Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective randomized trial has compared 3 policies of antibiotic prophylaxis in biliary surgery. Patients considered to be high-risked against postoperative infection were randomly allocated to 2 groups: in group CTM-H, patients were given cefotiam; in group CMX-H, patients were given cefmenoxime. Patients free of risk factors (group CTM-L) were all given cefotiam. The high-risk factors adopted in this trial were; emergency surgery, presence of jaundice or cirrhosis, malignant disease, diabetes mellitus, age over 70, recent biliary tract infection, choledocholithiasis, and previous biliary surgery. Postoperative infection occurred in 2.1% (4/190) in the CTM-L group, which was lower compared to 15.5% (11/71) of the CMT-H group (p less than 0.01), and 11.3% (8/71) of the CTM-H group (p less than 0.01). The rates of bacterial isolation from intraoperative bile culture and wound swab were significantly high in the two high-risk groups compared to the low-risk group, but is was not different within the two high-risk groups. These findings suggest that while cefotiam is appropriate for prophylaxis for the low-risk patients, the utmost care should be taken in the high-risk patients to prevent intraoperative contamination along with prophylactic antibiotic therapy which covers the bacteria isolated from the bile.
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PMID:[Identification and antibiotic prophylaxis of high-risk patients in biliary tract surgery]. 155 88

In a 4-year review of 509 patients with chronic pancreatitis, the incidence of clinically manifest fixed common bile duct (CBD) stenosis was 9% (45 patients). In 76% this was alcohol related, and pancreatic calcification was present in 51%. All patients presented with unrelenting jaundice and five (11%) had cholangitis. The mean serum bilirubin (165 +/- 108, normal 0-17 mumol/l), alkaline phosphatase (1790 +/- 1143, normal 73-207 U/l) and gamma glutamyl transferase (798 +/- 660, normal 7-64 U/l) were markedly raised. Diabetes occurred in 8 (18%). A biliary drainage operation was performed in 43 patients and 11 had concomitant pancreaticojejunostomy. Endoscopic retrograde cholangiopancreatography (ECRP) provided valuable information preoperatively in outlining both biliary and pancreatic disease in selecting patients for dual ductal drainage. Minor complications not related to biliary anastomosis occurred in 14%. Four patients died (9%), two from pseudocyst-related haemorrhage. Jaundice was successfully relieved in all and did not recur during follow-up. No secondary biliary cirrhosis was encountered, but varying degrees of portal fibrosis were present in 75% of liver biopsies. The commonest biliary pathogen was E. coli. It is recommended that a biliary bypass operation be performed when the diagnosis is radiologically confirmed and no improvement occurs within 1 month.
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PMID:Chronic pancreatitis with biliary obstruction. 156 30

Ultrasonic Doppler measurement of the blood flow in the portal vein and hepatic artery was conducted to evaluate the function and functional reserve of the liver in 146 patients with various forms of cholangitis combined with biliary cirrhosis and hepatic insufficiency. The functional reserve of the liver was judged by comparison of the basic blood flow on a fasting stomach with the blood flow after a functional histamine load. Five types of responses of the portal vein blood flow to the functional load according to the degree of disturbed hepatic function were revealed. Comparison of the flow of blood along the portal vein in healthy individuals with that in patients with diabetes mellitus and a formed splenorenal shunt showed that disconnection of the blood flow from the splenic vein has no effect on the flow of blood in the portal vein. The latter is regulated at the level of microcirculation in the liver, which is confirmed by the correlation between the blood flow in the portal vein and in the hepatic artery.
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PMID:[Doppler ultrasonic evaluation of hepatic functional reserve]. 157 35

