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Biomedical subjects

H Solomon

Publications and source records attributed to H Solomon.

At least 19 recordsLinked to original sources
PubMed2006

Erectile dysfunction and statin treatment in high cardiovascular risk patients.

Erectile dysfunction (ED) has been associated with risk factors for atherosclerosis. Medications used for atherosclerosis have also been implicated in ED. The aim of this study is to investigate the relationship of erectile function to cardiovascular risk factors and specific drug therapies before and after 6 months of statin therapy. In this prospective observational study, International Index of Erectile Function (IIEF) scores were measured in 93 men attending cardiovascular risk clinics. Cardiovascular risk factors and drug therapies were assessed prior to initiation and after 6 months of statin therapy. Prior to statin therapy, the median IIEF score was 21 (range 0-25), and 57% had impairment of erectile function. After statin therapy, IIEF scores were reduced to 6.5 (range 0-25) (p < 0.001), and 22% experienced new onset ED. Before statin therapy no correlation was observed between IIEF score and any individual cardiovascular risk factor. After 6 months of statin therapy, correlations were observed between lower IIEF scores (r = 0.62; p < 0.001) and age and diabetes and weakly with smoking. Differences in dose, relative efficacy or relative lipophilicity of statin prescribed showed no correlation with change in IIEF score. This study suggests ED following statin therapy is more likely in patients with severe endothelial dysfunction due to established cardiovascular risk factors including age, smoking and diabetes.

Adult↗
PubMed2003

Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator.

Erectile dysfunction (ED) is a common condition and studies predict that it will become even more common in the future. There is increasing evidence to suggest that it is predominantly a vascular disease and may even be a marker for occult cardiovascular disease. The common pathological process is at the level of the endothelium, and cardiovascular risk factor control may be the key to preventing ED. Many men with established cardiovascular disease have ED. Specific guidelines for the management of ED in these patients have been produced by an expert panel. Cardiovascular risk stratification is an important initial step in managing such patients. In cardiac patients considered to have low cardiovascular risk, the management of ED can be safe and effective.

Blood Pressure↗
PubMed2003

Erectile dysfunction: cardiovascular risk and the role of the cardiologist.

Erectile dysfunction (ED) shares the same risk factors as coronary artery disease, so the level of occult cardiovascular risk in men with ED was assessed. A total of 174 men presenting with ED underwent cardiac risk stratification according to the Princeton Consensus Guidelines. Thirty per cent were stratified as intermediate/high cardiovascular risk and had ED treatment deferred until further cardiological assessment; 37% had abnormal lipid profiles; 24% had elevated HbA1C/glucose levels; 17% had uncontrolled hypertension; and 6% were suspected of having significant angina. ED is associated with a high incidence of occult cardiovascular disease. We suggest that cardiologists can significantly contribute to the management of ED.

Adult↗
PubMed2002

Viagra on the internet: unsafe sexual practice.

The vast majority of men who experience some form of erectile dysfunction (ED) do not seek medical advice, mainly due to embarrassment and social stigma. They often prefer to seek unorthodox and covert methods of treatment. Unprescribed medication for ED is dangerous because of the strong association between ED and coronary heart disease. Published guidelines already exist for the management of patients presenting with sexual dysfunction and cardiovascular risks. In this case report we highlight that ED itself is a risk factor for occult CHD and illustrate the need for careful medical assessment and adherence to published guidelines for the management of ED.

Adult↗
PubMed2001

Cavoportal hemitransposition in liver transplantation.

Over the last decade a large number of patients with portal vein thrombosis have undergone successful liver transplantation. In most of these patients, simple modifications in vascular reconstruction techniques are adequate. However, anastomosis of the donor portal vein may not be possible in the presence of extensive portal and superior mesenteric venous thrombosis and in the absence of any other large tributary of the portal venous system. Cavoportal hemitransposition has been described as a salvage technique under these circumstances. We report a 43-year-old patient who underwent such a procedure and remains well 1 year later. We review the literature and discuss the implications of cavoportal hemitransposition.

Adult↗
PubMed2001

Small bowel perforation from a migrated biliary stent.

Stenting of the biliary tract is performed for a variety of benign and malignant disorders. Although uncommon, proximal and distal migration of these stents is known to occur. We report a case of jejunal perforation from a distally migrated biliary stent.

Biliary Tract Surgical Procedures↗
PubMed2001

Expression of c-myc promoter binding protein (MBP-1), a novel eukaryotic repressor gene, in cirrhosis and human hepatocellular carcinoma.

