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Biomedical subjects

A Elman

Publications and source records attributed to A Elman.

At least 19 recordsLinked to original sources
PubMed1999

Elevated circulating cardiac troponin I in patients with cirrhosis.

It has been shown that certain patients with cirrhosis have asymptomatic cardiac abnormalities that have not yet been explained. Thus, cardiac troponin I, a specific marker of myocardial injury, has been measured in patients with cirrhosis without previous cardiac disease. Thirty-two consecutive patients (age 49 +/- 11) with cirrhosis and normal ECG were selected, 22 of which were alcoholic. Hemodynamic investigations were performed. Left ventricular function and mass were evaluated by echocardiography. Serum creatine kinase MB mass, myoglobin, and cardiac troponin I concentrations were measured. Cardiac troponin I concentrations were elevated in 10 patients (32%) (range 0.06-0.25 microg/L) whereas creatine kinase MB mass and myoglobin were normal in all patients. Abnormal troponin I values were not related to the severity of cirrhosis, to the degree of portal hypertension, or to other hemodynamic values. In contrast, elevated serum cardiac troponin I concentrations were related to a decreased stroke-volume index (P <. 05) and a decreased left ventricular mass (P <.05). These results show a high prevalence of slightly elevated serum cardiac troponin I in patients with cirrhosis, especially in those with alcoholic cirrhosis. Elevated troponin I is associated with subclinical left ventricular myocardial damage. These findings may be linked to a lack of left ventricular adaptation in certain patients with cirrhosis and alcoholic cardiomyopathy.

Adult↗
PubMed1998

Influence of transjugular intrahepatic portosystemic shunts (TIPS) on tissue oxygenation in patients with cirrhosis.

UNLABELLED: AIMS/BACKGROUNDS: The aim of this prospective study was to evaluate the influence of transjugular portosystemic intrahepatic shunts (TIPS) on tissue oxygenation in patients with cirrhosis and refractory ascites. METHODS: Five shunted patients were included in the study. The blood and tissue oxygenation values were analyzed 12 days and 4 months after TIPS procedure. The results were compared with those observed in patients treated by paracentesis. RESULTS: Unlike patients treated by paracentesis, PaO2 values remained unchanged throughout follow-up in shunted patients. After the TIPS procedure, there was a transient increase in systemic O2 transport and O2 uptake and a transient decrease in O2 saturation of hepatic oxyhemoglobin. After 4 months, TIPS resulted in an increase in PCO2 values and bicarbonate concentrations. CONCLUSIONS: The TIPS procedure seems to prevent the decrease in PaO2 observed in patients treated by paracentesis and may improve the respiratory alkalosis of cirrhosis.

Adult↗
PubMed1997

Studies of portal hemodynamics and hepatic oxygen consumption during acute liver allograft rejection.

Hemodynamics and oxygen variables, plasma cytokines, and histological features of a liver tissue sample obtained by transvenous biopsy were evaluated during 65 episodes of acute rejection. The hepatic venous pressure gradient was significantly higher in patients with acute rejection than in those without (5.1+/-0.3 vs. 3.1+/-0.2 mmHg, P<0.01). The increase in pressure gradient was related to the severity of rejection lesions. Hepatic blood flow was significantly lower in patients with than in those without acute graft rejection (1.28+/-0.11 vs. 1.75+/-0.13 L/min, P<0.05). Plasma interleukin-6 levels were significantly increased in patients with acute rejection and positively correlated with pressure gradient values. In patients with acute rejection, a significant decrease in hepatic venous oxygen content (-16%) was associated with a significant increase in hepatic oxygen consumption (+24%), whereas hepatic oxygen transport did not change significantly. In treated patients with a favorable response, the pressure gradient decreased significantly by 46%, but it remained elevated in patients who later developed chronic graft rejection. In conclusion, this study confirms that acute graft rejection may induce an increase in portal pressure, which is related to the severity of rejection lesions. It also shows that acute rejection decreases hepatic blood flow and increases hepatic oxygen consumption. In addition, it suggests that the hepatic venous pressure gradient might be useful to determine the outcome of rejection.

Acute Disease↗
PubMed1997

[Influence of anemia on hemodynamic changes in patients with cirrhosis].

