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Biomedical subjects

A Braillon

Publications and source records attributed to A Braillon.

At least 73 records · Page 4Linked to original sources
PubMed1986

Transcatheter embolization of liver capsule perforation during transvenous liver biopsy.

Fatal hemoperitoneum due to liver capsule perforation has been reported after transvenous liver biopsy. We report 2 cases of prophylactic embolization of such capsular gap. We propose the following techniques for embolization: detection of liver capsule puncture if the liver biopsy is difficult to perform because the liver is small or moves in ascites; and therapeutic embolization of detected capsular gap.

Biopsy↗
PubMed1986

Alteration in response of the portal tributary vascular bed to the beta-agonist dobutamine in rats with extrahepatic portal hypertension.

The acute effects of 2 doses of the beta-agonist dobutamine on systemic and splanchnic haemodynamics were studied in normal rats and in rats with portal hypertension due to portal vein stenosis. Cardiac output and splanchnic organ blood flow were estimated with the radioactive microsphere method and portal pressure was measured. Low dose (5 micrograms/kg) of dobutamine did not change significantly arterial pressure and portal pressure but, cardiac output was significantly higher after dobutamine than after placebo in both groups of rats. Similar results were observed with 15 micrograms/kg of dobutamine except for a significant decrease in arterial pressure in portal-hypertensive rats. In sham-operated rats, dobutamine significantly increased portal tributary blood flow; this rise was parallel to cardiac output. In contrast, in portal-hypertensive rats, portal tributary blood flow did not change significantly after dobutamine. Accordingly in the former group, portal tributary vascular resistance significantly decreased, whereas in the latter group, no change in this resistance was observed with a low dose and a significant decrease was noted with a high dose. In both groups of rats, hepatic arterial blood flow was not significantly different after dobutamine than after placebo. This study demonstrates that the vasodilatory response of the portal tributary vascular bed to an increase in cardiac output is altered in anaesthetized rats with portal hypertension due to portal vein stenosis.

Animals↗
PubMed1986

Haemodynamic rebound phenomena after abrupt cessation of propranolol therapy in portal hypertensive rats.

The haemodynamic effect of sudden termination of propranolol therapy was studied in sham-operated and portal hypertensive rats. All animals were injected with propranolol (20 mg/kg/day) or saline i.p. for 10 days, then had an isoproterenol infusion test performed 48 h or 72 h after cessation of injections. The dose of isoproterenol required to increase the heart rate by 50 beats/min (CD50), was significantly lower in both sham-operated and portal hypertensive rats at 48 h after propranolol withdrawal. Maximum chronotropic response (Rmax), was significantly higher only in portal hypertensive rats at 48 h after propranolol withdrawal. These results show the existence of a transient beta-adrenergic hypersensitivity state following propranolol withdrawal in normal and portal hypertensive rats.

Animals↗
PubMed1986

Portal hypertensive gastric mucosa: an endoscopic study.

The endoscopic features of the gastric mucosa in patients with cirrhosis have not been systematically investigated. In these patients, we observed an endoscopic aspect, consisting of multiple small erythematous areas, outlined by a subtle yellowish network (resembling a mosaic), mainly located in the proximal part of the stomach. We tested the value of this sign by comparing two groups: 100 patients with portal hypertension due to cirrhosis, and 300 control patients without signs of liver disease or portal hypertension. This endoscopic pattern was observed in 94 of the patients with cirrhosis, whereas oesophageal varices were seen in 78 only. In contrast, only one patient of the control group had this aspect. Moreover, this sign was also found in seven of eight patients with non cirrhotic portal hypertension, but was seen neither in 100 patients with chronic alcoholism but without liver disease, nor in 10 cirrhotic patients with end-to-side portacaval shunts. These endoscopic changes might be because of mucosal and/or submucosal oedema and congestion highlighting the normal areae gastricae pattern and related to raised portal pressure. We conclude that the mosaic pattern of the gastric mucosa is a sensible and specific sign for diagnosis of portal hypertension, whatever the cause.

