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Biomedical subjects

J Rodés

Publications and source records attributed to J Rodés.

At least 415 records · Page 23Linked to original sources
PubMed1987

Randomized trial of portacaval shunt, stapling transection and endoscopic sclerotherapy in uncontrolled variceal bleeding.

Seventy consecutive cirrhotic patients with persistent or recurrent variceal bleeding were included in a clinical trial to compare the efficacy and safety of portacaval shunt (PCS) and stapler transection (ST) in patients with low surgical risk, and of stapler transection and endoscopic sclerotherapy (ES) in patients with high surgical risk. To classify the patients into low- and high-risk groups a new scoring system was used, based on an analysis of factors influencing operative mortality in an earlier series of emergency portacaval shunt. Thirty-eight low-risk patients were randomly allocated for treatment with portacaval shunt (19 patients) or stapler transection (19 patients), and 32 high-risk patients for stapler transection (17 patients) or ES (15 patients). The operative mortality of patients treated by PCS was close to that expected according to retrospective data, this indicating that the proposed scoring system is highly discriminant. In low-risk patients, portacaval shunt evidenced greater haemostatic efficacy and fewer complications than stapler transection. However, hepatic encephalopathy during follow-up was more frequent in the portacaval shunt group and there were no significant differences in operative mortality and long-term survival between the two groups. In high-risk patients, stapler transection and sclerotherapy had a similar haemostatic efficacy, operative mortality and long-term survival. However, sclerotherapy occasioned fewer complications than stapler transection. Our results motivate us to recommend stapler transection for low-risk patients and to consider sclerotherapy as an alternative for high-risk patients in the emergency treatment of uncontrolled variceal bleeding.

Clinical Trials as Topic↗
PubMed1987

Lactitol versus lactulose in the treatment of acute portal systemic encephalopathy (PSE). A controlled trial.

Preliminary data suggest that lactitol (beta-galactoside-sorbitol), a new synthetic non-absorbable disaccharide, has beneficial effects on chronic portal systemic encephalopathy. To compare the efficacy of lactitol vs. lactulose in the treatment of acute portal systemic encephalopathy (PSE), 40 cirrhotic patients with an acute episode of PSE were randomly allocated to one of two groups: group A (20 patients) received lactulose (30 ml/6 h) and group B (20 patients) lactitol (12 g/6 h). These doses were adjusted daily to obtain two bowel movements per day. The duration of treatment was 5 days. Age, sex, hepatic and renal function, precipitating factors and level of PSE measured by clinical examination, EEG and number connection test were similar in the two groups. A complete clinical resolution of PSE occurred in 11 patients in each group. In 5 patients of the lactulose group and in 6 of the lactitol group there was a moderate improvement of PSE during the study. Finally, 4 patients in the lactulose group and 3 in the lactitol group did not respond to treatment. No side effects attributable to therapy were observed in either group. These results indicate that lactitol is as effective as lactulose in the management of patients with cirrhosis and acute PSE.

Acute Disease↗
PubMed1987

Recombinant alpha 2c-interferon therapy in fulminant viral hepatitis.

Recombinant alpha 2c-interferon was administered to 12 consecutive patients with fulminant viral hepatitis. The disease was caused by coinfection by HBV and HDV in seven patients, by HDV superinfection of a chronic HBV carrier in two, by HBV alone in two and by HAV in one. Eight patients were drug addicts. Interferon administration was initiated shortly after the onset of hepatic encephalopathy and no patient was in grade IV coma at the beginning of therapy. Ten patients died and only two survived. One of the survivors was an asymptomatic HBV carrier superinfected by HDV in whom treatment with interferon for 3 months did not prevent the development of chronic delta infection and liver cirrhosis. These results show that alpha 2c-interferon does not have significant therapeutic value in fulminant viral hepatitis, particularly if it is caused by HDV.

Adolescent↗
PubMed1987

Predictive clinical factors of visible vessel in bleeding peptic ulcer.

The endoscopic finding of a visible vessel in the base of a bleeding gastrointestinal lesion is a well-known indicator of the possibility of recurrent hemorrhage. We carried out a multivariate analysis of 277 patients with gastrointestinal hemorrhage, but no chronic liver disease, of the clinical history and parameters in relation to hemorrhage, in order to select patients at risk for this endoscopic picture. A clinical history of associated disease, the absence of ulcerogenic drug intake, presentation of bleeding in the form of hematemesis and active hemorrhage on admission had predictive value for visible vessel, The incidence of visible vessel was significantly greater in anastomotic stoma ulcers than in gastric and duodenal sulcers. On the basis of the clinical parameters mentioned, patients with a high probability of having a bleeding lesion with a visible vessel can be selected for priority endoscopy.

