[Surgical risks for cirrhotic patients]. / Il rischio chirurgico nel paziente cirrotico.

Evaluation of the surgical risk in cirrhotic patients undergoing emergency operations must take into account potential anesthesia-related problems, the specific type of operation, and altered liver function. Therefore, (a) the generic surgical risk, (b) the specific surgical risk and (c) the anesthetic risk, must be distinguished. The factors which affect the generic risk are the conditions which can worsen pre-existing liver failure (e.g. cardiopulmonary disease, area of surgical intervention, stage of liver cirrhosis). Splanchnic reflexes as well as lower venous return to the heart are the potential factors which may lead to reduced hepatic blood perfusion and, therefore, represent the specific surgical risk. The anesthetic risk is due to negative interference with the splanchnic circulation by both artificial ventilation and direct pharmacologic vasoconstrictor effects. Finally, the possibility that the patient is positive for HBV or HIV markers must be considered in order to carry out the necessary measures to avoid direct contact with the blood.

Comparative analysis of torasemide and furosemide in liver cirrhosis.

This review concerns studies of the comparative efficacy and safety of torasemide and furosemide in patients with cirrhosis of the liver complicated by ascites and oedema. The short-term trials reviewed indicated that in patients who had failed to respond with adequate diuresis and loss of body weight and ascites to bed rest, restricted salt and water intake and spironolactone, torasemide had a longer duration of action than furosemide and resulted in a greater urinary excretion of salt and water and greater loss of body weight. Torasemide also had less effect than furosemide on urinary potassium excretion and unlike furosemide did not increase the fractional excretion of magnesium or phosphate or the blood ammonia concentration. Two longer term trials in similar patients with decompensated hepatic cirrhosis confirm the results of the shorter term studies. These studies, albeit each in relatively small numbers of patients, confirm the ability of torasemide to enhance diuresis, free water clearance and fractional excretion of sodium and chloride, resulting in loss of body weight and mobilization of ascites in patients with decompensated hepatic cirrhosis. In these patients, the relatively small increase in urinary excretion of potassium, induced by torasemide without any marked effect on renal function or on the plasma neurohormonal profile, enhances its potential safety.

[Acid-base modifications induced by treatment with concentration-reinfusion of ascitis fluid in cyrrhosis (author's transl)]. / Modificazioni dell'equilibrio acido-base indotte dal trattamento di estrazione-concentrazione-reinfusione del liquido ascitico nella cirrosi epatica

In 9 cyrrhotic patients with ascites we have studied the acid base status and the renal acidogenic capacity (urinary titrable acidity, ammonia) before, during and after reinfusion of concentrated ascitic fluid. Acid-base parameters have been evaluated also in the ascitic fluid and in the concentrated reinfusion fluid. The treatment does not determine any significant variation of acid base equilibrium in the cyrrhotic patients, while there is a remarkable loosing of CO2 with lowering of pCO2 in the concentrated ascitic fluid. We discuss the main physiopathological factors involved in such a type of treatment.