Search PubMed⌕ Search

Biomedical subjects

J Fevery

Publications and source records attributed to J Fevery.

At least 73 records · Page 4Linked to original sources
PubMed1996

The effect of long-term treatment with spironolactone on variceal pressure in patients with portal hypertension without ascites.

The effect of spironolactone on esophageal variceal pressure (VP) in patients without ascites was investigated. VP was assessed using a noninvasive endoscopic gauge. Spironolactone was administered during a 6-week period at a dosage of 100 mg/d. This treatment decreased VP from 16.8 +/- 1.9 (SD) to 14.1 +/- 2.7 mm Hg (P < .001) in a group of 12 patients and from 18.6 +/- 2.1 to 13.7 +/- 4.1 mm Hg (P < .01) in another group of 8 patients who still had high VP despite chronic intake of propranolol. In both groups, placebo administration to 12 and 8 comparable patients did not significantly alter VP. Spironolactone induced a significant reduction of plasma volume (42.1 +/- 5.5 to 36.1 +/- 6.6 mL/kg body weight, P < .01) and of the concentration of alpha-atrial natriuretic peptide (alpha-ANP) (39.8 +/- 22 to 27.7 +/- 20 pg/mL, P < .01); in addition, a pronounced increase in plasma renin activity (PRA) (1.1 +/- 0.9 to 7.5 +/- 3.4 ng/mL/h, P < .001) was induced by the treatment. No significant changes in systemic hemodynamics were observed during the studies. Severe side effects were not observed except for a high incidence (55%) of painful gynecomasty in the male patients. In conclusion, chronic spironolactone administration effectively lowers VP, even in patients under chronic propranolol therapy. The combination of propranolol and spironolactone deserves further study as a prophylactic therapy of variceal hemorrhage, but development of gynecomasty might be a problem. Finally, we confirmed the reproducibility of VP measurements with the noninvasive gauge in chronic conditions.

Adrenergic beta-Antagonists↗
PubMed1996

Percutaneous transhepatic cholangioscopy for diagnosis and therapy of biliary diseases in older patients.

OBJECTIVE: To describe the use of percutaneous cholangioscopy in older patients with complex diagnostic and therapeutic bile duct disorders. DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Fourteen patients with a mean age of 74 (SD +/- 9) years (range, 60-91 years) underwent percutaneous cholangioscopy. Eleven of these patients presented with endoscopically irretrievable bile duct stones. These 11 patients represent 4.1% of a group of 342 patients (age > or = 60 years) with a mean age of 76 (SD +/- 9) years who were treated endoscopically because of common bile duct stones between January 1993 and January 1996. Three patients presented with obstructive jaundice resulting from a bile duct stricture. In these three patients, brushing cytology of the strictures had proved to be negative. INTERVENTION: After creation and dilatation of a percutaneous transhepatic tract, cholangioscopy was carried out with a flexible cholangioscope. All procedures were performed under mild sedation and analgesia. Stone disintegration was obtained by electrohydraulic lithotripsy, applied through the working channel of the cholangioscope. RESULTS: Complete stone disintegration and removal was obtained after one to three cholangioscopic sessions in all 11 patients with stones. A histological diagnosis of malignancy was obtained in the three patients with biliary strictures. CONCLUSIONS: Percutaneous cholangioscopy is a well tolerated and promising technique in our diagnostic and therapeutic strategy in older patients with complex biliary disorders not responsive to peroral endoscopic diagnosis or treatment.

Age Factors↗
PubMed1996

Assessment of variceal pressure by continuous non-invasive endoscopic registration: a placebo controlled evaluation of the effect of terlipressin and octreotide.

