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Biomedical subjects

A Ruol

Publications and source records attributed to A Ruol.

At least 109 records · Page 6Linked to original sources
PubMed1987

Long-term effects of beta-adrenergic blockade with nadolol on hepatic and renal haemodynamics and function in cirrhotics.

Non-cardioselective beta-blockers are used for prevention of re-bleeding from oesophageal varices in cirrhotics with portal hypertension. Nadolol, a non-cardioselective beta-blocker with a low liposolubility and a low hepatic metabolism, has been demonstrated to decrease portal pressure in cirrhotic patients. Since cirrhotics need long-term treatment, we investigated long-term effects of beta-adrenergic blockade with nadolol on hepatic and renal haemodynamics and function in a group of patients with cirrhosis and portal hypertension. In 19 patients with cirrhosis, after one and six months of treatment with nadolol hepatic venous pressure gradient showed a significant and persistent decrease, averaging 19% and 22%, respectively. Hepatic function and renal haemodynamics and function remained unaffected. Oesophageal varices severity was lowered in 11/19 patients after one month, in 9/16 after six months, in 8/14 after 12 months and in 5/10 after 18 months. Our results showed that, also after long-term treatment, nadolol decreases portal pressure and, in approximately 50% of patients, oesophageal varices severity, without side-effects on liver and renal function.

Adult↗
PubMed1987

Nadolol for prevention of variceal rebleeding in cirrhosis: a controlled clinical trial.

Nadolol, a nonselective beta-blocker, has been shown to decrease portal pressure in patients with cirrhosis at the same degree as propranolol. No data are available, however, about its effect on rebleeding rate and mortality in patients undergoing prevention of rebleeding from esophageal varices. A prospective randomized clinical trial was performed in patients with cirrhosis who survived a documented episode of variceal hemorrhage. 12 patients received nadolol, 12 placebo. Patients with child's C grade, tense ascites, renal failure, contraindications to beta-blocker, or age greater than 70 were not included. After a follow-up of up to 145 weeks, 9 patients in the nadolol group and 4 in the placebo group survived free from rebleeding (log-rank test: chi 2 = 4.35, p less than 0.05). Survival was not statistically different in the two groups (1 death in the nadolol group, 3 in the placebo group). In conclusion, nadolol appears to represent an effective therapy in the prevention of variceal rebleeding in cirrhotic patients.

Adult↗
PubMed1987

Effect of somatostatin on liver blood flow and liver metabolic activity in patients with cirrhosis.

In a group of 10 patients with cirrhosis, protal hypertension, and previous gastro-intestinal bleedings, hepatic plasma flow, indocyanine green clearance and intrinsic hepatic clearance were determined before and during i.v. infusion of somatostatin (7.5 micrograms/min). The same study protocol was performed in a further seven patients with cirrhosis infused with placebo. All these parameters were significantly decreased by the drug (p less than 0.05; less than 0.01; less than 0.01, respectively) mean decrease being 12, 9 and 8%, respectively, while no significant change occurred in the placebo-infused patients. These data indicate that somatostatin infused at a dose of 7.5 micrograms/min in cirrhotics provokes a slight decrease in hepatic plasma flow and in liver metabolic activity. This effect may contribute to further decrease hepatic removal of harmful substances and may increase systemic concentration of drugs metabolized by the liver.

Adult↗
PubMed1987

Adenocarcinoma of the cardia: the choice of surgical treatment.

The ideal surgical treatment for adenocarcinoma of the cardia is still controversial. Out of 168 consecutive patients resected in a 10-year period, 98 underwent esophagogastric resection (EGR) and 70 total gastrectomy with esophageal resection (TGER). Early and long-term results were compared in order to define specific indications for both surgical procedures. Abdominal nodes were metastatic in 62% of the cases; mediastinal nodes were metastatic in 20.3% of 138 thoracotomized patients. Neoplastic permeation of the section margin occurred in 4.7% of the patients. No positive section margins were found in the cases with 10 cm or more of uninvolved esophagus resected. The superiority of the thoracoabdominal approach was therefore evident in terms of oncologic radicality. Anastomotic leakages occurred in 13.3% of EGR and in 7.1% of TGER patients. No correlation between the stage of the tumor or the neoplastic permeation of the section margin and the incidence of leak was found. Operative mortality was 7.1% after EGR and 10% after TGER, which may suggest that EGR is the procedure of choice in poor-risk and elderly patients. Loco-regional or systemic neoplastic recurrence was responsible for long-term mortality in 70% of the cases. Anastomotic recurrence was found in 12.2% of EGR patients and in 1.4% of TGER patients. Overall five-year survival was 19.1%. Mean survival was 29.5 months, 30 after EGR and 27 after TGER (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1986

Laparoscopy in abdominal staging of esophageal carcinoma. Report of 369 cases.

