Use of a very flexible guide wire to permit dilation of complex malignant strictures of the esophagus.

Risk of perforation is a major impediment to the use of polyvinyl bougies in palliative dilation of cancerous strictures of the esophagus. We encountered 23 patients with complex malignant strictures in whom initial dilation with Savary-Gilliard bougies was thwarted because attempts to pass a conventional Eder-Puestow guide wire were unsuccessful. As a recourse, we probed these strictures with a very flexible guide wire of the type used to implant prostheses in the biliary tract. The purpose was to establish a passage through which a standard guide wire could then be inserted. The procedure was successful in all but 4 of the 23 patients. We conclude that in such cases the preliminary use of the very flexible guide, even though time-consuming, improves the chance of effective dilation with minimal added risk.

Serum proline and blood lactate levels in alcoholic patients without hepatic failure: relationship with alcohol ingestion and histological activity.

It has not yet been established whether serum proline and blood lactate levels are increased in alcoholic liver disease. We measured serum proline and blood lactate in controls and in patients with different stages of alcoholic liver disease in the absence of hepatic failure. Samplings were done in both abstinent and drinking alcoholics. Compared to controls, there was a striking increase in serum proline levels in 52 abstinent alcoholics with little or no hepatic fibrosis by histological assessment (0.10 +/- 0.01 vs. 0.155 +/- 0.008; p less than 0.005). Blood lactate levels were within the normal range and did not correlate with serum proline levels. On the other hand, serum proline and blood lactate levels were independent of hepatic necrosis and inflammation scores. In addition, in 10 patients with blood alcohol concentrations between 0.3 mg/ml and 7.8 mg/ml, serum lactate and proline were significantly elevated (2.42 +/- 0.29 mg/ml and 0.275 +/- 0.0026 mg/ml, respectively; p less than 0.005). These results show that there is an association between serum proline levels and the abstinence period in alcoholic patients. They further suggest that in alcoholic patients neither serum proline nor blood lactate concentrations are reliable markers for liver histological activity (necrosis and inflammation) or fibrosis.

Tru-cut and Menghini needles: different yield in the histological diagnosis of liver disease.

An evaluation of the information obtained by percutaneous liver biopsy performed with Travenol Tru-cut ("Tru-cut"), Menghini's 1.9 and 1.6 needles, was done using cadavers. All needles used had a similar, low number of "failures". Recognition of diffuse liver lesions, excluding fibrosis, was very high regardless of the needle used. Identification of cirrhosis was significantly more frequent in biopsies performed with the Tru-cut needle.

Massive pleural effusions in cirrhotic patients with ascites.

A method is described based on the passage of air across the diaphragm to detect pathological diaphragmatic orifices in autopsies. This method was used in 65 post-mortem studies; orifices were detected in 7 cases. Only one of these appears histologically to be a real spontaneous orifice. This was found in the post-mortem study of a cirrhotic patient with ascites and massive and recurrent hydrothorax. In eight patients with cirrhotic ascites and pleural effusions, radioisotopes were introduced into the ascites fluid, and only in two of them, both with right massive and recurrent pleural effusion, was radioactivity detected in the pleural cavity within the 1st h after injection. The radioisotopic method for detecting in vivo these orifices avoids the repeated taps that are necessary when dyes are used.

Distribution of HLA histocompatibility antigens, ABO blood groups and Rh antigens in alcoholic liver disease.

The distribution of 16 antigens of the HLA-A and 15 antigens of the HLA-B series of HLA system, the blood groups ABO, and Rh antigens were studied in 40 alcoholics with cirrhosis, 18 alcoholics without cirrhosis, and in normal control subjects. The group of alcoholics with cirrhosis showed a significantly high frequency of HLA-B13 (corrected P less than 0.01) when compared with normal subjects, while the frequency of HLA-B13 was similar to normal in alcoholics without cirrhosis. On the basis of these findings, its seems that the carriers of HLA-B13 are more susceptible to liver damage caused by alcohol. Both groups of alcoholics and the normal controls had a similar distribution of ABO blood groups and Rh antigens.