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Biomedical subjects

H Ring-Larsen

Publications and source records attributed to H Ring-Larsen.

At least 73 records · Page 4Linked to original sources
PubMed1983

Plasma-to-ascitic fluid transport rate of albumin in patients with decompensated cirrhosis. Relation to intraperitoneal albumin.

Albumin-kinetics and haemodynamic studies were performed in 20 patients with decompensated liver cirrhosis in order to improve the knowledge on genesis and perpetuation of hepatic ascites, especially with respect to determinants of intraperitoneal protein. A positive relationship was found between the plasma-to-peritoneal transport rate of albumin (index of 'lymph-imbalance') and the mass of intraperitoneal albumin (rlog = 0.82, P less than 0.001), indicating a significant role of 'lymph-imbalance' to sequestration of protein in the peritoneal cavity. Ascitic fluid albumin concentration was on the average 0.22 of that of plasma and directly correlated to the plasma concentration (rlin = 0.68, P less than 0.01). The hydrostatic pressure difference across the splanchnic microvasculature (assessed as wedged hepatic vein minus inferior vena caval pressure) was directly correlated to the effective (plasma minus ascitic fluid) oncotic pressure (rlin = 0.74, P less than 0.001) but significantly higher than that (P less than 0.005), indicating a 'non-equilibrium' in the splanchnic Starling forces. The results point to a multivariate genesis and perpetuation of cirrhotic ascites as laid down in the 'lymph-imbalance' theory of ascites formation, whereas a 'fluid equilibrium' theory seems to be too simple, especially with respect to explain protein sequestration in the peritoneal cavity.

Adult↗
PubMed1983

Peritoneovenous shunt in treatment of ascites in patients with cirrhosis. A preliminary report with special reference to pathophysiology.

Peritoneovenous shunts (LeVeen type) were implanted in seven patients with cirrhosis complicated by ascites refractory to diuretic treatment. Three patients died of gastrointestinal bleeding and hepatic coma 1 to 7 weeks after the shunt implantation. The patients who died were those with the most severely impaired liver and kidney function. In two of the four surviving patients (observation time, 5-24 months) the shunt was patent during the observation time, and ascites disappeared. In the other two the shunt closed, in one patient repeatedly following several re-implantations. Enhanced urinary sodium excretion was observed in patients with patent shunts. After disappearance of ascites, the splanchnic venous pressures became less deranged. Long-term change in plasma volume or circulating albumin mass could not be detected. A patent shunt increases the drainage from the peritoneal cavity, but detectable increment in the overall lymph drainage was only found in a patient with a very low pre-shunt value. The findings do not support the 'overflow' theory of ascites formation but rather the 'lymph imbalance' theory. For clinical evaluation of peritoneovenous shunting in the treatment of ascites a controlled clinical trial is essential.

Aged↗
PubMed1981

Noradrenaline and adrenaline concentrations in various vascular beds in patients with cirrhosis. Relation to haemodynamics.

Plasma noradrenaline (NA) and adrenaline (A) concentrations were related to various haemodynamic parameters in fifteen patients with cirrhosis. In supine position at rest plasma NA and A in peripheral venous blood were significantly higher in patients with cirrhosis than in normal subjects. Mean plasma NA averaged 0.66 and 0.21 ng/ml, respectively (P less than 0.01). The corresponding values for plasma A were 0.14 and 0.05 ng/ml (P less than 0.03). Splanchnic arterial-hepatic venous extraction ratio of NA in patients with cirrhosis averaged 0.46 (P less than 0.01). The right kidney released NA into the systemic circulation. Renal venous plasma NA exceeded arterial concentration by 38% (P less than 0.02). NA concentrations in femoral vein and ascitic fluid were not different from that of arterial plasma. Plasma NA was positively correlated to wedged hepatic vein pressure (r = 0.86, P less than 0.001) and to heart rate (r = 0.61, P less than 0.02), but inversely correlated to plasma volume (r = 0.83, P less than 0.01) in cirrhotic patients. Arterial blood pressure was reduced in these patients compared to controls (P less than 0.02), but not significantly correlated to plasma NA. The increased plasma NA indicates that sympathetic nervous activity is enhanced in patients with cirrhosis. Based on the above positive correlation between NA and heart rate and the significant release of NA from the kidney, it may be hypothesized that the increased sympathetic nervous activity especially involves heart and kidney. This response may be mediated by baro- and volume receptors.

