Humans, Kaplan-Meier Estimate, Liver Neoplasms mortality, Male, Middle Aged, Patient Care Team, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular therapy, HIV Infections complications, Liver Neoplasms complications, Liver Neoplasms therapy, Patient Care Management standards
- Abstract
Objective: It has been suggested that HIV infection has a detrimental impact on patients with hepatocellular carcinoma (HCC). The present study sought to test this hypothesis, while controlling for tumor extension and liver disease., Design and Setting: A case control and a cohort approach were performed in patients with HCC managed prospectively via dedicated multidisciplinary team meeting in a single tertiary institution between 2004 and 2009., Subjects: Of 473 consecutive treatment-naive patients with HCC, 23 were HIV-positive (HIV) and 450 were HIV-negative (HIV). HIV patients were matched 1:2 with a control group of HIV patients in terms of the etiology of HCC, the severity of liver disease, tumor extension, and year of diagnosis., Intervention: Curative or palliative treatment of HCC., Main Outcome Measures: Eligibility for HCC treatment, the treatment actually administered, and the survival rate., Results: The HIV population was younger than the HIV population (mean age: 49 vs. 61 years, respectively; P < 0.0001). Curative treatment was recommended by the multidisciplinary team meeting and then actually performed to a similar extent in HIV patients (74% and 43%, respectively) and their matched HIV controls (74% and 56%, respectively). The HIV and their matched HIV patients did not differ significantly in terms of the 3-year survival rate [44% vs. 48%, respectively; mean (95% confidence interval) hazard ratio = 0.64 (0.3-1.3); P = 0.2]. In a cohort analysis, HIV status was not an independent predictor of survival among curatively treated patients., Conclusion: In an equal-access unbiased environment, HIV status does not significantly influence treatment access, delivery, and outcome.
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- 2012
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48. Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis.
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Smalberg JH, Arends LR, Valla DC, Kiladjian JJ, Janssen HL, and Leebeek FW
- Subjects
- Animals, Budd-Chiari Syndrome diagnosis, Budd-Chiari Syndrome genetics, Humans, Mutation, Myeloproliferative Disorders diagnosis, Myeloproliferative Disorders genetics, Portal Vein metabolism, Venous Thrombosis diagnosis, Venous Thrombosis genetics, Budd-Chiari Syndrome complications, Janus Kinase 2 genetics, Myeloproliferative Disorders complications, Portal Vein pathology, Venous Thrombosis complications
- Abstract
Myeloproliferative neoplasms (MPNs) are the most common cause of Budd-Chiari syndrome (BCS) and nonmalignant, noncirrhotic portal vein thrombosis (PVT). In this meta-analysis, we determined the prevalence of MPNs and their subtypes as well as JAK2V617F and its diagnostic role in these uncommon disorders. MEDLINE and EMBASE databases were searched. Prevalence of MPNs, JAK2V617F, and MPN subtypes were calculated using a random-effects model. A total of 1062 BCS and 855 PVT patients were included. In BCS, mean prevalence of MPNs and JAK2V617F was 40.9% (95% CI, 32.9%-49.5%) and 41.1% (95% CI, 32.3%-50.6%), respectively. In PVT, mean prevalence of MPNs and JAK2V617F was 31.5% (95% CI, 25.1%-38.8%) and 27.7% (95% CI, 20.8%-35.8%), respectively. JAK2V617F and MPNs were more frequent in BCS compared with PVT (P = .03 and P = .09, respectively). Polycythemia vera was more prevalent in BCS than in PVT (P = .001). JAK2V617F screening in splanchnic vein thrombosis (SVT) patients without typical hematologic MPN features identified MPN in 17.1% and 15.4% of screened BCS and PVT patients, respectively. These results demonstrate a high prevalence of MPNs and JAK2V617F in SVT patients and show differences in underlying etiology between these disorders. Furthermore, these results validate routine inclusion of JAK2V617F in the diagnostic workup of SVT patients.
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- 2012
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49. Pregnancy in women with portal vein thrombosis: results of a multicentric European study on maternal and fetal management and outcome.
