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N C Manzione

Publications and source records attributed to N C Manzione.

13 recordsLinked to original sources
PubMed1988

Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites. Another look.

The serum-ascites albumin difference is reported to be superior to ascitic total protein, ascitic-to-serum total protein ratio, lactic dehydrogenase, and ascitic-to-serum lactic dehydrogenase ratio in differentiating between ascites from liver disease and malignant ascites, S-A greater than 1.1 reflecting portal hypertension. We analyzed ascitic fluid from 46 consecutive patients with chronic liver disease, 28 patients with ascites associated with malignancy, 10 patients with right-sided heart failure, 4 patients with hypothyroidism, and 6 patients with miscellaneous causes of ascites to determine if this albumin difference is indeed a more valuable parameter. Analysis of our data confirms with a larger number of patients that the serum-ascites albumin difference is a more reliable indicator of transudative ascites, better termed portal hypertensive ascites. Malignant ascites without liver metastases had features of nonportal hypertensive ascites, and the serum-ascites albumin difference confirms this. The characteristics of malignant ascites associated with liver metastases, however, resemble those of the portal hypertensive ascites complicating liver disease. This new parameter is also helpful in distinguishing congestive heart failure with high protein ascites and portal hypertensive ascitic features from malignant ascites without liver metastases. Of particular note, myxedematous ascitic fluid, classically categorized as exudative, had an S-A greater than 1.1, indicating the possible role of portal hypertension in the development of ascites in these patients.

Ascitic Fluid↗
PubMed1988

Development of porphyria cutanea tarda after treatment with cyclophosphamide.

Porphyria cutanea tarda, a metabolic disorder of heme biosynthesis, is characterized by cutaneous hyperpigmentation, facial hypertrichosis, dark urine, and a distinctive pattern of excess porphyrin production. Hepatic uroporphyrinogen decarboxylase activity is markedly reduced in patients with this disorder. Although porphyria cutanea tarda may be familial, it is more often sporadic in occurrence, and has been associated with excess alcohol ingestion, estrogen administration, iron overload, and several environmental hepatotoxins. It has also been associated on occasion with malignancy. We report a 46-yr-old woman with ovarian carcinoma who developed porphyria cutanea tarda while undergoing treatment with cisplatin and cyclophosphamide. The temporal course of the porphyrin abnormality suggested that cyclophosphamide was the pathogenic agent, and symptoms regressed after cessation of this drug with continued administration of cisplatin. The pathogenesis of the porphyria is not clear; however, cyclophosphamide is a substrate for cytochrome P450, and may produce metabolites that destroy this protein. The resulting increased turnover of heme might then result in overproduction of porphyrin precursors, resulting in the clinical syndrome. Studies of porphyrin metabolism in patients treated with cyclophosphamide may help to elucidate this possibility.

Cisplatin↗
PubMed1988

Turner's syndrome and inflammatory bowel disease: a case report with immunologic studies.

A patient with Turner's syndrome who developed ulcerative colitis (UC) is reported, and reports from the literature of 16 cases of Turner's syndrome with inflammatory bowel disease (IBD) are reviewed. Most of the patients previously described had severe disease. Half of the patients had ulcerative colitis and half had Crohn's disease (CD). Of those with Crohn's, most had colonic involvement. Of note, also, half of the patients had an isochromosome for the long arm of X which usually is found in only 17% of all patients with Turner's syndrome. A high incidence of autoimmune diseases is associated with this syndrome. We demonstrate the presence of specific anticolonic antibodies in this patient and propose some possible explanations for the association of this particular chromosomal disorder with autoimmune diseases.

Adult↗
PubMed1987

Demonstration of Crohn's disease tissue-specific proteins by enzyme-linked immunosorbent assay (ELISA).

