ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00732.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This randomized, double‐blind, placebo‐controlled study on the hemodynamic effect of two different doses of octreotide administered subcutaneously was conducted among 20 cirrhotic portal hypertensive patients. The wedged hepatic venous pressure, the hepatic venous pressure gradient, the mean portal venous flow velocity, the resistive index of the superior mesenteric artery, the heart rate and the mean arterial pressure were simultaneously evaluated by hepatic vein catheterization and Doppler flowmetry at baseline, 30 and 45 min after a subcutaneous injection of octreotide [0.10 mg (7 patients), 0.05 mg (7 patients)] and of a placebo (6 patients). The portal blood flow velocity, the resistive index of the superior mesenteric artery, the heart rate and the mean arterial pressure were also measured 2, 4, 6 and 8 h after the injection. The hemodynamic changes observed 30 min after the injection did not differ from those at 45 min and the changes at 2, 4, and 6 h were similar to those at 8 h. A statistically significant decrease, in comparison to the placebo group, was observed 45 min after the injection of the two doses of octreotide in the wedged hepatic venous pressure (cumulative median decrease: —10%,p<0.005), in the hepatic venous pressure gradient (cumulative median decrease: —10%,p<0.005) and in the mean portal flow velocity (cumulative median decrease: —11%,p<0.005). A significant increase in the resistive index of the superior mesenteric artery was observed 45 min after the injection of the two doses of octreotide (cumulative median increase: + 10%,p<0.005). Lower, but significant changes in the mean portal flow velocity and in the resistive index of the superior mesenteric artery persisted until 8 h after the injection of the two doses of octreotide (cumulative median decrease of mean portal flow velocity: —7%,p<0.005 and cumulative median increase of resistive index of the superior mesenteric artery: +4%,p<0.005). Changes in the wedged hepatic venous pressure, the hepatic venous pressure gradient, the mean portal flow velocity and the resistive index of the superior mesenteric artery showed a great variability among patients. These changes were more pronounced in patients injected with the lower dose with no relationship with the plasma drug concentrations. Responder patients showed a significant higher baseline mean portal flow velocity in comparison with nonresponders (15.2±1.7 cm/s vs 11.3 ±1.3

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00733.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A case of hepatocellular adenoma arising in the left lobe of the liver in a 53‐year‐old man, not associated with any predisposing factor, is presen

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00734.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Endothelial damage within the sinusoids of the liver probably plays a key role in primary liver dysfunction following transplantation. The aim of this work was to study the serum levels of two potential markers of endothelial damage, creatine kinase‐BB and soluble thrombomodulin, during human graft revascularization. Thirteen human liver grafts were preserved in UW solution (mean time: 13.8 h). Creatine kinase‐BB and transaminase activities and soluble thrombomodulin levels were measured: 1) in effluent and 2) in serum samples sequentially collected before revascularization, then during the first 120 min of revascularization and first post‐operative week. No correlation was observed between serum values (peak) and effluent values. In serum, pre‐operative creatine kinase‐BB activities were correlated with soluble thrombomodulin levels (p=0.01). Both increased significantly during the first minutes of the revascularization, then decreased markedly. In contrast, AST activity was maximal at day 1. This detectable and early release of creatine kinase‐BB and soluble thrombomodulin in blood is in keeping with the early occurence of endothelial damage. Together with previous data, these findings suggest that serum determination of these two markers may be a useful tool in the assessment of endothelial injury in liver tran

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00735.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The present study was aimed to clarify the virologic status, liver histologies, and the results of follow‐up liver tests in symptom‐free individuals with anti‐HCV antibodies and normal liver tests. Forty‐nine individuals with normal liver tests and positive second generation anti‐HCV antibody assay were entered into this study. Cases with hepatitis C viremia were evaluated for HCV genotype, amount of circulating HCV‐RNA, and liver histology and were followed‐up for more than one year. Of the forty‐nine individuals, 36 had hepatitis C viremia, indicated by polymerase chain reaction (PCR) assay. Liver histology was as follows: 3 had non‐specific changes, 25 had chronic persistent hepatitis (CPH), and 8 had chronic active hepatitis (CAH). Twenty‐four cases with CPH and CAH developed an elevated AST and/or ALT concentration (>30IU/1) between 12 and 32 months of follow‐up. The amount of circulating HCV‐RNA ranged from 102to 107copies/50 μl serum. The distribution of HCV genotypes was nearly the same as that for symptomatic CAH. These data suggest that the histological examination and follow‐up examination are very important for following symptom‐free individuals with hepatitis C viremia because there are some candidates for interferon therapy among them. There are few individuals who will remain healthy amo

