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Biomedical subjects

M Angelico

Publications and source records attributed to M Angelico.

107 records · Page 6Linked to original sources
PubMed1979

Differences in serum bile acid composition between unoperated cirrhotic patients and patients with portacaval or mesocaval shunt.

Serum bile acids were determined in 13 cirrhotic patients with portacaval shunt and in 15 with mesocaval shunt. 20 nonshunted cirrhotics were used as controls. Serum bile acid levels were higher in portacaval (26.7 +/- 14.3 micrograms/ml) than in mesocaval shunt patients (16.9 +/- 8.1 micrograms/ml) and controls (14.1 +/- 11.5 micrograms/ml). The cholic/chenodeoxycholic ratio was lower after portacaval shunt than after mesocaval shunt (0.36 +/- 0.15 and 0.63 +/- 0.26, respectively). It is hypothesized that these findings may be consistent with a larger hepatic blood flow present in mesocaval shunted patients and with chenodeoxycholic absorption in the upper small intestine.

Adult↗
PubMed1977

Octopamine and ammonia plasma levels in hepatic encephalopathy.

It has been recently proposed that hepatic encephalopathy could be due to the accumulation of octopamine acting as a false neurotransmitter, and the increase of ammonia might reflect this accumulation. The simultaneous determination of octopamine and ammonia was performed in 88 cases with or without encephalopathy. The correlation between the two substances appeared to be good (P less than 0.01; r = 0.5), except in shunted patients. All the cases with low octopamine and high ammonia were patients who had been submitted to surgical portal-systemic anastomosis. This finding does not seem to be coincidental; in this type of patients, the mechanism of hepatic encephalopathy could involve other beta-hydroxyphenylethanolamines in addition to octopamine. The presence of the inhibition of the reaction of transmethylation constantly observed during octopamine plasma assay is in favour of this hypothesis.

Ammonia↗
PubMed1977

Fasting and postprandial serum bile acids as a screening test for hepatocellular disease.

Postprandial serum bile acid estimation was recently proposed as the most sensitive test of liver function. In our study, the fasting and postpranidal serum bile acid measurements were performed on 19 normal subjects, 20 patients with cirrhosis, 10 with acute hepatitis, 4 with resolving viral hepatitis, and 6 with chronic active hepatitis. A gas-chromatographic method was used. One healthy subject had postprandial serum bile acid levels above the normal range, while 7 patients with liver disease had postprandial levels within normal limits. Of the latter group, 2 had chronic active hepatitis in remission and 3 had resolving viral hepatitis. Significant correlations were seen between serum bile acid levels and most of the conventional "liver function" tests. Our data indicate that the postprandial serum bile acid determination is better than any of the other conventional tests taken separately, but no better than their combined use. No significant modification of the cholic acid/chenodeoxycholic acid ratio was observed between the fasting and the postprandial determinations.

Adolescent↗
PubMed1976

Octopamine plasma levels and hepatic encephalopathy: a re-appraisal of the problem.

An investigation on the blood levels of octopamine was carried out on 70 adult individuals. There was a statistically significant correlation between the levels of octopamine and hepatic encephalopathy. Normal subjects had values below 1 ng/ml, while patients with grade 3 or grade 4 encephalopathy constantly showed values above 3.2 ng/ml. In these two groups the distribution was fairly homogeneous. Through the differences between cirrhotics without neurologic involvement and those with grade 1 or 2 hepatic encephalopathy displayed statistical significance, distribution of values in these groups was rather non-homogeneous. Octopamine levels paralleled variations in mental state in 3 out 4 cases. No difference was found between venous and arterial values. The reaction of transmethylation used in the assay of octopamine was constantly found to be inhibited by the presence of plasma. This inhibition is probably due to the presence of one or more beta-hydroxyphenylethanolamines other than octopamine.

Adult↗
PubMedDate not supplied

Liver transplantation in the presence of portal vein thrombosis: report from a single center.

Portal vein thrombosis (PVT) is a frequent finding in liver transplantation, the management of which depends mainly on its extent. In cases of mild to moderate PVT, a low dissection of the portal trunk, a jump graft, or direct implantation of graft portal vein into large venous collaterals or thrombectomy offer alternatives. For severe PVT anecdotal reports suggest that cavoportal hemitransposition, portal arterialization, or combined liver and intestine transplantation may be attempted, although the results to date are not satisfactory. When extensive perivenous and venous inflammatory changes reach the infrapancreatic region, liver transplantation probably should not be performed due to the high mortality rate.

