Primary biliary cirrhosis: symptomatic treatment.
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Adult↗
Biomedical subjects
P Burra
Publications and source records attributed to P Burra.
Peptic ulcer in cirrhotic patients: a short- and long-term study with antisecretory drugs.
The clinical course of gastric and duodenal ulcer and the efficacy of H2 blockers in ulcer healing and the prevention of relapse in cirrhotic liver patients were studied. Seventy-four cirrhotic patients with endoscopically proven acute gastric ulcer (30), duodenal ulcer (34) or a combination of both gastric and duodenal ulcers (10) were treated for six weeks with either Cimetidine 800 mg/daily (27) or Ranitidine 300 mg/daily (47). Of the 77 patients 49 (66.2%) were healed after therapy, 11 cases (14.8%) remained unhealed even after two additional cycles of the same treatment and four were lost to follow-up. After an endoscopically proven healing of the active ulcer, 51 patients took part in the long-term study over a mean period of 24 months: 21.5% of the 27 patients were treated with a maintenance dosage of H2 blockers and 29.1% of the 24 patients left without therapy relapsed during the first year. We conclude that the ulcer healing rate with H2 blockers is lower and the relapse rate higher in cirrhotic patients than in the general ulcer population.
Adult↗
Dynamic tests to study liver function.
Two approaches have generally been used to assessing liver function: one is to measure the products of liver synthesis, the other is to monitor hepatic clearance function. The exogenous dyes that can be used to study liver function are sulphobromophthalein (BSF) and indocyanine green (ICG). One valuable way to measure hepatic function is to use non-toxic substances (stains, sugar, drugs) that are selectively metabolized by the liver and determine the rates of metabolism of these substances in vivo. The antipyrine clearance test is the most common and correlates well with the degree of liver damage. The caffeine clearance test is beneficial in severe liver lesions, but practically useless in the case of moderate liver damage. The galactose clearance test can be used early in the clinical course of jaundice to distinguish between hepatocellular disease and biliary obstruction. The MEGX test is useful as a real-time method for quantitatively assessing pre- and post-transplant liver function. In short, quantitative liver function tests are not suitable for use in screening for liver disease. They are more complex to perform and more expensive than conventional biochemical tests, but superior in monitoring the degree of liver dysfunction.
Humans↗
Longitudinal prospective study on quality of life and psychological distress before and one year after liver transplantation.
BACKGROUND: The impact of liver disease and medical complications on quality of life (QOL) and psychological distress before and after liver transplantation (LT) is a matter of growing interest. METHODS: In a longitudinal prospective study, perceived QOL (LEIPAD Quality of Life test) and psychological distress (Brief Symptom Inventory, BSI) were assessed in 25 cirrhotic patients when they were listed for LT and 1, 3, 6 and 12 months after LT. Patients were also evaluated for medical complications and blood levels of immunosuppressive agents. RESULTS: Overall QOL and psychological distress improved significantly and rapidly in most domains from the first month and up to a year after LT. Medical complications and immunosuppressive agents did not correlate with any changes in QOL and psychological distress after LT. When patients were divided according to liver disease etiology: 1. HCV patients listed for LT had worse QOL levels than the group of patients as a whole or the alcoholic liver disease (ALD) patients; 2. HCV patients reported a significant improvement in QOL only 6 and 12 months after LT, and still suffered more psychological distress 12 months after surgery; 3. in ALD patients, overall QOL and psychological distress improved significantly at all follow-up points after LT; 4. HCV patients reported a worse QOL and greater psychological distress 1 and 3 months after LT than the group as a whole or the ALD patients (p < 0.05). CONCLUSIONS: Liver transplantation improves QOL and psychological distress in most recipients, but not in the early stages after LT in patients transplanted for HCV cirrhosis.
Adaptation, Psychological↗
[Preservation of the liver with the University of Wisconsin solution. Clinical and experimental aspects].
The University of Wisconsin solution discovered in 1987 by Belzer and associates, has dramatically changed the logistics associated with liver transplantation. The extension of hypothermic preservation time has mode at possible: a) to operate in a semi-elective situation, rather than urgent; b) to improve patient selection and to be able to admit them from distant locations, and c) to reduce postoperative complications with a better quality of organ preservation. In the present work we illustrate the pathophysiological background and the rationale behind the various chemical constituents included in the new solution, emphasizing the antiedemogenic effect. Furthermore we report some experimental data on the role of energy level (ATP) and intracellular pH in the monitoring of liver preservation. Together with the improvements of surgical technique and immunosuppression, the new solution of the University of Wisconsin represents a fundamental step in the development of organ transplantation.
Adenosine↗