Blood Vessels↗
PubMed1987

Hepatic sinusoidal dilatation in Hodgkin's disease.

Examination of needle liver biopsy specimens from 46 patients with Hodgkin's disease revealed sinusoidal dilatation with a predominantly centrolobular and midlobular localisation in 23 cases (50%). It was present in 90% of patients with general symptoms and in only 20% of those without them (p less than 0.001), and it was unrelated to the staging, the existence of hepatic infiltration by the disease and the lymph node histology. The pathogenesis of the sinusoidal ectasia is not known, but it might be a consequence of an alteration of the sinusoidal barrier, since no abnormality of the hepatocytes or of the hepatic venules was detected at light microscopy. Sinusoidal dilatation may be considered as a further systemic manifestation of Hodgkin's disease.

Adolescent↗
PubMed1987

Hyperglucagonemia and hyperkinetic circulation after portocaval shunt in the rat.

The study was aimed at investigating whether increased portal venous inflow (PVI) after portocaval shunt (PCS) in the rat is the result of selective splanchnic vasodilatation or whether it is part of a generalized circulatory disturbance. Rats with PCS (n = 9) and sham-operated controls (n = 8) were studied 2 wk after surgery by measuring cardiac output (CO), PVI, and hepatic artery flow (HAF) with radioactive microspheres. Plasma glucagon (GL) was measured by radioimmunoassay. PCS rats had increased CO (46.2 +/- 2.8 vs. 28.2 +/- 1.7 ml X min-1 X 100 g-1, P less than 0.001) and reduced arterial pressure and total peripheral resistance. PVI was markedly increased (7.7 +/- 0.7 vs. 4.3 +/- 0.2 ml X min-1 X 100 g-1, P less than 0.001), but this appeared to be part of a generalized circulatory disturbance, since when PVI is expressed as percent of CO no difference is observed between PCS and sham-operated rats (17.0 +/- 1.5 vs. 15.8 +/- 1.3%, NS), indicating the absence of a preferential splanchnic vasodilatation. GL increased after PCS (548 +/- 130 vs. 156 +/- 23 pg/ml, P less than 0.005), and significant correlations were observed between GL and CO (r = 0.787, P less than 0.001) and between GL and PVI (r = 0.806, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Immunogenicity of a recombinant hepatitis B vaccine in haemodialysis patients.

The immunogenicity of a recombinant yeast-derived hepatitis B vaccine was evaluated in a randomized trial involving 80 haemodialysis patients in which three 40 microgram doses were administered according to either a 0, 1, 2 month, or a 0, 1, 6 month vaccination schedule. The vaccine induced an anti-HBs seroconversion in 54% of patients who received the three doses at intervals of one month (Group A) and in 55% of those who were vaccinated at months 0, 1, and 6 (Group B). The geometric mean titres (GMT) seven months after the first injection were 37.7 IU/l in Group A and 91 IU/l in Group B. The seroconversion rate in men (53.6%) was slightly lower than in women (60%), and the respective GMTs were 33.3 and 78.5 IU/l. An age-dependent effect was noted in the anti-HBs response, but the type of renal disease and length of time on dialysis did not influence the antibody response. A 0, 1, and 2 month vaccination schedule seems preferable for haemodialysis patients as it induces more rapid protection.

Age Factors↗
PubMed1987

Hepatic alcohol and aldehyde dehydrogenases in liver disease.

To investigate the influence of liver injury on the activities of hepatic alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), these enzymes have been measured in tissue from alcoholic and non alcoholic patients with different severity of liver damage. ADH and ALDH activities decreased proportionatelly with the progression of liver disease in alcoholics. By contrast, in non-alcoholics, there was a reduction of Low-Km ALDH related with the severity of liver injury but ADH was similar in patients with chronic hepatitis and non-alcoholic cirrhosis. Furthermore, ADH was significantly lower in alcoholic than in non-alcoholic cirrhotics. These results suggests that the decreased ADH and ALDH in alcoholics are not primary abnormalities predisposing to alcoholism and alcoholic liver disease. The diminution of ADH found only in alcoholics could be due to the loss of the enzyme produced by centrolobulillar cell necrosis, that is often observed in alcoholic liver disease.

