Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5(PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% w...Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5(PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored. In the acute setting, the PDE-5-inhibitor Vardenafil lowered portal pressure by 13%. The portal blood flow increased by 28% based onDoppler sonography and by 16% using MRI technique. As maintenance medication the PDE-5-inhibitor Tadalafil was used for eight consecutive years with comparable effects on portal pressure and portal blood flow. There were no recurrence of bleeding and no formation of new varices. Influencing the NO-pathway by the use of PDE-5 inhibitors may have long-term beneficial effects in compensated cirrhosis.展开更多
Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or perica...Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.展开更多
Muscular hypertrophy depends on metabolic exhaustion as well as mechanical load on the muscle.Mechanical tension seems to be the crucial factor to stimulate protein synthesis.The present meta-analysis was conducted to...Muscular hypertrophy depends on metabolic exhaustion as well as mechanical load on the muscle.Mechanical tension seems to be the crucial factor to stimulate protein synthesis.The present meta-analysis was conducted to determine whether stretching can generate adequate mechanical tension to induce muscle hypertrophy.We used PubMed,Web of Science,and Scopus to search for literature examining the effects of long-term stretching on muscle mass,muscle cross-sectional area,fiber cross-sectional area,and fiber number.Since there was no sufficient number of studies investigating long-lasting stretching in humans,we only included original animal studies in the current meta-analysis.Precisely,we identified 16 studies meeting the inclusion criteria(e.g.stretching of at least 15 min per day).The 16 studies yielded 39 data points for muscle mass,11 data points for muscle cross-sectional area,20 data points for fiber cross-sectional area,and 10 data points for fiber number.Across all designs and categories,statistically significant increases were found for muscle mass(d=8.51;95%CI 7.11-9.91),muscle cross-sectional area(d=7.91;95%CI 5.75-10.08),fiber cross-sectional area(d=5.81;95%CI 4.32-7.31),and fiber number(d=4.62;95%CI 2.54-6.71).The findings show an(almost)continuous positive effect of long-term stretching on the listed parameters,so that it can be assumed that stretch training with adequate intensity and duration leads to hypertrophy and hyperplasia,at least in animal studies.A general transferability to humans-certainly with limited effectiveness-can be hypothesized but requires further research and training studies.展开更多
文摘Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5(PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored. In the acute setting, the PDE-5-inhibitor Vardenafil lowered portal pressure by 13%. The portal blood flow increased by 28% based onDoppler sonography and by 16% using MRI technique. As maintenance medication the PDE-5-inhibitor Tadalafil was used for eight consecutive years with comparable effects on portal pressure and portal blood flow. There were no recurrence of bleeding and no formation of new varices. Influencing the NO-pathway by the use of PDE-5 inhibitors may have long-term beneficial effects in compensated cirrhosis.
文摘Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.
基金supported by the National Institutes of Health( Grant HL096782)King Charitable Foundation Trust+2 种基金American Heart AssociationCain FoundationTexas Health Presbyterian Hospital Dallas
文摘Muscular hypertrophy depends on metabolic exhaustion as well as mechanical load on the muscle.Mechanical tension seems to be the crucial factor to stimulate protein synthesis.The present meta-analysis was conducted to determine whether stretching can generate adequate mechanical tension to induce muscle hypertrophy.We used PubMed,Web of Science,and Scopus to search for literature examining the effects of long-term stretching on muscle mass,muscle cross-sectional area,fiber cross-sectional area,and fiber number.Since there was no sufficient number of studies investigating long-lasting stretching in humans,we only included original animal studies in the current meta-analysis.Precisely,we identified 16 studies meeting the inclusion criteria(e.g.stretching of at least 15 min per day).The 16 studies yielded 39 data points for muscle mass,11 data points for muscle cross-sectional area,20 data points for fiber cross-sectional area,and 10 data points for fiber number.Across all designs and categories,statistically significant increases were found for muscle mass(d=8.51;95%CI 7.11-9.91),muscle cross-sectional area(d=7.91;95%CI 5.75-10.08),fiber cross-sectional area(d=5.81;95%CI 4.32-7.31),and fiber number(d=4.62;95%CI 2.54-6.71).The findings show an(almost)continuous positive effect of long-term stretching on the listed parameters,so that it can be assumed that stretch training with adequate intensity and duration leads to hypertrophy and hyperplasia,at least in animal studies.A general transferability to humans-certainly with limited effectiveness-can be hypothesized but requires further research and training studies.