Alcoholism↗
PubMed1986

Influence of the degree of liver failure on systemic and splanchnic haemodynamics and on response to propranolol in patients with cirrhosis.

Systemic and splanchnic haemodynamics were studied in patients with cirrhosis who had been classified in three groups (A, B, and C) according to the degree of liver failure (modified Pugh's classification). In patients of group A, cardiac index was significantly lower than that of group C and systemic vascular resistance was higher, but not significantly so, than that of patients with liver failure. Wedged hepatic venous pressure was significantly lower in the former group than in the latter. In patients in group B, corresponding values fell between those of groups A and C. Azygos blood flow averaged 0.477 +/- 0.242 l/min (mean +/- SD) in group A and it was significantly lower than in groups B and C (0.642 +/- 0.224 and 1.061 +/- 0.476 l/min, respectively). In the three groups, acute administration of propranolol induced statistically significant changes in systemic and splanchnic haemodynamics. In patients of group C but not of group B, the mean value of azygos blood flow after propranolol remained significantly higher than in group A. Moreover, the fraction of azygos blood flow to cardiac output decreased in groups A and B while slightly increased in group C. This study shows that in patients with cirrhosis, the degree of liver failure may be a determinant for the haemodynamic responses to drugs acting on portal hypertension.

Female↗
PubMed1986

Hemodynamic characterization of chronic bile duct-ligated rats: effect of pentobarbital sodium.

Systemic and splanchnic hemodynamics of the chronic bile duct-ligated rat were characterized by radioactive microspheres. Conscious and pentobarbital sodium-anesthetized, bile duct-ligated and sham-operated rats had cardiac output and regional organ blood flows determined. The conscious bile duct-ligated rat compared with the sham-operated showed a hyperdynamic circulation with an increased cardiac output (153.3 +/- 9.8 vs. 112.6 +/- 6.0 ml/min, P less than 0.005) and portal tributary blood flow (21.32 +/- 1.43 vs. 12.79 +/- 1.47 ml/min, P less than 0.005). Pentobarbital sodium anesthesia induced marked hemodynamic changes in both sham-operated and bile duct-ligated rats. The latter group was especially sensitive to its effects; thus, comparison of cardiac output and portal tributary blood flow between anesthetized bile duct-ligated and sham-operated rats showed no significant differences. We conclude that the rat with cirrhosis due to chronic bile duct ligation is an excellent model for hemodynamic investigations but should be studied in the conscious state, since pentobarbital sodium anesthesia eliminates the hyperdynamic circulation.

Anesthesia, General↗
PubMed1986

Domperidone-induced increase in lower oesophageal sphincter pressure does not affect azygos blood flow in patients with cirrhosis.

An increase in lower oesophageal sphincter pressure induced by domperidone has previously been reported to decrease superior portosystemic collateral flow in patients with portal hypertension owing to cirrhosis. Although a 10-mg intravenous dose of domperidone was effective in increasing lower oesophageal sphincter tone in a group of six patients with cirrhosis, the same dose failed to affect azygos blood flow in a matched group of six patients. The results do not support the hypothesis that an increase in lower oesophageal sphincter tone can decrease flow through oesophageal varices in patients with cirrhosis.

Domperidone↗
PubMed1986

Role of portasystemic shunts in the hyperkinetic circulation of the portal hypertensive rat.

