Endoscopic therapy, involving either injection sclerosis or band ligation, is considered the intervention of first choice for acute variceal bleeding (AVB). Pharmacologic agents have also been shown to be highly effective in the control of the bleeding episode. The purpose of this meta-analysis was to assess whether vasoactive drugs may improve the efficacy of endoscopic therapy (injection sclerosis or band ligation) in the control of AVB and thus increase survival rates. Computer databases and scientific meeting abstracts from 1994 to 2001 were used to search for randomized trials that compared the combined use of endoscopic and drug therapy with endoscopic therapy alone in the control of AVB. Eight trials involving 939 patients fulfilled the selection criteria and the following evaluated by standard meta-analysis methods: initial hemostasis, 5-day hemostasis, 5-day mortality, and adverse events. Combined treatment improved initial control of bleeding (relative risk [RR], 1.12; 95% confidence interval (CI), 1.02-1.23), and 5-day hemostasis (RR, 1.28; 95% CI, 1.18-1.39), with numbers of patients needed to treat (NNT) of 8 and 5, respectively. The difference in favor of combined treatment remained significant when trials that used drugs other than octreotide or that included a low proportion of alcoholic patients (<40%) or high-risk cirrhotic patients (<35%) were excluded. Mortality was not significantly decreased by combined therapy (RR, 0.73; 95% CI, 0.45-1.18). Severe adverse events were similar in both groups. In conclusion, in patients with AVB, pharmacologic agents improve the efficacy of endoscopic therapy to achieve initial control of bleeding and 5-day hemostasis, yet fail to affect mortality. (HEPATOLOGY 2002;35:609-615.) A cute variceal bleeding (AVB) is the most severe consequence of portal hypertension. The treatment of this entity should involve the initial control of hemorrhage and prevention of early rebleeding. 1-3 Endoscopic sclerotherapy has been shown to be highly effective in the control of both these processes. Sclerotherapy stops bleeding in about 80% to 90% of patients, and band ligation appears to be equally effective. 4,5 Indeed, it was concluded at the Reston conference that endoscopic therapy is the intervention of first choice for AVB. 2 On the other hand, vasoactive drugs, such as somatostatin and terlipressin, are as effective as endoscopic sclerotherapy for the arrest of the acute episode of bleeding and prevention of early rebleeding. 6,7 However, hemodynamic and clinical data are not so consistent when other agents such as octreotide are employed. 8,9 The question arises as to whether drugs may improve the efficacy of endoscopy without enhancing adverse events. The combination of both types of therapy is aimed at adding the portal pressure-lowering effect of drugs to the local hemostatic effects of injection sclerosis or ligation, and different vasoactive agents have been tested to this end in several randomized trials. Whereas drugs improved the efficacy of endoscopic therapy...

Graft dysfunction associated with autoimmune phenomena has been recently described in liver transplant recipients without previous autoimmune disease. However, the natural history, diagnostic criteria, and definitive therapeutic approach of de novo autoimmune hepatitis (de novo AIH) are poorly understood. We report 12 cases of de novo AIH 27.9 ؎ 24.5 months after liver transplantation: the outcome of 7 patients treated with steroids is compared with a group of 5 nontreated patients. Nontreated patients lost the graft after 5.8 ؎ 2.6 months from de novo AIH onset. All treated patients were alive after 48.4 ؎ 14 (29-65) months from de novo AIH onset, and none of them lost the graft. However, 5 patients relapsed in relation to steroid tapering. All patients presented an atypical antiliver/ kidney cytosolic autoantibody, associated to classical autoantibodies in 10 cases. Histological study showed several degrees of lobular necrosis and inflammatory infiltrate. HLA antigen frequencies and matching were compared with 2 control groups (16 orthotopic liver transplantation [LTX] patients without de novo AIH and 929 healthy blood donors); de novo AIH patients showed a higher prevalence of HLA-DR3 (54.5% vs. 25.9%, P ‫؍‬ .04) than healthy controls, which was not observed in LTX patients without de novo AIH. In conclusion, this new disease should be included in the differential diagnosis of unexplained graft dysfunction. In addition, treatment with steroids results in a dramatically improved outcome. However, maintenance therapy is usually required. (HEPATOLOGY 2002;35:349-356.)

