RESUMEN
Chronic liver disease and/or portal hypertension may be associated with one of the two pulmonary vascular complications: portopulmonary hypertension and hepatopulmonary syndrome. These pulmonary vascular disorders are notoriously underdiagnosed; however, they have a substantial negative impact on survival and require special attention in order to understand their diagnostic approach and to select the best therapeutic options. Portopulmonary hypertension results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. On the other hand, abnormal intrapulmonary vascular dilations, profound hypoxemia, and a wide alveolar-arterial gradient are the hallmarks of the hepatopulmonary syndrome, resulting in difficult-to-treat hypoxemia. The aim of this review is to summarize the latest pathophysiologic concepts, diagnostic approach, therapy, and prognosis of portopulmonary hypertension and hepatopulmonary syndrome, as well as to discuss the role of liver transplantation as a definitive therapy in selected patients with these conditions.
Asunto(s)
Hipertensión Portal/complicaciones , Hepatopatías/complicaciones , Enfermedades Pulmonares/etiología , Circulación Pulmonar/fisiología , Síndrome Hepatopulmonar/fisiopatología , Síndrome Hepatopulmonar/terapia , Humanos , Hipertensión Portal/diagnóstico , Hipertensión Portal/tratamiento farmacológico , Hipertensión Portal/epidemiología , Hipertensión Portal/fisiopatología , Hepatopatías/diagnóstico , Hepatopatías/epidemiología , Hepatopatías/fisiopatología , Hepatopatías/terapia , Trasplante de Hígado , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/fisiopatología , Enfermedades Pulmonares/terapiaRESUMEN
Las plaquetas poseen más de 20 factores de crecimiento en sus gránulos. Su secreción promueve la reparación de heridas. La cicatrización es un intrincado proceso en el cual intervienen no solo los factores plaquetarios proangiogénicos sino también factores antiangiogénicos. La preservación por congelación de las plaquetas empleada para su preservación, desestabiliza y activa la membrana plaquetaria alterando sus propiedades . En el campo del tratamiento de heridas recalcitrantes en pacientes debilitados o con enfermedades crónicas, el uso de preparaciones plaquetarias en forma de plasma fresco congelado, las preparaciones plaquetarias sonicadas,l as preparaciones congeladas y deshidratadas y el uso de fragmentos de dermis alogénica, confiere efectos beneficiosos, logrando mejores tiempos de cierre en las heridas y menor alteración de la morfología de la cicatriz final. En el presente artículo, describiremos los estudios que han demostrado estos efectos, así como las encrucijadas actuales y los estudios que debemos esperar en un futuro no lejano (AU)
Platelets store more than 20 growth factors in their granules. Their secretion promotes wound healing and repair. The intricate wound healing process involves not only the angiogenic platelet factors but also de anti-angiogenicones. The process of platelet preservation, such as freezing, disrupt the platelet membrane structure and their angiogenic properties causing platelet activation. In the field of wound healing and the management of recalcitrant wounds in debilitated and chronically ill patients, there have been several studies. These studies have focused on the use of the different platelet preparations such as fresh frozen plasma, frozen-dried platelet richplasma, sonicated platelet rich plasma and the use of alogenica celular dermis. Platelet preparations posses positive effects on wound healing with little alterations of the final scar tissue. In this article we will describe and discuss the studies that have involved the use of these platelet rich preparations in the filed of wound healing and we will also state the road blocks and the studies that will come in the near future regarding the use of platelets products in the field wound healing (AU)
Asunto(s)
Humanos , Plasma Rico en Plaquetas , Cicatrización de Heridas , Regeneración/fisiología , Factor de Activación Plaquetaria/fisiología , Agregación Plaquetaria/fisiología , Factor de Crecimiento Epidérmico/fisiologíaRESUMEN
Severe acute pancreatitis (SAP) is a very important cause of morbi-mortality inside the context of gastrointestinal diseases, and there is still some controversy in important points regarding its medical and surgical management. The present review article assesses and compares the results and conclusions of several clinical trials with respect the staging of severity, supportive measurements, prophylactic antibiotics, surgical treatment of infected and sterile necrosis and the implications that such studies have in the prognosis and management of SAP. Endoscopic techniques of treatment are beyond the scope in this review.