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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical features, surgical management, and long term follow up of 32 patients from Iran with idiopathic portal hypertension are reported. Many features of the disease are similar to those reported from India and Japan. The unsuspected finding was a 46% history of marked pica of clay (geophagia) in a subset of 26 patients. In addition, 81% of our patients had a prolonged prothrombin time, despite otherwise normal to minimally abnormal liver function tests. Liver biopsies revealed intrahepatic periportal fibrosis with subintimal thickening of terminal branches, and in many specimens a striking peri-ductular fibrosis was seen in the adjacent bile ducts. The spleen was very large with a dilated artery (external diameter: 11 mm to 15 mm). Portal venous pressure (PVP) was measured intra-operatively before and after clamping the splenic artery (SA). Clamping the SA consistently caused a decreased in PVP which ranged from 2.0 to 18.2 cm water with the mean +/- SEM of 9.7 +/- 1.5 cm water (p < 0.001, paired t-test). It was equivalent to 32.3 +/- 3.6% decrease in PVP. Fifteen selected patients (Group I) were managed with splenectomy with excellent short and long term results. The selection criteria for splenectomy included a decrease in PVP to < 24 cm of water after clamping the SA. Three patients from this group were re-examined 10 to 12 years following splenectomy. Cirrhosis had not developed, but the minimal abnormalities in the liver function tests had persisted.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:"Endemic" idiopathic portal hypertension: report on 32 patients with non-cirrhotic portal fibrosis. 129 Feb 52

The susceptibility of the gastric mucosa to injury by topical sodium taurocholate (40 mmol/l) in hydrochloric acid (150 mmol/l) was studied in prehepatic and cirrhotic rat models of portal hypertension. Portal venous pressure was increased in rats who had undergone partial portal vein ligation compared with rats that had undergone sham operation on days 3, 7, and 28 after operation (20.6 (0.9), 14.8 (0.8), and 11.3 (0.5) mm Hg v 7.3 (0.7), 7.3 (0.6), and 8.2 (0.2) mmHg respectively (mean (SEM)). At day 3 gastric mucosal injuries were increased in rats with partial portal vein ligation compared with sham operated rats (55.3 (9.4) vs 22.3 (10.5) mm2, p = 0.006), but at the later time intervals there was no significant difference in injuries between the two groups. In rats with carbon tetrachloride induced hepatic cirrhosis, portal pressure was increased (15.6 (1.0) v 6.7 (0.6) mmHg), but again there was no significant difference in mucosal injuries relative to control animals. We conclude that gastric mucosal defence mechanisms are impaired in acute but not chronic experimental portal hypertension.
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PMID:Taurocholate induced gastric mucosal injuries in experimental portal hypertension. 154 11

To determine the systemic haemodynamic and organ blood flow responses to the administration of sevoflurane during spontaneous ventilation, heart rate, cardiac index, mean arterial pressure, arterial blood gases, and blood flows to the brain, spinal cord, heart, kidneys and splanchnic organs were measured awake (control values) and after 30 min of anaesthesia with 0.5, 1.0, 1.2 or 1.5 MAC sevoflurane in rats. Cardiac output and organ blood flows were measured using radiolabelled microspheres. The MAC (mean +/- SEM) of sevoflurane was found to be 2.30 +/- 0.05%. At each concentration, haemodynamic variables were similar to awake values with the exception of a 12% reduction in mean arterial pressure at 1.5 MAC (P less than 0.01). Arterial PCO2 increased in a dose-related fashion. Cerebral and spinal cord blood flows increased at 1.2 and 1.5 MAC whereas coronary and renal blood flows did not change significantly. Portal tributary blood flow and preportal vascular resistance were unaffected. Hepatic arterial flow increased by 63% at 1.5 MAC (P less than 0.05) but total liver blood flow remained unchanged compared with awake values. In conclusion, the administration of sevoflurane during spontaneous ventilation produces a high degree of cardiovascular stability and maintains blood flow to major organs in the rat.
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PMID:Haemodynamic and organ blood flow responses to sevoflurane during spontaneous ventilation in the rat: a dose-response study. 155 Nov 49

