Community responses to persons with aphasia participating in CoActive therapeutic theatre: A pilot study

BACKGROUND

Persons with aphasia (PWA) experience a number of communicative and social-emotional challenges. Reported experiences of PWA include but are not limited to, being misunderstood, isolated, frustrated, and infantilised.

AIMS

The aim of this pilot study, involving a Life Participation Approach to Aphasia (LPAA), conducted over the course of 2 years, was to understand community perceptions of aphasia while PWA engaged in an interprofessional treatment program involving speech and drama therapy.

METHODS & PROCEDURES

The interprofessional treatment program involved PWA participating in a therapeutic theatre program using the CoActive Therapeutic Theater (CoATT) while also receiving speech-language therapy. Each year, the PWA performed a different, original therapeutic theatre production for a public audience, at the culmination of their interprofessional treatment program. In this paper, we share data obtained from perspectives of audience members who witnessed the theatre production and aphasia education during the first year of the study and friends and family of PWA who participated in the therapeutic theatre process during the second year of the study.

OUTCOMES & RESULTS

Responses from audience members who participated in aphasia education and witnessed the therapeutic theatre performance by the PWA during the first year, indicated an increased knowledge of aphasia. Friends and family members of PWA who witnessed their loved ones engaging in the CoATT process through interprofessional treatment, in the second year, reported that their loved ones benefited from the CoATT process, which was distinct from other therapeutic processes to their knowledge and that they were impacted by watching their loved one perform.

CONCLUSIONS & IMPLICATIONS

These initial findings create footing towards understanding impact of therapeutic theatre in combination with speech-language therapy in the lives of PWA. They help us to obtain an initial appreciation of how therapeutic theatre and aphasia education help connect PWA and their community.

WHAT THIS PAPER ADDS

What is already known on this subject Caregivers and communities at large play a significant role in and substantially impact the recovery of their loved ones (Dalemans et al., 2010; Grawburget et al., 2013; Kniepmann & Cupler, 2014) with aphasia. However, existing research suggests that persons with aphasia (PWA) are often misunderstood, isolated and infantilised by their communities. What this paper adds to existing knowledge The findings of our study reveal that friends, families and extended communities of PWA gain a positive and deep understanding of challenges experienced by PWA through therapeutic theatre supported by speech language therapy, based in a new CoActive Therapeutic Theatre (CoATT) model. This PWA community also agrees that therapeutic theatre in combination with speech-language therapy provides confidence and camaraderie between PWAs and strengthen connection between all constituencies. These results support the need for interprofessional intervention within the framework of a Life Participation Approach to Aphasia (LPAA). What are the potential or actual clinical implications of this work? Treatment paradigms that bring PWAs in contact with their communities using an LPAA approach can increase confidence and social engagement for PWAs potentially leading to better outcomes for their individual speech-language therapy as well as create means of educating communities about PWA, and their stories.

Effect of Argon on the Properties of Copper Nitride Fabricated by Magnetron Sputtering for the Next Generation of Solar Absorbers

Copper nitride, a metastable semiconductor material with high stability at room temperature, is attracting considerable attention as a potential next-generation earth-abundant thin-film solar absorber. Moreover, its non-toxicity makes it an interesting eco-friendly material. In this work, copper nitride films were fabricated using reactive radio frequency (RF) magnetron sputtering at room temperature, 50 W of RF power, and partial nitrogen pressures of 0.8 and 1.0 on glass and silicon substrates. The role of argon in both the microstructure and the optoelectronic properties of the films was investigated with the aim of achieving a low-cost absorber material with suitable properties to replace the conventional silicon in solar cells. The results showed a change in the preferential orientation from (100) to (111) planes when argon was introduced in the sputtering process. Additionally, no structural changes were observed in the films deposited in a pure nitrogen environment. Fourier transform infrared (FTIR) spectroscopy measurements confirmed the presence of Cu-N bonds, regardless of the gas environment used, and XPS indicated that the material was mainly N-rich. Finally, optical properties such as band gap energy and refractive index were assessed to establish the capability of this material as a solar absorber. The direct and indirect band gap energies were evaluated and found to be in the range of 1.70-1.90 eV and 1.05-1.65 eV, respectively, highlighting a slight blue shift when the films were deposited in the mixed gaseous environment as the total pressure increased.

