Evaluation of paraumbilical vein as a prognostic index of severe liver cirrhotic patients with portal-systemic shunts.

AIM: The aim of this study was to predict the outcome in severe liver cirrhotic patients with portal-systemic shunts. METHODS: One-hundred and sixteen patients with liver cirrhosis diagnosed as Child-Pugh class B and C with portal-systemic shunts confirmed by abdominal ultrasonography, computed tomography and magnetic resonance imaging were enrolled in this study. Twenty-three factors were evaluated concerning clinical laboratory parameters and extracted prognostic factors using the Cox proportional hazards model, and the prognostic index (PI) was prepared by combining these factors. RESULTS: The cumulative survival rates after admission were 64.6%, 35.6% and 25% after 1, 3 and 5 years, respectively. Using multivariate analysis, age, the presence of hepatocellular carcinoma (HCC), portal vein tumor thrombosis (PVTT) and paraumbilical vein (PUV) shunt were selected as significant prognostic factors that contributed independently to the prognosis of severe liver cirrhotic patients with portal-systemic shunts. The PI was calculated with the following formula using these 4 factors. PI = 0.042 x Age + 0.913 x HCC + 0.989 x PVTT + 1.079 x PUV shunt. The group with a high score for PI was found to die with significantly higher frequency than the group with a low score. CONCLUSIONS: It was found that tumor related factors and PUV shunt were the most important factors for severe liver cirrhotic patients with portal-systemic shunts. The PI is suggested to be an appropriate index to predict the prognosis for these patients.

Effects of ritodrine hydrochloride, a beta 2-adrenoceptor stimulant, on uterine motilities in late pregnancy.

Ritodrine hydrochloride (ritodrine) is a beta 2-adrenoceptor stimulant which has been effectively prescribed for the prevention of premature labor. The present studies were carried out to investigate the effects of ritodrine on uterine motility in rats and rabbits during gestation, as compared with those of isoproterenol and isoxsuprine. The results were as follows: 1) Spontaneous movements and evoked contractile responses of isolated rat uterus (19-20th days of gestation) were suppressed by 10(-9) - 10(-6) M ritodrine. The potency of ritodrine was approximately 10 times more than that of isoxsuprine and 100 - 1,000 times less than that of isoproterenol. 2) When these drugs were administered to pregnant rats or rabbits intravenously, the tocolytic potency was in the following order: isoproterenol greater than ritodrine greater than isoxsuprine. 3) Ritodrine induced hypotension and tachycardia, but these effects were less than those of isoproterenol and isoxsuprine. 4) The effects of isoproterenol and ritodrine were almost prevented by pretreatment with propranolol, but those of isoxsuprine were only partially or not affected. These results suggest that ritodrine is effective in preventing the uterine contractions in rats and rabbits and that it has less effect on the circulatory system than isoproterenol and isoxsuprine. It is also concluded that ritodrine produces these effects through activation of beta-adrenoceptors.

[Effects of a beta 2-stimulant, ritodrine hydrochloride, on the fetuses and dams in the late stage of pregnancy: an experimental study using rabbits].

Ritodrine hydrochloride (ritodrine) is a beta 2-adrenoceptor agonist and has been effectively prescribed for the prevention of premature labor. The present study was carried out to investigate the effect of ritodrine on uterine motility, cardiovascular system, fetal heart rate and placental blood flow in late pregnant rabbits, in comparison with the effects of isoproterenol and isoxsuprine. Furthermore, we investigated the effect of ritodrine on the damage to utero-placental circulation evoked by drugs. Ritodrine (10-1,000 micrograms/kg) suppressed the spontaneous motility of pregnant rabbit uterus (27-29th days of gestation) in a dose-dependent manner. Maternal blood pressure and heart rate were little affected by ritodrine. Isoxsuprine induced hypotension and isoproterenol increased the heart rate. Ritodrine and isoproterenol had little effect on the fetal heart rate. On the other hand, isoxsuprine induced marked fetal bradycardia. Ritodrine, isoxsuprine and isoproterenol showed a tendency to decrease the placental blood flow. Isoxsuprine was more potent than the other two drugs and needed a long time for restoration. Ritodrine restored the changes in placental blood flow or fetal heart rate evoked by drugs. These results suggest that ritodrine effectively suppresses uterine motility and has little effect on the maternal land fetal cardiovascular system.