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30 záznamů v Medvik Filtry

Článek

Gallbladder Dyskinesia Is Associated With an Impaired Postprandial Fibroblast Growth Factor 19 Response in Critically Ill Patients

Koelfat, Kiran V K
Autor Koelfat, Kiran V K Department of Surgery, Maastricht University Medical Center and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
Plummer, Mark P
Autor Plummer, Mark P Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
Schaap, Frank G
Autor Schaap, Frank G Department of Surgery, Maastricht University Medical Center and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands. Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
Lenicek, Martin
Autor Lenicek, Martin Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
Jansen, Peter L M
Autor Jansen, Peter L M Department of Surgery, Maastricht University Medical Center and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
Deane, Adam M
Autor Deane, Adam M Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
Olde Damink, Steven W M
Autor Olde Damink, Steven W M Department of Surgery, Maastricht University Medical Center and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands. Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany

Hepatology. 2019 ; 70 (1) : 308-318. [pub] 20190605

ISSN 1527-3350
Medvik
Zdroj

Critical illness is associated with a disturbed regulation of gastrointestinal hormones resulting in functional and metabolic anomalies. Fibroblast growth factor 19 (FGF19) is an ileum-derived metabolic hormone induced by bile salts upon gallbladder emptying after enteral nutrient stimulation. Our aim was to study the nutrient-stimulated FGF19 response in 24 patients admitted to the intensive care unit (ICU) compared with 12 healthy controls. All subjects received intraduodenal high-lipid nutrient infusion for 120 minutes. Blood was collected every 30 minutes until 1 hour after infusion, and gallbladder emptying was studied by ultrasound. Serum levels of bile salts and FGF19 were assessed. ICU patients had significantly higher fasting bile salt serum levels compared with controls, whereas FGF19 serum levels were similar. In both groups, nutrient infusion elicited substantial bile salt elevations (P < 0.001), peaking at 90 minutes, albeit with a significantly lower peak in the ICU patients (P = 0.029). In controls, FGF19 was significantly elevated relative to baseline from 120 minutes onward (P < 0.001). In ICU patients, the FGF19 response was blunted, as reflected by significantly lower FGF19 elevations at 120, 150, and 180 minutes (P < 0.05) and significantly lower area under the curve (AUC) values compared with controls (P < 0.001). Gallbladder dysmotility was associated with the impaired FGF19 response in critical illness. The gallbladder ejection fraction correlated positively with FGF19 AUC values (ρ = +0.34, P = 0.045). In 10 of 24 ICU patients, gallbladder emptying was disturbed. These patients had significantly lower FGF19 AUC values (P < 0.001). Gallbladder emptying and the FGF19 response were respectively disturbed or absent in patients receiving norepinephrine. Conclusion: The nutrient-stimulated FGF19 response is impaired in ICU patients, which is mechanistically linked to gallbladder dysmotility in critical illness. This may contribute to disturbed liver metabolism in these patients and has potential as a nutritional biomarker.

Článek

Možnosti nukleární medicíny v diagnostice funkčních dyspepsií

Bulletin Sdružení praktických lékařů ČR. 2018 ; 28 (3) : 22-24.

Bull. Sdruž. prakt. lék. ČR
ISSN 1212-6152
Medvik
Zdroj

Článek

Peristaltic flow of lithogenic bile in the vateri's papilla as non-newtonian fluid in the finite-length tube: analytical and numerical results for reflux study and optimization

Lékař a technika. 2017 ; 47 (2) : 35-42.

Lék. tech.
ISSN 0301-5491
Medvik
Zdroj

Bile is one of 32 bio-fluids in the human body. Lithogenic bile (bile with tendency for the gallstones formation) is the pathological state of bile. Rheological properties of lithogenic bile differ from normal one. The Vateri's papilla is the narrowest duct in the biliary system. Peristaltic motion plays important role in the bile flow in the Vateri's papilla. In the literature, there are many papers devoted to peristaltic flow of fluids in the infinite length tubes. There are not many papers devoted to peristaltic flow of fluids in the finite length tubes. Modelling of peristaltic flow in the finite length tubes requires the imposing of boundary conditions on the ends of a tube. It leads to problem statement complication and to obtain the problem solution is getting harder. The current paper aims at developing mathematical model of the peristaltic bile transport flow through the duct at papillary stenosis as a tapered finite-length tube. It allows evaluating velocities and pressure distribution along the tube, and detecting choledochopancreatic reflux occurrence conditions. Adopting the perturbation method, the analytical solutions for velocities and pressures are obtained. Pressure distribution versus axial coordinate at different time instants are plotted for various values of Weissenberg number and amplitude ratio. It revealed that the amplitude ratio has more effect on the pressure distribution along the tube compared to the Weissenberg number. The values of the pressure gradient corresponding to reflux occurring are obtained. The comparison between developed model and numerical peristaltic model code implemented in ANSYS was made. Moreover, it is reported that the pressure drop value corresponding to average flow rate equal to zero may serve as reflux occurrence criterion. Moreover, channel shape optimization was made for subsequent stent installation to restore normal bile flow using Nelder-Mead method.

Článek

Kyselinu ursodeoxycholovou již mohou předepisovat i internisté

Medical tribune. 2016 ; 12 (21) : C4-C5.

Med. Trib. (Praha)
ISSN 1214-8911
Medvik
Zdroj

MeSH
alkalická fosfatasa krev MeSH
cholestáza * epidemiologie etiologie farmakoterapie patofyziologie MeSH
dyskineze žlučových cest diagnóza farmakoterapie MeSH
dyspepsie diagnostické zobrazování farmakoterapie MeSH
gama-glutamyltransferasa krev MeSH
intrahepatální cholestáza diagnóza farmakoterapie patofyziologie MeSH
kyselina ursodeoxycholová terapeutické užití MeSH
lidé MeSH
Check Tag
lidé MeSH
Publikační typ
novinové články MeSH

Článek

Acalculous cholecystitis or biliary dyskinesia for Epstein-Barr virus gallbladder involvement

Prague Medical Report. 2014 ; 115 (1-2) : 67-72.

Prague Med. Rep.
ISSN 1214-6994
Medvik
Zdroj

We present two patients with Epstein-Barr virus (EBV) infection related to gallbladder involvement. Such an association is already known as EBV induced acalculous cholecystitis, diagnosed on the basis of ultrasonographic findings. In our patients, radioisotopic cholescintigraphy was also performed and it showed that gallbladder was visualized in both patients in contrast to that what can be observed in cases of cholecystitis. However, the value of ejection fraction was compatible with biliary dyskinesia. We, therefore, consider that impaired gallbladder contractility in EBV infection cases may actually represent biliary dyskinesia and not acalculous cholecystitis taking into account the radioisotopic findings and the self limited course of the disorder.