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Biomedical subjects

Y Baruch

Publications and source records attributed to Y Baruch.

At least 37 records · Page 2Linked to original sources
PubMed1999

Clinical implication of VEGF serum levels in cirrhotic patients with or without portal hypertension.

AIM:To determine whether serum vascular endothelial growth factor (VEGF) levels correlates with the severity of liver cirrhosis and whether portal hypertension impacts on the expression of serum VEGF protein.METHODS:Fifty-three patients (mean age 56 ± 2 years) with HCV (n = 26), HBV (n = 13), and cryptogenic liver cirrhosis (n = 14) (Child-Pugh's class A: 24, B: 19 and C: 12) and normal renal function constitute the patient population, who were all diagnosed by clinical, histological and radiological findings. Six healthy people and six patients with acute hepatitis served as controls. Severity of liver disease was evaluated by the CP score. Serum levels of IGF-1 and VEGF were measured by radioimmunoassay and ELISA,respectively.Portal hypertension was assessed using pulsed Doppler ultrasound. RESULTS:The mean serum VEGF levels in all cirrhotic patients (73 ± 58) were significantly lower than those of healthy controls (360 ± 217, P < 0.01) and acute hepatitis (1123 ± 1261, P < 0.01) respectively. No significant difference in median serum VEGF levels were noted among the different Child-Pugh's classes (class A: median, 49.4ng/L, range, 21ng/L-260ng/L, Class B: median 59.9ng/L; range 21-92, and Class C: median 69; range 20ng/L-247ng/L). A significant correlation was noted between serum VEGF and two accurate parameters of portal hypertension: portal blood flow velocity (r = 0.6) and spleen size (r = 0.55). No correlation was found between VEGF serum levels and serum albumin, IGF-1, platelets count and aminotrasnferases (r = 0.2, r = 0.1, r = 0.2 and r = 0.2, respectively).CONCLUSION:Circulating VEGF level in patients with liver cirrhosis could not serve as an indicator of the progression of chronic liver disease but rather, they may reflect increased portal hypertension or decreased hepatic regenerative activity or the combination of both.

Journal Article↗
PubMed1998

Spontaneous pulsatility and pharmacokinetics of growth hormone in liver cirrhotic patients.

BACKGROUND/AIMS: Liver cirrhosis is characterized by high serum growth hormone levels and low serum insulin-like growth factor I and growth hormone-binding protein levels. The present study was designed to characterize the serum profile of growth hormone and growth hormone pharmacokinetics in postnecrotic liver cirrhosis, correlating it with liver function and nutritional states. METHODS: Fifteen patients were grouped by the Child-Pugh score (group 1, score of 5 to 8; group 2, score of 9 to 12). Five healthy subjects served as controls. Nutritional status was assessed by the creatinine-height index. Baseline growth hormone, insulin-like growth factor, and growth hormone binding protein were measured, and growth hormone pharmacokinetics was followed for 48 h after administration of subcutaneous recombinant human growth hormone (0.06 mg/kg). RESULTS: Trough serum growth hormone (microg/l) was higher in both patient groups (5.3+/-3.6) than in controls (1.0+/-0.3; p<0.01). More pulses were recorded in cirrhotic patients, and mean pulse amplitude (microg/l) was higher in cirrhotic patients than in controls (p<0.01). After subcutaneous recombinant human growth hormone injection, maximal growth hormone was higher in cirrhotic patients and the area under the curve over 24 h was greater (626+/-120) than in controls (330+/-54; p<0.01). Single regression analysis showed a weak correlation of both the Child-Pugh score and the creatinine-height index with the pharmacokinetic parameters. CONCLUSIONS: Due to decreased growth hormone clearance, patients with liver cirrhosis have increased trough and peak serum growth hormone levels, as well as lower serum growth hormone binding protein and insulin-like growth factor. Recombinant human growth hormone pharmacokinetics are typical of a high hepatic extraction substance administered to patients with liver disease and portal hypertension, and this may be relevant to the further use of growth hormone therapy.

Adult↗
PubMed1998

Prognostic value of generation of growth hormone-stimulated insulin-like growth factor-I (IGF-I) and its binding protein-3 in patients with compensated and decompensated liver cirrhosis.

