Sclerotherapy for actively bleeding esophageal varices in male alcoholics with cirrhosis
1997; 46 (1): 1-7
HEPATOCELLULAR-CARCINOMA IN CHINESE MALES AND FEMALES - POSSIBLE CAUSES FOR THE MALE PREDOMINANCE
1987; 60 (5): 1107-1110
Male alcoholics hospitalized with actively bleeding esophageal varices were treated with sclerotherapy or sham sclerotherapy and the outcomes during the index hospitalization were compared.The 87 patients were a subset of 253 patients enrolled in a prospective, randomized, single-blind, multicenter, controlled trial conducted in 12 VA medical centers. The patients (44 sclerotherapy, 43 sham therapy) were actively bleeding from esophageal varices at either randomization endoscopy (49) or follow-up endoscopy (38). Events and resource use during the index hospitalization were recorded.In 40 (91%) of the sclerotherapy and 26 (60%) of the sham therapy patients, bleeding was stopped during the endoscopy session (p < 0.001). During the hospitalization, 10 (25%) sclerotherapy and 21 (49%) sham therapy patients died (p = 0.04, relative risk 2.17, 95% CI [1.02, 4.61]); 9 sclerotherapy and 22 sham therapy patients rebled (p = 0.005). The median transfusion requirement was higher for sham therapy (8 vs 4 units, p = 0.001), the number of median ICU hours was greater (101 vs 55, p < 0.001), and more patients in this group required shunt surgery (6 vs 0, p = 0.01).Sclerotherapy, compared to no sclerotherapy, stops hemorrhage from actively bleeding esophageal varices and reduces use of resources. Sclerotherapy significantly increased hospital survival.
View details for Web of Science ID A1997XQ65400001
View details for PubMedID 9260697
SURVIVAL IN CHRONIC HEPATITIS-B - AN ANALYSIS OF 379 PATIENTS
ANNALS OF INTERNAL MEDICINE
1984; 101 (5): 613-616
The male-female ratio in 186 hepatocellular carcinoma (HCC) Chinese patients was 5:1. The clinical presentation, biochemical parameters, and histologic findings were the same in both sexes except for a higher proportion of underlying cirrhosis (P = 0.02), and spider naevi (P = 0.04) in the men. There were also more smokers and alcohol drinkers among the men. Over 75% of both sexes were positive for the hepatitis B surface antigen. The possible contributory factors to the predominance of males to females in HCC included: the association with the hepatitis B virus, the higher proportion of male cirrhotics, smoking, and alcohol drinking. The survival probability for both sexes was equally poor; the median survival was 8 weeks for males and 10 weeks for females.
View details for Web of Science ID A1987J662600030
View details for PubMedID 3038298
VIDARABINE MONOPHOSPHATE AND HUMAN-LEUKOCYTE INTERFERON IN CHRONIC HEPATITIS-B INFECTION
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1982; 247 (16): 2261-2265
Survival data from 379 patients with chronic hepatitis B were analyzed to determine life expectancy for the patient from the time of first contact. One hundred twenty-one patients had chronic persistent hepatitis, 128 had chronic active hepatitis, and 130 had chronic active hepatitis with cirrhosis. The frequency of symptoms (p less than 0.001), stigmata of chronic liver disease (p less than 0.001), and liver function test abnormalities (p less than 0.001) increased as the histologic features worsened, whereas the percentage of patients with circulating hepatitis B DNA polymerase declined (p less than 0.001). Women were uncommon in our series and had less severe disease than men (p less than 0.02). Fifty-one patients had died by the time of this analysis. The estimated 5-year survival rates were 97% for patients with chronic persistent hepatitis, 86% for those with chronic active hepatitis, and 55% for those with chronic active hepatitis with cirrhosis. The usual cause of death was liver failure and its sequelae. A multivariate analysis found age of 40 years or more, total bilirubin level of 1.5 mg/dL or more, ascites, and spider nevi to be factors that identified patients at a higher risk of death. The prognosis for patients with chronic hepatitis B is similar to that for patients with chronic hepatitis of other causes.
View details for Web of Science ID A1984TR73200006
View details for PubMedID 6486592
Upper gastrointestinal bleeding. Accuracy of clinical diagnosis and prognosis.
