Bahri Bilir | University of Michigan (original) (raw)
Papers by Bahri Bilir
Digestive Diseases and Sciences, 1995
Thrombocytopenia associated with chronic liver disease presents a difficult management issue. Mos... more Thrombocytopenia associated with chronic liver disease presents a difficult management issue. Most reports conclude that portocaval and distal splenorenal shunts do not improve platelet counts in this setting. The response of thrombocytopenia after transjugular intrahepatic portosystemic shunt placement has not been studied. All platelet counts of 21 patients undergoing intrahepatic shunt placement were determined retrospectively to accumulate values at one month prior to procedure, weekly for the first month after the procedure, and monthly thereafter to six months. Comparison of pre-and postshunt platelet means showed a significant increase in counts in patients with a postshunt portal pressure gradient <12 mm Hg, with the increment evident by one week after the procedure. This response was not seen when preshunt thrombocytopenia was used as the lone variable. This study suggests that the transjugular intrahepatic portosystemic shunt may improve the thrombocytopenia associated with liver cirrhosis when these pressure gradients are attained.
Data Revues 00029270 V98i9ss S0002927003010025, Aug 29, 2011
Amer J Med Genet, 2005
Here we report on a 39-year-old woman with severe mental retardation, short stature, unusual face... more Here we report on a 39-year-old woman with severe mental retardation, short stature, unusual face with prominent nose, broad thumbs, and broad first toes diagnostic of the Rubinstein-Taybi syndrome. Following admission because of headache and anorexia, a bifrontal lobe neoplasm was excised and diagnosed as an angioblastic meningioma. The unusual tumor and aged appearance of the patient add 2 facets to the natural history of Rubinstein-Taybi syndrome.
Cell and tissue banking, 2000
There is a pressing need for alternative therapeutic methods effective in the treatment of patien... more There is a pressing need for alternative therapeutic methods effective in the treatment of patients with liver insufficiency. Isolated human hepatocytes may be a viable alternative or adjunct to orthotopic liver transplantation in such patients. The purpose of this study was to evaluate the viability and functional integrity of freshly isolated and cryopreserved human hepatocytes, in preparation for a multi-center human hepatocyte transplantation trial. We are currently processing transplant-grade human parenchymal liver cells from nondiseased human livers that are obtained through a network of organ procurement organizations (OPOs). Thus far, sixteen hepatocyte transplants have been performed using hepatocytes processed by our methods. At the time of referral all specimens were deemed unsuitable for transplantation due to anatomical anomalies, high fat content, medical history, etc. Hepatocytes were isolated from encapsulated liver sections by a modified two-step perfusion techniqu...
Transplantation proceedings
H EPATOCYTE transplantation has been used to correct inborn errors of metabolism and to treat ful... more H EPATOCYTE transplantation has been used to correct inborn errors of metabolism and to treat fulminant hepatic failure in animal models.',' The use of allogeneic or xenogeneic cells has resulted in limited survival due to immunologic destruction. 3,4 Strategies then require immunosuppression of the recipient or reduction/elimination of the immunogenicity of the graft.' To investigate the effect of various modifications of the hepatocyte (HPC) preparation on the ability of these cells to stimulate an in vitro cytotoxic response, the following experiments were undertaken. SPLENOCYTES HPC CRUDE HPC (PERCOLL) 0 MATERIALS AND METHODS Animals BALBic ByJ (H-2") and CBA (H-2k) male mice were used as the source of target and responder cells, respectively. .bOOl ,001 .Ol .l % OF ASSAYED CULTURE Fig 1. Cytotoxic assays of different cell preparations in mixed lymphocyte culture.