Octreotide has been proposed for the treatment of variceal bleeding. The effects on portal pressure, however, have been variable in published studies. As bleeding is more directly related to pressure in the varices, this study investigated the effect on variceal pressure of octreotide and terlipressin, a vasoactive drug with a well established effect. Variceal pressure was measured during four to eight minutes by a continuous non-invasive endoscopic registration method. Thirty patients in whom a stable variceal pressure recording had been obtained during at least one minute, were randomised to receive either 2 mg terlipressin, 50 micrograms octreotide or an identical volume of saline, as a single intravenous injection given over 60 seconds. For the final analysis three patients had to be excluded because of lack of a satisfactory recording. There were no significant clinical differences between the three groups of patients. Placebo administration did not induce significant changes, but a mean decrease in variceal pressure of -27% was noted with terlipressin, starting from two minutes onwards. Variceal pressure changes after injection of octreotide were variable and the mean change in pressure did not reach statistical significance. Seven of 10 patients showed a temporary increase in variceal pressure. In conclusion, terlipressin induces a significant and progressive decrease in variceal pressure but inconsistent variations of variceal pressure changes were seen after octreotide administration. This is probably related to its effect on central venous pressure. This study also shows that continuous variceal pressure recording with the non-invasive endoscopic registration technique detects in an accurate way the effect of vasoactive drugs on variceal pressure, because placebo injection did not produce significant changes.

Adult↗
PubMed1996

Focal liver lesions: fast T2-weighted MR imaging with half-Fourier rapid acquisition with relaxation enhancement.

PURPOSE: To compare the clinical usefulness of the half-Fourier rapid acquisition with relaxation enhancement (RARE) technique at T2-weighted magnetic resonance (MR) imaging of focal liver lesions with that of multishot RARE MR imaging and contrast material-enhanced helical computed tomography (CT). MATERIALS AND METHODS: Half-Fourier RARE and multishot RARE imaging and helical CT were performed in 48 patients with 102 focal liver lesions and in three patients with diffuse metastatic liver disease. Images were compared qualitatively and quantitatively for image quality, lesion conspicuity, and ability to help differentiate solid lesions from hemangiomas. RESULTS: All half-Fourier RARE images were free of respiratory artifact. In the 48 patients with 102 focal lesions, CT, half-Fourier RARE, and multishot RARE images depicted 101, 99, and 90 lesions (99%, 97%, and 88%), respectively. CT failed to depict focal lesions in one patient with diffuse metastatic liver disease. All techniques had high accuracy for distinction of hemangiomas from solid masses (areas under the receiver operating characteristic curves were between 0.96 and 0.99). CONCLUSION: Half-Fourier RARE MR imaging is a rapid and accurate technique for detection and characterization of focal liver lesions.

Adult↗
PubMed1996

Combined treatment with methotrexate and ursodeoxycholic acid in non-cirrhotic primary biliary cirrhosis.

In the treatment of patients with primary biliary cirrhosis (PBC), methotrexate (MTX) and ursodeoxycholic acid (UDCA) have both been associated with clinical, biochemical, and histologic improvement. Studies with methotrexate have only been performed in uncontrolled conditions. We conducted a prospective controlled study on the combined treatment with methotrexate and ursodeoxycholic acid, comparing the clinical, biochemical, and histologic evolution in six untreated patients with that in eight patients treated with MTX 15 mg/week in association with UDCA 500 mg/day. All patients had noncirrhotic PBC and were followed up for two years. A significant decrease of alkaline phosphatase, glutamic pyruvic transaminase, and gamma-glutamyltranspeptidase was found in the methotrexate/ursodeoxycholic acid treated-group, as compared to the control group. The clinical and histologic evolution, however, was not significantly different in the two groups. Methotrexate toxicity consisted of interstitial pneumonitis in one, of a transient rise of transaminases at three months in five, and of a significant decrease of blood platelets and white blood cells after two years of treatment. In controlled conditions, a two-year treatment with methotrexate and ursodeoxycholic acid does not produce a significant clinical or histologic benefit. Based on this experience, and taking into account the possible risks associated with this therapy, the empiric use of methotrexate cannot be recommended in patients with non-cirrhotic PBC.

Adult↗
PubMed1995

Genotype, serum level of HCV-RNA and response to interferon-alpha treatment in patients with chronic hepatitis C.