Digestive diseases and sciences
1981; 26 (7): 65S-69S
DIURESIS IN THE ASCITIC PATIENT - A RANDOMIZED CONTROLLED TRIAL OF 3 REGIMENS
JOURNAL OF CLINICAL GASTROENTEROLOGY
1981; 3: 73-80
Ten young adult patients with chronic hepatitis B virus infection and positive hepatitis B e antigen and DNA polymerase (DNAP) levels were treated with alternating courses of seven to 28 days of 5 to 7.5 mg/kg of vidarabine monophosphate (adenine arabinoside monophosphate) and 28 days of human leukocyte interferon (IFN-alpha); three different regimens were given on an outpatient basis. All patients with a fall in their DNAP level, and the DNAP remained undetectable six months after treatment was stopped in one patient. The major side effect, which most often occurred in those patients receiving 7.5 mg/kg of vidarabine monophosphate, was severe muscular pains. This study demonstrated the feasibility of administering vidarabine monophosphate and interferon to outpatients. Based on data from this and other studies, it is now possible to use a relatively nontoxic regimen that includes 28 days of 5 mg/kg of vidarabine monophosphate in a larger controlled study to answer the question of efficacy.
View details for Web of Science ID A1982NL19400022
View details for PubMedID 6175774
COMPLICATIONS OF DIURESIS IN ALCOHOLIC PATIENT WITH ASCITES - CONTROLLED TRIAL
1977; 73 (3): 534-538
To compare the efficacy of three commonly used diuretic regimens in the treatment of ascites, we randomized 90 patients to three treatment groups: Sequential Spironolactone (spironolactone followed by furosemide if necessary), Combination (spironolactone and furosemide in combination), and Furosemide (furosemide given alone). Diuretics were begun at a low dose by mouth and the dosage increased until a 0.4-0.8 kg daily diuresis was achieved. The clinical and laboratory findings were comparable for the three experimental groups on admission to the study. All three regimens achieved a comparable rate of diuresis. To do so was far more difficult with furosemide alone, which required repetitious upward adjustments in dosage and massive KCl supplements. The incidence of encephalopathy, hepatorenal syndrome, and marked electrolyte abnormalities was similar for the three treatment groups except that severe hyperkalemia was more frequent on combination therapy. We conclude that diuresis should be initiated with one of the two spironolactone regimens and not with furosemide as the sole agent.
View details for Web of Science ID A1981MS73600015
View details for PubMedID 7035545
STEROID-THERAPY IN SEVERE VIRAL-HEPATITIS - DOUBLE-BLIND, RANDOMIZED TRIAL OF METHYL-PREDNISOLONE VERSUS PLACEBO
NEW ENGLAND JOURNAL OF MEDICINE
1976; 294 (13): 681-687
Forty-three patients with decompensated alcoholic liver disease and ascites of recent onset were randomized to salt and water restriction alone (control group) or to salt and water restriction plus diuretics (diuresis group). The two treatment groups were comparable in clinical findings and laboratory results. Seven patients in the control group and 5 patients in the diuresis group died during the acute illness. Weight loss was more marked and the disappearance of ascites more common in those given diuretics. A modest decrease in serum sodium and increase in serum potassium, and readily reversible elevations of blood urea nitrogen were noted in the diuresis group. Eight patients in each treatment group developed either the hepatorenal syndrome, marked electrolyte abnormalities, or encephalopathy. Diuresis can be accomplished in these critically ill patients without serious complications that can be attributed to the diuretic treatment.
View details for Web of Science ID A1977DT01500019
View details for PubMedID 892352
EFFECT OF HUMAN LEUKOCYTE INTERFERON ON HEPATITIS B VIRUS-INFECTION IN PATIENTS WITH CHRONIC ACTIVE HEPATITIS
NEW ENGLAND JOURNAL OF MEDICINE
1976; 295 (10): 517-522
The efficacy of corticosteroid therapy in severe viral hepatitis has never been demonstrated in a controlled clinical trial. For this reason, patients with severe viral hepatitis were randomly assigned to methyl-prednisolone or placebo treatment groups. The two groups were comparable in clinical findings, laboratory results and the presence of bridging necrosis on liver biopsy. Seven of the 14 patients assigned to methyl-prednisolone and two of the 15 assigned to placebo died during the 16-week study period. Although the apparent excess mortality in the steroid-treated patients is not quite statistically significant (P = 0.08), the trend persists when only patients positive for hepatitis B surface antigen (P = 0.04) are analyzed separately. Methyl-prednisolone does not enhance survival in patients with severe viral hepatitis, and it may be detrimental.
View details for Web of Science ID A1976BK23400001
View details for PubMedID 765822
SPLEEN SHIELDING IN SURVIVORS OF ATOMIC BOMB
1968; 33 (2): 204-?
