Search

SINCE the beginning of our experience with the surgical treatment of portal hypertension, we have believed that the operation of choice is portacaval shunt and that splenorenal shunts, because they are small and so frequently inadequate, should be restricted to patients with portal veins unsuitable for anastomosis to the inferior vena cava.§ There is abundant evidence that such a procedure is followed by the disappearance of esophagogastric varices and therefore the elimination of the hazards of massive varical hemorrhage. Although this is a laudable surgical achievement, critical analysis suggests that the problem of portal hypertension is not as simple as . . .

A survey of all patients with very high serum glutamic oxalacetic transaminase activity encountered during a 30-month period at The New York Hospital revealed 17 patients with cardiac disease who had 1 or more serum glutamic oxalacetic transaminase (SGOT) determinations exceeding 500 units. None had clinical evidence of primary liver or gallbladder disease. Eleven were admitted with acute myocardial infarction, 6 with severe heart failure. All 17 developed hypotension or shock and all but 1 right heart failure prior to high SGOT activity. Several patients had abnormalities of liver function when SGOT activity was very high. In 4 there was an excessive increase in prothrombin time following administration of anticoagulants. In the 8 patients who came to autopsy there was histologic evidence of acute hepatic central necrosis. In 4 there was necrosis of both heart and liver, in 4 necrosis of liver alone. Clinical and autopsy data from a control series of patients with heart disease selected without regard for the level of SGOT activity corroborate the association between hypotension, central necrosis of the liver, and increased SGOT activity. Increase in venous pressure in the absence of hypotension was not associated with acute central necrosis or elevated SGOT activity. It is concluded that very high SGOT activity (>500 units) in patients with heart disease is at least in part caused by acute hepatic central necrosis secondary to a drop in cardiac output and reduced hepatic blood flow. Caution is urged in the interpretation of increased blood activity of intracellular enzyme systems as evidence for myocardial necrosis. Acute circulatory changes may result in hepatic necrosis and increased blood enzyme activity without myocardial infarction.

The current use of bed rest in the treatment of diseases of the liver is admittedly empiric. All observers have agreed that bed rest during the acute stage of hepatitis generally improves the immediate symptoms. Hepatic tenderness is less under conditions of rest, while increase in size and tenderness of the liver frequently occurs with ambulation. Laboratory evidence of worsening hepatic function often parallels the change in liver size and tenderness. When the resistance of the host is high, and possibly when the virus is of a low degree of virulence, no permanent deleterious effects result from relapses due to early ambulation. Recovery progresses satisfactorily despite lack of rest. However, these clinical and laboratory signs of relapse may be the first indications of a more serious progressive hepatitis. The role of bed rest has not been tested by controlled observations under such circumstances. Until studies of this nature have been made, the judicious use of bed rest in the treatment of the acute stages of hepatic disease is recommended.

Excerpt Although more than a century has passed since Virchow first described amyloidosis (1), investigation of its pathogenesis has been limited by the paucity of pathological material available d...

SummaryA method has been described for testing the endocrine function of ovarian tissue after growth in culture at 37°C or storage at 10°C. Such tissue, when transplanted into the anterior chamber of the eyes of castrate female rats, after a latent period of from 8 to 24 days, produced typical estrous type of vaginal smears which compared favorably with the effects produced by transplants made directly after the removal of the tissue from the donor animal. Ovarian tissue frozen quickly in liquid air failed to produce cornification of the vaginal epithelium.

SummaryA new method has been presented for the preparation of fat for intravenous administration. Fat prepared in this manner is in the form of a colloidal aqueous suspension with a particle size less than 250mμ.

Excerpt The high incidence of homologous serum hepatitis among youthful drug addicts has been reported by other investigators.1-7Previous studies have been concerned with the epidemiology of serum ...