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Biomedical subjects

M Uribe

Publications and source records attributed to M Uribe.

At least 73 records · Page 4Linked to original sources
PubMed1984

Prednisone for chronic active hepatitis: pharmacokinetics and serum binding in patients with chronic active hepatitis and steroid major side effects.

The response of serum prednisolone to a single oral dose of 30 mg of prednisone was studied in 12 patients with chronic active hepatitis taking prednisone, and in six healthy volunteers. Five of the 12 patients developed major side effects with prednisone, and seven showed less or no side effects. The patients with major side effects generally had higher serum bilirubin and lower serum albumin levels than the others. Prednisolone peak levels were similar in the three groups. Unbound (free) serum prednisolone was higher at 2, 3, 4, and 8 hours, in patients with chronic active liver disease and major side effects, than in the other two groups. Studies in vitro showed that protein binding of prednisolone increased with increasing albumin concentrations, and that bilirubin could displace some bound prednisolone. We suggest that the association between major side effects, hypoalbuminemia, and hyperbilirubinemia in patients with chronic active hepatitis is attributable to increased serum unbound prednisolone caused by: 1) limited availability of binding sites (hypoalbuminemia), or 2) displacement of bound steroid by competition (hyperbilirubinemia).

Adult↗
PubMed1983

Standard and higher doses of bromocriptine for severe chronic portal-systemic encephalopathy.

In a single-blind, cross-over fashion we assessed the therapeutic value of the dopamine agonist bromocriptine at doses of 15 and 20 mg/day plus cleansing enemas, versus the vigorous standard treatment of neomycin 6 g/day plus cleansing enemas. We studied four patients with severe chronic portal systemic encephalopathy. All the patients presented elevated prolactin levels. During the study the following parameters were assessed: mental state, number connection test times, frequency of asterixis, EEG, blood ammonia, and serum prolactin levels. In all but one patient, portal systemic encephalopathy parameters improved during the standard therapy, as opposed to both bromocriptine periods. During the period with 30 mg/day of bromocriptine all four patients developed precoma, although later one patient improved. Serum prolactin levels were rapidly suppressed during both bromocriptine periods. Prolactin levels did not correlate with changes in mental state. In patients with severe portal systemic encephalopathy, treatments with 15 and 30 mg of bromocriptine plus cleansing enemas were no better than the standard therapy.

Bromocriptine↗
PubMed1982

Treatment of chronic portal--systemic encephalopathy with vegetable and animal protein diets. A controlled crossover study.

A controlled crossover clinical comparison of 40-g/day and 80-g/day vegetable protein diets vs a 40-g/day meat protein diet plus neomycin-milk of magnesia (as control therapy) was performed on 10 cirrhotic patients with mild chronic portal-systemic encephalopathy. The 40-g vegetable protein diet had a high fiber volume and contained low methionine and low aromatic amino acids. The 80-g vegetable protein diet was rich in branched-chain amino acids and fiber, with a similar content of sulfur-containing amino acids as compared to the 40-g meat protein diet. Serial semiquantitative assessments were done, including mental state, asterixis, number connection tests, electroencephalograms and blood ammonia levels. No patient developed deep coma while ingesting either vegetable protein diet or neomycin-milk of magnesia plus 40-g meat protein diet. A significant improvement in the number connection test times was observed during the 40-g vegetable protein diet (P less than 0.05) and during the 80-g vegetable protein diet (P less than 0.05) as compared to their previous 40-g meat protein--neomycin periods. In addition, during the period of 80-g vegetable protein diet, the patients showed a significant improvement in their electroencephalograms (P less than 0.05). The frequency of bowel movements significantly increased (P less than 0.05) during the 80-g vegetable protein diet period. During the 40-g vegetable protein diet, two cirrhotic--diabetic patients experienced hypoglycemia. Three patients complained of the voluminous 80-g vegetable protein diet. Patients with mild portal--systemic encephalopathy may be adequately controlled with vegetable protein diets as a single therapy.

Adult↗
PubMed1981

Dissolution of cholesterol ductal stones in the biliary tree with medium-chain glycerides.

