glypressin

OBJECTIVES: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis, leading to death in more than 90% of cases in the absence of liver transplantation. Several treatments have been attempted as a bridge to liver transplantation. Among such treatments, terlipressin has been studied in several reports, two prospective pilot studies and a double-blind, short-term, controlled haemodynamic study. Promising results have been shown with this drug. The purpose of this multicentre retrospective study was to evaluate the effects of terlipressin on renal function and survival of patients with HRS...

Endoscopic therapy and in particular endoscopic variceal banding ligation, in experienced hands, is the treatment of choice for acute variceal bleeding which remains a major cause of death in patients with cirrhosis and portal hypertension. Pharmacological therapy with Glypressin or somatostatin can be useful to gain time when the endoscopic expertise is not available or to help to obtain a clearer endoscopic view. Transjugular intrahepatic porto-systemic stent shunt is currently used for endoscopic failures, producing similar results with the surgical portacaval shunts...

BACKGROUND: Vasopressin given during hemorrhage is less effective than when given during a stable state in experimental portal hypertension or patients with cirrhosis (the so-called hyposensitivity phenomenon). This study investigated whether chronic inhibition of nitric oxide (NO) synthesis by NG-nitro-L-arginine methyl ester (L-NAME), a non-selective NO synthase inhibitor, could potentiate the portal-hypotensive effect of glypressin (a long-acting vasopressin analogue) in portal-hypertensive rats during acute bleeding status...

Prostacyclin (PGI2) is an important contributor to the mediation of hyporeactivity to vasoconstrictors and the development of hyperdynamic circulation in portal hypertensive states. Inhibition of PGI2 synthesis in haemorrhage-transfused partially portal vein-ligated rats could ameliorate the splanchnic hyposensitivity to glypressin, a long-acting vasopressin analogue. This study investigated whether the hyposensitivity to glypressin also exists in rats with common bile duct ligation (BDL) and whether the inhibition of PGI2 synthesis by indomethacin could potentiate the portal-hypotensive effect of glypressin in bleeding BDL rats...

Hyposensitivity to vasopressin is a well documented phenomenon in animals with portal hypertension and patients with cirrhosis subject to haemorrhage. Haemorrhage is associated with the endogenous release of bradykinin, which may subsequently stimulate the formation of nitric oxide (NO). The present study investigated the relative contribution of NO synthase (NOS) isoforms and the role of bradykinin in the pathogenesis of splanchnic hyposensitivity to a long-acting vasopressin analogue, glypressin, in rats with portal hypertension induced by partial portal vein ligation (PVL)...

BACKGROUND: Hyposensitivity to vasopressin is a well-documented phenomenon in animals with portal hypertension and patients with cirrhosis and hemorrhage. Similar findings exist with infusion of glypressin (a long-acting vasopressin analogue), and this phenomenon could be ameliorated by inhibition of nitric oxide (NO) synthase. Besides NO, excessive formation of prostacyclin (PGI2) has been shown to play an important role in the development of hyperdynamic circulation and the mediation of hyporeactivity to vasoconstrictors in portal-hypertensive states...

In the last decade, the knowledge of the pathogenesis of portal hypertension has increased dramatically. Indeed, apart from the well-known pathogenetic importance of structural factors, the role of vasoactive factors, which enhance the increase in intrahepatic resistance, has been highlighted. The two pathogenetic factors of portal hypertension are: the increase in portal outflow resistance and an increase in splanchnic blood flow, which worsens and maintains the increased pressure in the portal vein. The increase in portal inflow is part of the hyperdynamic circulatory syndrome, which is a haemodynamic characteristic of cirrhotic patients...

1. Hyposensitivity to vasopressin is a well-documented phenomenon in animals with portal hypertension and patients with cirrhosis subjected to haemorrhage. Excessive formation of nitric oxide is at least partly responsible for the vascular hyporesponsiveness to vasoconstrictors observed in experimental portal hypertension or in rats with haemorrhagic shock. This study investigated whether addition of aminoguanidine, a preferential inducible nitric oxide synthase inhibitor, to glypressin (a long-acting vasopressin analogue) could enhance its portal hypotensive effect in portal-hypertensive rats with bleeding...

The therapy of portal hypertension depends to a significant extent on its clinical manifestation. In cases of acute haemorrhage from oesophageal varices in patients with portal hypertension, the objective of the therapy is to stop the haemorrhage (endoscopically, or by compression by means of a balloon probe) and to decrease the pressure and the reflux within the portal vascular bed. Urgent sclerotisation under the simultanous pharmacologic decrease of portal hypertension is successful in 93-95%. There is an alternative procedure residing in introducing a balloon probe for several hours and subsequent repeated sclerotisation until a complete eradication of varices is achieved regarding the prevention of haemorrhage exacerbation...

