The extent of the collateral circulation influences the postprandial increase in portal pressure in patients with cirrhosis.

Background: In cirrhosis, repeated flares of portal pressure and collateral blood flow provoked by postprandial hyperaemia may contribute to variceal dilation and rupture. Aim: To examine the effect of the extent of the collateral circulation on the postprandial increase in portal pressure observed in cirrhosis. Patients and methods: The hepatic venous pressure gradient (HVPG), hepatic blood flow and azygos blood flow were measured in 64 patients with cirrhosis before and after a standard liquid meal. Results: Peak increases in HVPG (median+14.9%), hepatic blood flow (median+25.4%), and azygos blood flow (median+32.2%) occurred at 30 min after the meal. Compared with patients with marked postprandial increase in HVPG (above the median, n¿=¿32), those showing mild (<15%, n¿=¿32) increase in HVPG had a higher baseline azygos flow (p<0.01) and underwent a greater postprandial increase in azygos flow (p<0.02). Hepatic blood flow increased similarly in both groups. Postprandial increases in HVPG were inversely correlated (p<0.001) with both baseline azygos flow (r¿=¿¿0.69) and its postprandial increase (r¿=¿¿0.72). Food intake increased nitric oxide products in the azygos (p<0.01), but not in the hepatic vein. Large varices (p<0.01) and previous variceal bleeding (p<0.001) were more frequent in patients with mild increase in HVPG. Conclusions: Postprandial hyperaemia simultaneously increases HVPG and collateral flow. The extent of the collateral circulation determines the HVPG response to food intake. Patients with extensive collateralisation show less pronounced postprandial increases in HVPG, but associated with marked flares in collateral flow. Collateral vessels preserve their ability to dilate in response to increased blood flow.

Report on a special investigation of the University of Iowa Hospital and Clinics, Department of Orthopaedics and Rehabilitation, for the period December 1, 2002 through January 31, 2012

Report on a special investigation of the University of Iowa Hospital and Clinics, Department of Orthopaedics and Rehabilitation, for the period December 1, 2002 through January 31, 2012

Report on the Hamilton County Sheriff’s Office for the period July 1, 2008 through June 30, 2012

Report on the Hamilton County Sheriff’s Office for the period July 1, 2008 through June 30, 2012

The effect of a period of intense exercise on the marker approach to detect growth hormone doping in sports.

The major objective of this study was to investigate the effects of several days of intense exercise on the growth hormone marker approach to detect doping with human growth hormone (hGH). In addition we investigated the effect of changes in plasma volume on the test. Fifteen male athletes performed a simulated nine-day cycling stage race. Blood samples were collected twice daily over a period of 15 days (stage race + three days before and after). Plasma volumes were estimated by the optimized CO Rebreathing method. IGF-1 and P-III-NP were analyzed by Siemens Immulite and Cisbio Assays, respectively. All measured GH 2000 scores were far below the published decision limits for an adverse analytical finding. The period of exercise did not increase the GH-scores; however the accompanying effect of the increase in Plasma Volume yielded in essentially lower GH-scores. We could demonstrate that a period of heavy, long-term exercise with changes in plasma volume does not interfere with the decision limits for an adverse analytical finding. Copyright © 2014 John Wiley & Sons, Ltd.

Report on a special investigation of the Southwest Iowa Transit Agency for the period July 1, 2011 through June 30, 2012

Report on a special investigation of the Southwest Iowa Transit Agency for the period July 1, 2011 through June 30, 2012

Report on a review of selected general and application controls over the Iowa State University of Science and Technology Room and Board System for the period of April 9, 2012 through May 1, 2012

Report on a review of selected general and application controls over the Iowa State University of Science and Technology Room and Board System for the period of April 9, 2012 through May 1, 2012

Report on a review of selected general and application controls over the University of Iowa Hospitals and Clinics’ GE Centricity System for the period May 28, 2012 through July 30, 2012

Report on a review of selected general and application controls over the University of Iowa Hospitals and Clinics’ GE Centricity System for the period May 28, 2012 through July 30, 2012

Report on a special investigation of the City of Buffalo for the period September 25, 2008 through September 30, 2010

Report on a special investigation of the City of Buffalo for the period September 25, 2008 through September 30, 2010

Report on a special investigation of the Adair County Engineer’s Office for the period December 5, 2001 through December 31, 2011

Report on a special investigation of the Adair County Engineer’s Office for the period December 5, 2001 through December 31, 2011

Report on a review of certain Unemployment Insurance payments made by Iowa Workforce Development during the period January 1, 2006 through March 15, 2011

Report on a review of certain Unemployment Insurance payments made by Iowa Workforce Development during the period January 1, 2006 through March 15, 2011

Report on a special investigation of the City of Masonville for the period of March 18, 2002 to November 30, 2011

Report on a special investigation of the City of Masonville for the period of March 18, 2002 to November 30, 2011

Report on a special investigation of the Coggon Municipal Light Plant for the period July 1, 2004 through August 27, 2012

Report on a special investigation of the Coggon Municipal Light Plant for the period July 1, 2004 through August 27, 2012

Report on the IowaCare program administered by the Iowa Medicaid Enterprise, a division of the Department of Human Services, for the period July 1, 2009 through June 30, 2012

Report on the IowaCare program administered by the Iowa Medicaid Enterprise, a division of the Department of Human Services, for the period July 1, 2009 through June 30, 2012

Report on a special investigation of the City of Stockport for the period July 1, 2007 through October 31, 2011

Report on a special investigation of the City of Stockport for the period July 1, 2007 through October 31, 2011

Report on a special investigation of the City of Muscatine for the period July 1, 2008 through March 8, 2012

Report on a special investigation of the City of Muscatine for the period July 1, 2008 through March 8, 2012