American Journal of Gastroenterology, 2003
Transplantation, 1997
The long-term complications of immunosuppressive therapy such as diabetes, hypercholesterolemia, ... more The long-term complications of immunosuppressive therapy such as diabetes, hypercholesterolemia, and hypertension are a major source of morbidity in liver transplant recipients. In this prospective, randomized, open-label study we completely withdrew prednisone (PRED) 14 days after liver transplantation in an effort to decrease these metabolic complications. Patients were maintained on mycophenolate mofetil (MMF) in combination with either cyclosporine (CsA; Neoral formulation) or tacrolimus (TAC). Thus, we also were able to compare CsA to TAC in patients not receiving PRED with respect to efficacy, toxicity, and effect on posttransplant metabolic complications. A total of 71 patients were randomized to receive either TAC-MMF (n=35) or CsA-MMF (n=36) after liver transplantation and were analyzed for patient and graft survival. Fifty-eight patients continued the immunosuppressive protocol for at least 6 months after transplantation and were analyzed for the incidence of acute rejection and the prevalence of diabetes, hypertension, and hypercholesterolemia. The 6-month patient survival rates were 94.4% for CsA-MMF and 88.6% for TAC-MMF. Corresponding 6-month graft survival rates were 88.7% and 85.71% with no immunologic graft losses in either group. The incidence of biopsy-proven acute rejection was 46% for CsA-MMF and 42.3% for TAC-MMF. Six patients were converted from CsA to TAC (four for recurrent rejection) and seven patients were converted from TAC to CsA (four for neurotoxicity). Only one patient (in the TAC-MMF group) developed new-onset posttransplant diabetes. In contrast, four of eight patients in the CsA-MMF group who were diabetic before transplant became nondiabetic in the first 3 months after transplant. The mean serum cholesterol level was significantly lower in the TAC-MMF group than in the CsA-MMF group (145.2+/-41.8 mg/dl and 190.3+/-62.2, respectively; P<0.001) and the incidence of hypertension was lower in the TAC-MMF group (12% vs. 30.3% in the CsA-MMF group, P<0.01). Both groups had a lower incidence of metabolic complications compared with a historical group (n=100) maintained on CsA and PRED (10 mg/day at 6 months). MMF in combination with either TAC or CsA allows withdrawal of PRED 14 days after liver transplantation with a moderate rejection rate and no immunologic graft losses. Early PRED withdrawal decreases posttransplant diabetes, hypercholesterolemia, and hypertension, but patients maintained on TAC have lower serum cholesterol levels and a lower incidence of hypertension than CsA-treated patients.
Transplantation, 1998
Background: Few controlled trials have compared costs incurred by immunosuppression with Neoral® ... more Background: Few controlled trials have compared costs incurred by immunosuppression with Neoral® (NEO) versus Prograf® (PRO) under otherwise identical conditions within a single center. We recently conducted a study with 1:1 randomization to NEO:PRO, fixed dosing ...
Transplant International, 1999
Hepatocyte transplantation is a conceptually attractive alternative to whole organ grafting for s... more Hepatocyte transplantation is a conceptually attractive alternative to whole organ grafting for some inborn metabolic errors and for fulminant liver failure. However, studies of the immunogenicity of transplanted allogeneic hepatocytes have yielded contradictory results. In these experiments, the effect of purification and cryopreservation of the hepatocytes on the ability of these cells to engraft in the mouse allogeneic recipients without immunosuppression was studied. BALB/ cByJ mouse crude (unpurified), modified (purified or cryopreserved), or dead (irradiated) hepatocyte preparations labeled with fluorescein dye CFSE were infused either into the portal vein or into the spleen parenchyma of the recipient CBA mice. A histological examination revealed normal appearance of engrafted modified hepatocytes with no signs of acute rejection up to 21 days posttransplant. Many of the intrasplenically implanted hepatocytes migrated into the hepatic sinusoids. The modified hepatocytes showed intact ultrastructural appearance 7 days after transplantation. The numbers of inoculated crude hepatocytes rapidly declined with signs of dense infiltration of mononuclear cells in the graft indicating destructive response. The fluorescence of dead hepatocytes was undetectable. These results suggest that reduced immunogenicity may be responsible for the longer survival time of inoculated, purified or cryopreserved hepatocytes with no adverse morphological effects.
