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Biomedical subjects

N M Bass

Publications and source records attributed to N M Bass.

At least 19 recordsLinked to original sources
PubMed2003

Measurement of the profile angle and the aesthetic analysis of the facial profile.

Cephalometric measurement of the face in terms of aesthetics can be difficult and misleading due to the variability of the intra-cranial reference lines. Extra-cranial references are more accurate, but can be time-consuming to apply. The Aesthetic Horizontal is an intuitive datum line related to the 'photographic position' of the head, which is expedient in use and clinically relevant. A new and straightforward technique is presented for transferring the Aesthetic Horizontal directly from the patient to any recent radiograph, which can then be used as the reference line for an aesthetic analysis of the facial profile. The instrument used for measuring the profile angle and the transfer is readily constructed from a protractor and small weight. The technique can also be used to transfer any other orientation (e.g. Natural Head Position or Natural Head Posture) from the patient to a recent radiograph.

Cephalometry↗
PubMed2001

Tooth notations.

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Classification↗
PubMed2001

Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival.

The precise staging of hepatocellular carcinoma (HCC) based on the size and number of lesions that predict recurrence after orthotopic liver transplantation (OLT) has not been clearly established. We therefore analyzed the outcome of 70 consecutive patients with cirrhosis and HCC who underwent OLT over a 12-year period at our institution. Pathologic tumor staging of the explanted liver was based on the American Tumor Study Group modified Tumor-Node-Metastases (TNM) Staging Classification. Tumor recurrence occurred in 11.4% of patients after OLT. The Kaplan-Meier survival rates at 1 and 5 years were 91.3% and 72.4%, respectively, for patients with pT1 or pT2 HCC; and 82.4% and 74.1%, respectively, for pT3 tumors (P =.87). Patients with pT4 tumors, however, had a significantly worse 1-year survival of 33.3% (P =.0001). An alpha-fetoprotein (AFP) level > 1,000 ng/mL, total tumor diameter > 8 cm, age > or = 55 years and poorly differentiated histologic grade were also significant predictors for reduced survival in univariate analysis. Only pT4 stage and total tumor diameter remained statistically significant in multivariate analysis. Patients with HCC meeting the following criteria: solitary tumor < or = 6.5 cm, or < or = 3 nodules with the largest lesion < or = 4.5 cm and total tumor diameter < or = 8 cm, had survival rates of 90% and 75.2%, at 1 and 5 years, respectively, after OLT versus a 50% 1-year survival for patients with tumors exceeding these limits (P =.0005). We conclude that the current criteria for OLT based on tumor size may be modestly expanded while still preserving excellent survival after OLT.

Adult↗
PubMed2001

Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: a comparative study using a matched, untreated cohort.

Uncontrolled studies have suggested a beneficial effect of lamivudine in patients with decompensated cirrhosis caused by replicating hepatitis B virus (HBV). We analyzed the outcome of lamivudine treatment in 23 consecutive patients with severely decompensated HBV-cirrhosis defined as a Child-Pugh-Turcotte (CPT) score of > or =10, and compared with a historical untreated control group of 23 patients matched for age, gender, and baseline CPT score. Significant clinical response, defined as a decrease in the CPT score by > or =3 points, was observed in 14 of 23 (60.9%) treated patients versus none of the controls (P <.0001). The median change in CPT scores was -3.0 (range, -6 to +3) in the treated group versus +1.0 in the controls (range, -1 to +2) (P =.016). Orthotopic liver transplantation (OLT) was performed in 34.8% of treated patients (median, 3.5; range, 1-32 months), versus 73.9% of controls (median, 3.0; range, 1-14 months) (P =.04). Excluding transplanted patients, there were no deaths in the treated group versus 6 deaths in the control group (P =.009). Time to death or OLT was significantly longer in treated patients than in controls (P <.001). Two patients developed lamivudine resistance after 9 and 12 months, respectively. Our results suggest that lamivudine significantly improves hepatic function in over half of the patients with decompensated cirrhosis and replicating HBV, and may confer a survival advantage. However, the small sample size and the use of a retrospective control cohort preclude drawing definitive conclusions. Expedited OLT remains the only viable treatment for lamivudine nonresponders.