Our aim was to study the prognostic value of growth hormone (GH) -stimulated insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 (IGFBP-3) generation in patients with compensated [group 1 (N = 8) with a Child-Pugh (CP) score of 5-8] and decompensated postnecrotic liver cirrhosis [group 2 (N = 7) with a CP score of 9-12]. Serum levels of IGF-I, GH-binding protein (GHBP), and IGFBP-3 were measured before and 24 hr after a single subcutaneous injection of recombinant human GH (rhGH, 0.14 units/kg). Patients (mean age 56 years) were followed prospectively for three years. Six patients (40%) died during the follow-up period, of whom half had a CP score <9. Mean serum IGF-I levels 24 hr after rhGH injection (group 1 vs group 2, 17.4 +/- 6.8 vs 7.4 +/- 0.7 nmol/liter) predicted survival with 93% accuracy. Levels <10 nmol/liter portended a poor prognosis, with 15% survival at one year, whereas levels >10 nmol/liter had a 100% survival rate at one and two years, respectively. Baseline IGF-I (9.98 +/- 2.0 vs 6.38 +/- 0.8 nmol/liter), GHBP (9.2 +/- 3 vs 5.7 +/- 0.8%/50 microl), and IGFBP-3 serum levels at baseline (1.7 +/- 0.3 vs 0.86 +/- 0.2 mg/liter) and at 24 hr (2.04 +/- 0.38 vs 0.99 +/- 0.3 mg/liter) did not add to the predictive value of stimulated IGF-I levels at 24 hr and were less accurate in predicting the outcome in comparison to CP score (80%). We conclude that stimulated IGF-1 <10 nmol/liter may be a true predictor of a negative prognosis in patients with liver cirrhosis.

Adult↗
PubMed1998

Severe cholestatic jaundice induced by Epstein-Barr virus infection in the elderly.

Infectious mononucleosis due to Epstein-Barr virus (EBV) is almost always a self-limited disease, most commonly seen in young adults. Hepatitis is a well-recognized complication of EBV infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. We report a 60-year-old man with severe cholestatic jaundice whose history, liver histology and laboratory findings suggested EBV infection. He also developed significant jaundice related to his hepatitis, but not to autoimmune haemolysis, a situation that led to diagnostic delay. Costly diagnostic laboratory tests and invasive procedures were performed to rule out a malignant extrahepatic biliary obstruction. Physicians need to be aware of this complication and EBV infection should be included in the differential diagnosis of cholestatic jaundice in the elderly.

Aged↗
PubMed1997

Growth hormone-stimulated insulin-like growth factor (IGF) I and IGF-binding protein-3 in liver cirrhosis.

BACKGROUND/AIMS: The aim of this study was to evaluate the liver's potential to generate insulin-like growth factor (IGF) I and IGF-binding protein-3 (IGFBP-3), following stimulation by human recombinant growth hormone, as a possible marker for liver functional reserve in patients with liver cirrhosis. METHODS: In a pilot study, 15 patients (mean age 56 years) with postnecrotic liver cirrhosis were divided into two groups according to disease severity (Child-Pugh score): Group 1 (n=8) with scores of 5-8 and Group 2 (n=7) with scores of 9-12. Five age-matched healthy subjects served as controls. Human recombinant growth hormone (0.06 mg/kg) was administered subcutaneously on 2 consecutive days. Serum levels of IGF-I and IGFBP-3 were measured before and up to 48 h after human recombinant growth hormone injection. Nutritional status was assessed by the creatinine-height index and was compared to lymphocyte count, body mass index, and muscle arm circumference. RESULTS: Baseline IGF-I levels were significantly lower in patients with cirrhosis than in controls, while no differences were noted between the two patient groups. IGF-I levels increased significantly after rhGH administration to the healthy controls, to a lower degree in Group 1, while no change occurred in Group 2. IGF-I levels at 24 h and beyond correlated significantly with the nutritional status, the Child-Pugh score, and the basal levels of GH-binding protein and IGFBP-3. IGFBP-3 serum levels did not change after rhGH stimulation. CONCLUSIONS: IGF-I generation after GH stimulation may provide a new dimension in the assessment of liver function and nutritional status in patients with liver cirrhosis.

Adult↗
PubMed1997

Human parvovirus B19 infection associated with idiopathic thrombocytopenic purpura in a child following liver transplantation.

