GR Group Research Articles

Is early response to portoenterostomy predictive of long-term outcome for patients with biliary atresia?

Purpose: Therapy for biliary atresia (BA) typically involves portoenterostomy (PE). In light of the development of liver transplantation (LT) as an option for therapy in infancy, the authors reviewed their experience to determine factors that might predict the requirement for LT. Methods: Cases of BA diagnosed between September 1980 and September 1994 were reviewed. Responses to PE were rated as poor (PR; death or LT by 3 years), temporary (TR; LT > 3 years), or good (GR; anicteric). Results: Twenty-nine patients were identified; 24% were native indian or inuit. Twenty-three had PE; 11 responded. Seven (32%) became anicteric and continue to do well (GR). Four (18%) required LT after age 3 (TR). Twelve patients had PR; 3 underwent LT (average age, 1.3 years), 4 are listed for LTX, and 5 died by age 2.8 years. (Six patients did not have PE; 2 died in infancy and 4 had LT.) All transplant recipients are well. Factors associated with PR were older age at time of surgery (67 ± 7 days v 51 ± 4 days in the GR group), nadir of AST (273 ± 84 U/L v 70 ± 26 U/L in the GR group), and number of post-PE complications (3.6 v per patient v 1 per patient in the GR group). TR was differentiated from GR by bilirubin nadir (46 ± 10 μmol/L v 14 ± 3 μmol/L, respectively) and rate of bilirubin decline (2.6 ± 1.5 μmol/L/d v 10.8 ± 3.0 μmol/L/d, respectively). ( P < .05 for all comparisons.) Conclusion: Outcomes are comparable to those of North American series, but the incidence is lower overall and is higher among natives. Factors that correlate with outcome include age at time of surgery, post-PE complications, postoperative decline and rate of decline of bilirubin and AST. The latter had not been reported previously and may prove useful in planning therapy for partial responders after PE.

Cellular Development of Skeletal Muscle during Early Periods of Nutritional Restriction and Subsequent Rehabilitation

Summary: This study was designed to examine the effects of early periods of nutritional restrictions on the cellular growth potential of skeletal muscle. Skeletal muscle growth and cell development of male Sprague-Dawley rats were examined at 25 and 100 days of age in controls (c) and three treatment groups. Each of the three treatments consisted of a 50% restriction of food intake for 21 days through gestation (GR), lactation (LR), and an early postweanling period (PWR, 25–46 days of age). At the conclusion of the restrictions, body weights of the GR, LR, and PWR groups were 85, 42, and 59% of the weights of their respective age controls. Rehabilitation to 100 days of age enabled the GR, LR, and PWR groups to achieve, respectively, 93, 86, and 93% of the control group body weight. At 25 and 100 days of age, muscle weights, muscle fiber number, mean fiber diameter, DNA content, and protein content were determined in the soleus and extensor digitorum longus (EDL) muscles. Soleus and EDL muscle weights, DNA contents, and protein contents from the GR and LR groups were significantly less than C group values at 25 days, and the LR group values were significantly less than those from the GR group. When expressed as % of control values at 100 days, muscle weights and DNA contents were respectively: GR soleus 91%, 92%; GR EDL 87%, 89%; LR soleus 84%, 86%; LR EDL 89%, 80%; PWR soleus 87%, 83%; and PWR EDL 94%, 91%. Soleus and EDL muscle fiber numbers were unchanged by the gestational, lactational, and postweanling restrictions at both 25 and 100 days; however, an age-related decrease in fiber number occurred in both muscles for all groups. Reduction in muscle weights resulted from changes in muscle fiber size rather than fiber number. The ability of muscles to recover from a nutritional restriction appears to directly relate to the ability to achieve a normal complement of muscle nuclei (DNA).