We have examined the expression of c-myc and c-myc promoter binding protein (MBP-1), a novel eukaryotic repressor, in human hepatocellular carcinoma and cirrhosis by semiquantitative reverse transcription PCR amplification. Levels were normalized for glyceraldehyde-3-phosphate dehydrogenase messenger RNA and then compared between these two groups and to normal liver. We found that MBP-1 expression was significantly decreased in cirrhosis and c-myc and MBP-1 were even further diminished in hepatocellular carcinoma. There was no clear correlation between MBP-1 and c-myc messenger RNA levels. Our results therefore suggest that expression of MBP-1 and c-myc are decreased in a stepwise fashion in the presence of chronic liver disease and hepatocellular carcinoma in humans and that further study of the interactions of these two genes and their products is warranted to determine their role in human hepatocarcinogenesis.

Biomarkers, Tumor↗
PubMed2001

Combined cardio-renal transplantation (CCRT) from the same donor: report of two cases and review of the literature.

Two patients with successful combined cardio-renal transplantation (CCRT) using allografts from the same donor are reported. Both patients underwent staged procedure with hearts being transplanted first followed by kidneys. One patient suffered simultaneous acute rejection of both allografts, indeed a very rare event, which was successfully treated with pulse steroids. Because of the successful patient and graft outcomes, we propose that staged CCRT offers a reasonable therapeutic option for patients with co-existing, irreversible cardiorenal failure.

Acute Disease↗
PubMed2000

Spontaneous rupture of the liver upon revascularization during transplantation.

Spontaneous rupture of the liver has been described in association with many benign and malignant conditions. We report, to our knowledge, the first case of spontaneous rupture of the liver upon revascularization, requiring total hepatectomy and portocaval shunt, followed by successful retransplantation. Routine pathological examination of the explanted liver failed to reveal the etiology of the rupture. However, electron microscopy demonstrated abnormal collagen in the hepatic arterial wall compatible with a collagen disorder such as Ehlers-Danlos type IV disease. We conclude that the donor liver had a previously undiagnosed collagen disorder. Review of the literature does not preclude the use of livers from donors with a history of connective tissue disorders. Based on our experience one should exercise caution when using livers from such donors. With a history of connective tissue disorder in an immediate family member, further tests should be performed in the donor to rule out a subclinical connective tissue disorder. In addition, a review of all patients reported thus far to have undergone total hepatectomy and portocaval shunt, followed by liver transplantation as a two-stage procedure is presented.

Adult↗
PubMed2000

Positron emission tomography scanning in the evaluation of hepatocellular carcinoma.

BACKGROUND/AIMS: 18F-fluorodeoxyglucose uptake allows estimation of glucose metabolism by tumor cells using positron emission tomography (PET). We evaluated the role of PET imaging in the diagnosis of hepatocellular carcinoma. METHODS: PET images were collected after intravenous injection of 8-12 mCi of 18F-FDG in 20 patients with hepatocellular carcinoma (HCC). PET tumor activity level was assessed on a scale of 1 to 4 compared to normal liver tissue. The PET score was compared with abdominal computerized tomography (CT) scan results and between tumors of different grades and differentiation. RESULTS: Of the 20 patients studied, 11 (55%) had positive PET scans (PET score: 3 or 4) while nine (45%) were negative (PET score: 1 or 2). CT scan was positive in 18 patients (90%) and negative in two (10%). PET, however, revealed metastases in three patients that were not seen on CT. On pathological review, well-differentiated and low-grade tumors had lower PET scores. Comparison of the well-differentiated with the moderately- and poorly-differentiated tumors revealed a statistically significant difference. No statistical significance was observed between the moderately- and poorly-differentiated tumors or between different tumor grades and PET scores. CONCLUSIONS: The sensitivity of PET in diagnosis of HCC was 55% compared to 90% for CT scanning, although only PET detected some tumors (including distant metastases). Well-differentiated and low tumor grades had lower activity on PET and correspondingly lower PET scores. PET imaging may help assess tumor differentiation and may be useful in the diagnosis and staging and prognostication of HCC as an adjunct to CT.

Adult↗
PubMed2000

Three-dimensional gadolinium-enhanced MR angiography of vascular complications after liver transplantation.