OBJECTIVE: The aim of this retrospective study was to evaluate the systemic and splanchnic hemodynamic changes induced by anemia in patients with cirrhosis. METHOD: 148 patients (Child-Pugh A: 46 patients, Child-Pugh B: 64 patients and Child-Pugh C: 38 patients) were included in the study. Anemia was defined by a blood hemoglobin level < 12 g/dL. A systemic and splanchnic hemodynamic study was performed in all patients. RESULTS: A significant elevation of the hepatic venous pressure gradient was observed in Child-Pugh A patients with anemia but not in Child-Pugh B and C patients. In the 2 latter groups, cardiac index was significantly increased and systemic vascular resistance decreased in patients with anemia. CONCLUSION: Anemia may worsen the hemodynamic changes associated with cirrhosis.

Adult↗
PubMed1996

Systemic and splanchnic hemodynamic changes in patients with hepatic schistosomiasis.

Although hepatic schistosomiasis is a common cause of portal hypertension, only a few hemodynamic studies, in humans, have been published on this subject. The aim of this study was to determine the systemic and splanchnic hemodynamic changes in hepatic schistosomiasis and to evaluate the influence of liver fibrosis on these changes. A retrospective analysis of a series of 13 patients with hepatic schistosomiasis who had undergone hemodynamic studies was performed. Portal or perisinusoidal fibrosis was present at liver biopsy in 8 patients. The control group included 22 patients with chronic hepatitis and normal hepatic venous pressure gradients. Patients with schistosomiasis exhibited high cardiac index (4.11 +/- 1.15 l.min-1.m-2 vs 2.99 +/- 0.85 l.min-1.m-2; p < 0.05) and low systemic vascular resistance (1039 +/- 316 dyn.s.cm-5 vs 1334 +/- 336 dyn.s.cm-5; p < 0.05). The hepatic venous pressure gradient and hepatic blood flow were normal. Azygos blood flow was markedly increased (0.90 +/- 0.66 l.min-1 vs 0.13 +/- 0.04 l.min-1; p < 0.05). Hemodynamic values were not significantly different between patients with liver fibrosis and those without fibrosis at liver biopsy. In conclusion, patients with hepatic schistosomiasis had a hyperkinetic systemic and splanchnic circulation. In patients with esophageal varices, a normal hepatic venous pressure gradient confirmed presinusoidal portal hypertension. The presence of portal or perisinuoidal fibrosis did not influence hyperdynamic splanchnic state.

Adult↗
PubMed1984

Diffuse large cell (histiocytic) lymphoma of the spleen. Clinical and pathologic characteristics of ten cases.

Ten patients with diffuse large cell (histiocytic) lymphoma of the spleen had a characteristic clinical presentation and pathologic findings. Patients presented with left upper quadrant pain, fever, weight loss, and an elevated sedimentation rate. Imaging studies revealed an enlarged spleen with a discrete mass in all cases. Moderate to massive splenomegaly (average weight, 1025 g) was found at laparotomy; a single large mass or multiple confluent nodules with extensive central necrosis replaced 85% to 90% of the parenchyma. The tumor transgressed the splenic capsule in nine of ten cases, and either invaded or was adherent to the diaphragm, stomach, pancreas, or abdominal wall. Lymph nodes in the splenic hilum or retroperitoneum were frequently involved. Seven patients were in Ann Arbor Stage II, and three were in Stage I. Eight of the ten lymphomas were subclassified as centroblastic (large noncleaved cell) and two were immunoblastic. The B-cell lineage of six tumors was established by the presence of monoclonal immunoglobulin. Despite combination chemotherapy, with or without radiation, three of the seven patients whose follow-up was adequate died in less than 2 years; four are alive at 7, 12, 12, and 81 months, respectively, the last two with recurrent lymphoma. Large cell lymphoma of the spleen is a likely diagnosis in patients who present with left upper quadrant pain, fever, and radiographic evidence of a splenic mass.

Adult↗
PubMed1983

Large-cell lymphoma of the spleen: CT appearance.

CT and histopathological findings were correlated in 5 patients with large-cell lymphoma who presented with splenic enlargement. Prominent CT findings included splenomegaly with large solitary or multiple areas of low attenuation. The clinical presentation and operative findings are reviewed.

Humans↗
PubMed1981

Respiratory function is impaired less by transverse than by median vertical supraumbilical incisions.

Respiratory function in the first four days after elective cholecystectomy has been compared in 15 women in whom abdominal incision was transverse and 15 in whom it was median vertical. Ventilatory function (vital capacity and forced expiratory volume in one second) and blood gas tensions (partial pressures of oxygen and of carbon dioxide in arterial blood, arterial whole-blood carbon dioxide, and alveolo-arterial oxygen tension difference) were determined on the day before operation and on the first, second and fourth postoperative days. Ventilatory function was depressed postoperatively in all the patients, but the depression was significantly less, and of significantly shorter duration, after the transverse than after the median vertical approach. Significant changes in blood gas tensions were noted postoperatively after both incisions, but without significant difference between the two groups.