Adult↗
PubMed1987

Increased plasma volume in two models of portal hypertension in the rat: cirrhosis of the liver and partial portal vein ligation.

Portal hypertension has been studied in the rat to see if it is associated to altered blood volume composition, as it has been shown in other species. Plasma volume was measured by isotope dilution using 99mTc labelled albumin in three groups of male Sprague-Dawley rats: normal rats (controls), partially ligated portal vein rats and rats with Cl4C induced cirrhosis. Plasma volume was significantly higher in rats with portal hypertension due to partially ligated portal vein and cirrhosis than in control animals. Similarly, the calculated blood volume was also significantly higher in the portal hypertensive animals than in control group. Portal hypertension in the rat, therefore, has been demonstrated to be associated to a marked hypervolemia and this finding should be taken into consideration in haemodynamic and pharmacokinetic studies in portal hypertensive rat models.

Animals↗
PubMed1987

Cyanamide hepatotoxicity. Incidence and clinico-pathological features.

Ground-glass hepatocytes resembling those seen in HBsAg carriers on hematoxylin and eosin and on trichrome stained sections, but giving a negative reaction to orcein and a positive one to PAS, were found in liver biopsy specimens from nine asymptomatic former alcoholics who were on treatment with cyanamide, in one of four who had been treated with cyanamide several months before the liver biopsy procedure, in none of 15 treated with disulfiram, and in one of eight who had apparently not received aversive drugs. Portal and periportal inflammatory changes and fibrosis were more frequently observed in biopsy specimens containing PAS-positive ground-glass hepatocytes than in those without, but cirrhosis was found with a similar frequency. It is concluded that periportal PAS-positive ground-glass hepatocytes are a histological marker of cyanamide treatment.

Adult↗
PubMed1986

Upper gastrointestinal bleeding caused by gastroduodenal vascular malformations. Incidence, diagnosis, and treatment.

Within a two-year period, 12 patients with upper gastrointestinal bleeding due to gastroduodenal vascular malformations were admitted to a specialized intensive care unit. They represented 2.1% of all admissions for upper gastrointestinal bleeding, and 3.7% of those with severe hemorrhage (greater than or equal to 2 units of blood transfused). Early endoscopy was nondiagnostic during the first bleeding episode in all nine patients with nonhereditary vascular malformations; the diagnosis was eventually made after relapsing hemorrhage by repeat endoscopy in five patients, angiography in two, and histology in another two. These nine patients accounted for 23.6% of all cases of upper gastrointestinal bleeding considered to be of unknown origin after initial work-up. The remaining three patients had Rendu-Osler-Weber disease, and the first endoscopy was diagnostic in all of them. Emergency treatment was required for 11 patients; surgery was undertaken in seven, and transendoscopic therapy (electrocoagulation or endoscopic clipping) in four. There was a 25% mortality rate. No further bleeding has occurred in eight patients after a mean follow-up period of two years. Gastroduodenal vascular malformations are a more frequent cause of upper gastrointestinal bleeding than heretofore recognized, especially in patients whose hemorrhage is deemed to be of unknown origin after an initial work-up. Endoscopy, which may need to be repeated, is the most rewarding diagnostic procedure. Awareness of their possible existence facilitates endoscopic recognition. When available, transendoscopic therapy is a good choice to stop active bleeding from such lesions.

Adolescent↗
PubMed1986

Serum procollagen type III peptide as a marker of hepatic fibrogenesis in alcoholic hepatitis.