These studies characterized the secretion of GH-releasing factor (GRF) and somatostatin (SRIF) into the hypophysial portal circulation in ewes after long term restricted feeding. In addition, we examined the temporal relationship between the concentrations of these two hypothalamic peptides in portal blood and the concentration of GH in jugular blood. Six sheep were fed 1000 g hay/day (normal feeding) and 6 sheep were fed 400-600 g hay/day (restricted feeding). This resulted in a wt loss of 35% in restricted animals compared with 6% in control animals after 20 weeks. Fluctuations in portal levels of GRF indicated a pulsatile pattern of secretion with approximately 60% of pulses coincident with, or immediately preceding, a GH pulse. Similarly, 65% of GH pulses were associated with GRF pulses. Restricted feeding increased (P less than 0.01) mean ( +/- SEM) plasma GH levels (9.8 +/- 1.4 vs. 2.9 +/- 0.6 ng/ml) and mean GH pulse amplitude (7.9 +/- 1.8 vs. 2.8 +/- 0.3 ng/ml) but did not affect mean GH pulse frequency (6.0 +/- 1.1 vs. 5.7 +/- 1.1 pulses/8 h). The level of feeding had no effect on mean portal concentration of GRF (restricted: 5.5 +/- 0.8, normal: 6.6 +/- 1.4 pg/ml), GRF pulse amplitude (14.7 +/- 2.3 vs. 13.5 +/- 0.7 pg/ml), or GRF pulse frequency (5.3 +/- 1.1 vs. 6.7 +/- 0.9 pulses/8 h). Portal concentrations of SRIF in sheep on a restricted diet were half (P less than 0.01) those of sheep fed a normal diet (10.2 +/- 2.3 vs. 19.6 +/- 1.6 pg/ml). Pulses of SRIF were not significantly associated with changes in GH or GRF concentrations. These data indicate a functional role for hypothalamic GRF in initiating GH pulses. Furthermore, the increase in GH secretion in underfed sheep was most probably due to a decrease in the release of SRIF into hypophysial portal blood. Restricted feeding had no affect on GRF secretion, but because of the reduced exposure of the pituitary gland to SRIF, it is possible that responsiveness to GRF is enhanced.
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PMID:Effect of restricted feeding on the relationship between hypophysial portal concentrations of growth hormone (GH)-releasing factor and somatostatin, and jugular concentrations of GH in ovariectomized ewes. 167 Dec 14

The biological effects of a hormone are dependent on the concentration delivered to the target tissue. This is generally best reflected in the arterial concentration. However, the liver is unique in that it receives substantial additional blood flow from the portal venous system. This may be important in the case of the catecholamines, where extraction or spillover from the splanchnic circulation may occur. In this study we examined portal venous catecholamine concentrations in anesthetized, laparotomized rabbits. We compared the values with simultaneously sampled arterial levels to evaluate the effects of the splanchnic tissues upon a wide range of catecholamine concentrations delivered to the liver during a state of stress. Spillover of norepinephrine and extraction of epinephrine were observed in all rabbits. Mean (+/- SEM) arterial norepinephrine concentrations were elevated, 716 +/- 167 pg/ml (n = 11); mean portal concentrations were 178 +/- 37% higher (p less than 0.01), at 1,425 +/- 301 pg/ml, representing net spillover from splanchnic tissues. In addition, significant extraction of epinephrine was observed; arterial concentrations were 2,144 +/- 580 pg/ml (n = 11). Portal levels were 1,205 +/- 382 pg/ml, 38 +/- 7.45% lower than corresponding arterial concentrations (p less than 0.02). Furthermore, there was a concentration-dependent effect upon norepinephrine spillover; the highest arterial norepinephrine concentrations were associated with the lowest splanchnic spillover. This resulted in a negative correlation between the arterial norepinephrine levels and the percent increase from spillover into the portal vein (r = -0.81, p less than 0.003). We conclude that portal venous catecholamine concentrations are significantly different from arterial levels in anesthetized, laparotomized rabbits over a wide range of concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Catecholamine concentrations in the hepatic portal system: effect of surgical stress upon portal levels. 180 84