Changes in admissions, and hospitalization outcomes of IBD patients in an Italian tertiary referral center over a 13-year period

OBJECTIVE

The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center.

PATIENTS AND METHODS

Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed.

RESULTS

Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions.

CONCLUSIONS

Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

The educational role of IBD nurses in Italy in vaccinations: do not miss the moment for COVID-19

OBJECTIVE

The role of nurses has great educational-scientific potential in COVID-19 vaccination. The aim of this work is to clarify whether the educational role of IBD nurses in vaccination is perceived by IBD patients.

MATERIALS AND METHODS

A cross-sectional study was carried out, through a questionnaire, to evaluate how many IBD patients received health education about vaccinations from the dedicated nurses (IBD nurses).

RESULTS

There were four hundred questionnaires, 310 patients (77.5%) answered all questions. The nurse does not appear to help educate patients on influenza vaccination (66.1%) or pneumococcal vaccination (81.6%). Disclosed patients have many doubts about the new COVID-19 vaccination (74.4%) and many seek information (74.8%) and think that the nurse can provide the necessary information (70%).

CONCLUSIONS

IBD nurses do not seem very active in the vaccination education role, and they do not meet patients' expectations, which are conversely very high.

Severe eosinophilic asthma and aspirin-exacerbated respiratory disease associated to eosinophilic gastroenteritis treated with mepolizumab: a case report

Background

Mepolizumab (MEP) is the first anti Interleukin (IL)-5 add-on therapy approved for the treatment of severe refractory eosinophilic asthma.

Case presentation

We describe here the case of a 49 years-old woman with Aspirin-exacerbated respiratory disease (AERD), chronic rhinosinusitis, nasal polyposis and eosinophilic gastroenteritis successfully treated with MEP. Several laboratory and clinical items improved during therapy; moreover MEP showed to be useful as steroid sparing agent.

Conclusions

This case supports that the use of mepolizumab can be effective also in other eosinophilic conditions different from asthma and this opens to new therapeutic perspectives.

Optimal number of multiple rapid swallows needed during high-resolution esophageal manometry for accurate prediction of contraction reserve

BACKGROUND

Multiple rapid swallows (MRS) is a provocative test for assessment of contraction reserve, however reproducibility on repetitive MRS is incompletely understood. Our aim was to determine the optimal number of MRS sequences for consistent assessment of contraction reserve.

METHODS

One hundred and fifty-nine consecutive patients (79 IEM and 80 normal motility) who underwent high-resolution manometers were enrolled. Ten single swallows (SS) and 10 MRS were performed. Gold standard for evaluation of the contraction reserve was the ratio between the mean DCI of 10 MRS and the mean DCI of 10 SS (MRS/SS DCI ratio). Rates of false negatives and false positives were calculated for increasing numbers of MRS sequences, using either mean DCI or the MRS with the highest DCI.

KEY RESULTS

According to the gold standard, 50 IEM and 50 normal motility patients had contraction reserve. With progressively increasing numbers of MRS sequences, contraction reserve was detected using mean MRS DCI within three and four MRS sequences in IEM and normal motility respectively, whereas two and three MRS sequences were needed using the MRS sequence with the highest DCI. False positives were much higher with highest DCI method compared with mean DCI, (22% vs 9% respectively in IEM; 24% vs 9% in normal motility) when three MRS sequences were considered.

CONCLUSIONS & INFERENCES

At least three MRS are needed to reliably assess contraction reserve. The mean DCI of the three MRS sequences is the best variable to utilize as evidence of contraction reserve.

