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)

As a calcium antagonist, nitrendipine will be used in the treatment of various diseases in patients with hepatic insufficiency, and it is important to know if they require modified dosing schedules. In this study, six patients with biopsy-confirmed cirrhosis and six age/sex-matched normal healthy subjects were given 10 mg nitrendipine as a single dose on day 1 and 10 mg nitrendipine every 12 h from day 3 through the first dose on day 8. Blood levels of nitrendipine were determined to confirm the attainment of steady state and evaluate the pharmacokinetics in each group. Nitrendipine concentrations were consistently higher in the hepatic group. On day 1, the maximum concentration (Cmax) in the normals was 4.67 +/- 2.60 ng/ml and in the hepatic patients 16.87 +/- 9.42 ng/ml. On day 8, these values were 8.60 +/- 8.82 ng/ml and 27.37 +/- 8.56 ng/ml, respectively. The time to Cmax was not significantly different in the two groups. The elimination half-life was only slightly prolonged from 15.29 +/- 7.25 h in the normals to 19.57 +/- 4.28 h in the hepatic impairment group. This resulted in a marked increase in the area under the concentration-time curve from 28.71 +/- 28.92 ng . h/ml for the normals to 119.56 +/- 34.39 ng . h/ml for the hepatic patients on day 1 and similar results on day 8. Trough levels at steady state were expectedly higher in the hepatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Pharmacol 1984
PMID:Steady-state pharmacokinetics of nitrendipine in hepatic insufficiency. 608 88

The available evidence suggests that angiotensin plays an important role in sodium homeostasis not only via aldosterone release but also through control of the renal circulation, and thereby renal sodium handling. Perhaps this intrarenal action is the renin-angiotensin system's original, primitive function. Through its vascular action, angiotensin has an important influence on glomerular filtration and tubular reabsorption. Angiotensin almost certainly also has an additional intraglomerular action. More circumstantial, but compelling, evidence suggests that angiotensin contributes to the renal response in a host of conditions characterized by renal vasoconstriction, a reduction in filtration rate, and sodium retention, including heart failure, cirrhosis of the liver, complications of pregnancy, the renal response to trauma and shock, and in selected patients with essential and secondary hypertension. Pharmacologic interruption of the renin-angiotensin system is proving useful not only for blood pressure control in patients with hypertension but also because of its influence on the kidney in some or all of these conditions--at least in part attributable to restoration of more normal renal sodium handling.
J Cardiovasc Pharmacol 1984
PMID:The renin-angiotensin system and sodium homeostasis. 620 38

A 49-year-old woman with cirrhosis and portal hypertension was evaluated for a portal-systemic shunt procedure following recurrent variceal hemorrhage. The preoperative visceral angiogram demonstrated a hepatic arterial to portal venous fistula, presumably a complication of a previous liver biopsy. The fistula was successfully closed using isobutyl-2-cyanoacrylate (Bucrylate) delivered through a flow-directed, calibrated-leak balloon microcatheter.
Cardiovasc Intervent Radiol 1983
PMID:Occlusion of a hepatic artery to portal vein fistula with bucrylate. 662 61

A rare case of congenital obliteration of the suprahepatic portion of the inferior vena cava (IVC) associated with early liver cirrhosis is presented. The clinical signs of the condition and the standard methods of diagnosis are outlined. A survey of the available surgical management is given and a new alternative operation described. It consists of an indirect transatrial-transdiaphragmatic reconstruction of the IVC. For the first time, it has been used successfully for reconstruction of the interrupted vessel. Ten months following the operation, the patient shows no signs of portal hypertension or caval obstruction.
J Thorac Cardiovasc Surg 1982 Jul
PMID:Congenital obliteration of the suprahepatic inferior vena cava: case report. 708 27

