Joong Wha Park

Acute Hemodynamic Effects of Octreotide and Terlipressin in Patients with Cirrhosis: A Randomized Comparison

BACKGROUND:Octreotide and terlipressin are widely used in acute variceal hemorrhage to reduce the bleeding rate. They purportedly act by mesenteric arterial vasoconstriction, thus reducing portal venous flow (PVF) and portal pressure. Little is known about the immediate-early hemodynamic effects of these drugs.AIM:To compare the acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis.PATIENTS:Forty-two cirrhotic patients with a history of variceal bleeding were randomized to receive either octreotide 100 μg intravenous bolus followed by a continuous infusion at 250 μg/h (n = 21), or terlipressin 2 mg intravenous bolus (n = 21).METHODS:Mean arterial pressure (MAP), heart rate (HR), hepatic venous pressure gradient (HVPG), and PVF, assessed by duplex Doppler ultrasonography, were measured before and at 1, 5, 10, 15, 20, and 25 min after the start of drug administration.RESULTS:Octreotide markedly decreased HVPG (−44.5 ± 17.8%) and PVF (−30.6 ± 13.6%) compared to the baseline at 1 min (p < 0.05). Thereafter, both variables rapidly returned toward the baseline, and by 5 min, no significant differences in HVPG (−7.1 ± 28.9%) and PVF (10.2 ± 26.2%) were noted. A similar transient effect on MAP and HR was observed. Terlipressin significantly decreased HVPG (−18.3 ± 11.9%) and PVF (−32.6 ± 10.5%) at 1 min (p < 0.05) and sustained these effects at all time points. The effects on arterial pressure and HR were also sustained.CONCLUSIONS:Octreotide only transiently reduced portal pressure and flow, whereas the effects of terlipressin were sustained. These results suggest that terlipressin may have more sustained hemodynamic effects in patients with bleeding varices.

Comparison of Doppler ultrasonography and the hepatic venous pressure gradient in assessing portal hypertension in liver cirrhosis

Background and Aim: This prospective study aimed to determine whether Doppler ultrasonography can represent the hepatic venous pressure gradient (HVPG) as an assessment of the severity of portal hypertension and the response to terlipressin, which reduces the portal pressure in liver cirrhosis.

Captopril reduces portal pressure effectively in portal hypertensive patients with low portal venous velocity

BackgroundThe effect of an angiotensin II blockade in lowering the portal pressure in patients with liver cirrhosis and portal hypertension is controversial. This prospective study was undertaken to evaluate the portal hypotensive effect of captopril compared to that of propranolol, and to determine the factors that contribute to a successful reduction in the portal pressure after longterm captopril administration in patients with liver cirrhosis.MethodsThe hepatic venous pressure gradient (HVPG) and portal venous velocity (PVV) were measured both before and 3 months after initiation of the administration of captopril (n = 29) or propranolol (n = 29) in cirrhotic patients with a variceal bleeding episode. Patients who showed a reduction in the HVPG of more than 20% of the baseline were defined as being responders.ResultsAt 3 months, the mean reduction in the HVPG after captopril was less than that after propranolol (−3.0 ± 9.3% vs −28.5% ± 4.1%; P ≪ 0.05). However, of the 29 patients receiving captopril, 9 were classified as being responders. On multivariate analysis with parameters including age, cause, Child-Pugh score, HVPG, and PVV, only low PVV was found to be a significant independent factor for responders (PVV ≪ 12 cm/s; odds ratio [OR], 12.2; 95% confidence interval [CI], 1.47–102.40) in the captopril group.ConclusionsLongterm captopril administration reduces the portal pressure effectively in cirrhotic patients with a low PVV. This suggests that the reduction in portal pressure after captopril administration is a result of improved portal venous outflow brought about by a decrease in the intrahepatic vascular resistance. When the PVV is below 12 cm/s, a captopril trial might be useful in preventing variceal bleeding in portal hypertensive patients.

Identification and characterization of the major allergen of the Humulus japonicus pollen

Pollen of Humulus japonicus has been known as one of the important causes of pollinosis in Korea and China. To date, the major allergen of H. japonicus has not been determined.

Effects of 7,8-dihydro-8-oxo-deoxyguanosine on antigen challenge in ovalbumin-sensitized mice may be mediated by suppression of Rac.

Background and purpose:  Earlier we reported that 7,8‐dihydro‐8‐oxo‐deoxyguanosine (8‐oxo‐dG), an oxidatively modified guanine nucleoside, exerted anti‐inflammatory activity through inactivation of the GTP binding protein, Rac. In the present study, the effects of 8‐oxo‐dG were investigated on responses to antigen challenge in sensitized mice, as Rac is also involved at several steps of the immune process including antigen‐induced release of mediators from mast cells.

Asp–Tyr–Leu–Lys tetrapeptide inhibits airway inflammation in toluene‐2,4‐diisocyanate‐induced asthma mice

Background Airway inflammation and remodelling contribute to chronic airway obstruction of asthma. Currently, no medication effectively controls airway remodelling and related vascular changes. Therefore, new strategies need to be developed. The kringle 5 domain has anti‐angiogenic activity resulting from the tetrapeptide Lys–Leu–Tyr–Asp (KLYD).

Gallbladder carcinoma: Regional lymph nodes metastases on CT scan

CT scans of 23 patients with gallbladder carcinoma were retrospectively reviewed to determine the incidence of lymphatic spread and to access the pattem of regional lymph node metastases The lymphatic spread were noted in 74% (17/ 23). The involved pattems of regional lymph node metastases were nodes of porta hepatis 65 %, portocaval nodes 41%, superior pancreaticoduoden떠 nodes 47%, posterior pancreaticoduoden떠 nodes 59%, nodes around the celiac trunk 35%, nodes around the superior mesenteric arteη 29% and paraaortic nodes 35%. The findings suggested that the pattern of regional lumph node metastases in gallbladder carcinoma occurred along the normal lymphatic pathway of the gallbladder