Adolescent↗
PubMed2001

The role of the interventional radiologist. Transjugular procedures.

The transjugular route provides a convenient and safe approach for the interventional radiologist to access the hepatic parenchyma and hepatic vascular structures. The transjugular intrahepatic portosystemic shunt has revolutionized the management of the complications of portal hypertension, allowing the establishment of a side-to-side shunt without recourse to surgery and general anesthesia. On a smaller scale, the transjugular approach to obtaining a liver biopsy has also proven its worth in allowing the histologic diagnosis and staging of liver disease in patients in whom such information is required for appropriate management but major contraindications to percutaneous biopsy exist. This article reviews the current techniques, indications, and complications of these interventional procedures and their role in the management of patients with end-stage liver disease.

Ascites↗
PubMed2001

Primary biliary cirrhosis: from induction to destruction.

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease that predominantly affects middle-aged women; fatigue and pruritus are the most common symptoms at presentation. Liver function tests are consistent with cholestasis and reveal an elevation of serum alkaline phosphatase and gamma-glutamyl transpeptidase with or without elevation of aminotransferase levels. Histologically, PBC is characterized by the destruction of the intrahepatic small bile ducts and subsequently fibrosis. The serological hallmark of the disease is the presence of antimitochondrial antibodies, which are found in 95% of patients with PBC. The antimitochondrial antibodies are directed against the 2-oxo-acid dehydrogenase complexes located on the inner membrane of the mitochondria. PBC generally slowly progresses, even over decades, and may lead to liver failure. In symptomatic patients, advanced age, elevated serum bilirubin levels, decreased serum albumin levels, and cirrhosis each correlate with shortened survival. Immunosuppressive and anti-inflammatory drugs have been used in the treatment of PBC based on the presumed autoimmune pathogenesis, but satisfactory agents leading to complete reversal or cure of the disease are not available. At present ursodeoxycholic acid appears to be the only effective therapy in preventing or delaying the need for liver transplantation and improving survival. However, a number of patients receiving ursodeoxycholic acid still develop progressive disease and require transplantation; transplantation is the only effective therapy at the end stage of the disease.

Adult↗
PubMed2000

Severe liver injury after treatment with the leukotriene receptor antagonist zafirlukast.

BACKGROUND: In registration trials, zafirlukast, an asthma medication, caused asymptomatic elevated aminotransferase levels in up to 5% of participants. Until now, however, no cases of severe hepatitis attributed to zafirlukast have been reported. OBJECTIVE: To report the clinical characteristics of three patients with severe hepatitis due to zafirlukast. DESIGN: Case report. SETTING: One community hospital and two university hospitals. PATIENTS: Three middle-aged women taking zafirlukast, 20 mg twice per day. INTERVENTION: Discontinuation of zafirlukast therapy in three patients, steroid therapy in two patients, and orthotopic liver transplantation in one patient. MEASUREMENTS: Serum aminotransferase and bilirubin levels, standard blood tests for causes of hepatitis other than drug toxicity, and liver biopsy in two patients. RESULTS: Patient 1 recovered spontaneously, had a severe relapse after inadvertent rechallenge with the medication, and ultimately made a complete recovery. Patient 2 developed subfulminant hepatic failure and required liver transplantation. Patient 3 developed severe hepatitis that improved after treatment with corticosteroids. Liver tissue was available from two patients and showed histologic changes commonly associated with drug reactions. CONCLUSION: Patients receiving zafirlukast may develop severe liver injury and should be observed for signs and symptoms of hepatitis.

Adrenal Cortex Hormones↗
PubMed2000

Dental notations.

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Classification↗
PubMed2000

Intestinal fatty acid binding protein may favor differential apical fatty acid binding in the intestine.

