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La Tunisie médicale 06/2012; 90(6):487-8.
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La Tunisie médicale 05/2012; 90(5):414-5.
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La Tunisie médicale 03/2012; 90(3):266-8.
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ABSTRACT: Hepatorenal syndrome (HRS) is a particular form of functional renal failure which may develop in patients with liver cirrhosis. Recent advances in the understanding of the biology of vasoactive mediators and the physiology of microcirculation have allowed to better anticipate its pathophysiological mechanisms.
To review new advances in the knowledge of epidemiology, diagnosis criteria, pathophysiological mechanisms and treatment of HRS.
Review of literature using medical data bases (Medline) with the following key words: hepatorenal syndrome, pathophysiology, medical treatment, MARS, liver transplantation.
During the course of cirrhosis, portal hypertension leads to splanchnic and systemic vasodilation, responsible for a reduction of effective arteriel blood volume. As a result, a state of intense renal vasoconstriction develops, leading to renal failure in the absence of any organic renal disease. At this stage, liver transplantation is the only definitive therapy able to reverse renal dysfunction. Pharmacologic and radiologic therapy is aimed at improving renal function to enable patients to survive until transplantation is possible. These therapies are based on vasoconstrictor drugs associated with intravenous albumin infusion and transjugular intrahepatic portosystemic shunt (TIPS). They improve circulatory function, normalize serum creatinine and may improve survival.
Simple measures have been shown to reduce the risk of HRS in cirrhotic patients including the plasma volume expansion with albumin in patients with spontaneous bacterial peritonitis and optimal fluid management in patients undergoing large volume paracentesis.
La Tunisie médicale 12/2011; 89(12):885-90.
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Radhouane Debbeche,
Nadia Maamouri,
Salem Ajmi,
Mohamed Moussaddek Azzouz,
Nabyl Ben Mami,
Mohamed Hédi Dougui,
Azza Filali,
Abdeljabbar Ghorbel,
Faouzi Khedhiri,
Mohamed Salah Krichene,
Taoufik Najjar, Hammouda Saffar,
Béchir Zouari
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ABSTRACT: Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia.
To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia.
Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group (1999)
Eighty three patients were identified (70 female; mean age=49+17.9 years). 63% presented probable AIH and 37% presented definite AIH. Thirty two percent presented with the acute pattern. Eighty three per cent of cases were type I AIH and 5 % of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimmune diseases was seen in 27 patients, dominated by diabetes, autoimmune thyroiditis and Sjögren's syndrome. An overlap syndrome was diagnosed in 25% of cases; primary biliary Cirrhosis-AIH in 20% of cases and primary sclerosing cholangitis-AIH in 5% of cases. Fifty patients were treated by glucocorticoids as monotherapy or in combination with azathioprine. Complete remission was achieved in 90% of cases. Fourteen percent relapsed within a median time of 12 months. Factors associated with relapse were: treatment with Azathioprine<18 months, absence of lobular necrosis and anti-nuclear antibody (+) profile. Mortality was observed in 17 % of cases. Factors associated with death were encephalopathy as an independent factor and treatment with Azathioprine<18 months.
In Tunisia, epidemiological and clinical characteristics of AIH were similar to those reported in the literature but with a higher frequency of cirrhosis at presentation. Treatment with Azathioprine < 18 months was the main factor associated with relapse and represented with encephalopathy a factor associated with death.
La Tunisie médicale 11/2010; 88(11):834-40.
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ABSTRACT: Buerger's disease is an inflammatory non atheromatous distal arteriopathy affecting mainly young male smokers. There is some controversy about the existence of visceral localisations of the disease.
Report a new case.
We report the case of a 40-years-old man who developed a Budd Chiari syndrome with thromboses of the right hepatic venous. Later, he presented with rheumatic and distal occlusive arterial manifestations diagnosed as Buerger's disease.
We underline the fact that digestive manifestations and hepatic involvement are less known and sometimes misdiagnosed.
La Tunisie médicale 10/2009; 87(10):706-8.
