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Biomedical subjects

A Gurakar

Publications and source records attributed to A Gurakar.

At least 37 records · Page 2Linked to original sources
PubMed1995

Cavernous transformation of the portal vein: a common manifestation of Behçet's disease.

Behçet's disease (BD) is a chronic, multisystem inflammatory disorder of unknown etiology, which is characterized by recurrent aphthous ulcers of the mouth and genitalia, uveitis with hypopyon, and a diffuse vasculitis that involves the arterial and venous systems. From January 1968 to July 1993, 66 of 844 patients with BD seen at the Hacettepe University Hospital, Ankara, Turkey, experienced a vascular complication other than peripheral thrombophlebitis. The vascular complication in each case was identified based upon a combination of clinical data, digital subtraction angiography, CT, and ultrasonography findings. Six of these 66 (9.1%) had cavernous transformation of the portal vein. Five of these six had additional large vein involvement resulting in the Budd-Chiari syndrome with or without inferior vena caval obstruction. Based upon this experience, it can be concluded that portal vein thrombosis is not a rare complication of BD. When patients with BD are found to have or develop splenomegaly, portal vein thrombosis should be suspected and investigated. If hepatomegaly and ascites are detected, Budd-Chiari syndrome due to hepatic vein thrombosis should be suspected. Finally, if hepatosplenomegaly, ascites, and dependent edema of the lower body are present, thrombosis of the inferior vena cava should be suspected.

Behcet Syndrome↗
PubMed1995

Major gastrointestinal bleeding occurring after liver transplantation.

The incidence, frequency, and sites of major gastrointestinal bleeding occurring after successful liver transplantation are reported. Only 2.3% of liver transplant recipients experience a major gastrointestinal hemorrhage characterized by clinical hypotension or a need for more than three units of blood over a 12-hour period. Bleeding rarely occurs from a lesion identified pretransplantation. Most bleeding episodes, although clinically significant, can be managed without additional surgery unless liver graft failure occurs, necessitating a second liver graft.

Gastrointestinal Hemorrhage↗
PubMed1995

Right diaphragmatic paralysis following orthotopic liver transplantation.

Although most postoperative complications of liver transplantation are well known and their pathophysiology is reasonably understood, right diaphragmatic dysfunction occurring after liver transplantation remains an unappreciated complication. To evaluate the incidence and mechanisms responsible for such injury, a group of 48 liver transplant patients were studied prospectively. Partial right diaphragmatic paralysis was found in 11 (23%), complete paralysis was found in 10 (21%) and the remaining 27 patients had normal diaphragmatic motion (56%). The operative records of these 48 patients were reviewed. Right diaphragmatic injury was found to be a common postoperative complication of liver transplantation. Moreover, it was found to have a clinically significant effect upon the postoperative course of these patients, often necessitating a prolonged ICU stay and prolonged ventilatory support. Although the exact mechanism responsible for its occurrence remains speculative, careful attention to operative technique particularly in the dissection of the upper cava and careful closure of the bare area of the diaphragm, may reduce the frequency of this untoward complication.

Adolescent↗
PubMed1995

The polka dot liver and spleen: a case report.

Hepatomegaly occurring in association with an inhomogeneous liver documented on CT scanning in an individual with abnormal liver injury parameters is a common clinical finding. In most such cases, an increase in the canalicular enzymes (alkaline phosphatase and gamma-glutamyl transpeptidase) is present. Most individuals with this combination of findings are ill-appearing individuals with metastatic cancer. The same findings in an individual with few symptoms or one who appears quite fit is unusual and presents a unique problem in differential diagnosis. Herein we present such a case that, with appropriate medical therapy, had a near complete resolution of the biochemical and radiologic manifestations of disease.

Biopsy↗
PubMed1994

NK activity during graft-versus-host disease and graft rejection in rats following intestinal semiallogenic and allogenic transplantation with or without mesenteric lymphadenectomy.

