AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to ...AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency,clinical activity index (CAI),C reactive protein (CRP) level,erythrocyte sedimentation rate (ESR),values at baseline,use of immunosuppressant,duration of disease,and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used. RESULTS:In the univariate analysis,CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390,95% Confidence interval (CI):0.176-0.865,Wald 5.361,P = 0.0160] and low CAI levels at baseline (4 < CAI <7) (OR = 0.770,95% CI:0.425-1.394,Wald 3.747,P = 0.028) proved to be effective as factors predicting clinical response. CONCLUSION:GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.展开更多
We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.O...We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.Our patient presented with complaints of persistent,severe right-sided upper abdominal pain.The complaints developed gradually,one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma.The hematoma had resolved spontaneously.An upperabdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma,suspect of perihepatic adhesions.The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session.The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment.This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.展开更多
Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor ...Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor platelet apheresis transfusion in living donor LT （LDLT）. This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. Methods： This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. Results： Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival （78.9% vs. 94.2%, P = 0.009）, but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion（hazard ratio[HR]=3.103,95% confidence interval[CI]：1.720–5.600,P〈0.001）and preoperative platelet count（HR=0.170,95% CI：0.040–0.730,P=0.017）impacted 90-day survival independently.Multivariate Cox regression analysis also found that units of red blood cell（RBC）transfusion（HR=1.036,95% CI：1.006–1.067,P=0.018）,recipient＇s age（HR=1.045,95% CI：1.005–1.086,P=0.025）,and ABO blood group comparison（HR=2.990,95% CI：1.341–6.669,P=0.007）were independent risk factors for overall survival after LDLT. Conclusions： This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient＇s age, and ABO group comparison were independent predictors of long-term outcomes.展开更多
文摘AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency,clinical activity index (CAI),C reactive protein (CRP) level,erythrocyte sedimentation rate (ESR),values at baseline,use of immunosuppressant,duration of disease,and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used. RESULTS:In the univariate analysis,CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390,95% Confidence interval (CI):0.176-0.865,Wald 5.361,P = 0.0160] and low CAI levels at baseline (4 < CAI <7) (OR = 0.770,95% CI:0.425-1.394,Wald 3.747,P = 0.028) proved to be effective as factors predicting clinical response. CONCLUSION:GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.
文摘We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.Our patient presented with complaints of persistent,severe right-sided upper abdominal pain.The complaints developed gradually,one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma.The hematoma had resolved spontaneously.An upperabdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma,suspect of perihepatic adhesions.The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session.The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment.This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.
文摘Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor platelet apheresis transfusion in living donor LT （LDLT）. This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. Methods： This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. Results： Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival （78.9% vs. 94.2%, P = 0.009）, but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion（hazard ratio[HR]=3.103,95% confidence interval[CI]：1.720–5.600,P〈0.001）and preoperative platelet count（HR=0.170,95% CI：0.040–0.730,P=0.017）impacted 90-day survival independently.Multivariate Cox regression analysis also found that units of red blood cell（RBC）transfusion（HR=1.036,95% CI：1.006–1.067,P=0.018）,recipient＇s age（HR=1.045,95% CI：1.005–1.086,P=0.025）,and ABO blood group comparison（HR=2.990,95% CI：1.341–6.669,P=0.007）were independent risk factors for overall survival after LDLT. Conclusions： This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient＇s age, and ABO group comparison were independent predictors of long-term outcomes.
