Hepatology : official journal of the American Association for the Study of Liver Diseases
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Hyperammonemia is a well-recognized metabolic abnormality which occurs in cirrhotic patients with advanced liver dysfunction. We recently documented that hyperglucagonemia that occurs as a result of hepatic glycogen depletion may be responsible for this hyperammonemia by promoting gluconeogenesis to provide glucose as a fuel for functioning of several organ systems. Thus, hepatic glycogen depletion may be the initial process responsible for hyperammonemia. ⋯ The smallest glucose responses were seen in the patients with the highest basal plasma ammonia levels. Finally, significant negative relationships were noted between the glucose response to glucagon administration (delta glucose) and the degree of liver dysfunction as reflected by Composite Clinical Laboratory Index, as well as basal ammonia and ammonia responses (delta ammonia) on the other. Therefore, this study suggests that hepatic glycogen depletion may be the initial event leading to elevated plasma ammonia concentrations in hepatic cirrhosis.
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Comparative Study Clinical Trial
Vasopressin analogs in portal hypertension: different molecules but similar questions.
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Case Reports
Halothane hepatitis without halothane: role of inapparent circuit contamination and its prevention.
Halothane and other halogenated anesthetic agents are liquids which are highly soluble in rubber and plastic materials widely used as components of anesthesia machines. These agents must be administered using machines equipped with vaporizers. We report a patient with a past history of halothane hepatitis in whom recurrence was suspected despite the fact that halothane had been avoided purposely during the subsequent operation. ⋯ The validity of this conclusion was confirmed in five patients with previous diagnosis of halothane hepatitis who subsequently underwent operations under general anesthesia during which machines never equipped with vaporizers were successful in preventing recurrence of hepatitis. We conclude that patients with a prior history of halothane hepatitis are at risk of inapparent circuit contamination-induced recurrent hepatitis. Unless such contamination can be confidently excluded, vaporizer-equipped machines should not be used to administer general anesthesia in these susceptible patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial.
A prospective randomized controlled clinical trial was performed in 43 consecutive histologically proved cirrhotic patients with endoscopically proved actively bleeding esophageal varices. Twenty-two were randomly selected to have esophageal tamponade with the Sengstaken-Blakemore tube, and 21 were selected to have endoscopic sclerosis of the esophageal wall. The two groups were similar in demographic, clinical and laboratory data. ⋯ Within 30 days, six patients (27%) in the Sengstaken-Blakemore tube group had died compared to 2 (10%) in the endoscopic sclerosis group which is statistically significant (p less than 0.01) in favor of endoscopic sclerosis. The frequency of complications was similar in the two groups. Endoscopic sclerosis patients received serial endoscopic sclerosis after bleeding had been stopped during the whole period of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports Comparative Study
A comparison of liver ultrastructure in salicylate intoxication and Reye's syndrome.
All childhood liver biopsy specimens from The Cincinnati Children's Hospital Research Foundation which had been prepared for light and electron microscopy were reviewed to identify biopsies from children with salicylate intoxication. Only two cases of primary salicylate intoxication were identified. The histopathology and ultrastructural pathology were compared to that in two cases of Reye's syndrome which were selected because they had been treated with salicylates and had comparable serum salicylate concentrations at the time of liver biopsy. ⋯ All hepatocyte mitochondria were enlarged, pleomorphic, and had an expanded matrix and no mitochondrial dense bodies. The histopathology and ultrastructural pathology of liver biopsy specimens in salicylate intoxication were different from those in Reye's syndrome. In children in whom the diagnosis of Reye's syndrome is obscure, liver biopsy with electron microscopic examination is necessary for definitive diagnosis.