Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The nutritional support is essential in the treatment of the septic patient, but the optimal substrates, have not been well defined, although several studies advise the use of solutions with a high proportion of branched amino acids. The use of lipids in the Parenteral Nutrition (PN) of these patients is presently accepted by all authors, although there is no consensus of the composition of the mix to be used. We have done a prospective, randomized study in a group of critical septic patients who received PN. All cases were used a solution with a high proportion of branched amino acids and glucose. 40% of the non-protein calories were administered as lipids. Based on this, two groups were formed. Group 1 medium chain triglycerides and long chain triglycerides (MCT/LCT) in a ratio of 1:1, and Group II LCT. After ten days, both groups showed an increase in hepatic cholestasis enzymes and an improvement of the parameters of protein anabolism and catabolism. Group 1 showed a significantly higher increase in the retinol birdring protein and the improvement of the nitrogen balance. Besides this, the global analysis of all the parameters of protein anabolism and catabolism showed a more favorable evolution, with statistical significance, in those who received MCT/LCT. Therefore, the MCT/LCT in the PN of the septic patient who is given a solution rich in branched amino acids, achieves a greater protein saving and a faster recevesy of the markers of protein synthesis, than those with LCT. Both groups show an increase in cholestasis enzymes.
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PMID:[Comparative study of two lipid emulsions in the parenteral nutrition of the septic patient]. 870 17

Malnutrition and growth retardation remain a major complication in infants with extrahepatic biliary atresia associated cholestasis. The purpose of this study was to investigate whether oral supplementation with branched chain amino acids (BCAA) can correct malnutrition in a rat model of biliary atresia. Four groups of 15 rats, 30 d old, were used. Group A were shamoperated animals, given a normal laboratory diet (17.5% of caloric intake as proteins). Group B were cholestatic rats (biliary atresia) fed a diet enriched in BCAA (supplement of 8.5%, valine/leucine/isoleucine ratio 1:1:1). Group C were cholestatic mice fed a diet enriched in casein (supplement of 8.5%). Group D were cholestatic mice fed a normal diet. Thirty-two days after surgery, groups were compared for body weight, serum amino acid content, nitrogen balance, muscle mass, and carcass composition. The results showed that the weight of group B, C, and D animals was 85, 81, and 64% of group A (controls). Serum BCAA levels were markedly increased in group B animals. Nitrogen retention was similar in groups B and A, but reduced to 63 and 44% in groups C and D, respectively. Dry weights were similar in group A (39.1% of body weight) and B (37.7%), but reduced to 28.1 and 28.6% of body weight in groups C and D. Body proteins were higher in groups A (13.9%) and B (14.2%) than in group D (9.7%) rats. Mineral content of group B animals was 84% of those of group A, 50% in group C, and 23% in group D rats. It was concluded that an oral supplement of BCAA can correct growth, nitrogen retention, and body composition in experimental biliary atresia. Administration of BCAA supplements to cholestatic infants should be considered.
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PMID:Branched chain amino acids improve body composition and nitrogen balance in a rat model of extra hepatic biliary atresia. 879 48

Malnutrition is a critical predictor of mortality and morbidity in children with biliary atresia who undergo orthotopic liver transplantation. Growth hormone (GH) enhances nitrogen retention in patients with chronic obstructive lung disease, sepsis, and in fasted adult volunteers. The goal of this study was to assess the acute response to recombinant human GH (rhGH) treatment in children with biliary atresia to determine whether GH therapy was likely to improve pretransplant nutritional status. Five children, aged 10-32 months, with biliary atresia and persistent cholestasis despite surgical attempts to reestablish bile flow, were studied. All five children had portal hypertension, conjugated hyperbilirubinemia, and decreased serum albumin concentrations. Length, weight, and growth velocity were decreased in all five children. Despite adequate energy and protein intake, fat stores were depleted in all five subjects, and somatic protein stores were diminished in all except one child. Baseline serum concentrations of insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were low (8.4 +/- 2 ng/ml and 0.2 +/- 0.1 mg/l respectively). In the four children who completed the study, serum IGF-I and IGFBP-3 levels did not change after treatment with rhGH (0.1 mg/kg/day) for 4 days. Our findings indicate that children with biliary atresia awaiting liver transplantation are insensitive to GH and that treatment with GH is unlikely to promote anabolism. A rationale exists for examining the effect of treatment with IGF-I, which mediates the anabolic effects of GH.
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PMID:Growth hormone insensitivity in children with biliary atresia. 885 79

