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Biomedical subjects

Marek Hartleb

Publications and source records attributed to Marek Hartleb.

10 recordsLinked to original sources
PubMed2005

[Circulatory dysfunction syndrome associated with liver cirrhosis].

Splanchnic arterial relaxation is the most important pathology in systemic circulation of portal hypertensive patients. Progressive decline of splanchnic vascular resistance is responsible for development of circulatory dysfunction syndrome (CDS), associated with reduction of effective blood volume within central vascular compartment and compensatory stimulation of vasopressor and natrium retaining hormonal mechanisms. Advanced CDS is characterized by increased cardiac output, tachycardia and low arterial pressure. Complications of CDS have functional nature and comprise: renal failure (hepatorenal syndrome), respiratory failure in context of hepatopulmonary syndrome, cardiac insufficiency produced by portopulmonary hypertension or portal cardiomyopathy, hemorrhages from digestive tract caused by hypertensive portal gastropathy or derangements of brain perfusion. The management of CDS relies on adequate filling of vascular system (albumin), constriction of arterial splanchnic vessels (beta-blocker, analogs of vasopressin and somatostatin), reduction of cardiac output (beta-blocker) and giving support to local vasoprotective mechanisms (prostaglandins, nitric oxide, blockade of ET-A receptors).

Blood Circulation↗
PubMed2004

[Benign form of idiopathic biliary ductopenia in an adult woman].

Idiopathic adult ductopenia is a rare disease characterized by chronic cholestasis related to an unexplained loss of the interlobular bile ducts. We report on a 43-year-old woman, whose clinical course of cholestatic disease was indolent and non-progressive, and laboratory abnormalities occurred intermittently. Histological examination of liver specimen showed absence of interlobular bile ducts, intensive proliferation of peripheral bile ductules and only minimal inflammatory portal response. Given the presence of microscopic non-specific chronic proctitis, hypothyroidism and antinuclear antibodies in serum we hypothesize that idiopathic adult ductopenia could be a variant of primary sclerosing cholangitis affecting exclusively small bile ducts.

Adult↗
PubMed2003

[Alcoholic liver disease].

Ethanol toxicity on liver is a function of duration of alcoholism, amount of daily intake of alcohol and patient's nutrition. The threshold of alcohol toxicity on the liver is about 40 g of ethanol daily in men and 20-30 g in women, however liver cirrhosis develops in no more than 8-20% of patients exceeding this values. Ethanol is oxidized in the liver to acetaldehyde--a compound considerably more toxic than ethanol itself. Despite small amount of alcohol dehydrogenase (ADH) found in gastric mucosa, the metabolism of ethanol in this site may have an important hepatoprotective effect. The oxidation of ethanol is associated with a change of hepatocyte redox homeostasis, which leads to a number of metabolic disorders such as lactic acidosis, hyperlipidaemia and hyperuricaemia. Chronic ethanol consumption does not influence ADH activity, but has a profound stimulatory effect on microsomal enzymes, in particular cytochrome CYP2E1. This fact is responsible for development in alcoholic liver associated with rise of oxygen consumption, excessive production of free radicals and increased metabolism of ethanol, vitamin A and testosterone. Ethanol and acetaldehyde have a deleterious effect, both the direct and indirect, on hepatocytes e.g., generating radical oxygen species and damaging intestinal mucosal barrier. Cellular oxidative stress that is caused by both an excess of free radicals and the antioxidatives' deficiency (glutathion, vitamin E, phosphatidylcholine), may be the principal factor responsible for progression of alcoholic liver disease. Among other factors accelerating alcohol-related liver lesion there are certain drugs, high fat diet, infection with HCV and genetic factors (female sex, enzymatic polymorphic forms of ADH and ALDH, hemochromatosis). Great importance in pathogenesis of necrotic and inflammatory hepatic events is being attributed to portal endotoxaemia and cytokines induced within the liver, in particular TNF-alpha and interleukin 8. These cytokines play a key role in development of alcoholic hepatitis, which clinical severity ranges from subclinical to fatal forms. Apart from abstinence, the treatment of alcohol liver disease is based on hyperalimentation, since alcoholism is generally associated with protein malnutrition. In severe forms of alcohol hepatitis corticosteroids are recommended.

Alcoholism↗
PubMed2003

[Evaluation of probability of bile duct stone presence by using of non-invasive procedures].

Precise evaluation of bile duct stones presence in particular moment, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound--US) but also more sophisticated imaging methods (CT or MRI) are frequently useless. The "gold standards" of bile duct stones diagnosis are still endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and surgical choledochotomy. However, the ERCP expose the patients to the risk of some serious complications. The aim of the study was to evaluate the diagnostic capabilities of patients case history data and non-invasive tests (such as biochemistry, ultrasound data) in order to establish a risk scale in cases suspected for common bile duct stones. The investigated group comprised of 135 patients treated from January 1996 through March 1997 in the Department of Gastroenterology Silesian Medical Academy. In patients prospectively enrolled to the study case history and a set of blood biochemical examinations were completed. In following, US was performed. The verification of the biliary tree (done with ERCP with endoscopic sphincterotomy or surgical choledochotomy) was performed. Examiners (US, ERCP) were blind to the other results of a patient. Case history data, laboratory blood tests and US results were used to select parameters significantly differing between patients with and without bile duct stones. Thirteen parameters were tested using Mann-Whitney's and chi 2 tests and four parameters were finally selected. For every selected parameter cut off values (i.e. values best differentiating patients with and without stones) were chosen on the basis of the chi 2 value, 95% confidence interval of risk ratio and Youden's index (gamma-GTP, alanine transaminase, enlarged bile ducts on US, bile duct stones on US). In the next step a set of different combinations of selected parameters was tested to find out the best waged scale for bile duct stones risk diagnosis. Finally, diagnostic efficacy of the best constructed scales and US alone were compared. Constructed risk scales can not be employed in the primary selection of patients, as their positive predictive value is quite high, but negative predictive value is low. US is also not valuable in evaluation of patients suspected for common bile duct stones.

Aged↗
PubMed2002

Drug-induced liver damage -- a three-year study of patients from one gastroenterological department.

BACKGROUND: The aim of our study was to analyze drug-induced liver disease over a 3-year period in one gastroenterological department. MATERIAL/METHODS: International consensus standard definitions and criteria for assessing causality of adverse drug reactions were applied to all patients with abnormal hepatic test results. RESULTS: Drugs were implicated in hepatic injury in 14 patients (8 females) in whom causal relationship between drug and liver disease was definite or highly probable. The drugs responsible were amoxicillin with clavulanic acid (3 cases), fluvastatin and pravastatin (3 cases), antituberculous drugs (2 cases), estrogens, roxithromycin, asacol, satolol, enalapril and thiamazol. A total of 78.6% (11 cases) were classified as hepatocellular or mixed hepatitis, while cholestatic injury was found in 21.4% (3 cases). There were no lethal or severe (prothrombin < 50%) hepatic drug reactions. In 13 patients the course of liver disease after withdrawal of the offensive drug was either acute or protracted, while in one patient there was chronic cholestasis (>3 years) resulting from injury to interlobular bile ducts by amoxicllin with clavulanic acid. CONCLUSIONS: A thorough history of drug intake should be taken in all patients presenting with abnormal hepatic test results. Amoxicillin & clavulanic acid, cholesterol-lowering and antituberculin drugs were the most frequent hepatotoxic factors in our patients. In a majority of cases the liver injury was not severe, and resolved after prompt withdrawal of the responsible drug.

Adult↗