Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Case Series



Discrepancies between clinical and autopsy diagnosis in liver transplant recipients – A case series


Price: €10,00

The utility of the autopsy in patients who have undergone prior orthotopic liver transplantation (OLT) has not previously been defined. We sought to investigate the role of the autopsy in liver transplantation by comparing the clinically derived cause of death with the autopsy cause of death in a cohort of liver transplant recipients at our institution. This study was undertaken in the setting of declining autopsy rates worldwide. Between 2006 and 2011 twenty-nine patients died who had previously undergone OLT, of on whom 19 postmortem examinations were performed. We retrospectively reviewed all post mortem findings, and separately we examined the corresponding medical records to determine the clinical impression of the cause of death. Discrepancies between the post mortem and clinical findings were categorised according to a modification of Goldman’s criteria. Our case series demonstrated a discrepancy between the clinical and post mortem examination (PME) findings in 54% of patients. Two patients had major diagnoses (Goldman Class 1) not detected clinically and in seven patients the PME revealed additional undetected minor diagnoses. This case series demonstrates that, even in the modern era of advanced diagnostic imaging techniques, the post mortem examination continues to be a valuable tool in confirming diagnostic accuracy and improving standards in the care of liver transplant recipients. (Acta gastroenterol. belg., 2013, 76, 429-432). [Product Details...]



Lamivudine treatment for Hepatitis B in dialysis population : Case reports and literature review


Price: €10,00

It is well known that chronic hepatitis B plays a detrimental role on survival in patients on long-term dialysis and after kidney transplantation. The advent of nucleos(t)ide analogues offers the opportunity to change the natural history of hepatitis B in patients with chronic kidney disease. We report our experience on lamivudine use in two patients with HBV-related liver disease on long-term dialysis. At the beginning, both the patients were HBsAg positive and HBeAg positive with high viral load ; after long-term lamivudine therapy, clearance of HBV viremia from serum was observed in both. Raised aminotransferase levels fell into the normal range and one patient experienced clearance of HBsAg by anti-HBV therapy. Tolerance to lamivudine was satisfactory and lamivudine resistance was not detected. Information on antiviral therapy with lamivudine in HBsAg positive patients on regular dialysis is extremely limited ; we identified by an extensive review of the literature five studies with a total of 38 unique patients, most of them being renal transplant candidates. Lamivudine proved to be effective as the clearance of HBV viraemia from serum ranged between 56% and 100% ; the clearance of HBeAg from serum was less evident (between 37.5% and 100%). No significant side-effects due to lamivudine were observed and emergence of lamivudineresistant strains was observed in two (5%) patients. Only a minority of patients experienced HBsAg loss (13%). We conclude that anti- HBV treatment with a nucleoside analogue such as lamivudine gives satisfactory results in some patients on long-term dialysis. Clinical trials are in progress to assess efficacy and safety of lastgeneration nucleos(t)ide analogues for anti-HBV therapy in dialysis population. (Acta gastroenterol. belg., 2013, 76, 423-428). [Product Details...]


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