Adequate size and distribution of the circulating medium are important for cardiovascular function, tissue oxygenation and fluid homoeostasis. Patients with cirrhosis have an abnormal distribution of increased blood volume, increased total vascular compliance and increased arterial compliance. The pattern and temporal relations of plasma and blood volume expansion are important for pathophysiological, diagnostic and therapeutic purposes and depend highly on the type of load (water, saline, oncotic material, red blood cells). In some aspects patients with cirrhosis respond differently from healthy subjects. Thus the reaction during volume expansion may be somewhat blunted, and in advanced cirrhosis, the non-central parts of the circulation in particular, including the splanchnic blood volume, are expanded by a volume load. The use of vasoactive drugs has provided important information on the changes in haemodynamic and homoeostatic mechanisms in patients with cirrhosis. Infusion of oncotic material (preferably albumin) may prevent circulatory dysfunction during certain types of stress. Volume expansion in advanced cirrhosis is qualitatively and quantitively different from that of healthy subjects and those with early cirrhosis. Timely volume handling is essential, but difficult as it is a balance between hypovolaemia and excess extravascular volume loading with further circulatory dysfunction in these patients with a hyperdynamic, but hyporeactive circulation.
Mean platelet volume (MPV) and count (PLT) were assessed in patients with moderately affected liver function. PLT was significantly decreased in patients with liver disease (197 X 10(9)l-1 +/- 87 (SD), no. = 79) compared with that of controls (273 X 10(9)l-1 +/- 53 (SD), no. = 37, P less than 0.001). MPV in patients with liver disease (9.25 +/- 1.14 fl) was significantly lower than that of controls (10.52 +/-0.74 fl, P less than 0.001). In control subjects MPV and PLT were inversely correlated (r = -0.48, P less than 0.01), but statistical significance was not found in patients with liver disease (r = -0.2, 0.05 less than P less than 0.1). It is concluded that the low MPV and PLT are compatible with an intravascular activation (loss of granules) and increased consumption of platelets, which may take place in the diseased liver even in patients with a relatively well preserved liver function.
To obtain information on possible determinants of weight loss after horizontal gastroplasty, pouch emptying was prospectively investigated in 27 morbidly obese patients. A scintigraphic method was used. Examinations were carried out every 6 months until 2 years after surgery. Pouch emptying was described by means of delay, time until half emptying, mean transit time, and emptying rate. The measures all showed a significant (p less than 0.05) acceleration of pouch emptying during the first 6 months after gastroplasty. Thereafter pouch emptying was unaltered. No significant association could be detected between measures of pouch emptying and weight loss. From calculation of 95% confidence intervals for coefficients of correlation it proved very unlikely that pouch emptying is an important determinant of weight loss.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.