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Biomedical subjects

D R Triger

Publications and source records attributed to D R Triger.

At least 55 records · Page 3Linked to original sources
PubMed1989

Variceal bleeding is associated with reduced risk of severe cholestasis in primary biliary cirrhosis.

To test the hypothesis that, in primary biliary cirrhosis, bleeding from oesophageal varices implies a reduced risk that a patient will subsequently develop severe cholestasis, the case records of 76 patients with this condition who had died were examined. Fifty-nine patients (78 per cent) had died solely or largely as a consequence of liver disease. Their median survival from the onset of symptoms was 72 months. Most died from either hepatic failure with marked jaundice, infected ascites or variceal bleeding. Fifteen patients had a plasma bilirubin less than 100 mumol/l at the time of death. Twenty-eight patients had had variceal bleeding. Compared with the remaining 31 who had also died from cirrhosis, the patients who had bled from varices survived longer, were much less likely to die of hepatic failure and to become severely jaundiced but were more likely to develop fatal infected ascites.

Adult↗
PubMed1989

Autonomic neuropathy and chronic liver disease.

Autonomic neuropathy has been reported in association with alcoholic cirrhosis but there is no information on its occurrence in non-alcoholic liver disease. We have examined autonomic function in 64 patients with biopsy-proven liver disease (22 with alcoholic liver disease and 42 with non-alcoholic liver disease) together with 29 age-matched controls. Forty-five per cent of patients with alcoholic liver disease and 43 per cent with non-alcoholic liver disease showed evidence of parasympathetic damage; 11 per cent of patients with alcoholic liver disease and 12 per cent with non-alcoholic liver disease had sympathetic damage. Forty-five per cent of patients with alcoholic liver disease and 22 per cent with non-alcoholic liver disease had peripheral neuropathy on clinical examination. Sixty-eight per cent of those with peripheral neuropathy also had autonomic neuropathy. This study confirms that autonomic neuropathy is common in alcoholic patients but the fact that it is found with comparable frequency in non-alcoholic liver disease suggests that the neurological defect may be secondary to the disturbed liver function. The implications of these observations with regard to prognosis of chronic liver disease are discussed.

Adult↗
PubMed1987

Serum aldolase isoenzymes in benign and malignant liver disease.

Using a radio-immunoassay, aldolase A and B isoenzyme concentrations have been measured in the sera of patients in order to assess their specificity and sensitivity in a variety of hepatic disorders. Serum aldolase A has been confirmed to be elevated in some patients with malignant infiltration of the liver, but its sensitivity is not sufficient to be of clinical value. Aldolase B is a sensitive marker of liver cell damage which correlates closely with conventional biochemical markers of inflammation. It appears to distinguish successfully between hepatic and cardiac damage.

Fructose-Bisphosphate Aldolase↗
PubMed1987

Antibody responses to tetanus toxoid in patients with primary biliary cirrhosis.

The primary and secondary antibody responses to tetanus toxoid were measured in 18 patients with primary biliary cirrhosis and compared with those in age and sex matched controls. Although the primary antibody response in the two groups was similar, the secondary IgM antibody response in primary biliary cirrhosis was significantly higher than that in control subjects. There seems to be a correlation between secondary IgM antibody titre and total serum IgM concentration, although this fails to reach significance (p = 0.069). These results show that in primary biliary cirrhosis there is a failure to switch from IgM to IgG antibody synthesis in response to foreign antigens, and this may account for the increased serum IgM concentrations that are usually found in this disease.

Adult↗
PubMed1987

Predictive markers of chronic liver disease in hemophilia.

In an attempt to predict progressive liver damage in hemophiliac patients by noninvasive means, we conducted a retrospective analysis of clinical and laboratory data from 44 liver biopsies taken from 35 hemophiliac patients. This showed that serum IgG was normal in patients with chronic persistent hepatitis (CPH) but significantly elevated in those with chronic active hepatitis (CAH) or cirrhosis (CIR) (P less than .001). Relationships were less significant between liver histology and IgM (P less than .01), IgA (P less than .05), and globulin (P less than .05). This was unaffected by human immunodeficiency virus (HIV) antibody status in asymptomatic individuals. Although patients with progressive liver disease were also older than those with CPH (P less than .001), the immunoglobulin abnormalities were independent of this. Neither clinical examination nor liver biochemistry at the time of biopsy were of significant diagnostic value. Our results indicate that in the absence of AIDS an elevated IgG level is a reliable indicator of progressive hemophilic liver disease.