Adult↗
PubMed1981

Reversible colour vision defects in obstructive jaundice.

The ocular function of 14 non-alcoholic, high icteric patients with recent occlusion of the common bile duct and 3 patients with viral hepatitis with a cholestatic pattern was studied. By means of a colour vision test panel including the Farnsworth-Munsell 100-hue test, 12 patients were initially classified as colour defective with a pattern of acquired colour vision deficiency (ACVD), predominantly of a tritan type. Visual acuity, visual field, slit lamp microscopy, intraocular pressure, ophthalmoscopy and tear secretion tests were normal, and all patients had normal levels of serum vitamin A. Retesting of 4 initially colour defective patients after disappearance of the obstructive jaundice showed a complete normalisation of the ACVD's. It is concluded, that the colour perception in patients with obstructive jaundice is related to the serum bilirubin level, and not to a deficiency of vitamin A.

Adult↗
PubMed1981

Renal failure in fulminant hepatic failure and terminal cirrhosis: a comparison between incidence, types, and prognosis.

Forty patients with terminal cirrhosis and 40 patients with fulminant hepatic failure-all consecutively admitted-were studied with regard to incidence, types, and prognosis of complicating renal insufficiency. Renal failure was considered present when the serum creatinine was greater than 0.20 mmol/l. Of the patients with cirrhosis 26 (65%) developed renal failure. In 15 the type was functional, in three due to acute tubular necrosis, and in eight indeterminable. Of the patients with fulminant hepatic failure 22 (55%) had renal insufficiency; of these 13 had functional renal failure, five acute tubular necrosis, and in four the type was indeterminable. In both categories of patients, renal failure was equally frequent among patients with or without gastrointestinal bleeding and with or without ascites or diuretic therapy. The biochemical tests of liver function were similar in patients with or without renal failure in both categories. The mean renal blood flow in seven unselected patients with fulminant hepatic failure was reduced in the same order as previously observed in patients with cirrhosis. In terminal cirrhosis the mortality rate was 88% in the presence of renal failure, 71% in its absence (p greater than 0.05), while the same figures in fulminant hepatic failure were 100% and 67% (p less than 0.05). The incidence, relative frequency, and prognosis of renal failure were not different in the two conditions, indicating identical pathophysiological circumstances.

Acute Kidney Injury↗
PubMed1981

The effect of ascitic fluid hydrostatic pressure on albumin extravasation rate in patients with cirrhosis of the liver.

Overall transvascular escape rate of albumin [TERalb, i.e. the fraction of intravascular mass of albumin (IVMalb) passing to the extravascular space per unit time] was determined from the disappearance of i.v. injected radioiodinated serum albumin. Patients with tense ascites due to liver cirrhosis and pigs with posthepatic portal hypertension and intraperitoneally instilled fluid were studied before and after abdominal paracentesis in order to evaluate the effect of ascitic fluid hydrostatic pressure on the transvascular escape rate of albumin. TERalb of the ascitic patients (n = 6) were on average 7.8% IVMalb.h-1, which is somewhat higher but not significantly above normal (mean 5.6% IVMalb.h-1). After paracentesis and removal of the ascitic fluid, TERalb rose significantly to an average of 11.9% IVMalb.h-1 (P less than 0.05). The fraction of IVMalb passing into the peritoneal cavity was on average 0.21 and 0.38% IVMalb.h-1 before and after paracentesis, respectively (n = 4). In ascitic, posthepatic portal-hypertensive pigs (n = 6), TERalb averaged 15.1% IVMalb.h-1, a value not being significantly different from non-ascitic, normotensive controls (mean 16.1% IVMalb.h-1). After paracentesis, TERalb rose significantly to an average of 24.3% IVMalb.h-1. The increased albumin extravasation rate after removal of ascites is best explained by an increased sinusoidal-tissue pressure difference caused by a decreased hydrostatic fluid pressure in the liver interstitium (portal and subcapsular spaces) due to the hydrostatic effect of the removed ascitic fluid.

