Medicine of the Future in America

Category Archives: Liver disease

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: Recommendation

We attribute the increased dispersion of the Po2 values in our cirrhotic patients to four factors: (1) Alterations in the activities of enzymes controlling the phosphoglycerate shunt are observed in liver cirrhosis: glucokinase activity is low or absent, hexokinase increases, and the glucokinase/hexokinase ratio is reduced. Glucose-6-phosphatase is also lower in cirrhotics. In alcoholic liver cirrhosis and primary biliary cirrhosis, the activity of glucokinase is < 10 of the activity in control subjects. (2) Thyroxine stimulates 2,3 DPG synthesis; hypothyroidism is present in 7% to 20% of patients with primary biliary cirrhosis. 2,3 DPG was not measured in these patients, but it is likely that its concentration was decreased and therefore that the ODC was shifted to the left. (3) Plasma ions are disturbed in cirrhosis: for instance, sodium and water excretion are im-paired, especially in the presence of ascites and when diuretics are administered. Hyponatremia or hypernatremia and hypokalemia are frequently present. In our results, disturbed plasma ions in cirrhotic patients included sodium, calcium, and potassium (Table 4). http://buy-asthma-inhalers-online.com/

Continue reading

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: Research

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: ResearchWe have already described the same pattern, ie, a normal mean ODC and an increased dispersion of the Po2 values for different levels of So2% in patients with chronic obstructive lung disease27 and in patients with severe comorbid illnesses. When the patients of this last group were treated, their ODC normalized, suggesting that the increased dispersion is reversiЫe. Why does the dispersion of Po2 values for different levels of So2% increase in patients with cirrhosis? Synthesis and breakdown of 2,3 DPG are controlled by several enzymes in the phosphoglycerate cycle of Rapoport and Luebering, a side-shuttle of the main Embden-Meyerhoff pathway36 (Fig 3).

Continue reading

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: Results

The mean ODC was the same in the two groups (Fig 1). However, the dispersion of the Po2 values for the cirrhotic patients was significantly (p < 0.01 to p < 0.0001) increased: So2% of 20 to 80% (Table 1). Table 1 shows the SD of the Po2 values for 11 levels of oxygen saturation and related indexes (mean ± SD) for control subjects (n = 50) and cirrhotic patients (n = 50). Table 2 shows the effect of dispersion (1.96 X SD) of the Po2 values around the So2% in terms of oxygen content (volume percentage).
Continue reading

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: Statistical Analysis

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: Statistical AnalysisDuring this process, two variables were measured continuously: So2% by photometry, and Po2 using a Po2 electrode (Eschweiler; Kiel, Germany). A plot was continuously made of hemoglobin oxygen saturation as a function of Po2. In addition, 10 mL of blood was sampled for measurements of 2,3 DPG, plasma ions, and arterial and mixed venous blood gases. For each curve, one hundred pairs of Po2 and So2% values were processed by a homemade computer program in order to obtain the entire curve. The accuracy of the method, as expressed by the SD of the P50, was 0.1 mm Hg for six curves obtained from the same blood sample. Biological variation, estimated from 16 curves traced from four blood samples taken every Monday during 4 weeks from the same healthy nonsmoking volunteer, was 0.3 mm Hg. http://asthma-inhalers-online.com/buy-advair-diskus-inhaler.html

