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11.
Hepatocellular carcinoma is the main liver-related cause of death in patients with compensated cirrhosis. The early phases are asymptomatic and the prognosis is poor, which makes prevention essential. We propose that non-selective beta-blockers decrease the incidence and growth of hepatocellular carcinoma via a reduction of the inflammatory load from the gut to the liver and inhibition of angiogenesis. 相似文献
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Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome 总被引:1,自引:0,他引:1
Aleksander Krag Tine Borup Søren Møller Flemming Bendtsen 《Advances in therapy》2008,25(11):1105-1140
Terlipressin is an analog of the natural hormone arginine-vasopressin. It is used in the treatment of patients with cirrhosis
and bleeding esophageal varices (BEV) and in patients with hepatorenal syndrome (HRS): two of the most dramatic and feared
complications of cirrhosis. Terlipressin exerts its main pharmacological effect through stimulation of vasopressin-1 receptors.
These receptors are located in vascular smooth muscle and mediate vasoconstriction. In patients with cirrhosis and portal
hypertension, treatment with terlipressin increases mean arterial pressure and decreases portal flow and pressure within minutes
of administration. Furthermore, in patients with ascites terlipressin improves glomerular filtration and excretion of sodium.
Terlipressin decreases failure of initial hemostasis by 34%, decreases mortality by 34%, and is considered a first-line treatment
for BEV, when available. Terlipressin in combination with albumin reverses type 1 HRS in 33%–60% of cases and is the only
treatment with proven efficacy in randomized trials. The safety profile is favorable when considering the clinical efficacy
and the high mortality of these clinical entities. Adverse events are mostly cardiovascular and related to vasoconstriction.
Mortality and withdrawal of terlipressin due to adverse events occurs in less than 1% of cases. Mild adverse events related
to terlipressin treatment occur in 10%–20% of patients. The benefit, however, of terlipressin on long-term survival in HRS
remains to be determined. At present, treatment with terlipressin and albumin is considered the most efficient therapy and
should therefore be recommended for the treatment of type 1 HRS-1. 相似文献
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Vahid Reza Dabbagh Kakhki Reza Bagheri Shahrzad Tehranian Pardis Shojaei Hassan Gholami Ramin Sadeghi David N. Krag 《Surgery today》2014,44(4):607-619
The use of sentinel node surgery for esophageal carcinoma is still under investigation. We evaluated the data available in the literature on this topic, and herein present the results in a systematic review format. PUBMED, SCOPUS, the ISI web of knowledge and the information from the annual meetings of the Japan Esophageal Society were searched using the search terms: “(esophagus OR esophageal) AND sentinel”. The outcomes of interest were the detection rate and sensitivity. Overall, 18 studies were included. The pooled detection rate was 89.2 % [82.6–93.5]. Patients with T1 and two tumors had a 17 % higher detection rate compared to those with T3 and four tumors. The pooled sensitivity was 84 % [78–88 %]. The sensitivity was higher for adenocarcinoma compared to squamous cell carcinoma (SCC) (91 vs. 81 %). In the SCC patients, there was a trend toward decreased sensitivity associated with an increasing tumor depth (T1:88 %, T2:76 %, T3:50 %). Our analysis indicated that sentinel node biopsy is useful in adenocarcinoma patients. For SCC patients, including only cN0 patients (preferably T1 and 2) would increase the detection rate and sensitivity. Due to the limited number of high-quality studies, drawing any more definite conclusions is impossible. Large cohort studies with a standardized and consistent design will be needed in the future. 相似文献
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