Nutritional support to patients in neonatal and pediatric intensive care units is critical not only to minimize negative nitrogen balance but also to promote growth and development. Continuous technological and logistical advances in the Western countries have improved the efficacy and reduced the complications of parenteral nutrition (PN) to the extent that despite the constraints of cost and infrastructure, PN is now fast growing in India. Although widespread availability is very much desired, it is important that the technique is developed with considerable expertise and used judiciously with full knowledge of its indications, limitations, dangers and benefits. Indications for PN include surgical conditions (short gut syndrome), very low birth weight infants (particularly with necrotizing enterocolitis and surgical anomalies), malabsorption syndromes, conditions requiring bowel rest (acute pancreatitis, severe ulcerative colitis and necrotizing enterocolitis) and several non-gastrointestinal indications (end stage liver disease, renal failure, multiple trauma and extensive burns). Provision of PN is associated with significant and sometimes life threatening complications. The possible complications are technical (thrombosis, perforation of vein, thrombophlebitis), infections, metabolic disturbances, hepatobiliary stenosis, cholestasis, fibrosis, cirrhosis or cholelithiasis and bone related complications like osteopenia and fractures. Meticulous monitoring is necessary not only to detect complications but also to document clinical benefit.
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PMID:Pediatric parenteral nutrition in India. 1113 60

Toxicity of a choleretic compound, phloracetophenone (2,4,6-trihydroxyacetophenone; THA) was investigated in mice, rats and hamsters. Acute toxicity of THA was observed to be dependent on species and route of administration, but not sex and age. LD(50) values for an acute toxicity of a single i.p. administration to adult male hamsters and mice were 338 and 365 mg/kg BW, respectively. It was significantly increased to 489 mg/kg BW in adult male rats and greatly increased by i.g. route. Subacute toxicity was investigated in adult male mice by giving THA at a doses of 37-300 mg/kg BW/day, i.g. for 30 consecutive days. High doses of THA induced periportal hepatocyte degeneration whereas plasma concentrations of alanine and aspartate aminotransferases, bilirubin, and blood urea nitrogen, and hepatic triglyceride content were only slightly increased. The possible therapeutic effect of the choleretic THA was evaluated in the ethinylestradiol (EE)-induced cholestasis. THA enhanced the hepatic clearance of sulfobromophthalein and decreased the elevated plasma alkaline phosphatase in EE-cholestatic rats to control levels. These results suggested that THA at biologically active choleretic dose had low toxicity, it might be safe for further development as a therapeutic agent for a short period of treatment in cholestasis.
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PMID:Evaluation of the acute and subacute toxicity of a choleretic phloracetophenone in experimental animals. 1187 83

Several studies suggested that branched-chain amino acids (BCAA) improve plasma amino acid imbalance as well as protein metabolism in patients with cirrhosis. However, commercial formulas supplemented with free BCAA have their limitations. We evaluated a modified soy protein diet with covalently bound BCAA (diet M) by comparing it with diets based on casein (diet C) or Hepatic Aid II (diet H; commercial formula) as protein sources. After 3 weeks of bile duct obstruction, 24 Sprague-Dawley rats divided into three groups received diets with 9% (w/w) protein/amino acids for 7 days. Nutritional and clinical parameters were determined. Nitrogen balance and weight gain (g)/protein intake (g) with diet M (0.19 +/- 0.31 and 1.33 +/- 1.43 g, respectively) were significantly higher (p < 0.05) than with diet H (-0.34 +/- 0.20 and -0.34 +/- 1.11 g), but comparable to those with diet C (0.04 +/- 0.38 and 0.20 +/- 0.93 g). Animals on diet M had a significantly (p < 0.05) increased plasma BCAA:aromatic amino acid ratio (1.8 +/- 0.3) as compared with those on diets H (1.3 +/- 0.1) and C (0.8 +/- 0.0). There were no significant differences in organ weight or liver function among the groups. We conclude that the BCAA-modified protein is an attractive option in the nutritional support of patients having cirrhosis.
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PMID:Nutritional and clinical evaluation of a modified soy protein with covalently bound branched-chain amino acids in cirrhotic sprague-dawley rats. 1265 60