SCLEROTHERAPY FOR MALE ALCOHOLIC CIRRHOTIC-PATIENTS WHO HAVE BLED FROM ESOPHAGEAL-VARICES - RESULTS OF A RANDOMIZED, MULTICENTER CLINICAL-TRIAL
1994; 20 (3): 618-625
LIMITATIONS OF LIVER SURFACE US IN THE DIAGNOSIS OF CIRRHOSIS
1992; 185 (1): 21-23
Four patients with chronic hepatitis B infection and chronic active hepatitis were treated with human leukocyte interferon. Three of them had consistently elevated levels of circulating Dane-particle markers, including Dane-particle-associated DNA polymerase activity, hepatitis B core antigen and Dane-particle-associated DNA. Parenteral interferon administration at a dosage between 6.0 X 10(3) and 17 X 10(4) U per kilogram per day was associated with a rapid and reproducible fall in all Dane-particle markers in the three patients. The suppressive effect was transient when the interferon was given for 10 days or less but appeared to be more permanent when administration was prolonged for a month or more. In addition, long-term interferon therapy was associated with a marked fall in hepatitis B surface antigen in two of three patients and a disappearance of e antigen in two of two patients. Interferon may be useful in limiting carrier infectivity or eradicating chronic infection.
View details for Web of Science ID A1976CB97100001
View details for PubMedID 950957
ACCELERATED IMPROVEMENT OF ALCOHOLIC LIVER-DISEASE WITH ENTERAL NUTRITION
1992; 102 (1): 200-205
Ultrasound (US) of the liver surface with a high-frequency, small-parts, short-focused probe has been proposed as a method of diagnosing cirrhosis. US of the liver was performed in 50 consecutive patients undergoing diagnostic liver biopsy to assess the clinical usefulness of this noninvasive procedure in diagnosing hepatic cirrhosis. Eight patients had histologically proved cirrhosis, and 42 had no histologic evidence of cirrhosis. Seven of the eight patients with cirrhosis had a normal liver surface at US, and five of the 42 patients without cirrhosis had an abnormal liver surface. US of the liver surface with this probe was not reliable in this heterogeneous patient population.
View details for Web of Science ID A1992JN60800005
View details for PubMedID 1523310
ACUTE DELTA HEPATITIS DURING TREATMENT WITH ADENOSINE ARABINOSIDE MONOPHOSPHATE WITH RESOLUTION OF THE HBSAG CARRIER STATE
WESTERN JOURNAL OF MEDICINE
1990; 153 (1): 80-82
ADENINE-ARABINOSIDE MONOPHOSPHATE (VIDARABINE PHOSPHATE) IN COMBINATION WITH HUMAN-LEUKOCYTE INTERFERON IN THE TREATMENT OF CHRONIC HEPATITIS-B - A RANDOMIZED, DOUBLE-BLINDED, PLACEBO-CONTROLLED TRIAL
ANNALS OF INTERNAL MEDICINE
1987; 107 (3): 278-285
This prospective study compared the effects of tube-fed nutrition with those of a regular diet in alcoholic liver disease. The high prevalence of malnutrition in patients with alcoholic liver disease requires clarification of the benefits of aggressive nutritional support. Patients were randomly assigned a regular diet without or with tube-fed supplementation, delivering 1.5 g/kg protein and 167 kJ/kg daily. Comparisons of encephalopathy, antipyrine clearance, metabolic rate, and biochemical parameters were performed weekly for 4 weeks. Sixteen patients receiving enteral supplementation had antipyrine half-life (50% vs. 3% reduction), serum bilirubin (25% vs. 0% reduction), and median encephalopathy scores that improved more rapidly than those of controls. Initially, 15 controls did not consume adequate calories to meet measured resting energy expenditure. Aggressive nutritional intervention accelerated improvement in alcoholic liver disease. Adverse effects did not offset the demonstrated benefits of a 2-cal/mL, casein-based tube-fed supplement. These findings support the use of standard, casein-based solutions in the treatment of alcoholic liver disease and as the control condition for future studies.