The intestinal mucosa metabolizes fatty acids differently when presented to the lumenal or basolateral membrane. Expression of both liver and intestinal fatty acid binding proteins (L- and I-FABPs) uniquely in the enterocyte offers a possible explanation of this phenomenon. An organ explant system was used to analyze the relative binding of fatty acids to each protein. More fatty acid was bound to L-FABP than to I-FABPs (28% vs. 6% of cytosolic radioactivity), no matter on which side the fatty acid was added. However, a 2-3-fold increase in fatty acid binding to the intestinal paralog was noted after apical addition of palmitic or oleic acid in mucosa from chow fed rats. When oleic acid was added apically, a 1.4-fold increase in binding to I-FABP was observed in mucosa derived from chronically fat fed rats, consistent with the previously observed 50% increase in the content of that protein. Immunocytochemical localization of both FABPs in vivo demonstrated an apical cytoplasmic localization in the fasting state, and redistribution to the entire cytoplasm after fat feeding. These data are consistent with the hypothesis that I-FABP may contribute to the metabolic compartmentalization of apically presented fatty acids in the intestine.

Animals↗
PubMed2000

Lamivudine treatment in patients with severely decompensated cirrhosis due to replicating hepatitis B infection.

BACKGROUND/AIMS: Lamivudine is highly effective in suppressing hepatitis B viral replication and hepatic necroinflammatory activity. The potential for recovery of hepatic decompensation in patients with chronic hepatitis B infection treated with lamivudine has not been established. The aim of this study was to evaluate the effectiveness of lamivudine treatment in severely decompensated cirrhosis due to chronic hepatitis B. METHODS: Thirteen consecutive patients with chronic hepatitis B infection, Child's-Pugh-Turcotte (CPT) score of > or =10 (median score=11) and detectable circulating hepatitis B DNA (range 15 to 9634 pg/ml) were included and treated with lamivudine 150 mg once daily. Hepatitis B envelope antigen (HBeAg) was positive in 9 of 13 patients pre-treatment. RESULTS: Two patients underwent liver transplantation at 4 and 6 weeks after starting lamivudine treatment. The remaining 11 patients were followed for a mean of 17.5 months without liver transplantation (range 3 to 39 months). Significant improvement of liver function, defined as a decrease in CPT score of > or =3, was observed in 9 of 13 patients (69%). In five patients, CPT score improved to <7 and they were placed on the inactive status (UNOS status 7) for liver transplantation. Hepatitis B DNA remained negative in all except one patient who developed breakthrough viral replication 12 months after starting lamivudine treatment, while maintaining stable liver function. Three of seven HBeAg-positive patients who did not undergo liver transplantation lost HBeAg during follow-up, but none had sustained seroconversion to hepatitis B e antibody. CONCLUSION: Lamivudine appears highly effective in reversing severe hepatic decompensation due to replicating hepatitis B infection.

Administration, Oral↗
PubMed2000

Troglitazone-induced fulminant hepatic failure. Acute Liver Failure Study Group.

The three reported cases demonstrate that troglitazone is an idiosyncratic hepatotoxin that can lead to irreversible liver injury. Thus, troglitazone should be prescribed with caution and should not be used as a first-line agent in the treatment of type II DM when potentially less toxic alternatives are available. It remains to be seen whether the hepatotoxicity associated with troglitazone is a drug-class effect or specific to troglitazone. Other thiazolidinediones currently in clinical trials may be able to provide the therapeutic benefits of troglitazone without significant hepatotoxicity. If troglitazone is used, frequent monitoring of serum aminotransferases and symptoms is mandatory. However, as illustrated by these and other cases reported to date, the onset of troglitazone-induced liver injury is insidious and temporally variable. Thus, the value of close monitoring and when, if ever, it is safe to stop such monitoring are currently unclear.

Chromans↗
PubMed2000

Hepatic tissue endothelin-1 levels in chronic liver disease correlate with disease severity and ascites.

