Search PubMed⌕ Search

Biomedical subjects

M R Lucey

Publications and source records attributed to M R Lucey.

At least 55 records · Page 3Linked to original sources
PubMed1994

Diet and liver disease--a glimpse into the future.

The complex interaction between liver disease and food intake is not well defined. There are two aspects to consider: how liver disease affects food intake and whether or not diet can affect liver disease. Acute and chronic liver disease have been shown to influence taste, smell, food preference, and appetite. The liver may also play a role in food selection through reflex pathways. Intake of various macronutrients can alter serum liver enzymes and bilirubin without necessarily being associated with changes in pre-existing liver disease. Nonetheless, there is evidence that diet can be associated with both adverse and beneficial changes in outcome in animal models and patients with liver disease. These issues are difficult to unravel; however, there is potential for significant clinical advances from examining this area.

Diet↗
PubMed1994

Renal duplex Doppler ultrasonography: a noninvasive predictor of kidney dysfunction and hepatorenal failure in liver disease.

Hepatorenal failure, a well-recognized complication of established liver disease, is characterized by early renal hemodynamic changes (vasoconstriction) before clinically recognized kidney disease. This renal vasoconstriction (increased renal vascular resistance) should be detectable noninvasively by Doppler ultrasonography. We studied whether renal Doppler ultrasonography detects abnormalities in patients with nonazotemic liver disease and its prognostic value for subsequent kidney status. We observed by renal Doppler ultrasonography 180 patients who had liver disease without azotemia. A simple parameter, resistive index, was derived for each subject on the basis of Doppler waveform analysis. Traditional parameters used to assess patients with liver disease were also recorded at the time of Doppler ultrasonography. Subsequent kidney outcomes were kidney dysfunction (doubling of initial creatinine level to 1.5 mg/dl [133 mumol/L]) or more and the presence or absence of the hepatorenal syndrome. Abnormal results of Doppler examinations (elevated resistive index) were seen in 76 (42%) of the 180 patients. Kidney dysfunction developed in 55% (42/76) of the patients with an elevated resistive index and 6% (6/104) of those with normal results of Doppler study (p < 0.00005). Hepatorenal syndrome developed in 26% (20/76) of subjects with an elevated resistive index and 1% (1/104) of those with a normal resistive index (p < 0.00005). Cox regression analysis identified resistive index as a significant independent predictor of subsequent hepatorenal syndrome (p < 0.00005) and kidney dysfunction (p < 0.00005). Renal duplex Doppler ultrasonography can noninvasively identify a subgroup of nonazotemic patients with liver disease that is at significantly higher risk for subsequent development of kidney dysfunction and the hepatorenal syndrome.

Adolescent↗
PubMed1993

A man with type III glycogenosis associated with cirrhosis and portal hypertension.

Type III glycogenosis, an inherited disorder of glycogen metabolism that results from reduced or absent activity of the enzyme amylo-1,6-glycosidase (debranching enzyme), has not been frequently associated with cirrhosis and portal hypertension in adults. An adult Caucasian man with well-document type IIIa glycogenosis, who presented with a variceal hemorrhage secondary to hepatic cirrhosis, is described here. No other cause of cirrhosis was found.

Adult↗
PubMed1993

Liver transplantation for alcoholic liver disease.

The role of liver transplantation as a treatment for end-stage liver disease occurring in alcoholic patients is controversial. Earlier predictions that survival of alcoholic patients after liver transplantation was worse than that of non-alcoholic liver graft recipients, or that few alcoholic patients with serious liver disease could meet stringent selection criteria, have proved false. As a result, in many liver transplant programmes, alcoholic liver disease constitutes one of the most common diagnoses among patients proceeding to transplantation. Survival of alcoholic patients after transplantation is similar to that in non-alcoholic patients, i.e. up to 80% or more alive at 1 year. A multidisciplinary selection process has been introduced which includes careful psychiatric assessment to try to identify those patients most likely to maintain long-term abstinence after transplantation. Using this method, approximately 45% of alcoholic patients referred for transplantation have been selected for surgery. Furthermore, the survival rate of alcoholic patients not selected for transplantation because they were considered a poor prognostic risk for sobriety was significantly less than that of alcoholic patients undergoing liver transplantation. The ethical foundations for this multidisciplinary approach are explained in this chapter. Good data on recidivism after transplantation are few. In many programmes, including ours, instances of recidivism, defined as a relapse to a pathologic pattern of alcohol use, are uncommon and occur in 10% or less of alcoholic patients selected for liver transplantation, at least in the first 3 postoperative years. This figure underestimates the incidence of consumption of small amounts of alcohol. The data are limited also by the relatively short period of follow-up in most studies published to date. Whether recidivism will become more common as more patients are followed beyond 3 years remains to be seen.