OBJECTIVE: Since only a small proportion of patients with chronic hepatitis C benefit from interferon therapy, we assessed the viral factors such as HCV genotype and the level of viraemia for prediction of interferon response. METHODS: HCV genotype and serum levels of HCV-RNA were determined in 24 patients before, during and after interferon treatment. RESULTS: Pre-treatment serum levels of HCV-RNA were significantly lower in patients with normalization of serum ALT and disappearance of serum HCV-RNA upon therapy than in patients with persistent abnormal ALT and/or serum HCV-RNA positivity. Sole infection with HCV genotype 1b was associated with a significantly higher pre-treatment serum HCV-RNA level than infection with genotype other than 1b or mixed types. CONCLUSIONS: HCV genotype and pre-treatment serum HCV-RNA levels are indeed important predictors for response to interferon treatment in patients with chronic hepatitis C.

Adolescent↗
PubMed1995

Liver biopsy.

An overview is given of the technical aspects and the diagnostic usefulness of liver biopsy. From the clinical side, the procedures for taking liver biopsies and the various types of biopsy are summarized. The histopathology section mentions precautions for tissue sampling and processing, and reviews the diagnostically useful techniques and special microscopy procedures. Consideration is given to the factors which determine the accuracy of histopathological diagnosis, both those relating to the tissue specimen and those relating to the interpreter. Published studies on quantitation and semi-quantitation of liver biopsy findings and their reproducibility are mentioned, with a final remark on the contribution of liver biopsy to diagnosis and therapy. Emphasis is placed throughout on the necessity for close collaboration between clinician and pathologist.

Biopsy↗
PubMed1995

Desmin expressing nonhematopoietic liver cells during rat liver development: an immunohistochemical and morphometric study.

The expression and cellular distribution of desmin, alpha-smooth muscle actin (A-SMA) and cytokeratin no. 8 (CK-8) and no. 18 (CK-18) in normal adult, neonatal and fetal rat liver were examined immunohistochemically on cryostat sections. At days 14 and 15 of gestation, nonhematopoietic cells in embryonic liver were strongly desmin-positive, and some of the cells, mainly located in the periphery, were also stained with anti-A-SMA. Desmin immunoreactivity gradually decreased from day 16 of gestation. A close association of desmin-positive cell processes with hematopoietic cells was observed during fetal and early neonatal development. From day 16 of gestation the pre-hepatocytes became desmin-negative, remained CK-8 and CK-18 positive. Desmin-expressing cells were numerous in the liver from the embryonic period to the neonatal age. However, their absolute number per unit area, as well as their number relative to hepatocytes, decreased with age. We suggest that desmin-positive cells in embryonic liver may act as stromal cells in the hepatic hematopoietic microenvironment and support hepatocyte development.

Actins↗
PubMed1994

Potential role of bile duct collaterals in the recovery of the biliary obstruction: experimental study in rats using microcholangiography, histology, serology and magnetic resonance imaging.

Obstructive cholestasis induced in animals at the level of the lobar and common bile ducts is known to be reversible with time. This study was conducted not only to test the hypothesis that formation of bile duct collaterals is responsible for the recovery of biliary obstruction but also to assess the potential of hepatobiliary agent-enhanced magnetic resonance imaging for visualizing cholestasis. A total of 52 rats were divided into three groups with selective biliary obstruction, total biliary obstruction and sham surgery. We studied the evolution of cholestasis by correlating microcholangiographic, histological findings with the results of liver tests and hepatobiliary agent-enhanced magnetic resonance imaging. Lobar cholestasis undetected by liver tests but seen on magnetic resonance imaging as a difference between ligated and unligated lobes, occurred in 15 out of 20 rats subjected to selective biliary obstruction within 48 hr after ligation, and recovered later on as a result of the development of bile duct collaterals. Five rats failed to show local cholestasis as a result of the existence of interlobar accessory bile channels. All 18 total biliary obstruction-treated rats were cholestatic soon after ligation, as confirmed by high serum bilirubin and alkaline phosphatase levels and as documented by poor liver enhancement on magnetic resonance imaging. Cholestasis recovered within 4 wk with normalization of liver enhancement on magnetic resonance imaging as a result of the formation of bile duct collaterals (as demonstrated by microcholangiographic and histological study). Bile duct collateral formation is responsible for the recovery from obstructive cholestasis in rats. A similar mechanism might be present in conditions of bile duct obstruction without cholestasis. Hepatobiliary agent-enhanced magnetic resonance imaging is more sensitive than blood tests in detecting local cholestasis and can be used to monitor noninvasively the evolution of biliary obstruction.

