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Biomedical subjects

E Elias

Publications and source records attributed to E Elias.

At least 163 records · Page 9Linked to original sources
PubMed1989

Soluble interleukin-2 receptors in serum and bile of liver transplant recipients.

Soluble interleukin-2 receptors (IL2R) were measured as markers of lymphocyte activation in serum and bile of liver transplant recipients. Serum and biliary levels were significantly higher in patients with acute rejection than in those with other complications (serum p less than 0.0025, bile p less than 0.001) or stable grafts (both p less than 0.0001). Levels rose 24 h before rejection could be detected by conventional liver tests. Biliary levels were more specific and sensitive than serum levels for rejection. Local production of IL2R accounted for the high levels in bile; the bile to serum ratio of IL2R was greater than that of albumin in 16 of 18 patients with acute rejection. Serum levels were high early in the course of chronic rejection but fell as it progressed to end-stage. Measurement of soluble IL2R may have a role in the early diagnosis of acute rejection and in identifying patients with chronic rejection in whom further immunosuppression will provide no benefit.

Acute Disease↗
PubMed1989

Patterns of leukocyte chemotaxis to bile after liver transplantation.

The role of chemotactic factors in the recruitment of leukocytes to human liver allografts was assessed by studying the effect of bile from transplant recipients on the chemotaxis of cells from normal subjects. Bile samples taken 2-3 days before clinical rejection were more chemotactic for lymphocytes than samples taken during rejection (p less than 0.01), during stable graft function (p less than 0.001), and from nontransplant patients (p less than 0.007). During clinical rejection there was an increase in bile chemotactic activity for both monocytes and neutrophils compared with samples from stable patients (monocytes: p less than 0.001; neutrophils: p less than 0.001) and nontransplant patients (monocytes: p less than 0.001; neutrophils: p less than 0.001). In serial studies chemotactic activity for lymphocytes reached a peak 1-3 days before the onset of clinical rejection, whereas maximum chemotactic activity for monocytes and neutrophils occurred at the time of rejection, when lymphocyte chemotaxis was decreasing. These results suggest that chemotaxis may be important in the recruitment of inflammatory cells to liver allografts and that chemotactic factors for lymphocytes, which appear in bile before clinical rejection, may be critical in the pathogenesis of rejection.

Bile↗
PubMed1989

Hepatic vein webs and resistant ascites. Diagnosis, management and implications.

Webs of hepatic veins have been rarely described. Two patients presented with intractable ascites in whom hepatic venography demonstrated this unusual finding. Liver biopsies from both patients showed variable patterns of perivenular fibrosis. Transvenous balloon dilatation of the web was effective in abolishing the pressure gradient across the obstruction and improving hepatic venous outflow. Both patients showed a dramatic clinical improvement following the procedure, with complete resolution of ascites in one patient and considerable improvement in the other with symptoms not recurring over 18 months of follow-up. The histological features that help to distinguish hepatic venous outflow obstruction from other causes of perivenular fibrosis are described.

Adult↗
PubMed1989

Serum cortisol levels in camels (Camelus dromedarius) during the reproductive cycle.

1. Cortisol concentrations were measured in sexually mature female camels (N = 18), two newborn camels and one adult male. 2. The study revealed a significant difference in the amounts of cortisol in pluriparous mated camels (N = 7) during the breeding season before (8.0 +/- 1.3 ng/ml) and immediately after mating, 45.0 +/- 11.9 ng/ml (P less than 0.01). 3. At the start of parturition (N = 7), the maternal serum cortisol level rose suddenly from the basal value, 11.4 +/- 1.3 ng/ml, 3 days pre partum, to 45.3 +/- 5.0 ng/ml (P less than 0.005). 4. Immediately after birth, serum levels of cortisol in the newborn camels were 35.9 ng/ml and 37.0 ng/ml, respectively; in the dams, the concentrations of serum cortisol were 60.0 and 57.0 ng/ml, respectively. 5. In the female camels (N = 2) in seasonal anoestrus the amount of serum cortisol did not exceed 8 ng/ml. 6. During the breeding season the level of serum cortisol in the male was 1.15 ng/ml; 10 min post coitus the serum cortisol level rose to 9.92 ng/ml.

Anestrus↗
PubMed1989

Effect of anaesthetic agents on bile flow and biliary excretion of 131I-cholylglycyltyrosine in the rat.

We have compared in the rat the effects of i.v. anaesthetic agents on bile flow rate and on the biliary excretion of a novel bile acid, 131I-cholylglycyltyrosine (131I-cholylgly.tyr.). Etomidate 1-mg bolus and 2-mg h-1 infusion, Althesin 3-mg bolus and 14.5-mg h-1 infusion and propofol 3.3-mg bolus and 3.3-mg h-1 were given via a tail vein cannula and pentobarbitone 50 mg kg-1 was given by the intraperitoneal route, to groups of six rats. Each animal received only one anaesthetic agent. One hour after cannulation of the common bile duct, 131I-cholylgly.tyr. 5 microCi was injected into the jugular vein and bile was collected every 1 min for 10 min. The mean (SD) percentage cumulative biliary excretion of 131I-cholylgly.tyr. at the end of 10 min was: propofol group 74.1 (5.2)%; Althesin group 82.3 (2.2)%; etomidate group 69.4 (17.6)%; pentobarbitone group 76.4 (3.2)%. Propofol and Althesin were relatively more choleretic, causing bile flow rates twice that produced by pentobarbitone. Only Althesin caused a significant increase in biliary excretion of 131I-cholylgly.tyr. relative to that in rats that received pentobarbitone. Bile flow rates for the respective anaesthetic techniques (microliter min-1/100 g body weight) (mean (SD)) were: propofol group 14.1 (1.8); Althesin group 12.5 (1.7); etomidate 8.5 (1.4); pentobarbitone group 7.3 (1.0). There was a marked metabolic acidosis in all rats except in the propofol group, in which normal acid-base status and oxygenation were observed.

