Journal of hepatology
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Increased cardiac output was first described in patients with cirrhosis more than fifty years ago. Later, various observations have indicated the presence of a latent cardiac dysfunction, which includes a combination of reduced cardiac contractility with systolic and diastolic dysfunction and electrophysiological abnormalities. This syndrome is termed cirrhotic cardiomyopathy. ⋯ The QT interval is prolonged in about half of the cirrhotic patients and it may be normalised by beta-blockers. No specific therapy for cirrhotic cardiomyopathy can be recommended, but treatment should be supportive and directed against the cardiac dysfunction. Future research should better describe the prevalence, impact on morbidity and survival, and look for potential treatments.
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Journal of hepatology · Nov 2008
ReviewThe importance of immune dysfunction in determining outcome in acute liver failure.
Acute liver failure (ALF) shares striking similarities with septic shock with regard to the features of systemic inflammation, progression to multiple organ dysfunction and functional immunoparesis. While the existence of opposing systemic pro- and anti-inflammatory profiles resulting in organ failure and immune dysfunction are well recognised in septic shock, characterization of these processes in ALF has only recently been described. ⋯ Clinical studies measuring levels of pro- and anti-inflammatory cytokines and expression of the antigen presentation molecule HLA-DR on monocytes, in combination with ex-vivo experiments, demonstrate that the persistence of a compensatory anti-inflammatory response syndrome, leading to functional monocyte deactivation, is a central event in the evolution of systemic immune dysfunction. Accurate immune profiling in ALF may permit the development of immunomodulatory strategies in order to improve outcome in this condition.
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Journal of hepatology · Oct 2008
ReviewNon-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review.
To perform a systematic review of the studies addressing the association between non-alcoholic fatty liver disease (NAFLD) and carotid intima-media thickness (IMT). ⋯ Routine measurement of carotid IMT might be implemented in NAFLD patients, as they carry an increase of 13% of carotid IMT.
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Journal of hepatology · Oct 2008
ReviewNon-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review.
To perform a systematic review of the studies addressing the association between non-alcoholic fatty liver disease (NAFLD) and carotid intima-media thickness (IMT). ⋯ Routine measurement of carotid IMT might be implemented in NAFLD patients, as they carry an increase of 13% of carotid IMT.
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Journal of hepatology · Jan 2008
ReviewHot topics in liver transplantation: organ allocation--extended criteria donor--living donor liver transplantation.
Liver transplantation has become the mainstay for the treatment of end-stage liver disease, hepatocellular cancer and some metabolic disorders. Its main drawback, though, is the disparity between the number of donors and the patients needing a liver graft. In this review we will discuss the recent changes regarding organ allocation, extended donor criteria, living donor liver transplantation and potential room for improvement. ⋯ Recent data clearly indicate that center experience is of major importance in achieving good results. Great progress has been made in recent years. However, further research is needed to improve results in the future.