Search PubMed⌕ Search

Biomedical subjects

N Tygstrup

Publications and source records attributed to N Tygstrup.

At least 109 records · Page 6Linked to original sources
PubMed1978

Clinical aspects of drug-induced hepatitis.

The drug reactions of the liver may be classified as to (1) reproducibility, (2) severity, (3) localization and (4) duration of the lesion. Ad 1) Few drugs give a reproducible, dose dependent, hepatic reaction (e.g. acetaminophen), a greater problem is the unpredictable, dose independent reactions caused by "indirect" hepatotoxic drugs (e.g. imipramin). Ad 2) Drug reactions may be fatal (e.g. halothane), of limited clinical importance (e.g. clorpromazin) or clinically insignificant (e.g. iopanoic acid). Ad 3) Histologically, and to some extent clinically, hepatocellular (e.g. propylthiouracil) may be distinguished from cholestatic (e.g. tolbutamide) reactions, but overlapping (e.g. phenylbutazone) and individual variations are common. Ad 4) Most drug reactions are acute, but an insiduous course, developping to cirrhosis, is increasingly recognized (e.g. oxyphenacetin). Drug reactions are usually not clinically, biochemically and morphologically distinct from other common liver diseases and are only diagnosed if this possibility is constantly kept in mind. Treatment other than withdrawal of suspected or known etiologic agents is virtually lacking. The basis for prophylaxis is careful registration of all drug reactions. Potentially hepatotoxic drugs should only be administered after thorough cost/benefit considerations.

Chemical and Drug Induced Liver Injury↗
PubMed1978

Treatment of gastric ulcer. The randomized clinical trials from 1964 to 1974 and their impact.

Twenty-nine randomized clinical trials (RCTs) from the decade 1964-74 evaluating treatments of gastric ulcer have been analyzed. None of them ful-filled all criteria for an ideal RCT. The most frequent shortcomings were: short treatment or follow-up periods, incomplete description of the patients included, small patient samples, suboptimal experimental design, lack of double-blind testing, high number of drop-outs, less precise or less relevant types of evaluation of the treatment effect, uncontrolled ancillary treatment, or lack of statistical evaluation of the results. The most frequently tested drug was carbenoxolone, which has been shown to be clearly effective. Judged by the effect on the recommendations in standard medical textbooks the impact of the best RCTs have been small. This situation emphasizes the need for more well-planned and performed RCTs on treatments of gastric ulcer.

Adult↗
PubMed1977

Treatment of acute viral hepatitis with (+)-cyanidanol-3.

A double-blind trial of (+)-cyanidanol-3 (2 g/day) versus placebo tablets was carried out in 100 patients with acute viral hepatitis. 51 received the drug and 49 placebo. (+)-Cyanidanol-3 accelerated the disappearance of HBsAg from the blood, lowered serum-bilirubin, and relieved symptoms such as anorexia, nausea, and pruritus. The drug was well tolerated. None of the patients had a relapse of acute hepatitis. Chronic active hepatitis developed in 1 of the placebo-treated patients. Thus, (+)-cyanidanol-3 seems to be of benefit in acute viral hepatitis.

Adult↗
PubMed1977

The epidemiology of the gastrointestinal randomized clinical trial.

Has the randomized clinical trial (RCT), generally accepted as the method of choice for evaluation of most treatments, obtained a footing in gastroenterology? Among 35,228 citations on gastroenterologic therapy indexed in MEDLARS 1964-1974 306 (0.9 per cent) were RCT's. During the decade their frequency rose significantly (P less than 0.05) from 0.3 per cent in 1964 to 1.7 per cent in 1973. The "typical" RCT was a double-blind two-group comparison of a new and an established drug on the symptoms of peptic ulcer; 50 patients were followed for six weeks, and the number of dropouts was unknown. The new drug was found to be more effective. It is postulated that the RCT's in gastroenterology are quantitatively and qualitatively insufficient and that co-ordinated planning of RCT's and uninhibited publication of statistically proved negative results may help to ensure that the patient with gastrointestinal disease receives the best available treatment.

Europe↗
PubMed1977

Effect of sites of blood sampling in determination of the galactose elimination capacity.

The galactose elimination capacity was calculated from both arterial and capillary or peripheral venous curves in twenty patients. The capillary curves on the average were delayed 1.4 min in relation to the arterial curves. No significant difference was found between the calculated galactose elimination capacity from either curve. On the average the slope of the venous curves was smaller than that of the arterial curve, and their time delay was very variable (from 1.55 to 5.27 min). Galactose elimination capacity calculated from venous curves was smaller than those calculated from arterial curves, especially in patients with a high galactose elimination capacity. Capillary blood sampling may replace arterial puncture for routine use, whereas venous blood sampling introduces a significant bias.

Adult↗
PubMed1977

Significance of suspected "chronic aggressive hepatitis" in acute hepatitis.

Transition from acute to chronic hepatitis has important prognostic and therapeutic implications. In 17 patients with acute viral hepatitis, observed during a period of 7 years, a liver biopsy showed changes compatible with chronic aggressive hepatitis and superimposed acute hepatitis. Follow-up biopsies showed normal liver in 14 cases, chronic persistent hepatitis in 1, and cirrhosis in 2. In 12 cases the initial biopsy which showed changes suggestive of chronicity was taken 1 month after onset of symptoms of acute hepatitis, or later. Cases developing chronic liver disease showed no characteristic clinical, laboratory, or histological features at the time of the first biopsy. If the diagnosis of chronic active hepatitis is based on histological findings alone in patients with prolonged acute hepatitis, the incidence of this condition will be grossly overestimated. The transition from acute to chronic hepatitis cannot be recognized with any degree of certainty by presently available methods.

