Endoscopic therapy for biliary tract disease before orthotopic liver transplantation.

Biliary tract and gallbladder diseases in patients with end-stage liver disease awaiting orthotopic liver transplantation may increase the morbidity and mortality. This article discusses the endoscopic management of biliary tract and gallbladder diseases to avoid complications and maintain their candidacy for liver transplantation.

Use of transjugular intrahepatic portosystemic shunt as a bridge to liver transplantation in a patient with severe hepatopulmonary syndrome.

Hepatopulmonary syndrome (HPS) is defined by the presence of the triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. The clinical implication of this disorder is impairment of gas exchange. Numerous reports in the literature show that this condition is reversible with orthotopic liver transplantation (OLT).

Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension.

Graded intraesophageal balloon distension (IEBD) has been utilized in the past to evaluate esophageal pain thresholds. With use of a technique that we have found to provide reproducible results for pain thresholds, two groups of normal individuals without esophageal symptoms or diabetes were studied. Group 1 included 10 "young" (age < 65 yr) individuals (mean age 27 yr, range 18-57 yr).

Intraesophageal balloon distention in the evaluation of sensory thresholds: studies on reproducibility and comparison of balloon composition.

Objective: Graded intraesophageal balloon distention has been suggested as a provocative test in the assessment of undetermined chest pain. Balloon distention was used to determine pain threshold reproducibility for 20 normal individuals (mean age: 27 yr).

Methods: Balloons made of silicone and latex were each evaluated in 10 subjects, with the balloon located 10 cm above the lower esophageal sphincter.

Effect of MR imaging on the normal human pineal body: measurement of plasma melatonin levels.

Production of melatonin, a hormone synthesized and secreted by the pineal body, has been suppressed by electromagnetic fields in some but not all animal studies. Magnetic resonance (MR) imaging at 1.5 T was evaluated for its ability to modulate the level of melatonin in eight male volunteers.

Alveolar surfactant and adult respiratory distress syndrome. Pathogenetic role and therapeutic prospects.

The adult respiratory distress syndrome (ARDS) is characterized by extended inflammatory processes in the lung microvascular, interstitial, and alveolar compartments, resulting in vasomotor disturbances, plasma leakage, cell injury, and complex gas exchange disturbances. Abnormalities in the alveolar surfactant system have long been implicated in the pathogenetic sequelae of this life-threatening syndrome. This hypothesis is supported by similarities in pulmonary failure between patients with ARDS and preterm babies with infant respiratory distress syndrome, known to be triggered primarily by lack of surfactant material.

Coagulation inhibitors in pulmonary cancer patients.

Pulmonary cancer patients are known to have an elevated risk to suffer from thromboembolic complications. Because hereditary deficiencies of coagulation inhibitors antithrombin III, protein C and protein S are known to cause thromboembolic events it was the aim of our study to search for acquired alterations of these proteins in pulmonary cancer patients. We could demonstrate antithrombin III and protein C to be within the normal range in patients suffering from pulmonary carcinoma.

Catecholamines and thrombocyte alpha 2-adrenoceptors in patients with acute myocardial infarction.

In 28 patients with first myocardial infarction plasma catecholamines and thrombocyte alpha 2-adrenoceptors were studied. The first determination (by HPLC and radioligand binding, respectively) was performed immediately after hospital admission and 6 weeks later. In the acute phase of myocardial infarction plasma adrenaline and noradrenaline levels were high.

Omega-oxidized leukotriene B4 detected in the broncho-alveolar lavage fluid of patients with non-cardiogenic pulmonary edema, but not in those with cardiogenic edema.

Leukotriene (LT) generation has been implicated in the pathogenesis of the acute respiratory distress syndrome, ARDS. In the present study, we analysed broncho-alveolar lavage fluids of patients on mechanical ventilation because of ARDS (17 samples taken from 9 patients) or because of cardiogenic edema (8 samples taken from 6 patients) and of healthy volunteers (10 samples from different donors). LTs were separated as methylated and non-methylated compounds using different HPLC procedures, and were identified by chromatographic mobility, on-line UV-spectrum analysis and post HPLC immunoreactivity.

[Pulmonary function parameters of shock lung patients--results of a follow-up study].

In seventeen patients out of a total of 219 survivors who had received long-term ventilation for pulmonary failure, an examination was carried out to clarify the question as to late pulmonary sequelae. The following sequelae were detected: 1. a diffusion disturbance in five cases, 2.

"Haemostasis time", a modified bleeding time test and its comparison with the Duke and Ivy/template bleeding times. II. Application in bleeding disorders.

"Haemostasis time" (HT), the occlusion time of a Butterfly 25 short cannula inserted into the cubital vein, is a bleeding time modification comparable to the skin bleeding times according to Duke and Ivy/Mielke. It also measures platelet function and is not influenced more than the latter tests by clotting factors. In HT, subendothelium is replaced by a standard artificial surface.

[The progress of a fibrinolytic therapy with streptokinase, urokinase and warfarin in a thoroughbred with intermittent lameness with special reference to resonance thrombography].

A thoroughbred horse, suffering from intermittent lameness was treated with streptokinase, urokinase and warfarin. The appearing fibrinolytic changes in coagulation were exhibited in a resonance thrombogram. In attendant coagulation studies fibrinogen- and fibrin-degradation products were demonstrated.

Septic lung.

"Septic lung" is a variant of the acute respiratory distress syndrome. The key alterations of this syndrome are an increase in pulmonary vascular resistance and a diffuse increase in pulmonary vascular permeability, with subsequent formation of protein-rich interstitial and intraalveolar edema, disturbance of alveolar surfactant function, and severe impairment of gas exchange. In a model of blood-free perfused rabbit lungs, all these alterations in pulmonary physiology are mimicked by stimulation of the pulmonary vascular arachidonic acid (AA) cascade: increased pulmonary artery pressure is predominantly caused by the AA cyclooxygenase product thromboxane A2, whereas vascular leakage must be ascribed to the stimulation of the various AA lipoxygenase pathways.

[Changes in the coagulation system in shock].

Disorders of the coagulation system in shock are caused by injuries of the endothelium, influx of thromboplastic material into the blood and stasis. In this way, the intrinsic and the extrinsic system is activated. Fibrin is generated in the blood stream and forms high molecular complexes together with fibrinogen (hypercoagulability).

[Principles of drug prevention of thrombosis].

The most important reasons of venous thrombosis are injuries of the vessel wall, hypocirculation (stasis) and hypercoagulability of the blood (Virchow-Trias). The prophylaxis of thrombosis is based on the inhibition of the plasmatic coagulation system and on the improvement of circulation. In general surgery the onset of venous thrombosis can be reduced from 28% to about 9% by low-dose heparin prophylaxis.

Mechanisms of altered myocardial contractility during hemodialysis: importance of changes in the ionized calcium to plasma potassium ratio.

Hemodialysis is associated with alterations in myocardial contractility, but duration and precise determinants responsible for these changes are unknown. We investigated the effect of several variables, established to influence left ventricular (LV) contractility, which normally changed during dialysis: the plasma concentrations of ionized calcium, potassium, bicarbonate, and magnesium and the removal of uremic toxins. The influence of three different isovolemic bicarbonate-dialysis procedures in 16 patients with normal (group 1) and hypertrophied myocardium (group 2) was assessed by echocardiography prior to and up to 44 h following each dialysis.