Three hundred sixty-nine patients with cancer of the esophagus (280) and of the cardia (89) underwent laparoscopy, which revealed single or multiple metastases to the liver, peritoneum, omentum, stomach, and lymph nodes in 52 patients (14%) and a metastasis to the gastric wall or to the regional lymph nodes in 36 patients (9.7%). Laparoscopic false negative findings in our series of 250 cases submitted to laparotomy was only 4.4% (2.8% for the liver, 1.2% for the peritoneum, and 0.4% for the omentum). Cirrhosis was diagnosed in 14.3% and severe portal hypertension in 6.7% of our series. Laparoscopy is a very effective procedure in pretherapy staging of esophageal cancer.

Abdominal Neoplasms↗
PubMed1986

[Radiologic methods in the evaluation of upper esophagoplasties].

Post-operative radiologic control of esophageal plastic surgical procedures in pathologic conditions of the cervical esophagus involves difficulties due to the poor collaboration of the patient, who swallows only small quantities of contrast medium. Contrast medium injection through esophageal-gastric probes, and its reflux toward the cervical region with the Trendelemburg position and/or straining, enables the demonstration of fistulas otherwise unrecognized.

Administration, Oral↗
PubMed1985

[Diagnostic aspects and results of drug therapy in pulmonary thromboembolism].

Out of a group of 28 patients examined for suspected pulmonary thromboembolism (PTE), the diagnosis was confirmed by angiopneumography in 18 cases. In these patients the symptoms and clinical, electrocardiographical, radiological and scintiphotographical findings corresponded with those reported in the literature. 9 patients were treated with Urokinase (UK) at the dosages recommended by the Food and Drug Administration (FDA), followed by full-dose heparin, and 9 were treated with heparin alone. All patients survived and were discharged undergoing warfarin treatment. Follow-up checks were made after 1 and 6 months. Most of the patients treated with UK showed signs of swift improvement (within 24 hours) in clinical and instrumental terms with no significant haemorrhagic complications. An improvement was also observed in patient treated with heparin alone after the first week of treatment. To conclude: a) clinical diagnosis of PTE is neither sensitive nor specific; b) standard blood tests, electrocardiogram, chest x-ray and lung perfusion scintiphotography display different degrees of sensitivity compared with angiopneumography but all have a poor specificity; c) thrombolytic treatment is safe and effective in selected cases; d) long-term clinical results do not depend on treatment given during the acute stage of the disease.

Adult↗
PubMed1985

Effect of somatostatin on splanchnic hemodynamics in patients with liver cirrhosis and portal hypertension.

The effect of somatostatin on splanchnic hemodynamics in patients with liver cirrhosis is not clearly defined, as some authors report a decrease in portal pressure and in liver blood flow during intravenous administration of this hormone, while others do not. In 19 subjects with liver cirrhosis and portal hypertension the following parameters were measured before and during intravenous administration of somatostatin (7.5 micrograms/min): porto-hepatic gradient, estimated hepatic blood flow, specific splenic blood flow, cardiac index. Estimated hepatic blood flow decreased significantly during somatostatin infusion (p less than 0.05), averaging a 13% decrease; porto-hepatic gradient, splenic specific blood flow and cardiac index did not vary significantly. These data indicate that somatostatin infused at a dose of 7.5 micrograms/min induces a slight decrease in liver blood flow without affecting portal hypertension.

Adult↗
PubMed1984

[Effect of somatostatin on splanchnic hemodynamics in liver cirrhosis].

