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At least 487 records · Page 27Linked to original sources
PubMed1989

An association between parameters of liver blood flow and percentage hepatic replacement with tumour.

The extent of hepatic replacement with tumour is a significant prognostic factor in patients with liver metastases. Measuring the percentage hepatic replacement (PHR) accurately is difficult, but is important for both patient management and clinical trial evaluation. This study correlates haemodynamic indices obtained by dynamic liver scintigraphy (DLS) with estimates of PHR made from isotope scan, ultrasound, CT scan and laparotomy in 45 patients with established colorectal liver metastases and 21 controls who also underwent DLS. There was a significant reduction in the mesenteric fraction (MF) in the group of patients with metastases compared to the controls (P less than 0.001), and also a significant trend for progressive reduction in the MF with increasing PHR. A significant rise in an index of total hepatic arterial blood flow was also demonstrated with increasing PHR. These results are important with current interest in regional hepatic arterial therapy, and may prove of clinical value for prediction or monitoring of response to therapy.

Colorectal Neoplasms↗
PubMed1983

Splanchnic galactose uptake in patients with cirrhosis following single injection.

The galactose elimination capacity is used as a quantitative liver function test and is supposed to express the functioning liver cell mass. Clinical observations indicate, however, that the galactose elimination capacity overestimates functioning liver cell mass, and we therefore compare hepatic (splanchnic) and extrahepatic, extrarenal galactose elimination after a single injection of galactose in 23 patients with reduced liver function. The galactose elimination capacity was consistently greater than the hepatic (splanchnic) galactose elimination rate, estimated during liver vein catheterization. The difference was on the average 0.68 mmol min-1 (SD +/- 0.19, P less than 0.001) or about 40% of the galactose elimination capacity. If this difference, partly or fully, is due to extrahepatic extrarenal elimination, the clinical test for galactose elimination needs a correction (of the order of magnitude of 0.7 mmol min-1) to serve as an absolute measure of the hepatic functional capacity, but since the hepatic uptake rate may be underestimated following a single injection, the correction may be smaller.

Catheterization↗
PubMed1978

[Clinical experience in the use of modern inhalation anaesthetic enflurane (author's transl)].

A clinical investigation was carried out on the findings obtained during 120 anaesthetics conducted with enflurane. The anaesthetic properties and the effects of enflurane on respiration, heart and circulation, liver, kidney, haematopoesis, clotting mechanisms and carbohydrate metabolism were evaluated. The results are discussed and the data compared with those of halothane for better quantitative assessment.

Anesthesia, Inhalation↗
PubMedDate not supplied

[Angiographic control of portocaval anastomoses. A study of hepato-portal circulatory changes after shunt (author's transl)].

The hepatoportal circulatory changes which occur after porto-systemic shunts have been evaluated in 55 cirrhotic patients studied by post-operative arterioportography. In every one of these cases the shunt was patent. After side to side portocaval shunt (28 patients) the arterioportography shows the complete drainage of the splanchnic blood into the inferior vena cava. A reversed flow was observed in 20 patients. After conventional spleno renal shunt (eight patients) a maintained hepatopetal flow was present only in early angiographic controls, while in later controls all splanchnic blood flow was towards the renal vein, with evidence of reversed portal flow. Even after mesocaval shunt (ten patients) the splanchnic flow was hepatofugal. Instead, after distal splenorenal Warren shunt (two cases) the hepatopetal portal flow seems to be unaffected as evidence by angiography 15 days post-operatively. An increased of the hepatic artery diameter and its intrahepatic branches was observed in 20 out of 27 controls. This hepatic artery "hepertrophy" is related in increased hepatic artery blood flow which seems to be, according to Burchell [5], an important factor in the reestablishment of the liver circulation after portocaval shunt.

Adult↗
PubMed2000

Effects of moniliformin on performance and immune function of broiler chicks.

Three trials were conducted to evaluate the effect of moniliformin (M) on performance and immune function in chicks. Day-old chicks were randomly assigned to four dietary treatments (0, 50, 75, or 100 mg M/kg diet). In Trial 1, chicks were placed on treatments for 3 wk and were injected intravenously with 4.6 x 10(6) Escherichia coli on Day 21. Blood samples were collected at 60, 120, and 180 min after inoculation, and liver, spleen, and lung were collected at 180 min postinjection. Compared with control chicks, chicks fed 75 and 100 mg M/ kg diet had higher (P < 0.05) numbers of E. coli colonies in the circulation, liver, and spleen. In Trial 2, chicks were placed on diets for 4 wk and were injected with 0.5 mL Newcastle disease virus (NDV) vaccine intramuscularly on Weeks 2 and 3 of the experiment. The primary and secondary anti-NDV antibody titers were measured 7 d after each injection. Chicks fed 100 mg M/kg diet had lower (P < 0.05) secondary antibody titers than did control chicks. In Trial 3, lymphocyte proliferation in chicks exposed to M in vivo and in vitro was determined. Results of the in vivo study showed that cell proliferation in response to mitogens from control- and M-fed chicks did not differ (P > 0.05). For the in vitro study, lymphocyte proliferation decreased linearly (P < 0.01) with increased concentrations of M. In all three trials, chicks fed 100 mg M/kg diet had lower (P < 0.05) feed intake and weight gain than did control chicks. Data from the current study suggested that M decreased performance and immune response in chicks at the level of 75 mg/kg diet.

Animals↗
PubMed2000

Detection of isolated disseminated tumor cells in bone marrow and blood samples of patients with hepatocellular carcinoma.

BACKGROUND: Patients with hepatocellular carcinoma (HCC) often develop recurrences after curative resection or liver transplantation. Therefore, tumor cell dissemination must have occurred preoperatively or intraoperatively. Current staging methods cannot reliably detect micrometastasis. Reverse transcription-polymerase chain reaction (RT-PCR) for alpha-fetoprotein (AFP) has been used to detect circulating liver cancer cells, but results in blood samples have been contradictory. HYPOTHESIS: AFP-RT-PCR is a specific and sensitive assay for the detection of disseminated tumor cells in central venous blood and bone marrow samples of patients with HCC and has prognostic relevance. DESIGN: Prospective consecutive series. SETTING: University hospital. PATIENTS AND METHODS: We performed preoperative, intraoperative, and postoperative analyses of central venous blood samples and preoperative analysis of bone marrow samples of patients with HCC and patients without malignant disease, using a modified AFP-RT-PCR method. Preoperative serum AFP levels were measured. Clinical follow-up ranged from 4 to 20 months. MAIN OUTCOME MEASURES: Sensitivity and specificity of AFP-RT-PCR, correlation of AFP-RT-PCR results to tumor stage and tumor recurrence. RESULTS: In serial dilution experiments, 50 AFP-expressing HepG2 cells were detected in 10 mL of blood. Peripheral blood samples of 20 healthy volunteers and bone marrow samples of 21 patients with benign diseases consistently tested negative for AFP, whereas 4 of 24 patients with HCC showed AFP expression in bone marrow samples. All these patients had advanced disease; however, correlation of positive RT-PCR results to tumor stage was not significant (P = .07). One of the 4 AFP-positive patients developed an intrahepatic recurrence soon after liver transplantation. Central venous blood of patients with HCC (n = 24) and patients with benign liver diseases (n = 13) equally demonstrated AFP-expressing cells. There was no correlation of RT-PCR results to serum AFP levels. CONCLUSIONS: Perioperative screening for micrometastasis in bone marrow of patients with HCC is sensitive and specific with AFP-RT-PCR and may have prognostic relevance. Alpha-fetoprotein is not a suitable marker for the detection of tumor cells in central venous blood samples.

Bone Marrow↗
PubMedDate not supplied

Hepatic and extrahepatic glucuronidation of lorazepam in the dog.

The pharmacokinetic disposition of lorazepam was investigated in sham-operated aneshetized dogs, dogs with hepatic devascularization, and dogs with total splanchnic devascularization following i.v. administration of 0.3 mg per kg of the drug. In sham-operated dogs, lorazepam distribution was extensive (100 +/- 15.2 liters) and clearance approximately expected liver blood flow (971 +/- 91 ml per min). Lorazepam glucuronide levels in plasma rose rapidly in the first hour and reached a plateau by 5 hr. Urinary recovery of the conjugate in 5 hr was 45% of administered dose. Hepatic devascularization resulted in 39% reduction in distribution volume, and 89% reduction in clearance; however, there was still 105 +/- 88 ml per min of extrahepatic lorazepam clearance. Five-hour urinary recovery of conjugate decreased by 80%. Total splanchnic devascularization resulted in 37% further reduction in extrahepatic clearance, almost complete inhibition of urinary recovery of conjugate, and further reduction in the volume of distribution. It is concluded that the liver is the major site for lorazepam metabolism in dogs; however, appreciable extrahepatic metabolism occurs, partly in nonhepatic components of the splanchnic organs which act as a reservoir during drug distribution.

Animals↗
PubMed1984

Effects of nadolol treatment on renal and hepatic hemodynamics and function in cirrhotic patients with portal hypertension.