Liver Transplantation, 2001
ABSTRACT
Liver Transplantation, 2000
The majority of patients with acute liver failure (ALF) die waiting for orthotopic liver transpla... more The majority of patients with acute liver failure (ALF) die waiting for orthotopic liver transplantation (OLT). No other treatment modality is shown to improve survival. This study was conducted to assess the safety and feasibility of hepatocyte transplantation (HT) and subsequent engraftment and function of donor cells. Functional and structural integrity of cryopreserved and thawed human hepatocytes were assessed by their morphological characteristics, induction of P-4501A1 transcription, and survival in vivo by xenotransplantation into rats. Five patients with severe ALF underwent intrasplenic (4 patients) and/or intrahepatic (2 patients) HT through angiography under cyclosporine immunosuppression. All patients had grade III to IV encephalopathy and factor V levels less than 0.5 U/mL, were ventilator and dialysis dependent, and were not OLT candidates. Three of the 5 patients who survived 48 hours after HT had substantial improvement in encephalopathy scores, arterial ammonia levels, and prothrombin times. Clinical improvement was paralleled by an increase in aminopyrine and caffeine clearances. All 3 patients lived substantially longer than expected based on clinical experience after HT (12, 28, and 52 days) but eventually died. Postmortem examination showed the presence of transplanted hepatocytes in liver and spleen by light microscopy and fluorescent in situ hybridization (FISH). Cryopreserved and thawed human hepatocytes can be transplanted into recipients with ALF with some acceptable but definite complications. Engraftment of donor hepatocytes was proven by histological examination and FISH by both transjugular biopsy and at autopsy. Improvement in brain edema, encephalopathy grade, and clearance of antipyrine and caffeine suggested function, albeit with a 24- to 72-hour delay posttransplantation.
Liver Transplantation and Surgery, 1998
As the number of liver transplantations performed around the world and the survival rates increas... more As the number of liver transplantations performed around the world and the survival rates increase, attention is turning to the broad impact this procedure has on patients' quality of life (QOL), including their physical and psychosocial functioning and their perceived sense of wellbeing. There exists a small body of literature that examines the global effects of liver transplantation on QOL. The purpose of this article is to discuss the general framework used to assess QOL and to critically review the studies that have broadly examined QOL outcomes after liver transplantation. The reviewed studies used measures that led to broad assessment of the various domains of QOL. Although the instruments used to measure QOL in these studies are largely validated, there is significant heterogeneity in this literature in terms of the instruments used, leading to difficulties in making generalizable conclusions among the studies. Although limited by internal validity problems, the available data suggest improvement in QOL by liver transplantation. Additionally, a large recent study that used the Liver Transplant Database Quality of Life Questionnaire also reported a subset of patients in whom QOL seemed to worsen after liver transplantation. Knowledge of the factors related to QOL outcome after liver transplantation is important because it might allow development of new interventions that may have an impact on future allocation decisions.
Liver Transplantation and Surgery, 1998
Mesenteric vein thrombosis (MVT) is a rare cause of intestinal ischemia. Because of its nonspecif... more Mesenteric vein thrombosis (MVT) is a rare cause of intestinal ischemia. Because of its nonspecific symptoms, diagnosis is often delayed. We describe a patient with liver cirrhosis who developed acute MVT while waiting for liver transplantation. Surgical intervention carried a high risk because of her underlying cirrhosis. Mesenteric venous thrombectomy and thrombolysis were performed with an AngioJet (Possis Medical, Min-neapolis, MN) thrombectomy device and streptokinase infusion through transjugular route. The patient subsequently received an orthotopic liver transplant. We also present a review of the literature about the occurrence and treatment options for MVT.
Liver Transplantation and Surgery, 1997
Journal of Clinical Gastroenterology, 2000
A Sengstaken-Blakemore (SB) tube, when used approximately, still has a place in the management of... more A Sengstaken-Blakemore (SB) tube, when used approximately, still has a place in the management of acute variceal bleeding. Due to a number of reported complications from the misplacement of this tube, an x-ray localization before full inflation of the gastric balloon is recommended as the standard of care. Here, we report a new technique of SB tube placement with endoscopic confirmation in three patients. This technique is easy, accurate, and can be performed in any unit where a patient with variceal bleeding can be managed. Because it cuts down on the need for an x-ray or ultrasound confirmation, this technique may well become the "standard of care" among the practicing gastroenterologists.