Graft-versus-host disease (GVHD) and graft rejection are major problems following intestinal transplantation (IT). Natural killer (NK) cells may be important effector cells in both conditions. In this study, Sprague-Dawley (SD) or SD-Brown Norway (BN) F1 rat intestine was transplanted into BN recipients with and without associated graft mesenteric lymphadenectomy (GML). Cyclosporine (15 mg/kg day) was administered to all animals. Pieces of the intestinal graft were examined 4 days posttransplant and again at death. NK activity calculated using intestinal intraepithelial lymphocytes (IL) was determined utilizing an 18-hr cytotoxic assay assessing 51Cr release and the results are reported as lytic units. YAC-1 cells were used as the target. NK activity was reduced 4 days after IT both in native (8.02 +/- 0.64) and in grafted bowel (3.14 +/- 1.51), with histological evidence of rejection as compared with that of control bowel in ungrafted rats (21.1 +/- 2.14). Survival was increased, on mean, a total of 6 days with the addition of GML in both semiallogenic and allogenic transplanted rats. At the time of death, the NK activity in the native bowel had increased (17.1 +/- 3.02) and histologic evidence of GVHD was present. These data suggest that: (1) NK cells are important in GVHD and (2) both semiallogenic and allogenic transplants survive longer if they are combined with GML (P < or = 0.05 and P < or = 0.01, respectively).

Animals↗
PubMed1994

Is rejection a diffuse or localized process in small-bowel transplantation?

Utilization of endoscopy to both visualize and selectively biopsy an intestinal allograft has become the standard for early recognition and treatment of intestinal allograft rejection. Despite the widespread acceptance of the need for selective mucosal biopsies, it has not been shown that the histological features of intestinal allograft rejection are either localized or occur as part of a more diffuse phenomenon within a tubular allograft. To resolve these issues, 88 ileoscopies were performed in 12 small-bowel allograft recipients and mucosal biopsy samples were obtained at 5, 10, and 15 cm, respectively, from the ileal stoma. Each mucosal biopsy was labeled, processed, and evaluated individually for the presence and severity of any evidence for allograft rejection. The data obtained suggest that intestinal allograft rejection is a diffuse process, and biopsies obtained randomly from an ileal graft are likely to demonstrate evidence of allograft rejection when such is present.

Adult↗
PubMed1994

The use of granulocyte-macrophage colony-stimulating factor to enhance hematologic parameters of patients with cirrhosis and hypersplenism.

In patients with end-stage liver disease complicated with hypersplenism, neutropenia and thrombocytopenia are risk factors for systemic sepsis and spontaneous bleeding. Granulocyte-macrophage colony-stimulating factor is a naturally occurring cytokine that promotes proliferation and differentiation of granulocyte and monocyte progeny cells. In addition, it is reported to promote the proliferation of megakaryocytes. Its use as an intravenous infusion is Federal Drug Authority (USA) approved for the enhancement of myeloid recovery following autologous bone-marrow transplantation. The present study was initiated to determine whether granulocyte-macrophage colony-stimulating factor could be used to increase the white blood cell and platelet count in patients with cirrhosis and hypersplenism and to determine whether the more convenient subcutaneous route can be used with the same efficacy as the recommended intravenous route. Nine patients with cirrhosis and hypersplenism manifested by a reduced absolute neutrophil count (mean value of 1300 +/- 200/mm3) were studied. In eight patients, Indium white blood cell splenic sequestration scans were obtained before and after the administration of granulocyte-macrophage colony-stimulating factor intravenous infusion or subcutaneously for 7 days. One patient had to discontinue the therapy due to a reaction to granulocyte-macrophage colony-stimulating factor. Following intravenous infusion of granulocyte-macrophage colony-stimulating factor, the mean absolute neutrophil count increased to 2600 +/- 1100/mm3. Following subcutaneous administration, the mean absolute neutrophil count increased to 4100 +/- 200/mm3. No significant change in platelet count occurred with either route of administration. Indium scans obtained before and after the treatment period revealed no significant difference in the splenic uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1994

Androgenic/anabolic steroid-induced intrahepatic cholestasis: a review with four additional case reports.