We evaluated the role of portasystemic shunts in the hyperkinetic circulatory state in rats with portal hypertension. Cardiac output and regional blood flow were measured by the radioactive microsphere technique in rats with portal hypertension caused by portal vein stenosis, in rats with end-to-side portacaval shunts, and in sham-operated rats. Cardiac output was significantly higher in rats with surgical shunts than in those of the two other groups and was significantly lower in sham-operated rats compared with portal hypertensive rats. Portal tributary blood flow and hepatic arterial blood flow expressed in absolute flow as well as in percentage of cardiac output were significantly increased in rats with surgical shunts compared with other groups. These blood flows were also significantly higher in portal hypertensive rats than in sham-operated animals. A significant correlation was found between cardiac output and portal tributary blood flow in rats with portal vein stenosis and in rats with surgical shunts; this correlation was absent in sham-operated rats. This study shows that the hyperkinetic circulatory state in rats with portal hypertension and a normal liver is related to the presence of portasystemic shunts but not to portal hypertension per se.

Animals↗
PubMed1985

Superior portosystemic collateral circulation estimated by azygos blood flow in patients with cirrhosis. Lack of correlation with oesophageal varices and gastrointestinal bleeding. Effect of propranolol.

In patients with cirrhosis, superior portosystemic collateral circulation was evaluated by the continuous thermodilution method in the azygos vein. Azygos blood flow was 5 times higher in a group of patients with cirrhosis (alcoholic in 27, cryptogenic in 8, post-hepatitic in 2 and primary biliary cirrhosis in 1), than in a group of patients without portal hypertension (steatosis in 2, granulomatous hepatitis in 2, persistent chronic hepatitis in 2 and Hodgkin's disease in 1). Azygos blood flow was not different in cirrhotic patients with no visible, in those with small-sized, and in those with large sized oesophageal varices. Azygos blood flow was not different in cirrhotic patients with and without a previous episode of gastrointestinal bleeding. Fifteen min after intravenous administration of 15 mg of propranolol, azygos blood flow significantly decreased whereas azygos blood flow did not change after placebo. The decrease in azygos blood flow was significantly more marked than the reduction in cardiac output. It is concluded that superior portosystemic collateral blood flow is elevated in patients with cirrhosis and that the reduction in this collateral circulation might explain the efficiency of propranolol in the prevention of recurrent gastrointestinal bleeding.

Azygos Vein↗
PubMed1985

Acute effect of propranolol on splanchnic circulation in normal and portal hypertensive rats.

Propranolol decreases portal venous pressure in patients with cirrhosis but no method is available in man to study the effect of this beta-blocker on splanchnic organ blood flow. Because in rats, the microsphere method allows evaluation of regional blood flow, the acute effect of propranolol on both splanchnic and systemic circulations was studied in normal rats and in rats with portal hypertension due to portal vein stenosis. Portal venous pressure significantly decreased during propranolol administration in normal (5.6 +/- 1.0-4.7 +/- 1.1 mm Hg; mean +/- SD) as well as in portal hypertensive rats (11.7 +/- 2.3-10.3 +/- 1.8 mm Hg). Propranolol slightly decreased cardiac output and arterial pressure in all rats. Portal tributary blood flow was significantly reduced by propranolol in normal rats (17.4 +/- 3.0-11.3 +/- 2.2 ml/min) and in portal hypertensive rats (23.7 +/- 5.0-16.6 +/- 3.3 ml/min). Accordingly vascular resistance of the different organs in the portal venous territory increased in these rats receiving propranolol. The percentage of the decrease in portal tributary blood flow was significantly more marked than the percentage of reduction in cardiac output in portal hypertensive rats but, in normal rats, these percentages were parallel. Hepatic arterial blood flow did not change or slightly increased and, consequently, hepatic arterial vascular resistance decreased. These findings further clarify the marked effects of propranolol on splanchnic circulation.

Animals↗
PubMed1985

Effect of propranolol on hepatic blood flow in patients with cirrhosis.

