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)

Sensitive radioimmunoassay for determination of immunoreactive atrial natriuretic peptide (ANP) in human plasma was developed and employed for the study of plasma ANP concentrations in healthy controls under basal conditions (2.4 +/- 0.1 pmol/l) and during volume expansion by saline infusion (9.6 +/- 2.0 pmol/l and 14.2 +/- 1.8 pmol/l, respectively). Plasma renin activity and plasma aldosterone concentration exhibited opposite changes during saline infusion. In pathological states associated with extracellular fluid volume (ECFV) expansion, ANP concentration were significantly higher than in the controls (liver cirrhosis 8.6 +/- 0.9; congestive heart failure 33.1 +/- 4.8; chronic renal failure before haemodialysis 72.2 +/- 6.4 pmol/l). Further volume expansion in liver cirrhosis by saline infusion led to the further increase in ANP (13.3 +/- 1.3 and 16.1 +/- 1.5 pmol/l, respectively) and ECFV reduction by ultrafiltration during haemodialysis in chronic renal failure diminished but did not normalize plasma ANP (22.5 +/- 2.9 pmol/l). In patients with arterial hypertension the concentration of ANP exceeded the normal range by 62.5% and reached 8.0 +/- 0.5 pmol/l on the average. Our results support the suggestion that ANP is an important regulatory humoral mechanism participating in the regulation of sodium, volume and blood pressure homeostasis.
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PMID:Radioimmunoassay of atrial natriuretic peptide in human plasma: application to studies of volume and blood pressure homeostasis. 297 15

In this prospective study of 240 black patients with liver enlargement admitted to the medical wards of King Edward VIII Hospital, Durban, a cause for the hepatomegaly was found in 92.5% of cases (63.8% without recourse to biopsy, 28.7% after liver biopsy). The commonest cause was congestive heart failure (36.7%), followed by amoebic liver abscess (7.1%), hepatocellular carcinoma (5.8%) and cirrhosis (5.4%). Liver biopsy provided the diagnosis in 90.8% of patients with initial unexplained hepatomegaly. The diagnostic yield of liver biopsy was increased by submitting 3 biopsy specimens for histological examination. The 3 specimens are obtained using a single intercostal entry site and redirecting the biopsy needle, without increasing the risk of complications. Hepatic tuberculosis was present in 9.2% of patients who underwent biopsy. There were no consistent clinical findings in these patients. Therefore, in communities in which tuberculosis is endemic, all patients with unexplained hepatomegaly require liver biopsy since it provides the only means of making this diagnosis.
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PMID:Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients. 300 36

Because hyponatremia is frequently associated with preceding diuretic treatment and unrestricted fluid intake--conditions which have not been addressed sufficiently in published literature--we studied the pathophysiology and the clinical setting of such hyponatremia in a large group of internal medicine patients. We observed: a) Of an initial 310 patients with chemical hyponatremia only 204 (64%) had an associated plasma hypoosmolality. Since a normal plasma osmolality excludes a disturbance of water metabolism only the 204 patients with hypoosmolar hyponatremia were included in the study. This data shows that plasma osmolality is an essential measurement in any evaluation of hyponatremia. b) In 204 consecutive patients with hypoosmolar hyponatremia the electrolyte disturbance was related to advanced congestive cardiac failure in 25%, decompensated liver cirrhosis in 18%, volume contraction in 28%, syndrome of inappropriate antidiuretic hormone secretion in 19% and renal insufficiency in 4%. c) Plasma vasopressin was measurable in 90% of the 204 patients. It is known that radioimmunoassays to measure vasopressin fail to reliably detect low concentrations of circulating vasopressin (less than 0.5 pg/ml). It may therefore be stated that hypoosmolar hyponatremia was generally characterized by a failure of antidiuretic hormone suppression. d) Mean daily fluid intake of hyponatremic patients was 2.35 +/- 0.15 l. In the presence of stimulated vasopressin this large a fluid intake is bound to worsen the severity of hyponatremia. e) Of 204 patients 126 were treated with diuretics at the time of study. In these patients hyponatremia worsened during such treatments and was associated with evidence of prerenal azotemia. However there were no significant differences between diuretic-treated and -untreated patients with respect to plasma vasopressin stimulation and amount of fluid intake.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Role of diuretics, hormonal derangements, and clinical setting of hyponatremia in medical patients. 305 Feb 65

