ABSTRACT— In patients with chronic liver disease, the reliability of various criteria generally used to diagnose impaired glucose tolerance and diabetes was evaluated. Twenty‐one patients with chronic persistent hepatitis, 68 patients with chronic active hepatitis and 57 patients with liver cirrhosis were studied. All subjects underwent an oral glucose tolerance test (75 g). Impaired glucose tolerance and diabetes were diagnosed according to the criteria established by: the National Diabetes Study Group; Fajans and Conn; the European Diabetes Study Group; Deutsche Diabetes Gesellschaft; Kobberling & Creutzfeld criteria 1 and 2; Wilkerson; and the University Group Diabetes Program. The results obtained are in partial agreement with other reported data, showing a high prevalence of both impaired glucose tolerance and diabetes in chronic liver disease, with a positive correlation to the severity of hepatic involvement. However, our results show that the agreement among the criteria most frequently used for diagnosing impaired glucose tolerance and diabetes is still far from satisfactory.
ABSTRACT— The renal and hormonal effects of repeated atrial natriuretic peptide (ANP) boli (1 μg/kg of body weight) were studied in eight cirrhotic patients with refractory ascites. Under basal conditions the patients showed a striking activation of the renin‐angiotensin‐aldosterone system (plasma renin activity 19.3 ± 3.0 μg/ml±h, plasma aldosterone concentration 3.87 ± 0.58 ng/ml) and a tenfold elevation in plasma ANP levels compared to healthy subjects (131.7, range 47.0–288.6, vs. 9.8, range 5.0–15.0, fmol/ml, p < 0.001). The first ANP injection was followed by a remarkable increase in plasma ANP levels and by a slight increase in urinary cyclic guanosine‐monophosphate excretion (from 1050.8 ± 454.8 to 1446.6 ± 822.2 pmol/min). A significant reduction of mean blood pressure (MBP) occurred 5 min after the first injection (from 86.7 ± 7.2 to 79.9 ± 5.8 mmHg, p < 0.05), but values gradually returned to the baseline after 30 min. Heart rate (HR) increased 10 min after the first bolus injection (from 83.75 ± 4.7 to 88.1 ± 4.6 beats/min) and reached baseline values after 30 min. Similar behaviour of MBP and HR was observed after the second, third and fourth bolus injections. Urinary sodium excretion, urinary flow, glomerular filtration rate, plasma renin activity, and plasma aldosterone concentration did not show any significant modification during ANP administration, nor did these parameters change in the following 12‐h recovery period. The striking activation of the renin‐angiotensin‐aldosterone system and probably of other vasoconstricting and sodium‐retaining systems observed in basal conditions in patients with cirrhosis and refractory ascites seems the most likely explanation for the lack of any appreciable natriuretic and diuretic effect after repeated ANP boli.
The present review firstly gives some details regarding nosological approach to the cholestatic syndrome. In addition, different steps are considered, identifying 12 possible metabolic defects responsible for determining a cholestatic syndrome either in man or in experimental conditions. Eleven defects out of these 12 steps should be considered related to the structure and function of the hepatocyte, whereas the twelfth one, which comprises 3 different sub-groups, is based on a mechanical obstructive mechanism, localized exclusively into the liver parenchyma, thus resembling the other ones included in the chapter of intrahepatic cholestasis.