Abdomen↗
PubMed1979

[Double blind randomized trial of metopimazine: for postoperative nausea and vomiting after cholecystectomy].

Eighty-four patients submitted to cholecystectomy were randomly assigned in a double-blind study either to an intravenous dose of 10 mg of metopimazine, three times D-1, for two days or to an identically administered placebo. A definite superiority of metopimazine as an anti-emetic drug was demonstrated. General acceptance was excellent, but arterial pressure might be looked over closely when metopimazine was administered intravenously immediately after a general anesthesia.

Adult↗
PubMed1979

[Clinical study of massive transfusions (108 cases)].

Amongst 108 surgical patients receiving massive transfusions, 60 died. Study of the aetiology of the haemorrhage, the circumstances of the transfusion, and the role of massive transfusions in the transmission of infectious diseases, disturbances in haemostasis, immunological, respiratory and metabolic complications led to the determination of certain simple criteria of gravity which may restrict their use:age over 60 years; the number of units used, if it exceeds 30; the existence of cirrhosis, of an acute lesion as the source of bleeding, or of peroperative haemorrhage. By contrast, the transmission of hepatitis, coagulation disturbances, immediate or delayed incompatibility accidents and variations in pH, blood potassium and calcium levels and arterial pO2 had little influence on mortality.

Adolescent↗
PubMed1977

[The value of early routine radiological examination following esophagectomy for carcinoma of the lower third of the esophagus].

An early upper gastrointestinal series may be carried out on a routine basis after recovery of the postoperative ileus and makes it possible to confirm the good quality of the anastomoses or, by contrast, reveal a benign fistula. Under some circumstances, it may be carried out very early following the development of postoperative complications: pain, fever, respiratory, circulatory and renal insufficiency or in the presence of abnormal discharge from the drains. It then shows whether this complication is due to an oesophagomediastinal or pleural fistula.

Adult↗
PubMed1977

[Pulmonary complications of esophagectomy for carcinoma of the middle third of the esophagus].

The authors studied 20 patients undergoing operation for a carcinoma of the middle third of the oesophagus during the period January 1972 to April 1975. Postoperative pulmonary complications are extremely common in such patients. All the patients had pulmonary function study results which were compatible with this type of surgery. All underwent resection with oesophagogastric anastomosis via a left thoracophrenolaparotomy. Of the 20 patients, 14 suffered from one or more episodes of acute respiratory insufficiency, some related to pneumonia. On the basis of various associated clinical, radiological, biological, evolutive and histopathological criteria, five types of pulmonary complication were distinguished: 1-Shock lung; 2-Infective pneumonia; 3-Traumatic pulmonary disease; 4-Acute cor pulmonale; 5-Lung disease of undetermined origin. Twelve patients died as a result of pulmonary complications, 11 early (before the 16th day). One patient only died as a result of rupture of the oesophagogastric anastomosis.

Esophageal Neoplasms↗
PubMed1976

Chloroquine retinopathy in patients with rheumatoid arthritis.

270 consecutive patients with rheumatoid arthritis who had received chloroquine therapy were examined ophthalmologically for toxic retinal lesions. The total annual dose of chloroquine was 70-75 g. The maximum total dose given was 1330 g. The duration of treatment ranged up to 15 years. The primary material was divided into four groups according to total chloroquine dose received: greater than 100 g, 101-300 g, 301-600 g, and less than 600 g. Each dose group was arbitrarily split into two age groups, one with patients under 63 years of age and the other with patients over 63, in order to analyse the effect of age upon the ocular findings. In the present study, slight macular changes were included in the concept of maculopathy and were not thought to contra-indicate chloroquine therapy. Macular changes were found in about 25% of the patients, regardless of age in the lowest dosage group. The frequency of maculopathy increased with increasing total dose only in the older age group. It was also shown that the frequency of maculopathies and other eye diseases also increased with increasing age. This was evident even from the age of 50. The only patient with chloroquine retinopathy was an inadequately controlled 74-year-old woman. Chloroquine treatment of rheumatoid arthritis in the absence of any other disease which may cause retinopathy implies negligible risks in adult patients under 50 years of age. These patients could be less frequently checked. Older patients require regular ophthalmological checks. It is important to use the smallest effective dose possible, and never higher than 4 mg of chloroquine phosphate/kg body weight and day for 10 months annually; in elderly patients, preferably even lower doses.

Age Factors↗