Long-Term Safety of In Utero Exposure to Anti-TNFα Drugs for the Treatment of Inflammatory Bowel Disease: Results from the Multicenter European TEDDY Study

OBJECTIVES

The long-term safety of exposure to anti-tumor necrosis factor (anti-TNFα) drugs during pregnancy has received little attention. We aimed to compare the relative risk of severe infections in children of mothers with inflammatory bowel disease (IBD) who were exposed to anti-TNFα drugs in utero with that of children who were not exposed to the drugs.

METHODS

Retrospective multicenter cohort study. Exposed cohort: children from mothers with IBD receiving anti-TNFα medication (with or without thiopurines) at any time during pregnancy or during the 3 months before conception. Non-exposed cohort: children from mothers with IBD not treated with anti-TNFα agents or thiopurines at any time during pregnancy or the 3 months before conception. The cumulative incidence of severe infections after birth was estimated using Kaplan-Meier curves, which were compared using the log-rank test. Cox-regression analysis was performed to identify potential predictive factors for severe infections in the offspring.

RESULTS

The study population comprised 841 children, of whom 388 (46%) had been exposed to anti-TNFα agents. Median follow-up after delivery was 47 months in the exposed group and 68 months in the non-exposed group. Both univariate and multivariate analysis showed the incidence rate of severe infections to be similar in non-exposed and exposed children (1.6% vs. 2.8% per person-year, hazard ratio 1.2 (95% confidence interval 0.8-1.8)). In the multivariate analysis, preterm delivery was the only variable associated with a higher risk of severe infection (2.5% (1.5-4.3)).

CONCLUSIONS

In utero exposure to anti-TNFα drugs does not seem to be associated with increased short-term or long-term risk of severe infections in children.

Structural and spectral characterisation of Er3+ and Nd3+ doped Ga-La-S-Se glasses

Spectral characterisation of Er³⁺ and Nd³⁺ doped novel GLS-Se glass showing strong green fluorescence.

Gastro-esophageal reflux and antisecretory drugs use among patients with chronic autoimmune atrophic gastritis: a study with pH-impedance monitoring

BACKGROUND

Patients with chronic autoimmune atrophic gastritis (CAAG) often refer digestive symptoms and are prescribed antisecretory medications. Aims were to investigate: (i) gastro-esophageal reflux (GER), (ii) psychopathological profile, (iii) frequency of use and clinical benefit of antisecretory drugs.

METHODS

Prospective observational study on 41 CAAG patients who underwent: 24 h multichannel intra-luminal impedance-pH (MII-pH) monitoring off-therapy, standardized medical interview and psychological questionnaire (i.e., SCL-90R). The medical interview was repeated at least 1 month after MII-pH in patients who were using antisecretory drugs. Statistical analysis was performed calculating median (10th-90th percentiles) and risk ratios (RR) with 95% confidence interval.

KEY RESULTS

Median intra-gastric pH was 6.2 (4.6-7.0). One patient had acid reflux (AC) associated with symptoms, five had increased total reflux number and four had symptoms associated to non-acid reflux (NA) (patients referred as 'GER positive'). Using patients 'GER negative' with normal SCL-90R as reference, the RR of being symptomatic in patients GER positive was 2.1 (1.1-4.1) if SCL-90R was normal and 0.9 (0.5-1.7) if it was altered (difference in RR significant being p = 0.04). Seventeen/28 (61%) symptomatic patients were on antisecretory drugs, which were stopped in 16 of them according to results of MII-pH and clinical evaluation after 574 days (48-796) showed that symptoms were unchanged.

CONCLUSIONS & INFERENCES

In patients with CAAG (i) AC reflux rarely occurred whereas increased NA reflux was not infrequent both being related to symptoms in some patients, (ii) psychopathological profile has a role in symptoms' occurrence, (iii) antisecretory drugs were generally inappropriately used and clinically ineffective.

Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti-TNF alpha: 5-year follow-up study

BACKGROUND

Psoriasis is an emerging paradoxical side effect in patients with inflammatory bowel disease (IBD) when treated with anti-TNF alpha. Patients with severe skin lesions unresponsive to topical therapy need to withdraw from treatment.

AIM

To estimate the incidence of paradoxical psoriasis in a large cohort of IBD patients treated with anti-TNF alpha and to analyse its clinical correlates.

METHODS

A retrospective cohort study on all IBD patients who started anti-TNF alpha at our IBD Centre from January 2008 to December 2013 was performed. Proportional hazards regression models were used to estimate the association between each predictor and time to the development of psoriasis. Time-dependent predictors were updated at each available time point.

RESULTS

Four hundred and two patients were included. Participants contributed a total of 839 person-years of follow-up, during which 42 incident cases of psoriasis were recorded, with an incidence rate of five per 100 person-years. Cox-regression survival analysis revealed smoking as independent predictor of psoriasis (HR: 2.37, 95% CI: 1.36-4.48; P = 0.008). Conversely, concomitant immunosuppressive therapy was inversely related to psoriasis (HR: 0.33, 95% CI: 0.12-0.92; P = 0.03).

CONCLUSIONS

Paradoxical psoriasis is a relevant side effect of anti-TNF alpha therapy, with an incidence rate of five per 100 person-years. Smoking is confirmed as the main risk factor for developing lesions. The combination therapy with anti-TNF alpha plus immunosuppressants is associated with a reduced risk of paradoxical psoriasis.

Histopathological Features of Tissue Alterations Induced by Low Frequency Ultrasound with Cavitational Effects on Human Adipose Tissue

Low frequency, high energy level ultrasound (US) induces physical effects on tissues called ultrasonic cavitation (UC). Endermic US therapy has recently been proposed as a method to reduce non-invasively the amount of adipose tissue. Very few published studies have dealt with the biological effects of such therapies on human adipose tissue. The aim of this study is to evaluate, through histopathological examination, the effects of various levels of ultrasonic radiation on supravital human adipose tissue. Four ex vivo human tissue samples were treated as follows: sample 1: no US radiation; sample 2: US radiation 2,5 W/cm2 for 15 minutes; sample 3: US radiation 5 W/cm2for 15 minutes; sample 4: infiltration of 30 ml physiological saline and US radiation, 5 W/cm2 for 15 minutes. For lower levels of ultrasonic energy, interruption of the adipocytic membranes was evident both in the surface and in the deeper cutaneous and subcutaneous layers, with focal dissolution and homogenization of the surface dermal fascia. For higher levels of ultrasonic energy, alterations of the adipocytes and of the collagen fibers were greater, resulting in the dissolution of the cells and of the interlobular fibrous septa. Both effects were amplified by tumescent saline infiltration. The histological lesions demonstrated in adipocytes confirm the theoretical premises of a possible usefulness in the treatment of localized adiposis. The alterations observed in the connective stroma could have positive effects on the structural re—organization and consequently on the in vivo external appearance of the treated areas.

The 'ability' paradigm in vocational rehabilitation: challenges in an Ontario injured worker retraining program

INTRODUCTION

In recent years, a focus on workers' ability, rather than impairment, has guided disability management services. However, a challenge with the notion of 'ability' is identification of the border between ability and inability. This article considers this gray zone of disability management in the case of a workers' compensation vocational retraining program for injured workers in Ontario.

METHODS

In-depth interviews and focus groups were conducted with a purposive sample of 71 participants who were directly involved with the vocational retraining process. Workers in the program had on average incurred injury 3 years earlier. Procedural and legal documents were also analyzed. Principles of grounded theory and discourse analysis guided the data gathering and analysis.

RESULTS

A program focus on worker abilities did not allow for consideration of unresolved medical problems. Concepts such as maximum medical rehabilitation distracted attention from workers' ongoing chronic and unstable health situations, and incentive levers to employers directed some of the least capable workers into the program. As well, communication pathways for discussing health problems were limited by rules and provider reluctance to reveal problems. Therefore, workers completing the program were deemed 'employable', while ongoing and problematic health conditions preventing employment remained relatively uncharted and invisible.

