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Biomedical subjects

A L Baker

Publications and source records attributed to A L Baker.

At least 73 records · Page 4Linked to original sources
PubMed1988

Liver transplantation, including the concept of reduced-size liver transplants in children.

Since the establishment of a clinical program in liver transplantation in 1984, 162 liver transplants have been performed in 131 patients (78 adults, 53 children). The patient mortality rate while waiting for a suitable organ has been 8% for adults and only 4% for children (25-46% reported in the literature). The low pediatric mortality is a result of the use of reduced-size liver transplants. A total of 14 procedures have been performed in recipients whose clinical condition was deteriorating and for whom no full-size graft could be located. Of 14 children, 13 were less than 3 years of age. Patient survival is 50%, comparable to survival of high-risk recipients of full-size livers. Using reduced-size liver grafting in a transplant program can lower mortality for children awaiting a transplant by overcoming size disparity. Reduced-size liver grafting will allow more effective use of donor resources and provide a potential avenue of research for organ splitting and living related donation.

Adolescent↗
PubMed1987

Hepatic complications of total parenteral nutrition.

Total parenteral nutrition is now widely used in the treatment of nutritional depletion. Among problems that persist in the use of this technique, the development of hepatic abnormalities has received increasing attention. In this review, the current understanding of the pathogenesis and management of liver injury during short-term total parenteral nutrition is summarized. These complications include fatty liver, cholestasis, and nonspecific triaditis. The experience with hepatic complications during long-term total parenteral nutrition is also reviewed. Evidence that progressive liver injury develops in some patients requiring lifelong total parenteral nutrition raises a serious dilemma for both patients and physicians. Better understanding of the pathogenesis is required before appropriate treatment can be prescribed.

Adult↗
PubMed1987

Urinoma detected by dual isotope renogram-cystogram.

A case is reported in which a urinoma developed following a renal transplant. Dual isotope renography-cystography using Tc-99m DTPA and Ga-67 citrate revealed the diagnosis after ultrasonography and radiographic cystography were nondiagnostic.

Cysts↗
PubMed1987

Contraindications to lumbar puncture as defined by computed cranial tomography.

Papilloedema is not always an adequate predictor of potential complications from lumbar puncture, and many clinicians are using computed tomography (CT) before lumbar puncture in an effort to identify more accurately the "at risk" patient. This paper identifies the following anatomical criteria defined by CT scanning that correlate with unequal pressures between intracranial compartments and predispose a patient to herniation following decompression of the spinal compartment: lateral shift of midline structures, loss of the suprachiasmatic and basilar cisterns, obliteration of the fourth ventricle, or obliteration of the superior cerebellar and quadrigeminal plate cisterns with sparing of the ambient cisterns. These criteria should be considered to be contraindications to lumbar puncture.

Adult↗
PubMed1985

Evolution of acute hepatitis B in homosexual men to chronic hepatitis B. Prospective study of placebo recipients in a hepatitis B vaccine trial.

To determine whether the frequency of chronic hepatitis B in homosexual men reflects the high rate of acute hepatitis B or an altered response to hepatitis B, 236 homosexual men were prospectively followed up after entry into the placebo group of a hepatitis B vaccine trial. Sixty-six participants (28.0%) developed hepatitis B ten to 18 months after entering the study. Only four (6.1%) of the 66 had persistence of hepatitis B beyond six months, similar to reports in nonhomosexual subjects. This study suggests that the high rate of acute hepatitis B is the major factor contributing to the high prevalence of chronic hepatitis B in homosexual men, rather than an altered host response. Clinical features of the acute illness could not be used to identify patients who developed chronic hepatitis B.

Acute Disease↗
PubMed1985

Liver diseases in pregnancy.