The success or failure of antiarrhythmic drug treatment depends, in part, on the selection of the initial dosage. Too low a dosage can lead to unnecessary (and frequently life-endangering) delays in achievement of arrhythmia suppression. Conversely, an excessively high dosage can lead to intolerable toxicity and cessation of treatment. The recommended approach to therapy is to begin with a relatively low dosage, i.e., the lowest dosage with a reasonable chance of producing a favorable response, and titrating the dose upward as needed. Dose titration should be guided by clinical response and, when appropriate, concentrations of the drug and any active metabolites in the plasma. In situations frequently encountered in practice, however, the initial dosage must be modified because of interindividual differences in drug disposition. These changes in drug pharmacokinetics can arise from a variety of factors, including disease processes (e.g., congestive heart failure, cirrhosis and renal failure), concomitant medications (e.g., hepatic enzyme inducers such as phenytoin and inhibitors such as amiodarone), drug formulation, protein binding and inherited drug metabolism capacity. Knowledge of these factors can help the clinician to avoid potential pitfalls in initial dosage selection and can enhance the changes of successful drug treatment of arrhythmias.
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PMID:Initial dosage selection of antiarrhythmic therapy. 305 5

The renin-angiotensin-aldosterone system plays an important role in the development and maintenance of high blood pressure in several forms of hypertension. In hypertensive patients with primary aldosteronism, antimineralocorticoids are, as expected, very effective in reducing blood pressure and correcting metabolic disturbances. In patients with essential hypertension, an abnormal relationship between angiotensin II and aldosterone can occur. Aldosterone secretion in these patients is often too high relative to circulating levels of angiotensin II. Antimineralocorticoids effectively lower blood pressure in a large number of these patients. The reactive hyperreninemia caused by salt depletion is a factor limiting the antihypertensive effect of natriuretic agents including that of antimineralocorticoids. The enhanced aldosterone secretion resulting from treatment with a diuretic other than an antimineralocorticoid may diminish the natriuretic action of that diuretic. Therefore, antimineralocorticoids given in addition to a diuretic enhance natriuresis. The renin-angiotensin-aldosterone system is also involved as a compensatory mechanism in cardiovascular and body fluid homeostasis of patients with severe congestive heart failure or liver cirrhosis with ascites. Antimineralocorticoids are very effective in such conditions. In patients with congestive heart failure treated with digitalis, these natriuretic agents are particularly useful because of their potassium-sparing properties. The risk of developing hyperkalemia during antimineralocorticoid administration is negligible unless renal function is impaired. Antimineralocorticoids have the advantage of exerting no deleterious effect on carbohydrate and lipid metabolism. The use of these agents seems therefore rational in a variety of diseases concerned with blood pressure and body fluid volume regulation.
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PMID:Clinical applications of antimineralocorticoids. 305 64

The removal of pathogens from the circulation is achieved primarily by cells of the mononuclear phagocyte system, also known as the reticuloendothelial system. The tissue macrophage is the most important component of this system. The phagocytic activity of macrophages is regulated by opsonins on pathogenic materials and by endogenous cytokines. A number of diseases are caused by qualitative or quantitative disorders of phagocytosis by four major mechanisms: a decrease in the flow of blood to organs which contain macrophages (e.g. congestive heart failure and portal hypertension); a decrease in the quantity of tissue which contains macrophages (e.g. hepatic cirrhosis and splenectomy); a decrease in the effective opsonization of pathogens because of a deficiency of complement or IgG; and qualitative dysfunction of macrophages due to a deficiency of regulatory cytokines (e.g. gamma interferon and tuftsin) or a direct inhibitory effect on the macrophage (e.g. viral infections). New approaches for selective regulation of the phagocytic activity of macrophages are emerging.
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PMID:Regulation of macrophage phagocytosis. 308 38