OBJECTIVES: Plasma endothelin-1 (ET-1) levels are increased in patients with cirrhosis and ET-1 production is increased in the liver itself during experimental injury. These data suggest a possible role for this vasoactive peptide in intrahepatic microcirculatory changes that contribute to the pathogenesis of portal hypertension in cirrhosis. Therefore the aims of this study were to determine whether ET-1 levels were abnormal in the livers of patients with cirrhosis and to investigate possible clinical correlates of altered hepatic ET-1 in cirrhosis. METHODS: Liver specimens were obtained from explants at the time of liver transplantation in 62 cirrhotic patients; 49 without pretransplantation transjugular intrahepatic portosystemic shunt (TIPS) and 13 with pretransplantation TIPS. The presence of ascites was evaluated by physical examination and ultrasonography. Control specimens consisted of livers with normal morphology obtained from patients who died from nonliver-related causes. Hepatic ET-1 was measured by enzyme immunoassay. RESULTS: Hepatic ET-1 levels in cirrhotics without (0.17 pg/mg liver tissue) or with TIPS (0.12 pg/mg) were higher than in control patients [0.04 pg/mg (p = 0.02 for ET-1 levels in cirrhotics with or without TIPS vs. control)]. In cirrhotics without ascites who had not had TIPS, ET-1 levels (0.07 pg/mg [0.04-1.00]) were similar to those of the controls. In contrast, ET-1 content was increased in cirrhotics with small (0.11 pg/mg; p = 0.0002) and moderate-to-large (0.69 pg/mg; p = 0.0002) amounts of ascites compared to patients without ascites. There was a modest correlation between ET-1 levels and Child-Pugh score (correlation coefficient 0.32; p = 0.03) and ET-1 levels were significantly higher in patients with Child-Pugh score of 13 or greater (0.88 pg/mg; p = 0.02) than in those with Child-Pugh score of 12 or less (0.16 pg/mg). CONCLUSIONS: Hepatic tissue ET-1 levels are increased in the liver of patients with cirrhosis. This increase appears to be proportional to the severity of both liver disease and ascites. These data raise a possible role for ET-1 in modulation of intrahepatic resistance in cirrhotic portal hypertension.

Adult↗
PubMed1999

Down-regulation of liver and heart specific fatty acid binding proteins by endotoxin and cytokines in vivo.

Fatty acid binding proteins (FABPs) are abundantly present in tissues that actively metabolize fatty acids (FA). While their precise physiological function is not known, FABPs have been shown to play a role in the uptake and/or utilization of FA within the cell. FA metabolism is markedly altered during the host response to infection and inflammation. Previous studies have demonstrated that endotoxin or bacterial lipopolysaccharide (LPS) enhances hepatic FA synthesis and re-esterification while inhibiting FA oxidation in liver, heart and muscle. Now, we have examined the in vivo effects of LPS and cytokines on FABPs in liver (L-FABP), heart and muscle (H-FABP). Syrian hamsters were injected with LPS, tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) and the mRNA and protein content for L-FABP and H-FABP were analyzed. 16 h after administration, LPS (100 microg/100 g body weight) produced a 72% decrease in L-FABP mRNA levels in liver and this effect was sustained for 24 h. LPS also produced a 41% decrease in the protein content of L-FABP in liver after 24 h of treatment. TNF-alpha and IL-1beta decreased L-FABP mRNA levels in liver by 30 and 45%, respectively. LPS decreased H-FABP mRNA levels in skeletal muscle by 60% and in heart by 65%. LPS also produced a 49% decrease in H-FABP protein content in muscle. Neither TNF-alpha nor IL-1beta had any significant effect on H-FABP mRNA expression in heart and muscle. Taken together, these results indicate that LPS decreases FABP mRNA and protein levels in liver, heart and muscle, tissues that normally utilize FA as their primary fuel, whereas the inhibitory effect of cytokines is limited to the liver. The LPS-induced decrease in L-FABP and H-FABP may be an additional mechanism contributing to the decrease in FA oxidation that is associated with the host response to infection and inflammation.

Animals↗