AIM:To evaluate the non-invasive assessments of volume status in patients with cirrhosis.METHODS:Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable ...AIM:To evaluate the non-invasive assessments of volume status in patients with cirrhosis.METHODS:Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis.RESULTS:Both groups had similar clinical assessments,cortisol response and total body water(TBW),however the ratio of extracellular water(ECW)/TBW was significantly greater in the trunk(0.420±0.004 vs0.404±0.005),and limbs(R leg 0.41±0.003 vs 0.398±0.003,P<0.05,and L leg 0.412±0.003 vs 0.399±0.003)with decompensated cirrhosis compared to stable cirrhotics,P<0.05).Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups.The decompensated group had lower systemic blood pressure,mean systolic 101.8±4.3 vs122.4±5.3 and diastolic 58.4±4.1 mmHg vs 68.8±3.1 mmHg respectively,P<0.01,and serum albumin30(27-33)vs 32(31-40.5)g/L,P<0.01.CONCLUSION:Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.展开更多
Significant concerns over the health,social and economic burdens of the two most common,and frequently co-misused drugs of abuse,alcohol and tobacco,has encouraged focused but separate health promotion and disease pre...Significant concerns over the health,social and economic burdens of the two most common,and frequently co-misused drugs of abuse,alcohol and tobacco,has encouraged focused but separate health promotion and disease prevention policies.However,this separation of focus means that while individuals who present with alcohol-related problems are increasingly supported to attain and maintain abstinence from alcohol they are not routinely assisted to refrain from smoking.This is tragically inopportune as alcohol and tobacco have an established"synergistic"effect on aerodigestive cancer risk.Moreover,even when patients successfully tackle their alcohol problems they remain at increased risk for developing these cancers,especially if they continue to smoke.A case series is presented together with a discussion on how service provision for co-misuse could be improved to obviate aerodigestive cancer risk.Given the prevalence of alcohol and tobacco use in the United Kingdom,these observations may have far reaching implications for the individual,health provider(s)and wider society.展开更多
文摘AIM:To evaluate the non-invasive assessments of volume status in patients with cirrhosis.METHODS:Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis.RESULTS:Both groups had similar clinical assessments,cortisol response and total body water(TBW),however the ratio of extracellular water(ECW)/TBW was significantly greater in the trunk(0.420±0.004 vs0.404±0.005),and limbs(R leg 0.41±0.003 vs 0.398±0.003,P<0.05,and L leg 0.412±0.003 vs 0.399±0.003)with decompensated cirrhosis compared to stable cirrhotics,P<0.05).Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups.The decompensated group had lower systemic blood pressure,mean systolic 101.8±4.3 vs122.4±5.3 and diastolic 58.4±4.1 mmHg vs 68.8±3.1 mmHg respectively,P<0.01,and serum albumin30(27-33)vs 32(31-40.5)g/L,P<0.01.CONCLUSION:Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.
文摘Significant concerns over the health,social and economic burdens of the two most common,and frequently co-misused drugs of abuse,alcohol and tobacco,has encouraged focused but separate health promotion and disease prevention policies.However,this separation of focus means that while individuals who present with alcohol-related problems are increasingly supported to attain and maintain abstinence from alcohol they are not routinely assisted to refrain from smoking.This is tragically inopportune as alcohol and tobacco have an established"synergistic"effect on aerodigestive cancer risk.Moreover,even when patients successfully tackle their alcohol problems they remain at increased risk for developing these cancers,especially if they continue to smoke.A case series is presented together with a discussion on how service provision for co-misuse could be improved to obviate aerodigestive cancer risk.Given the prevalence of alcohol and tobacco use in the United Kingdom,these observations may have far reaching implications for the individual,health provider(s)and wider society.