Adolescent↗
PubMed1987

Neutrophil phagocytic and bactericidal function in primary biliary cirrhosis and other chronic liver diseases.

We have examined neutrophil phagocytosis and intracellular killing of Staphylococcus aureus in patients with primary biliary cirrhosis, alcoholic liver disease and chronic active hepatitis in comparison with age and sex matched controls. Significant decrease in neutrophil phagocytosis was found in both early and advanced primary biliary cirrhosis while impaired phagocytosis was seen in alcoholic cirrhosis but not in alcoholic fatty liver. In both disorders the effect appeared to be mediated by the patient's serum as there was no difference between patient and control neutrophil function when the test was performed in AB serum. Although total bacterial killing was reduced in chronic active hepatitis, phagocytosis was not impaired. Intracellular killing was not affected in any of the liver disease groups. These results support the view that serum factors exist in patients with liver disease which inhibit neutrophil phagocytosis. While these studies confirm earlier finding in alcoholic liver disease, this is the first demonstration of such a defect in primary biliary cirrhosis.

Adult↗
PubMed1986

Sedation for gastroscopy: a comparative study of midazolam and Diazemuls in patients with and without cirrhosis.

A double-blind controlled study comparing the effects of intravenous Diazemuls (0.15 mg kg-1) with midazolam (0.07 mg kg-1) in patients with normal liver function and with cirrhosis and portal hypertension is described. The clinical effect of the two drugs was assessed by serial tests of psychomotor function before and at varying intervals after administration. Using this dosage regime, midazolam caused significantly greater impairment in psychomotor function in both cirrhotic and non cirrhotic subjects, and the time taken for recovery of normal function was also significantly prolonged. Patients with cirrhosis showed a significantly prolonged recovery time following administration of either benzodiazepine compared with the controls. Administration of midazolam in a lower dose might reduce the degree of sedation and shorten the recovery time, but this could also lead to a loss of some of the amnesic effect. Caution is recommended in the administration of benzodiazepines to patients with cirrhosis.

Adult↗
PubMed1986

Unilateral Kayser-Fleischer ring.

A patient is presented who had unrecognised Wilson's disease. He had developed a clinically obvious Kayser-Fleischer ring in only one eye. The eye without the corneal ring had been injured in childhood and had a low intraocular pressure. Possible mechanisms for formation of a Kayser-Fleischer ring are reviewed and the lack of Kayser-Fleischer ring in this case is discussed.

Cornea↗
PubMed1986

Management of bleeding oesophageal varices.

Variceal haemorrhage has long been recognized as a serious complication of portal hypertension. The last few years have seen a considerable expansion in the techniques available for its control. This review examines these therapeutic options and their role in patient management.

Esophageal and Gastric Varices↗
PubMed1985

Progressive liver disease in haemophilia: an understated problem?

In an 8-year study of 79 unselected patients with haemophilia who had received clotting factor concentrates, there was evidence of chronic progressive liver disease in at least 17 (21%). 8 patients had chronic active hepatitis and 9 had cirrhosis (5 with oesophageal varices). Histological evidence suggested that non-A non-B hepatitis was mainly responsible, although the influence of other viruses could not be excluded. Serial liver biopsies showed progression from chronic persistent hepatitis to chronic active hepatitis and cirrhosis within 6 years, suggesting that chronic persistent hepatitis in haemophiliacs is not as benign as hitherto supposed. Symptoms and abnormal physical signs were uncommon in these patients. There was no relation between degree of abnormality of serum aminotransferase levels and severity of the underlying liver disease. It is anticipated that liver disease in haemophiliacs will become an increasing clinical problem in the future.

Adolescent↗