- Email: [email protected]
Fasting and meal-stimulated portal venous flow (PF) is supranormal early, but not late, after liver transplantation (OLT) in man
$164
BILIARY LITHIASIS IN C A R O L I ' S D I S E A S E DIAGNOSIS AND MANAGMENT _L.Floros ,Ch. Spllladms** tM. Tsouroulas* ** tG. Simitzi s A. Pefanis*, A. Lepouras* 2nd Dept of Medicine* ,Gastroenterology Dept** and Radiology Dept (U/S, CT, MRI )*** . General Hospital of Athens,Athens,Greece . We present 4 cases of Caroli's d ~ 3 (~ simple type and 1 associated with Congenital Hepatic Fibrosis (CHF)-in 2 men and 2 women,complicated with formation of Intrahepatic(IS)and common duct stones. During the 3 to 14 years follow up period 3 of them suffered from reccurent episodes of right upper qu~ldrant abdominal pain or cholangitis.The patient with CHF presented with painless jaundice 3 years ago erd she remains jaundiced without any evidence of the presence of common duct stones.Meanwhile she experienced cholangitis only once.All the pts were s ~ ed with non invasive diagnostic methods.Ultrasound and ERCP revealed IS in all of them, CT scan revealed IS in 3 pts but it was better than ERCP in estimating the ntmlber of the pigmented stones.On the (xmltrary CT scan failed to demostrate the radiolucent stones in one case.ERCP was the best method in C~unsLu~L~q the corsnon bile duct stones.In one cBse s~hin cterotomy and removal of the stones was done successfully.In another case ERCP was applied for the p ~ ment of naso-biliary catheter and the subsecuent drainage of purulent collection from an intrahe~st/c cyst.Two pts unterwent surgery for the removal of common duct stones.Extracorporeal shock waves were used twice for the fragmentation of common duct and intrahepatic stones in one of them.
PSORIATIC LESIONS IN PATIENTS WITH CHRONIC LIVER DISEASE ARE DISTINCT FROM PSORIASIS VULGARIS LESIONS BASED ON INTEGRIN ADHESION RECEPTORS.
G. Giannelli *, P. Savoia^, Schiraldi O.*, Lospalluti M. °, De Luca M.§, P.C. Marchisio", V. Quaranta* '. * Istituto di Clinica Medica II Universiui degli Studi di Bail, " Dipart. Scienze Biomediche, Universitfi di Torino, o Clinica Dennatologica Universitd degli Studi di Bad, § Istit. Naz. Ricerca sul Cancro Genova, ' Departement of Cell Biology, The Scripps Research Institute, La Jolla CA. USA. Psoriatic lesions are relatively frequent in patients with chronic liver disease (CLD). Furthermore therapy with interferons tends to exacerbate the symptoms. The pathogenesis of psoriatic lesions is unclear. An important question is whether they are incidental manifestations of Psoriasis Vulgaris. We collected biopsies from involved and uninvolved skin areas of CLD patients with psoriatic manifestations as well as from psoriasis vulgaris patients, and investigated the patterns of integrin adhesion receptors by immunohistochemistry. Integrin expression is known to be characteristically altered in psoriasis vulgaris. We found some of these change in CLD psoriatic lesions, namely pericellular redistribution and suprabasal expression of the basement membrane receptor 0t6134 and of the intercellular integrins ct21~l and ct3~l. However, psoriasis vulgaris displays two other typical changes: one is the induction of the prototype fibronectin receptor ct5131, the other is the alteration of integrin expression in areas of the epidermidis that are macroscopically normal. These two changes were not found in CLD psoriasis biopsies, in fourteen patients investigated. Thus, integrin expression may be useful to differentiate CLD psoriatic lesions from psoriasis vulgaris lesions. Even though the two types of lesions are indistinguishable by inspection and by histological features, they may be caused by distinct pathogenetic mechanisms. It remain to be seen whether the underlying CLD has a role, albeit indirect, in such mechanisms.