To evaluate if serum procollagen type III peptide levels reflect the extent of liver fibrosis and hepatic collagen synthesis, we have studied 19 patients with histologically proven alcoholic hepatitis and 9 chronic alcoholics with normal liver histology or minimal steatosis. Serum procollagen peptide type III was measured at the time of liver biopsy, and determination of hepatic prolyl-hydroxylase activity, as an index of collagen synthesis, was performed in all liver samples. Hepatic prolyl-hydroxylase activity and serum procollagen peptide levels were significantly higher in patients with alcoholic hepatitis (959 +/- 115 cpm/mg and 33.2 +/- 5.3 ng/ml, respectively) than in alcoholics from the control group (537 +/- 62 cpm/mg and 10.9 +/- 1.5 ng/ml, respectively) (p less than 0.05 and p less than 0.01, respectively). All patients with alcoholic hepatitis had fibrosis (10 mild and 9 severe). Prolyl-hydroxylase activity and procollagen peptide levels were significantly higher in alcoholic hepatitis patients with severe fibrosis than in those with mild fibrosis (1208 +/- 154 cpm/mg vs. 734 +/- 138 cpm/mg, p less than 0.05 and 49.1 +/- 8.8 ng/ml vs. 20.4 +/- 2.6 ng/ml, p less than 0.01). Furthermore, a close correlation was found between the hepatic prolyl-hydroxylase activity and the serum level of procollagen peptide (r = 0.76, p less than 0.001). We conclude that the serum procollagen peptide level is a good marker of hepatic fibrogenesis in alcoholic hepatitis; thus, its serial measurement could be useful in identifying patients in progress to cirrhosis and in assessing the therapeutic efficiency of antifibrogenic drugs.

Adult↗
PubMed1986

Utility of biliary microscopy for the prediction of the chemical composition of gallstones and the outcome of dissolution therapy with ursodeoxycholic acid.

To learn whether microcrystalline solids in bile could predict gallstone composition, the findings determined by polarizing microscopy of gallbladder bile were related to stone type at cholecystectomy in 53 patients. Cholesterol crystals were present in 36 of 39 cholesterol stone bile and absent in 12 of 14 bile from non-cholesterol stones. Fifteen cholesterol stones (eight radiopaque) contained calcium carbonate, and characteristic vaterite microspheroliths were observed in 53% of their bile. In another study, crystals in basal duodenal bile were related to the outcome of gallstone dissolution treatment with ursodeoxycholic acid, 10 mg/kg X day. In 39 patients treated for 1 yr, efficacy (complete gallstone dissolution) was 41% overall and 52% in patients with stones less than or equal to 10 mm in diameter. In connection with the findings of biliary microscopy, efficacy was 93% in 14 patients with cholesterol crystals in bile, and 27% in 11 patients with microspheroliths in bile. Cholecystectomies in 9 patients with dissolution failure revealed 4 cases of non-cholesterol stones and 5 cases (including 3 with on-therapy calcification) of calcium carbonate-rich cholesterol stones with a surface/interior mineral ratio greater than 3. The results confirm that cholesterol crystals in bile are a sensitive measure of cholesterol gallstones. They also show that vaterite microspheroliths in bile indicate the presence of calcium carbonate in gallstones. Both findings suggest that biliary crystals reflect gallstone composition, and it is demonstrated that this information is useful in predicting the success or failure of cholelitholysis with ursodeoxycholic acid. Finally, the data show that radiologically undetectable stone calcification reduces the probability of dissolution, and that the calcified structures appearing in some stones during treatment are composed of calcium carbonate.

Bile↗
PubMed1986

Histological course of alcoholic hepatitis. Influence of abstinence, sex and extent of hepatic damage.

The factors influencing the histological evolution of alcoholic hepatitis without cirrhosis have been evaluated in 26 patients (14 males and 12 females) submitted to repeated liver biopsies over a mean period of 1.7 years (1-3). Drinking habits during follow-up were checked by inquiries to patients and relatives and by serial determination of ethanol in urine. At the end of the follow-up, 9 patients (34.6%) had progressed to cirrhosis, 5 (19.2%) still had alcoholic hepatitis and 12 (46.1%) had normal liver or only minimal changes. Nine patients continued drinking heavily, 4 reduced their daily intake markedly and 13 stopped drinking. Improvement of liver lesions was observed in 9 of the abstainers and in 3 non-abstainers that had markedly reduced their alcohol consumption. Among the 9 patients with persistent heavy alcohol consumption, 5 developed cirrhosis and 4 still showed alcoholic hepatitis in their last biopsy. Cirrhosis also developed over 1-2 years in 4 females who had stopped drinking, indicating a marked influence of sex on the course of alcoholic hepatitis. Progression of the disease to cirrhosis despite abstinence occurred in a high proportion of women (4/7) but not in men (0/6). These observations indicate that discontinuation of heavy alcohol consumption often results in improvement of liver lesion in patients with alcoholic hepatitis. However, the risk of progression to cirrhosis remains elevated in women.

Adult↗