Nasobiliary drainage: an effective treatment for pruritus in cholestatic liver disease

IntroductionNasobiliary drains (NBDs) have been successfully used to manage intrahepatic cholestasis, bile leaks and obstructive cholangitis. It allows external drainage of bile, bypassing the ileum where bile salts are reabsorbed. We assessed the utility of placement with effect on markers of cholestasis and patient symptoms.MethodsConsecutive patients undergoing NBD over 12 years for the management of pruritus were retrospectively analysed. Recorded variables included patient demographics, procedural characteristics and response to therapy.ResultsTwenty-three patients (14, 61% male) underwent 30 episodes of NBD. The median age was 26 years old (range 2–67 years old). A single procedure was carried out in 20. One patient each had two, three and five episodes of NBD. The most common aetiologies were hereditary cholestatic disease (n=17, 74%) and drug-induced cholestasis (n=5, 22%),NBD remained in situ for a median of 8 days (range 1–45 days). Significant improvement in bilirubin was seen at 7 days post-NBD (p=0.0324), maintained at day 30 (335 μmol/L vs 302 µmol/L vs 167 µmol/L). There was symptomatic improvement in pruritus in 20 (67%, p=0.0494) episodes. One patient underwent NBD during the first trimester of pregnancy after medical therapy failure with a good symptomatic response. The catheters were well tolerated in 27 (90%) of cases. Mild pancreatitis occurred in 4 (13%) cases.ConclusionNBD can be used to provide symptomatic improvement to patients with pruritus associated with cholestasis. It is well tolerated by patients. They can be used in pregnancy where medical management has failed.

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A Retrospective Review of Angiotensin II Use in Adult Patients With Refractory Distributive Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066619872720 ◽

2019 ◽

Vol 35 (12) ◽

pp. 1490-1496 ◽

Cited By ~ 3

Author(s):

Adrian Wong ◽

Afrah Alkazemi ◽

I. Mary Eche ◽

Camille R. Petri ◽

Todd Sarge ◽

...

Keyword(s):

Angiotensin Ii ◽

Safety Profile ◽

Infectious Complications ◽

Response To Therapy ◽

Limited Data ◽

First Line ◽

Patient Demographics ◽

Included Patient ◽

Failure Assessment ◽

Distributive Shock

Purpose: Catecholamines are first-line vasopressors for hemodynamic support in distributive shock but are associated with adverse effects, which may be mitigated with noncatecholamine vasopressors. Angiotensin II (ATII) is a noncatecholamine vasopressor recently approved for the management of distributive shock, but limited data support its clinical utility. The purpose of this study was to describe our institution’s usage of ATII including patient outcomes (eg, response to therapy, safety profile). Materials and Methods: Patients who received ATII at our institution were included. Patient demographics, degree of concordance with institutional ATII use guidelines, safety profile of ATII, and response to therapy (1 and 3 hours after ATII initiation) were collected. Results: A total of 16 patients received ATII for distributive shock. The median Sequential Organ Failure Assessment score at the time of ATII initiation was 16.5 (interquartile range: 15.8-20.0). Fourteen (87.5%) patients met institutional guidelines for ATII use; 10 (62.5%) and 8 (50.0%) patients met our definition for response at 1 and 3 hours, respectively. No patients developed thrombotic or infectious complications after receiving ATII. Conclusions: In this cohort, ATII appears to be well tolerated in patients with a high predicted mortality. Future studies evaluating the clinical efficacy of ATII are needed to determine its role in the management of distributive shock.

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Drug-induced cytolytic syndrome in pregnancy: clinical and biochemical diagnostic criteria

Journal of obstetrics and women s diseases ◽

10.17816/jowd65628-35 ◽

2016 ◽

Vol 65 (6) ◽

pp. 28-35

Author(s):

Irina V Borisova

Keyword(s):

Pregnant Women ◽

Hormone Therapy ◽

Clinical Manifestations ◽

First Trimester ◽

Gamma Glutamyl Transpeptidase ◽

Drug Induced ◽

Planning Stage ◽

Protein Levels ◽

First Trimester Of Pregnancy ◽

In Pregnancy

The aim of the study was evaluation of clinical and laboratory manifestations of drug-induced cytolytic syndrome in pregnancy. In the research group included 62 pregnant women with drug-induced liver injury (DILI) in the first trimester of pregnancy. These pregnant women received hormone therapy at the planning stage and/or during pregnancy for the prevention and treatment of miscarriage and had clinical and biochemical manifestations of cytolytic syndrome. Pregnancy after IVF and ovulation induction was in 60.8% of cases. Hormone therapy for pregnant patients received long-term, 85% of pregnant women used estrogen and progestin drugs. DILI during pregnancy characterized by low-symptom or asymptomatic clinical manifestations. DILI manifested cytolytic biochemical syndrome, in which there is isolated increase of transaminase levels, in some cases accompanied by increased level of gamma glutamyl transpeptidase, liver glutamate dehydrogenase and decreased total protein levels, in the first place due to the albumin fraction.