Humans↗
PubMed1993

Acute effects of alcohol administration on regional cerebral blood flow: the role of acetate.

The effect of alcohol intoxication on regional cerebral blood flow (rCBF) is unclear. The few published studies provide a mixed picture of alcohol effects, suggesting that blood flow increases at low doses and decreases at higher doses of alcohol. Using the cerebral blood flow agent 99mtechnetium hexamethyl-propylene-amine-oxime (HMPAO) and image reconstruction with single photon emission computed tomography (SPECT), we evaluated the effect of an oral dose of ethanol (0.6 g/kg) on rCBF in two age-stratified groups of healthy, nonalcoholic men (12 age 22-37 and 12 age 63-77). Intoxication was associated with a significant 4% increase in global cortical CBF (t = 2.54, p = 0.02). Changes in HMPAO uptake were negatively correlated to ethanol levels in the entire group (r = -0.47, p = 0.04). This relationship was seen in the older subgroup (r = -0.70, p = 0.05), but not in the younger group (r = -0.34, p = 0.26). In contrast, the younger group showed a significant positive correlation between rCBF and increases in acetate levels (r = 0.71, p < 0.01), which was not seen in the older group (r = -0.02, p = 0.96). These findings suggest that both acetate and alcohol contribute to the changes in CBF seen in the intoxication syndrome and that their relative influence is age-dependent.

Acetates↗
PubMed1993

Epidermal growth factor and transforming growth factor-alpha directly inhibit parietal cell function through a similar mechanism.

Epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) are naturally occurring peptides which are present throughout the gastrointestinal tract and are capable of inhibiting gastric acid secretion. Although previous studies have suggested that TGF-alpha may serve as an autocrine factor regulating parietal cell function, the cellular mechanisms by which it exerts its inhibitory action have not been fully elucidated. In addition, no systematic comparison has been undertaken of the effects of EGF and TGF-alpha on parietal cell function. The aims of the present studies were to compare the actions of EGF and TGF-alpha on basal and stimulated acid secretion by isolated rabbit parietal cells and to elucidate the intracellular mechanisms by which these growth factors inhibit acid secretion stimulated by agents that activate the adenylate cyclase and cyclic AMP second messenger system. Although EGF and TGF-alpha did not alter basal parietal cell function, they both inhibited histamine-stimulated [14C]aminopyrine accumulation in a identical time- and dose-dependent fashion. The maximal effect of approximately 40% inhibition for histamine-stimulated action was achieved with concentrations of 10(-6) M for both EGF and TGF-alpha. The inhibitory effect of EGF and TGF-alpha appeared to be at the postreceptor level as neither growth factor significantly altered binding of histamine to its receptor (H2) on parietal cells. Consistent with this postulated mechanism of action, both EGF and TGF-alpha dose-dependently inhibited forskolin-stimulated aminopyrine uptake with IC50 similar to those required for inhibiting the stimulatory effect of histamine. Of note, neither growth factor inhibited parietal cell activity stimulated by dibutyryl cyclic AMP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylate Cyclase Toxin↗
PubMed1993

Liver transplantation for the alcoholic patient.

A review of the data from the University of Michigan and other transplant centers suggests that the outcome of liver transplantation, when considered as either mortality or psychological morbidity, is similar for alcoholics and nonalcoholics alike. The process to select alcoholic patients for transplantation has been outlined herein. Care is taken to identify alcoholic patients in whom long-term abstinence is likely, but a fixed period of abstinence prior to transplantation does not appear to be a useful selection tool. Resource utilization by alcoholics undergoing liver transplantation does not appear to differ from that by nonalcoholic recipients. Carefully conducted long-term studies are necessary to assess the natural history of liver allografts in alcoholics.

Alcoholism↗
PubMed1992

Resource utilization and outcome of liver transplantation for alcoholic cirrhosis. A case-control study.