View details for Web of Science ID A1992GX35500027
View details for PubMedID 1727754
INTERFERON IN CHRONIC HEPATITIS-B
1986; 90 (1): 237-240
PRELIMINARY TRIAL OF RECOMBINANT FIBROBLAST INTERFERON IN CHRONIC HEPATITIS-B VIRUS-INFECTION
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
1986; 29 (1): 122-126
Study Objective: To determine the efficacy of adenine arabinoside monophosphate (Ara-AMP vidarabine phosphate) with or without human leukocyte interferon in chronic hepatitis B. Study Design: Randomized, double-blinded, placebo-controlled trial with 6-month treatment and an 18-month follow-up. Setting: Referral-based liver-disease clinics at three university medical centers. Patients: Twenty-five patients with chronic active hepatitis or cirrhosis and 39 with chronic persistent hepatitis. Interventions: Thirteen patients received intramuscular Ara-AMP, 2.5 mg/kg body weight, twice daily, alternated monthly for 6 months with subcutaneous human leukocyte interferon, 5 million units, twice daily. Painful paresthesia of the legs necessitated dosage reduction and early discontinuation of enrollment. Twenty-four patients received intramuscular Ara-AMP, 2.5 mg/kg, twice daily, alternated monthly for 6 months with a matching placebo given subcutaneously twice daily. Twenty-seven patients received placebo by intramuscular and subcutaneous injections twice daily for 6 months. Measurements and Main Results: Of the 64 patients, 95% had symptomatic and virologic data available and 64% had biopsies at 12 months; at 24 months, 77% had data available and 56% had repeat biopsies. The highest dropout rate was seen in the group receiving Ara-AMP. The group receiving the placebo was less symptomatic (Karnofsky score of 96% compared with 91% in the group receiving Ara-AMP/placebo and 92% in the group receiving Ara-AMP/human leukocyte interferon, p = 0.02) at 12 but not at 24 months. Loss of DNA polymerase, the hepatitis B e antigen, and the serum hepatitis B virus DNA was similar in all three groups. Histologically, erosion of the limiting plate and lobular activity favored Ara-AMP at 12 but not at 24 months and these differences did not result in differences in the histologic diagnosis. Conclusion: These results do not support the use of Ara-AMP and human leukocyte interferon in chronic persistent or chronic active hepatitis B.
View details for Web of Science ID A1987J946200002
View details for PubMedID 2441633
PRELIMINARY OBSERVATION OF HEPATITIS B-ASSOCIATED MEMBRANOUS GLOMERULONEPHRITIS TREATED WITH LEUKOCYTE INTERFERON
1985; 5 (2): 317-320
MEASUREMENT OF ATTENUATION AND SCATTERER SPACING IN HUMAN-LIVER TISSUE - PRELIMINARY-RESULTS
JOURNAL OF ULTRASOUND IN MEDICINE
1984; 3 (12): 557-561
Five patients with chronic hepatitis B were treated with 8-day courses of leukocyte (alpha) interferon (5 X 10(6) U/day) and with 8-day courses of recombinant fibroblast (betaser) interferon at dosages of 5 X 10(6), 35 X 10(6), and 105 X 10(6) U/day. Inhibition of hepatitis B virus replication as evidenced by a decrease in DNA polymerase (DNAP) activity was seen during all treatment courses. Equivalent reduction in DNAP was seen from the low-dose alpha and beta ser regimens, but beta ser interferon at 35 X 10(6) U/day achieved a significantly greater decrease in DNAP activity than did the low-dose regimens. In no patient, however, was permanent loss of DNAP noted. Because of dose-limiting toxicity, only two patients were escalated to the 105 X 10(6)-U/day dosage level. Transient proteinuria was noted in two patients while they were receiving interferon. This has not been noted in other patients receiving this preparation and could not be explained by the development of anti-interferon antibodies. This study has defined an appropriate dosage for future longer-term trials of this agent alone and in combination with other antivirals for the treatment of chronic hepatitis B.
View details for Web of Science ID A1986AXH3700024
View details for PubMedID 3524420
ANTI-VIRAL IN CHRONIC HEPATITIS-B - PROBLEMS OF SMALL CLINICAL-TRIALS
1984; 86 (1): 201-204
HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHIC ANALYSIS OF HYPOXANTHINE ARABINOSIDE IN PLASMA
JOURNAL OF CHROMATOGRAPHY
1984; 307 (2): 410-415
ACUTE DANE PARTICLE SUPPRESSION WITH RECOMBINANT LEUKOCYTE-A INTERFERON IN CHRONIC HEPATITIS-B VIRUS-INFECTION
JOURNAL OF INFECTIOUS DISEASES
1983; 148 (5): 907-913
A study measuring two quantitative parameters of human liver in vivo was performed to assess the reliability of measurement of the two parameters, and to evaluate their potential for diagnosing and grading diffuse fibrotic liver disease. The parameters measured were attenuation and "mean scatterer spacing," a measure of tissue structure. Components of variance analysis demonstrated that variation in the measured parameters was a function of the subject being examined, with significant variation noted between data acquisition sessions performed the same day. There was no significant additional variation of the measurements from week to week over a one-month period. A good correlation of the parameters with the severity of liver disease indicates that the technique may be useful in the clinical evaluation of diffuse liver disease.