Human & Experimental Toxicology, 1999
Omeprazole, a proton pump inhibitor therapeutically administered for the treatment of gastric ulc... more Omeprazole, a proton pump inhibitor therapeutically administered for the treatment of gastric ulcers, induces the expression of cytochromes P4501A1/2 (CYP1A1/2) through transcriptional activation mediated by the Ah-dioxin)-receptor. Primary cultures of hepatocytes isolated from rabbit, rat, mouse and human livers were compared for CYP1A1/2 mRNA inducibility by omeprazole (1 to 100 microM). Primary cultures of human hepatocytes were the most sensitive to the inducing effects of omeprazole. Rabbit hepatocytes were the only other cells studied that showed induced CYP1A1/2 mRNA expression from a concentration lower than 100 microM (i.e., 10 microM). Rat hepatocytes were the least sensitive to omeprazole induction. The response of mouse hepatocytes to omeprazole treatment was variable, with CYP1A1/2 mRNA expression being induced in only two of the three cultures examined. Differences in the time dependence of CYP1A1/2 mRNA expression were observed between species. In general, after treatment of hepatocytes with omeprazole the levels of CYP1A1 mRNA peaked prior to that of CYP1A2 mRNA. Due to the interspecific variability of CYP1A mRNA inducibility by omeprazole, we conclude that human hepatocytes in culture are probably the only appropriate animal model for prediction of CYP1A induction in humans.
Hepatology, 1997
prine and cyclosporine was maintained on double therapy. Liver Address reprint requests to: Mark ... more prine and cyclosporine was maintained on double therapy. Liver Address reprint requests to: Mark D. Stegall, M.D., University of Colorado School of function tests (serum aspartate transaminase; alanine transami-Medicine, Campus Box C318, 4200 East Ninth Ave., Denver, CO 80262.
Digestive Diseases and Sciences, 1995
Thrombocytopenia associated with chronic liver disease presents a difficult management issue. Mos... more Thrombocytopenia associated with chronic liver disease presents a difficult management issue. Most reports conclude that portocaval and distal splenorenal shunts do not improve platelet counts in this setting. The response of thrombocytopenia after transjugular intrahepatic portosystemic shunt placement has not been studied. All platelet counts of 21 patients undergoing intrahepatic shunt placement were determined retrospectively to accumulate values at one month prior to procedure, weekly for the first month after the procedure, and monthly thereafter to six months. Comparison of pre-and postshunt platelet means showed a significant increase in counts in patients with a postshunt portal pressure gradient <12 mm Hg, with the increment evident by one week after the procedure. This response was not seen when preshunt thrombocytopenia was used as the lone variable. This study suggests that the transjugular intrahepatic portosystemic shunt may improve the thrombocytopenia associated with liver cirrhosis when these pressure gradients are attained.
Data Revues 00029270 V98i9ss S0002927003010025, Aug 29, 2011
Amer J Med Genet, 2005
Here we report on a 39-year-old woman with severe mental retardation, short stature, unusual face... more Here we report on a 39-year-old woman with severe mental retardation, short stature, unusual face with prominent nose, broad thumbs, and broad first toes diagnostic of the Rubinstein-Taybi syndrome. Following admission because of headache and anorexia, a bifrontal lobe neoplasm was excised and diagnosed as an angioblastic meningioma. The unusual tumor and aged appearance of the patient add 2 facets to the natural history of Rubinstein-Taybi syndrome.
