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Alcoholic Hepatitis

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28441. A randomized clinical trial of insulin and glucagon infusion for treatment of alcoholic hepatitis: progress report in 50 patients. (Abstract)

A randomized clinical trial of insulin and glucagon infusion for treatment of alcoholic hepatitis: progress report in 50 patients. A randomized, double-blind, controlled trial of insulin and glucagon infusion was conducted in 50 patients with acute alcoholic hepatitis. Twenty-five treatment patients received 24 U regular insulin and 2.4 mg glucagon over 12 h daily for 3 wk. Twenty-five control patients received 200 ml dextrose solution in identical bottles over the same time period. Six control (...) infusion is a promising treatment of alcoholic hepatitis and merits further study in the most severely ill patients.

1981 Gastroenterology Controlled trial quality: uncertain

28442. Double-blind, controlled trial of propylthiouracil in patients with severe acute alcoholic hepatitis. (Abstract)

Double-blind, controlled trial of propylthiouracil in patients with severe acute alcoholic hepatitis. Sixty-seven patients entered a double-blind, controlled trial to evaluate the efficacy of propylthiouracil treatment in severe alcoholic hepatitis. Twenty-three percent (7 of 31) given propylthiouracil and 19% (7 of 36) given placebo died during the 6-wk study. Propylthiouracil treatment did not reduce the frequency and incidence of complications in alcoholic hepatitis, but induced (...) hypothyroidism in 4 patients. Treatment produced no beneficial effect on any of the hepatic biochemical tests. We were unable to show any beneficial effect of propylthiouracil treatment on morbidity and mortality in patients with severe acute alcoholic hepatitis.

1982 Gastroenterology Controlled trial quality: uncertain

28443. Effect of parenteral amino acid supplementation in alcoholic hepatitis. (Abstract)

Effect of parenteral amino acid supplementation in alcoholic hepatitis. A controlled randomized study was performed in 15 patients with biopsy-proven alcoholic hepatitis to determine the effect of the administration of a parenteral amino acid-glucose solution for 1 month on nutritional, clinical, biochemical and histological parameters. All patients were allowed ad libitum consumption of a hospital diet. Five patients received the amino acid-glucose solution, while 10 received the glucose (...) in the control group, but this early advantage was no longer apparent at the end of one month. Hepatocellular necrosis, inflammation and fat improved in the entire group. Amino acid treatment resulted in a greater resolution of fatty infiltration, but did not otherwise affect hepatic histology. Hepatocellular necrosis and inflammation in both the initial and final liver biopsies were highly correlated with nitrogen balance on admission. Initial clinical index correlated with the quantity of ethanol

1985 Hepatology Controlled trial quality: uncertain

28444. Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis. (Abstract)

Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis. Sixty-four patients admitted with acute alcoholic hepatitis, with or without underlying cirrhosis, were randomized regardless of encephalopathy to receive a controlled diet either alone, or supplemented orally, nasogastrically, or intravenously as necessary, with 2000 kCal and 10 g nitrogen daily. Whether this came from a conventional protein source

1985 Journal of hepatology Controlled trial quality: uncertain

28445. Liver function in patients with mild alcoholic hepatitis, after enflurane, nitrous oxide-narcotic, and spinal anesthesia. (Abstract)

Liver function in patients with mild alcoholic hepatitis, after enflurane, nitrous oxide-narcotic, and spinal anesthesia. The effects of three anesthetic techniques on liver function were compared in patients with mild alcoholic hepatitis who required surgery, both peripheral and superficial. Thirty patients were randomly assigned to receive one of three anesthetics: thiopental, nitrous oxide and oxygen, enflurane, plus muscle relaxant; thiopental, nitrous oxide and oxygen, narcotic, plus (...) by the first postoperative day and again on the third. The data suggest that the choice among the three anesthetic methods studied could be based on factors other than the presence of mild alcoholic hepatitis and that, when peripheral surgery is required, one may not anticipate a worsening of any biochemical disorder in the first three postoperative days.

1985 Anesthesia and analgesia Controlled trial quality: uncertain

28446. Therapeutic effect of (+)-cyanidanol-3 in toxic alcoholic liver disease and in chronic active hepatitis. (Abstract)

Therapeutic effect of (+)-cyanidanol-3 in toxic alcoholic liver disease and in chronic active hepatitis. (+)-Cyanidanol-3 is considered to have cytoprotective effect in toxic liver injury. A randomized clinical trial was carried out in alcoholic precirrhotic patients and in chronic active hepatitis with (+)-cyanidanol-3 versus placebo. The daily dose of the drug was 1.5-2.0 g for a one-year period. A: Toxic alcoholic precirrhotic liver disease: 38 patients were treated with (+)-cyanidanol-3, 36 (...) with placebo. We found significant improvement in the subjective symptome like asthenia and anorexia, and in serum aspartate-transaminase (GOT) levels. However, it is possible that the improvement was in part due to abstinence from alcohol. B: Chronic active hepatitis: previously introduced continuous prednisolone therapy (10-15 mg/day) was combined with (+)-cyanidanol-3 in 13 patients and with placebo in 12 controls. The results showed a more favourable, but not significantly better response in patients

1984 Acta physiologica Hungarica Controlled trial quality: uncertain

28447. The effect of lactulose on psychomotor performance tests in alcoholic cirrhotics without overt hepatic encephalopathy. (Abstract)

The effect of lactulose on psychomotor performance tests in alcoholic cirrhotics without overt hepatic encephalopathy. Thirty-two alcoholic cirrhotics without clinical evidence of encephalopathy were randomized to lactulose or sucrose treatment in order to evaluate the effects of chronic lactulose therapy on five psychomotor performance tests. Statistically significant improvement was seen in three of the five tests in the lactulose-treated group, while no significant improvement in any test

1984 Journal of clinical gastroenterology Controlled trial quality: uncertain

28448. A prospective multicenter study of insulin and glucagon infusion therapy in acute alcoholic hepatitis. (Abstract)

A prospective multicenter study of insulin and glucagon infusion therapy in acute alcoholic hepatitis. A randomized, single-blind controlled multicenter study of insulin and glucagon infusion was carried out in 66 patients with acute alcoholic hepatitis. Thirty-three patients were treated with insulin 10 U and glucagon 1 mg in 500 ml 5% glucose in water via a peripheral vein for 2-6 h three times every day for 3 weeks. Patients in the control group received 5% glucose in an identical fashion (...) . Fourteen control patients and five treated patients died from liver failure during the study (P less than 0.02). Clinical features of liver disease on entry into the study were similar in the two groups, but the total serum bilirubin, aspartate aminotransferase, gamma-glutamyltranspeptidase activities and prothrombin time significantly improved in the treated patients (P less than 0.05). Insulin and glucagon infusion appears to be a promising treatment of acute alcoholic hepatitis.

1987 Journal of hepatology Controlled trial quality: uncertain

28449. A randomized controlled study of peripheral parenteral nutrition in moderate and severe alcoholic hepatitis. (Abstract)

A randomized controlled study of peripheral parenteral nutrition in moderate and severe alcoholic hepatitis. We performed a controlled trial of peripheral hyperalimentation in moderate and severe alcoholic hepatitis to determine whether improvement in survival and liver function could be obtained. Twelve patients with moderate and 22 with severe alcoholic hepatitis were randomized to 28 days of peripheral parenteral nutrition (PPN) or standard therapy (ST). In the moderate group, six were (...) PPN, 3 ST). PPN produced greater improvement than ST in serum bilirubin and transferrin concentrations and a trend toward greater improvement in prothrombin time, serum albumin and galactose elimination capacity. PPN had no deleterious effect on encephalopathy or ascites as only ST patients developed ascites or encephalopathy after randomization. We conclude that PPN compared to ST (1) provides no benefit in moderate alcoholic hepatitis, but (2) did more rapidly improve morbidity (liver tests

1988 Journal of hepatology Controlled trial quality: uncertain

28450. [Treatment of acute alcoholic hepatitis with prednisolone. 45 patients]. (Abstract)

[Treatment of acute alcoholic hepatitis with prednisolone. 45 patients]. Whether or not prednisolone (or prednisone) should be used to treat alcoholic hepatitis remains controversial. This new controlled study performed on 45 patients with steatosis, fibrosis or cirrhosis of the liver suggests that prednisolone is not effective: after a 3-month follow-up clinical course, biochemical alterations, anatomical lesions and portal hypertension were the same in patients treated with prednisolone

1987 Presse médicale (Paris, France : 1983) Controlled trial quality: uncertain

28451. A prospective randomized clinical trial of peripheral amino acid-glucose supplementation in acute alcoholic hepatitis. (Abstract)