View details for Web of Science ID A1984TW41300007
View details for PubMedID 6392587
LOCATION AND ACTIVITY OF ULCERATIVE AND CROHNS COLITIS BY IN-111 LEUKOCYTE SCAN - A PROSPECTIVE COMPARISON STUDY
1983; 84 (2): 388-393
The clinical, virologic, biochemical, and immunologic effects of a biosynthetic human leukocyte interferon, recombinant leukocyte A interferon (rIFN-A or HuIFN-alpha 2) are reported in nine patients with chronic hepatitis B virus infection and circulating Dane particle-associated polymerase activity. Eight-day courses of rIFN-A were given starting at a dose of 3 X 10(6) units per day and reaching 68 X 10(6) units per day in two patients. Major toxic side effects included fever, fatigue, gastrointestinal symptoms, myalgias, and headache. Most courses of rIFN-A were associated with a reduction in Dane particle-associated polymerase activity, but in no case was this change permanent. There were also changes in lymphocyte subpopulations at the higher dosage levels of rIFN-A. Because of the reproducible, statistically significant effect on viral replication, further study with this and other biosynthetic interferon species is warranted.
View details for Web of Science ID A1983RR57200018
View details for PubMedID 6631076
ANTIVIRAL TREATMENT OF CHRONIC HEPATITIS-B VIRUS-INFECTION - INFECTIOUS VIRUS CANNOT BE DETECTED IN PATIENT SERUM AFTER PERMANENT RESPONSES TO TREATMENT
1982; 2 (1): 39-49
A prospective blinded study comparing the indium 111 leukocyte scan to barium enema, colonoscopy, or surgery or a combination of these, was carried out in 15 patients (10 with active ulcerative colitis and 5 with active Crohn's colitis). Correlation of disease location to colonic regions between indium scan and other diagnostic studies was excellent in 11 instances, good in 2, and poor in 3. In 2 of the 3 studies where major disagreement occurred, the comparative barium enema was performed greater than 2 mo after the indium scan. Disease activity, estimated by the intensity of radionuclide uptake, was compared to clinical disease activity assessed by the Crohn's Disease Activity Index for both forms of colitis. The relative degree of inflammation estimated by the indium scan correlated well with the independent clinical assessment (correlation coefficient = 0.81). The indium 111 leukocyte scan appears to be an accurate, noninvasive method for assessing the extent and the severity of the inflammation in patients with acute ulcerative or Crohn's colitis.
View details for Web of Science ID A1983PY22000026
View details for PubMedID 6848412
PRELIMINARY STUDIES OF ACYCLOVIR IN CHRONIC HEPATITIS-B
AMERICAN JOURNAL OF MEDICINE
1982; 73 (1A): 267-270
Fourteen chimpanzees were inoculated with pre- and posttreatment sera from seven patients with persistent hepatitis B virus infection and chronic hepatitis who had permanent responses of their infection to treatment with interferon and/or adenine arabinoside. Inoculation of pretreatment serum at a dilution of 10(-8) from a patient with a Type I response to treatment [disappearance of Dane particle DNA polymerase (DNAP) activity, HBeAg, and HBsAg from serum] resulted in infection, while undiluted posttreatment serum (all markers negative) failed to infect another animal. Pretreatment sera (DNAP, HBeAg, and HBsAg positive) from all six patients with a Type II response to treatment (disappearance of DNAP activity and HBeAg but not HBsAg from serum) led to infection in six chimpanzees after inoculation of serum dilutions varying between 10(-2) and 10(-7). Inoculation of undiluted posttreatment sera (HBsAg positive and DNAP and HBeAg negative) from the same six patients produced no evidence of hepatitis B virus infection in another six animals. These results indicate that a Type I or II response to treatment with these antiviral agents reduces the infectivity in the serum of patients with chronic hepatitis B to below the level of detection by this assay. Such changes should be useful in interrupting spread of the infection between individuals. Our findings suggest that the serum of some patients who, without treatment are HBsAg positive and DNAP and HBeAg negative, may also be free of detectable infectious hepatitis B virus.