Cell and tissue banking, 2000
There is a pressing need for alternative therapeutic methods effective in the treatment of patien... more There is a pressing need for alternative therapeutic methods effective in the treatment of patients with liver insufficiency. Isolated human hepatocytes may be a viable alternative or adjunct to orthotopic liver transplantation in such patients. The purpose of this study was to evaluate the viability and functional integrity of freshly isolated and cryopreserved human hepatocytes, in preparation for a multi-center human hepatocyte transplantation trial. We are currently processing transplant-grade human parenchymal liver cells from nondiseased human livers that are obtained through a network of organ procurement organizations (OPOs). Thus far, sixteen hepatocyte transplants have been performed using hepatocytes processed by our methods. At the time of referral all specimens were deemed unsuitable for transplantation due to anatomical anomalies, high fat content, medical history, etc. Hepatocytes were isolated from encapsulated liver sections by a modified two-step perfusion techniqu...
Transplantation proceedings
H EPATOCYTE transplantation has been used to correct inborn errors of metabolism and to treat ful... more H EPATOCYTE transplantation has been used to correct inborn errors of metabolism and to treat fulminant hepatic failure in animal models.',' The use of allogeneic or xenogeneic cells has resulted in limited survival due to immunologic destruction. 3,4 Strategies then require immunosuppression of the recipient or reduction/elimination of the immunogenicity of the graft.' To investigate the effect of various modifications of the hepatocyte (HPC) preparation on the ability of these cells to stimulate an in vitro cytotoxic response, the following experiments were undertaken. SPLENOCYTES HPC CRUDE HPC (PERCOLL) 0 MATERIALS AND METHODS Animals BALBic ByJ (H-2") and CBA (H-2k) male mice were used as the source of target and responder cells, respectively. .bOOl ,001 .Ol .l % OF ASSAYED CULTURE Fig 1. Cytotoxic assays of different cell preparations in mixed lymphocyte culture.
American Journal of Gastroenterology, 2003
Transplantation, 1997
The long-term complications of immunosuppressive therapy such as diabetes, hypercholesterolemia, ... more The long-term complications of immunosuppressive therapy such as diabetes, hypercholesterolemia, and hypertension are a major source of morbidity in liver transplant recipients. In this prospective, randomized, open-label study we completely withdrew prednisone (PRED) 14 days after liver transplantation in an effort to decrease these metabolic complications. Patients were maintained on mycophenolate mofetil (MMF) in combination with either cyclosporine (CsA; Neoral formulation) or tacrolimus (TAC). Thus, we also were able to compare CsA to TAC in patients not receiving PRED with respect to efficacy, toxicity, and effect on posttransplant metabolic complications. A total of 71 patients were randomized to receive either TAC-MMF (n=35) or CsA-MMF (n=36) after liver transplantation and were analyzed for patient and graft survival. Fifty-eight patients continued the immunosuppressive protocol for at least 6 months after transplantation and were analyzed for the incidence of acute rejection and the prevalence of diabetes, hypertension, and hypercholesterolemia. The 6-month patient survival rates were 94.4% for CsA-MMF and 88.6% for TAC-MMF. Corresponding 6-month graft survival rates were 88.7% and 85.71% with no immunologic graft losses in either group. The incidence of biopsy-proven acute rejection was 46% for CsA-MMF and 42.3% for TAC-MMF. Six patients were converted from CsA to TAC (four for recurrent rejection) and seven patients were converted from TAC to CsA (four for neurotoxicity). Only one patient (in the TAC-MMF group) developed new-onset posttransplant diabetes. In contrast, four of eight patients in the CsA-MMF group who were diabetic before transplant became nondiabetic in the first 3 months after transplant. The mean serum cholesterol level was significantly lower in the TAC-MMF group than in the CsA-MMF group (145.2+/-41.8 mg/dl and 190.3+/-62.2, respectively; P<0.001) and the incidence of hypertension was lower in the TAC-MMF group (12% vs. 30.3% in the CsA-MMF group, P<0.01). Both groups had a lower incidence of metabolic complications compared with a historical group (n=100) maintained on CsA and PRED (10 mg/day at 6 months). MMF in combination with either TAC or CsA allows withdrawal of PRED 14 days after liver transplantation with a moderate rejection rate and no immunologic graft losses. Early PRED withdrawal decreases posttransplant diabetes, hypercholesterolemia, and hypertension, but patients maintained on TAC have lower serum cholesterol levels and a lower incidence of hypertension than CsA-treated patients.
Transplantation, 1998
Background: Few controlled trials have compared costs incurred by immunosuppression with Neoral® ... more Background: Few controlled trials have compared costs incurred by immunosuppression with Neoral® (NEO) versus Prograf® (PRO) under otherwise identical conditions within a single center. We recently conducted a study with 1:1 randomization to NEO:PRO, fixed dosing ...
Transplant International, 1999
Hepatocyte transplantation is a conceptually attractive alternative to whole organ grafting for s... more Hepatocyte transplantation is a conceptually attractive alternative to whole organ grafting for some inborn metabolic errors and for fulminant liver failure. However, studies of the immunogenicity of transplanted allogeneic hepatocytes have yielded contradictory results. In these experiments, the effect of purification and cryopreservation of the hepatocytes on the ability of these cells to engraft in the mouse allogeneic recipients without immunosuppression was studied. BALB/ cByJ mouse crude (unpurified), modified (purified or cryopreserved), or dead (irradiated) hepatocyte preparations labeled with fluorescein dye CFSE were infused either into the portal vein or into the spleen parenchyma of the recipient CBA mice. A histological examination revealed normal appearance of engrafted modified hepatocytes with no signs of acute rejection up to 21 days posttransplant. Many of the intrasplenically implanted hepatocytes migrated into the hepatic sinusoids. The modified hepatocytes showed intact ultrastructural appearance 7 days after transplantation. The numbers of inoculated crude hepatocytes rapidly declined with signs of dense infiltration of mononuclear cells in the graft indicating destructive response. The fluorescence of dead hepatocytes was undetectable. These results suggest that reduced immunogenicity may be responsible for the longer survival time of inoculated, purified or cryopreserved hepatocytes with no adverse morphological effects.
Liver Transplantation, 2001
ABSTRACT
Liver Transplantation, 2000
The majority of patients with acute liver failure (ALF) die waiting for orthotopic liver transpla... more The majority of patients with acute liver failure (ALF) die waiting for orthotopic liver transplantation (OLT). No other treatment modality is shown to improve survival. This study was conducted to assess the safety and feasibility of hepatocyte transplantation (HT) and subsequent engraftment and function of donor cells. Functional and structural integrity of cryopreserved and thawed human hepatocytes were assessed by their morphological characteristics, induction of P-4501A1 transcription, and survival in vivo by xenotransplantation into rats. Five patients with severe ALF underwent intrasplenic (4 patients) and/or intrahepatic (2 patients) HT through angiography under cyclosporine immunosuppression. All patients had grade III to IV encephalopathy and factor V levels less than 0.5 U/mL, were ventilator and dialysis dependent, and were not OLT candidates. Three of the 5 patients who survived 48 hours after HT had substantial improvement in encephalopathy scores, arterial ammonia levels, and prothrombin times. Clinical improvement was paralleled by an increase in aminopyrine and caffeine clearances. All 3 patients lived substantially longer than expected based on clinical experience after HT (12, 28, and 52 days) but eventually died. Postmortem examination showed the presence of transplanted hepatocytes in liver and spleen by light microscopy and fluorescent in situ hybridization (FISH). Cryopreserved and thawed human hepatocytes can be transplanted into recipients with ALF with some acceptable but definite complications. Engraftment of donor hepatocytes was proven by histological examination and FISH by both transjugular biopsy and at autopsy. Improvement in brain edema, encephalopathy grade, and clearance of antipyrine and caffeine suggested function, albeit with a 24- to 72-hour delay posttransplantation.