The relationship of stature with the prevalence of 18 chronic diseases or groups of diseases was analysed using data from the 1983 Italian National Health Survey, based on a sample of 63,859 individuals aged 20 or over randomly selected within strata of geographical area, size of the place of residence and of the household in order to be representative of the Italian population. Rate ratios (RR) were computed using multiple logistic regression, including terms for sex, age, geographical area, education and smoking. For 15 out of 18 diseases or groups of diseases the RR was below unity in the highest quartiles of height, and the inverse trends with stature were significant for 11 (diabetes, RR 0.90 for highest vs lowest quartile; heart disease, RR 0.92; chronic bronchitis and emphysema, RR 0.84; bronchial asthma, RR 0.70; anaemias, RR 0.70; liver cirrhosis, RR 0.62; urolithiasis, RR 0.76; renal insufficiency, RR 0.71; arthritis, RR 0.89; psychiatric and neurological disorders, RR 0.82). None of the diseases considered showed significant direct trends with height, but hypertension (RR 1.09 for the highest vs lowest quartile), haemorrhoids or varices (RR 1.09) and cancers (RR 1.22) tended to be elevated in the highest quartile of height. The generalised inverse relationship between height and prevalence of chronic disease suggests that poorer nutrition in childhood and adolescence is an unfavourable indicator for the subsequent occurrence of several diseases. Major exceptions were hypertension and varices, two conditions highly dependent on the pattern of health care utilization, and cancer.
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PMID:Height and the prevalence of chronic disease. 160 29

Between 1981 and 1989, 3 of 134 patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) developed clinically significant hepatic dysfunction and showed histologic evidence of severe liver disease (fibrosis and cirrhosis). Factors identified in these patients that may have been linked to liver toxicity included diabetes, congestive heart failure and Felty's syndrome. In the patient group that received a post-MTX liver biopsy, pulmonary fibrosis and obesity were significantly associated with hepatic fibrosis/cirrhosis. Severe liver disease may occur in patients with RA treated with low dose MTX (less than 3%). Early liver biopsy is recommended in selected cases.
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PMID:Clinical liver disease in patients with rheumatoid arthritis taking methotrexate. 162 19

A 58-year-old man, with primary hemochromatosis, cirrhosis, and diabetes mellitus treated with insulin developed hepatoma. As the tumor grew, he lost his dependence on insulin therapy and experienced episodes of hypoglycemia. His response to infuse insulin was studied using the euglycemic clamp technique. Insulin was infused at rates of 1 and 10 mu/kg/min. The insulin dose response curve was shifted to the left and at plasma insulin levels of 72 microU/ml, steady-state glucose consumption was 9.6 mg/kg/min, 50% more than in normals, and nearly three times greater than that in other cirrhotics. The insulin clearance rate was 4417 m1/m2/min, almost five and six times more than in normals and cirrhotics, respectively. Basal hepatic glucose production was 3.6 mg/kg/min, two and three times higher than in normal and in cirrhotic subjects, respectively. The decrease in amino acid during hyperinsulinemia was more than 30% higher than in normal and other cirrhotics. IFG-I and II levels were not elevated in this patient. Increased insulin sensitivity and increased insulin clearance and serum amino acid decrease in response to insulin in vivo, suggest that insulin responsive tissues are at last partially responsible for tumor hypoglycemia. The increased glucose disposal rate probably accounted for the disappearance of the diabetes.
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PMID:Case report: increased insulin sensitivity in tumor hypoglycemia in a diabetic patient: glucose metabolism in tumor hypoglycemia. 165 53

Localized 1H NMR spectra of human brain in vivo are affected by signal overlap, strong spin-spin coupling, and complex J modulation, and therefore differ considerably from those obtained at higher magnetic fields. This paper deals with the assignment of 1H NMR resonances of cerebral metabolites under the experimental conditions used for human investigations. Conventional 7.0-T FID spectra and 2.0 T localized, short echo time STEAM spectra (TE = 20 ms) of aqueous metabolite solutions are compared to in vivo brain spectra of human volunteers and patients. In addition to singlet resonances from N-acetyl aspartate (NAA), creatines, and cholines, short echo time STEAM spectra exhibit multiplets due to the NAA aspartyl group, glutamate, taurine, and myo-inositol. Enhanced levels of cerebral glutamine are detected in patients with liver cirrhosis. For the first time elevated levels of brain glucose are observed in patients with diabetes mellitus.
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PMID:On the identification of cerebral metabolites in localized 1H NMR spectra of human brain in vivo. 167 88

