Biomedical subjects

U Bolder

Publications and source records attributed to U Bolder.

24 records · Page 2Linked to original sources

PubMed1993

Postoperative course of functional and cellular variables in liver resection.

The determination of total serum bile acids (BA) is a sensitive variable for detection of altered liver function. This study investigated the course of serum bile acids in 44 liver-resected patients with different factors possibly compromising liver function. These factors were 1) amount of resected parenchyma; 2) duration of intraoperative ischemia; and 3) patient's age. The course of BA was compared with that of transaminases, bilirubin, lactate, and NH3. Serum BA showed a course correlated to the amount of resected liver parenchyma and differentiated between groups with < or = 35% and > 35% resected parenchyma. Whereas BA were more accurate in paralleling the resected tissue in the first postoperative days, a rise of bilirubin indicated complications in the postoperative course. As BA did not increase in a case of pulmonary-induced multiorgan failure, the specificity of this variable for liver function is implied. Different amounts of resection could not be distinguished by determination of transaminases. Different ischemic periods did not result in significant differences in the postoperative course of BA or bilirubin. However, marked elevations of transaminases depending on the duration of hepatic inflow occlusion were seen. None of the traced variables were related to the patient's age.

Adolescent↗

PubMed1990

[Increased bile acid retention in biliodigestive Roux-Y anastomosis in animal experiment].

In an experimental study on 65 rats the influence of different Roux-Y biliary anastomoses on the enterohepatic bile acid circulation was investigated. Long (10 cm) and short (3 cm) isoperistaltic and long (10 cm) anisoperistaltic Roux-Y loops were studied and compared to sham-operated controls. 75-SeHCAT a y-labeled synthetic bile acid was used for assessment of enterohepatic circulation. Hepatic excretion and enteric bile flow was investigated by 99m-Tc-HIDA. Intestinal transit time was evaluated by 51-Cr-EDTA an inert marker of intestinal contents. Animals with biliary anastomoses showed an increased retention of the synthetic bile acid 75-SeHCAT compared to the controls. Highest retention values were found in animals with anisoperistaltic loops (t1/2 = 98.6 h). Isoperistaltic loops showed uniform values independently of the length of the Roux-limb (t1/2 = 59.8 h resp. 59.3 h). Differences to the controls (t1/2 = 42.6 h) were highly significant (p less than 0.001). In the 99m-Tc-HIDA hepatic excretion into the connected small bowel was normal in all groups. But in rats with biliary anastomoses a marked stasis of the 99m-Tc-HIDA in the Roux-Y loop was apparent. Bowel transit time tested by 51-Cr-EDTA showed comparable results in all groups without significant differences. The results demonstrate an increased bile acid retention in Roux-Y biliary anastomoses. An alteration of the enterohepatic circulation due to stasis in the Roux-Y limb seems to be the underlying mechanism.

Anastomosis, Roux-en-Y↗

PubMed1990

Bile acid retention after Roux-en-Y biliary reconstruction demonstrated by tauro-23-(75Se)selena-25-homocholic acid. An experimental animal study.

In this study of 65 laboratory rats the influence of biliary Roux-en-Y anastomosis on the enterohepatic circulation was investigated. Three different types of Roux-en-Y limbs were studied and compared with sham-operated controls. To collect information about the influence of the length and motility of the Roux limb, 10-cm and 3-cm isoperistaltic Roux segments and 10-cm anisoperistaltic Roux limbs were investigated. 75SeHCAT, a tau-labelled synthetic bile acid, was used for assessment of enterohepatic circulation. Intestinal transit time was evaluated by measuring the decrease of whole-body counts of 51Cr-labelled ethylenediamintetraacetic acid (EDTA), an inert marker of intraluminal contents. 99mTc-labelled dimethyl-iminodiacetic acid (HIDA) was used to detect possible alterations of bile flow. 75SeHCAT results showed marked retention of bile acids in all Roux-en-Y animals compared with controls. Results of short and long Roux limbs did not differ significantly from each other (t1/2 10 cm, 59.8 h; 3 cm, 59.3 h; control, 42.6 h; p less than or equal to 0.001). The anisoperistaltic Roux limbs showed prolonged retention even when compared with isoperistaltic limbs (t1/2 98.6 h; p less than or equal to 0.001). 51Cr-EDTA results did not show significant differences between all groups. 99mTc-HIDA showed undelayed excretion in all animals but increase of radioactivity at the site of the Roux-en-Y enteroanastomosis, indicating marked stasis in the biliodigestive Roux limb. The results demonstrate the impact of biliary Roux-en-Y anastomosis on bile acid retention due to stasis in the defunctioning jejunal segment.