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00736.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We studied 81 patients with chronic hepatitis C to investigate the relationship between iron and α‐interferon response. Sixty‐one patients (group A) were given α‐interferon irrespective of iron status, whereas 20 (group B) with iron overload, were iron depleted before α‐interferon therapy. In group A, 21 patients responded to α‐interferon and 40 were non‐responders. Increased iron indices were significantly more frequent in non‐responders than responders. Multivariate analysis showed that among the independent variables evaluated, only γ‐GT and liver iron concentration predicted therapy outcome. After phlebotomy treatment, serum alanine aminotransferase fell significantly both in patients of group B (196±122 IU/1 vs 82±37 IU/1,p<10‐6) and in 12 non‐responders of group A (198±89 IU/1 vs 107±81 IU/1,p<10‐6). In 16 iron depleted patients, eight from each group, subsequent treatment with α‐interferon produced a response in only one patient. These results suggest that increased liver iron is a negative prognostic factor for a‐interferon response in chronic hepatitis C. Iron depletion had a beneficial effect on serum alanine aminotransferase in all the patients treated, but did not i

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00737.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The distinction between hepatobiliary cystadenoma or cystadenocarcinoma and simple hepatic cyst complicated by intracystic hemorrhage may prove difficult to determine on the sole basis of clinical and radiological features because of the presence of intracystic structures and septations well‐demonstrated by ultrasound examination in both situations. We investigated four patients with various types of hepatic cysts, in whom diagnostic difficulties led to further investigations. In this small group, CA 19–9 serum levels were abnormal only in the two patients with cystadenoma or cystadenocarcinoma. Cystic fluid CA 19–9 values were also five times higher in cystadenoma and cystadenocarcinoma than in other benign lesions. Our data thus suggest that the determination of serum and cyst fluid CA 19–9 may be of help in distinguishing between hemorrhagic simple cyst and cystadenoma or cystadenoca

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00738.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:In order to estimate the tissue liver function, tissue hepatic blood volume was measured quantitatively and non‐invasively using C15O inhalation in conjunction with positron‐emission tomography. Fifty‐eight patients with normal liver function, 14 patients with chronic hepatitis, 28 patients with hepatic cirrhosis, and 4 patients with obstructive jaundice were studied by positron‐emission tomography scan after the single breath inhalation of 20 mCi of high specific activity15O‐labeled carbon monoxide. The mean tissue hepatic blood volume was significantly greater in patients with normal livers than in patients with chronic hepatitis or hepatic cirrhosis (mean: 20.5, 18.2, and 16.1 ml per 100 cm3, respectively,p=8.6×10‐8). Tissue hepatic blood volume (tHBV) correlated with the reaction of the mesenchymal system and protein synthesis, because there was a potent correlation between tHBV and hepatic fibrosis. In normal livers, we were able to demonstrate significant differences in tissue hepatic blood volume among li

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00739.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Although an increase in sympathetic nervous activity has been recognized in cirrhosis, the contribution of this overactivity to the regulation of arterial pressure is unknown. The arterial pressure response to increasing doses of hexamethonium (0.05 to 3.2 mg · kg‐1· min‐1), a ganglionic blocker that decreases sympathetic cardiovascular tone, was explored in normal rats and in two models of portal hypertension, i.e., rats with cirrhosis and rats with portal vein stenosis. Changes in plasma norepinephrine concentrations were greater in rats with cirrhosis (356±50 vs 166±30 pg/ml,p=0.04) than in normal rats (186±23 vs 86±31 pg/ml,p=0.06) and rats with portal vein stenosis (103±37 vs 93±5 pg/ml,p=0.10). The maximum decrease in arterial pressure was obtained at a dose of 1.6 mg · kg‐1· min‐1in each group. However, the decrease in arterial pressure was significantly greater in rats with cirrhosis (‐25±2%) than in normal rats (‐11±1%) and in rats with portal vein stenosis (‐13±2%) (p=0.04). In conclusion, the results of this study suggest that the sympathetic cardiovascular tone is more important for the maintenance of arterial pressure in rats with cirrhosis than in normal rats and in rats

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00740.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Hospitals have few published guidelines to follow when performing a liver biopsy. In 1992, we began revising our protocol in an effort to institute new guidelines for our teaching hospitals. To assess the current practice of liver biopsy, we sent 500 multilingual questionnaires to international academic centers, and 85 U.S. centers were surveyed by telephone. The survey assessed: 1) patient preparation, 2) technical aspects of the biopsy, and 3) post‐procedural care. One hundred and eighty international centers and 85 U.S. centers responded (total=265). We found a wide variation in the practice of this surgical procedure at both national and international centers. Many Asian centers (73%) performed a bleeding time prior to liver biopsy. This practice was seen in only 36% of the U.S. centers. Most centers preferred platelet counts of 50,000/mm3and above. The aspiration needle was more widely used in the U.S. (74%) and in many international centers, but Asian centers (61%) preferred a cutting needle. Thirty percent of Japanese centers performed more than 50% of their liver biopsies laparoscopically. Few laparoscopics were done at other centers. While about a quarter of the reported U.S., European, Asian, and South American centers observed patients for 4–6 hours after a biopsy, the majority of centers observed patients 10 hours or more. In addition to the wide variation seen, this survey provided us with an academic view of the contemporary practice of liver biopsy and an insight into how to redefine our present guideli

ISSN:0106-9543    

DOI:10.1111/j.1600-0676.1996.tb00741.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY