A randomized clinical trial of total parenteral nutrition (TPN) in jaundiced alcoholic cirrhotic patients

A randomized clinical trial of total parenteral nutrition (TPN) in jaundiced alcoholic cirrhotic patients

EFFECT OF SILYMARIN (S) ON BILIARY LIPID COMPOSITION. EXPERIMENTAL AND CLINICAL STUDY. 235 G.Nassuato,R.M.Iemmolo,M.Strazzabosoo,R.Orlando,M.Muraoa,F...

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EFFECT OF SILYMARIN (S) ON BILIARY LIPID COMPOSITION. EXPERIMENTAL AND CLINICAL STUDY. 235

G.Nassuato,R.M.Iemmolo,M.Strazzabosoo,R.Orlando,M.Muraoa,F.Lirussi,G. Csomos,S.Targhetta,and L.Okolicsanyi. I s t i t u t o di M e d i c i n a I n t e r n s , Universit~ di P a d o v a , P a d o v a , I t a l l a .

S,a n a t u r a l l y o c c o u r r i n g flavonoid,is Known to s t a b i l i z e the l i v e r cell m e m b r a n e , b y r e d u c i n g lipid m e m b r a n e t u r n o v e r . In o r d e r to s t u d y the i n f l u e n c e of S on biliary lipid composition,we p e r f o r m e d the f o l l o w i n g e x p e r i m e n t a l and c l i n i c a l study.Rats:43 animals were treated for 7 days i.p.:with s a l i n e ( n = 2 3 ) ; w i t h S, 100mg/Kg/day (n=14);with S,50mg/Kg/day (n=6).Bile flow (BF),biliary cholesterol (Ch),phospholipid ( P h l ) , a n d t o t a l bile salt (TBS) e x c r e t i o n s and l i v e r Ch concentration were assayed,Biliary Ch and Phl e x c r e t i o n w e r e s i g n i f i c a n t l y reduced a f t e r the h i g h e r S d o s e ; B F , b i l i a r y T B S , a n d l i v e r Ch c o n c e n t r a t i o n w e r e not changed.After the l o w e r S dose all p a r a m e t e r s considered were unchanged.In 6 addit i o n a l c o n t r o l rats and 6 S t r e a t e d rats ( l O O m g / k g / d a y for 7 d a y s i . p . ) , C h , P h l , and TBS e x c r e t i o n s in the bile w e r e d e t e r m i n e d after progressively h i g h e r doses of i.v. N a - T a u r o c h o l a t e infusion ( f r o m 0.1 to O . 8 p m o l / m i n / l O O g b.w.).We found i n c r e a s i n g e x c r e t o r y r a t e of C h , P h l , a n d TBS w i t h o u t s i g n i f i c a n t differences bet w e e n the two g r o u p s . M a n : i n the s e c o n d part of the s t u d y , c h o l e s t e r o l saturation index (SI) was determi-'n-e-d b e f o r e and a f t e r S a d m i n i s t r a t i o n ( 4 2 0 m g / d a y f o r 30 days) in 4 g a l l s t o n e and 6 c h o l e c y s t e c t o m i z e d patients,and b e f o r e and a f t e r pla cebo t r e a t m e n t in 9 c h o l e c y s t e c t o m i z e d subjeots.Biliary bile acid p a t t e r n was performed by H P L C m e t h o d in two S t r e a t e d p a t i e n t s . T h e SI s i g n i f i c a n t l y decrea sed a f t e r S t r e a t m e n t , m a i n l y due to a m a r k e d r e d u c t i o n of b i l i a r y Ch o o n c e n t r a tion;biliary bile acid p a t t e r n r e m a i n e d u n c h a n g e d . P l a c e b o t r e a t m e n t did not modify S I . T h e s e d a t a s h o w that S i n f l u e n c e s b i l i a r y l i p i d c o m p o s i t i o n , b o t h in exp e r i m p n t a l and c l i n i c a l c o n d i t i o n ,

A RANDOMIZED CLINICAL TRIAL OF TOTAL PARENTERAL NUTRITION (TPN) IN OAUNDICED ALCOHOLIC CIRRHOTIC PATIENTS, 236

S. Naveau, C. P e l l e t i e r * , T. Poynard, D. Vauzelle, P. A t t a l i * , A. P o i t r i n e , C. Buffet*~ OP. Etienne*, 3C. Chaput. HSpital Antoine Becl~re, F 92141 Clamart, et *HSpital de Bic~tre, F 94270 Le Kremlin-Bic~tre.

Between March 1982 and September 1983, 40 inpatients with alcoholic c i r r h o s i s and t o t a l serum b i l i r u b i n ~/80~moles/1 were included. Exclusion c r i t e r i a were hepatocellular c a r c i noma, renal f a i l u r e , hyponatremia, septicemia, spontaneous b a c t e r i a l p e r i t o n i t i s , gastroi n t e s t i n a l bleeding, hepatic coma. The study lasted 28 days. Oral group were offered a daily d i e t of 40 Kcal/kg/d. TPN group received, using central catheter, 40 Kcal/kg/d given as equal proportions of glucose and intravenous f a t emulsion and 200 mg nitrogen/kg/d and an oral ad l i b i t u m n u t r i t i o n . Major end point was t o t a l serum b i l i r u b i n on day 28. 25 men, 15 women 53 + i i years (m + SD) old were included. Results :--On admission ~erum b i l i r u b i n was not s i g n i f i c a n t l y d i f f e r e n t in two groups : Oral group : 214 + 113 pmoles/l, TPN group : 211 + 146 pmoles/l. On day 28 serum b i l i r u b i n was lower in TPN group (43 + 24 pmoles/l) than in--oral group (71 ~ 37 pmoles/l) - p < 0.02. Serum b i l i r u b i n was also lower in TPN group than i n o r a l group on day 7, 14, 21 - p<0.01. A covariance analysis, considering serum b i l i r u b i n on admission and a t randomization and time between admission and randomization, corroborate these results. On day 28, anthropometric parameters, serum t r a n s f e r r i n , prealbumin, r e t i n o l binding protein were more elevated in TPH group, but differences were not s i g n i f i c a n t . Albumin was s i g n i f i c a n t l y lower in TPN group. Encephalopathy and sepsis were not d i f f e r e n t . 1 p a t i e n t died i n each group during treatment period. Cumulative s u r v i v a l p r o b a b i l i t y at i year was 50 + 11% i n each group. Conclusion : Total parenteral n u t r i t i o n s i g n i f i c a n t l y decreases ~otal serum b i l i r u b i n on day 28 i n comparison with oral n u t r i t i o n .

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