Mild abnormalities of liver function tests are frequently seen in pregnancy but return to normal after delivery. A raised serum alkaline phosphatase is common, along with a decline in the serum albumin, but the aminotransferases remain within normal limits. The physician must interpret abnormal liver function tests in pregnancy with these changes in mind, but most liver diseases in pregnancy result in more marked alterations. Viral hepatitis is the most common cause of jaundice in pregnancy, and the maternal prognosis is generally good. Perinatal transmission of hepatitis B virus is likely when the mother is positive for HBsAg. Concurrent administration of hepatitis B vaccine and HBIG to the infant has an efficacy of 90 per cent in preventing transmission to the infant. ICP is the second most common cause of jaundice in pregnancy. The condition is generally benign, although maternal and fetal mortality occasionally result, probably due to premature delivery and the bleeding tendency of cholestatic patients. Vitamin K administration may correct the coagulopathy, and cholestyramine is effective in controlling pruritus. AFLP is rare but carries a high mortality rate for both the mother and the fetus. Early diagnosis, correction of the coagulopathy, and prompt delivery may improve the outcome significantly. Patients with cirrhosis have reduced fertility, and in those who become pregnant, fetal loss is high. The effect of pregnancy or hepatocellular function is variable, but, when evidence of liver failure is present in the first trimester, termination should be considered. Variceal size and the risk of bleeding may be assessed by endoscopy. Pregnant cirrhotic patients with large esophageal varices and a history of bleeding can undergo shunt surgery. Conservative management may be appropriate for patients with small varices and no history of bleeding.

Acute Disease↗
PubMed1983

Aminopyrine breath test. Prospective comparison with liver histology and liver chemistry tests following jejunoileal bypass performed for refractory obesity.

To determine whether the aminopyrine breath test reflects the presence of increased pericentral fibrosis, steatonecrosis, and cirrhosis following jejunoileal bypass, 21 patients were evaluated with liver biopsies, liver chemistry tests, 45-min bromosulfothalein retention tests, and aminopyrine breath tests prior to bypass and at 3, 6, and 12 months thereafter. Following bypass, 15 biopsies demonstrated increased pericentral fibrosis, steatonecrosis, or cirrhosis, and 35 biopsies revealed increased fatty infiltration alone. Although the aminopyrine breath test results were significantly lower in patients with increased pericentral fibrosis, steatonecrosis, and cirrhosis at 6 and 12 months following bypass (P less than 0.05), this test had a positive predictability of only 0.67. An abnormal AST had a positive predictability of 0.87. Other liver function tests were less reliable in identifying patients with potentially progressive lesions following bypass. Thus, the AST is more useful than the aminopyrine breath test in reflecting increased pericentral fibrosis, steatonecrosis, and cirrhosis following jejunoileal bypass. The nonspecific effects of obesity and increased fatty infiltration of the liver following jejunoileal bypass may account for the low predictability of the aminopyrine breath test.

Adipose Tissue↗
PubMed1983

Hormonal control of biliary lipid secretion in dogs.

Five dogs were anesthetized, their cystic ducts were ligated, and their common bile ducts cannulated. The experiments were divided into four 1-hour periods. Taurocholic acid (18 mumol/min) and pipenzolate methylbromide (0.5 mg/kg body weight initially followed by 0.1 mg/kg body weight/20 minutes) were infused during all periods. Somatostatin (800 ng/kg/min) was infused during periods 2, 3, and 4 to suppress the endogenous secretion of peptide hormones. During periods 3 and 4, insulin was infused into a mesenteric vein at rates of 0.2 mU/kg/min and 0.8 mU/kg/min, respectively. These rates have been shown to produce fasting and postprandial portal vein insulin levels. Bile was collected during each period and the volume, bile acid concentration, and biliary lipid content were measured. Another five dogs were studied in a similar way, except that glucagon was infused in place of insulin at rates of 0.6 and 3.0 ng/kg body weight/min to produce fasting and postprandial portal vein levels. The results show that 1) the biliary secretion of cholesterol and phospholipid is increased by pharmacologic doses of somatostatin and 2) physiologic doses of glucagon, but not insulin , suppress the biliary secretion of cholesterol and phospholipid.

Animals↗
PubMed1983

Pharmacological and physiological doses of insulin and determinants of bile flow in dogs.