Alanine Transaminase↗
PubMed1994

Clinical aspects of incomplete septal cirrhosis in comparison with macronodular cirrhosis.

BACKGROUND/AIMS: Incomplete septal cirrhosis (ISC) is a form of macronodular cirrhosis characterized by slender, incomplete septa that demarcate inconspicuous nodules. Its clinical features have not been investigated in a large series. The aims of this study were to review the clinical symptoms and evolution of ISC in 42 patients. METHODS: Forty-two patients with at least one liver biopsy strongly suggestive of ISC were selected for the study covering a period between 1968 and 1987. Data for these patients were compared with the evolution of 49 patients with classical macronodular cirrhosis after chronic active hepatitis type B or C. RESULTS: Possible etiological factors for ISC were alcohol abuse, arsenic treatment, and hepatitis B infection. In three cases, a genetic factor could not be excluded. Patients with ISC had significantly lower serum concentrations of transaminases and bilirubin at diagnosis. Compared with macronodular cirrhosis, bleeding varices were more frequent (57% vs. 22%) in ISC. Ten-year survivals in the ISC and the macronodular cirrhosis groups were 54% and 57%, respectively. CONCLUSIONS: ISC represents a relatively stable burnt-out form of macronodular cirrhosis with an unusually high incidence of variceal bleeding. This could be explained by a superimposed insufficiency of the portal vascular supply.

Adolescent↗
PubMed1994

Detection of hepatitis C virus antigen by immuno-histochemical staining: a histological marker of hepatitis C virus infection.

Hepatitis C virus has been recognized as a major cause of non-A, non-B viral hepatitis. Although serologic tests have been commercialized, no specific histological or immuno-histochemical markers for hepatitis C virus infection are available for routine use. In an effort to detect hepatitis C virus antigen in liver tissue we investigated the immuno-reactivity to monoclonal antibodies on frozen liver tissue from a chimpanzee and patients with chronic non A, non B hepatitis. Monoclonal antibodies were developed in mice immunized with a synthetic peptide derived from hepatitis C virus core antigen. One monoclonal antibody was reactive and showed typical cytoplasmic granules in chimpanzee hepatocytes. Using this monoclonal antibody a similar staining pattern was found in the liver biopsies of 21 out of 28 chronic non-A, non-B hepatitis patients, positive for hepatitis C virus-RNA and anti-HCV. The granular immuno-reactivity was abolished after pre-incubation of this monoclonal antibody with infected chimpanzee liver or with hepatitis C virus synthetic peptide but not with normal chimpanzee or human liver tissue. There was no reactivity in four patients with hepatitis C virus-RNA-negative, anti-HCV-positive chronic non-A, non-B hepatitis, in 11 patients with chronic type B hepatitis or in 12 hepatitis C virus-RNA-negative, anti-HCV-negative patients with various liver diseases. However, staining was found in three out of four additional chronic type B hepatitis patients suspected of co-infection with non-A, non-B agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1994

The effect of different doses of a bolus injection of somatostatin combined with a slow infusion on transmural oesophageal variceal pressure in patients with cirrhosis.

Transmural variceal pressure was measured by fine-needle puncture following a 250-micrograms bolus injection of somatostatin given intravenously, together with a slow infusion of 250 micrograms/h, and compared with results following a 500-micrograms bolus and with placebo in 19 patients with cirrhosis who had recently bled. Pressure was recorded continuously for a 4-min period. Placebo did not alter variceal pressure (n = 6), whereas a 250- or 500-micrograms bolus produced a rapid decrease in pressure from 33 +/- 7 cmH2O to 20 +/- 6 (n = 7) and from 35 +/- 5 cmH2O to 24 +/- 6 (n = 6), respectively. The difference between the two groups was not significant. This decrease occurred within 30 to 90 s, but was followed by a progressive increase in variceal pressure over the next 2 min in all except two patients. After 3-4 min, variceal pressure still remained below pretreatment levels. Further studies are needed to evaluate the optimal infusion rate. These results seem to indicate that future clinical studies using somatostatin in the treatment of variceal haemorrhage should include repeated bolus injections to arrest variceal bleeding.

