PubMed Health⌕ Search

Biomedical subjects

J Karani

Publications and source records attributed to J Karani.

At least 19 recordsLinked to original sources
PubMed1992

Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome.

BACKGROUND: Severe renal vasoconstriction is central to the pathogenesis of renal failure in the hepatorenal syndrome. Endothelin-1 and endothelin-3 are potent, long-acting vasoconstrictors, and endothelin-1 has selective potency as a renal vasoconstrictor. These properties suggest a role for endothelins in the hepatorenal syndrome. METHODS: We measured plasma endothelin-1 and endothelin-3 concentrations using specific radioimmunoassays in subjects with hepatorenal syndrome, liver disease but normal renal function, chronic renal failure, acute renal failure, liver dysfunction and renal impairment, or normal liver and kidney function. RESULTS: The patients with the hepatorenal syndrome had markedly elevated mean (+/- SE) plasma concentrations of endothelin-1 (36 +/- 5 ng per liter [14.5 +/- 1.8 pmol per liter]) and endothelin-3 (43 +/- 3 ng per liter [16.3 +/- 1.0 pmol per liter]) as compared with the normal subjects (endothelin-1, 4 +/- 1 ng per liter [1.7 +/- 0.2 pmol per liter]; and endothelin-3, 18 +/- 1 ng per liter [6.8 +/- 0.4 pmol per liter]; P < 0.001) and with the patients in the other four groups (P < 0.001 to P < 0.05). The plasma endothelin-1, but not endothelin-3, concentrations in these four patient groups were significantly higher than in the normal subjects (P < 0.001 to P < 0.05). The concentrations of endothelin-1 in renal arterial plasma and renal venous plasma, measured in five patients with the hepatorenal syndrome and three with chronic liver disease and normal renal function, were 20 +/- 4 ng per liter (7.9 +/- 1.8 pmol per liter) and 24 +/- 4 ng per liter (9.5 +/- 1.5 pmol per liter), respectively (P < 0.05). CONCLUSIONS: The increase in plasma endothelin-1 and endothelin-3 concentrations in patients with the hepatorenal syndrome is consistent with the hypothesis that these substances have a role in the pathogenesis of the disease.

Acute Kidney Injury↗
PubMed1992

Management of common bile duct stones with a biliary endoprosthesis. Report on 40 cases.

Endoscopic placement of a biliary endoprosthesis has been proposed for the management of choledocholithiasis when stone extraction is difficult or considered hazardous. Over a two year period this approach was used in 40 such patients. There were 24 women and 16 men with a median age of 76 years. In seven patients with severe cholangitis no attempt was made to extract the stones. Twenty three (57.5%) patients underwent a sphincterotomy and four (10%) needle knife papillotomy. The endoprosthesis insertion was considered a temporary measure in 13 (32.5%) patients and definitive treatment in 27 (67.5%). Bile duct drainage was established in all patients. Early complications occurred in six patients (15%), but were without sequelae. Late complications developed in eight (20%) of the patients and included biliary colic (four), cholangitis (three), and cholecystitis (one). Two patients (one cholangitis and one cholecystitis) died as a consequence of the complication. Only patients without a sphincterotomy developed cholangitis. A total of eight patients (20%) underwent surgery (one as an emergency) and nine a repeat endoscopic retrograde cholangio pancreatography (two as an emergency) to clear the duct. The remaining 23 patients are asymptomatic at a median of 13 months (range five to 24 months). Biliary endoprosthesis insertion for choledocholithiasis is an important alternative means of establishing drainage in selected cases, and is probably the optimum method of management for the elderly and or debilitated patients with previous cholecystectomy. Caution must be exercised, however, in patients with an in situ gall bladder.

Adult↗
PubMed1992

Comparison of a subjective and a quantitative assessment of the neonatal chest radiograph.

The aim of this study was to assess if quantitative classification of the chest radiograph appearance at 7 days predicted chronic oxygen dependency (oxygen dependency beyond 8 weeks of age) more accurately than did subjective classification at 28 days of age. Thirty preterm infants, median gestational age 27 weeks, who had chest radiographs taken for clinical purposes at 7 and 28 days of age, were recruited into the study. The 7-day chest radiograph was scored according to the lung volume, presence of opacification, interstitial changes, pulmonary interstitial emphysema and cystic elements. The range of chest radiograph scores was from 0-18, a score of 18 indicating the most abnormal appearance. The 28-day chest radiograph was classified as Type I or Type II chronic lung disease (CLD), according to the presence or absence, respectively, of coarse reticulation. The median chest radiograph score at 7 days of the 30 infants was 5 (range 2-14). In predicting chronic oxygen dependency, a chest radiograph score of 5 at 7 days had 83% sensitivity and 75% specificity, but a diagnosis of Type II CLD at 28 days of age had only 67% sensitivity and 67% specificity. We conclude that a quantitative assessment of the chest radiograph appearance at 7 days is more useful than a subjective assessment at 28 days of age.