Papers read by title
LONG DURATION CHOLESTASIS ASSOCIATED WITH SHORT TERM THERAPY WITH AMDXYCILLIN-CLAVULANIC ACID O3MBINATION. A CASE REPORT. J.Hatzipanagiotis, G.Koutsounopoulos, M. Zissis, D.Arvanitidis.Hellenic Airforce and V.A. General Hospital, Dept of Gastroenterology,Athens ,Greece. A case of cholestatic hepatitis related with the intake of the antibiotic combination of amoxycillin and clavulanic acid is presented.A 35 years old man presented with jaundice and pruritus following 3 days of treatment with amoxycillin-clavulenic acid at a dose of I ,875gr/day for upper respiratory tract infection. His total bilirubin level increased gradually to 18mg/dl in the eighth week after the onset of symptoms and the rest of his liver function tests were only slightly abnormal. Serological tests for HBV,HCV,EBV,CMV infection and IgM-Anti-HAV ware negative and IgG-Anti-HAV was positive. Tests for antoimmune hepatitis (ANA, SMA,AMA,Anti-LKM) were negative. Ultrasonography of the liver and biliary tract was normal. The liver biopsy showed changes of non specific reactive hepatitis and moderate cholestasis. We present an unusual case of cholestasis due to amoxycillin-clavulanic acid hepatoxicity.
FASTING AND MEAL-STIMULATED PORTAL VENOUS FLOW (PF) IS SUPRANORMAL EARLY, BUT NOT LATE, AFTER LIVER TRANSPLANTATION (OLT) IN MAN. B.Helbling & E.L.Renner. Dept. Clin. Pharmacol., Univ. Berne, CH A hyperdynamic systemic and splanchnic circulation is known to persist after OLT (Hepatology 17: 175, 1993 and 15: 258, 1992). Whether after a meal PF to the denervated liver graft still increases physiologically is unknown. AIM: To determine the effect of a meal on PF after OLT. MJ~_tLO.~: 6 healthy volunteers (4F, 2M; 26-40 yr) and 10 OLT-patients with normal liver function (3F, 7M; 41-67 yr; 0.5-58 months after OLT) were studied. 4 consecutive Doppler sonographic determinations of mean portal flow velocity (PFV) and portal vein diameter (PD) were perlormed by the same investigator and averaged in the lasted state and 30rain after a standardized meal (900kcal) using an Acuson XP/10, a 3.5MHz transducer, a 125 Hz filter, a sample volume of 2/3 the PD placed at the crossing of the hepatic artery, and a Doppler angle <60o. ~ : Intraobserver variability was <10%. After fasting and meal, flow parameters were similar in volunteers and patients :>4 months, but higher in patients <4 months after OLT: Healthy <4 months >4 months Volunteers after OLT after OLT ~n=6) (n=4) (n=6~ PFVelocity fasting 13.7 + 2.9 21.8 ± 8.05 13.3 ± 2.0 (cm/sec) postprandial 19.7 ± 4.0" 34.1 ± 5.5 *$ 19.0 + 4.5" meal induced A 6.0 ± 3.5 12.3 ± 5 . 2 5 ~ PDiameter fasting 9.1 ± 0.8 11.7 ± 2.45 8.0 ± 0.8 (mm) postprandial 10.7 + 1.0" 15.5 ± 3.5 *$ 10.3 ± 2.3" meal induced A 1.6±0.9 3.7±2.1 2.2±1.5 PFIow fasting 5192 80 1463+ 7285 425±123 (ml/min) posprandial 1047±238" 3939±1732 "$ 1019±562" meal induced A 528± 274 2476±1110 $ 594_+442 Mean + SD; ° p vs. fasting <0.05 (paired t-test); $ p vs. volunteers and vs. >4 months after OLT <0.05 (ANOVA). CONCLUSION : Fasting PF is elevated and the physiologic, meal-induced PF-increase supranormal early, but not late, after OLT. Persisting hyperdynamic circulation and graft denervation likely contribute to this altered PF-regulation.
