Intrarenal hemodynamics in cirrhotic patients with refractory ascites after large-volume paracentesis with I.V. albumin infusion

Poster Sessions

70

I226

OXIDANT STRESS

IN PRIMARY BILIARY CIRRHOSIS

(PBC) -

THE LINK TO HEPATIC FIBROSIS?

P.W. Pemberton’, A. Smith’, A. Aboutwerat2, P.C. Burrows’, R.F.T. McMahon3, S.J. Jain4, T.W. Warnes2. ‘Clinical Research Department, Manchester Royal Injirmary, Manchestes UK; 2The Liver UnitManchester Royal Injirmary, Manchestes UK; ‘Histopathology Department, Manchester Royal Injirmary, Manchestes UK; 4Gastroenterology Department, Wythenshawe Hospital, Manchestes UK

INTRARENAL

HEMODYNAMICS

WITH REFRACTORY PARACENTESIS

ASCITES

IN CIRRHOTIC

PATIENTS

AFTER LARGE-VOLUME

WITH I.V. ALBUMIN

INFUSION

S. Siringo’, C. Virgillito’, C. Patane2, R. D’Amico’, A. Aliffi3, ‘Divisione Di M. Raspagliesi3, F!Di Gregorio 3, M Zammataro’. Medicina 2. Osp. Garibaldi., Catania., Italy; 2Divisione Di Pediattia. Osp. Garibaldi., Catania., Italy; ‘Divisione Di Malattie Infettive 1. Osp. Garibaldi., Catania., Italy In&-arena1 arterial vasoconstiction is common in cirrhotic patients with ascites and can be assessed by Doppler-US measuring the intrarenal Resistive Index (RI) (Hepatology 1994;20: 362). Large-volume paracentesis (LVP) with i.v. albumin infusion is an effective treatment of refractory ascites. We assessed the effect of LVP on intrarenal vasoconstriction, as evaluated by intrarenal RI, in 10 patients with refractory ascites: 5 M, mean age 59.4 years, 7 with HCV, 2 with alcohol and 1 with HBV related cirrhosis. Intrarenal RI, mean blood pressure (MBP) and heart rate (HR) were measured just before (TO) and: soon after (Tl), 3 hr (T2), 24 hr (T3), 3 days (T4), 6 days (T.5) afterLVl? Measurements were repeated again 1.5.1(&1.6) days after, when another LVP was necessary (T6).). Serum creatinine and electrolites were tested at TO, T3-T5. A large volume of ascites (11.8&2.3 liters) was drained in 1.59(&0.43) hrs with an intrabdominal 14G needle and 97.1(&16.7) gr of albumin were simultaneously infused i.v.. Results: The table shows the results. After LVP it was observed a significant decrease of MBP from Tl to T3, of HR from T4 to T5, and of RI from T2 to T5. No other differences were observed. Conclusions: LVP with i.v. albumin infusion causes a persistent intrarenal arterial vasodilation that returns to baseline values when large volume of ascites reaccumulates indicating that the ascites volume plays a central role in the intrarenal vasoconstriction. Intrarenal RI is a valuable tool to assess renal hemodynamics after LVl?

While there is no evidence to suggest that oxidant stress is involved in the initial autoimmune insult to bile ducts in PBC, it has been suggested that it may be a factor in disease progression to fibrosis. Stimulation of lipid peroxidation or treatment with by-products of lipid peroxidation is known to increase expression of procollagen mRNA in human hepatic stellate cells. Patients and Methods: Fasting blood and urine samples were obtained from 20 PBC patients (95% Child’s grade A; all having undergone liver biopsy within the previous 9 months) and from 34 controls. A range of markers of oxidant stress, hepatic fibrogenesis (PIIINP) and liver function were measured and correlated with Ludwig stage, orcein staining and granuloma formation on liver biopsy. Results: The lipid peroxidation marker 8-isoprostane (8.IP) was significantly elevated in PBC (p
I 227

RANDOMIZED,

DOUBLE

PLUS ENDOSCOPIC GASTROESOPHAGEAL

BLIND, TRIAL OF OCTREOTIDE

TREATMENT VARICEAL

IN CONTROLLING BLEEDING

EC. Souza’, V. Arantes’, R.D. Cambraia’, L.O.F. Cangussu’, O.F.M. Couto’, R. Teixeira2. ‘Department of Internal Medicine, Hospital Joao XX III, Belo Horizonte, Brazil; 21nstitutoAlfa De Gastroenterologia Do Hospital Das Clinicas Da Universidade Federal De Minas Gerais, Belo Horizonte, Brazil, Background: Gastro esophageal varices bleeding (GEVB) in portal hypertension (PH) have a high mortality in cirrhotic patients or hepatoesplenic schistosomiasis (HES). The current endoscopic treatment (ET) is banding and/or sclerotherapy. Recently, somatostatinloctreotide (OCT) has been used as co adjuvant treatment of ET. Aim: To evaluate if OCT improves the efficacy of ET in GEVB. Methods: A total of 143 cirrhotic and schistosomotic patients with GEVB related to PH were assigned 2 hours before endoscopy (time zero) to receive either ET (2.5% ethanolamin-oleate) plus OCT (1OOkg bolus before endoscopy, followed by infusion -5Okg/h for 72 h) (n=56), Group I (GI) or ET plus placebo (n=56), Group II (GII). The primary end point was control of bleeding during the 3-day infusion. Results: There was no significant differences concerning clinical features between the two groups. Treatment failures were 13/56 (23.21%) in GI and 17/56 (30.36%) in GII (p=O, 52) during the first 6 hours and 19/56 (33.9%) in GI and 32/56 (57.1%) in GII (p=O.O23) in 24 hours. The rate of rebleeding during OCT treatment was 19/56 (33.9%) in GI and 33/56 (58.9%) in GII- (p=O.O14, RR 0.38 -CI 0.58 - 0.88). The overall mortality was (23012) 20.5%, (43.45%) in GI and (56.52%) in GII (p=O.64). Conclusion: Preliminary results suggest that combined treatment of OCT and ET is more effective than sclerotherapy alone in controlling the acute