Hepato Gastroenterol
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Hepato Gastroenterol · May 2010
Randomized Controlled TrialProspective randomized controlled study of short-term perioperative oral nutrition with branched chain amino acids in patients undergoing liver surgery.
Early prospective randomized clinical trials demonstrated that perioperative parenteral nutrition (PN) with branched chain amino acids (BCAA) is beneficial in cirrhotic patients with hepatocellular carcinoma who undergo hepatectomy. However, PN support is expensive and requires a long hospital stay. Moreover, PN support has not been evaluated in patients with a normal liver who undergo hepatectomy. It was studied the benefits of perioperative oral nutrition (ON) with BCAA in patients who underwent hepatectomy, including those with a non-hepatitis liver. ⋯ Short-term ON support with BCAA was associated with higher serum EPO levels than was a normal diet in patients with non-hepatitis who underwent curative hepatic resection. Higher EPO levels might be beneficial in protecting liver cells from ischemic injury and preventing intraoperative hemorrhage associated with lower perioperative levels of alanine aminotransferase and aspartate aminotransferase in serum. This is the first study to demonstrate an effect of EN support with BCAA in patients with non-hepatitis, as well as those with hepatitis.
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Hepato Gastroenterol · May 2010
The peculiar processing of pancreatic hormone glucagon seen in traumatized patients.
The kinetics of the pancreatic hormone glucagon in traumatized patients has not been minutely investigated as well as that of insulin, despite its significant influence on energy metabolism. In the present study, we examined the kinetics of glucagon and glucagon-related peptides assessed by radioimmunoassay, and the molecular forms of these peptides using gel filtration chromatography. In addition, we discuss glucagon processes in the pancreas and intestine in traumatized patients in the early operative days. ⋯ The kinetics and processing of glucagon in traumatized patients was different from those of healthy subjects. In traumatized patients, the peculiar processing of glucagon was processed in the intestine, which is different from the ordinary glucagon processing either in the pancreas or the intestine, generating a peculiar glicentin-like peptide (GLLP).
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Hepato Gastroenterol · May 2010
Pre-operative biliary drainage in hilar cholangiocarcinoma, benefits and risks, single center experience.
Post-operative hepatic insufficiency is a critical complication after hepatic resection in jaundiced patients with hilar cholangiocarcinoma (hilar CC). Attempts to reduce the post operative risks associated with biliary obstruction by preoperative biliary drainage (PBD) remain controversial. ⋯ Major liver resections in hilar CC without PBD are safe in most patients. PBD increases morbidity, biliary leakage, transfusion requirement and hospital stay. In our experience, PBD is recommended in selected patients with: cholangitis, long standing jaundice, impaired renal function and severe malnourishment state.