The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest in the supine position or normal daily activity in the upright position for the next six hours. Two days later the procedure was repeated, the patients being assigned to the other posture. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine than in the upright position: mean 1133 v 626 ml/6 h (p less than 0.01). The natriuresis was similarly larger during recumbency: mean sodium 96 v 45 mmol(mEq)/6h (p less than 0.01), and the excreted potassium in six hours was similar in both postures. The glomerular filtration rate was 100 and 66 ml/min (p less than 0.01) and heart rate 76 and 83 beats/min (p less than 0.01) in the supine and upright positions respectively. Plasma concentrations of noradrenaline, renin, and aldosterone were all raised even when the patient adopted the supine position, and a further significant rise was observed during the upright position. The results suggest that the attenuated response to intravenous bumetanide in the upright position and during normal daily activity may be due to the activation of several homeostatic mechanisms that may reduce the excretion of water and salt.
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PMID:Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture. 308 44

The pathogenesis of hyponatremia remains debated; therefore, we determined the roles of plasma vasopressin, fluid intake and renal free water excretion in hyponatremic medical patients. We evaluated 100 consecutive hypo-osmolar hyponatremic patients (PNa = 127 +/- 0.7 mM l-1) in a prospective manner. We observed: hyponatremia was often found in association with advanced congestive cardiac failure (twenty-five of 100 patients), liver cirrhosis (16%) and primary volume contraction (29%). There was a 17% in-hospital mortality of hyponatremic patients. This was primarily related to the severity of underlying illnesses rather than to hyponatremia per se. The most consistently observed laboratory finding of hyponatremia was non-osmotic vasopressin stimulation; mean observed PADH was 4.7 +/- 0.7 pg ml-1 and vasopressin was detectable by radioimmunoassay (RIA) in 91% of all patients. In addition to vasopressin stimulation we also found evidence of advanced 'circulatory underfilling' in most hyponatremic patients. Mean urinary osmolality was hypertonic to plasma (441 +/- 17.4 m0sm kg H2O-1). This applied to patients with hyponatremic cardiac failure, liver cirrhosis and volume contraction. Almost all of these patients received high ceiling diuretics. (v) Spontaneous mean daily fluid intake was 2.4 +/- 0.2 l. In summary, our findings suggest that disturbances of vasopressin, fluid intake and renal free water excretion co-operate in the pathogenesis of hyponatremia. In clinical states of advanced circulatory underfilling the occurrence of hyponatremia indicates a poor prognosis of the patient.
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PMID:Pathogenesis of clinical hyponatremia: observations of vasopressin and fluid intake in 100 hyponatremic medical patients. 310 2

Tests were performed to study the transforming growth factor (TGF) activity in samples of pleural fluid and ascites in patients with solid tumors and non-neoplastic diseases such as congestive heart failure and liver cirrhosis. The measurement of the activity was carried out in terms of colony formation in soft agar with NRK cells as indicator cells. When the fluid samples were directly assayed, 24% (4/17) of the cancer cases and 1 of the 4 control cases were positive. The eluate of Bio-Gel P-60 gel filtration was positive in all cases. beta-Type as well as alpha-type TGF activity was found in pleural and peritoneal effusions not only from cancer patients, but also from patients with non-malignant diseases.
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PMID:Transforming growth factor activity in pleural and peritoneal effusions from cancer and non-cancer patients. 311 27

A comprehensive prospective ultrasonographic study was performed in 93 patients to investigate gallbladder wall thickness and gallbladder volumes in various nonbiliary disease states. Without changes in gallbladder volume, mean gallbladder wall thickness was significantly increased (p less than 0.01) in patients with liver cirrhosis, viral hepatitis, chronic congestive heart failure, hypoalbuminemia, and chronic renal failure (p less than 0.05) but not in patients with diabetes mellitus (n = 14) as compared to a control group. The present study confirms that a variety of nonbiliary disorders are associated with significant thickening of gallbladder walls and that this finding is not caused by incomplete gallbladder contraction.
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PMID:Gallbladder wall thickening: a frequent finding in various nonbiliary disorders--a prospective ultrasonographic study. 314 57


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