Four cases of severe cholestasis attributed to anabolic/androgenic steroid usage are reported. These cases are reported because each was severely jaundiced (peak bilirubin level 62 mg/dl), developed advanced hepatic failure (Child's Class B) and was referred to a liver transplant center for consideration for liver transplantation. The hepatic dysfunction and cholestasis in each persisted for 3 months or more. Moreover, in two the hepatic dysfunction was complicated by the development of renal dysfunction and anemia requiring additional medical interventions. With prolonged medical therapy, each case recovered fully without transplantation. These cases are important because they demonstrate that drug-induced cholestasis can be prolonged, can mimic advanced liver disease, and can be associated with co-existent renal dysfunction.

Adult↗
PubMed1993

Liver transplantation for subfulminant hepatitis.

The preceding discussion has characterized the various types of viral hepatitis, both common and unusual, that can lead to subfulminant hepatic failure. Whenever specific medical therapy exists, it is preferred. If the disease has progressed sufficiently to prohibit survival inspite of medical therapy, OLT is indicated under the umbrella of continuing specific medical therapy. Conversely, if no medical therapy exists, OLT is the only possible therapy but should be used only if extrahepatic disease processes do not prohibit survival. Hopefully, with better and more effective means of immunosuppression, immunosuppression monitoring and the development of additional medical therapies for viruses, OLT will be used less often in cases of subfulminant viral hepatitis in the future.

Hepatic Encephalopathy↗
PubMed1989

Distribution and functions of lecithin:cholesterol acyltransferase and cholesteryl ester transfer protein in plasma lipoproteins. Evidence for a functional unit containing these activities together with apolipoproteins A-I and D that catalyzes the esterification and transfer of cell-derived cholesterol.

The distribution of apolipoprotein A-I, apolipoprotein D, lecithin:cholesterol acyltransferase, and cholesteryl ester transfer protein in fasting normal human plasma was determined by two-dimensional electrophoresis followed by immunoblotting. The synthesis and transfer of labeled cholesteryl esters generated in plasma briefly incubated with [3H]cholesterol-labeled fibroblasts was followed in terms of the lipoprotein species containing these antigens. Following the early appearance of labeled free cholesterol in two pre beta-migrating apolipoprotein A-I species (Castro, G. R., and Fielding, C. J. (1988) Biochemistry 27, 25-29), labeled esters were first detected, after a 2-min delay, in a third pre beta-migrating species which also contained apolipoprotein D, lecithin:cholesterol acyltransferase, and cholesteryl ester transfer protein. Pulse-chase experiments determined that label generated in this fraction was the precursor of at least a major part of labeled cholesteryl esters in the bulk of alpha-migrating high density lipoprotein. Over the maximum time course of these experiments (15 min, 37 degrees C), less than 10% of labeled cholesteryl esters were recovered in low or very low density lipoproteins separated by electrophoresis, immunoaffinity, or heparin-agarose chromatography. These data suggest channeling of cell-derived cholesterol and cholesteryl esters derived from it through a preferred pathway involving several minor pre beta-migrating lipoproteins to alpha-migrating high density lipoprotein.

Antibodies, Monoclonal↗
PubMed1989

Hypertension, erectile dysfunction, and occult sleep apnea.

Sleep-related respiratory pattern was evaluated in 175 hypertensive and 110 normotensive men, none of whom reported difficulties in initiating or maintaining sleep. Patients were grouped according to sexual status (complaint of erectile problems), hypertension treatment status (treated or untreated), and blood pressure (diastolic less than 90 or greater than or equal to 90). The prevalence of sleep apnea, apnea index, duration of the longest episode of apnea, and penile rigidity were tabulated. The group with elevated blood pressure, persistent even with antihypertensive drug therapy, had the most sleep apnea. The treated hypertensive men with controlled blood pressure had significantly less apnea than those whose blood pressure remained high. Untreated hypertensive groups, however, did not differ from normotensive groups with respect to apnea. Evidence of abnormal sleep-related respiratory activity was found in both hypertensive and normotensive groups with erectile problems. Interestingly, penile rigidity was significantly lower for hypertensive men with erectile complaints than for normotensive men with erectile complaints. There was also a small, but significant, negative correlation between apnea index and penile rigidity among men with erectile complaints. These results indicate that sexual status is an important consideration in the diagnosis of hypertension and sleep apnea. Moreover, these data suggest an interrelationship among hypertension, erectile dysfunction, and sleep apnea.

