World J Gastroentero
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World J Gastroentero · Aug 2008
Editorial ReviewCytomegalovirus infection after liver transplantation: current concepts and challenges.
Cytomegalovirus (CMV) is a common viral pathogen that influences the outcome of liver transplantation. In addition to the direct effects of CMV syndrome and tissue-invasive diseases, CMV is associated with an increased predisposition to acute and chronic allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall patient and allograft survival. Risk factors for CMV disease are often interrelated, and include CMV D+/R- serostatus, acute rejection, female gender, age, use of high-dose mycophenolate mofetil and prednisone, and the overall state of immunity. ⋯ The treatment of CMV disease consists mainly of intravenous (IV) ganciclovir, and if feasible, a reduction in the degree of immunosuppression. A recent controlled clinical trial demonstrated that valganciclovir is as effective and safe as IV ganciclovir for the treatment of CMV disease in solid organ (including liver) transplant recipients. In this article, the author reviews the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.
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World J Gastroentero · Jul 2008
ReviewHepatocellular carcinoma: defining the place of surgery in an era of organ shortage.
Liver resection (LR) and transplantation offer the only potential chance of cure for patients with hepatocellular carcinoma (HCC). Historically, all patients were treated by hepatic resection. With the advent of liver transplantation (LT) patients with HCC were preferentially placed on the waiting list for LT. ⋯ To date there have been no randomised clinical trials comparing LR to LT. We review the evidence supporting LR and/or LT for HCC and discuss the role of neoadjuvant therapy. The decision of whether to resect or transplant remains debatable and is often determined by centre experience, availability of LT and donor organs.
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World J Gastroentero · Jul 2008
Case ReportsSeptic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis.
Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. ⋯ He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.
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World J Gastroentero · Jul 2008
Is the pain in chronic pancreatitis of neuropathic origin? Support from EEG studies during experimental pain.
To prove the hypothesis that patients with chronic pancreatitis would show increased theta activity during painful visceral stimulation. ⋯ The differences in the theta band indicate that neuropathic pain mechanisms are involved in chronic pancreatitis. This has important implications for the understanding and treatment of pain in these patients, which should be directed against drugs with effects on neuropathic pain disorders.
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World J Gastroentero · Jul 2008
Review Meta AnalysisHow good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review.
To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers. ⋯ EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to have true anatomic stage of T4 disease.