Patients with cystic fibrosis who have end-stage respiratory failure and associated liver cirrhosis have been considered poor candidates for lung transplantation because of high morbidity and mortality resulting from hepatic insufficiency after the operation. Since April 1989, our policy has been to combine heart-lung or lung and liver transplantation in this group of patients. Between June 1990 and March 1995, among 25 patients accepted in the program for combined transplantation, nine died awaiting transplantation and 10 underwent one of the following procedures: heart-lung-liver transplantation (n = 5), en bloc double lung-liver transplantation (n = 1), sequential double lung-liver transplantation (n = 3), and bilateral lobar lung transplantation from a split left lung and reduced liver transplantation (n = 1). There were 5 male and 5 female patients. The ages of the recipients ranged from 10 to 24 years. Mean forced expiratory volume in 1 second was 29% and mean forced vital capacity was 35% of predicted values. All patients were infected with resistant Pseudomonas, three with Pseudomonas cepaceia, and two patients had Aspergillus species in addition. All patients had severe cirrhosis with portal hypertension. Four patients had a history of esophageal variceal bleeding and two had had previous portosystemic shunts. The operation was performed as a two-stage procedure, the intrathoracic operation being completed before the abdominal stage was begun. Cardiopulmonary bypass was used in all patients because of poor clinical condition. Immunosuppression consisted of azathioprine, cyclosporine, and prednisone, as for isolated lung transplantation. There were two perioperative deaths, one caused by primary liver failure and the second by early lung dysfunction. For the first 3 months after transplantation pulmonary infection was the most common cause of morbidity. Other complications included tracheal stenosis (n = 1), bronchial stenosis (n = 1), biliary stricture (n = 2), and severe ascites (n = 3). All were successfully treated. Obliterative bronchiolitis developed in three patients. This was stabilized with FK 506 in two patients; the other patient underwent retransplantation at 38 months but eventually died of bleeding. Actuarial survival was 70% at 1 year and remained unchanged at 3 years. Significant functional improvement was observed in all survivors. For patients who have chronic respiratory failure with advanced cirrhosis, lung transplantation combined with liver transplantation can be performed with a satisfactory outcome.
J Thorac Cardiovasc Surg 1995 Nov
PMID:Combined lung and liver transplantation in patients with cystic fibrosis. A 4 1/2-year experience. 747 93

Torasemide is a new loop diuretic that differs from others in this class in that only 20% of the drug is excreted unchanged in the urine with the remaining 80% being eliminated by hepatic metabolism. The large component of nonrenal clearance would predict that torasemide would have only minimal accumulation and prolongation of half-life in patients with renal insufficiency, and this proves to be the case. In contrast, in patients with liver disease, impairment of hepatic elimination causes accumulation of torasemide in plasma with prolongation of half-life. In addition, in cirrhosis, there is increased elimination of unchanged drug into the urine compared to healthy controls. In patients with renal insufficiency, response to remaining nephrons is normal as has been observed with other loop diuretics. In patients with cirrhosis and in those with congestive heart failure, response is diminished, again as has been observed with other loop diuretics. Interestingly, in patients with cirrhosis, the increased delivery of drug into the urine is sufficient to compensate for the decreased pharmacodynamics of response so that overall response is similar to that which occurs in health subjects.
J Cardiovasc Pharmacol 1993
PMID:Pharmacokinetics and pharmacodynamics of torasemide in health and disease. 750 34

A 49-year-old male with Budd-Chiari syndrome complicated by liver cirrhosis and intractable ascites is reported. The left hepatic vein was stenosed by a short subocclusive ostial web; the right and medial hepatic veins were thrombosed. A spontaneous intrahepatic portosystemic shunt had developed between the left portal and left hepatic veins. After ineffective balloon angioplasty, the left hepatic venous outflow was restored by placement of a 10-mm-diameter Wallstent across the web via a femoral approach. The hepatic venous pressure dropped from 29 to 12 mmHg. Rapid clinical improvement followed. The patient underwent liver transplantation 3 months later in stable condition.
Cardiovasc Intervent Radiol
PMID:Treatment of Budd-Chiari syndrome by metallic stent as a bridge to liver transplantation. 764 99