View details for Web of Science ID A1982NL29100006
View details for PubMedID 6172352
ANTIVIRAL TREATMENT OF CHRONIC HEPATITIS-B VIRUS-INFECTION - PHARMACOKINETICS AND SIDE-EFFECTS OF INTERFERON AND ADENINE-ARABINOSIDE ALONE AND IN COMBINATION
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
1982; 21 (1): 93-100
Three patients with HBsAg-positive and DNA-polymerase-positive chronic hepatitis were treated with increasing dosages of intravenous acyclovir. A fall in DNA polymerase activity was seen with all courses of acyclovir but no dose-response relationship was evident. In only one patient did DNA polymerase fall to zero where it has remained for five months. Two out of 10 courses were associated with significant side effects with the highest dosages of acyclovir but these promptly resolved when the agent was stopped. Acyclovir's apparently partial and transient action suggests that it will not have a role in the treatment of chronic hepatitis B virus infection.
View details for Web of Science ID A1982NZ89000052
View details for PubMedID 7102705
CONTINUOUS INTRAVENOUS VASOPRESSIN IN ACTIVE UPPER GASTROINTESTINAL-BLEEDING - A PLACEBO-CONTROLLED TRIAL
ANNALS OF INTERNAL MEDICINE
1982; 96 (5): 565-569
In an uncontrolled trial, 29 patients with chronic hepatitis B virus infection were treated with 93 courses of adenine arabinoside at doses ranging from 2.5 to 15 mg/kg per day. Most patients were treated concomitantly with human leukocyte interferon. Significant, but transient, neurotoxicity was seen with adenine arabinoside therapy in 44% of all courses. Manifestations of toxicity were mainly neurological and ranged from pain syndromes to tremors and, rarely, seizures. Suppression of numbers of lymphocytes was also noted. All effects were reversible with time. The extent of toxicity was dependent upon the dosage of adenine arabinoside. Treatment with interferon appeared to potentiate the occurrence of toxicity with adenine arabinoside. Arabinofuranosylhypoxanthine serum levels increased in a dose-dependent manner and tended to accumulate in interferon-treated hepatitis patients during a course of therapy. Elevated blood levels and drug accumulation were associated with toxicity in a significant fashion. Human leukocyte interferon was administered to 38 patients in 113 separate courses. Interferon side effects were rapidly reversible upon cessation of therapy. These included initial fever, myalgias, and hair loss as well as suppression of granulocytes, platelets, and lymphocytes in the blood.
View details for Web of Science ID A1982MX19200016
View details for PubMedID 6177285
LYMPHOMAS INVOLVING THE GASTROINTESTINAL-TRACT
1982; 82 (1): 143-152
Dane particle DNA polymerase and HBeAg: impact on clinical, laboratory, and histologic findings in hepatitis B-associated chronic liver disease.
1981; 1 (6): 583-585
Sixty patients with active upper gastrointestinal bleeding were randomized to received either continuous intravenous infusions of vasopressin (29 patients) or placebo (31 patients) at a rate of 40 U/h. Six hours after beginning the study, 13 patients in the vasopressin group and 11 in the placebo group] had ceased bleeding (p = 0.46). By 24 hours. 17 patients in the vasopressin group and 14 in the placebo group had stopped bleeding (p = 0.30). Restriction of the analysis to patients bleeding from varices showed no advantage with vasopressin treatment after 6 or 24 hours. No consistent trend favoring use of vasopressin to stop hemorrhage was noted during the 30-month study period. There was little difference between the two groups in the number of patients needing surgery (13 on vasopressin, 18 on placebo; p = 0.30) or the number of deaths (eight on vasopressin, 11 on placebo; p = 0.51); the transfusion requirement was the same. In our patients, a continuous intravenous infusion of vasopressin neither controlled bleeding nor altered outcome.
View details for Web of Science ID A1982NP94900004
View details for PubMedID 7041728
THE DEMISE OF CORTICOSTEROID-THERAPY FOR ACUTE VIRAL-HEPATITIS
1981; 80 (2): 404-406
HALOTHANE HEPATITIS IN 3 PAIRS OF CLOSELY RELATED WOMEN
NEW ENGLAND JOURNAL OF MEDICINE
1981; 304 (17): 1023-1024
FUROSEMIDE DISPOSITION IN CIRRHOTIC-PATIENTS
1981; 81 (6): 1012-1016
Fifty patients with chronic HBs antigenemia and Dane particle-associated DNA polymerase and HBeAg in their serum were contrasted to 46 HBsAg positive patients who had neither serum DNA polymerase or HBeAg. The time from acute onset and the duration of antigenemia were longer in patients who were DNA polymerase and HBeAg negative than in those who had both serum markers. Cirrhosis, hypoalbuminemia, and sequelae of chronic liver disease were more common in DNA polymerase, HBeAg negative patients than in those who were positive. These findings are consistent with the hypothesis that active viral replication is an early, albeit prolonged stage in the development of advanced HBsAg-associated liver disease.