The role of insulin in control of bile secretion is uncertain. To study the mechanism of choleresis produced by large doses of insulin, bile was collected through modified Thomas cannulas from dogs anesthetized with pentobarbital. Animals received pipenzolate methylbromide, sodium taurocholate, and [14C]erythritol. After bile flow had stabilized three animals received infusions of insulin at 2, 4, 13, 26, 35, and 70 mU . kg-1 . min-1 for 40 min each. Bile and [14C]erythritol clearance increased (P less than 0.005), but bile salt output remained constant, suggesting that the choleresis was mainly due to enhanced bile salt-independent canalicular flow. Plasma insulin and glucagon levels also rose when insulin was infused. To exclude the possible effects of glucagon three additional animals received somatostatin (800 ng . kg-1 . min-1) along with infusions of insulin. Bile flow and [14C]erythritol clearance again increased significantly, but glucagon levels remained low, suggesting that the effects on bile flow were due to insulin alone. To determine whether physiological doses of insulin altered bile flow dogs were anesthetized with pentobarbital and received pipenzolate methylbromide, taurocholate, [14C]erythritol, and somatostatin (800 ng . kg-1 . min-1). Insulin (0.2 and 0.8 mU . kg-1 . min-1) was infused through the portal vein for 1 h each. Bile flow and [14C]erythritol clearance increased with insulin (0.8 mU . kg-1 . min-1; P less than 0.02), suggesting that the choleresis may have been due to bile salt-independent canalicular flow. Plasma insulin rose to physiological postprandial levels. These studies demonstrate that pharmacological and physiological levels of insulin administered to dogs produce a significant choleresis. Thus insulin may play an important role in the regulation of bile secretion.

Animals↗
PubMed1982

Secretin enhances [14C]erythritol clearance in unanesthetized dogs.

To determine the effect of secretin infusion on clearance of inert markers into bile, unanesthetized dogs fitted with Thomas cannulas received continuous infusions of [14C]erythritol and [3H]inulin throughout study. Taurocholic acid administered sequentially at 9.0, 20.0, and 40.0 mumol/min enhanced [14C]erythritol clearance, and GIH secretin (3 units/min) administered along with TCA (40.0 mumol/min) increased [14C]erythritol clearance from 4.9 +/- 1.2 ml/10 min to 6.8 +/- 1.3 ml/10 min (P less than 0.001), but simultaneously measured [3H]inulin clearance was unaltered. Secretin alone also increased [14C]erythritol clearance but did not alter [3H]inulin clearance. The increase in [14C]erythritol clearance per unit increase in bile flow was less during secretin infusion than TCA. Thus, secretin increases [14C]erythritol transport through restricted channels, probably distal to the canaliculi. [14C]Erythritol may not be an accurate marker for canalicular bile flow in dogs during secretin infusion.

Animals↗
PubMed1982

Is glucagon a choleretic hormone at physiologic blood levels?

The mechanism of action and possible physiologic implications of glucagon-induced choleresis were investigated in two groups of dogs. Group I demonstrated, in chronic animal models, that glucagon-induced choleresis was not associated with increased bile acid output and was not blocked by somatostatin or Piptal, suggesting a direct stimulatory effect on bile acid-independent canalicular flow. In acute animal models (group II), glucagon infusion at rates which produced postprandial levels in the portal vein induced significant choleresis, implying that glucagon may have a physiologic role in the regulation of bile secretion. No consistent relation between bile secretion and portal venous blood flow could be demonstrated.

Alkaline Phosphatase↗
PubMed1982

Prognostic significance of posttransfusion hepatitis and chromosomal abnormalities in adult acute nonlymphocytic leukemia.

In a retrospective analysis, we studied the effects of posttransfusion hepatitis (non-A, non-B) and chromosomal leukemia upon the overall times of adult patients with acute nonlymphocytic leukemia (ANLL). Seventy-two patients treated at the University of Chicago from 1970 to 1981 were evaluable. The complete remission (CR) rate for the entire group of patients was 33%, and the median survival was 246 days. Twenty-eight patients (39%) developed hepatitis, and 42 (61%) did not. The CR rate of the patients with hepatitis was 54%, and the median survival of this group was 615 days. In comparison, the CR rate for those who did not develop hepatitis was 20%, and their median survival was 136 days (p less than 0.0001). The groups were comparable in terms of race, sex, initial hematologic parameters, chromosomal abnormalities, dates of treatment, chemotherapy treatment programs, and French-American-British (FAB) subtype, but the median age of the patients who did not develop hepatitis was higher than that of the others. Patients who had normal karyotypes and who developed hepatitis had the best overall prognosis (median survival of 738 days). Patients with abnormal karyotypes who failed to develop hepatitis had the shortest survival times (median, 124 days). The group of patients who had the longest survival (median, 1130 days) included those over 40 years old, with posttransfusion hepatitis, and with normal karyotypes. The development of posttransfusion hepatitis and the presence of chromosomal abnormalities appear to be important, but opposite, indicators of overall prognosis for patients with ANLL.

Adolescent↗