A prospective randomized clinical trial of peripheral amino acid-glucose supplementation in acute alcoholic hepatitis. Twenty-eight patients with biopsy or clinical acute alcoholic hepatitis were prospectively randomized to 21 days of conventional therapy (14 control patients) or, in addition, to 2 L/day of a peripheral iv infusion of a 900 mosmol amino acid-glucose solution (14 patients). Cirrhosis was present in 64% of controls and in 54% of infused patients. There were three deaths (...) in controls and one in the infused group. There were no significant intergroup differences in mortality, clinical findings, liver tests, or functional mass by the galactose elimination capacity either at entry or after completion of the study. In controls, there was intragroup improvement in serum bilirubin (p = 0.033) and AST (p = 0.008) but not in other "liver tests" or in functional hepatic mass by galactose elimination capacity. In infused patients there was improvement in bilirubin (p = 0.001), AST

1987 The American journal of gastroenterology Controlled trial quality: uncertain

28452. Treatment of alcoholic hepatitis with colchicine. Results of a randomized double blind trial. (Abstract)

Treatment of alcoholic hepatitis with colchicine. Results of a randomized double blind trial. A randomized double-blind trial of colchicine vs placebo was conducted in 67 patients with histologically proven alcoholic hepatitis, 33 of whom had cirrhosis. Patients with hepatic encephalopathy, ascites, protracted prothrombin time, severe thrombocytopenia, hepatocellular carcinoma, evident lack of discipline or refusal to participate in the trial were not included. Thirty-three patients received (...) colchicine (1 mg/day) and 34 received placebo for 6 months. Blood parameters including N-terminal peptide of type III procollagen were assessed in the serum, and a percutaneous liver biopsy was performed at the start of the trial and after 3 and 6 months. Alcoholic hepatitis and fibrosis scores were established for each biopsy specimen. Twenty-eight percent of patients were lost to follow-up at 3 months, and fifty-two percent at 6 months. One patient died of liver failure. Fifty-eight percent of patients

1989 Gastroentérologie clinique et biologique Controlled trial quality: uncertain

28453. [Uridine diphosphate glucose (UDPG) in the treatment of hepatic disease from chronic alcohol abuse]. (Abstract)

[Uridine diphosphate glucose (UDPG) in the treatment of hepatic disease from chronic alcohol abuse]. Fatty liver can be determined by chronic abuse of alcohol, by means of direct action of the same on the level of membrane's proteins. The UDPG restores the levels of a membrane's component, the phosphoribosylpyrophosphate (PRPP), which normally results reduced in cellular cultures of rat's liver, after the addition of alcohol. It has been made a study on 40 patients (27 men and 13 women age (...) medium 54 years) alcoholics for at least 1 year with a quantity of ethanol ingested less than 1 g gamma/die/kg of body weight with alternated values of serum GOT, GPT and gamma-GT and clinical aspects of a modest alcoholic hepatopathy, assigning through, at random in double blind, two groups of treatment: the first one with UDPG (400 mg/im/die for 30 days) the second one with placebo. It has been considered like variable of therapeutic effect the difference between basal value and the result

1990 Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue européenne pour les sciences médicales et pharmacologiques Controlled trial quality: uncertain

28454. Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. (Abstract)

Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. To determine the efficacy of a corticosteroid in reducing the short-term mortality of patients with severe alcoholic hepatitis.Randomized, double-blind, placebo-controlled multicenter trial.Four university teaching hospitals.We enrolled 66 patients with alcoholic hepatitis and either spontaneous hepatic encephalopathy or a discriminant function value greater than 32, calculated using (...) in mortality was 14% to 66%. The Cox proportional hazards regression model showed the advantage of methylprednisolone over placebo after adjustment for other potentially important prognostic variables (P = 0.004).Methylprednisolone therapy decreases short-term mortality in patients with severe alcoholic hepatitis manifested either by spontaneous hepatic encephalopathy or a markedly elevated discriminant function value.

1989 Annals of internal medicine Controlled trial quality: predicted high

28455. [Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients]. (Abstract)

[Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients]. A randomized double-blind trial of silymarin versus placebo was carried out in 116 patients with histologically proven alcoholic hepatitis, 58 of them with cirrhosis. Patients were not included in case of hepatic encephalopathy, contraindication to percutaneous liver biopsy, hepatocellular carcinoma, evident lack of discipline or refusal to enter the trial. Fifty-seven patients received (...) silymarin orally 420 mg/day and 59 received placebo during 3 months. Biologic parameters were assessed in the serum, and a percutaneous liver biopsy was obtained at the start of the trial and 3 months later. Histologic scores of alcoholic hepatitis and fibrosis were established on each biopsy specimen by two independent pathologists. The 2 groups were comparable at inclusion; 26 p. 100 of patients were lost to follow-up at 3 months, abstinence was obtained in 46 p. 100 of patients at the end