No abstract

No abstract

No abstract

SummaryIn the period January 1988-December 1995. a case-control study of diet and renal cell carcinoma (RCC) risk involving 121 cases and 243 hospitalized controls was carried out in Montevideo, Uruguay. After adjusting for major covariates, red meat intake was associated with a 3.4 increase in risk for the highest category of intake, with a significant dose-response pattem. Also, barbecued meat, protein and heterocyclic amine intakes were associated with significant increases in risk of RCC. The consumption of the beverage known as 'mate' (a local tea derived from the herb Ilex paraguariensis) was associated with an increased risk of 3.0 for heavy drinkers. by tx-o trained social wvorkers using a standard routine questionnaire. designed to obtain information on risk factors for all cancers and non-neoplastic conditions. The database so created. from which the study subjects were obtained. has also been used for a study of luncg cancer (De Stefani et al. 1996). In this particular instance. all patients w-ith RCC admitted to the Instituto Nacional de Oncologia in the time period 1988-95 and successfully interviewed were included in the case series. The response rate for cases was high (92.7%7). All cases were histologically verified as having RCC. Most had RCC of the clear cell variant (85%7c). The remaining, 15%7 had RCC of the eosinophilic cell variant.In the same period. 5295 patients with a variety of other disorders. both neoplastic and non-neoplastic. were admitted to the same institution. The oxerall response rate for these patients was 93.0%c. From this pool of patients. potential controls were randomly selected excluding the following conditions: (1) malignancies. (2) smoking-related conditions. (3) conditions related to mate' consumption (see hst above) and (4) digestive diseases or disorders associated Awith a long-term modification of diet. Cases were frequency matched with controls on age. sex and residence.

SVR can be achieved in approximately one-third of patients with HCV-related cirrhosis. SVR independently reduces the likelihood of clinical decompensation and improves survival.

Patients with HCV genotype 3 (GT3) infection and cirrhosis are currently the most difficult to cure. We report our experience with sofosbuvir+daclatasvir (SOF+DCV) or sofosbuvir/ledipasvir (SOF/LDV), with or without ribavirin (RBV) in clinical practice in this population. This was a multicenter observational study including cirrhotic patients infected by HCV GT3, treated with sofosbuvir plus an NS5A inhibitor (May 2014-October 2015). In total, 208 patients were included: 98 (47%) treatment-experienced, 42 (20%) decompensated and 55 (27%) MELD score >10. In 131 (63%), treatment was SOF+DCV and in 77 (37%), SOF/LDV. Overall, 86% received RBV. RBV addition and extension to 24 weeks was higher in the SOF/LDV group (95% vs 80%, P=.002 and 83% vs 72%, P=.044, respectively). A higher percentage of decompensated patients were treated with DCV than LDV (25% vs 12%, P=.013). Overall, SVR12 was 93.8% (195/208): 94% with SOF+DCV and 93.5% with SOF/LDV. SVR12 was achieved in 90.5% of decompensated patients. Eleven treatment failures: 10 relapses and one breakthrough. RBV addition did not improve SVR (RR: 1.08; P=.919). The single factor associated with failure to achieve SVR was platelet count <75×10E9/mL (RR: 3.50, P=.019). In patients with MELD <10, type of NS5A inhibitor did not impact on SVR12 (94% vs 97%; adjusted RR: 0.49). Thirteen patients (6.3%) had serious adverse events, including three deaths (1.4%) and one therapy discontinuation (0.5%), higher in decompensated patients (16.7% vs 3.6%, P<.006). In patients with GT3 infection and cirrhosis, SVR12 rates were high with both SOF+DCV and SOF/LDV, with few serious adverse events.