Alfaxalone Alfadolone Mixture↗
PubMed1989

Prognosis after liver transplantation for primary biliary cirrhosis.

Timing of transplantation for patients with primary biliary cirrhosis (PBC) requires identification not only of individual risk factors for the operation but estimation of survival with and without transplantation. To identify those risk factors and develop a prognostic model, 82 patients grafted for PBC since 1980 in the Birmingham and Cambridge/King's College Hospital series have been analyzed. Using logrank tests it was found that treatment with diuretics, hemoglobin above 10 g/dl, prothrombin time less than 5 sec prolonged, serum sodium above 130 mmol/L and serum bilirubin less than 350 mumol/L were all individually associated with a better prognosis. Using Cox regression analysis to identify independent variables, it was found that year of transplant, serum bilirubin, serum urea, and diuretic responsive ascites had a significant association with survival. Using these four variables, it was possible to develop a model to identify those patients with a good and a poor probability of survival after transplantation.

Bilirubin↗
PubMed1989

Massive haemorrhagic necrosis of the liver after liver transplantation.

Six of the first 85 patients who received the first 100 liver transplantations carried out in Birmingham developed a syndrome of fulminant liver failure with distinctive clinical and pathological features. The typical clinical presentation was of an uneventual initial postoperative period, followed by a sudden deterioration in graft function, progressing rapidly to graft failure. All six patients died. The characteristic pathological changes were those of massive haemorrhage and hepatocyte necrosis with only mild inflammation and without occlusive lesions in large arteries or veins. These distinctive features differed from other recognised patterns of graft damage and seemed to comprise a specific post-transplant syndrome. The pathogenesis was not clear and in the absence of any definite aetiology it is suggested that the term "massive haemorrhagic necrosis" be used to describe these cases. Additional findings seen in five of the six cases were venoocclusive lesions (n = 4) and a combination of ductopenia and foam cell arteriopathy (n = 2). The presence of these associated lesions suggests that there may be an overlap with other types of graft damage.

Adult↗
PubMed1989

How to perform a percutaneous liver biopsy.

Liver biopsy is a safe and indispensable tool for the diagnosis and management of many forms of liver disease. Percutaneous techniques are easy to learn and relatively little experience is required to obtain an adequate specimen of liver safely. Most doctors training in general medicine and some training in general surgery and radiology should develop experience with this technique.

Adult↗
PubMed1988

High incidence of poor sulfoxidation in patients with primary biliary cirrhosis.

An impaired sulfoxidation pathway has been implicated in the pathogenesis of chlorpromazine-induced hepatotoxicity. Since some patients with chronic chlorpromazine-induced cholestasis may have features of primary biliary cirrhosis, we studied the ability to sulfoxidate the amino acid analogue S-carboxymethyl-cysteine in 44 patients with primary biliary cirrhosis and in two control groups--one without liver disease and one with a variety of liver diseases other than primary biliary cirrhosis. Poor sulfoxidation was observed in 84 percent of the patients with primary biliary cirrhosis, as compared with 24 percent of patients with other liver diseases and 22 percent of normal controls (P less than 0.0005 for both comparisons). Poor sulfoxidation did not correlate with the degree of hyperbilirubinemia or histologic severity of liver disease in any of the groups studied. There was an inverse correlation with age only in the patients with primary biliary cirrhosis (r = -0.44, P less than 0.001). Liver transplantation was performed in six of the patients and improved sulfoxidation in five; in the four with primary biliary cirrhosis, sulfoxidation improved from poor to good or intermediate. We conclude that poor sulfoxidation is closely associated with primary biliary cirrhosis but not with the other liver diseases we studied.

Adolescent↗
PubMed1988

The accuracy of aspiration cytology in the diagnosis of rejection following orthotopic liver transplantation.

The role of aspiration cytology (AC) and the total corrected increment (TCI) in the diagnosis of hepatic rejection was assessed in 30 patients following 36 liver transplants. A total of 174 AC specimens were "blindly" evaluated. Patients underwent protocol AC twice weekly and when biochemical or clinical parameters suggested rejection. Hepatic rejection was only confirmed when clinical and biochemical changes were accompanied by positive histological diagnosis. In all, 103 specimens were matched against histology, the remainder assessed against retrospective clinical and biochemical diagnoses. There were 80 cytological diagnoses of rejection, confirmed in 69 specimens, and 94 diagnoses of no rejection, confirmed in 73 specimens. These figures give a sensitivity of 76.7%, a specificity of 86.9% and a positive predictive value of 86.3%. Overall, 39.7% of specimens taken more than 2 months after grafting proved to be incorrectly diagnosed. However, the accuracy was higher in 145 specimens taken within 8 weeks of transplantation, with a sensitivity of 81.3%, a specificity of 90%, a positive predictive value of 89.7% and an accuracy of 85.5%. Although histology remains the gold standard in the diagnosis of acute rejection after hepatic grafting, AC using a TCI with a positive predictive value of 86.3% may prove to be of value in monitoring liver transplant patients in the first 2 months after grafting.

Adolescent↗