Abdomen↗
PubMed1980

Vasoactive intestinal polypeptide (VIP) in cirrhosis: arteriovenous extraction in different vascular beds.

The concentration of vasoactive intestinal polypeptide (VIP) was determined in peripheral venous plasma from 136 patients with liver cirrhosis without gastrointestinal bleeding or coma and from 112 controls. In eight patients (cirrhosis, six; fibrosis, one; steatosis, one) arteriovenous extraction or release of VIP was measured during catheterization at four locations: brain, lower limb, intestine-liver, and kidney. The mean concentration of VIP in peripheral venous plasma from patients with cirrhosis was 9.4 pmol/l (median, 7.0; range, 0-86), which was significantly higher than that of the controls, who had a mean of 6.2 pmol/l (median, 6.0; range, 0-20, P less than 0.01). No significant extraction or release of VIP could be detected across the vascular bed in brain or lower limb. A significant arterio-hepatovenous VIP extraction ratio (mean, 0.43; range, 0.05-0.87) confirmed at net splanchnic elimination of VIP from extra-splanchnic areas and from porto-systemic shunting of VIP in cirrhosis. The net splanchnic elimination rate of VIP was estimated to be about 3 pmol/min. The concentration of VIP in ascitic fluid was on the average three times that of arterial plasma. In conclusion, VIP is significantly elevated in peripheral plasma from patients with cirrhosis, probably due to porto-systemic shunting and/or compromised hepatic elimination. Hepatic elimination is still likely to account for the inactivation of most of the VIP escaping from the neurosynapses throughout the body in patients with cirrhosis without coma.

Adult↗
PubMed1979

Renal and cerebral blood flow in experimental liver failure in the pig.

The renal and cerebral blood flow was measured in six pigs after total devascularization of the liver. The animals died 21 to 26 h after the operation, with biochemical and electroencephalographic changes compatible with liver failure. The renal blood flow increased slightly, from 2.12 to 2.61 ml.g-1.min-1, throughout the period of observation but did not differ significantly from that of the controls. Conversely, the cerebral blood flow decreased 38%, from 1.30 to 0.80 ml.g-1.min-1, p less than 0.05. The results failed to confirm a simultaneous decrease in cerebral and renal blood flow due to false neurotransmitters in liver failure, as previously suggested. The results do not support the suggested hypothesis that a substance produced by the liver is essential for renal function and perfusion, nor can they confirm that vasoactive material from the gut is responsible for the renal hypoperfusion in liver failure. The absence of renal hypoperfusion in the present preparation might be due to the exclusion of the failing liver from the circulation, giving indirect evidence to the theory that the vasoactive agent(s) responsible for the renal hypoperfusion in liver failure originates in the failing liver itself.

Animals↗
PubMed1978

Hepatic elimination of renin in man.

1. Hepatic elimination of renin was measured in 10 well-compensated cardiac patients with normal liver function during a control period and during a period of reduced hepatic plasma flow, induced by physical exercise (seven patients) or intravenous infusion of lysine vasopressin (three patients). 2. Hepatic renin elimination rate (hepatic plasma flow x arterial-hepatic vein difference of plasma renin activity) was found to be linearly correlated with arterial plasma renin activity (r = 0.986, P less than 0.001). 3. When hepatic plasma flow fell by 45% the hepatic extraction ratio of renin (arterial-hepatic vein plasma renin activity difference/arterial plasma renin activity) increased by 75%. Hepatic renin clearance (hepatic plasma flow x extraction ratio) remained constant. 4. The results indicate that changes in the hepatic elimination rate of renin do not contribute to changes in plasma renin activity during these events.

Adult↗
PubMed1978

The influence of acute blood volume changes on plasma renin activity in man.