BACKGROUND/AIMS: Idiopathic (autoimmune) thrombocytopenic purpura has been previously reported as a rare complication in children following parvovirus B19 infection. In the immunocompromised host who is unable to produce neutralizing antibody, an infection with parvovirus B19 can persist and cause chronic bone marrow failure. METHODS: We describe a child who had undergone liver transplantation and who had idiopathic thrombocytopenic purpura, whose history and laboratory findings suggested parvovirus B19 infection. The infection disappeared without persistent viremia, and the thrombocytopenia responded completely to the administration of gamma globulin while the patient was undergoing chronic immunosuppression therapy. RESULTS/CONCLUSION: Transplant physicians need to be aware of this complication, and parvovirus B19 infection should be included in the differential diagnosis of liver recipients presenting with severe thrombocytopenia.

Child↗
PubMed1996

Sanctuary of hepatitis B virus in bone-marrow cells of patients undergoing liver transplantation.

Hepatitis B virus (HBV) reinfection after liver transplantation is a major problem. HBV is mainly a hepatotrophic virus but replicates in many extrahepatic tissues. We present here two cases of infected patients who underwent liver transplantation. Both underwent bone marrow (BM) and liver biopsies after transplantation. Biopsy specimens were stained for hepatitis B surface antigen (HB-sAg), and bone marrow aspirates and were separated for all subsets of cells. In both cases, HBV DNA analysis detected DNA in all BM fractions after transplantation, but HBV recurrence was found only in one case. We suggest that graft reinfection after liver transplantation may be caused by active replication of HBV in extrahepatic tissues and that BM cells are probably one of the major sanctuaries. The use of immunoprophylaxis based on BM-HBV studies is discussed.

Bone Marrow Cells↗
PubMed1995

The need for liver transplantation: a nationwide estimate based on consensus review.

Orthotopic liver transplantation (OLT) is widely practised in developed countries. The procedure is costly, the supply of donor organs limited, and it is not known how many patients need transplantation. A community-wide estimate of the needs for OLT was performed over two years in all general hospitals in Israel. Records of 1851 patients with liver disease were screened to identify those who might eventually need OLT. The annual estimate of transplantation needs in the country was 10-15.5 per million population, with equal numbers of males and females. The addition of patients with nonreformed alcoholism and end-stage liver disease, originally set as an exclusion criteria, would have added 20% to this estimate. 37% of potential candidates were under 40 years of age at diagnosis, and about 50% were 55-64 years old. Almost 80% of patients had cirrhosis of the liver and 13.6% had fulminant hepatitis. These findings provide a basis for a national plan of OLT in Israel, and similar studies might be useful in other countries.

Adolescent↗
PubMed1995

Blood exchange [correction of exchance]-a rescue procedure for complicated falciparum malaria.

Falciparum malaria is the most hazardous form of malaria. Its high degree of parasitemia interferes with vital functions of most organs and is directly responsible for its high rate of mortality and morbidity. Quinine and other antimalarial drugs are relatively slow acting and not always effective due to the growing resistance developed by Plasmodium toward these drugs. Another emergency modality, which would remove the parasitic burden quickly and effectively, is thus much needed. We present a case of a 51-year-old sailor, who was admitted to the hospital because of complicated falciparum malaria. His situation deteriorated rapidly into a desparate stage, despite the various intensive treatments and quinine. He soon developed a systemic inflammatory response syndrome manifested as cerebral malaria, renal failure, acute respiratory distress syndrome and disseminated intravascular coagulation. An emergency blood exchange reversed the situation dramatically, and the patient recovered completely. It is recommended that any doctor, both in endemic and in non endemic areas, dealing with blood transfusions or infectious diseases, should be acquainted with this lifesaving modality, regardless of the controversy still surrounding this subject.

Emergencies↗
PubMed1995

Basic fibroblast growth factor is hepatotropic for rat liver in regeneration.