Chronic Disease↗
PubMed1991

Natural history and prognostic variables in primary sclerosing cholangitis.

The clinical features at the time of presentation and the outcome in 126 patients with primary sclerosing cholangitis were studied to clarify the natural history and prognosis in symptomatic and asymptomatic individuals. The median age of the patients at the time of presentation was 36 years, 62% were male, and 16% were asymptomatic. The median follow-up from time of presentation was 5.8 years. There were more patients who had liver transplants (21%) than patients who died of liver-related disease (16%); the estimated median survival to these end points was 12 years. Cholangiocarcinoma was found in 8 patients and in 23% of those undergoing liver transplantation. Asymptomatic patients had milder disease than symptomatic patients, but in a univariate analysis the presence of symptoms was not prognostically significant. On multivariate analysis, the following independent prognostic factors were found: hepatomegaly, splenomegaly, serum alkaline phosphatase, histological stage, and age. These features were combined to produce a prognostic model that should be valuable in the stratification of patients in clinical trials and in the timing of liver transplantation, particularly in those patients seen soon after presentation.

Adenoma, Bile Duct↗
PubMed1991

A chest radiograph scoring system to predict chronic oxygen dependency in low birth weight infants.

The usefulness of a chest radiograph scoring system to predict chronic oxygen dependency (oxygen dependency at 36 weeks post conceptual age) was determined in 40 infants with a median gestational age 27 weeks (range 24-32 weeks). The scoring system assessed the appearance of the preterm infant's chest radiograph taken at one month of age, and graded the radiograph according to lung volume, the presence of opacification, cystic elements and interstitial change (maximum score 24). Infants who were chronically oxygen dependent had significantly higher scores (median 9, range 7-20) than those not oxygen dependent (median 3, range 0-13, P less than 0.01). All nine chronically oxygen dependent infants had a score greater than 6, in comparison with only two of 31 infants not chronically oxygen dependent (P less than 0.01). A chest radiograph score of 6 thus had a sensitivity of 100% and specificity of 93.5% in predicting chronic oxygen dependency.

Bronchopulmonary Dysplasia↗
PubMed1991

Pre-operative radiological and clinical assessment of hepatic tumours--is biopsy necessary?

The pre-operative investigations of 72 consecutive patients who underwent liver resection for hepatic tumours have been reviewed. A combination of clinical, biochemical and radiological findings correctly predicted histology in 93% of cases (the benign or malignant nature in 97%). Biopsy was performed in only 20 patients. Five of the biopsy reports were incorrect (75% accuracy, benign or malignant nature accuracy 90%). Although guided biopsy can be performed during radiological assessment of focal hepatic lesions we argue that it is rarely indicated and can be misleading in patients proceeding to hepatic resection.

Biopsy↗
PubMed1991

Improving biliary-enteric drainage in primary sclerosing cholangitis: experience with endoscopic methods.

Six jaundiced patients with primary sclerosing cholangitis and a dominant biliary stricture were managed by endoscopic placement of endoprostheses. Five showed considerable improvement within weeks of stenting: their serum bilirubin concentration fell from mean (range) 266 mumol/l (63-681) to 65 mumol/l (10-280) after one month. One patient required a liver transplant at five months because of continued deterioration in hepatic function. Follow up of 12-49 months in the remaining five patients shows sustained biochemical improvement, with repeat cholangiograms indicating doubling of the minimum calibre of the extrahepatic bile duct in four patients and considerable shortening of stricture length in three. Three patients developed sepsis at the time of the initial endoprosthesis insertion: surgical drainage was necessary in one. Endoscopic methods of improving biliary-enteric drainage in jaundiced patients with primary sclerosing cholangitis may be preferable to surgical and percutaneous methods, which may complicate subsequent liver transplantation.

Adult↗
PubMed1991

Chest radiograph scoring system for use in pre-term infants.

A scoring system to characterize the pre-term infant's chest radiograph appearance has been evaluated. Chest radiographs taken at 1 month of age in 20 infants (median gestational age 27 weeks) were scored according to abnormalities of lung volume, presence of opacification, interstitial changes and cystic elements (maximum score 17). The median score was 4 (range 1-14); the highest scores were for the only infants with cystic elements and/or interstitial changes on their chest radiographs. The scoring system documented accurately the severity of neonatal respiratory distress; the highest scores occurred in those infants requiring the most prolonged respiratory support, i.e. ventilated beyond 1 week of age (p less than 0.01) and oxygen-dependent beyond 1 month (p less than 0.01). It was also a useful predictor of chronic respiratory problems, with an 88% sensitivity in the detection of infants with the most severe lung function abnormalities at 6 months of age.

Female↗
PubMed1991

Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty.