The effect of somatostatin on splanchnic haemodynamics in patients with liver cirrhosis is not clearly defined, as some Authors reported a decrease in portal pressure and in liver blood flow during i.v. administration of this hormone, while others did not. In 19 subjects with liver cirrhosis and portal hypertension the following parameters were measured before and during i.v. infusion of somatostatin (7.5 micrograms/min): porto-hepatic gradient, effective hepatic plasma flow, specific splenic blood flow, cardiac output. Moreover the gastrin-G-17 plasma levels, those of insulin and growth hormone were measured. Effective hepatic plasma flow decreased significantly during somatostatin infusion (P less than 0.05), averaging a 15% decrease. Porto-hepatic gradient, specific splenic blood flow, cardiac output did not vary significantly. Gastrin, insulin and growth hormone plasma levels decreased significantly (P less than 0.02, 0.01, 0.05). These data indicate that somatostatin infused at the dose of 7.5 micrograms/min provokes endocrine effects, but as far as the splanchnic circulation is concerned, it induces a slight decrease in liver blood flow without affecting portal hypertension.

Adult↗
PubMed1984

Beta 2-microglobulin concentration in plasma and production in liver cirrhosis.

The beta 2-microglobulin plasma level is often high in patients suffering from cirrhosis. Many authors believe this to be due to an increased production, provided that the creatinine level is in the normal range. In the present study, alterations in the plasma level and production of beta 2-microglobulin were investigated in patients with liver cirrhosis without overt renal failure. 62 patients, 48 men and 14 women, suffering from liver cirrhosis were examined. The glomerular filtration rate (GFR) and plasma beta 2-microglobulin were measured in all patients and in 16 controls. As beta 2-microglobulin is freely filtered by glomeruli and its extrarenal catabolism is negligible, the beta 2-microglobulin filtration rate was calculated as the product of the beta 2-microglobulin plasma level times the GFR. In steady state conditions, the beta 2-microglobulin filtration rate may be used as an indirect index of beta 2-microglobulin production. The beta 2-microglobulin plasma level was high in 26 patients; however, only 12 of them showed a definite rise in beta 2-microglobulin production, as shown by an increased beta 2-microglobulin filtration rate. The 14 patients with high beta 2-microglobulin plasma levels without high beta 2-microglobulin filtration rates obviously showed a decreased GFR; however, creatinine was not increased because of its small sensitivity as an index of renal function. A linear correlation was found between IgG and the beta 2-microglobulin filtration rate (r = 052; p less than 0.02), not between IgG and the beta 2-microglobulin plasma level. The other indices of liver damage were not related to the beta 2-microglobulin filtration rate of plasma level.

Female↗
PubMed1983

[Immunostimulation with levamisol in inoperable cancer of the esophagus].

In the light of previous personal research indicative of immunodepression in patients with cancer of the oesophagus, the effect of aspecific immunostimulation with Levamisol was assessed on 70 patients with inoperable forms. All patients were treated by positioning of a Celestin endoesophageal prosthesis for the palliation of dysphagia, and submitted to a randomised protocol involving aspecific immunostimulation with 150 mg Levamisol per os twice a week on nonconsecutive days for an indefinite period. The mean survival of the treated group was not significantly better than that of the controls, nor was any real advantage detected on dividing the series in terms of age, tumour histology and degree of differentiation, extension, or the clinical stage.

Carcinoma, Squamous Cell↗
PubMed1983

Pathogenetic relationships between renal tubular acidosis and sodium metabolism alterations in liver cirrhosis.

5 cirrhotic patients with latent distal renal tubular acidosis (RTA) and 5 cirrhotic patients with normal distal acidification ability were studied. All the patients were maintained on a 80 mEq/day sodium diet for at least 5 days before the study. Only 2 of the 5 patients with RTA showed a reduced daily sodium excretion while the 3 other patients with RTA had a normal natriuresis. Acidification ability was retested in all the patients after increasing sodium distal delivery by intravenous administration of ethacrynic acid. Some hours after the maximal natriuretic effect induced by ethacrynic acid, a normalization of the acidification test was seen in all patients with RTA. These findings support the concept that although sodium metabolism alterations are not the only factor in the pathogenesis of RTA in liver cirrhosis, reduced availability of sodium at the distal tubule may impair tubular acidification, probably by influencing the distal transtubular potential difference.

