Cannabinoids are a group of compounds acting pri-marily via CB1 and CB2 receptors.The expression of cannabinoid receptors in normal liver is low or absent.However,many reports have proven up-regulation of the expressi...Cannabinoids are a group of compounds acting pri-marily via CB1 and CB2 receptors.The expression of cannabinoid receptors in normal liver is low or absent.However,many reports have proven up-regulation of the expression of CB1 and CB2 receptors in hepatic myofibroblasts and vascular endothelial cells,as well as increased concentration of endocannabinoids in liver in the course of chronic progressive liver diseases.It has been shown that CB1 receptor signalling exerts profibrogenic and proinflammatory effects in liver tis-sue,primarily due to the stimulation of hepatic stellate cells,whereas the activation of CB2 receptors inhibits or even reverses liver fibrogenesis.Similarly,CB1 re-ceptor stimulation contributes to progression of liver steatosis.In end-stage liver disease,the endocannabi-noid system has been shown to contribute to hepatic encephalopathy and vascular effects,such as portal hypertension,splanchnic vasodilatation,relative pe-ripheral hypotension and probably cirrhotic cardiomy-opathy.So far,available evidence is based on cellular cultures or animal models.Clinical data on the effects of cannabinoids in chronic liver diseases are limited.However,recent studies have shown the contribution of cannabis smoking to the progression of liver fibrosis and steatosis.Moreover,controlling CB1 or CB2 signal-ling appears to be an attractive target in managing liver diseases.展开更多
AIM: To evaluate the spatial distribution of cerebral abnormalities in cirrhotic subjects with and without hepatic encephalopathy (HE) found with magnetization transfer imaging (MTI).METHODS: Nineteen cirrhotic patien...AIM: To evaluate the spatial distribution of cerebral abnormalities in cirrhotic subjects with and without hepatic encephalopathy (HE) found with magnetization transfer imaging (MTI).METHODS: Nineteen cirrhotic patients graded from neurologically normal to HE grade 2 and 18 healthy control subjects underwent magnetic resonance imaging. They gave institutional-review-board-approved written consent. Magnetization transfer ratio (MTR) maps were generated from MTI. We tested for significant differences compared to the control group using statistical non-parametric mapping (SnPM) for a voxelbased evaluation.RESULTS: The MTR of grey and white matter was lower in subjects with more severe HE. Changes were found in patients with cirrhosis without neurological defi cits in the basal ganglia and bilateral white matter. The loss in magnetization transfer increased in severity and spatial extent in patients with overt HE. Patients with HE grade 2 showed an MTR decrease in white and grey matter: the maximum loss of magnetization transfer effect was located in the basal ganglia [SnPM (pseudo-)t = 17.98, P = 0.0001].CONCLUSION: The distribution of MTR changes in HE points to an early involvement of basal ganglia and white matter in HE.展开更多
Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and ...Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis （LVP） and transjugular intrahepatic portasystemic stent-shunt （TIPS） are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morlJidity and mortality （most surgical options） rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.展开更多
Portal vein thrombosis(PVT)is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare,but can be life-threatening.However,different aspects of clinical relevanc...Portal vein thrombosis(PVT)is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare,but can be life-threatening.However,different aspects of clinical relevance,diagnosis and management of PVT are still areas of uncertainty and investigation in international guidelines.In this article,we elaborate on PVT classification,geographical differences in clinical presentation and standards of diagnosis,and briefly on the current pathophysiological understanding and risk factors.This review considers and highlights the pitfalls of the various treatment approaches and prophylactic treatments.Finally,we review the controversial issue of clinical impact of PVT on prognosis,especially considering liver transplantation and future perspectives.展开更多
文摘Cannabinoids are a group of compounds acting pri-marily via CB1 and CB2 receptors.The expression of cannabinoid receptors in normal liver is low or absent.However,many reports have proven up-regulation of the expression of CB1 and CB2 receptors in hepatic myofibroblasts and vascular endothelial cells,as well as increased concentration of endocannabinoids in liver in the course of chronic progressive liver diseases.It has been shown that CB1 receptor signalling exerts profibrogenic and proinflammatory effects in liver tis-sue,primarily due to the stimulation of hepatic stellate cells,whereas the activation of CB2 receptors inhibits or even reverses liver fibrogenesis.Similarly,CB1 re-ceptor stimulation contributes to progression of liver steatosis.In end-stage liver disease,the endocannabi-noid system has been shown to contribute to hepatic encephalopathy and vascular effects,such as portal hypertension,splanchnic vasodilatation,relative pe-ripheral hypotension and probably cirrhotic cardiomy-opathy.So far,available evidence is based on cellular cultures or animal models.Clinical data on the effects of cannabinoids in chronic liver diseases are limited.However,recent studies have shown the contribution of cannabis smoking to the progression of liver fibrosis and steatosis.Moreover,controlling CB1 or CB2 signal-ling appears to be an attractive target in managing liver diseases.
文摘AIM: To evaluate the spatial distribution of cerebral abnormalities in cirrhotic subjects with and without hepatic encephalopathy (HE) found with magnetization transfer imaging (MTI).METHODS: Nineteen cirrhotic patients graded from neurologically normal to HE grade 2 and 18 healthy control subjects underwent magnetic resonance imaging. They gave institutional-review-board-approved written consent. Magnetization transfer ratio (MTR) maps were generated from MTI. We tested for significant differences compared to the control group using statistical non-parametric mapping (SnPM) for a voxelbased evaluation.RESULTS: The MTR of grey and white matter was lower in subjects with more severe HE. Changes were found in patients with cirrhosis without neurological defi cits in the basal ganglia and bilateral white matter. The loss in magnetization transfer increased in severity and spatial extent in patients with overt HE. Patients with HE grade 2 showed an MTR decrease in white and grey matter: the maximum loss of magnetization transfer effect was located in the basal ganglia [SnPM (pseudo-)t = 17.98, P = 0.0001].CONCLUSION: The distribution of MTR changes in HE points to an early involvement of basal ganglia and white matter in HE.
文摘Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis （LVP） and transjugular intrahepatic portasystemic stent-shunt （TIPS） are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morlJidity and mortality （most surgical options） rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.
基金We thank Sabine Dentler for English proofreading and editing.Andrea De Gottardi is supported by the Swiss National Science Foundation(Grant 31003A_163143)Jonel Trebicka is supported by DFG(SFB TRR 57,P18)and Cellex-Foundation.
文摘Portal vein thrombosis(PVT)is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare,but can be life-threatening.However,different aspects of clinical relevance,diagnosis and management of PVT are still areas of uncertainty and investigation in international guidelines.In this article,we elaborate on PVT classification,geographical differences in clinical presentation and standards of diagnosis,and briefly on the current pathophysiological understanding and risk factors.This review considers and highlights the pitfalls of the various treatment approaches and prophylactic treatments.Finally,we review the controversial issue of clinical impact of PVT on prognosis,especially considering liver transplantation and future perspectives.