Liver transplantation for alcoholic cirrhosis remains controversial at some transplantation centers. We compared resource utilization and outcome in alcoholic and nonalcoholic cirrhotic patients undergoing liver transplantation. Data were collected from 56 patients who underwent transplantation for alcohol-related cirrhosis from August 1985 to February 1991 and compared with data from a control group matched for age, sex, Child-Pugh class, and date of transplantation. No significant differences were noted in the resource utilization variables examined or in outcome (as assessed by indicators of early graft function, frequency of sepsis, incidence of rejection, renal function, and retransplantation rate). One-year survival was not significantly different (75% for the alcoholic cirrhotic group vs 76% for the nonalcoholic cirrhotic group). We conclude that liver transplantation for end-stage alcohol-related cirrhosis provides excellent results and that resource utilization appears to be equivalent to that for patients undergoing transplantation for non-alcohol-related cirrhosis.

Actuarial Analysis↗
PubMed1992

Biochemical and histopathological correlation in liver transplant: the first 180 days.

It is not known whether the histopathology of the liver allograft can be predicted from biochemical measurements in serum with the same confidence as in the native liver. To answer this question we compared the histopathological diagnoses in 170 biopsy specimens from 70 adult transplant recipients obtained during the first 180 days, with the concentrations of the serum bilirubin and the activities of AST, ALT and alkaline phosphatase measured at the same time. The most frequent diagnosis was cholestasis (n = 45), which was mild, moderate or severe and which may have been complicated by rejection (n = 28) or ischemia (n = 14). Hepatitis (n = 14), ischemia with rejection (n = 6) and spotty focal necrosis (n = 6) were diagnosed less frequently. Fifteen biopsy specimens were reported as histopathologically normal. In general, biochemical measurements discriminated poorly between different histopathological diagnoses. The histopathologically normal liver often showed an abnormal pattern of enzymes and an increase in the serum bilirubin level. As a result histopathologically normal biopsy specimens were indistinguishable biochemically from those with hepatitis. When two pathological conditions were found to coexist (e.g., cholestasis with either rejection or ischemic necrosis, or ischemic necrosis with rejection), the effect on the serum biochemistry was usually not additive and in some instances returned the biochemical abnormalities toward normal. With the exception of the serum bilirubin level, which increased with the severity of uncomplicated cholestasis, we could not identify a specific pattern of biochemical changes corresponding to a given histopathological diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Selection for and outcome of liver transplantation in alcoholic liver disease.

It has been proposed that evaluation of alcoholic patients for liver transplantation should comprise a multidisciplinary program including medical, surgical, and psychiatric assessment. This article presents the outcome in 99 alcoholic persons evaluated from 1985 through 1989. Alcoholism was defined as alcohol dependence or abuse according to the DSM-III-R. Forty-five patients (43%) were considered suitable candidates and underwent transplantation. Actuarial survival in this group was 78% and 73% at 12 and 24 months, respectively, and did not differ from that observed in nonalcoholic recipients. Return to alcohol use after transplantation has been documented in 5 persons, 2 of whom have had episodes of uncontrolled drinking. Of 54 patients not selected for transplantation, 17 were considered too well and suitable for alternative therapy. Actuarial survival was 93% at 12 and 18 months but declined to 59% at 24 months. Nineteen patients were medically unsuitable and had very poor survival; survival was 35% at 3 months and 0% at 12 months. Seventeen patients were not selected on psychiatric grounds. Actuarial survival in this group (65% at 12 months, 43% at 18 months) was significantly less than that in alcoholics with transplants (P less than 0.05). There were no differences in age, sex ratio, degree of hepatic dysfunction, or duration of abstinence between alcoholics with transplants and those considered psychiatrically unsuitable. It was concluded that liver transplantation is successful in selected patients with alcoholic cirrhosis, that patients who are not selected because they are "too well" need continuing surveillance as a significant decline in survival can occur 18-24 months after initial evaluation and, finally, that patients not selected on psychiatric grounds have a significantly worse survival rate than those with transplants.

Adolescent↗
PubMed1992

The short-term psychological health of alcoholic and non-alcoholic liver transplant recipients.

