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Biomedical subjects

R R Schade

Publications and source records attributed to R R Schade.

At least 55 records · Page 3Linked to original sources
PubMed1986

Thyroid and pituitary hormone responses to TRH in advanced nonalcoholic liver disease.

Basal T4, T3, TSH, prolactin and growth hormone levels were determined in several groups: patients with postnecrotic cirrhosis with hepatocellular carcinoma (n = 14); patients with postnecrotic cirrhosis but without hepatocellular carcinoma (n = 26); cholangiolar carcinoma (n = 9); and normal controls age-matched to within 5 yr of the liver disease subjects studied. In addition, TRH stimulation (400 micrograms TRH) was performed; TSH, prolactin and growth hormone responses over a 180-min time interval were evaluated for each subject. The responses observed varied between liver disease groups. The presence or absence of hepatocellular carcinoma was found to determine, at least in part, the type of response observed. Similarly, the presence or absence of hepatic encephalopathy determined, and/or reflected, at least in part, the type of response observed. Finally, for purposes of continuity, basal and TRH-stimulated levels of TSH, prolactin, growth hormone, T4 and T3 are compared in 3 settings of cirrhosis: alcoholic, nonalcoholic postnecrotic cirrhosis, and postnecrotic cirrhosis with hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1986

Does previous abdominal surgery alter the outcome of pediatric patients subjected to orthotopic liver transplantation?

The medical, anesthesia, and surgical records of 89 consecutive pediatric patients who underwent an orthotopic hepatic transplantation procedure at the University of Pittsburgh from February 1981 to May 1984 were reviewed to evaluate the effect of prior abdominal surgery upon the morbidity and mortality of orthotopic liver transplantation in children. Fifty-seven children (group 1) had had prior abdominal surgery, whereas 32 (group 2) had not. The group 1 subjects were younger (p less than 0.001), had better prothrombin times (p less than 0.01), and better platelet counts (p less than 0.02) than did those in group 2. No difference in the duration of anesthesia or intraoperative use of fresh frozen plasma or platelets was evident between the two groups. However, group 1 patients were given more red blood cells intraoperatively than were the group 2 patients (p less than 0.01). The group 1 patients had more total postoperative infections (p less than 0.05), which was due solely to a greater number of abdominal infections (p less than 0.05), but similar total hospital and intensive care unit stays as did the group 2 patients. When those in group 1 were divided into those having a previous Kasai procedure versus those who did not, no differences between the two groups were apparent except for age. Based upon these data, we conclude that prior abdominal surgery does not affect mortality, the duration of hospital or intensive care unit stay, plasma or platelet requirements, and total anesthesia time required for orthotopic liver transplantation, but does enhance the number of red blood cell transfusions and infections, particularly abdominal infections, in children undergoing this procedure.

Abdomen↗
PubMed1985

Effect of metoclopramide on gastric liquid emptying in patients with diabetic gastroparesis.

Metoclopramide tablets have been approved for use in the acute and chronic management of diabetic gastroparesis. Its efficacy as an antiemetic has been well documented. We measured the acute and chronic effects of oral metoclopramide on gastric liquid emptying in 12 diabetic patients with symptoms of stasis using scintiscanning techniques. We found that liquid emptying in these subjects was abnormal, as determined by residue area determination when compared to normal volunteers (P less than 0.01). Metoclopramide 10 mg orally acutely enhanced emptying, restoring it to control values (P less than 0.01). In contrast, when gastric emptying was evaluated following one month of chronic liquid metoclopramide use, 10 mg before each meal, the acute effect of the drug on emptying could no longer be demonstrated and residue areas returned to baseline values, suggesting that chronic oral administration of metoclopramide may result in a loss of the gastrokinetic properties of this drug.

Adult↗
PubMed1985

In vivo hepatic volume determination using sonography and computed tomography. Validation and a comparison of the two techniques.

Ultrasonography and computed tomography were used to determine hepatic volume in vivo. The data obtained were compared with the weight and volume of the same livers after surgical removal at the time of orthotopic hepatic transplantation. The relationship between hepatic weight and volume was found to be linear over a 16-fold range of weights and a 19-fold range of volumes. The sonographic results more closely paralleled the results obtained directly. These data demonstrate that both methods can determine, within acceptable limits, hepatic volume or weight. The sonographic technique, however, is more accurate than the computed tomography scan method as it allows the use of sagittal scanning of the liver, which is superior to the transverse scanning technique required by the computed tomography scanner. In addition, these results demonstrate that these methods might be applied in the future for better matching of donors and recipients of orthotopic liver transplants.

Body Water↗
PubMed1985

Pituitary and thyroid hormone levels before and after orthotopic hepatic transplantation and their responses to thyrotropin-releasing hormone.

