Search

Your search keyword '"Forrest, E. H."' showing total 148 results
Start Over Author "Forrest, E. H."
148 results on '"Forrest, E. H."'

1. Haemodynamic disturbance in cirrhosis : a study of humoral mediators and implications for therapy

Author

Forrest, E. H.

Subjects
615.1
Abstract

Many complications of cirrhosis of the liver can be related to the haemodynamic disturbance associated with this condition. Patients with cirrhosis have a variety of circulatory anomalies: portal hypertension, systemic hypotension, systemic vasodilatation and renal vasoconstriction being characteristic. This thesis set out to clarify the causes and possible treatments of these disturbances. Investigations were carried out by studying the regional haemodynamics of patients with cirrhosis using vascular catheters, and also by studying the platelets from such patients as models of vascular smooth muscle cell reactivity. In particular the roles of nitric oxide and adenosine were studied. Nitric oxide synthase inhibition led to an improvement in the mean arterial pressure presumably by increasing systemic vascular resistance without affecting the portal or porto-systemic circulations. Adenosine receptor blockade reduced portal pressure slightly but did not improve the hyperdynamic circulation of cirrhosis. However renal perfusion, both in absolute terms and as a proportion of cardiac output, improved significantly. Plasma from patients with cirrhosis was found to possess a factor(s) which reduces platelet cytosolic calcium. This induced signal transduction defect may reflect changes in vascular tissue in cirrhosis. Nitric oxide synthase inhibition partly ameliorated this by increasing basal cytosolic calcium in platelets from patients with cirrhosis. Adenosine receptor blockade did not affect the cytosolic calcium of platelets. The pharmacological manipulation haemodynamics was also studied. Propranolol lowered portal pressure by reducing portal vein inflow. Isosorbide-5-mononitrate mediated its portal hypotensive effect by reducing intra-hepatic vascular resistance. Carvilol, a vasodilating beta-blocker, lowered portal pressure significantly without compromising renal perfusion. However patients with ascites were more susceptible to systemic hypotension. In conclusion nitric oxide appears to have a role as a significant systemic vasodilator, whilst adenosine is a potent renal vasoconstrictor in cirrhosis. Vasodilating beta-blockers may have an important role in the treatment of portal hypertension.

Published
1997

28. Longterm follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension: results in 130 patients

Author

Stanley, A J, Jalan, R, Forrest, E H, Redhead, D N, and Hayes, P C

Subjects
Hypertension, Portal, Humans, Portasystemic Shunt, Surgical, Esophageal and Gastric Varices, Gastrointestinal Hemorrhage, Research Article
Abstract

BACKGROUND: Transjugular intrahepatic portosystemic stent shunts (TIPSS) are increasingly being used to manage the complications of portal hypertension. This study reports on the follow up on 130 patients who have undergone TIPSS. PATIENTS AND METHODS: One hundred and thirty patients (81 male), mean (SD) age 54.7 (12.5) years underwent TIPSS. The majority (64.6%) had alcoholic cirrhosis and 53.2% had Childs C disease. Indications were: variceal haemorrhage (76.2%), refractory ascites (13.1%), portal hypertensive gastropathy (4.6%), others (6.1%). Shunt function was assessed by Doppler ultrasonography and two then six monthly portography and mean follow up for survivors was 18.0 months (range 2-43.5). RESULTS: The procedure was successful in 119 (91.5%). Sixty three episodes of shunt dysfunction were observed in 45 (37.8%) patients. Variceal rebleeding occurred in 16 (13.4%) patients and was always associated with shunt dysfunction. Twenty (16.8%) patients had new or worse spontaneous encephalopathy after TIPSS and 11 (64.7%) patients had an improvement in resistant ascites. Thirty day mortality was 21.8% and one year survival 62.5%. CONCLUSION: TIPSS is an effective treatment for variceal bleeding, resistant ascites, and portal hypertensive gastropathy. Rebleeding is invariably associated with shunt dysfunction, the frequency of which increases with time, therefore regular and longterm shunt surveillance is required.

Published
1996

31. Is the Glasgow Blatchford Score useful in the risk assessment of patients presenting with variceal haemorrhage?

Author

Reed, B., primary, Dalton, H. R., additional, Blatchford, O., additional, Ashley, D., additional, Mowat, C., additional, Gaya, D. R., additional, Cahill, A., additional, Warshow, U., additional, Hare, N., additional, Begum, H., additional, Cheung, A., additional, Thompson, E., additional, Groome, M., additional, Forrest, E. H., additional, Morris, A. J., additional, and Stanley, A. J., additional

Published
2011
Full Text
View/download PDF

39. The effect of nitric oxide synthase inhibition on portal pressure and azygos blood flow in patients with cirrhosis

Author

Forrest, E H, Jones, Alison L, Dillon, John R, Walker, James, Hayes, P C, Forrest, E H, Jones, Alison L, Dillon, John R, Walker, James, and Hayes, P C

Abstract

It has been proposed that the hyperdynamic circulation found in cirrhosis is mediated by nitric oxide released through the induction of nitric oxide synthase. To investigate this the effect of the nitric oxide synthase inhibitor, N~-monomethyl-L-arginine (LNMMA), was studied upon the portal circulation. After a 30-min infusion of 3 mg/kg of L-NMMA there was a significant fall in heart rate from 83.2+_4.4 to 74.2-+3.9 bpm (p=0.005), and a significant rise in mean arterial pressure from 91.6+_2.2 to 103.7+_3.2 mmHg, p=0.004). There was, however, no change in hepatic venous pressure gradient (16.7+_1.5 to I6.1+_1.7 mmHg, p=0.477) nor in azygos venous blood flow (366---126 to 368+_145 ml/min, p=0.683). On subgroups analysis by Child-Pugh grade, significant changes occurred in heart rate and mean arterial pressure only in grade A and B patients (p=0.0061 and p=0.0068, respectively). Regional peripheral blood flow was studied using hand thermography. All patients who had anisothermic hands (relatively cold fingers compared to palmar temperature) at the start of the study developed an isothermic pattern after the L-NMMA infusion This study demonstrates a significant systemic effect of nitric oxide synthase inhibition in patients with cirrhosis but no effect upon the portal or portosystemic collateral circulations at this dose.

Published
1995

50. THE GLASGOW ALCOHOLIC HEPATITIS SCORE IDENTIFIES PATIENTS LIKELY TO BENEFIT FROM CORTICOSTEROIDS.

Author

Forrest, E. H., Morris, J. M., Stewart, S., and Day, C. P.

Subjects
*CORTICOSTEROIDS, *LIVER diseases, *HEPATITIS, *SYMPTOMS, *THERAPEUTICS, *ALCOHOLIC liver diseases, *COMPLICATIONS of alcoholism
Abstract

The use of corticosteroids in the treatment acute alcoholic hepatitis remains controversial. Their use has been recommended for patients with a discriminant function. The recently described Glasgow Alcoholic Hepatitis Score (GAHS) appears to have a greater accuracy in predicting patient outcome. Patients with a GAHS less than 9 have a good prognosis and do not appear to benefit further from corticosteroid treatment. A GAHS greater than or equal to 9, indicates a poor prognosis without corticosteroids therapy or if corticosteroids are contra-indicated.

Published
2004

Catalog

Books, media, physical & digital resources
See catalog results