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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Haemodynamic measurements were made in 80 patients who underwent acute haemodilution (up to 40 ml/kg blood withdrawal) before cardiopulmonary bypass. Measurements of cardiac output, pulmonary arterial pressures including wedge pressure were made. Cardiac index, stroke volume and total peripheral resistance were calculated. Oxygen studies included: arterial and central venous partial pressures and saturations. Haemoglobin content, haematocrit and blood gas determinations were made during haemodilution and bypass. There was a direct relationship between haemodilution and stroke volume (stroke volume increase of 8,5% with 9,4 ml/kg and 25% increase with 40 ml/kg blood withdrawal). No change was found in mean pulmonary artery or wedge pressures. Central venous oxygen saturation remained constant during haemodilution which indicates that oxygen supply was adequate. Haemodilution should be avoided in patients with less than 35% haematocrit, with more than two vessel coronary artery disease and Class IV N.Y.H.A. because of the risk of possible impaired cardiac output compensation. During bypass, a haematocrit of 20% and 6 g% provides greater perfusion and optimal microcirculation. The problems of large volume homologous blood transfusion, hepatitis risk and loss of clotting factors can be lessened with haemodilution.
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PMID:[Haemodynamic effects of acute intra-operative haemodilution in open heart surgery (author's transl)]. 69 82

Acute normavolemic hemodilution is a mean of autotransfusion and allow hepatitis prophylaxis in major surgical procedures which general require homologous blood transfusions. The dilutional drop in blood viscosity is followed by an increased cardiac output, while blood pressure and heart rate remain stable. The CO incerase compensates for the reduced oxygen capacity of the diluted blood. Hemodilution was applied in a total of 88 patients. In 46 cases thorough circulatory and laboratory investigations were performed. While an average of 1785 ml blood was withdrawn and replaced synchronically by plasma substitutes, hematocrit was lowered to 24.8% mean and CO rose from 4.4 to 6.01 l/min. In one half of the patients side reactions were observed that occurred in combination as a syndrome in 8 patients: rise in systemic blood pressure and pulmonary artery pressure, disproportional CO increase, peripheral vasoconstriction, and ST-depression in ECG. The possible pathomechanisms of these side reactions are discussed. A sympathetic adrenergic reaction could be excluded by catecholamine estimation. Hyposia may be assumed to be the more probable reason. Since severe side reactions only occured at hematocrit levels below 26%, the dilution waslimited lately to hct 27%. Patients with coronary heart disease, age greater than 70 years, and anemia less than 12 g% hgb were excepted. In 70% of major surgical procedures, e.g. colonic surgery, homologous blood becomes necessary, in 50% in the amount of 2-4 units. The corresponding blood loss of 1000-2000 ml may be compensated by acute normovolemic hemodilution and autotransfusion. In fact, only 15% of our patients required homologous blood transfusions.
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PMID:[Clinical experiences with the acute normovalemic hemodilution (author's transl)]. 96 Nov 42

We have previously reported that a hypermetabolic state, resembling that produced by thryoid hormones, exists in the livers of animals treated chronically with ethanol. We propose that this alteration produces a relative hypoxia in the centrilobular zone of the liver which, if severe enough, leads to cellular death and to the production of hepatitis. Rats consuming ethanol for 30 days, given with a nutritionally adequate diet, and exposed to reduced oxygen tensions for only 6 hr, developed histological and biochemical evidence of hepatocellular necrosis and inflammatory lesions confined to the centrilobular zone. The severity was proportional to the degree of hypoxia. Pair-fed (nonalcohol) controls showed no such lesions. Treatment of the animals with propylthiouracil for 3-10 days abolished the hypermetabolic state of the liver in ethanol-consuming animals, and drastically reduced the histological and biochemical effects of hypoxia in them. These findings may have implications for pathogenesis and treatment of alcoholic hepatitis in man.
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PMID:Experimental alcohol-induced hepatic necrosis: suppression by propylthiouracil. 105 71

Preoperative haemodilution was performed in 46 patients. By exchange of 1785 ml of patient's blood with plasma substitutes, haematocrit was lowered to 24.8% mean. Cardiac output rose, the other circulatry parameters remained constant on average. 8 patients experienced, however, a circulatory reaction with acute systemic and pulmonary hypertension, peripheral vasoconstriction, and ST-depression in ECG. These cases showed a decrease in oxygen uptake. In further 42 patients haemodilution was limited to haematocrit 27%, and only three weak hypertonic reactions were observed. Therefore we recommend haemodilution to be limited to this hematocrit. Saving homologous blood transfusions is the major goal of haemodilution. In comparable surgical procedures 60-70% of patients without haemodilution are given homologous blood. In our two patient groups with haemodilution blood transfusions were necessary in 15 and 21%, respectively. Thus, haemodilution is a valuable mean of hepatitis prophylaxis by saving homologous blood transfusions. This advantage outweighs the possible risks of circulatory reactions.
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PMID:[Hypertonic circulatory response to clinical haemodilution (author's transl)]. 127 13