Anastomosis, Roux-en-Y↗

PubMedDate not supplied

Percutaneous transhepatic angioplasty and stent implantation for prehepatic portal vein obstruction.

Twenty-nine months after a Whipple procedure for pancreatic carcinoma, a 47-year-old woman developed esophageal variceal bleeding. Percutaneous transhepatic portography revealed a severe stenosis of the portal vein with prehepatic portal hypertension and collateral circulation mainly to the gastric and esophageal veins. Percutaneous transhepatic balloon angioplasty was used to dilate the stenoses, but it did not remove the stenosis sufficiently. Therefore, an 8-mm, self-expandable stent was implanted, creating a nearly normal lumen without a pressure gradient. Portal hypertension was relieved, and the patient had no recurrent variceal bleeding for the 5 months up to her death.

Angioplasty, Balloon↗

PubMedDate not supplied

Conditioning of liver grafts with prostaglandins improves bile acid transport.

INTRODUCTION: Conditioning of liver grafts by bolus pretreatment with prostaglandins has been previously demonstrated to improve hepatic bile flow. However, the underlying mechanisms have not been investigated. To elucidate whether improved bile flow after prolonged ischemia is due to maintained bile acid secretion or due to increased paracellular permeability, we performed a study using increasing doses of the marker acid taurocholate in the isolated perfused rat liver system. METHODS: Livers were harvested from adult Lewis rats and stored for 24 hours in UW solution. Pretreatment of livers was performed 1 minute before preservation. One group received prostaglandin I2, the second group received prostaglandin E1, and the control group was treated with saline. After 24 hours of cold storage the grafts were investigated in the isolated perfused rat liver system by perfusion with an oxygenated Krebs-Ringer-Henseleit buffer. Increasing doses of the radiolabeled marker bile acid taurocholate were infused to investigate bile acid transport. RESULTS: Bile flow and bile acid output were increased by pretreatment of the livers with prostaglandin I2 and prostaglandin E1, as compared to the control group. More specifically, the maximum transport rate was tripled by prostaglandin I2 and by prostaglandin E1 preconditioning of liver grafts, in comparison to the control group (P < .01 vs prostaglanin I2 and E1). CONCLUSION: The results clearly demonstrate that increased bile flow after conditioning of liver grafts with prostaglandins is not due to increased paracellular permeability but is based on markedly improved bile acid output.

Adenosine↗

PubMedDate not supplied

Long-term risk of gastrointestinal tumor recurrence after postoperative treatment with recombinant human growth hormone.

BACKGROUND: Recombinant human growth hormone (rhGH) promotes protein synthesis, accelerates wound healing, and maintains immune function in the catabolic state. It has also been claimed that rhGH may promote the activation of residual tumor cells, and therefore, increases the risk of tumor recurrence. This study aimed to investigate whether postoperative administration of rhGH increases the long-term risk of tumor recurrences in patients undergoing major gastrointestinal surgery for malignancy. METHODS: Patients (n =104) received three different doses of rhGH (0.075 IU/kg, 0.150 IU/kg, and 0.300 IU/kg) during 5 postoperative days in a placebo-controlled trial. Follow-up was performed for 56-70 months after radical tumor resection. Mean survival period and relapse-free survival were compared with the control group. RESULTS: Complete data were available for 75 patients. Thirty-five percent (n = 20) of all patients treated with rhGH showed tumor recurrences in comparison to 44% (n = 8) of patients given placebo. Mean survival period for rhGH-treated patients was 46 months (median 59 months); in controls, 42 months (median 58 months). The length of relapse-free survival tended to be longer in rhGH-treated patients (2-47 months; median, 21 months) compared with the patients who were given placebo (2-18 months; median, 13 months). CONCLUSIONS: The results demonstrate no evidence for an increased risk of tumor recurrence after rhGH treatment for a short period of time after removal of a gastrointestinal adenocarcinoma. Therefore, the positive metabolic effects of rhGH application can be used safely in the treatment of the postoperative catabolic state in the patient groups investigated.

Adenocarcinoma↗