The effect of an acute 10% blood volume reduction on plasma renin activity (PRA) was examined in seven patients with minor heart diseases during haemodynamic investigation and in five healthy subjects after 3 days furosemide administration. PRA was not significantly changed. Blood pressure remained constant, atrial pressures decreased. The effect on PRA of an acute 10% blood volume expansion with albumin infusion was studied in thirteen patients with liver or heart diseases. A slight reduction of PRA after albumin did not exceed the expected decrease due to plasma dilution. Blood pressure was unchanged, atrial pressures increased. Renal blood flow increased after albumin in all of the five patients investigated. The effect of PRA of an acute 10% blood volume expansion with whole blood flow increased after albumin in all of the five patients investigated. The effect on PRA of an acute 10% blood volume expansion with whole blood was then investigated in five healthy subjects, pretreated with furosemide for 3 days. A significant decrease in PRA was found. Blood pressure remained constant. It is concluded that an acute blood loss of 10% and an acute blood volume expansion of 10% with albumin have little influence on PRA in supine man, whereas an acute blood volume expansion of 10% with whole blood induces a significant PRA suppression.

Adult↗
PubMed1978

Renin stimulation by passive tilting: the influence of an anti-gravity suit on postural changes in plasma renin activity, plasma noradrenaline concentration and kidney function in normal man.

Plasma renin activity (PRA), plasma noradrenaline concentration, heart rate, blood pressure, and clearances of para-aminohippurate and inulin were measured in twelve normal subjects (clearances in only three subjects) before and after 40 min of 60 degrees upright tilting. The tilting experiments were repeated after inflation of an anti-gravity suit to 60 mmHg on the lower extremities. Inflation of the anti-gravity suit caused an abolition of the postural PRA increase, a marked reduction of the postural increases in plasma noradrenaline and heart rate, and elimination of the decreases in pulse pressure, inulin and para-aminohippurate clearances and sodium excretion. The results suggest a decisive role of the sympathetic nervous system for postural renin increase, probably mainly activated by stretch receptors in the low-pressure cardiopulmoanry area.

Adult↗
PubMed1978

Reduced myocardial blood flow in acute and chronic digitalization.

The myocardial blood flow was measured by the 133Xenon disappearance curve from the left ventricular wall following an injection of 133Xenon in the left coronary artery in 8 dogs without digoxin pretreatment and in 8 chronically digitalized dogs. The myocardial blood flow was significantly less (30%) in the digitalized dogs than in the dogs without pretreatment. In the digitalized dogs as well as in those without pretreatment an intravenous injection of digoxin resulted in a further significant decrease of the myocardial blood flow of about 20% and a significant increase of the coronary vascular resistance. The reduced myocardial blood flow both during acute and chronic digitalization is beleived to be of clinical importance.

Animals↗
PubMed1977

Splanchnic blood flow in patients with abdominal angina before and after arterial reconstruction. A proposal for a diagnostic test.

The diagnostic value of determining the splanchnic blood flow (SBF) and oxygen uptake before and after a test meal in patients suspected of abdominal angina was investigated in 15 patients with unexplained abdominal pain. Six patients with typical abdominal angina and occlusive lesions of two or three splanchnic arteries were investigated before and after successful arterial reconstruction. Five patients with less severe arterial lesions were classified as suspected of abdominal angina and four patients with eventual normal arteriography served as controls. No significant difference was found in fasting SBF between the three groups. Postprandial SBF rose in the controls and in the abdominal angina suspected group, but not in the patients with abdominal angina. After arterial reconstruction fasting SBF was higher than before and postprandial SBF rose to the level of the controls. No difference in oxygen uptake before or after test meal was seen in any of the groups or after arterial reconstruction.

Abdomen↗
PubMed1977

Ocular function in cirrhosis of the liver.

The ocular state of 28 ascertained non-alcoholic females with cirrhosis of the liver was assessed. Only twenty were able to go through the complete colour vision test, and among these, three patients (one without, and two with increased level of serum bilirubin) with acquired colour vision defects were observed. Visual acuity, visual field, intraocular pressure, binocular function, slit lamp microscopy, ophthalmoscopy and tear production were normal in all cases. It is concluded that the frequency of colour vision defects in the present sample is increased, and that alcohol abuse is not a prerequisite for colour vision defects in patients with cirrhosis.

Adolescent↗