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Nadia Bouzgarrou,
Elham Hassen,
Karim Farhat,
Olfa Bahri,
Sallouha Gabbouj,
Nadia Maamouri,
Nabil Ben Mami, Hammouda Saffar,
Abdelhalim Trabelsi,
Henda Triki,
Lotfi Chouchane
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ABSTRACT: Today there is increasing evidence concerning the contribution of pro-/anti-inflammatory cytokine balance and genetic factors in hepatitis C pathogenesis and interindividual heterogeneity of disease outcome. In the current study, we investigated the influence of functionally described single nucleotide polymorphisms (SNPs) present in interferon-gamma (IFNgamma) and interleukin-10 (IL-10) genes, on chronic hepatitis C severity. IFNgamma (+874T/A) and IL-10 (-1082G/A) genotypes were determined in 100 hepatitis C patients with different disease severities (chronic hepatitis, n = 42, liver cirrhosis [LC], and hepatocellular carcinoma in liver cirrhosis [HCC], n = 58) and 103 healthy controls using allele-specific polymerase chain reaction. No statistical differences in allele or genotype distributions of IFNgamma and IL-10 genes were observed between patients and controls. However, some significant differences in IFNgamma genotype frequencies were observed between the two groups of patients. IFNgamma(high producer) genotypes TT and TA were significantly more common in patients with LC and HCC (odds ratio = 2.65; p = 0.019). Although IL-10 genotypic frequencies were comparable between the different clinical forms of the disease, the combination of IFNgamma(low producer) and IL-10(high producer) genotypes was significantly associated with a lower risk of LC and HCC (odds ratio = 0.21; p = 0.015). In conclusion, our findings suggest that the imbalance between the pro-inflammatory and anti-inflammatory responses mediated by polymorphisms in the IFNgamma and IL-10 genes may influence the outcome of chronic HCV infection.
Human immunology 05/2009; 70(4):230-6. · 2.55 Impact Factor
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ABSTRACT: Chronic viral hepatitis remains a major problem among patients with chronic renal failure. Hepatitis B and C viruses are frequent among dialysis patients and after renal transplantation and may significantly diminish the survival of both the patient and the graft. Hepatitis B and C viral infection in these patients is often characterized by normal transaminase levels despite viremia and progressive liver lesions. Liver biopsy remains essential for assessing the extent of liver disease. Cirrhosis is a contraindication to transplantation of only a kidney, because of elevated morbidity and mortality. A combined as liver-kidney transplantation may be considered. The best treatment of hepatitis infections is preventive: vaccination against the hepatitis B virus and attentive hygiene, especially to prevent nosocomial transmission. Among patients not awaiting transplant, antiviral treatment should be reserved for patients with active or even fibrotic liver disease. For hemodialysis patients awaiting kidney transplant: Alpha interferon is ineffective and poorly tolerated by dialysis patients. Lamivudine is effective and well tolerated, but its long-term efficacy and its optimal effective dose in dialysis patients remain unknown.
La Presse Médicale 05/2008; 37(4 Pt 2):665-78. · 0.67 Impact Factor
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ABSTRACT: REGARDING THE DEFINITION: The primary biliary cirrhosis (PBC) - autoimmune hepatitis (AIH) overlap syndrome is defined by the simultaneous or consecutive association of at least two of three diagnostic criteria usually recognized in both pathologies. The prevalence of this syndrome is of the order of 8-20% of all the CBP and HAI diagnosed as such. DIAGNOSTIC CRITERIA: In most of the cases, the characteristics of these diseases are concomitant from the start at the time of diagnosis. Those are forty-years-old women's diseases. Diagnosis is based on the combination of clinical, biologic, immunologic and histological arguments. Histologically, the characteristic lesions of each of the diseases are usually combined. TREATMENT MODALITIES: The optimal treatment is not yet well codified. Ursodesoxycholic acid and immunosuppressor treatment, prescribed individually, are less effective than in the isolated PBC or AIH forms. The combination of these two drugs merits assessment.
La Presse Médicale 01/2005; 33(22):1606-10. · 0.67 Impact Factor
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Asma Ouakaa-Kchaou,
Jamel Kharrat,
Khaoula Mir,
Boussourra Houda,
Nabil Abdelli,
Salem Ajmi,
Msaddek Azzouz,
Hatem Ben Abdallah,
Nabyl Ben Mami,
Slim Bouzaidi,
Sofiene Chouaib,
Lamia Golli,
Wissem Melki,
Taoufik Najjar, Hammouda Saffar,
Najet Belhadj,
Abdeljabbar Ghorbel
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ABSTRACT: Variceal bleeding is a life-threatening complication of portal hypertension with a high probability of recurrence. Treatment to prevent first bleeding or rebleeding is mandatory. The study has been aimed at investigating the effectiveness of endoscopic band ligation in preventing upper gastrointestinal bleeding in patients with portal hypertension and to establish the clinical outcome of patients.
We analyzed in a multicenter trial, the efficacy and side effects of endoscopic band ligation for the primary and secondary prophylaxis of esophageal variceal bleeding. We assigned 603 patients with portal hypertension who were hospitalized to receive treatment with endoscopic ligation. Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The primary end point was recurrent bleeding.
The median follow-up period was 32 months. A total of 126 patients had recurrent bleeding. All episodes were related to portal hypertension and 79 to recurrent variceal bleeding. There were major complications in 51 patients (30 had bleeding esophageal ulcers). Seventy-eight patients died, 26 deaths were related to variceal bleeding and 1 to bleeding esophageal ulcers.
A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.
Saudi Journal of Gastroenterology 17(2):105-9.