Vascular complications after liver transplantation include occlusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. From our experience with more than 600 liver transplants, vascular stenoses have been identified in 10 patients and treated by balloon angioplasty in nine. Three patients with hepatic artery stenosis and deteriorating graft function were treated by balloon angioplasty with a coaxial technique. A specially designed catheter facilitated a successful femoral artery approach. Portal vein stenoses in three patients resulted in portal hypertension. These were treated by balloon dilatation via transhepatic catheterization of the portal vein. Stenoses of the suprahepatic caval anastomosis were dilated in three patients with severe lower limb edema. Technical success was achieved in all three cases of hepatic artery stenosis with improvement in graft function. Recurrent stenoses in two patients were successfully treated with repeated dilatations. Portal hypertension resolved in two of three patients after portal venoplasty. Dilatation of a caval stenosis resulted in the resolution of leg edema in all three cases. Repeated dilatation was required in one case. No reduction in the portal venous pressure gradient occurred after venoplasty in one case, and an ultimately fatal caval thrombosis developed in one patient with caval stenosis before venoplasty could be performed. Our experience suggests that balloon angioplasty of arterial and venous stenoses complicating hepatic transplantation carries little risk and is a useful procedure for the treatment of these problems.

Adult↗
PubMed1990

Chronic intussusception.

Chronic intussusception is a rare but completely correctable cause of failure to thrive in infants and children. The presenting features differ from acute intussusception. We present the case of a 16 month old boy presenting with a three week history of anorexia, diarrhoea, and weight loss with subsequent delayed diagnosis.

Chronic Disease↗
PubMed1990

Superselective embolization using a coaxial catheter technique.

A method of superselective embolization of 0.64 mm or 0.89 mm coils using a coaxial catheter system is described. The normally functioning parts of an organ can be easily preserved. A number of clinical cases are briefly described which illustrate the application of this method. It is particularly suited to the control of bleeding points in diseased organs or precious organs such as transplants where embolization of a larger volume of tissue would have serious consequences.

Arteriovenous Fistula↗
PubMed1989

Mesoatrial shunt: a surgical option in the management of the Budd-Chiari syndrome.

The Budd-Chiari syndrome, arising from hepatic venous outflow obstruction, is frequently complicated by inferior vena caval occlusion or obstruction. Satisfactory decompression of the liver by either portacaval or mesocaval shunts may therefore prove impossible or be prone to failure from shunt thrombosis. The mesoatrial shunt which allows the portal vein to drain directly into the right atrium has previously been advocated in this situation. Five patients with the Budd-Chiari syndrome and caval occlusion and/or obstruction have had mesoatrial shunts constructed using externally supported polytetrafluoroethylene grafts. A single thoracoabdominal incision, incorporating a median sternotomy, was found to provide a satisfactory approach. All patients recovered well with resolution of ascites, diminution in liver size and improvement in inferior vena caval pressure gradients. Furthermore, all shunts have remained patent, as determined by Doppler flow studies and contrast-enhanced computed tomographic scanning, during follow-up periods ranging from 9 to 16 months. If these results are supported by longer term studies, the mesoatrial shunt may become the surgical treatment of choice in patients with hepatic vein occlusion and the Budd-Chiari syndrome associated with inferior vena caval obstruction.

Adolescent↗
PubMed1989

Adoptive immunotherapy administered via the hepatic artery and intralesional interleukin-2 in hepatocellular carcinoma.

We assessed the feasibility of using lymphokine-activated killer cells (adoptive immunotherapy) with infusions of interleukin-2 when given regionally in three patients with unresectable primary hepatocellular carcinoma (PHC). In 2 patients, 2 cycles, which included a bolus of LAK (10(7) to 10(8) cells followed by a 4-hourly infusion of IL-2 were administered via selective arterial catheterization of the hepatic artery. One further patient received 3 cycles of IL-2 alone by direct intralesional and perilesional injections. Minimal toxicity was observed and side effects such as fever were comparable to those observed with systemic infusions of IL-2 alone. Serial alpha-fetoprotein (AFP) levels initially fell but subsequently rose within 2 to 4 weeks of therapy. AFP levels had not reached pre-treatment values at 4 months in 2 patients, 1 of whom was alive and well at 15 months follow-up.

Carcinoma, Hepatocellular↗
PubMed1989

Lipiodol enhanced CT scanning in assessment of hepatocellular carcinoma.

We studied 20 patients with computed tomography (CT) following the intra-arterial injection of Lipiodol. Comparison with conventional CT, angiography and plain abdominal radiographs revealed additional satellite tumours in four patients. Technical difficulties occurred in selective hepatic arterial catheterisation and in satisfactory delivery of Lipiodol to all segments of the liver in a third of our patients. Plain abdominal radiographs following Lipiodol injection are inadequate in our experience in assessing tumour mass and distribution; we failed to demonstrate retention of Lipiodol by tumour tissue for longer than a few weeks in any case. The pattern of Lipiodol uptake within the tumour is not related to histology but to the vascular supply and size of the tumour. Our findings do not accord with the Japanese experience and this small study suggests that Lipiodol enhanced CT should be reserved for patients with small tumours in non-cirrhotic livers who are being considered for resection of their tumour. Such patients are likely to be encountered rarely in UK practice.

Adult↗