View details for PubMedID 7308991
HEPATITIS-B VIRAL MARKERS IN SEVERE VIRAL-HEPATITIS - INFLUENCE OF STEROID-THERAPY
1981; 1 (1): 54-57
Furosemide disposition in 7 cirrhotic subjects and 4 age-matched healthy controls was studied to determine the contribution of differences in pharmacokinetics to the decreased responsiveness observed in cirrhotics. Subjects were given 80 mg of furosemide orally and intravenously on separate occasions, and plasma and urine samples were collected and analyzed for furosemide by high performance liquid chromatography. The half-life of furosemide was 74% greater in the cirrhotic subjects, the result of a smaller increase in volume of distribution (30%) and a decrease in total plasma clearance (15%). The change in plasma clearance was due entirely to a change in nonrenal clearance, since renal clearance was very similar in both groups. The fraction of furosemide not bound to plasma proteins increased by 48%. Furosemide bioavailability was the same in cirrhotic subjects and controls. Consistent with other reports, there was considerable intersubject variability in all of the measured and computed parameters. The results show that differences in disposition play little, if any, role in the decreased renal responsiveness to furosemide.
View details for Web of Science ID A1981MP88900006
View details for PubMedID 7286579
ANTI-VIRAL TREATMENT OF CHRONIC HEPATITIS-B VIRUS-INFECTION .1. CHANGES IN VIRAL MARKERS WITH INTERFERON COMBINED WITH ADENINE-ARABINOSIDE
JOURNAL OF INFECTIOUS DISEASES
1981; 143 (6): 772-783
In our double-blind randomized trial of methylprednisolone vs. placebo in severe viral hepatitis, 16 patients with hepatitis B (8 on steroid, 8 on placebo) were followed for at least 4 weeks. Four of the eight patients receiving methylprednisolone eventually died and all patients on placebo survived. Despite marked reduction in serum IgG in steroid-treated patients, the decline in HBsAg titer and disappearance of Dane particle markers was the same in both treatment groups. A nonspecific depression of anti-HBc was noted in patients given steroid. There is no evidence that corticosteroid therapy accelerates viral replication when the acute hepatitis is severe.
View details for Web of Science ID A1981MP47500008
View details for PubMedID 7026400
BLEEDING AFTER LIVER-BIOPSY
WESTERN JOURNAL OF MEDICINE
1981; 134 (1): 11-14
Twenty patients with chronic active hepatitis and 12 patients with chronic persistent hepatitis associated with hepatitis B virus (HBV) infection were treated with human leukocyte interferon or adenine arabinoside alone or in combination. With interferon alone, four of 16 patients showed a permanent disappearance of HBV-associated DNA polymerase (DNAP) activity from serum. Of six patients treated with adenine arabinoside alone, only one patient became permanently DNAP-negative. With a regimen of multiple cycles of combined interferon and adenine arabinoside, seven of 16 male patients became permanently DNAP-negative. Of 69 patients who met the criteria for admission to the program, spontaneous decreases in DNAP activity without treatment were observed in only 9% during a mean observation period of 10 months. In general, patients with chronic active hepatitis, those who are female, and those with a history of recent steroid therapy responded to the antiviral agents significantly better than did the other patients.
View details for Web of Science ID A1981MA30400003
View details for PubMedID 6166691
ANTIVIRAL TREATMENT OF CHRONIC HEPATITIS-B VIRUS-INFECTION - IMPROVEMENT IN LIVER-DISEASE WITH INTERFERON AND ADENINE-ARABINOSIDE
1981; 1 (3): 228-232
EFFECTS OF IMMUNOSUPPRESSIVE THERAPY ON VIRAL MARKERS IN CHRONIC ACTIVE HEPATITIS-B
1981; 81 (6): 987-991
During nine years 3,080 liver biopsies were carried out and bleeding occurred in 22 of the patients (0.7 percent). Transfusions were given to 17 of these patients and laparotomies were done to control the bleeding in six. All survived. Bleeding was evident within three hours in 19 patients, but occurred from 3 to 13 days after biopsy in the remaining three. Pain requiring analgesic medication and a fall in blood pressure were the usual indications that major bleeding had occurred. Relative contraindications to biopsy (particularly a prolonged prothrombin time) were present in 10 of the 22 bleeding patients and in only 2 of the 41 nonbleeding controls (P<0.001). We believe that some of the bleeding episodes could have been prevented with more careful attention to the indications and contraindications to biopsy, and more rigorous correction of recognized clotting abnormalities.