To evaluate the feasibility of temporary portal vein arterialization (PVA) in orthotopic partial liver transplantation (PLT), we performed 5 canine PLTs with PVA assessing the changes in arterial ketone body ratio (AKBR) as an index of hepatic energy status, and measuring portal pressure and flow. After anastomosis of hepatic vein, the graft liver was revascularized with arterial blood shunted from the external iliac artery to the hepatic side of the portal vein. By using this technique, both anhepatic period of the recipient and ischemic time, especially warm ischemic time, of the allograft were markedly shortened (31.0 +/- 4.5 min: Mean +/- SEM). Four out of 5 recipients survived for at least 5 days (13 days in average). The AKBR was restored immediately after PVA and showed almost the same values as those at preclamping and after completion of anastomoses of both portal vein and hepatic artery. No significant difference in portal venous pressure was observed between during PVA and after vascular reconstruction. Portal blood flow during PVA was about one fourth of the total hepatic blood flow at preclamping. These results suggest that PVA can be used as an alternative procedure in PLT.
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PMID:The experimental study on the temporary portal vein arterialization in the canine liver transplantation: preliminary report. 213 88

The effects of fluoxetine, a relatively selective long-acting serotonin uptake inhibitor, on the consumption of alcoholic and nonalcoholic drinks, cigarette smoking, and body weight were assessed in 29 men who were early stage problem drinkers. After a 2-week baseline, subjects were randomly assigned to receive 40 mg/day fluoxetine (n = 8), 60 mg/day fluoxetine (n = 11), or placebo (n = 10) for 4 weeks. Fluoxetine 60 mg/day decreased mean daily alcoholic drinks from (X +/- SEM) 8.3 +/- 0.7 during baseline to 6.9 +/- 0.7 and decreased total drinks per 14 days from 115.8 +/- 9.3 to 96.5 +/- 9.5 (p less than 0.01; 17.3% decrease from baseline), with no significant increase in days of abstinence. Neither 40 mg/day fluoxetine nor placebo had effects on intake of alcohol. Fluoxetine 60 mg/day decreased total and mean daily alcoholic drinks compared with 40 mg/day fluoxetine (ANCOVA, both p less than 0.02), but neither dose of fluoxetine was different from placebo. Compared with placebo, both 40 mg/day fluoxetine and 60 mg/day fluoxetine no differences were detected between treatment groups, 60 mg/day fluoxetine increased mean daily nonalcoholic beverages from baseline (5.0 +/- 0.4 to 5.6 +/- 0.3, p less than 0.01) and increased daily cigarettes smoked (from 25.1 +/- 4.6 to 26.9 +/- 4.5, p less than 0.05), whereas no significant changes from baseline were observed with 40 mg/day fluoxetine or placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fluoxetine differentially alters alcohol intake and other consummatory behaviors in problem drinkers. 232 57