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Risk Factors of Drug-Induced Liver Involvement in First Trimester of Pregnancy

Doctor Ru ◽

10.31550/1727-2378-2020-19-7-31-36 ◽

2020 ◽

Vol 19 (7) ◽

pp. 31-36

Author(s):

L.K. Palgova ◽

◽

M.A. Tarasova ◽

I.V. Borisova ◽

N.V. Zhestkova ◽

...

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Hormonal Therapy ◽

First Trimester ◽

Liver Involvement ◽

Study Group ◽

Drug Induced ◽

Hepatic Involvement ◽

Somatic Disorders ◽

First Trimester Of Pregnancy

Study Objective: to identify the risk factors of drug-induced liver involvement in first trimester of pregnancy. Study Design: prospective randomized comparative clinical research. Materials and Methods. At the Scientific Centre of Obstetrics, Gynaecology and Reproductive Medicine named after D.O. Ott, we selected 113 pregnant women in first trimester of pregnancy. The study group included 81 patients with clinical, anamnestic and biochemical signs of drug-induced liver involvement, while the comparison group included 20 pregnant women who took hormonal drugs to prevent or treat habitual miscarriage and who did not have aminotransferases changed; and the control group of 12 healthy women who did not take any hormonal drugs. Diagnosis of hepatic involvement was based on the RUCAM criteria (Roussel Uclaf Causality Assessment Method). We assessed biochemical blood analysis which demonstrated hepatic functional status; ultrasound results for liver and gall bladder; amount and types of drugs used; incidence of background gynaecological and somatic disorders. Study Results: During pregnancy planning, 71.8% of women from the study group were treated with hormonal agents; 49.4% had their present pregnancy after in vitro fertilisation (IVF) and cryoconservation protocol. In addition to hormonal therapy, in first trimester of pregnancy some patients were prescribed antimicrobials and immunoglobulins, more frequently in the study group (31.3% and 34.3%, respectively). Apart from hormonal agents, women in the study group were prescribed 7.7 ± 0.2 medicines on the average vs. 3.8 ± 0.3 medicines in controls. Pregnant women in the study group were treated with hormones for 35 ± 1.7 days vs. 15.8 ± 0.8 days in controls. Conclusion. The following risk factors of drug-induced hepatic involvement in first trimester of pregnancy were identified: hormonal therapy during pregnancy planning and in first trimester of pregnancy; pregnancy after ovulation stimulation and IVF; long-term use (over 4 weeks) of estrogenic and gestagenic drugs; polypragmasy. No correlation was found between somatic disorders and the risk of hepatic involvement. Hepatocellular hepatic involvement prevailed; the incidence of cholestatic and vessel types made 9% and 5%, respectively. Keywords: drug-induced liver involvement, pregnancy, first trimester, oestrogens, gestagens, risk factors.

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Catheter Directed Thrombolysis for Deep Vein Thrombosis during the First Trimester of Pregnancy: Two Case Reports

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2008.58.2.127 ◽

2008 ◽

Vol 58 (2) ◽

pp. 127

Author(s):

Kum Rae Kim ◽

Won Kyu Park ◽

Jae Woon Kim ◽

Woo Hyung Kwun ◽

Bo Yang Suh ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Case Reports ◽

First Trimester ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

First Trimester Of Pregnancy ◽

Deep Vein

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FRACTIONAL DETERMINATIONS OF URINARY 17-KETOSTEROIDS IN HYPEREMESIS GRAVIDARUM

Acta Endocrinologica ◽

10.1530/acta.0.0410123 ◽

1962 ◽

Vol 41 (1) ◽

pp. 123-128 ◽

Cited By ~ 6

Author(s):

Pentti A. Järvinen ◽

Sykkö Pesonen ◽

Pirkko Väänänen

Keyword(s):

Hyperemesis Gravidarum ◽

First Trimester ◽

Control Group ◽

Before And After ◽

Daily Urine ◽

First Trimester Of Pregnancy ◽

The Difference

ABSTRACT The fractional determination of 17-ketosteroids in the daily urine was performed in nine cases of hyperemesis gravidarum and in four control cases, in the first trimester of pregnancy both before and after corticotrophin administration. The excretion of total 17-KS is similar in the two groups. Only in the hyperemesis group does the excretion of total 17-KS increase significantly after corticotrophin administration. The fractional determination reveals no difference between the two groups of patients with regard to the values of the fractions U (unidentified 17-KS), A (androsterone) and Rest (11-oxygenated 17-KS). The excretion of dehydroepiandrosterone is significantly higher in the hyperemesis group than in the control group. The excretion of androstanolone seems to be lower in the hyperemesis group than in the control group, but the difference is not statistically significant. The differences in the correlation between dehydroepiandrosterone and androstanolone in the two groups is significant. The high excretion of dehydroepiandrosterone and low excretion of androstanolone in cases of hyperemesis gravidarum is a sign of adrenal dysfunction.

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