Optimal medical management is with octreotide or terlipressin (Glypressin) for acute variceal bleeding and combined beta-blocker and nitrate prophylaxis for prevention of rebleeding. Injection sclerotherapy is necessary to arrest acute bleeding, with variceal banding preferred for the obliteration of large varices. Transjugular intrahepatic portosystemic shunts (TIPS) are best used for uncontrolled or recurrent bleeding episodes which fail to respond to endoscopic or drug therapy. They can also rarely be used to treat refractory ascites...

Direct measurement of portal venous blood flow is technically difficult, yet crucial for accurate assessment of liver hemodynamic and metabolic functions. The aim of this investigation was to assess the feasibility of implanting transit-time ultra-sound (TTUS) perivascular flow probes on the portal vein of the rat and to validate this technique as a means of directly measuring portal blood flow in conscious rats. A TTUS flow probe was implanted on the portal veins of 10 rats. One week later, portal flow was measured under basal conditions in these rats by TTUS probes and after pharmacological manipulation of portal flow by intravenous injections of Glypressin or infusions of adenosine while the rats were conscious...

UNLABELLED: Between 1983 and 1992 altogether 638 alcoholic cirrhotic patients had been treated because of acute esophageal variceal bleeding. In 96 cases the treatment were carried out in the following circumstances; volume and coagulation factor substituate, vasopressin or glypressin and nitroglycerin, urgent endoscopy and ballontamponade but in 47 cases an urgent sclerotherapy were also performed. The survival, cases of rebleeding,-from the first bleeding events-of the 49 nonsclerosed patients were compared to those of the 47 sclerosed one...

One hundred and six episodes of bleeding from esophageal or gastric varices in 72 patients with cirrhosis of the liver were randomized to treatment either with intravenous terlipressin 2 mg initially and 1 mg every four hours for 24 hours together with bolus injection and continuous infusion of placebo, or with somatostatin 250 micrograms as a bolus and continuous infusion of 250 micrograms/h somatostatin for 24 hours and placebo injections. Standard treatment with transfusions, fluid and electrolyte correction, and lactulose was administered in both groups...

Fastidious resuscitation is essential in the initial management of acute variceal bleeding and requires adequate monitoring. Where endoscopic services are available diagnostic endoscopy should be performed ideally within 4-6 hours of admission and endoscopic therapy with injection sclerotherapy or binding ligation performed. Treatment to prevent early rebleeding will require further endoscopic treatment and possibly adjuvant vasoconstrictor therapy (somatostatin/octreotide or glypressin). Where endoscopy is unavailable vasoconstrictor therapy and/or balloon tamponade should be started prior to transfer to a centre with endoscopic facilities...

Terlipressin (Glypressin), a vasopressin analog, may be administered to patients with cirrhosis receiving a beta-adrenergic antagonist. Since terlipressin alone and beta-blockers alone both decrease portal pressure, a combination of these substances may have additional portal hypotensive effects. However, the negative side effects of terlipressin may be accentuated by long-term beta-blockade. Thus, the present study examined hemodynamic and metabolic responses to terlipressin in 12 patients receiving nonselective beta-blockers (propranolol or nadolol)...

No abstract text is available yet for this article.

A questionnaire was sent to 116 consultant gastroenterologists in Scotland and North-East England to assess their management of oesophageal variceal haemorrhage. Most respondents (58%) dealt with < 10 variceal bleeds per year. Sclerotherapy, tamponade, vasoconstrictor therapy and oesophageal transection were available to 87.5-97.5% clinicians, compared with trans-jugular intrahepatic porto-systemic shunts (TIPSS) (39.5%) and band ligation (27%). To arrest bleeding, sclerotherapy, tamponade, octreotide/somatostatin and vasopressin/glypressin were used by 75...

No abstract text is available yet for this article.

A systematic review of available treatments for controlling active variceal bleeding provides important guidelines for choosing an overall strategy. The initial prerequisite of a diagnostic endoscopy provides the opportunity for early intervention with local endoscopic techniques, such as injection sclerotherapy, direct intravariceal injection of tissue adhesives and banding ligation of varices. This approach currently represents the optimal strategy. If the endoscopic expertise is not available, the use of vasoactive drugs may provide temporary control of bleeding while allowing time for more definitive treatment...

Plasma ronidazole concentrations were examined after intravenous (i.v.) and oral administration of ronidazole in sheep (n = 6) at a dosage of 5 mg/kg body weight. In three sheep a ruminal and an abomasal fistula were inserted. The ronidazole determinations were performed by an HPLC method. Oral bioavailability in the fistulated sheep was only 5.5 +/- 1.8% (mean +/- SE). Somewhat lower values (4.6 +/- 1.4%) were obtained when the drug was administered through the ruminal fistula in the rumen. After administration of the same dose directly in the abomasum through the intraabomasal fistula, bioavailability was increased to 86...