Liver therapy

AUen, J.W., and Bhati, S. N., Engineering liver therapies for the future. Tissue Eng. 

Despite these failures, the need still exists for alternative liver therapies. Several new techniques including cell transplantation, tissue-engineered constructs, and extra- and paracorporeal devices seek to relieve some of the demands placed on a compromised liver. Liver assist devices allow the liver to regenerate its function by removing some of the demands. Bridge-to-transplant devices seek to maintain patients until suitable donors are available. Some therapies seek to remove toxins from the blood, and they have a place in the treatment scheme, but due to the complex and multifunctional nature of the organ, some type of cell-based therapy is considered a more complete solution. 

The treatment of Uver disease has improved greatly with the development of transplantation techniques including surgical methods and suppression of the immune response. However, few liver diseases are curable, and surgical replacement is expensive and problematic from the perspectives of both the live donor and the recipient. Because the demand for transplantable livers far outstrips availability, alternative liver therapies are critical. 

First of all, two terms need rectifying, since the superficial yet incorrect use of the designations liver therapy and protective therapy of the liver have rendered it fundamentally more difficult to make accurate statements. These terms are relics from the epochs of speculative or empirical therapy and constitute the origin of the catchword therapeutic nihilism . (s. tab. 40.1)... 

A liver-protective preparation must therefore be capable of protecting the hepatocytes (as well as the sinus endothelium) from a particular liver toxin, or from 2 or 3 clearly defined (or, in the optimal case, all obligate) liver toxins, by administration before or, at the latest, when the damage occurs. The use of a substance in existing cellular damage would be classified as therapy and no longer protection . The term protective liver therapy clearly implies prophylaxis - which, apart from the above exceptions (e. g. vaccination), is usually not feasible under the provisions of the respective health insurance system. (12)... 

Perhaps the expectations or requirements of liver therapy are too high. With regard to other organs and their respective diseases, established medication often does not really achieve a cure , but merely functional improvements (e. g. recompensation, inhibition of progression, stabilization in everyday life, improvement in quality of life, rehabilitation). In principle, these fully acceptable therapy aims apply to the treatment of liver diseases as well. 

George R. Minot, William P. Murphy, medicine. discoveries concerning liver therapy against anemias... 

AOS Bile and liver therapy AO5A Bile therapy... 

Minot, G.R., Murphy, W.P., and Stetson, R.P., 1928. The response of the reticulocytes to liver Therapy particularly in pernicious anemia. American Journal of Medical Science. 175 581-598. 

Regional liver therapies are considerably more common now than they were a decade ago. Kato et al. described in 1981 the first arterial chemoembolization with a microencapsulated anticancer drug in different organs (Kato et al. 1981). 

Seeding along the needle track with percutaneous minimally invasive tumor treatment modalities has not yet been reported in lung data for liver therapy report seeding to occur along the track in 0.7%-2.3% of hepatocellular carcinoma patients treated with PEI (ISHii et al. 1998). 

It is perhaps surprising that megaloblastic anemia does not occur more frequently after total gastrectomy (Witts, 1962). MacDonald et al. (1947) traced 46 patients who had lived for three years or more after total gastrectomy and who were not known to have received prophylactic liver therapy. Only 12 patients had anemia of a pernicious type. This had seldom developed within 2 years, and two patients survived 10 and 20 years, respectively, without anemia. Witts compares these periods with the time (2 to 38 months) taken for idiopathic pernicious anemia to relapse after cessation of liver therapy (Schwartz and Legere, 1944). He remarks that cessation of substitution therapy in established pernicious anemia thus produces a prompter and more constant effect on blood formation than does complete removal of the stomach. This is perhaps because substitution therapy in the patients with pernicious anemia had not been intensive enough to maintain normal concentrations of vitamin Bi2 in the liver and other tissues. 

The labeling technique has been used to study the life-span of erythrocytes in patients with anemias and porphyrias (343, 359). In a hemolytic anemia patient most of the labeled stercobilin was found to be excreted some 20 days after feeding of labeled glycine. In sickle cell anemia it was concluded that a random destruction of erythrocytes took place to compensate for this destruction the rate of hemoglobin formation was nearly tripled. In pernicious anemia an abnormal pattern of erythrocyte destruction was also found but the erythrocyte life-span returned to normal after liver therapy. 

In their second case, one which had previously responded well to both arsenic and liver, Cuthbertson and associates observed that on subcutaneous injection of the amino acids, the clinical condition of the patient became worse. However, after a transfusion, liver therapy produced favorable results. Although tryptophan and histidine produced an early small reticulocyte response in both cases, there was no appreciable increase in the hemoglobin or red cell levels. Thus, even though there are indications that they have some stimulating action on hematopoietic tissue, the results do not justify ascribing the activity of liver to its content of free tryptophane and histidine. Dominici and Penati (27) were also unable to confirm the favorable results of the French authors. 

Although it is not yet possible to present the properties of the anti-pernicious anemia material from liver with chemical exactness, it is, nevertheless, proper to note that during the seventeen years rince whole liver therapy has been introduced, the amount of material needed by the patient per day has decreased from 400 g. to less than 1 mg. Such progress makes it reasonable to expect the isolation and identification of the active material to be an attainable objective. 

In 1935, Fiske, SubbaRow, and Jacobson presented results which suggested that the application of liver therapy in pernicious anemia could be achieved most successfully by a combination of two or more substances... 

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