Antihypertensive Agents↗
PubMed1985

Levels of lipoprotein Lp(a) decline with neomycin and niacin treatment.

Total and low density lipoprotein cholesterol concentration reduction in patients with markedly increased levels of these substances, leads to a decline in the incidence of myocardial infarction and death. A unique cholesterol-rich lipoprotein, lipoprotein Lp(a), has been identified which not only can be confused with low density lipoproteins, but has also been associated with premature cardiovascular disease. Using the cholesterol-lowering drugs neomycin and niacin in 14 type II hyperlipoproteinemic subjects, we determined the effect of lipid-lowering therapy on lipoprotein Lp(a) concentrations. Neomycin (2g/day) reduced low density lipoprotein cholesterol and lipoprotein Lp(a) concentrations by 23% and 24%, respectively. Combination therapy with neomycin (2 g/day) and niacin (3 g/day) induced a 48% decline in low density lipoprotein cholesterol levels and a 45% reduction in the concentration of lipoprotein Lp(a). These changes in lipoprotein Lp(a) levels were associated with a striking decline in the intensity of the slow pre-beta-lipoprotein fraction determined Lp(a) by lipoprotein electrophoresis. This slow pre-beta-lipoprotein fraction contained Lp(a) determined by immunofixation. These observations indicate that lipoprotein Lp(a) concentrations can be altered pharmacologically and that the progression of cardiovascular disease may be altered through changes in lipoprotein (a) levels.

Adult↗
PubMedDate not supplied

Prostate-specific antigen levels among cirrhotic patients.

PURPOSE: The aim of this study was to determine serum prostate-specific antigen (PSA) levels in patients with liver cirrhosis. PATIENTS AND METHODS: Between January 1995 and August 2001, 216 men with cirrhosis were evaluated. The extent of their liver disease was classified according to the Child-Pugh classification. Serum PSA levels were measured with the Hybritech Tandem-R RIA method and matched with age-related reference PSA levels. Digital rectal examination (DRE) was performed in all patients. Patients with elevated PSA levels and/or abnormal DRE were recommended to undergo further assessment including transrectal ultrasonography (TRUS) and biopsy performed by an urologist. RESULTS: Two hundred and sixteen men (mean age 54.09 +/- 9.09 years, range 25-76) with cirrhosis were examined. Their mean PSA value was 0.57 +/- 0.84 ng/mL and tended to be lower than in the normal population. The degree of PSA decrease was found to parallel the severity of the liver disease (p=0.002). The mean serum PSA level increased with each age decade in a statistically significant manner (p<0.001). Four patients (three with elevated PSA values) underwent prostate biopsy. Three biopsies were positive for prostate cancer, the other showed evidence of benign prostatic hyperplasia (BPH). CONCLUSION: Serum PSA is influenced by the severity of liver disease and its levels tend to be lower in cirrhotic patients than in the normal population. However, serum PSA can still be considered a reliable marker in the clinical management of prostatic disease in patients with cirrhosis.

Adult↗
PubMedDate not supplied

A comparison of chemoembolization with conventional chemotherapy and symptomatic treatment in cirrhotic patients with hepatocellular carcinoma.

