Abstract
[13N] Ammonia produced by the cyclotron was instilled intrarectally in patients with cirrhosis and other liver diseases to study the turnover of rectally absorbed [13N] ammonia. A positron camera connected to an on-line computer system was used for the measurement of sequential changes of13N activity in blood and for coincidence positron imaging of the liver and heart.13N activity over the head was also recorded. Chromatographic analysis of13N-labeled substances in blood was carried out using a Dowex 50Wx8 column at varying times after the administration. In the control, [13N] ammonia was absorbed quickly and visualized the liver, whereas in patients with cirrhosis, the lungs and heart were first visualized, and13N activity over the head was also higher. It was suggested that a large proportion of absorbed [13N] ammonia bypassed hepatocytes and reached peripheral tissues in cirrhosis. The heart/liver ratio of13N and13N over the head were correlated with various indices of portal hypertension. The relative proportion of nonammonia13N metabolites in blood was lower at 5 and 15 min after administration in cirrhosis, suggesting a reduced capacity of the liver to remove and metabolize ammonia.
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Summerskill WHJ, Wolpert E: Ammonia metabolism in the gut. Am J Clin Nutr 23:633–639, 1970
Shaldon S, Chiandussi L, Guevara L, Caesar J, Sherlock S: The estimation of hepatic blood flow and intrahepatic shunted blood flow by colloidal heat denatured human serum albumin labelled with131I. J Clin Invest 40:1346–1354, 1961
McDermott WV Jr, Adams RD: Episodic stupor associated with an Eck fistula in the human with particular reference to the metabolism of ammonia. J Clin Invest 33:1–9, 1954
Breen KJ, Schenker S: Hepatic coma: Present concepts of pathogenesis and therapy.In Progress in Liver Diseases, H Popper, F Schaffner (eds). New York, Grune & Stratton, 1972, pp 301–312
Turner MD, Sherlock S, Steiner RE: Intrasplenic pressure measurement and splenic venography in the clinical investigation of the portal circulation. Am J Med 23:846–859, 1957
Gonzeles Calbalhaes O: Hepatoportografia por via umbilical. Rev Sanid Mil 12:42–48, 1959
Lunderquist A, Vang J: Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varice. N Engl J Med 291:646–649 1974
Okuda K, Suzuki K, Musha H, Arimizu N: Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. Gastroenterology 73:279–284, 1977
Kashiwagi T, Kameda T, Abe H: Dynamic studies on the portal hemodynamics by scintiphotosplenoportography: the visualization of portal venous system using99mT. Gastroenterology 67:668–673, 1974
Deterling RA, Powers SR, Bhonslay SB: The use of radioactive sodium in the evaluation of patency of portacaval shunts. Surg Forum 5:193–200, 1954
Castell DO, Grace ND, Wennar MH, Chalmers TC, Moore EW: Evaluation of portal circulation in hepatic cirrhosis. Gastroenterology 57:533–541, 1969
Triger DR, Boyer TD, Redeker AG, Reynolds TB, Waxman AD: Differences in intrahepatic portal-systemic shunting in alcoholic and nonalcoholic liver disease as assessed by liver scan, portal pressure, andE. coli antibodies. Dig Dis Sci 24:509–513, 1979
Gelbard AS, Clarke LP, McDonald JM, Monahan WG, Tilbury RS, Kuo TYT, Laughlin JS: Enzymatic synthesis and organ distribution studies with13N-labeledl-glutamine andl-glutamic acid. Radiology 116:127–132, 1975
Tomitani T, Tanaka E, Nohara N: A positron camera by use of a focal detector of hexagonal multi-crystal array. Radio-isotopes 25:693–697, 1976
Wolpert E, Phillips SF, Summerskill WHJ: Ammonia production in the human colon. N Engl J Med 283:159–164, 1970
Dienst SG: An ion exchange method for plasma ammonia concentration. J Lab Clin Med 58:149–155, 1961
Moore S, Stein WH: Procedures for the chromatographic determination of amino acids on four percent cross-linked sulfonated polystyrene resins. J Biol Chem 211:893–906, 1954
Traeger HS, Gabuzda FJ Jr, Ballou AN, Davidson CS: Blood ammonia concentration in liver diseases and liver coma. Metabolism 3:99–109, 1954