Cause of Death↗
PubMedDate not supplied

Interposition of the right colic angle between the liver and thoracic wall: an unusual cause of massive rectal bleeding following percutaneous biopsy in a liver transplant recipient.

A 37-year-old male liver transplant recipient developed hemorrhagic shock from massive rectal bleeding a few hours after a protocol liver biopsy. Conservative treatment was not possible and the patient underwent a radiological investigation of the celiac and mesenteric arterial trunks, which showed active bleeding from a branch of the middle colic artery. Embolization with Tabotamp (Ethicon, Neuchatel, CH Switzerland) particles led to successful hemostasis. We thus discuss the possible mechanisms of injury. To our knowledge, no other cases of major rectal bleeding following percutaneous liver biopsy have been reported in the literature. We emphasize the need for Doppler ultrasound assistance, in terms of either preoperative examination with or without marking or guidance. The latter is the safest and most reliable technique, given the low risk of puncture of other organs and the low probability of obtaining an inadequate sample.

Adult↗
PubMedDate not supplied

Effect of glucose and/or branched chain amino acid infusion on plasma amino acid imbalance in chronic liver failure.

The characteristic amino acid pattern observed in chronic liver failure with high aromatic and low branched chain amino acid levels is considered to be consequent to increased muscle protein catabolism. The main catabolic stimulus has been attributed to hyperglucagonemia and to a reduced insulin/glucagon molar ratio. Intravenous administration of a solution containing branched chain amino acids and glucose to patients with chronic liver cirrhosis rapidly normalizes the plasma amino acid pattern. This effect may result from either a change in the insulin/glucagon ratio, induced by glucose, or from the anticatabolic influence of branched chain amino acids on muscle protein turnover. To discriminate between these two possibilities, a crossover study was carried out to determine the effect of a 24-hour infusion of either glucose alone, or glucose plus branched chain amino acids, in seven patients with chronic liver failure. Blood glucose, insulin, glucagon, free fatty acids, and amino acid levels were determined. Branched chain amino acids were much more effective than glucose (p less than 0.01) in decreasing the levels of aromatic amino acids. Conversely, the insulin, glucagon, and free fatty acid levels with glucose alone were not altered with the addition of branched chain amino acids. These findings suggest an anticatabolic effect of branched chain amino acids on muscle protein turnover and suggest that factors other than insulin and glucagon may be responsible for the characteristic plasma amino acid pattern present in chronic liver failure.

Adult↗
PubMedDate not supplied

[The medical therapy of cholelithiasis. Critical reflections].

Gallbladder stones can be asymptomatic, symptomatic or complicated. Medical therapy can be indicated only in patients with symptomatic gallstones. Indications to medical therapy is today limited by the knowledge of the benign natural history of the disease and by the availability of new surgical techniques, such as laparoscopic cholecystectomy. The ideal patient to be treated by medical therapy is mildly symptomatic, non obese, with functioning gallbladder and with radiolucent, floating stones, not larger than 5 mm in diameter. This type of patient represents only 3% of the population of gallstone patients and has a 90% likelihood of having complete stone dissolution after one year of treatment with ursodeoxycholic acid (12 mg/kg of body weight/day). Medical treatment can be proposed also in patients with stones up to 10 mm in diameter, but the likelihood of complete dissolution after one year drops to 60%, thus, treatment is indicated only in selected or high-risk patients. Ursodeoxycholic acid therapy can be useful in patients with biliary sludge or microlithiasis, especially if recently developed.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

One-year pilot study on tauroursodeoxycholic acid as an adjuvant treatment after liver transplantation.