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Hoekstra J, Seijo S, Rautou PE, Ducarme G, Boudaoud L, Luton D, Alijotas-Reig J, Casellas-Caro M, Condat B, Bresser E, Thabut D, Larroque B, Gárcia-Pagán JC, Janssen HL, Valla DC, and Plessier A
- Subjects
- Abortion, Spontaneous epidemiology, Adolescent, Adult, Female, Heparin, Low-Molecular-Weight therapeutic use, Humans, Middle Aged, Pregnancy, Pregnancy Outcome, Premature Birth epidemiology, Retrospective Studies, Venous Thrombosis complications, Portal Vein, Pregnancy Complications, Cardiovascular drug therapy, Venous Thrombosis drug therapy
- Abstract
Background & Aims: Women of childbearing age account for approximately 25% of patients with non-cirrhotic portal vein thrombosis (PVT). We aimed at assessing maternal and fetal outcome in pregnant women with known PVT., Methods: We performed a retrospective analysis of the files of women with chronic PVT in three European referral centers between 1986 and 2010., Results: Forty-five pregnancies, 28 (62%) treated with low molecular weight heparin, occurred in 24 women. Nine (20%) were lost before gestation week 20. Preterm birth occurred in 38% of deliveries: there were 3 births at week 24-25, 7 at week 32-36, and 26 after week 37. A term birth with a healthy infant occurred in 58% of pregnancies. Cesarean section was used in 53% of deliveries. Two women developed HELLP syndrome. A favorable outcome happened in 64% of pregnancies. Pregnancies with an unfavorable outcome were associated with a higher platelet count at diagnosis. Bleeding from esophageal varices occurred in 3 patients during pregnancy, all without adequate primary prophylaxis. Genital or parietal bleeding occurred postpartum in 4 patients, only one being on anticoagulation therapy. Thrombotic events occurred in 2 patients, none related to lower limbs or mesenteric veins. There were no maternal deaths., Conclusions: In pregnant PVT patients treated with anticoagulation on an individual basis, the rate of miscarriage and preterm birth appears to be increased. However, fetal and maternal outcomes are favorable for most pregnancies reaching gestation week 20. High platelet counts appear to increase the risk for unfavorable outcome. Pregnancy should not be contraindicated in stable PVT patients., (Copyright © 2012. Published by Elsevier B.V.)
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- 2012
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50. Obliterative portal venopathy: findings at CT imaging.
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Glatard AS, Hillaire S, d'Assignies G, Cazals-Hatem D, Plessier A, Valla DC, and Vilgrain V
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- Adult, Aged, Biopsy, Contrast Media, Female, Humans, Liver Cirrhosis complications, Liver Cirrhosis diagnostic imaging, Male, Middle Aged, Portal Vein pathology, Retrospective Studies, Vascular Diseases complications, Vascular Diseases pathology, Vascular Patency, Portal Vein diagnostic imaging, Tomography, X-Ray Computed methods, Vascular Diseases diagnostic imaging
- Abstract
Purpose: To retrospectively analyze the computed tomographic (CT) findings in a single-center series of adult patients with biopsy-proved obliterative portal venopathy (OPV) and to compare them with those observed in patients with cirrhosis., Materials and Methods: The requirement for informed consent was waived. This institutional review board-approved study included 42 consecutive patients with a histologically proved diagnosis of OPV who underwent CT at diagnosis. The clinical characteristics at diagnosis were recorded, and CT examination results were reviewed. Two radiologists evaluated portal vein patency and intrahepatic portal branches, the morphologic changes in the liver, the presence of hepatic nodules, and signs of portal hypertension in consensus. The control group consisted of 42 patients who had histologically proved cirrhosis. CT findings were compared between the OPV patient group and the cirrhotic group and also among the conditions associated with patients with OPV. The Fisher exact test was used. P values of .05 or less were considered to indicate significant differences., Results: The following CT findings were observed significantly more frequently in OPV than in cirrhosis: extrahepatic portal vein thrombosis (18 [43%] of 42 vs five [12%] of 42); intrahepatic portal abnormalities (18 [58%] of 31 vs one [2%] of 42) such as reduced caliber, occlusive thrombosis, and lack of visibility; focal nodular hyperplasia-like nodules (six [14%] of 42 vs 0 [0%] of 42); and perfusion disorders (15 [36%] of 42 vs six [14%] of 42). Conversely, the combination of hypertrophy of the caudate lobe and atrophy of segment IV (27 [64%] of 42 vs 10 [24%] of 42) and nodular surface (37 [88%] of 42 vs seven [17%] of 42) were seen significantly more often in cirrhosis., Conclusion: Characteristic CT findings in patients with OPV that differ from those in patients with cirrhosis were shown, the most common being the presence of intra- or extrahepatic portal abnormalities.
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- 2012
- Full Text
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