Penetrating the hepatic artery during transjugular intrahepatic portosystemic shunt (TIPS) is a relatively frequent but almost always benign complication. We report a patient in whom the right hepatic artery, originating from the superior mesenteric artery, was inadvertently catheterized and stented. The arteriovenous fistula was treated with a detachable balloon positioned within the hepatic artery. A second TIPS was attempted and successfully created during the same session. The patient died of cardiac failure, attributed to rapid resolution of massive ascites after TIPS with circulatory overload. At autopsy, the liver distal to the arterial occlusion balloon was infarcted, illustrating the importance of hepatic artery perfusion on liver cirrhosis.
Cardiovasc Intervent Radiol
PMID:Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion. 764 98

To improve safety and efficacy of the transjugular intrahepatic portosystemic shunt (TIPS) procedure, we introduced a new, thin-needle (21-gauge long PTC needle) puncture technique using biplane fluoroscopy and targeting of a guidewire tip in the right hepatic artery. After puncture of the right portal vein, a 0.016-inch guidewire was inserted into the portal vein, followed by a 4 Fr dilator. The 4 Fr dilator allowed introduction of a 0.035-inch working guidewire. We successfully performed TIPS in seven patients with postnecrotic cirrhosis using this technique and encountered no technical difficulties or complications.
Cardiovasc Intervent Radiol
PMID:A new coaxial needle system, hepatic artery targeting wire, and biplane fluoroscopy to increase safety and efficacy of TIPS. 788 4

Nilvadipine is a new calcium antagonist of the the dihydropyridine group. Owing to its high receptor affinity, nilvadipine blocks L-type calcium channels in vascular muscle cells. This leads to prolonged vascular relaxation and lowering of blood pressure. In comparison with nifedipine, the prototype of the dihydropyridines, nilvadipine possesses special pharmacokinetic and pharmacodynamic properties. The duration of action is longer, and the vasodilatory effect is 5-16 times greater. Compared with nifedipine, the cardiodepressive action and the adrenergic counterregulation are less intense for nilvadipine. Nilvadipine's higher vasoselectivity is expressed in a vascular/cardiac efficacy quotient of 251, is 9-10 times higher than that of nifedipine. In therapeutic dosages nilvadipine has no negative inotropic, chronotropic, or dromotropic effects. In various in vitro and animal experiments, nilvadipine demonstrated a good antiatherogenic action. Nilvadipine is absorbed quickly and completely. Owing to a marked first-pass effect, the absolute bioavailability is 14-19%. The final elimination half-life is between 15 and 20 h, probably due to slow redistribution from the tissue. Nilvadipine is mainly excreted via the kidneys in the form of inactive metabolites. The pharmaceutical preparation as a depot form prevents an over-increase of the plasma level, and therefore reduces the typical side effects of dihydropyridine calcium antagonists. The pharmacokinetics of nilvadipine are not affected by reduced renal function. The bioavailability is increased in liver cirrhosis, but with repeated administration no cumulative effect takes place. Because of nilvadipine's long half-life, a once-daily administration is adequate to reduce blood pressure over 24 h in the treatment of arterial hypertension. At a daily dosage of 8-16 mg, the responder rate (RRdiast < 90 mm Hg) is 60-70% in single-drug therapy and up to 80% in combination therapy. Nilvadipine can be used to treat hypertensive patients who are also suffering from diabetes mellitus, lipometabolic disturbances, chronic obstructive respiratory tract disease, or cerebral circulatory disturbances. Owing to its high vascular selectivity, antiatherogenic properties, 24-h action, and good tolerance, nilvadipine fulfills the requirements for a modern antihypertensive agent.
J Cardiovasc Pharmacol 1994
PMID:Nilvadipine: profile of a new calcium antagonist. An overview. 789 1


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