Basal and TRH-induced responses of T3, T4, TSH, GH, and PRL were determined before and 1 month after orthotopic hepatic transplantation in 41 patients (22 with primary biliary cirrhosis and 19 with primary sclerosing cholangitis). The responses of these patients before and after transplantation were compared to those of age-matched normal subjects. The results demonstrate that 1 month after successful hepatic transplantation, basal and TRH-induced TSH, GH, and PRL levels had decreased toward, but not completely to, normal levels.

Adult↗
PubMed1984

T-lymphocyte subsets in liver tissues of patients with primary biliary cirrhosis (PBC), patients with primary sclerosing cholangitis (PSC), and normal controls.

T lymphocytes infiltrating hepatic tissues were typed and enumerated in liver biopsies of patients with primary biliary cirrhosis (PBC), patients with primary sclerosing cholangitis (PSC), and normal controls using monoclonal antibodies and the avidin-biotin-immunoperoxidase technique. The peripheral blood mononuclear cells were studied also by flow cytometry. In PBC, T lymphocytes were decreased (P less than 0.001) in the blood [absolute number was 426 +/- 200 (SE) vs 1351 +/- 416 in 15 controls], as was the helper/suppressor (T4/T8) ratio (1.0 +/- 0.1 vs normal 2.3 +/- 0.3). T lymphocytes were the most numerous mononuclear cells infiltrating portal areas of PBC livers: 749 +/- 93/5 high-power fields (HPF) in PBC vs 98 +/- 15/5 HPF (P less than 0.01) in controls. The T4/T8 ratios varied from 0.9 to 2.3 (mean, 1.8 +/- 0.1) in the portal triads (normal mean, 1.6 +/- 0.1), with the T4+ cells accounting for more than 75% of infiltrating T cells. In contrast, the mean T4/T8 ratio in portal triads of PSC was reduced (1.0 +/- 0.3) due to a significant increase (P less than 0.001) in the number of T8+ cells. The T cells around and in the walls of bile ducts in PBC were mostly T8+, and the T4/T8 ratio was 0.8 +/- 0.2. No T8+ cells were seen in this location in PSC and normal livers. Few mononuclear cells were present in hepatic lobules. Subtyping of T lymphocytes in liver tissues of patients with PBC and PSC may be helpful in the differential pathologic diagnosis. In patients with advanced PBC, a decrease in T4+ cells in the blood appeared to be accompanied by their accumulation in the portal triads. In contrast, T8+ cells accumulated preferentially around bile ducts.

Adult↗
PubMed1984

Chronic idiopathic ulcerative colitis. Pregnancy and fetal outcome.

Many frequently cited studies of the interaction of chronic idiopathic ulcerative colitis (CIUC) and pregnancy were performed in the 1950s before pharmacotherapy for this disease was common. We retrospectively reviewed obstetrical records at a large maternity facility to determine the effects of CIUC on pregnancy and on fetal outcome. We observed that the prevalence of CIUC in pregnant women was below that expected based on published data (P less than 0.01). The use of prednisone and sulfasalazine in pregnant women with CIUC was common; 85% of these patients received these medications. We found significantly greater (P less than 0.01) incidence of low-birth-weight in infants (less than 2500 g) of mothers with CIUC than in the control population. The delivery of infants of low birth weight occurred despite adequate maternal weight gain.

Adolescent↗
PubMed1984

Esophageal function after injection sclerotherapy: pathogenesis of esophageal stricture.

Injection sclerotherapy effectively controls hemorrhage from esophageal varices. Treatment must be repeated at intervals to obliterate varices. Long-term sequelae of such treatment are unknown but may include stricture formation. To assess the impact of repeated sclerotherapy on esophageal function, this prospective study measured lower esophageal sphincter pressure, reflux, and motility in patients before and after treatment. Injection sclerotherapy had no effect on lower esophageal sphincter pressure. Reflux was common before treatment and became even more prevalent after treatment, with reflux occurring in 60 percent of postsclerotherapy patients. Striking disturbances in esophageal motility were observed after treatment. Injection sclerotherapy induces a chemical esophagitis that impairs esophageal motility. Delayed acid clearance in the presence of reflux results in superimposed acid esophagitis. Esophageal strictures may thus be produced. We advise a standard antireflux medical regimen in our sclerotherapy patients.

Esophageal Stenosis↗
PubMed1984

The esophagus after injection sclerotherapy of varices: immediate postoperative changes.