Extracorporeal liver devices have gained great attention as a complementary approach to liver transplantation in patients with acute on chronic liver failure. Among others, Molecular Adsorbent Recycling System (MARS) is a hemodiafiltration against albumin able to remove low molecular weight toxins. We aimed to validate the use of MARS in patients presenting with acute on chronic liver failure with severe cholestasis. We enrolled 7 patients with acute on chronic liver failure, presenting with bilirubin >25 mg/dl and hepatorenal syndrome and/or hepatic encephalopathy grade >II. Liver biochemistry, coagulation, blood cell count, electrolytes, ammonia, lactate, blood urea nitrogen, creatinine, bile acids, Fischer ratio, and encephalopathy grade were assessed before and after each MARS treatment. MARS can represent a safe therapeutic choice to achieve a quick improvement of neurological status, a hemodynamic stability, and a better clinical outcome. In particular, our encouraging results suggest that also, patients with severe cholestasis may represent in the future a good indication for MARS treatment.
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PMID:Successful MARS treatment in severe cholestatic patients with acute on chronic liver failure. 1278 May 11

Pruritus is a common manifestation of dermatologic diseases, including xerotic eczema, atopic dermatitis, and allergic contact dermatitis. Effective treatment of pruritus can prevent scratch-induced complications such as lichen simplex chronicus and impetigo. Patients, particularly elderly adults, with severe pruritus that does not respond to conservative therapy should be evaluated for an underlying systemic disease. Causes of systemic pruritus include uremia, cholestasis, polycythemia vera, Hodgkin's lymphoma, hyperthyroidism, and human immunodeficiency virus (HIV) infection. Skin scraping, biopsy, or culture may be indicated if skin lesions are present. Diagnostic testing is directed by the clinical evaluation and may include a complete blood count and measurement of thyroid-stimulating hormone, serum bilirubin, alkaline phosphatase, serum creatinine, and blood urea nitrogen levels. Chest radiography and testing for HIV infection may be indicated in some patients. Management of nonspecific pruritus is directed mostly at preventing xerosis. Management of disease-specific pruritus has been established for certain systemic conditions, including uremia and cholestasis.
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PMID:Pruritus. 1452 1

The aim of our research was the study of the intensity of the oxidative homeostasis of the organism during the mechanical jaundice. From the results of our study it follows that during the cholestasis the violation of the balance between pro-and antioxidant blood system takes place in the patient's blood. The latter is manifested in the blood EPR spectrum in the considerable increase (about 47%) of the intensity of the EPR oxidated ceruloplazmin signal, in the decrease of the intensity of the EPR signal Fe3+ transferin (on 16%), in the increase of the contents of promoters of the free-radical oxidation of ions Fe2+ and Mn2+. As it follows from the results of our researches, the considerable increase of the contents of the free nitrogen oxide is observed during the mechanical jaundice. So it can be concluded, that the intensification of the free-radical processes and the emanation of the protective antioxidant enzyme systems takes place in the organism. Consequently, activation of the peroxide oxidation processes takes place, which disrupts cell membrane integrity and leads to the development of the irreversible tissue injuries.
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PMID:[Oxidative homeostasis of organism during mechanical jaundice]. 1678 84

30 cecum-ligated rats were divided into 3 groups: group OS fed with stock diet; group HTPN (high-energy total parenteral nutrition) infused with 260 kcal/kg/d of non-protein energy (NPE), which was isoenergetic to the first group; and group LTPN (low-energy total parenteral nutrition) infused with 160 kcal/kg/d. All rats received approximately 1.4 g/kg/d of nitrogen. Positive nitrogen balances were obtained in all 3 groups, although the values were lower in group LTPN. Serum albumin remained normal. Total bilirubin, lipoprotein-X, alkaline phosphatase (AKP), gamma-glutamyl trans-peptidase (gamma-GT) and glutamic-pyruvic transminase (GPT) were significantly lower in group LTPN than in group HTPN. Histological examination with both light and electron microscopy revealed more severe bile stasis in the canaliculi in group HTPN than in group LTPN. In a separate clinical study, lasting more than 4 weeks, two groups of surgical patients received isonitrogenous TPN regimes containing different amounts of energy (40 kcal/kg/d and 30 kcal/kg/d, respectively). 40% of the NPE was infused as fat. The patients were matched for age, clinical condition and nutritional support technique. There were no differences between the groups in nitrogen balance or serum albumin. However serum AKP and gamma-GT increased in the HTPN group after 2 weeks of nutritional support, whilst in the LTPN group the increase did not occur until the fourth week. Our results suggest that TPN-induced cholestasis can be prevented or delayed by reducing the intake of NPE.
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PMID:Prevention of total parenteral nutrition-induced cholestasis by low non-protein energy supply: an animal experiment and clinical study. 1684 91


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