Kirk E: Amino acid and ammonia metabolism in liver disease. Acta Med Scand (Suppl) 77:1–147, 1936
Phillips GB, Schwartz R, Gabuzda GJ, Davidson CS: The syndrome of impending hepatic coma in patients with cirrhosis of the liver given certain nitrogenous substances. N Engl J Med 247:239–246, 1952
Conn HO: Ammonia tolerance in the diagnosis of esophageal varices. A comparison of endoscopic, radiologic, and biochemical techniques. J Lab Clin Med 70:442–451, 1967
Castell DO: The ammonia tolerance test: An index of portal hypertension. Gastroenterology 49:539–543, 1965
Conn HO: Ammonia tolerance in assessing the patency of portacaval anastomoses. Arch Intern Med 13:221–226, 1973
Price JB, McCullough W, Peterson L, Britton RC, Voorhees AB: Determination of ammonia tolerance in animals with and without portal systemic shunting. Surgery 60:701–709, 1966
White LP, Phear AE, Summerskill WHJ, Sherlock S: Ammonia tolerance in liver diseases. Observations based on catheterization of the hepatic veins. J Clin Invest 34:158–168, 1955
Harper PV, Lathrop DA, Krizek H, Lembares N, Stark V, Hoffer PB: Clinical feasibility of myocardial imaging with13NH3 J Nucl Med 13:278–280, 1972
Walsh WF, Harper PV, Resnekov L, Fill H: Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13-labelled ammonia. Circulation 54:266–275, 1976
Hazenberg HJA, Gips CH, Beekhuis H, Vaalburg W: Rectal administration of13N-ammonia in cirrhosis of the liver. Acta Hepato-Gastroenterol 23:308–318, 1976
Hazenberg HJA, Gips CH, Beekhuis H, Kruizinga K: Rectal13N-ammonia test (13N-liver/heart ratio), hepatic sinusoidal pressure and prevailing portal flow direction in cirrhosis of the liver. Acta Hepato-Gastroenterol 23:319–327, 1976
Walsh WF, Fill HR, Harper PV: Nitrogen-13-labelled ammonia for myocardial imaging. Semin Nucl Med 7:59–66, 1977
Hoop B Jr, Smith TW, Burnham CA, Correll JE, Brownell GL, Sanders CA: Myocardial imaging with13NH3 and a multicrystal positron camera. J Nucl Med 14:181–183, 1973
Harper PV, Schwartz J, Beck RN, Lathrop KA, Lembares N, Krizek H, Hloria I, Dinwoodie R, Mclaughlin A, Stark V, Bekerman C, Hoffer PB, Gottschalk A, Resnekov L, Al-Sadir J, Mayorga A, Brooks HL: Clinical myocardial imaging with nitrogen-13-ammonia. Radiology 108:613–617, 1973
Carter CC, Lifton JF, Welch MJ: Organ uptake and blood pH and concentration effects of ammonia in dogs determined with ammonia labelled with 10 minute half lived nitrogen-13. Neurology 23:204–213, 1973
Monahan WG, Tilbury RS, Laughlin JS: Uptake of13N-labelled ammonia. J Nucl Med 13:274–277, 1972
Phelps ME, Hoffman EJ, Coleman RE, Welch MJ, Raichle MZ: Tomographic images of blood pool and perfusion in brain and heart. J Nucl Med 17:603–612, 1976
Lockwood AH, McDonald JN, Reiman RE, Gelbard AS, Laughlin JS, Duffy TE, Plum F: The dynamics of ammonia metabolism in man. J Clin Invest 63:449–460, 1979
Rodwell VM: Protein and amino acid metabolism.In Review of Physiological Chemistry, 16th ed., HA Harper (ed). Los Altos, Lange Med Publications, 1977, pp 337–368
Chamalau RAFM, Tager JM: Nitrogen metabolism in the perfused rat liver. Biochim Biophys Acta 222:109–118, 1970
Davidson S, Sonnenblick EH: Glutamine production by the isolated perfused rat heart during ammonium chloride perfusion. Cardiovasc. Res 9:295–301, 1975
Bessman SP, Bessman AN: The cerebral and peripheral uptake of ammonia in liver disease with an hypothesis for the mechanisms of hepatic coma. J Clin Invest 34:622–628, 1955
Bessman SP, Bradley JE: Uptake of ammonia by muscle: Its implications in ammoniagenic coma. N Engl J Med 253: 1143–1147, 1955
Egense J: Ammonium tolerance test. A diagnostic aid in liver disease. Acta Med Scand 167:53–59, 1960
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Koen, H., Okuda, K., Musha, H. et al. A dynamic study of rectally absorbed ammonia in liver cirrhosis using [13N] ammonia and a positron camera. Digest Dis Sci 25, 842–848 (1980). https://doi.org/10.1007/BF01338526
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DOI: https://doi.org/10.1007/BF01338526