Theories on the etiology of Crohn's disease have included extrinsic agents and intrinsic bowel wall defects. We sought to determine the presence of immunoreactive antigens specific to Crohn's disease tissue by modifying the enzyme-linked immunosorbent assay. Tissue proteins were extracted from four patients with Crohn's disease and from four normal segments of colon from patients with colonic cancer. These tissue extracts were further purified on Con A Sepharose 4B affinity column. The glycoproteins eluted from this column were adsorbed by polystyrene plates as antigen and tested against 85 sera from patients with Crohn's disease, ulcerative colitis, other diarrheal diseases, and normal subjects. Sera from 48 patients with Crohn's disease showed significantly greater recognition of Crohn's disease tissue glycoproteins than sera from 27 disease controls (P less than 0.0125) and 10 normal subjects. These Crohn's disease sera also showed preferential recognition of glycoproteins extracted from Crohn's disease tissue compared to glycoproteins from normal colonic tissue (P less than 0.0005). The nature of these immunoreactive proteins, whether extrinsic or intrinsic, is not yet known. The ELISA may help in further characterization of Crohn's disease tissue-specific glycoprotein(s) and to develop a clinically useful serological test.

Antigens↗
PubMed1987

Unusual sites of upper gastrointestinal variceal bleeding.

When patients with portal hypertension bleed from varices, these are most commonly located in the esophagus and gastric fundus. However, varices can develop anywhere in the upper or lower gastrointestinal tract. Oftentimes if an active upper gastrointestinal bleeding site is not evident at the time of endoscopy, bleeding is attributed to any esophageal or gastric varices that are present. This supposition may not always be true as illustrated in the two patients presented here. Likewise, the absence of esophagogastric varices in a patient with portal hypertension does not preclude the presence of varices elsewhere. Endoscopic examination of the second and third portion of the duodenum can sometimes be helpful in accurately locating the bleeding site.

Adult↗
PubMed1986

Immunofluorescence assay using Crohn's disease tissue-injected athymic nude mouse lymph nodes in the diagnosis of inflammatory bowel diseases.

Sometimes, even after extensive investigative efforts, the diagnosis of inflammatory bowel disease remains in doubt. The accurate diagnosis is important if appropriate therapy is to be instituted. A simple indirect immunofluorescence assay that tests the patient's serum against lymphoid tissues from athymic nude (nu/nu) mice receiving injections of filtrates of Crohn's disease tissue is proposed. Eighty percent of serum samples from patients with active, symptomatic Crohn's disease give positive results of immunofluorescence when tested with these lymphoid tissues. The false-positive rate has been very low (less than 10 percent). Because this assay is fairly sensitive and least invasive, it was used for the clarification of many puzzling cases that were seen at the Albert Einstein College of Medicine over the past three years. Ten of these cases were selected for illustration and discussion and are presented in this report.

Adult↗
PubMed1986

The effects of two new inotropic agents on microsomal liver function in patients with congestive heart failure.

The aminopyrine breath test (APBT) was used to study patients with chronic congestive heart failure before and after treatment with two chemically similar inotropic agents, amrinone (AR) and milrinone (MR), to determine their effects on hepatic microsomal function. Liver chemistries and cardiac indices were measured and correlated with the 2-hour APBT score in 11 patients with chronic congestive heart failure (5 treated with AR, 6 with MR) and five healthy control subjects. Despite normal or near-normal liver chemistries, patients with chronic congestive heart failure demonstrated overall depressed hepatic microsomal oxidative function. Patients with severe congestive heart failure had a lower mean pretreatment APBT score (AR = 3.05 +/- 1.02, MR = 5.38 +/- 3.09) when compared with healthy controls (10.02 +/- 1.02). However, the APBT score for each individual could not be predicted from the cardiac index. Although the mean cardiac index increased significantly in both the AR and the MR treated patients by 26.14% +/- 15.28 (p less than 0.01) and 40.0% +/- 42.27 (p less than 0.025), respectively, compared with pretreatment values, the mean APBT score fell by 62.02% +/- 22.5 (p less than 0.005) in the former and increased by 38.35% +/- 25.69 (p less than 0.01) in the patients receiving MR. This discordance between the effects of AR and MR suggests possible differences in the effects of the two drugs on hepatic microsomal function.

Adult↗
PubMed1982

Enflurane hepatitis.

Enflurane (ethrane; 2-chloro-1,2,2-trifluoroethyl difluoromethyl ether) has been widely used as an alternative general anesthetic agent to halothane over the past decade because halothane has been directly linked to hepatocellular damage. Several case reports have subsequently described a hepatitis after exposure to enflurane. We describe another case of enflurane hepatitis which supports earlier reports of this entity, discuss possible mechanisms of such hepatocellular damage, and review the pertinent literature.

Anesthesia, General↗