OBJECTIVE: The goal of this study was to evaluate three-dimensional gadolinium-enhanced MR angiography as a tool for examination of liver transplant patients with potential vascular complications. MATERIALS AND METHODS: Thirty-eight consecutive three-dimensional gadolinium-enhanced MR angiograms were obtained in 34 patients. Results were retrospectively reviewed and correlated with conventional angiography in 20 of the 38 cases and sonography in 37 of the 38 cases. MR angiograms were evaluated for technical adequacy, vascular patency, and parenchymal abnormalities, and results were compared with angiography and sonography. Conventional angiography and surgery were used as gold standards when available. RESULTS: Thirty-four (90%) of 38 MR angiograms were technically adequate. Vascular abnormalities were identified in 20 patients, and 19 of these patients subsequently underwent angiography, surgery, or both. There were seven cases of hepatic artery thrombosis; all were detected with MR angiography with no false-positive or false-negative interpretations. Seven patients had moderate to severe hepatic artery stenosis (>50% narrowing as determined by conventional angiography). MR angiography revealed this stenosis in six of the seven patients, with one false-negative and three false-positive interpretations. Portal vein thrombosis was detected in three patients, and portal vein stenosis was detected in two patients. CONCLUSION: Three-dimensional gadolinium-enhanced MR angiography is useful in the examination of liver transplant patients and offers a noninvasive adjunct in patients with difficult or indeterminate sonographic examinations.

Adult↗
PubMed1999

Liver transplantation in patients with chronic hepatitis C and alcoholism.

We evaluated the contribution of alcohol abuse to liver failure among patients undergoing liver transplantation by reviewing their records for alcohol consumption, hepatitis serology, and outcome. Anti-HCV was present in the serum of 42 patients (39%), while 35 had consumed more than 80 g/day of alcohol for at least 10 years, allowing patients to be divided into four groups: group I, hepatitis C alone (N = 31); group II, alcoholic liver disease alone (N = 24); group III, both hepatitis C and alcoholism (N = 11); and group IV, liver failure due to other causes (N = 41). Patients were followed for a mean of 29 months after transplantation (range 0-66). Twenty-eight (26%) died during follow up, while 11 (10%) required retransplantation. There were no other significant differences in patient or graft survival among patients in the four groups. Patients with both alcoholism and chronic hepatitis C comprise a large proportion of those undergoing liver transplantation and appear to do as well as those with other causes of liver failure, at least in the short term.

Adult↗
PubMed1999

Comparison of genetic heterogeneity of hepatitis C viral RNA in liver tissue and serum.

OBJECTIVE: Hepatitis C virus (HCV) is known to be heterogeneous and to circulate as a group of closely related quasispecies in individual patients, although hepatic viral genetic characteristics have not been well documented. METHODS: Matched serum and liver samples were tested by reverse transcription polymerase chain reaction amplification and single stranded conformation polymorphism analysis of the hypervariable portion of the E2/NS1 region of the HCV genome. The number of quasispecies was compared with the amount of HCV RNA, HCV genotyping, and infection with the hepatitis G virus. RESULTS: Sixteen of 40 patients had HCV RNA detectable in serum and liver. The HCV genotype was identical in serum and liver of all but one case. HCV RNA levels were approximately 10-fold higher in liver than serum. The number of HCV quasispecies in serum ranged between two and six (median 3.0) and in the liver between 2 and 19 (median 3.5, mean liver/serum ratio 1 to 6.3, median 1.8). The number of quasispecies in liver was equal to or greater than that in serum in all cases. HGV infection was found in 14 cases and did not influence serum or hepatic levels of HCV RNA. CONCLUSIONS: The number of hepatic HCV quasispecies usually exceeds that in serum, independent of the amount of HCV RNA and HCV genotype. This finding is compatible with clearance of some quasispecies from serum, but not liver, by putative neutralizing antibodies.

Adult↗
PubMed1999

Oxalate kinetics and reversal of the complications after orthotopic liver transplantation in a patient with primary hyperoxalosis type 1 awaiting renal transplantation.

We present the case of a young woman with end-stage renal disease secondary to primary hyperoxaluria type 1, who after 3 years and 6 months of maintenance hemodialysis, and despite intensification of the dialytic treatment, developed severe livedo reticularis in her extremities leading to ischemic cutaneous ulcerations, necessitating continuous intravenous infusion of narcotics for pain control. She received a liver transplant after native hepatectomy. However, due to positive crossmatch, she could not receive a kidney from that donor. After transplantation, following serial serum oxalate levels, the hemodialysis regimen was safely reduced from 4 h daily to 3 h three times weekly. Over the course of 6 weeks after liver transplantation, her livedo reticularis resolved, the ischemic ulcers markedly improved, she was weaned off all pain medications, and her erythropoietin-resistant anemia resolved. Our results suggest that in patients with primary hyperoxaluria type 1, who have received a liver transplant and are on maintenance hemodialysis, after serial serum oxalate determinations, some may safely be changed to a thrice-weekly maintenance hemodialysis regimen. Moreover, with this regimen the complications of systemic oxalosis can reverse.

Adult↗