We investigated by enzyme electrophoresis after prolonged neuraminidase treatment the activity of "intestinal variant" (alpha 2-globulin mobility) alkaline phosphatase (EC 3.1.3.1; ALP) in the plasma of 189 patients selected for disorders (diabetes mellitus, liver cirrhosis, and chronic renal failure) with a known high frequency of increased plasma intestinal (beta-globulin mobility) ALP activity. The overall frequency of the variant ALP was 23.8%, whereas in the samples showing intestinal ALP it was 45.0%. The variant ALP was not observed in the absence of intestinal ALP, nor in patients of blood group A. Its frequency did not differ significantly between the different patient groups. Quantification of the variant ALP by densitometry was unsatisfactory but the quantity could be estimated by subtracting the intestinal ALP activity measured by electrophoresis from the activity determined by immunoassay with monoclonal antibody that reacts with both the intestinal and the variant forms. This indicated median activity of 12 U/L for the variant, approximately equal to that of the concomitant intestinal ALP. From the effects of papain and bromelain treatments, we suggest that "intestinal variant" represents intestinal ALP with attached membrane-binding domain.
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PMID:Intestinal variant alkaline phosphatase in plasma in disease. 170 Jul 41

Our aim was to analyze the predictive value of a variety of preoperative risk factors on operative outcomes. We reviewed all colorectal resections performed in a single hospital between January 1985 and May 1990. Nine hundred seventy-two resections were performed on 825 patients. We studied 17 preoperative risk factors generated from various medical risk categories. Using the multivariate discriminant function analysis, we calculated that 11 of the 17 risks were of significance in predicting outcomes (all with P less than or equal to 0.031). These factors included emergent operation, age greater than or equal to 75 years, congestive heart failure (CHF), prior abdominal or pelvic radiation therapy, corticosteroid use, albumin less than 2.7 g/dl, chronic obstructive pulmonary disease (COPD), previous myocardial infarction (MI), diabetes, cirrhosis, and renal insufficiency. The classification function generated by the discriminant analysis was used to categorize patients into one of four risk groups depending on their "risk score." The index used to develop each patient's "risk score" ranged from six points for an emergency operation to one point for diabetes. The mortality rates for the various risk groups were as follows: Group 1, zero to four points, 1 percent; Group 2, five to eight points, 10 percent; Group 3, 9 to 13 points, 19 percent; Group 4, greater than 13 points, 33 percent. In contrast to previous reports, we showed that age greater than or equal to 75 years alone is not a major preoperative risk factor but, rather, acts as a modifier for the other predictors of postoperative complications. We then assessed clinical questions concerning specific preoperative risks, such as steroid use, obesity, inflammatory bowel disease, COPD, and prior laparotomy, and their associated specific postoperative complications and have developed prevention strategies based on these findings. Through the use of the risk index, we also were able to assess an individual patient's operative risk more accurately.
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PMID:Multifactorial index of preoperative risk factors in colon resections. 173 12

This report provides our initial experience in islet isolation and intrahepatic allotransplantation in 21 patients. In group 1, 10 patients underwent combined liver-islet allotransplantation following upper-abdominal exenteration for cancer. In group 2, 4 patients received a combined liver-islet allograft for cirrhosis and diabetes. One patients had plasma C-peptide greater than 3 pM and was therefore excluded from analysis. In group 3, 7 patients received 8 combined cadaveric kidney-islet grafts (one retransplant) for end-stage renal disease secondary to type 1 diabetes mellitus. The islets were separated by a modification of the automated method for human islet isolation and the preparation were infused into the portal vein. Immunosuppression was with FK506 (group 1) plus steroids (groups 2 and 3). Six patients in group 1 did not require insulin treatment for 5 to greater than 16 months. In groups 2 and 3 none of the patients became insulin-independent, although decreased insulin requirement and stabilization of diabetes were observed. Our results indicate that rejection is still a major factor limiting the clinical application of islet transplantation in patients with type 1 diabetes mellitus, although other factors such as steroid treatment may contribute to deteriorate islet engraftment and/or function.
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PMID:Human islet isolation and allotransplantation in 22 consecutive cases. 173 36


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