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Biomedical subjects

N Breuer

Publications and source records attributed to N Breuer.

At least 37 records · Page 2Linked to original sources

[Increased plasma endothelin concentrations in patients after liver transplantation and in liver cirrhosis].

Endothelin, one of the most potent vasoconstrictors known today, is released by the vascular endothelium. Patients after liver transplantation and patients with liver cirrhosis show significantly higher plasma endothelin concentrations and significantly reduced results in the quantitative liver function tests (ICG-HL, GEC, Lidocaine-HL, MEGX) compared with healthy control persons. The plasma endothelin concentrations were better correlated with the more liver bloodflow dependent function tests (ICG-HL, Lidocaine-HL) than with the more metabolic-capacity dependent function tests (GEC, MEGX). As cyclosporine A in vitro can increase the liberation of endothelin, we conclude that in patients after liver transplantation an endothelin mediated cyclosporine induced hepatotoxicity might be the reason for the demonstrated association.

Endothelins↗

[Postprandial serum bile acid level and 75SeHCAT retention in diagnosis of bile acid malabsorption syndrome. A comparative study].

Postprandial serum bile acids (expressed as integrated bile acid response [IR]) after a standardized test meal were compared with 75SeHCAT retention, measured in a whole body counter, in healthy controls (n = 20), in 44 patients with ileal disease or resection and in 23 patients with colitis without ileal involvement. In the controls the IR after 180 min was 736 +/- 186 mumol x min x 1(-1) (mean +/- standard deviation), the 75SeHCAT retention 31 +/- 9%. 80% of the patients with ileal disease or resection had a decreased 75SeHCAT retention, indicating bile acid malabsorption, but only 59% had a diminished IR. One of the 23 patients with colitis and radiologically normal ileum had a decreased 75SeHCAT retention but a normal IR, reflecting a dysfunction of the morphologically normal ileum. The characteristics of the two tests are: 75SeHCAT retention test: sensitivity 80%, specificity 98%, accuracy 89%; postprandial serum bile acids: sensitivity 64%, specificity 74%, accuracy 69%. With respect to chronic inflammatory bowel disease the positive predictive value of the 75SeHCAT retention test is 1.0%, for postprandial serum bile acids 0.1%, whereas the negative predictive values amount to 99% for both tests. Thus 75SeHCAT retention is more reliable in detecting bile acid malabsorption than the determination of postprandial serum bile acids, although both tests are not usefull for screening the population for ileal disease.

Adolescent↗

[Hemangiosarcoma of the liver. The diagnostic difficulties and therapeutic possibilities].

A 65-year-old man complained of decreasing physical capacity and weakness over the preceding six months, associated with marked painless jaundice and subsequently ascites. Despite extensive tests, some invasive, in three different hospitals no cause was found of the patient's symptoms and the marked though nonspecific abnormalities of various biochemical values (raised bilirubin concentration; increased alkaline phosphatase activity). Liver transplantation was performed because of progressive liver failure, without a firm diagnosis being established. At operation the liver was found to contain a haemangiosarcoma. The patient died 14 months after the transplantation of a suppurative cholangitis. At autopsy neither metastases nor recurrences were found.

Aged↗

[Hereditary angioedema type II with predominantly abdominal symptoms].

For two years a 19-year-old patient had been complaining of recurrent abdominal symptoms consisting of severe colicky pain, nausea, vomiting and diarrhoea. Occasionally he noticed concomitant subcutaneous swellings in the limbs. There were no swellings in the face or the region of the upper airway. The symptoms occurred once or twice a month, spontaneously receding within 3-4 days. These signs and symptoms indicated hereditary angio-oedema. Serum concentration of C1-esterase inhibitor was normal (13 mg/dl), but its serum activity was reduced to 16% (normal range 80-125%). This is thus a case of type II C1-esterase inhibitor deficiency. Since starting low-dosage treatment with Danazol (initially, for two months, 200 mg daily, then 200 mg five times per week) the patient has been symptom-free.

Adult↗

Influence of the calcium antagonist nitrendipine on the hepatotoxic effect of cyclosporine A.

Calcium antagonists have a protective effect on different forms of nephrotoxicity due to cyclosporine A (CsA). The objective of the present study was to examine the influence of a calcium antagonist on the liver function in CsA-treated patients after kidney transplants. Different quantitative liver function tests were performed in six patients before and 3 months after administration of the calcium antagonist nitrendipine. Indocyanine green clearance (ICG-Cl) as a marker for hepatic blood flow and excretion showed a significant increase under nitrendipine. In addition, there was an improvement of the galactose elimination capacity. Although nitrendipine and lidocaine are both metabolized by the cytochrome P system, there was no reduction in lidocaine clearance. These results suggest an improvement of liver function under nitrendipine. Whether these findings alone are the expression of an improved liver blood flow or whether there is an additional hepatoprotective characteristic of the calcium antagonist nitrendipine cannot be determined.

Cyclosporine↗