In vitro and in vivo experiments were carried out with medium-chain glycerides. In vitro, cholesterol gallstones were rapidly dissolved by medium-chain glycerides; control experiments with saline solution failed to modify the size of the stones. In vivo, medium-chain glycerides were instilled through an intraductal tube in 12 patients with retained bile duct stones. Perfusions lasted 2-10 days. After perfusion, stones disappeared in six cases, were reduced in size in one case, and remained unchanged in five cases. In five cases, nausea, vomiting, diarrhea, or pain were observed. Medium-chain glyceride infusion rapidly dissolves cholesterol gallstones, but is commonly associated with mild to severe side effects.

Cholesterol↗
PubMed1981

Survival and quality of life after selective portasystemic shunts.

Selective portasystemic shunts were performed in 55 consecutive patients; 27 underwent end-to-end selective renosplenic shunt, 18 distal splenorenal shunt and 10 splenocaval shunt. Thirty-one patients were in Child's class A, 18 were in class B and 6 in class C. Hospital mortality for the whole group was 16 percent and occurred less frequently in class A than in class B and C patients. Five year predicted survival for the whole group was 59 percent. At the same period of follow-up, class A patients had a higher survival rate than those in class B and C (83 percent versus 36 percent; p < 0.01). No striking difference in 5 year survival was evident in alcoholics and nonalcoholics (52 percent versus 61 percent). After surgery, long-term portasystemic encephalopathy and bleeding were noted in 2 of 36 survivors. For class A patients, selective portal shunts offer an adequate and relative safe method for decreasing mortality due to variceal bleeding.

Adolescent↗
PubMed1981

Decreased bioavailability of prednisone due to antacids in patients with chronic active liver disease and in healthy volunteers.

To investigate the potential action of antacids on prednisone absorption and on prednisolone serum levels, we studied 5 healthy volunteers and 12 patients with chronic active liver disease. Six patients responded to treatment and 6 did not. After administering two 5-mg tablets of prednisone with 60 ml of water, 60 ml of Melox (AlOH 3.75 g/100 ml + MgOH 4.0 g/100 ml), or 60 ml of Aldrox (AlOH 8.0 g/100 ml + MgOH 1.95 g/100 ml), we measured prednisolone by radioimmunoassay. Both peak heights and areas under the serum-concentration curves were significantly reduced when prednisone was administered with antacids. The relative bioavailability of prednisone after prednisone-antacid treatments compared to that after prednisone-water treatment was 74% +/- 13% (p less than 0.05) with Melox and 57% +/- 15% (p less than 0.01) with Aldrox in healthy volunteers. In patients with chronic active liver disease responding to treatment, prednisone bioavailability was 65% +/- 120% (p less than 0.01) and 87% +/- 20%, respectively. Among patients with chronic active liver disease not responding to treatment, this parameter was 76% +/- 12% (p less than 0.05) and 80% +/- 21% (p less than 0.05), respectively. To insure adequate prednisolone levels in patients with chronic active liver disease, prednisone should not be given simultaneously with antacids.

Adult↗
PubMed1981

Lactose enemas plus placebo tablets vs. neomycin tablets plus starch enemas in acute portal systemic encephalopathy. A double-blind randomized controlled study.

A randomized, double-blind comparison of lactose enemas plus placebo tablets vs. starch enemas plus neomycin tablets was performed on 18 patients with acute portal systemic encephalopathy. Ten patients received starch enemas (10%; 1000 ml t.i.d.) plus neomycin tablets and 8 patients received lactose enemas (20%; 1000 ml t.i.d.) plus placebo tablets. A significant mental state improvement was demonstrated in the group of patients treated with starch enemas-neomycin tablets (p less than 0.05) and in the group of patients treated with lactose enemas-placebo tablets (p less than 0.025). Both treatments significantly improved the frequency of asterixis, ammonia blood levels, and electroencephalograms. In addition, patients treated with lactose enemas showed significant improvement in number-connection test times (p less than 0.02), and their stools showed a more acid pH (p less than 0.05). No side effects were evident with either treatment. Lactose enemas are a safe and effective treatment for acute portal systemic encephalopathy.

Acute Disease↗
PubMed1980

Treatment of chronic portal-systemic encephalopathy with lactose in lactase-deficient patients.