CONCLUSIONS

This study reinforces how the shift in disability management paradigm to a focus on ability and return to work requires consideration of environmental conditions, including policies and programs and implementation. A focus on the environment in which worker ability can be enacted might be as important as a focus on improving individual worker characteristics.

Unexplained refractory iron-deficiency anaemia in a 41-year-old woman

The clinical and instrumental findings revealed a case of autoimmune polyendocrine syndrome (APS) type 3B+C in a 41-year-old Caucasian woman with unexplained refractory iron-deficiency anaemia secondary to autoimmune atrophic gastritis and a long-term history of two different autoimmune diseases-Hashimoto's disease and vitiligo. Indeed the occurrence in the same patient of three or more autoimmune diseases defines APS. The first classification of APS was suggested by Neufeld and Blizzard in 1980 and it included four main types of APS on the basis of clinical features. The only case of APS type 3B+C was described by Amerio et al in 2006.

New biological agents for the treatment of the "high risk" IBD patients

BACKGROUND

Several new biological drugs have been introduced in the last decade or are under investigation for the treatment of IBD. They include anti TNFalpha agents, anti adhesion molecules, anti IL-12/23, anti IL-6R and others. Their role in IBD therapy will be discussed in regard of the association of chronic inflammation and cancer in the gut. The risk of colorectal cancer is increased in ulcerative colitis (UC) and, to some extent, in Crohn's disease (CD). This association is well known from many years. However, the mechanisms linking chronic inflammation and carcinogenesis are beginning to be elucidated only recently.

RESULTS AND CONCLUSIONS

Experimental data indicate that several cytokines could play a role in promoting tumour development. In this perspective, the anti cytokine agents could be not only powerful tools in treating inflammation but also efficacious in preventing the onset of inflammation associated colorectal cancer.

A Randomized Trial to Evaluate Lopinavir/Ritonavir versus Saquinavir/Ritonavir in HIV-1-Infected Patients: The Maxcmin2 Trial

Objective

To assess the rate of protocol-defined treatment failure and safety of lopinavir/ritonavir (LPV/r) and saquinavir/ritonavir (SAQ/r).

Design

Open-label, prospective, randomized (1:1), international multi-centre trial.

Methods

Adult HIV-1-infected patients were assigned LPV/r 400/100 mg twice daily or SAQ/r 1000/100 mg twice daily with two or more nucleoside reverse transcriptase inhibitors (NRTIs)/non-NRTIs. All patients, whether on or off the assigned treatment, were followed for 48 weeks.

Results

Of 339 randomized patients, 324 initiated assigned treatment (intention-to-treat/exposed [ITT/e] population). At 48 weeks, treatment failure occurred in 29/163 (18%) and 53/161 (33%) of patients in the LPV/r and SAQ/r arms, respectively (ITT/e, P=0.002, log rank test). In an analysis that also considered those patients who discontinued treatment as having failed treatment (ITT/e/discontinuation=failure), 40/161 (25%) LPV/r-treated individuals versus 63/161 (39%) SAQ/R-treated individuals failed treatment ( P=0.005, log rank test). Discontinuation of the assigned treatment occurred in 23/163 (14%) patients in the LPV/r-treated group, compared with 48/161 (30%) in the SAQ/r-treated group (ITT/e; P=0.001). The primary reasons for premature discontinuation were non-fatal adverse events (LPV/r: 12/163; SAQ/r: 21/161) and patients’ choice (LPV/r: 7/163; SAQ/r: 8/161). In the on-treatment analysis of time to treatment failure, no difference was observed between the two arms ( P=0.27, log rank test).

