Volume 84 - 2021 - Fasc.2 - Case series
Portal vein thrombosis: an overview of current treatment options
Portal vein thrombosis (PVT) is a splanchnic vascular disorder
characterised by a recent or chronic thrombotic occlusion of
the portal venous system. Its aetiology is miscellaneous, and its
management is demanding since PVT can play a critical role as far
as morbidity and mortality are concerned. Indeed, PVT can develop
as a complication of portal hypertension (PH), in association or
not with advanced chronic liver disease, and aggravate its clinical
consequences such as variceal bleeding and ascites. Furthermore,
a diagnosis of PVT in a non-cirrhotic context can potentially
reveal a previously unknown hypercoagulable condition, requiring
further diagnostic steps and specific treatment in addition to
anticoagulation.
In addition to established therapeutic approaches, new
strategies, including newer pharmacological treatments and interdisciplinary
invasive procedures, gain more attention and have
been increasingly introduced into clinical practice. This review
aims at discussing the current knowledge in terms of treatment
options for PVT.
Antibiotic prophylaxis for prevention of spontaneous bacterial peritonitis in liver cirrhosis: systematic review
Background and aim : Spontaneous bacterial peritonitis is
a potentially life-threatening infection in patients with liver
cirrhosis and ascites. Its prevention is vital to improve prognosis
of cirrhotic patients. The main objective of this systematic review
was to evaluate what is the most efficacious and safest antibiotic
prophylactic strategy.
Methods : Studies were located by searching PubMed and
Cochrane Central Register of Controlled Trials in The Cochrane
Library until February 2019. Randomized controlled trials
evaluating primary or secondary spontaneous bacterial peritonitis
prophylaxis in cirrhotic patients with ascites were included. The
selection of studies was performed in two stages: screening of
titles and abstracts, and assessment of the full papers identified as
relevant, considering the inclusion criteria. Data were extracted in
a standardized way and synthesized qualitatively.
Results : Fourteen studies were included. This systematic review
demonstrated that daily norfloxacin is effective as a prophylactic
antibiotic for the prevention of spontaneous bacterial peritonitis in
patients with cirrhosis. Once weekly ciprofloxacin was not inferior
to once daily norfloxacin, with good tolerance and no induced
resistance. Trimethoprim-sulfamethoxazole and norfloxacin
have similar efficacy for primary and secondary prophylaxis of
spontaneous bacterial peritonitis, however, trimethoprim-sulfamethoxazole
was associated with an increased risk of developing an
adverse event. Rifaximin was more effective than norfloxacin in the
secondary prophylaxis of spontaneous bacterial peritonitis, with a
significant decrease in adverse events and mortality rate.
Conclusions : Continuous long-term selective intestinal decontamination
with norfloxacin is the most widely used prophylactic
strategy in spontaneous bacterial peritonitis, yet other equally
effective and safe options are available.
Buschke-Löwenstein tumor in a human immunodeficiency virus-positive patient : a case report and short literature review
Giant condyloma acuminatum, also known as Buschke-Löwenstein
tumor, is a rare variant of verrucous carcinoma presenting
in the ano-genital region. While its metastatic potential is limited,
aggressive local growth is common, with invasion and destruction
of the surrounding tissues often causing important therapeutic
challenges. Also, data to inform the optimal management approach
are scarce and mostly limited to anectodical reports. We present
the case of a human immunodeficiency virus-associated locally
advanced Buschke Löwenstein tumor that was successfully treated
with extensive surgery.