1989 Gastroentérologie clinique et biologique Controlled trial quality: uncertain

28456. [Corticoid therapy in the treatment of acute alcoholic hepatitis. Results of a meta-analysis]. (Abstract)

[Corticoid therapy in the treatment of acute alcoholic hepatitis. Results of a meta-analysis]. A meta-analysis of 10 randomized trials comparing steroid therapy with placebo or abstention was performed. Trials were pooled for severity of acute alcoholic hepatitis and time of analysis. Papers with survival analyses at one and three months were included. The robustness of this meta-analysis was analysed after exclusion of trials analysing survival at three months only, trials including mild forms (...) , or atypical trials. Comparisons were made use the Der Simonian-Laird and Mantel-Haenszel-Peto methods. All results were statistically significant. However, if only one medium size trial were to be added, the results would no longer be significant. Taking into account the complications of steroid therapy, we conclude that further clinical trials are necessary to confirm the effectiveness of steroid therapy, especially for the group of patients with severe alcoholic hepatitis.

1991 Gastroentérologie clinique et biologique

28457. Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials. (Abstract)

Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials. To determine whether corticosteroids affect short-term mortality from alcoholic hepatitis.Studies published from 1966 to 1989 were identified through a MEDLINE computer search and an extensive manual search of the bibliographies of identified articles.We found 11 randomized studies (10 of which were placebo controlled) that assessed mortality in hospitalized patients diagnosed with acute (...) alcoholic hepatitis and treated with corticosteroids.Two critical appraisers independently evaluated trial quality and abstracted quantitative data on clinical characteristics of the populations, interventions, and all-cause mortality.Overall, the protective efficacy (or percent reduction in mortality) of corticosteroids was 37% (95% CI, 20% to 50%). Protective efficacy was higher among trials with higher quality scores and trials that excluded subjects with active gastrointestinal bleeding. In subjects

1990 Annals of internal medicine

28458. Failure of colchicine to improve short-term survival in patients with alcoholic hepatitis. (Abstract)

Failure of colchicine to improve short-term survival in patients with alcoholic hepatitis. Colchicine treatment was used in this randomized placebo-controlled trial in patients with severe acute alcoholic hepatitis [serum bilirubin greater than or equal to 5 mg/dL (85.5 mumol/L) mean, 17.5 +/- 7.5 mg/dL (299.25 +/- 128.25 mumol/L)]. Hospitalization mortality and morbidity and the effect on biochemical test results were the end points of the treatment. Patients in the two groups were evenly (...) of colchicine treatment on mortality and morbidity of severe alcoholic hepatitis. Colchicine cannot be recommended for the treatment of patients with alcoholic hepatitis.

1990 Gastroenterology Controlled trial quality: uncertain

28459. Treatment of severe alcoholic hepatitis by infusion of insulin and glucagon: a multicenter sequential trial. (Abstract)

Treatment of severe alcoholic hepatitis by infusion of insulin and glucagon: a multicenter sequential trial. Severe alcoholic hepatitis is still a therapeutic challenge. It has been recently advocated that a 3-wk infusion with insulin and glucagon reduces its short-term mortality rate. A multicenter, randomized, single-blind, sequential trial was designed to compare this treatment with placebo. The triangular boundary was defined with alpha = 0.05, beta = 0.10 and estimated survival at 4 wk (...) of 50% with placebo, 75% with treatment. Patients with biopsy-proven severe alcoholic hepatitis (presence of one or more of three criteria: encephalopathy, prothrombin activity less than or equal to 50%, bilirubinemia greater than or equal to 100 mumol/L) were randomized into two groups; one treatment group received an infusion (12 hr/day) of an association of insulin (30 IU) and glucagon (3 mg), and a control group received an infusion of glucose. Treatments were administered during a 3-wk period

1992 Hepatology Controlled trial quality: uncertain

28460. Effect of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial. (Abstract)

Effect of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial. The effect of parenteral amino acid administration on nutritional state, liver function and mortality was assessed in patients with severe alcoholic hepatitis. Twenty-eight patients received 2 l/day of a solution of dextrose (65 gm/L) and amino acids (25.8 gm/L) for 1 mo, whereas 26 received only the dextrose solution. All patients were allowed

1991 Hepatology Controlled trial quality: uncertain

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