Twelve cirrhotic patients with portal hypertension and esophageal varices were treated with nadolol for 1 month, and the effects on renal and hepatic hemodynamics and function were studied. A significant decrease in cardiac output, portohepatic gradient, and effective hepatic blood flow was found, whereas mean arterial pressure, liver function, effective renal blood flow, glomerular filtration rate, and urinary sodium and potassium excretions were not affected. In seven patients esophageal varices were also reduced. A significant correlation was found between the decrease in portohepatic gradient and that in cardiac output. The percentage of cardiac output distributed to the kidneys was significantly increased after nadolol treatment. In conclusion, nadolol seems to have properties useful for the treatment of portal hypertension in patients with liver cirrhosis.

Adrenergic beta-Antagonists↗
PubMed1988

Arterial occlusion reduces tumour cell lodgement in the rat liver.

The lodgement of tumour cells (TCs) is a key event in the development of metastases in distant organs. Experimental and clinical studies have shown that ligation of the hepatic artery may reduce the mass of established metastases. In the present study the effect of hepatic artery or portal vein occlusion on the early phase of metastasis development, i.e. TC lodgement, was investigated. Occlusion of the hepatic artery immediately before intraportal TC infusion reduced TC lodgement, while a temporary occlusion of the portal vein directly after the TC infusion led to increased TC lodgement. It is speculated that the decrease in TC lodgement after arterial occlusion is due to local increase in blood flow, which might enhance the passage of the TCs through the liver, and to a decrease in pH causing an increased rate of TC destruction. The increased TC lodgement after portal vein occlusion, on the other hand, should mainly be due to flow reduction, promoting TC trapping in the liver microvasculature.

Animals↗
PubMed1991

Systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine in patients with cirrhosis.

The effects of dopamine on kidney function have not been elucidated in patients with cirrhosis. Moreover, although increased portal pressure has been observed with supradopaminergic doses of dopamine in these patients, the splanchnic hemodynamic effects of low doses of dopamine have not been previously studied. Thus we studied the acute systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine (1.5 micrograms/kg body wt min) in nine cirrhotic patients. Plasma dopamine levels increased markedly from 35 +/- 20 pg/ml to 31,400 +/- 4,900 pg/ml during dopamine administration. A significant diastolic pressure decrease of 10% was associated with a 15% increase in heart rate. Cardiac output was not altered. Although dopamine significantly increased azygos blood flow by 16%, wedged and free hepatic venous pressures were not altered. Dopamine significantly increased renal blood flow by 31%, but did not change the glomerular filtration rate. We conclude that a dopaminergic dose of dopamine increases azygos blood flow but not the hepatic venous pressure gradient. Finally, although it increases renal blood flow, dopamine does not seem to have any beneficial effects on glomerular filtration rate in cirrhotic patients.

Dopamine↗
PubMedDate not supplied

Changes in hepatic hemodynamics after orthotopic liver transplantation: color Doppler sonography.

BACKGROUND: Liver perfusion has an influence on therapy results in patients undergoing orthotopic liver transplantation (OLT). The objective of the present study was to investigate changes in hepatic hemodynamics in patients after OLT with color-coded Doppler sonography (CCDS). METHODS: Forty-five consecutive patients were included. The examinations were done before, on postoperative day 1, and then weekly until the patients were discharged. Mean velocity of the portal (PV-V) and splenic (SV-V) veins and the maximum velocity and resistance index of the hepatic artery were determined. RESULTS: After OLT a significant increase in PV-V and SV-V was observed. Twenty-five patients had normal perfusion of the hepatic artery, whereas 16 patients had abnormal flow patterns. In these patients prostaglandin I(2) was used until flow rates normalized. In four patients, CCDS could not detect perfusion of the hepatic artery. CONCLUSIONS: CCDS is a suitable method for evaluating hepatic hemodynamics before and after OLT. Changes in blood flow velocities in the liver-supplying vessels are detectable, but perfusion of the hepatic artery is seldom detectable. These observations are of special interest after OLT, where liver circulation has an influence on therapy results.

Adult↗
PubMed1995

Comparison of the effects of sevoflurane, isoflurane and halothane on indocyanine green clearance.