BACKGROUND: The usefulness of ursodeoxycholic acid after liver transplantation is controversial. Tauroursodeoxycholic acid, the natural taurine-amidate, is a highly hydrophilic and cytoprotective bile salt currently under investigation. AIMS: To investigate the clinical usefulness of tauroursodeoxycholic acid after liver transplantation. PATIENTS: Thirty-three patients undergoing liver transplantation entered the study. METHODS: Sixteen patients were randomized to receive tauroursodeoxycholic acid (250 b.i.d. for 12 months) and 17 served as controls. Tauroursodeoxycholic acid was given from day 5 after transplantation for one year. RESULTS: Tauroursodeoxycholic acid treatment was safe and well tolerated. No drop outs occurred. Among the 29 patients undergoing long-term follow-up, five deaths occurred (3 of whom in the tauroursodeoxycholic acid group), none of which was related to treatment. The one-year actuarial survival was 78.6% in patients treated with tauroursodeoxycholic acid and 86.7% in controls (n.s.). No differences were observed with respect to early or late graft function and survival, nor to acute cellular rejection. Tauroursodeoxycholic acid therapy was associated with lower serum cholesterol levels (p < 0.02) during the early postoperative months; with milder cholestasis; with a drop in biliary cholates but no changes in endogenous hydrophobic bile salts. CONCLUSIONS: Long-term treatment with low dose tauroursodeoxycholic acid after liver transplantation is safe but does not affect graft function and survival.

Adult↗
PubMedDate not supplied

Different levels of variability in subtypes 1b and 4a of hepatitis C viruses.

We performed genetic and phenic analyses to evaluate nucleotide and amino-acid sequences of the amino-terminus of the E1 protein of HCV genotype 1b (extracted from databank) and 4a (characterised in this study). The non-synonymous (ka) mutation analysis demonstrated that the genome of genotype 1b was not saturated by variations, with a rate of transition/transversion (s/v) of 1.5, which is similar to the expected ratio (i.e., 2.0). The s/v ratio in genotype 4a isolates was lower (0.98), indicating saturation due long-term variability. Moreover, the genotype 1b sequences showed a higher number of ka mutations (s+v) (mean of 2.8 per sequence) than genotype 4a (mean of 1.5). The introduction of ka mutations resulted in a higher degree of amino acid variability in genotype 4a. In the genome of genotype 1b, each nucleotide mutation introduced new amino acids, with a Granthan distance of 3.35-42.5, whereas for genotype 4a the distances ranged from 48.8 to 102.1. The phenic analysis also indicated different and complex patterns of amino-acid substitution. Finally, diverse isoelectric points and hydrophobicity were predicted for the two genotypes, with a higher acidity for genotype 4a E1 proteins.

Amino Acid Substitution↗
PubMedDate not supplied

Breath tests with stable isotopes: have they a role in liver transplantation?

Evaluation of liver function is crucial in the overall management of patients with liver disease. In particular, patients with end-stage liver disease need accurate prognostic indicators to plan liver transplantation, and in this case, to manage their presence in the waiting list. Availability of predictors of clinical outcome is further essential after liver transplant, mainly to correctly diagnose and adequately treat complications, such as acute rejection, drug toxicity, liver dysfunction. Breath tests using labelled substrates selectively metabolized within the liver may represent an accurate diagnostic and prognostic tool in these clinical conditions, possibly with an adjuntive role to the most commonly used prognostic models (Child-Pugh and MELD scores). Promising results have been in fact recently obtained by the use of different substrates (aminopyrine, methacetin, erythromycin, methionine) which explore different metabolic function of the hepatocyte. The usefulness of breath tests has been documented in liver disease patients both before and after liver transplantation, in the early as well as in the late phase.

Breath Tests↗
PubMedDate not supplied

Donor liver steatosis and graft selection for liver transplantation: a short review.

Early graft dysfunction develops in up to 10-50% of liver transplanted patients and is related to the number of risk factors which identify marginal livers. Marginal livers are defined by the presence of af least one of the following risk factors: (1) donor aged > 50 years; (2) donor with hemodynamic instability or with a residence time in ICU greater than 5 days; (3) donor with hypersodiemia; (4) donor with HCV or HBV infection; and (5) donor with macrovescicular steatosis present in > 25% of hepatocytes. The presence of steatosis involving less than 25% of hepatocytes is not considered sufficient to identify a marginal donor, although it may be associated with some risk of early or late graft failure. The reason is that the steatotic liver is characterized by a decreased tolerance to ischemia/reperfusion. It has been observed that the accumulation of fat in the hepatocytes and the increased cell volume cause an impairment of liver microcirculation. Steatosis is associated with decreased capability of ATP production and storage, with increased lipid peroxidation, and with increased release of tumor necrosis factor-a which is believed to be responsible of the lung damage possibly occurring after transplant. The assessment of the type and extent of steatosis requires liver biopsy, not usually indicated in healthy individual. In the transplant setting a precise assessment of steatosis is the prominent reason for performing a liver biopsy of the donor liver.

Biopsy↗