BILIARY LITHIASIS IN C A R O L I ' S D I S E A S E DIAGNOSIS AND MANAGMENT _L.Floros ,Ch. Spllladms** tM. Tsouroulas* ** tG. Simitzi s A. Pefanis*, A. Lepouras* 2nd Dept of Medicine* ,Gastroenterology Dept** and Radiology Dept (U/S, CT, MRI )*** . General Hospital of Athens,Athens,Greece . We present 4 cases of Caroli's d ~ 3 (~ simple type and 1 associated with Congenital Hepatic Fibrosis (CHF)-in 2 men and 2 women,complicated with formation of Intrahepatic(IS)and common duct stones. During the 3 to 14 years follow up period 3 of them suffered from reccurent episodes of right upper qu~ldrant abdominal pain or cholangitis.The patient with CHF presented with painless jaundice 3 years ago erd she remains jaundiced without any evidence of the presence of common duct stones.Meanwhile she experienced cholangitis only once.All the pts were s ~ ed with non invasive diagnostic methods.Ultrasound and ERCP revealed IS in all of them, CT scan revealed IS in 3 pts but it was better than ERCP in estimating the ntmlber of the pigmented stones.On the (xmltrary CT scan failed to demostrate the radiolucent stones in one case.ERCP was the best method in C~unsLu~L~q the corsnon bile duct stones.In one cBse s~hin cterotomy and removal of the stones was done successfully.In another case ERCP was applied for the p ~ ment of naso-biliary catheter and the subsecuent drainage of purulent collection from an intrahe~st/c cyst.Two pts unterwent surgery for the removal of common duct stones.Extracorporeal shock waves were used twice for the fragmentation of common duct and intrahepatic stones in one of them.
PSORIATIC LESIONS IN PATIENTS WITH CHRONIC LIVER DISEASE ARE DISTINCT FROM PSORIASIS VULGARIS LESIONS BASED ON INTEGRIN ADHESION RECEPTORS.
G. Giannelli *, P. Savoia^, Schiraldi O.*, Lospalluti M. °, De Luca M.§, P.C. Marchisio", V. Quaranta* '. * Istituto di Clinica Medica II Universiui degli Studi di Bail, " Dipart. Scienze Biomediche, Universitfi di Torino, o Clinica Dennatologica Universitd degli Studi di Bad, § Istit. Naz. Ricerca sul Cancro Genova, ' Departement of Cell Biology, The Scripps Research Institute, La Jolla CA. USA. Psoriatic lesions are relatively frequent in patients with chronic liver disease (CLD). Furthermore therapy with interferons tends to exacerbate the symptoms. The pathogenesis of psoriatic lesions is unclear. An important question is whether they are incidental manifestations of Psoriasis Vulgaris. We collected biopsies from involved and uninvolved skin areas of CLD patients with psoriatic manifestations as well as from psoriasis vulgaris patients, and investigated the patterns of integrin adhesion receptors by immunohistochemistry. Integrin expression is known to be characteristically altered in psoriasis vulgaris. We found some of these change in CLD psoriatic lesions, namely pericellular redistribution and suprabasal expression of the basement membrane receptor 0t6134 and of the intercellular integrins ct21~l and ct3~l. However, psoriasis vulgaris displays two other typical changes: one is the induction of the prototype fibronectin receptor ct5131, the other is the alteration of integrin expression in areas of the epidermidis that are macroscopically normal. These two changes were not found in CLD psoriasis biopsies, in fourteen patients investigated. Thus, integrin expression may be useful to differentiate CLD psoriatic lesions from psoriasis vulgaris lesions. Even though the two types of lesions are indistinguishable by inspection and by histological features, they may be caused by distinct pathogenetic mechanisms. It remain to be seen whether the underlying CLD has a role, albeit indirect, in such mechanisms.