View details for Web of Science ID A1981KZ82400003
View details for PubMedID 7210659
UPPER GASTROINTESTINAL-BLEEDING - ACCURACY OF CLINICAL-DIAGNOSIS AND PROGNOSIS
DIGESTIVE DISEASES AND SCIENCES
1981; 26 (7): S65-S69
RAPID REDUCTION OF TRANSAMINASE LEVELS IN FULMINANT-HEPATITIS
NEW ENGLAND JOURNAL OF MEDICINE
1980; 302 (17): 970-970
INTERFERON IN CHRONIC HEPATITIS-B INFECTION
1980; 1 (8165): 422-423
A SEQUENTIAL CLINICAL-TRIAL FOR TESTING P1=P2
ANNALS OF STATISTICS
1980; 8 (6): 1219-1228
ENHANCED BIOAVAILABILITY AND DECREASED CLEARANCE OF ANALGESICS IN PATIENTS WITH CIRRHOSIS
1979; 77 (1): 96-102
Hepatitis B virus associated DNA polymerase activity, hepatitis b surface antigen (HBsAg), and serum aspartate aminotransferase were followed in 21 patients with chronic active hepatitis while immunosuppressive therapy (prednisone +/- azathioprine) was being withdrawn. In every case, DNA polymerase activity fell within 6-10 wk of decreasing treatment and became undetectable in 8 patients. This was usually accompanied by a fall in HbsAg titer and a transient rise in serum aspartate aminotransferase activity. Four additional patients with previously untreated HbsAg positive chronic active hepatitis were placed on prednisone for 12 wk. There was a rise in DNA polymerase activity and HBsAg titer with a fall in serum aspartate aminotransferase values during treatment. Upon discontinuing therapy, DNa polymerase activity fell dramatically in all 3 patients who completed their course of prednisone and became undetectable in 1. These findings suggest that immunosuppressive therapy has a potentiating effect on hepatitis B viral replication in patients with chronic active hepatitis.
View details for Web of Science ID A1981MP88900002
View details for PubMedID 7286593
The treatment of ascites.
Rational drug therapy
1978; 12 (7): 1-4
EFFECT OF VIDARABINE ON CHRONIC HEPATITIS-B VIRUS-INFECTION
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1978; 239 (16): 1648-1650
CORTICOSTEROID TREATMENT OF HEPATITIS (CONT)
NEW ENGLAND JOURNAL OF MEDICINE
1976; 295 (23): 1322-1322
MISLEADING SGOT (ASPARTATE-AMINOTRANSFERASE) VALUES IN OBSTRUCTIVE-JAUNDICE DUE TO PANCREATIC CARCINOMA
AMERICAN JOURNAL OF DIGESTIVE DISEASES
1976; 21 (6): 509-511
REFRACTORY CASE OF HEPATIC AMEBIASIS
1976; 70 (4): 585-588
The effect of moderate cirrhosis on the bioavailability and systemic clearance of three model analgesic compounds (pethidine, pentazocine, and salicylamide) with substantial first-pass metabolism was examined in 8 cirrhotic subjects and 4 agematched healthy controls. There was a 46% decrease in the clearance of pentazocine and a 278% increase in bioavailability. The corresponding figures for pethidine were 36% and 81%. The area under the plasma curve after oral salicylamide was increased by 551% in cirrhotic subjects compared with controls. This study demonstrated that drugs with the highest hepatic clearance will have the largest relative increases in bioavailability in cirrhotic patients due to portosystemic shunting. The decrease in clearance and increase in bioavailability will have multiplicative, rather than simply additive, effects on total area under the curve and, if related, pharmacologic response.
View details for Web of Science ID A1979GZ61000016
View details for PubMedID 447033
LIVER-FUNCTION IN SURVIVORS OF ATOMIC BOMB
1975; 63 (3): 578-583
SPLENOMEGALY IN UNCOMPLICATED BILIARY-TRACT AND PANCREATIC DISEASE
1972; 62 (3): 436-?
RENAL TUBERCULOSIS IN JAPANESE
JOURNAL OF CHRONIC DISEASES
1967; 20 (4): 225-?
1965; 44 (3): 249-?
A 39-year-old man had three separate episodes of hepatic amoebiasis despite one course of emetine and chloroquine, two courses of metronidazole, and one prolonged course of chloroquine. Asymptomatic intestinal amoebiasis was first detected after his third episode of hepatic disease, and his eventual cure followed an intensive regimen designed primarily to treat the intestinal infection. It seems likely that the intestinal amoebiasis had been present undetected since the onset of hepatic disease and had served as the source for reinfection of the liver.
View details for Web of Science ID A1976BK79000022
View details for PubMedID 1254142