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Sildenafil does not influence hepatic venous pressure gradient in patients with cirrhosis

World Journal of Gastroenterology 2008年第40期14卷 6208-6212页

作者： Jens Otto Clemmesen Annamaria Giraldi Peter Ott kim dalhoff Bent Adel Hansen Fin Stolze Larsen Department of Hepatology RigshospitaletUniversity Hospital of Copenhagen Clinical Pharmacology RigshospitaletUniversity Hospital of Copenhagen

AIM： To investigate if sildenafil increases splanchnic blood flow and changes the hepatic venous pressure gradient （HVPG） in patients with cirrhosis. Phosphodiesterase type-5 inhibitors are valuable in the treatment of erectile dysfunction and pulmonary hypertension in patients with end-stage liver disease. However, the effect of phosphodiesterase type-5 inhibitors on splanchnic blood flow and portal hypertension remains essentially unknown. METHODS： Ten patients with biopsy proven cirrhosis （five females/five males, mean age 54：1：8 years） and an HVPG above 12 mmHg were studied after informed consent. Measurement of splanchnic blood flow and the HVPG during liver vein catheterization were done before and 80 min after oral administration of 50 mg sildenafil. Blood flow was estimated by use of indocyanine green clearance technique and Fick＇s principle, with correction for non-steady state. RESULTS： The plasma concentration of sildenafil was 222 ± 136 ng/mL 80 min after administration. Mean arterial blood pressure decreased from 77 ±7 mmHg to 66 ± 12 mmHg, P = 0.003, while the splanchnicblood flow and oxygen consumption remained unchanged at 1.14 ± 0.71 L/min and 2.3 ± 0.6 mmol/ min, respectively. Also the HVPG remained unchanged （18 ± 2 mmHg vs 16 ± 2 mmHg） with individual changes ranging from -8 mmHg to ±2 mmHg. In seven patients, HVPG decreased and in three it increased. CONCLUSION： In spite of arterial blood pressure decreases 80 min after administration of the phosphodiesterase type-5 inhibitor sildenafil, the present study could not demonstrate any clinical relevant influence on splanichnic blood flow, oxygen consumption or the HVPG.

关键词： Cirrhosis Sildenafil Portal hypertension Portal hemodynamics Hepatic blood flow Erectile dysfunction Hepatic venous pressure gradient

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The validity of medication lists in hospital files and discharge letters

The validity of medication lists in hospital files and disch...

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第十五届国际药理学大会

作者： Bente Glintborg Stig Ejdrup Andersen kim dalhoff Clinic of Internal Medicine I H: S Bispebjerg HospitalDepartment of Clinical Pharmacology Q7642 H: S RigshospitaletCopenhagenDenmark.MD Unit of Clinical Pharmacology H: S Bispebjerg Hospital.MD PhD Department of Clinical Pharmacology Q7642 H: S RigshospitaletCopenhagenDenmark.MD DMSc

＜正＞ Aim was to compare medication lists in hospital files and discharge letters with information on prescription only medication （POM） use collected during home visits among recently hospitalised patients. Patients were visited within one week after discharge from hospital and interviewed about POM use. Stored drugs were inspected. We compared drug lists in hospital files and discharge letters to the list obtained during the home visit. 83 surgical and 117 medical patients were included （median age 75 years）. 6 patients stored no POM. 194 patients stored 1189 POM. Among the 954 POM reported used at discharge 768 POM （81 % ） were registered in hospital files. Only 453 （47 % ） of used POM were registered in discharge letters. 66 POM users had no medication list in their discharge letter. 63 POM were used in obvious disagreement with prescribed regimen. Patients knew little about side effects and drug interactions. Approximately 1/5 of used POM are unknown to the hospital and half of used POM are not registered in discharge letters. Lack of communication between health care sectors may cause inappropriate drug therapy.

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