Papers read by title
LONG DURATION CHOLESTASIS ASSOCIATED WITH SHORT TERM THERAPY WITH AMDXYCILLIN-CLAVULANIC ACID O3MBINATION. A CASE REPORT. J.Hatzipanagiotis, G.Koutsounopoulos, M. Zissis, D.Arvanitidis.Hellenic Airforce and V.A. General Hospital, Dept of Gastroenterology,Athens ,Greece. A case of cholestatic hepatitis related with the intake of the antibiotic combination of amoxycillin and clavulanic acid is presented.A 35 years old man presented with jaundice and pruritus following 3 days of treatment with amoxycillin-clavulenic acid at a dose of I ,875gr/day for upper respiratory tract infection. His total bilirubin level increased gradually to 18mg/dl in the eighth week after the onset of symptoms and the rest of his liver function tests were only slightly abnormal. Serological tests for HBV,HCV,EBV,CMV infection and IgM-Anti-HAV ware negative and IgG-Anti-HAV was positive. Tests for antoimmune hepatitis (ANA, SMA,AMA,Anti-LKM) were negative. Ultrasonography of the liver and biliary tract was normal. The liver biopsy showed changes of non specific reactive hepatitis and moderate cholestasis. We present an unusual case of cholestasis due to amoxycillin-clavulanic acid hepatoxicity.
FASTING AND MEAL-STIMULATED PORTAL VENOUS FLOW (PF) IS SUPRANORMAL EARLY, BUT NOT LATE, AFTER LIVER TRANSPLANTATION (OLT) IN MAN. B.Helbling & E.L.Renner. Dept. Clin. Pharmacol., Univ. Berne, CH A hyperdynamic systemic and splanchnic circulation is known to persist after OLT (Hepatology 17: 175, 1993 and 15: 258, 1992). Whether after a meal PF to the denervated liver graft still increases physiologically is unknown. AIM: To determine the effect of a meal on PF after OLT. MJ~_tLO.~: 6 healthy volunteers (4F, 2M; 26-40 yr) and 10 OLT-patients with normal liver function (3F, 7M; 41-67 yr; 0.5-58 months after OLT) were studied. 4 consecutive Doppler sonographic determinations of mean portal flow velocity (PFV) and portal vein diameter (PD) were perlormed by the same investigator and averaged in the lasted state and 30rain after a standardized meal (900kcal) using an Acuson XP/10, a 3.5MHz transducer, a 125 Hz filter, a sample volume of 2/3 the PD placed at the crossing of the hepatic artery, and a Doppler angle <60o. ~ : Intraobserver variability was <10%. After fasting and meal, flow parameters were similar in volunteers and patients :>4 months, but higher in patients <4 months after OLT: Healthy <4 months >4 months Volunteers after OLT after OLT ~n=6) (n=4) (n=6~ PFVelocity fasting 13.7 + 2.9 21.8 ± 8.05 13.3 ± 2.0 (cm/sec) postprandial 19.7 ± 4.0" 34.1 ± 5.5 *$ 19.0 + 4.5" meal induced A 6.0 ± 3.5 12.3 ± 5 . 2 5 ~ PDiameter fasting 9.1 ± 0.8 11.7 ± 2.45 8.0 ± 0.8 (mm) postprandial 10.7 + 1.0" 15.5 ± 3.5 *$ 10.3 ± 2.3" meal induced A 1.6±0.9 3.7±2.1 2.2±1.5 PFIow fasting 5192 80 1463+ 7285 425±123 (ml/min) posprandial 1047±238" 3939±1732 "$ 1019±562" meal induced A 528± 274 2476±1110 $ 594_+442 Mean + SD; ° p vs. fasting <0.05 (paired t-test); $ p vs. volunteers and vs. >4 months after OLT <0.05 (ANOVA). CONCLUSION : Fasting PF is elevated and the physiologic, meal-induced PF-increase supranormal early, but not late, after OLT. Persisting hyperdynamic circulation and graft denervation likely contribute to this altered PF-regulation.