Acute Disease↗
PubMed1976

Galactose elimination capacity as a prognostic index in patients with fulminant liver failure.

In 25 patients with fulminant hepatic failure the prognostic value of a quantitative liver function test, the galactose elimination capacity, was assessed and comapred with routine liver function tests and clinical features. The galactose elimination capacity was significantly higher (P less than 0-05) in the five patients who survived than in the 20 patients who died. None of the other liver function tests, was significantly different. The values of the galactose elimination capacity overlapped considerably between survivors and non-survivors, but all patients with a galactose elimination capacity below 12-8 mumol galactose/min and kg body weight died. The disease among most patients who died having a galactose elimination capacity greater than 13 mumol ran a subacute course. It is suggested that quantitative liver function tests be included when new treatments of fulminant hepatic failure are investigated.

Adolescent↗
PubMed1976

Michaelis-Menten kinetics of galactose elimination by the isolated perfused pig liver.

The relation between galactose elimination rates and blood concentrations in the isolated perfused pig liver was analyzed by a mathematical kinetic model. It assumes that the substrate, under steady-state conditions, is removed from the blood that flows through the sinusoids by an irreversible process which follows Michaelis-Menten (i.e., saturation) kinetics. The experiments consisted of successive periods with constant infusions of galactose. The model fitted the data to within the experimental uncertainty. The estimated maximal rate (Vmax) ranged from 0.34 to 0.57 mmol-min(-1)-kg(-1) liver, and the Michaelis constant, Km, ranged from 0.12 to 0.30 mmol-liter(-1) plasma water in nine experiments. The ratio between the galactose concentration in hepatocyte water and plasma water was not significantly different from 1.0, indicating that membrane transport is not rate limiting for the elimination of galactose. In experiments with increasing concentrations of galactose in hepatocyte water and approximately saturated elimination rates, the concentrations of galactose 1-phosphate, UDPgalactose, and UDPglucose remained essentially constant. This indicates that the phosphorylation of galactose to galactose 1-phosphate is the rate-determining process.

Animals↗
PubMed1976

The clinical significance of classifications of cirrhosis. A comparison between conventional criteria and numerical taxonomy.

Classification of patients with cirrhosis serves the clinical purpose of selecting patients for adequate therapy. A material of 441 patients from a randomized clinical trial of prednisone treatment were classified according to different criteria, and the effect of this therapy was assessed by comparing the survival curves of controls and treated patients in the groups. Six classifications based on single criteria were studied, viz. females vs. males, alcoholics vs. non-alcoholics, compensated vs. decompensated cases, active vs. inactive cases, manifest vs. latent cases, and non-primary biliary vs. primary biliary cirrhosis. The latter group was too small for further analysis. Furthermore, the material was classified by numerical taxonomy, based on 56 clinical symptoms and signs and histological and serological changes. The taxonomical classification showed interdependence with all the clinical classifications, except that of primary biliary cirrhosis. Three clinical classifications, viz. those based on sex, alcoholism, and compensation, and one taxonomic class showed a significant therapeutic relevance. Combination of these criteria revealed that female patients with compensated non-alcoholic cirrhosis, previously demonstrated to benefit from prednisone treatment, showed a markedly greater prednisone effect if they belonged to the taxonomic group than if they did not. According to clinical, histologic, and laboratory data, the latter group was characterized as less severe cases than the former one. Whereas this discrepancy between clinical severity and therapeutic effect cannot be fully explained, the data do suggest that clinical criteria may not be ideal for selection of patients with cirrhosis for steroid therapy, and that numerical taxonomy may provide clues for more clinically significant classifications.

Alcoholism↗
PubMed1975

[Cholestasis].

Explore the source record for details and available documents.

Acute Disease↗
PubMed1975

Diagnostic value of routine liver tests.

In 131 patients on a medical service and 97 patients on a surgical service, in whom a diagnosis of hepatobiliary disease was verified in the hospital, the diagnostic value of routine liver tests performed soon after admission was evaluated by stepwise discriminant analysis. By measurements of alanine aminotransferase, alkaline phosphatases, gamma globulin, prothrombin time, bilirubin, and albumin, half of the medical patients were correctly classified into one of seven diagnostic categories. Aminotransferase contributed most to the classification, being twice as effective as random allocation. Decreasing the number of diagnostic categories to three (hepatitis, fatty liver, and chronic liver disease) increased the frequency of correct allocation to 80%. The allocation of all the patients to seven medical and four surgical diagnostic categories by means of four tests (aminotransferase, alkaline phosphatases, prothrombin time, and bilirubin) was significantly improved by each step with a misclassification rate of 55% when all tests were used. A reduction of the diagnostic groups to five (hepatitis, fatty liver, chronic liver disease, duct obstruction and tumor) increased the frequency of correct allocation to 63%. The analysis demonstrates the limited diagnostic effectiveness of routine liver tests when used alone. The absolute discrimination values depend on the a priori frequencies of the diagnostic groups investigated, and therefore may vary from time to time and from place to place.

Alanine Transaminase↗