Conclusion

LPV/r had better antiretroviral effects compared with SAQ/r at the doses and in the formulations studied. This may have been a result of patients’ preferences and ability to adhere to assigned therapy, rather than a result of differences in the intrinsic potency of the study protease inhibitors.

Combined protein C deficiency and protein C activated resistance as a cause of caval, peripheral, and cerebral venous thrombosis--a case report

A 26-year-old woman suffered concomitant inferior vena cava, iliac, and femoral vein thrombosis and cerebral venous thrombosis. Ten days before symptom onset she had started using an oral contraceptive that contained low-dose ethynilestradiol and gestodene. Both protein C deficiency and protein C activated resistance were detected. To our knowledge, the association of cerebral, caval, and ilio-femoral-popliteal venous thrombosis has not been described previously. The severity of the clinical features could be a consequence of the two combined thrombophilic mechanisms and of the continuation of the oral contraceptive. A thrombophilic disorder should be considered in young patients with thromboembolic disease. Because of the high prevalence of the genetic deficiency causing protein C activated resistance, it is probably worthwhile to perform general screening before prescription of oral contraceptives.

[Echo-color Doppler in the study of portal hypertension]

Color-Doppler US is currently an extremely valuable tool in the study of abdominal circulation, cirrhosis of liver and its complications, different kinds of portal hypertension, vascular/avascular liver malformations and, finally, in the evaluation of liver transplants. Moreover, its use in experimental studies has yielded good results. Even spontaneous porto-systemic shunts can be demonstrated in most cases (up to 88%). Color-Doppler allows partial obstructions to be demonstrated and permits qualitative and quantitative dynamic evaluations the presence/absence of flow, vascular masses--e.g., mean velocity measurement and blood flow assessment. The interobserver variability of the method was calculated with a double-blind study carried out by our laboratory team cooperating with a study group from the University of Yale, USA. The study evidenced how color-Doppler US cannot be used to follow the single patient unless the variations to measure are higher than variability itself. Color-Doppler limitations depend on the subjectivity of the results and on its difficult application to obese patients or to those with severe intestinal meteorism.

Systemic and splanchnic hemodynamic effects of intravenous hypertonic glucose in patients with cirrhosis

In animals, there may exist a hyperemic response in the portal circulation during intravenous administration of hypertonic glucose, but a hemodynamic response of this kind has never been described in man. This study was designed to evaluate if hyperglycemia itself could induce systemic or splanchnic hemodynamic changes in patients with cirrhosis. Sixteen patients with cirrhosis were studied before and during i.v. infusions of hypertonic (900 mOsmoles per liter) glucose (n = 8), mannitol (n = 4) or saline (n = 4) at 2 ml per min. In the group receiving glucose, there were significant increases in hepatic venous pressure gradient (+12%), azygos blood flow (+27%) and pulmonary capillary pressure (+32%), while calf blood flow decreased (-26%). No changes occurred in the mannitol or saline groups. Changes in plasma osmolality, plasma volume, splanchnic oxygen extraction and vasoactive hormones, including vasoactive intestinal polypeptide and glucagon, did not appear to be involved in the mechanism of these vasoactive phenomena. It is suggested that the possible deleterious effects of increase in portal pressure and azygos blood flow should be taken into consideration when administering hypertonic glucose to patients with portal hypertension.

Effects of nitroglycerin on forearm haemodynamics in patients with cirrhosis

1. Basal forearm haemodynamics were studied by venous occlusion plethysmography in three groups of subjects: group I, healthy controls, group II, patients with cirrhosis age- and sex-matched with group I, and group III, an older group of patients with cirrhosis. Subsequently, responses to sublingual nitroglycerin were measured in group I and II subjects. 2. Controls responded to nitroglycerin with an increase in venous distensibility; group II patients had higher initial venous distensibility but did not respond to nitroglycerin. No other variables in either group were affected by nitroglycerin. 3. Group II and III patients differed in forearm blood flow and vascular resistance and venous distensibility. A significant inverse correlation was found between age and forearm blood flow (r = 0.57, P less than 0.001) in all patients with cirrhosis. 4. We conclude that (a) venous tone is reduced in cirrhosis, possibly as a result of chronic venodilatation; (b) this venodilatation impedes further dilatory response to a small dose of nitroglycerin; (c) cirrhosis is also associated with age-related decreases in peripheral haemodynamics.

