AIM:To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis,and to evaluate the role of different liver function scores in predicting prognosis.METHODS:Sixty-eight pat...AIM:To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis,and to evaluate the role of different liver function scores in predicting prognosis.METHODS:Sixty-eight patients with severe alcoholic hepatitis(Maddrey score≥32)received pentoxifylline(n=34,groupⅠ)or prednisolone(n=34,groupⅡ) for 28 d in a randomized double-blind controlled study,and subsequently in an open study(with a tapering dose of prednisolone)for a total of 3 mo,and were followed up over a period of 12 mo.RESULTS:Twelve patients in groupⅡdied at the end of 3 mo in contrast to five patients in groupⅠ.The probability of dying at the end of 3 mo was higher in groupⅡas compared to groupⅠ(35.29%vs 14.71%,P=0.04;log rank test).Six patients in groupⅡ developed hepatorenal syndrome as compared to none in groupⅠ.Pentoxifylline was associated with a significantly lower model for end-stage liver disease(MELD)score at the end of 28 d of therapy(15.53±3.63 vs 17.78±4.56,P=0.04).Higher baseline Maddrey score was associated with increased mortality.CONCLUSION:Reduced mortality,improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.展开更多
AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received...AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to ≤ 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.展开更多
Diabetes mellitus(DM)and obesity are interrelated in a complex manner,and their coexistence predisposes patients to a plethora of medical problems.Metabolic surgery has evolved as a promising therapeutic option for bo...Diabetes mellitus(DM)and obesity are interrelated in a complex manner,and their coexistence predisposes patients to a plethora of medical problems.Metabolic surgery has evolved as a promising therapeutic option for both conditions.It is recommended that patients,particularly those of Asian origin,maintain a lower body mass index threshold in the presence of uncontrolled DM.However,several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome.Laparoscopic Roux-en-Y gastric bypass(RYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used bariatric procedures worldwide.The bariatric benefits of RYGB and LSG are similar,but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission.Several scoring systems have been formulated that are utilized to predict the chances of remission.A glycemic target of glycated hemoglobin<7%is a reasonable goal before surgery.Cardiovascular,pulmonary,gastrointestinal,hepatic,renal,endocrine,nutritional,and psychological optimization of surgical candidates improves perioperative and long-term outcomes.Various guidelines for preoperative care of individuals with obesity have been formulated,but very few specifically focus on the concerns arising from the presence of concomitant DM.It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.展开更多
Introduction: Marcus Gunn jaw winking syndrome (MGJWS) is a rare congenital disorder belonging to the synkinetic eye movement group of disorders observed in children. It occurrence in adults and patients with diabetes...Introduction: Marcus Gunn jaw winking syndrome (MGJWS) is a rare congenital disorder belonging to the synkinetic eye movement group of disorders observed in children. It occurrence in adults and patients with diabetes has not been reported. Material and Methods: A 64 year man with poorly controlled diabetes of 18 years presented with 3 month history of jaw winking on the left side along with gustatory sweating, which was managed conservatively. There was spontaneous improvement in jaw wink at 4 months of follow up. Conclusions: Acquired causes of MGJWS are not known. This is probably the first report of this syndrome occurring at such a late age. Long standing poorly controlled diabetes may have had some role in the development of jaw winking in this patient.展开更多
文摘AIM:To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis,and to evaluate the role of different liver function scores in predicting prognosis.METHODS:Sixty-eight patients with severe alcoholic hepatitis(Maddrey score≥32)received pentoxifylline(n=34,groupⅠ)or prednisolone(n=34,groupⅡ) for 28 d in a randomized double-blind controlled study,and subsequently in an open study(with a tapering dose of prednisolone)for a total of 3 mo,and were followed up over a period of 12 mo.RESULTS:Twelve patients in groupⅡdied at the end of 3 mo in contrast to five patients in groupⅠ.The probability of dying at the end of 3 mo was higher in groupⅡas compared to groupⅠ(35.29%vs 14.71%,P=0.04;log rank test).Six patients in groupⅡ developed hepatorenal syndrome as compared to none in groupⅠ.Pentoxifylline was associated with a significantly lower model for end-stage liver disease(MELD)score at the end of 28 d of therapy(15.53±3.63 vs 17.78±4.56,P=0.04).Higher baseline Maddrey score was associated with increased mortality.CONCLUSION:Reduced mortality,improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.
文摘AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to ≤ 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.
文摘Diabetes mellitus(DM)and obesity are interrelated in a complex manner,and their coexistence predisposes patients to a plethora of medical problems.Metabolic surgery has evolved as a promising therapeutic option for both conditions.It is recommended that patients,particularly those of Asian origin,maintain a lower body mass index threshold in the presence of uncontrolled DM.However,several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome.Laparoscopic Roux-en-Y gastric bypass(RYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used bariatric procedures worldwide.The bariatric benefits of RYGB and LSG are similar,but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission.Several scoring systems have been formulated that are utilized to predict the chances of remission.A glycemic target of glycated hemoglobin<7%is a reasonable goal before surgery.Cardiovascular,pulmonary,gastrointestinal,hepatic,renal,endocrine,nutritional,and psychological optimization of surgical candidates improves perioperative and long-term outcomes.Various guidelines for preoperative care of individuals with obesity have been formulated,but very few specifically focus on the concerns arising from the presence of concomitant DM.It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.
文摘Introduction: Marcus Gunn jaw winking syndrome (MGJWS) is a rare congenital disorder belonging to the synkinetic eye movement group of disorders observed in children. It occurrence in adults and patients with diabetes has not been reported. Material and Methods: A 64 year man with poorly controlled diabetes of 18 years presented with 3 month history of jaw winking on the left side along with gustatory sweating, which was managed conservatively. There was spontaneous improvement in jaw wink at 4 months of follow up. Conclusions: Acquired causes of MGJWS are not known. This is probably the first report of this syndrome occurring at such a late age. Long standing poorly controlled diabetes may have had some role in the development of jaw winking in this patient.