A role for fibroblast growth factor in liver regeneration has recently been suggested. In this study we followed the intravenous delivery of recombinant human [125I]basic fibroblast growth factor to the liver of rats following 68% partial hepatectomy. The concentration of [125I]basic fibroblast growth factor was higher in the liver (mean +/- SD, 6.8 +/- 0.89% of injected dose) and the kidney (6.7 +/- 0.2%) of sham-operated rats than in the spleen (2.8 +/- 0.45%). It increased threefold in the liver only, soon after 68% partial hepatectomy (20.3 +/- 5.3%, p < 0.001), and remained high for the first 24 h. We also studied the effect of basic fibroblast growth factor injection on the rate of [3H]thymidine incorporation into liver DNA in rats subjected to either 21% or 68% partial hepatectomy. A significant increase was seen after intramesenteric injection of 500 ng basic fibroblast growth factor into rats subjected to 21% partial hepatectomy (23.5 +/- 7.3 cpm/micrograms DNA) compared to saline-injected rats (14.5 +/- 6.4 cpm/micrograms DNA, p = 0.034). A dose of 5000-25,000 ng injected into a peripheral vein resulted in higher thymidine incorporation than in saline-injected control rats (36.9 +/- 12.7 and 9.7 +/- 6.1 cpm/micrograms DNA, respectively; p < 0.0001). No significant effect was seen after 68% partial hepatectomy. Autoradiography showed that the hepatocytes were the predominant labelled cells early after hepatectomy and basic fibroblast growth factor injection. We conclude that basic fibroblast growth factor uptake by the liver is increased after 68% partial hepatectomy and that basic fibroblast growth factor is mitogenic to liver parenchymal cells early after 21% partial hepatectomy.

Animals↗
PubMed1994

Differentiation between major and milder acute mental stress by means of the leukocyte adhesiveness/aggregation test.

Following previous observations that the adhesive state of white blood cells in the peripheral blood increases during stress, we examined 645 volunteers in various conditions of anticipatory anxiety. The volunteer subjects included 465 controls in whom stress was related solely to impending venipuncture, 149 persons under moderate stress (students before delivering a graded lecture, patients before dental treatment, etc), as well as 31 individuals under major stress (eg, before induction of anesthesia in the operating room). The respective values of aggregated leukocytes in the peripheral blood were 5.2 +/- 3.8, 6 +/- 4.2, and 19.3 +/- 9.3% of aggregated cells, with a significant difference (p < .0001) between the third and the other two groups. In both discriminant analysis and multiple regression, the leukocyte adhesiveness/aggregation test (LAAT) was shown to be superior to the white blood cell count for the detection of major stress. The LAAT had a sensitivity of 0.8, compared with only 0.35 for leukocyte count for that purpose. We concluded that the LAAT could be a powerful tool for the diagnosis of major acute mental stress and for discrimination between conditions causing major stress and those conditions that are less stressful.

Adolescent↗
PubMed1994

HLA-DR positive epidermal Langerhans' cells in liver cirrhosis and immunosuppressed liver transplanted patients.

The aim of the present study was to evaluate the number of Langerhans' cells (LC) in immunosuppressed liver transplanted patients, compared to patients with liver cirrhosis and healthy volunteers. The detection of LC was performed in the epidermal sheet of each patient by using indirect immunoperoxidase and ATPase staining. A significant reduction in the number of LC was found in the liver transplanted patients as compared to patients with liver cirrhosis and healthy volunteers. This reduction may be related to prolonged treatment with corticosteroids and azathioprine.

Adult↗
PubMed1993

[Transjugular liver biopsy in patients with bleeding tendency].

Transjugular liver biopsy (TJB) was successful in 14 of 23 patients with chronic liver disease and abnormal coagulation profiles. There were 7 men and 7 women between the ages of 20 and 65. No bleeding followed the procedure, nor were there any other significant complications. The size of the specimens and the number of portal spaces included were compared with those obtained by percutaneous liver biopsy from 12 patients with advanced liver cirrhosis. TJB samples were smaller than those obtained by percutaneous biopsy (0.56 +/- 1.6 cm vs 1.0 +/- 0.05) and contained fewer portal spaces (2.2 +/- 1.6 vs 3.4 +/- 2.3). Despite the smaller size, the contribution of TJB to diagnosis and prognosis was defined as good in 78% of the patients. We conclude that TJB is safe and is an important tool for liver tissue diagnosis in patients with bleeding tendency.

Adult↗
PubMed1993

Pregnancy after liver transplantation.

Two patients who became pregnant after liver transplantation for end-stage liver disease were carefully monitored using pulsed Doppler waveform measurements. One patient with Wilson's disease, on triple immunosuppressive therapy including prednisone, azathioprine and low-dose cyclosporin A, delivered a healthy girl weighing 2650 g after 38 weeks' gestation. The other patient, with HBV-related postnecrotic cirrhosis, became pregnant less than 3 months postoperatively, under triple therapy, after being amenorrheic for 6 years. Episodes of elevation in liver enzymes were noted, and severe osteoporosis with low back pain developed. A healthy boy weighing 2975 g was born at 35 weeks' gestation. Our cases add to previous reports of successful pregnancies under cyclosporin A immunosuppression.

Adult↗