Following the endoscopic injection sclerosis (EIS) of esophageal varices, radiographic procedures heretofore have played a minimal role in the dynamic assessment of structural and physiological alterations of the esophagus. This study includes a control esophagogram of each patient before any treatment. Esophageal studies were performed both before and after barium ingestion within a few hours of the treatment session, and findings were contrasted with those of the control esophagography and correlated with those of endoscopy. In all patients, immediately after EIS there was marked narrowing along the distal esophagus with both an upwardly convex border or shoulder effect at the sites of injection and variceal thrombosis. Functional changes of weakened peristalsis or achalasia evolved after early treatment sessions. Delayed emptying of the contrast-medium bolus was observed above the stricture and occasionally in the more proximal esophagus. The radiographic findings demonstrate the immediate sequela of transient dysphagia and the more long term complications of fibrosis and stricture.

Aged↗
PubMed1984

Prenatal and neonatal exposure of male rat pups to cimetidine but not ranitidine adversely affects subsequent adult sexual functioning.

Cimetidine, ranitidine, or water was administered to pregnant rats from the 12th day of pregnancy through weaning at 21 days of age. The effects of such treatments upon the male progeny were evaluated. Anogenital distance and indices, measures of masculinity, were found to be reduced (p less than 0.05) in pups of cimetidine-exposed dams but not in the pups obtained from either the ranitidine or water controls. In addition, at 55 days and 110 days of age, the testes and ventral prostate-seminal vesicles (androgen-responsive tissues) of the rats exposed to cimetidine were smaller (p less than 0.05) than those of the other two groups. Moreover, at both 55 and 110 days of age, the testosterone levels were reduced (p less than 0.05) in these same pups. Despite the fact that the cimetidine-exposed animals had reduced testosterone levels compared with the levels of the other two groups, the luteinizing hormone levels did not differ among the three groups. Finally, both before and after exogenous androgen replacement, the sexual behavior of the cimetidine-exposed animals was diminished when compared with that of the other two groups.

Animals↗
PubMed1984

Neuropsychiatric status after liver transplantation.

A neuropsychiatric study of individuals who underwent successful liver transplantation an average of 3 years previously was conducted to assess quality of life in terms of cognitive capacity and psychiatric status, as well as social and behavioral functioning. Compared with a control group of patients with Crohn's disease, liver transplant patients did not differ on measures of intelligence, language, attention, concentration, spatial organization, memory, or learning. Performance on these diverse aspects of cognitive functioning was in the normal ranges for both groups when compared with normative or standardized test values. The control and liver transplant patients were not different from each other on measures of psychiatric status or social functioning; however, both groups exhibited some disruption of functioning in these two areas when contrasted with normative values. We conclude that relatively young individuals (mean age in this study, 27.8 years) do not exhibit debilitating long-term neuropsychiatric disability after liver transplantation, although some disturbance in social and psychiatric adjustment was observed.

Adult↗
PubMed1984

Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy.

Although much is known about the neuropsychological functioning of cirrhotic individuals with Laennec's (alcohol associated) cirrhosis, little is known about the neuropsychological functioning of individuals with nonalcoholic cirrhosis. In the present investigation, we have determined that individuals suffering from chronic nonalcoholic cirrhosis, despite the absence of clinical signs of hepatic encephalopathy, are impaired on neuropsychological tests that measure visuopractic capacity, visual scanning, and perceptual-motor speed. In contrast, intellectual, language, memory, attentional, motor, and learning abilities are intact. In comparison with a chronically ill control group of patients suffering from Crohn's disease, individuals with advanced nonalcoholic cirrhosis exhibit less emotional disturbance, but are more impaired in their daily activities. These findings indicate that individuals with nonalcoholic cirrhosis, even in the absence of overt clinical signs of encephalopathy, manifest neuropsychological impairments and experience significant disruption in the routines of everyday living.

Adult↗
PubMed1983

Studies of lymphocyte subpopulations in the liver tissue and blood of patients with chronic active hepatitis (CAH).

Monoclonal antibodies to antigens on the surfaces of mononuclear cells (MNC) were used to characterize lymphocyte subpopulations infiltrating portal areas and parenchyma of livers in 31 patients with chronic active hepatitis (CAH). The distribution and numbers of infiltrating lymphocytes were determined in serial sections immunostained by the avidin-biotin-peroxidase complex method. T lymphocytes were the major component of inflammatory cells in the portal tracts. In the peripheral blood and portal areas, T helper-inducer (T4+) cells were the more numerous subpopulation. However, the hepatic lobules and areas of "piecemeal" necrosis always contained more T suppressor-cytotoxic (T8+) cells. The latter were demonstrated in contact with HBsAg-containing hepatocytes in tissues of patients with HBsAg-positive CAH. The mean numbers of T lymphocytes infiltrating the portal and periportal areas of livers from patients with HBsAg-negative and HBsAg-positive CAH were not different. Large numbers of B cells forming distinct follicles were seen in tissues from patients with HBsAg-positive CAH. The presence of increased numbers of portal T and B lymphocytes correlated with progressive liver damage as observed in two patients studied at yearly intervals.

Adolescent↗