[Does liver cirrhosis cause clinically relevant, but reversible chronic heart failure?].
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Ascites↗
Biomedical subjects
F Wewalka
Publications and source records attributed to F Wewalka.
Conjugated bile acid replacement therapy in short bowel syndrome patients with a residual colon.
AIM: To test the efficacy of cholylsarcosine (synthetic conjugated bile acid) and ox bile extracts (mixture of natural conjugated bile acids) on fat absorption, diarrhea, and nutritional state in four short bowel syndrome (SBS) patients with a residual colon not requiring parenteral alimentation. METHODS: The effect of cholylsarcosine (2 g/meal) on steatorrhea and diarrhea was examined in short-term balance studies with a constant fat intake in all four patients. The effect of continuous cholylsarcosine ingestion on nutritional state was assessed by changes in body weight in three patients. In two patients, the effects of cholylsarcosine were compared with those of ox bile extracts. Because of the low incidence rate of SBS this is not a controlled study. RESULTS: In balance studies, cholylsarcosine increased fat absorption from 65.5 to 94.5 g/day (a 44 % increment), an energy gain of 261 kcal/d. Fecal weight increased by 26 %. In two patients natural conjugated bile acids also reduced steatorrhea, but greatly increased diarrhea. As outpatients consuming an unrestricted diet and ingesting cholylsarcosine, three patients gained weight at an average rate of 0.9 kg/week without worsening of diarrheal symptoms. CONCLUSIONS: Cholylsarcosine is efficacious and safe for enhancing fat absorption and nutritional status in short bowel syndrome patients with residual colon. Natural conjugated bile acids improve steatorrhea to a smaller extent and greatly worsen diarrhea.
Aged↗
[Acute appendicitis after colonoscopy: causality or coincidence?].
Complications due to diagnostic colonoscopy are very rare. Perforation is the most frequent colon-related event. So far only ten cases of acute appendicitis after colonoscopy have been reported in the literature. We present the case of a 79-year-old man who developed acute appendicitis after diagnostic colonoscopy. Diagnosis was aggravated by the fact that in the patient's history an appendectomy had been performed 65 years earlier. Because of the rarity of this event it is doubtful whether the endoscopic examination was causal or coincidental. However, in cases of pain after colonoscopy, appendicitis has to be included in the differential diagnosis.
Abdomen, Acute↗
[Noradrenalin and albumin: effective in hepatorenal sydrome type 1?].
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Comment↗
Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.
BACKGROUND & AIMS: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. METHODS: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. RESULTS: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). CONCLUSIONS: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori-positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.
Adult↗
Indirect immunofluorescence assay (IFA), microagglutination test (MA) and enzyme-linked-immunosorbent assay (ELISA) in diagnosis of legionellosis.
Lipopolysaccharide was extracted with cold phenol water from Legionella pneumophila and used as antigen for ELISA. IgG and IgM antibodies were measured with the ELISA and the immunofluorescence assay (IFA). Agglutinating antibodies were measured by the microagglutination (MA) test. In tests on sera from 27 patients with confirmed Legionella infections predominantly due to L. pneumophila serogroup 1 the results with the ELISA, the IFA and the MA were compared to each other. Antibody titers obtained by the ELISA were in general much higher than those obtained by both other tests. The ELISA proved to be the most sensitive method (IgG: 91.3%, IgM: 52.2%) whereas the sensitivities of IFA and MA were IgG: 69.6%, IgM: 30.4% and 60.9%, respectively. There was low correlation of the IgG antibody titers but good correlation of the IgM titers. Further 49 sera from patients without Legionella infection were screened to calculate the specificities of the three tests which were equally good with all methods (98%).
Agglutination Tests↗
Plasma catecholamines in hepatic coma and liver cirrhosis: role of octopamine.
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Adolescent↗
Hormone serum levels during oral cimetidine treatment of patients with peptic ulcers.
Radioimmunoassayable basal serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (hPRL), 17 beta-estradiol (E2) and testosterone (T) were estimated in a total of 68 patients, who were treated because of peptic ulcer with 1 g cimetidine per day. 37 patients were male and 31 were female subjects, respectively. Hormone serum levels were assayed before and 4 to 6 weeks after start of therapy. A significant increase of LH serum levels (p less than 0.025) and a significant decrease of hPRL (p less than 0.025) was noted in the male subjects during therapy. Similarly, a decrease of hPRL serum levels (p less than 0.001) was registered in the female subjects during treatment with 1 g cimetidine per day. All other hormone serum levels in both female and male subjects remained unchanged. The present data combine to suggest that 1 g cimetidine per day does not provoke hyperprolactinemia. In addition, cimetidine at the dose used does not interfere with other hormones of the hypothalamus-pituitary-gonadal axis and therefore, cannot be considered, responsible for endocrine disorders during treatment with cimetidine.