In response to limited resources and overwhelming clinical need, we previously developed an approach to alcoholic patient selection for liver transplant based on factors reported to predict short- and long-term sobriety in prospective studies of alcoholics. The present study reports follow-up data comparing alcohol dependent (n = 22, DSM-3-R criteria) and non-dependent (n = 39) subjects followed from 6 months to 3 years post-transplant. Nine percent of the alcoholics had returned to symptomatic drinking with 14% reporting some exposure to ethyl alcohol. Nearly half (46%) of the non-alcoholic group reported occasional social alcohol use. The alcoholic patients were less likely to be in their first marriage and more likely to be asked about alcohol use at follow-up clinic visits. In most other respects the two groups resembled each other more often than they differed. The alcoholic group reported continued high rates of prognostic factors associated with long-term abstinence although the content of these shifted noticeably between pre- and postoperative assessment. Members of both groups reported high frequencies of medication side effects, of missed doses of medications, and of depressive symptoms. Most felt the transplant had improved their lives but had brought on significant financial burden. There were no differences in subjective appraisals of either psychological or physical health between the two groups. These follow-up data suggest that carefully selected alcohol dependent patients will do as well as non-dependent patients after liver transplant.

Adaptation, Psychological↗
PubMed1992

Recurrence of hepatitis B and delta hepatitis after orthotopic liver transplantation.

The clinical course of 10 liver transplant recipients who had hepatitis B virus (HBV) and five recipients with HBV and D (delta) infection before transplantation is described. Six patients who underwent eight transplants died. The estimated one and two year survival rates in patients with HBV only before transplantation were 74% and 67% respectively. The estimated one and two year survival in patients with HBV and HDV infection beforehand was 100%. Graft infection by HBV occurred in 8 of 10 patients infected with HBV only; and in 4 of 5 patients with previous HBV and HDV infection. There was a widely variable time from transplantation to the appearance of HBV markers in liver or serum, ranging from 6-331 days. Hepatitis D antigen (HDAg) appeared in three grafts very rapidly after transplantation at 4, 8, and 37 days respectively. Graft infection by HBV was accompanied by significant liver injury in six allografts in five recipients. In particular, there was a striking morphological appearance in five infected livers in which the hepatocytes became progressively enlarged and distorted as they accumulated huge amounts of hepatitis B surface and core antigens (HBsAg, HBcAg). These features were accompanied by pericellular fibrosis and cholestasis but little associated inflammation. This syndrome carried a poor prognosis. A gradual progression to cirrhosis occurred in one additional liver. Finally, recurrent HBV infection was a principal or a contributing factor in all deaths. The presence of HBcAg and inflammation in he native liver increased the risk of HBV induced tissue damaged in the graft whereas HDV infection in the host liver seemed to reduce the risk of significant HBV induced tissue damage in the allograft. These data suggest that post transplant HBV infection is accompanied by a variety of changes in the liver allograft, some of which are unique to the transplanted liver and may result in impaired allograft function.

Adolescent↗
PubMed1992

Preoperative risk factor assessment in liver transplantation.

BACKGROUND: Despite the increasing success of liver transplantation, there is lack of objective data defining appropriate candidate suitability. This study was undertaken to determine preoperative risk factors that independently or in combination affected outcome after orthotopic liver transplantation. METHODS: We reviewed data on 229 consecutive adult liver transplant recipients. Thirty-one preoperative risk factors recorded at the time of listing and immediately before transplantation were analyzed. Outcome variables included hospital mortality rates, bacterial or fungal sepsis, and the need for renal support. RESULTS: The overall hospital mortality rate was 15.7%. Patients who were in the intensive care unit immediately before transplantation had the highest hospital mortality rate (32.6%; p = 0.006), incidence of bacterial sepsis (51%; p = 0.001), fungal infection rate (27.6%; p = 0.001), and need for renal support (38.7%; p = 0.001). Preoperative renal dysfunction was significantly associated with sepsis and was reflected in higher hospital mortality rates (29.5%; p = 0.011). Child-Pugh class C was associated with higher mortality rates (23.9%; p = 0.017), an increased incidence of bacterial (37.2%; p = 0.020) and fungal infection (20.3%; p = 0.049), and a 30.4% requirement for postoperative renal support (p = 0.004). CONCLUSIONS: These results emphasize the need for earlier referral and transplantation in patients with advanced liver disease. Further studies are needed to refine identified risk profiles and devise strategies to decrease morbidity and mortality rates.

Adult↗