Liver Transplantation and Surgery, 1998
As the number of liver transplantations performed around the world and the survival rates increas... more As the number of liver transplantations performed around the world and the survival rates increase, attention is turning to the broad impact this procedure has on patients' quality of life (QOL), including their physical and psychosocial functioning and their perceived sense of wellbeing. There exists a small body of literature that examines the global effects of liver transplantation on QOL. The purpose of this article is to discuss the general framework used to assess QOL and to critically review the studies that have broadly examined QOL outcomes after liver transplantation. The reviewed studies used measures that led to broad assessment of the various domains of QOL. Although the instruments used to measure QOL in these studies are largely validated, there is significant heterogeneity in this literature in terms of the instruments used, leading to difficulties in making generalizable conclusions among the studies. Although limited by internal validity problems, the available data suggest improvement in QOL by liver transplantation. Additionally, a large recent study that used the Liver Transplant Database Quality of Life Questionnaire also reported a subset of patients in whom QOL seemed to worsen after liver transplantation. Knowledge of the factors related to QOL outcome after liver transplantation is important because it might allow development of new interventions that may have an impact on future allocation decisions.
Liver Transplantation and Surgery, 1998
Mesenteric vein thrombosis (MVT) is a rare cause of intestinal ischemia. Because of its nonspecif... more Mesenteric vein thrombosis (MVT) is a rare cause of intestinal ischemia. Because of its nonspecific symptoms, diagnosis is often delayed. We describe a patient with liver cirrhosis who developed acute MVT while waiting for liver transplantation. Surgical intervention carried a high risk because of her underlying cirrhosis. Mesenteric venous thrombectomy and thrombolysis were performed with an AngioJet (Possis Medical, Min-neapolis, MN) thrombectomy device and streptokinase infusion through transjugular route. The patient subsequently received an orthotopic liver transplant. We also present a review of the literature about the occurrence and treatment options for MVT.
Liver Transplantation and Surgery, 1997
Journal of Clinical Gastroenterology, 2000
A Sengstaken-Blakemore (SB) tube, when used approximately, still has a place in the management of... more A Sengstaken-Blakemore (SB) tube, when used approximately, still has a place in the management of acute variceal bleeding. Due to a number of reported complications from the misplacement of this tube, an x-ray localization before full inflation of the gastric balloon is recommended as the standard of care. Here, we report a new technique of SB tube placement with endoscopic confirmation in three patients. This technique is easy, accurate, and can be performed in any unit where a patient with variceal bleeding can be managed. Because it cuts down on the need for an x-ray or ultrasound confirmation, this technique may well become the "standard of care" among the practicing gastroenterologists.
Human & Experimental Toxicology, 1999
Omeprazole, a proton pump inhibitor therapeutically administered for the treatment of gastric ulc... more Omeprazole, a proton pump inhibitor therapeutically administered for the treatment of gastric ulcers, induces the expression of cytochromes P4501A1/2 (CYP1A1/2) through transcriptional activation mediated by the Ah-dioxin)-receptor. Primary cultures of hepatocytes isolated from rabbit, rat, mouse and human livers were compared for CYP1A1/2 mRNA inducibility by omeprazole (1 to 100 microM). Primary cultures of human hepatocytes were the most sensitive to the inducing effects of omeprazole. Rabbit hepatocytes were the only other cells studied that showed induced CYP1A1/2 mRNA expression from a concentration lower than 100 microM (i.e., 10 microM). Rat hepatocytes were the least sensitive to omeprazole induction. The response of mouse hepatocytes to omeprazole treatment was variable, with CYP1A1/2 mRNA expression being induced in only two of the three cultures examined. Differences in the time dependence of CYP1A1/2 mRNA expression were observed between species. In general, after treatment of hepatocytes with omeprazole the levels of CYP1A1 mRNA peaked prior to that of CYP1A2 mRNA. Due to the interspecific variability of CYP1A mRNA inducibility by omeprazole, we conclude that human hepatocytes in culture are probably the only appropriate animal model for prediction of CYP1A induction in humans.
Hepatology, 1997
prine and cyclosporine was maintained on double therapy. Liver Address reprint requests to: Mark ... more prine and cyclosporine was maintained on double therapy. Liver Address reprint requests to: Mark D. Stegall, M.D., University of Colorado School of function tests (serum aspartate transaminase; alanine transami-Medicine, Campus Box C318, 4200 East Ninth Ave., Denver, CO 80262.