The ideal site to transplant pancreatic islets has yet to be determined. To evaluate this problem, we have compared the efficacy of pancreatic microfragments transplanted into the splenic, intrahepatic and renal subcapsular sites. Function was assessed by plasma glucose (PG) and intravenous glucose tolerance test (ivGTT). Portal pressures and coagulation profiles (PT, PTT, FDP, Platelet count) were measured following intrasplenic and intraportal transplants. Liver enzymes (LDH, Alk. Phos., SGOT), serum bilirubin, BUN and creatinine were assessed serially in all groups. Nine of 10 dogs that received islets refluxed into the spleen were normoglycemic (mean PG = 94.5 mg/dL) at 1 mo with one dog failing four days following implantation (PG = 350 mg/dL). Following intraportal embolization, two of six dogs remained normoglycemic (PG = 95.7 mg/dL) at 1 mo. One dog died due to mesenteric venous thrombosis, two died suddenly within 24 h of engraftment without obvious cause, and a fourth died six days following transplantation (PG = 678 mg/dL). None of the six renal subcapsular transplants induced normoglycemia (mean PG = 430 mg/dL) at 1 mo. Mean rise in portal pressure (cmH2O +/- SEM) during intrasplenic and intraportal transplantation of islets was 1.7 +/- 0.6 and 31.2 +/- 3.3 respectively (p less than 0.001). Following intrasplenic and intrahepatic engraftment, significant coagulation abnormalities did not occur. Elevation of liver enzymes occurred 24 h following implantation to all three recipient sites but returned to preoperative values by 1 mo. Bilirubin was not affected. Renal function tests were not significantly altered in any groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of sites for transplantation of canine pancreatic microfragments. 250 86

The kinetics of appearance of amino acids (AA) in portal blood following the ingestion of casein or rapeseed protein were compared. Six pigs, fitted with permanent catheters in the portal vein and in the carotid artery, as well as with an electromagnetic flow probe around the portal vein, received three 800 g test meals, one containing 12% rapeseed proteins (RA12) and the others containing 12% and 24% casein (CA12 and CA24), at 1-week intervals and according to a double Latin square design. Portal and arterial blood samples were collected and portal blood flow rate was recorded for 8 h after the test meals. At the end of measurement, an average of 76.1 +/- 5.6% (mean +/- SEM) of total AA from the CA24 diet had appeared in portal blood, compared with 94.3 +/- 10.4% for the CA12 diet and 103.5 +/- 12.6% for the RA12 diet. Similar results were obtained for essential AA. Differences were found in the kinetics of appearance of individual AA. Eight hours after the meal, 79% of lysine, 84% of methionine, and 73% of valine from the CA24 diet had appeared in portal blood compared, respectively, with 100, 89, and 83% from the CA12 diet and 99, 86, and 106% from the RA12 diet. Arginine from rapeseed had a net appearance level lower (82%) than the overall mixture of essential AA. With casein diets, the net appearance of arginine reached 97% (CA12) and 82% (CA24). Following the ingestion of rapeseed proteins, there seemed to be a significant appearance of endogenous AA in portal blood.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Net appearance of amino acids in portal blood during the digestion of casein or rapeseed proteins in the pig. 262 81

Glucagon and insulin metabolism was studied in 9 cirrhotic patients and 4 non-cirrhotic controls. Net output of glucagon and insulin into portal circulation was calculated from difference between portal venous and systemic arterial concentrations multiplied by portal plasma flow. Metabolic clearance rate was also calculated as the ratio of the output to systemic concentration. Portal blood flow was measured by the continuous local thermodilution method. The results were as follows: 1) Arterial glucagon concentration was elevated in liver cirrhotics compared with non-cirrhotic-controls. Glucagon output in cirrhotics was higher than in controls [46.3 +/- 11.8 vs. 13.2 +/- 2.5 ng/min (mean +/- SEM), p less than 0.05]. Metabolic clearance rate of glucagon was not significantly different between the two groups. 2) There was a significant correlation between glucagon output and portal venous concentration of norepinephrine (r = 0.625, p less than 0.05). 3) Insulin levels in systemic arterial blood were higher in cirrhotic patients than non-cirrhotic subjects. Insulin output was not significantly different between the two groups, however, metabolic clearance rate of insulin in cirrhotics was reduced in comparison with the controls (274.5 +/- 44.3 vs. 557.7 +/- 108.6 ml/min, p less than 0.05).
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PMID:[The implication of hyperglucagonemia and -insulinemia in liver cirrhotics]. 267 48


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