Continue reading

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis: Materials and Methods

We examined two groups of 50 subjects: one group of patients with cirrhosis (27 men and 23 women), all candidates for OLT, and one group of 50 gender-, age-, and height-matched control subjects. Mean age ± SD was 54 ± 7 years in the cirrhotic patients and 53 ± 8 years in the control subjects (not significant [NS]). Mean height was 1.72 ± 0.05 m in cirrhotic patients and 1.74 ± 0.06 m in normal subjects (NS). All subjects were lifelong nonsmokers or ex-smokers since at least 5 years of age. Criteria for diagnosis and liver serobiochemistry followed routine clinical methods. The origin of cirrhosis was as follows: cryptogenetic (n = 12), alcoholic (n = 7), postviral type B or C (n = 20), and primary biliary cirrhosis (n = 11). Four patients had a Child-Pugh score A, 20 patients had a score B, and 26 patients had score C. Ascites was present in 26 cirrhotic patients. Twenty-two cirrhotic patients were treated with spironolactone, and the other 4 patients received furosemide. Ten patients received propranolol for prophylaxis of digestive bleeding due to portal hypertension. http://birthcontroltab.com/buy-levlen-online.html

Continue reading

The Oxyhemoglobin Dissociation Curve in Liver Cirrhosis

The Oxyhemoglobin Dissociation Curve in Liver CirrhosisTwo indexes characterize the oxyhemoglobin dissociation curve (ODC): shape and position. The latter index is usually described by the Po2 at half-saturation of hemoglobin (P50). Historically, the first factors found to be able to influence hemoglobin affinity for oxygen were salts studied in hemoglobin solutions. Anions, such as chloride or inorganic phosphates, induce a right shift of the ODC that enhances tissue oxygenation, whereas cations such as sodium, potassium, or magnesium have an opposite effect. http://buy-asthma-inhalers-online.com/combivent-inhaler-albuterol-sulfate.html

Continue reading

The role of liver biopsy in the management of patients with liver disease: CONCLUSION

On the other hand, McNair argued that, since the only proven treatment for NAFLD is weight loss, liver biopsy was pointless. He stated that it is difficult to justify liver biopsy simply to provide better prognostic information. Indeed, it is not clear that patients with simple steatosis and mild fibrosis will not, with time, develop more severe liver disease. Likewise, Kirsch did not feel that liver biopsy in patients with persistently abnormal liver enzymes should undergo a liver biopsy simply to make the diagnosis of NAFLD, since there is no defined therapy and knowing the histology is unlikely to have any clinical impact. Continue reading

The role of liver biopsy in the management of patients with liver disease: Nonalcoholic fatty liver disease

steatonecrosisNonalcoholic fatty liver disease (NAFLD) is a spectrum of disorders ranging from simple fatty liver to steatonecrosis and nonalcoholic steatohepatitis. It is associated with obesity, type II diabetes mellitus, hyperlipidemia, jejunoileal bypass and certain medications, but NAFLD can occur without identifiable risk factors . Patients typically present with unexplained chronic elevation of liver enzymes. Without treatment, a small number of patients with NAFLD develop cirrhosis . This process is accelerated by the presence of HCV and iron overload. Continue reading

The role of liver biopsy in the management of patients with liver disease: Hepatitis B

The literature about the role of liver biopsy in the management of patients with hepatitis B (HBV) infection is much less extensive. This may be related to several aspects of the disease itself and of the available treatment options. Firstly, HBV is not cytotoxic; rather, it is the host’s immune response to the virus that injures the liver. Therefore, the mere presence of an infection does not warrant a liver biopsy, which is most likely to be normal. Secondly, compared with HCV, the treatment for HBV is much more easily tolerated and widely applicable across the spectrum of infection, especially if nucleoside analogues like lamivudine or adefovir are used. Therefore, liver biopsy is not required to predict treatment outcome. Continue reading

The role of liver biopsy in the management of patients with liver disease: Hepatitis C

Pretreatment biopsyWith improvements in the outcome of treatment of HCV, however, many experts now question the need for liver biopsy. In the Consensus Conference of the National Institutes of Health held in 2002, it was concluded that liver biopsy, although not mandatory, should still be performed in patients with HCV infection. The rationale of this decision is that patients with moderate to severe hepatitis on liver biopsy are likely to develop cirrhosis and therefore warrant immediate treatment, while treatment can be postponed for milder cases until more effective and tolerable options become available. Continue reading

Copyright © 2012 Medicine of the Future in America www.perfexis.org