Portal hemodynamics after meal in normal subjects and in patients with chronic liver disease studied by echo-Doppler flowmeter

Changes of portal, superior mesenteric, and splenic venous flows after a meal were studied with the duplex ultrasonic Doppler flowmeter in normal subjects, in patients with chronic active hepatitis, and in those with cirrhosis for 2 h after ingestion of a liquid meal (14% protein, 56% lipid, 30% carbohydrate, 300 kcal). Portal and superior mesenteric venous flows increased significantly throughout the experiment, whereas no significant change occurred in splenic venous flow after the meal in all three groups. The extent of the increase in portal venous flow was significantly lower in patients with cirrhosis, compared with normal subjects and patients with chronic active hepatitis, whereas superior mesenteric venous flow increased to the same extent in all three groups. The sum of superior mesenteric and splenic venous flows was less than the estimated portal venous flow in both normal subjects and patients with chronic active hepatitis; however, this value was greater than the portal venous flow in patients with cirrhosis. The difference widened during postprandial mesenteric hyperemia, indicating an increase of blood flow into the portal-systemic shunts. In conclusion 1) postprandial hyperemia occurs in the intestine, but not in the spleen, to the same extent in patients with chronic active hepatitis or with cirrhosis, as in normal subjects, and 2) a considerable amount of postprandial mesenteric hyperemia bypasses the liver into the systemic circulation of patients with cirrhosis but not in patients with chronic active hepatitis and normal subjects.

Changes of splanchnic circulation with progression of chronic liver disease studied by echo-Doppler flowmetry

Changes that occurred in splanchnic circulation with the progression of chronic liver disease were investigated using an ultrasonic Doppler flowmeter in healthy adults and in patients with chronic active hepatitis and liver cirrhosis in the supine position after an overnight fast. Superior mesenteric venous flow, splenic venous flow, and portal venous flow were significantly increased in patients with liver cirrhosis but not in patients with chronic active hepatitis compared with normal subjects. Portal venous flow (control value 10.5 +/- 2.3 ml/min/kg body weight) minus the sum of superior mesenteric venous flow and splenic venous flow was 0.8 +/- 2.1 ml/min/kg body weight in the control, (0.1 +/- 1.9) in chronic active hepatitis, and (-2.2 +/- 4.3) in liver cirrhosis; the difference was significant between the control and cirrhosis groups. These results indicate that in patients with liver cirrhosis a hyperdynamic state occurs in the splanchnic circulation of the intestine and spleen and that some portion of splanchnic blood flow bypasses the liver into the systemic circulation.

[Strain-gauge plethysmographic measurement of the systemic bioavailability of oral nitroglycerin in liver cirrhosis]

7 cirrhotic (M = 3, F = 4, mean age 55, range 35-74) and 7 healthy subjects (M = 6, F = 1, mean age 24, range 23-40) were studied. 2.5mg% nitroglycerin were administered per os. This drug is quite completely metabolized in its first pass through the liver (first pass effect). Peripheric vascular effect of nitroglycerin was evaluated by venous occlusion strain-gauge plethysmography, ECG-coupled (Rest Flow measurement RF, in ml/min/100 ml). No statistically significant differences were found between pre-drug RF in the two groups and between pre and post-drug measurements in healthy subjects. Post-drug RF decreased in cirrhotic subjects when compared either to pre-drug values or to post-drug values in normal subjects (statistically significant after the third minute, p ranging less than 0.05 and less than 0.001). The different peripheric vascular effect found in the two groups was considered as a consequence of the increased drug bioavailability in cirrhotics, caused by portosystemic shunts.