In the coming decade, it is likely that oxygen-carrying alternatives to red blood cells will become available for clinical use. The driving force behind their development is the risk of transfusion of homologous blood, which includes transmission of viral disease (HIV and hepatitis) and transfusion reactions as well as the expense of collecting and storing human blood. A number of clinical applications for these products can be anticipated now, but when available, it is likely that the list will grow. How widely these products will be used depends on their safety. In addition to these clinical applications, blood substitutes will be useful in furthering our understanding of basic oxygen transport physiology.
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PMID:Potential clinical applications for blood substitutes. 139 35

Lyophilized PHP as an oxygen carrier is prepared from outdated red cell and dicarboxymethylated polyoxyethylene. In order to apply PHP for a clinical use, a large scale production of high quality PHP has been studied. We have set up a 20 L scale production flow of PHP88. The product was tested to confirm the quality and lot-to-lot consistency. The blood group specific materials were weakly positive in stroma-free hemoglobin (SFH), however, were found negative in the PHP of this scale. The amount of phosphatidylethanolamine (PE) in purified SFH and PHP88 reconstituted solution was 0.19 +/- 0.04 and 0.03 +/- 0.01 ppm, respectively. Contamination of viruses such as HBV and Non A non B hepatitis virus could not be observed in the final product. Elimination and inactivation of HIV was validated through a spike test. The characterizations of the final products in 20 L scale were done through MW, P50, Hill coefficient, viscosity, and molecular weight distribution by SDS-PAGE and batch to batch consistency was also confirmed. The results show that production process is appropriate to eliminate the blood group materials, PE and virus, and produce PHP of high quality. Lyophilized PHP88 can be produced by addition of maltose and can be stored over 1 year.
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PMID:Large scale production and characterization of lyophilized pyridoxalated hemoglobin-polyoxyethylene (PHP). 139 59

During the past 10 years, liver transplantation has developed into an established form of treatment. In 1991 alone, almost 450 liver transplants were performed in Germany with a mean 1-year survival of 70%. Consistent progress in the fields of organ preservation, surgical techniques, and prevention of disease recurrence has made a more than 90% 1-year survival rate achievable during the last 3 years in Berlin. Progress in organ preservation is based on the use of colloidal solutions, pharmacological improvement of microcirculation, and probably prevention of reperfusion injury by the use of calcium antagonists and free oxygen radical scavengers. Improvements in surgical techniques have led to a reduction in blood loss and vascular complications, and to a drastic reduction of biliary leaks and stenosis. The introduction of cyclosporin, FK-506, and monoclonal antibodies into immunosuppressive therapy has contributed to the improvement of results in a major way. Furthermore, progress in intensive care in the areas of fluid therapy and blood component substitution, respiratory care and prophylaxis of infection as well as postoperative nutrition has led to a reduction in early postoperative morbidity and mortality. Efficient prophylaxis of the recurrence of hepatitis-B-virus-related disease by using hepatitis B hyperimmunoglobulin after liver transplantation has prevented this lethal recurrence, which was previously frequent, in a large group of patients.
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PMID:[Progress in the field of liver transplantation in the last 10 years]. 149 68

There is a growing body of experimental and clinical evidence to suggest that oral or rectal administration of 5-ASA or 5-ASA conjugates is associated with significant adverse side effects including pancreatitis, hepatitis, and renal toxicity. The objective of this study was to assess the ability of 5-ASA to interact with low-molecular-weight iron to yield oxygen-derived free radicals and to determine whether these oxidants could damage model biological compounds. We found that 5-ASA was very effective at chelating ferric iron (Fe3+), and it rapidly reduced Fe3+ to the ferrous form (Fe2+). Addition of the 5-ASA/Fe2+ chelate to solutions containing polyunsaturated fatty acids or deoxyribose resulted in lipid peroxidation and oxidative carbohydrate degradation, respectively. These results are consistent with the formation of the highly reactive (and cytotoxic) hydroxyl radical. Formation of this free radical species was confirmed by the ability of hydroxyl radical scavengers (dimethyl sulfoxide, dimethyl thiourea) to inhibit the 5-ASA/Fe-mediated oxidative reactions. Maximum hydroxyl radical formation was achieved at a 5-ASA-to-Fe3+ ratio of 1.0 (20 microM 5-ASA and 20 microM Fe3+). Increasing this ratio significantly inhibited OH. formation with a concomitant reduction in lipid peroxidation and deoxyribose degradation. Finally, we demonstrated that 5-ASA promotes the reductive release of Fe3+ from ferritin. Data obtained in this study suggest that 5-ASA may, under certain conditions, promote the formation of potentially injurious free radical species. These oxidative reactions may contribute to some of the adverse side effects known to be associated with the newer preparations of 5-ASA.
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PMID:Prooxidant properties of 5-aminosalicylic acid. Possible mechanism for its adverse side effects. 150 90