Blood Pressure Determination↗
PubMed1994

Three cases of non-tumoural tight stenosis of the bifurcation of the hilar bile ducts.

Stenosis of the bifurcation of the hepatic bile duct is usually caused by malignant lesion. We report on three different causes of benign stenosis of the hepatic confluence with a similar radiological pattern on direct cholangiography. The first case is considered a spontaneous neuroma, the second a periductal abscess, and the third case a postoperative stricture Bismuth type 4.

Adult↗
PubMed1994

Rapid clearance of hepatitis C virus RNA in peripheral blood mononuclear cells of patients with clotting disorders and chronic hepatitis C treated with alpha-2b interferon is not a predictor for sustained response to treatment.

Thirteen patients with congenital coagulation disorders and chronic hepatitis C were treated with alpha-interferon (IFN). Serum transaminases (ALT) and hepatitis C virus (HCV)-RNA in plasma and peripheral blood mononuclear cells (PBMC) were followed during and after treatment. During IFN treatment ALT levels normalized in 8/13 patients. In all patients HCV-RNA disappeared from PBMC. In 9/13 HCV-RNA also became undetectable from plasma; in six of these nine this occurred earlier in PBMC than in plasma; in the remaining three the disappearance of HCV-RNA occurred simultaneously in plasma and PBMC. All but two patients relapsed within 3 weeks after cessation of IFN, one relapsed after 6 weeks and one patient remains in remission after 6 months. HCV-RNA reappeared either earlier in plasma (3/12) or simultaneously in plasma and PBMC (9/12). Viral replication in PBMC thus can easily be suppressed by IFN, whereas longer treatment is needed for the eradication of HCV-RNA in plasma. The detection of HCV-RNA in PBMC cannot be used as a prognostic marker for the identification of patients with chronic hepatitis C who will have a sustained response to IFN treatment.

Adult↗
PubMed1994

Measurement of variceal pressure and its clinical implications.

BACKGROUND: Recent investigations show that variceal pressure (VP) is more closely related to the risk of variceal bleeding than is the hepatic venous pressure gradient. As a consequence, the measurement and follow-up of VP is receiving more attention. METHODS AND RESULTS: Variceal pressure can be measured by the fine needle puncture technique. A close correlation with intrasplenic pressure recording and a high reproducibility in chronic conditions with this technique were confirmed in our laboratory. Using this technique, we recently demonstrated that an intravenous bolus injection of somatostatin 250 micrograms or 500 micrograms given together with a slow infusion of 250 micrograms/h yielded a rapid and transient decrease in VP. Our experience with the non-invasive pressure sensitive gauge shows that the procedure is easy to perform, well standardized and that it has a high reproducibility in acute conditions. CONCLUSION: We inferred from our study of the acute effect of somatostatin that, in the event somatostatin is used in the treatment of variceal haemorrhage, repeated bolus injection should be included to arrest the bleeding. The high accuracy of non-invasive VP measurements suggests that this technique may have an application in the follow-up of patients with oesophageal varices.

Esophageal and Gastric Varices↗
PubMed1994

Simultaneous macroamylasemia and macrolipasemia.

The first case of the simultaneous presence of macroamylasemia and macrolipasemia in a patient with gluten enteropathy (celiac disease) is described. Both macroenzymes were formed by association of polyclonal IgA with amylase and lipase. Both macroenzymes had molecular masses > 300 kDa.

Amylases↗
PubMed1994

Focal fatty infiltration of the liver associated with important mass effect.

A case of focal fatty infiltration of the liver (FFIL) with partly multinodular appearance and significant mass effect on computed tomography (CT) is presented. Mass effect in FFIL is sometimes seen with alcoholic liver disease and makes the differential diagnosis with malignant disease often difficult. Diagnosis of FFIL was confirmed on 1.5 T MR images.

Adult↗