The effect of propranolol on systemic and hepatic hemodynamics was studied in patients with cirrhosis. One hour after 40 mg propranolol by mouth as well as during continuous oral dosing at doses that reduced heart rate 25%, cardiac output and the hepatic venous pressure gradient fell significantly, whereas arterial pressure and hepatic blood flow did not change significantly. In six patients with cirrhosis and surgical end-to-side portacaval shunts, cardiac output and the hepatic venous pressure gradient also decreased 15 minutes after intravenous propranolol (5 mg), whereas hepatic blood flow did not change significantly. In the patients with surgical shunts, systemic vascular resistance rose significantly but hepatic arterial vascular resistance fell. Our data show that in patients with cirrhosis, propranolol induces an increase in the fraction of cardiac output reaching the liver.

Administration, Oral↗
PubMed1985

Liver in obesity.

We report on clinical, nutritional, and hepatic histological findings in 50 non-selected obese subjects (mean overweight +74%; range +21-138%). The pathogenesis of the liver damage was assessed with the help of multidimensional analysis of a number of clinical variables. According to the severity of the hepatic lesions, the patients have been ranged in five groups: O (normal liver) 10%; I (fatty liver) 48%; II (fatty hepatitis) 26%; III (fatty fibrosis) 8%; IV (fatty cirrhosis) 8%. The more severe changes (groups III and IV) were constantly associated with excessive alcohol intake. The multidimensional analysis was unable to find a relationship between obesity and the development of fibrosis and cirrhosis whereas it showed that: (a) there was a highly significant correlation between the daily ethanol intake and the degree of overweight, (b) severe fatty metamorphosis was significantly associated with the degree of overweight, the existence of diabetes mellitus, and the amount of alcohol and fat intake, (c) nutritional factors, in particular deficient protein intake, have only an accessory effect in the development of mild inflammation and fibrosis, (d) the consumption of potentially hepatotoxic drugs, very high in the obese (about five drugs per day) could have a role in the development of cirrhosis. In conclusion in our study, there was no evidence that obesity per se could result in severe liver damage.

Adult↗
PubMed1985

Comparison of the short-term effects of mepindolol and propranolol on splanchnic and systemic haemodynamics in patients with cirrhosis.

The splanchnic and systemic haemodynamic effects of mepindolol (0.6 mg, IV), a beta-blocker with a marked beta 2-blockade activity and propranolol (15 mg, IV) were studied in two groups of eight patients with portal hypertension due to cirrhosis. Similar decreases in the hepatic venous pressure gradient were observed after mepindolol and propranolol, whereas hepatic blood flow significantly decreased after mepindolol but did not significantly do so after propranolol. The decreases in cardiac output and heart rate were statistically significant and similar after mepindolol and propranolol. Mepindolol slightly decreased mean arterial pressure and propranolol slightly increased this pressure. Both beta-blockers significantly increased systemic vascular resistance. From these observations, it was not possible to demonstrate that mepindolol offered a beneficial effect on splanchnic haemodynamics in patients with portal hypertension due to cirrhosis.

Adult↗
PubMed1984

[Evaluation of the blood flow of superior portacaval anastomoses by the measurement of azygos blood flow in patients with alcoholic cirrhosis].

In patients with portal hypertension the azygos system collects the main part of superior portosystemic shunts; accordingly, azygos blood flow might be a reflection of this collateral circulation. Azygos blood flow, estimated by the continuous thermodilution method with a catheter inserted into the azygos arch, was measured in 20 patients with cirrhosis. The variability of baseline measurements was 6.9 +/- 3.0 p. 100 and the reproducibility was 5.7 +/- 5.8 p. 100. In patients with cirrhosis, azygos blood flow ranged from 0.22 to 1.25 l/min (0.64 /+- 0.30 l/min; mean +/- SD) and was significantly higher than in patients without portal hypertension (0.13 +/- 0.04 l/min). In this series of patients, azygos blood flow was significantly correlated with the hepatic venous pressure gradient but neither with hepatic blood flow nor with cardiac output. This study shows that azygos blood flow may be estimated with the continuous thermodilution method and that azygos blood flow is approximately six times higher in cirrhotic patients than in controls. This result suggests that blood flow through the superior portosystemic shunts is very high.

Azygos Vein↗