The relationship between oxygen consumption (VO2) and oxygen delivery (DO2) is of interest in critically ill patients. Various studies of these parameters have resulted in different concepts for optimizing DO2 and VO2. During liver transplantation without anhepatic veno-venous bypass, caval cross-clamping initiates a series of haemodynamic and metabolic alterations including the rapid change from hyperdynamic to hypodynamic conditions. In addition, simultaneous changes in DO2 and VO2 occur in these patients. The goal of our present study was to test the clinical relevance of therapeutic interventions based on metabolic monitoring in patients with terminal liver disease undergoing orthotopic liver transplantation. PATIENTS AND METHODS. One hundred sixty-two consecutive patients were evaluated. According to outcome, patients were divided into survivors (n = 115, group A), nonsurvivors (n = 30, group B), and patients with primary nonfunction of the liver graft (n = 17, group C). One hundred twenty patients were cirrhotics due to either alcohol (n = 36), aggressive hepatitis (n = 30), or biliary cirrhosis (n = 54); 42 had a neoplastic disease. Haemodynamic measurements, data for calculations of DO2 and VO2, and blood samples for arterial and mixed-venous blood gases and subsequent laboratory analysis were taken during the surgical procedure at six timepoints: after induction of anaesthesia (I); during preparation of the recipient liver, before cross-clamping (II); 10 min after clamping of the inferior vena cava (III); 10 min before unclamping (IV); with all vessels open, 10 min after declamping during reperfusion (V); and 60 min after declamping (VI). Anaesthesia was induced with thiopentone (3-5 mg/kg i.v.) and fentanyl (15 micrograms/kg min i.v.). Muscle relaxation was achieved with pancuronium (0.1 mg/kg i.v.). Anaesthesia was maintained with i.v. supplements of fentanyl (5-10 micrograms/kg) and pancuronium (4 mg) as required. Volume-cycled ventilation was established with a mixture of O2 in air with a positive end-expiratory pressure of 5 mm H2O to keep the PaO2 above 100 mm Hg and the PaCO2 around 35 mm Hg (Servo 900 C-Ventilator, Siemens). To maintain body temperature, all patients were positioned on a heating blanket set at 38 degrees C. The inspired gases were warmed and humidified using a dual servo-heated humidifier. Mannitol (20-40 g i.v.) or sorbitol (16-24 g i.v.) was given to prevent renal dysfunction during the cross-clamping procedure. Lactated Ringer's solution and fresh frozen plasma administration was guided by cardiovascular performance and requirements for clotting factors, respectively. Cardiac output was measured by the thermodilution method using a pulmonary artery catheter. Blood lactate, haemoglobin concentration, arterial and mixed-venous oxygen content, and oxygen saturation were measured (Hemoxymeter OSM3). VO2 and DO2 were calculated according to standard formulas. STATISTICAL ANALYSIS. The data from groups A, B, and C were compared using a multivariate analysis of variance with Tukey's method for multiple comparisons. A least-square regression was used to correlate metabolic data. RESULTS. The perioperative course of the determinants of oxygen transport is shown in Table 1. After cross-clamping, the cardiac index (CI) decreased in groups A (47%), B (53%), and C (51%) and increased to pre-anhepatic levels after reperfusion of the new liver. This was associated with distinct decreases in DO2 (A: 42%, B: 47%, and C: 45%) and VO2 (A: 8%, B: 19%, C: 25%). After reperfusion of the new allograft (V), VO2 increased in groups A (24%) and B (18%) as compared to controls (I). By contrast, in group C, a distinct further decrease in VO2 (13%) was detected. In these patients, there was a significantly greater increase in mixed-venous saturation accompanied by a further decrease in body temperature. As shown in Figures 1 and 2, no significant relationship was found between O2 transport, VO2, and blood lactate. DISC
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PMID:[Anesthesia-relevant changes in metabolic parameters with different circulatory and liver functions]. 152 56

Pretreatment with the reactive oxygen species scavengers superoxide dismutase (SOD) and catalase or with the xanthine oxidase inhibitor allopurinol protected mice against hepatitis induced by the combined administration of lipopolysaccharide (endotoxin) and D-galactosamine. In the sera of protected animals no tumor necrosis factor (TNF alpha) was detectable in contrast to abundant amounts in the sera of injured control animals. A similar protection by the suppression of systemic TNF alpha was observed following the pretreatment of mice with polystyrene-coupled SOD prior to endotoxic challenge. Both pretreatments were ineffective when hepatitis was evoked by administration of the mediator TNF alpha instead of endotoxin. These findings indicate that the formation of extracellular reactive oxygen species is a condition needed to induce the release of TNF alpha and thus to mediate endotoxin-induced toxicity.
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PMID:A link between extracellular reactive oxygen and endotoxin-induced release of tumour necrosis factor alpha in vivo. 155 88


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