ABSTRACT
In a prospective, randomized, double-blind study of prednisolone therapy of acute alcoholic hepatitis, 39% of the total group of 28 patients died. Mortality and cumulative survival were similar in steroid- and placebo-treated patients. After 14 days of therapy, the serum albumin concentration and white blood count were significantly higher in the steroid group, but all other parameters were similar. An increased risk of fungal infection appeared to be associated with steroid therapy.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Alcoholism/complications , Hepatitis/drug therapy , Acute Disease , Alkaline Phosphatase/blood , Aspartate Aminotransferases/blood , Bilirubin/blood , Clinical Trials as Topic , Connecticut , Double-Blind Method , Hepatic Encephalopathy/complications , Hepatitis/etiology , Hepatitis/mortality , Humans , Leukocyte Count , Liver Function Tests , Male , Middle Aged , Mycoses/complications , Placebos , Prednisolone/adverse effects , Prednisolone/therapeutic use , Prospective Studies , Serum Albumin/metabolismABSTRACT
Intraarterial vasopressin has been reported to be effective in the treatment of massive upper gastrointestinal hemorrhage. A prospective, controlled clinical trial comparing conventional treatment with conventional therapy plus intraarterial vasopressin was undertaken. Sixty episodes of upper gastrointestinal hemorrhage were evaluated during a 40-month period; 32 received conventional and 28 conventional plus vasopressin therapy. The two groups of patients were similar in type and severity of their bleeding lesions and in their underlying diseases. Vasopressin was more effective in controlling hemorrhage from nonvariceal lesions (P less than 0.05) and from varices (P less than 0.01) than conventional therapy. Transfusion requirements were significantly reduced in those patients who received vasopressin. Paradoxically, survival was not affected by vasopressin administration. The failure of cessation of hemorrhage to improve survival is thought to be due to the degree of advancement of the underlying disease, to the torrential nature of the hemorrhage, to the frequency of recurrent hemorrhage, and to the use of intraarterial vasopressin in some patients in the conventional treatment group in whom conventional therapy had failed.