We have examined the effects of inhalation anaesthetics on indocyanine green (ICG) clearance, as an index of hepatic function, in patients undergoing elective surgery. Recently, a new method has been developed to measure in real-time the disappearance rate of ICG from plasma. This method eliminates the multiple sampling and delay of the conventional ICG test. ICG clearance is displayed as two indices: K (ICG disappearance rate) and R15 (ICG retention rate 15 min after injection of ICG 0.5 mg kg-1). This measurement was performed in patients before and after 1 MAC of sevoflurane (n = 6), 2 MAC of sevoflurane (n = 6), 1 MAC of isoflurane (n = 6), 2 MAC of isoflurane (n = 6), 1 MAC of halothane (n = 6) or 2 MAC of halothane (n = 6) without surgical stress. Although mean arterial pressure decreased significantly at 1 and 2 MAC of sevoflurane, 2 MAC of halothane, and 1 and 2 MAC of isoflurane, ICG clearance was maintained at awake levels, except at 2 MAC of halothane (K = mean-33 (sem 3)%, R15 = +90 (3)% from awake values). We conclude that sevoflurane and isoflurane have a more favourable effect on liver circulation than halothane.

Adult↗
PubMed1996

Transvisceral lactate fluxes during early endotoxemia.

The pathogenesis of hyperlacticemia during sepsis is poorly understood. We investigated the role of lung, kidney, gut, liver, and muscle in endogenous lactate uptake and release during early endotoxemia in an intact, pentobarbital-anesthetized dog model (n = 14). Ultrasonic flow probes were placed around the portal vein and hepatic, renal, and femoral arteries. After splenectomy, catheters were inserted into the pulmonary artery, aorta, and hepatic, left renal, and femoral veins. Whole blood lactate and blood gases from all catheters, organ flows, and cardiac output were measured before and 30 to 45 min after a bolus infusion of Eacherichia coli endotoxin (1 mg/kg). After endotoxin infusion, mean arterial blood lactate level increased from 0.92 +/- 0.11 to 1.60 +/- 0.15 mmol/L (p < 0.0001). Lung lactate flux changed from uptake to release of lactate adding a mean of 9.97 +/- 16.23 mmol/h (p < 0.05) to the systemic circulation. Liver and muscle lactate fluxes remained neutral at all times, while kidney and gut took up lactate from the circulation both before and after endotoxin infusion (mean renal uptake, 2.73 +/- 3.85 mmol/L; p < 0.001; mean gut uptake, 2.46 +/- 2.31 mmol/h; p < 0.002). Except for the kidney, where a decrease in blood flow correlated with diminished uptake, there was no correlation between changes in transvisceral lactate fluxes and organ or systemic oxygen delivery during endotoxemia. A positive correlation between lactate uptake and oxygen consumption during endotoxemia was seen for both gut (p < 0.0001) and kidney (p < 0.002). We conclude that, in the dog, the pathogenesis of endotoxin-induced hyperlacticemia is complex. The lung may be responsible for significant lactate release, and other viscera that normally take up lactate are unable to adequately clear this increased lactate.

Animals↗
PubMed2000

Hepatorenal syndrome.

Hepatorenal syndrome is a functional renal failure that occurs in cirrhotic patients with advanced liver disease and ascites. The diagnostic criteria and clinical types of this syndrome have recently been revised. Hepatorenal syndrome is caused by marked hypoperfusion of the kidney as the result of renal vasoconstriction, which is thought to be the extreme manifestation of an underfilling of the arterial circulation. This circulatory dysfunction is the consequence of arterial vasodilation in the splanchnic circulation. Liver transplantation is the best treatment for HRS, but its applicability is low because of the short survival of these patients. New therapies, such as the use of systemic vasoconstrictors or TIPS, seem promising, but prospective investigations are needed to delineate their role in the management of cirrhotic patients with HRS.

Diagnosis, Differential↗
PubMed1996

Colorectal carcinoma metastases to the liver. Does primary tumor location affect its lobar distribution?

BACKGROUND: There is considerable evidence that blood returning from different abdominal organs does not mix completely but maintains streamline flow in the portal vein. This study tested the hypothesis that the location of primary colorectal carcinoma affects the intrahepatic distribution of liver metastases according to streamline flow in the portal vein. METHODS: Eighty-five patients with histologically verified liver metastases from colorectal carcinoma underwent potentially curative hepatectomy. Primary tumor location was the right-sided colon in 18 patients and the left-sided colon in 67. The liver was divided into two lobes by Cantlie's line. RESULTS: A total of 195 metastatic deposits were resected: 135 in the right lobe and 60 in the left. In the right-sided colon carcinoma group, 29 deposits were in the right lobe and 3 in the left. In the left-sided colon carcinoma group, 106 deposits were in the right lobe and 57 in the left. The pattern of lobar distribution was significantly different in the two groups (P = 0.003). CONCLUSIONS: Right-sided colon cancers selectively involve the right lobe, while left-sided tumors involve the entire liver, considering the ratio of weights of the right to left lobe is 2:1. This difference suggests that primary tumor location affects the pattern of lobar distribution of colorectal carcinoma liver metastases according to streamline flow in the portal vein.

Carcinoma↗