A controlled cross-over clinical comparison of lactose (50 g twice a day) versus neomycin (3 g/day) plus milk of magnesia, was carried out in ten cirrhotic patients with chronic portal-systemic encephalopathy and documented lactase deficiency. Serial semiquantitative assessments were done including: mental state, asterixis, number connection test, electroencephalogram, and blood ammonia levels. No patient developed deep coma while ingesting either lactose or neomycin plus milk of magnesia. However, a significant improvement of mental state, asterixis, number connection tests, and electroencephalograms was evident during lactose therapy. apart from mild diarrhea and bloating, no severe side effects were noticeable during lactose treatment. Based on these results, we propose lactose as a valuable alternate treatment of portal-systemic encephalopathy in lactase-deficient populations.

Chronic Disease↗
PubMed1979

Treatment of chronic portal systemic encephalopathy with bromocriptine: a double-blind controlled trial.

A randomized double-blind clinical comparison of bromocriptine, a new dopamine agonist, and placebo was performed on 7 cirrhotic patients with chronic portal systemic encephalopathy (PSE). Before given either medication, patients were stabilized with a standard treatment (neomycin and cathartics). Serial semiquantitative assessments were done, including mental state, asterixis, number connection test, electroencephalogram, and ammonia blood levels. Three patients developed signs of precoma while ingesting both placebo and bromocriptine. Two patients experienced precoma only with placebo, and another patient only while taking bromocriptine. One patient remained awake throughout the study. All patients responded initially to neomycin and cathartics. Bromocriptine proved not to be significantly superior to placebo and was always inferior to standard treatment. During treatment with bromocriptine, 3 patients experienced constipation. This may be partially responsible for the ineffectiveness in the treatment of PSE.

Ammonia↗
PubMed1979

Treatment of cirrhosis with colchicine. A double-blind randomized trial.

As part of a double-blind, randomized, controlled trial to evaluate the effect of colchicine on liver cirrhosis, 43 cirrhotic patients were assigned to either a placebo (20 patients) or a colchicine (23 patients) treatment group. Colchicine 1 mg and an indistinguishable placebo were administered orally on a daily dose 5 days a week. In the colchicine group, 12 were males and 11 females, while in the control group 13 were males and 7 females. The time elapsed between diagnosis and inclusion in the study was 14.1 mo for the controls and 14.5 mo for the patients on colchicine. Mortality related to the liver disease occurred in 4 patients on colchicine and 8 patients on placebo. Although the probability of surviving in the colchicine group was greater than that of the placebo, the difference did not reach statistically significant levels. Of the colchicine-treated patients, in three a remarkable decrease in liver fibrosis was observed in serial biopsies. In two other patients, carcinoma of the liver developed. Six of the survivors on colchicine have improved clinically, noticing disappearance of ascites and edema, as well as a decrease in the size of the spleen. All the survivors on placebo continue to show clinical deterioration. In contrast to the usual drop of serum albumin seen in the cirrhotic patients, those receiving colchicine increased and maintained their serum albumin levels throughout the study. Serum proline values were elevated only in the alcohol cirrhotic patients. Serum alkaline phosphatase increased only in those patients receiving colchicine. The results indicate that in some cases, liver fibrosis could be modified by treatment with antifibrotic drugs. The use of colchicine at present should remain within controlled studies.

Adult↗
PubMed1978

Oral prednisone for chronic active liver disease: dose responses and bioavailability studies.

Serum concentrations of prednisolone were measured by radioimmunoassay after the administration of prednisone (10, 20, or 30 mg) by mouth to five healthy volunteers, five patients with severe chronic active liver disease (CALD), and five patients with CALD in remission induced by prednisone. Only minor differences were found between the groups and bioavailability was linearly related to the dose of prednisone (r = 0.993). After prednisone (10 mg) was given by mouth and by vein to similar groups of volunteers and 11 additional patients with CALD, bioavailability of oral prednisone approximated 100% of the intravenous dose and no differences were found in the pharmacokinetics of prednisolone. We conclude that prednisone is effectively absorbed and converted to prednisolone in health and CALD and find no pharmacological evidence that either drug would be superior to the other for treating CALD.

Administration, Oral↗