BACKGROUND/AIMS: The results of transcatheter arterial chemoembolization (TACE) in 28 cirrhotic patients with advanced hepatocellular carcinoma (HCC) were compared to those obtained in 15 cirrhotic patients with HCC treated with systemic chemotherapy, and 14 patients with HCC receiving no specific anti-cancer treatment. MATERIALS AND METHODS: From November, 1986 through May 1994, 235 patients with HCC were seen by the investigators. Twenty eight of these patients actually received TACE. The chemotherapeutic agent used was mitomycin C mixed with Lipiodol and arterial embolization was achieved using Gelfoam. In 19 of 28 cases treated with TACE, the embolization was limited to an artery feeding the tumor, thereby avoiding liver cell injury in non-tumor tissue. In 9 others, the main left or right hepatic artery was embolized. The results obtained in these 28 cases were compared to those obtained in 15 patients with HCC larger than 5 cm. who received systemic mitomycin C and doxorubicin chemotherapy and with those obtained in 14 patients who received no specific anti-tumor therapy. RESULTS: One patient died of liver failure related to the TACE and three patients died of bleeding from esophageal varices within weeks of the TACE procedure. Two of the remaining 24 patients are alive with a follow-up of 6 and 22 months. Twenty-six of the 28 patients treated with TACE died within 1 and 28 months of the initiation of the TACE therapy. The mean survival of those receiving TACE was 13.0 months. Chemotherapy without embolization yielded a mean survival of 7.2 months. The mean survival of the patients receiving no specific anti-cancer treatment was only 6.9 months. There was no statistical differences between the survival of those receiving systemic chemotherapy and those receiving no specific treatment. In contrast, the mean survival of the group receiving TACE was significantly greater than that of either of the other two groups (p < 0.005). CONCLUSIONS: These data suggest that TACE provides the best survival for individuals with larger hepatocellular carcinomas (> 5 cm) not eligible for surgery or percutaneous ethanol injection (PEI).

Antibiotics, Antineoplastic↗
PubMedDate not supplied

gamma-Glutamyl transpeptidase as a response predictor when using alpha-interferon to treat hepatitis C.

BACKGROUND/AIMS: This study was performed to identify response predictors for Interferon therapy given to patients with chronic hepatitis C. MATERIALS AND METHODS: The biochemical measures of liver injury that characterize viral hepatitis due to hepatitis C were followed prospectively in 84 individuals treated with alpha-Interferon. In addition, the liver histology and the hepatic iron content of these same individuals, prior to the initiation of Interferon therapy, were determined. RESULTS: Patients not responding to the interferon therapy showed an increase in liver iron content from an average of 337 micrograms/g wet weight. In responder to a value of 1075 micrograms/g wet weight in non responders. gamma-glutamyl transpeptidase levels in responders were significantly lower than in partial or non-responders. CONCLUSIONS: Both the hepatic iron content of the liver and the gamma-glutamyl transpeptidase value prior to treatment were able to predict a clinical response to Interferon therapy. More importantly, the gamma-glutamyl transpeptidase level measured in serum could be used to monitor the IFN response during treatment and was found to predict clinical exacerbations of hepatitis following withdrawal of Interferon therapy.

Adult↗
PubMedDate not supplied

Hepatitis C and the controversies it creates relative to liver transplantation and autoimmune hepatitis.

The paradox of hepatitis C. An agent that persists in tissue for years by escaping the immune system and not killing but only damaging its host while simultaneously being associated with autoimmune hepatitis as well as other putative autoimmune diseases is presented. Liver transplantation necessitates immune suppression and is associated with progressive HCV disease albeit at a rather slow rate. Diagnosis and treatment concerns are raised and discussed.

Autoimmune Diseases↗
PubMedDate not supplied

Liver transplantation after an acute episode of spontaneous bacterial peritonitis.

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is a common complication of advanced cirrhosis. Thus many potential transplant recipients will experience this problem while waiting for a liver donor. The minimal amount of time with the use of appropriate antibiotics after which a potential recipient can be transplanted safely is not currently known. We examined the effect of pretransplant SBP on subsequent post-transplant outcome. MATERIALS AND METHODS: A retrospective review of the records of 100 liver transplant recipients having an episode of spontaneous bacterial peritonitis within 30 days of their transplant was performed. The records of transplant controls without an episode of spontaneous bacterial peritonitis were reviewed to compare the outcome between the two groups in terms of sepsis during the initial 30 post-transplant days. RESULTS: Post-transplant sepsis occurred in 8.8% of the cases and 10% of the controls (NSO). Only one episode in the study group could be ascribed to the pre-transplant episode of spontaneous bacterial peritonitis and it occurred in an IgA deficient recipient. CONCLUSIONS: These data suggest that SBP prior to liver transplantation does not lead to an increased rate of postoperative sepsis if 4 or more days of appropriate treatment for SBP are administered prior to liver transplantation.

Acute Disease↗