Acidosis, Renal Tubular↗
PubMed1982

Proteinuria in patients with cirrhosis: relationship between renal and hepatic function.

1. In 37 patients with cirrhosis of the liver of different severity (11 in class A, 18 in class B, and 8 in class C, according to Child's criteria modified by Hobbs), inulin and p-aminohippurate clearances, total fractional protein excretion and the fractional clearances of alpha 1-acid glycoprotein, albumin, transferrin, alpha 2-macroglobulin and beta 2-microglobulin (in 20 patients) were determined. 2. Insulin clearance was lower than 70 ml/min in 19 patients had p-aminohippurate clearance was lower than 300 ml/min in 20 patients. Total fractional protein excretion was above normal in 19 patients; alpha 1-acid glycoprotein fractional clearance was above normal in 11, albumin fractional clearance in 10, transferrin fractional clearance in five, alpha 2-macroglobulin fractional clearance in three, and beta 2-microglobulin fractional clearance in 10. 3. The increases in protein excretion were independent of any impairment of renal tubular function. An inverse relationship between protein excretion and the clearances of inulin and p-aminohippurate was found. No difference in protein excretion was found between the three groups of patients with different degrees of liver damage. 4. The results suggest that in cirrhosis an increase in glomerular permeability is frequent, though generally slight; it is correlated with an impairment of kidney function and is independent of the severity of the liver damage.

Adult↗
PubMed1982

Lack of correlation between endotoxaemia and renal hypoperfusion in cirrhotics without overt renal failure.

Renal involvement in patients with liver cirrhosis is characterized by renal vasoconstriction, the aetiology of which remains obscure. Endotoxaemia, frequently found in patients with liver cirrhosis and renal failure, has been emphasized as a pathogenic factor. In fifty-seven patients with liver cirrhosis without overt renal failure endotoxin plasma level (Limulus Lysate test), mean renal blood flow (MRBF) (133Xe washout technique), and effective renal plasma flow (ERPF) (p-aminohippurate clearance) were determined. MRBF was decreased in nineteen out of twenty-seven patients, averaging 1.88 +/- 0.51 ml g-1 min-1 (in fourteen controls 3.17 +/- 0.51 ml g-1 ml-1). ERPF was decreased in seventeen out of thirty patients, averaging 380 +/- 164 ml/min (in eighteen controls 624 +/- 127 ml/min). Systemic endotoxaemia was found in sixteen out of fifty-seven patients, levels ranging from 0.62 to 200 ng/ml. No significant difference in renal blood flow values was found between patients with and without endotoxaemia (MRBF = 1.78 +/- 0.51 and 1.93 +/- 0.52 ml g-1 min-1 respectively; ERPF = 429 +/- 119 and 365 +/- 175 ml/min respectively). No significant difference in the frequency of endotoxaemia was found between patients with impaired and unimpaired renal blood flow. Moreover no relation was found between endotoxin plasma levels and MRBF and ERPF respectively. In conclusion in patients with cirrhosis without overt renal failure renal vasoconstriction does not seem to be related to endotoxaemia.

Adult↗
PubMed1982

Long-term follow-up of acute and chronic non-A, non-B post-transfusion hepatitis: evidence of progression to liver cirrhosis.

The long-term outcome of non-A, non-B post-transfusion hepatitis was evaluated in 21 patients who developed the illness after open-heart surgery and could be followed thereafter up to five years. Histological chronic sequelae were documented in 13 patients, and consisted of chronic persistent hepatitis in one case, chronic lobular hepatitis in two and chronic active hepatitis in 10, five of whom also developed superimposed cirrhosis. Progression to these chronic states was in most cases symptomless, independently of the severity of liver lesions; one patient, however, died of gastrointestinal bleeding due to cirrhosis of the liver. During follow-up the biochemical pattern of chronic non-A, non-B hepatitis was unique, while striking fluctuations of transaminase levels. Liver histology proved essential to identify the severity of chronic liver lesions, as clinical and biochemical features were uniform and not indicative of it. Our results suggest that cirrhosis may develop, often with an asymptomatic course, in a significant number of patients who do not recover after acute post-transfusion non-A, non-B hepatitis.

Acute Disease↗