Administration, Oral↗
[Endoscopic papillotomy in Austria].
In 5 gastroenterologic centres in Austria 383 EPT were performed at a total of 10031 ERCP until July 1980. In 350 cases this procedure was successful (91.3%). The most frequent indication was a choledocholithiasis in 300 cases (85.7%). Complete disappearance of gall stones was achieved in 94%. Complications happened in 14 patients (4%), in 4 patients (12%) surgical procedures were necessary consequently. The death rate was 0.6% (2 patients). These favorable results and the low rates of complications and letality of this procedure encourage for the more frequent use of this method for the treatment of choledocholithiasis also in Austria in capable and experienced hands. In view of reducing complications the limitation of the EPT to few specialised centres is demanded.
Ampulla of Vater↗
[Parenteral nutrition in liver diseases].
A total parenteral nutrition may particularly be used in patients with liver diseases, for comatous patients or postoperatively. By using central venous catheterization the practical application of high osmolar solutions, fat emulsions and amino acid mixtures is easy to be performed. Partial parenteral nutrition is needed mainly for decompensation of metabolic disturbances of amino acids in liver diseases. As carbohydrates particularly glucose is used, but because of the deranged glucose tolerance also fructose and glucose substitutes are given in mixed solutions. The infusion of fat emulsions partly covers the need of energy and on the other side prevents a lack of essential fatty acids. Recent investigations demonstrated that fat emulsions may be tolerated by patients with liver diseases and fat is utilized for energy metabolism. The changes of plasma amino acids in blood in patients with chronic liver diseases, especially in the stage with liver insufficiency, demands for a special amino acid solution. For the accomplishment of a total as well as for partial parenteral nutrition principles are given and relevant clinical problems are discussed.
Amino Acids↗
[The influence of therapy with silymarin on the survival rate of patients with liver cirrhosis (author's transl)].
A randomized double-blind study about the therapy of the cirrhosis of the liver shows a significant higher surviving rate of the alcoholic cirrhosis in the group treated with Silymarin. This result can be well explained by the protective influence of this substance against toxic injuries. The etiology of many chronic liver diseases is uncertain and therefore it is advisable to try the therapy also in other cases. The conditions of the study are exactly reported. The influence on the clinic of the disease and on the laboratory data obtained in many controls will be published later, because the statistical analysis needs some more time.
Clinical Trials as Topic↗
[Parenteral feeding of patients with liver cirrhosis with hepatic encephalopathy].
The amino acid solution, Aminofusin hepar, was evaluated for treatment of hepatic encephalopathy and for parenteral nutrition of patients with liver cirrhosis in correlation to changes in amino acid levels. In contrast to amino acid solutions used for the parenteral nutrition of patients without liver disease, this solution contains an increased proportion of branch chained amino acids and of arginine and ornithine, and a reduced proportion of phenylalanine, methionine, glycine and threonine. The changes in the plasma amino acid levels after infusion of this solution were measured in 4 cirrhotics. The concentration of leucine, isoleucine, valine, ornithine and arginine increased markedly, whereas phenylalanine, methionine, tyrosine, glycine and threonine decreased. The ammonia level in venous blood increased slightly. 4 cirrhotics with encephalopathy were treated for 7 days. In 3 of them the neuropsychiatric symptoms were completely reversed, whereas in the remaining 1 no clinical improvement was achieved in spite of normalization of the plasma aminogramm. In this patient a constant rise of blood ammonia was noted. The indications for special amino acid solutions in liver diseases are discussed.
Amino Acids↗
[Histotopographic demonstration of hepatitis-B-surface-antigen (HBSAg) in liver-biopsies with the peroxidase-antiperoxidase (PAP)-method in symptomfree HBSAg-carriers].
In 241 paraffin-embedded liver-biopsies of HBSAg-positive, voluntary blood-donors hepacellular HBSAg was demonstrated with the immunomorphologic peroxidase-antiperoxidase (PAP)-method. In all sections, HBSAg-positive liver-cells were estimated, their distribution-pattern was assessed and different types of cytoplasmatic localisation of HBSAg were described. Despite high sensitivity of the PAP-method, 24% of seropostive cases were histologically negative. A correlation of HBSAg-content and histologic diagnosis was lacking. An association of high HBSAg-content with non-aggressive liver-disease and of low HBSAg-content with aggressive liver-disease in a single biopsy could not be found in our material in contrast to the literature. 34 patients were followed up through 4-6 years. Constant or improved liver-histology was associated with increased, deterioration with decreased HBSAg-tissue-content.
Biopsy↗
OMGE--Study on prevalence of hepatitis B surface antigen in different liver diseases.
The prevalence of hepatitis B viral infection has been evaluated by means of a questionnaire. Contributions were made by 160 institutions from 39 countries and involved more than 400 collaborators. HBsAg was identified by a variety of test kits which were available at the time of the questionnaire. Data are presented for the prevalence of HBsAg in acute viral hepatitis, chronic hepatitis, cirrhosis of the liver and primary liver cancer. Wide variations in antigenaemia were identified in different countries and between the various forms of liver disease. HBsAg is positive more often in chronic hepatitis than cirrhosis. More data using sensitive tests are needed but it appears as if at least one-fifth of the world population has had a previous hepatitis B virus infection.
Blood Donors↗
[Hepatitis b infection in renal transplant recipients (author's transl)].
During a period of 4 1/2 years the incidence and clinical course of endemic hepatitis B infection was studied in 43 renal transplant recipients with an observation time of 3 to 47 (average: 26.3) months after surgery. During the investigation period 27 out of 43 patients (62.8 per cent) had hepatitis B infection. In 8 patients HBs antigenaemia persisted after chronic dialysis treatment. After surgery HBs antigenaemia was detected for the first time in 7 patients. Recurrence of HBs antigenaemia was noted in one patient. In 7 further cases with HBs antigenaemia after transplantation regular controls of HBsAg and HBsAb were not available before transplantation. In 2 patients HBs antibodies were detectable at the time of transplantation; 2 further patients developed HBs antibodies postoperatively. Hepatitis B infection showed a mild and persistent clinical course. 6 out of 7 icteric patients simultaneously had other severe mycotic and viral infections. Therefore, the conclusion was drawn that in patients with coexisting multiple infections liver damage is not necessarily attributable to HBs antigenaemia.
Azathioprine↗
[Therapy of hepatic encephalopathy. Modification of the plasma aminogram using amino acid infusions].
When amino acid solutions with high concentrations of branched chained amino acids and low concentrations of aromatic amino acids were administered to patients with cirrhosis of the liver 1. the serum levels of tyrosine and phenylalanine were significantly reduced, 2. the molar ratio of the branched chained amino acids to the aromatic amino acids substantially increased, and 3. as therapeutic response in all cases treated, a marked improvement of hepatic encephalopathy was achieved.
Aged↗
Plasma amino acids in hepatic encephalopathy.
In 75 cases of histologically verified liver cirrhosis the plasma amino acids were determined by ion exchange chromatography and the results were correlated with different liver function tests as prothrombin time, pseudocholinesterase, serum albumin, GOT, bilirubin and venous ammonia. Out of these parameters prothrombin time, pseudocholinesterase and serum albumin significantly correlated with the sum of branched-chain amino acids and with the Fischer's quotient (molar ratio of branched-chain and aromatic amino acids). Methionin and aromatic amino acids inversely correlated with these parameters, additionally methionin positively correlated with bilirubin and GOT. By comparing plasma amino acid levels in cirrhotics without and with hepatic encephalopathy (grade 3 or 4) no significant differences were found. "Fischer's quotient" showed an overlap in patients with and without encephalopathy. Therefore the precipitation of hepatic encephalopathy is not fully explained by the changes in plasma amino acids. Therapeutic administrations of specially mixtures of amino acids with a high content in branched-chain and a low content in aromatic amino acids correct the plasma amino inbalance for a short time and improves hepatic encephalopathy.
Amino Acids↗
[Faulty nutrition as viewed by the hepatologist].
Looking back over the past centuries, a survey shows that for the past 2000 years definite dietetic rules have existed for the treatment of liver diseases, which to a great extent have disregarded the distribution of protein and carbohydrates. Deviations from the principles of nutrition followed as a result of intensive physiological-chemical research during the 19th century. This new knowledge, however, lead to misinterpretation and exaggerations in the recommended dietary proportions of fat, protein and carbohydrates. Protein deficiency, which is particularly disadvantageous in cases of hepatitis during pregnancy, and lack of vitamins, along with other types of malnutrition, became apparent. Various attempts providing diets rich in protein and fat, for the treatment of hepatitis, proved rather the tolerance of these nutrients than discovering a new, more efficient therapy. In spite of some resignation, recommendations made on the basis of experience should rather be dispensed with, as regards diet, and the search for further knowledge of the supply of nutrients in liver diseases should be continued. In addition, the study of endotoxins and toxic amines in the metabolism of the brain offers a source of future research.
Blood Glucose↗