Prompt endoscopic diagnosis of upper gastrointestinal hemorrhage: its value for specific diagnosis and management.

From July 1, 1973 to June 30, 1976 789 patients admitted as upper gastrointestinal bleeders had endoscopies performed within 24 hours after preliminary resuscitation and preparation. More than one lesion was found in approximately 45% of the patients. Erosive hemorrhagic gastritis was the most common lesion, being present in 27.3--48.2% of the subjects (the latter precentage was found in those with a history of intake of both alcohol and ulcerogenic drugs). Gastric ulcer was the next most common lesion, present in 16.3--18.42%; the higher percentage represents the patients who were taking ulcerogenic drugs. The highest incidence of gastric ulcer (19.59%) or duodenal ulcer (10.5%) was among the patients in a group who had no apparent definite cause for the bleeding. A small number of patients had rare causes for the bleeding and in only a small percentage of the patients was the cause not diagnosed. These data suggest that early endoscopy is of diagnostic value in upper G.I. bleeders leading to prompt, lifesaving management and prevention of prolonged morbidity.

Congestive heart failure as cause of fulminant hepatic failure.

In this patient with long-standing cardiomyopathy and congestive heart failure the syndrome of fulminant hepatic failure developed on two occasions; he recovered both times. There was no evidence of viral or toxic hepatitis as a cause of his liver failure. We conclude that in this case, aggravation of long-standing congestive heart failure may have led to severe hepatocellular necrosis with signs of encephalopathy not commonly observed.

Immunoglobulins in submassive hepatic necrosis.

The presence of submassive hepatic necrosis in acute liver injury of viral or toxic etiology in liver biopsy specimens is of great diagnostic and prognostic significance. Liver biopsy, however, cannot be performed in some of these patients due to an abnormal coagulation profile. Hence, other noninvasive methods for diagnosis of submassive hepatic necrosis would be helpful. We compared the serum immunoglobulin-G levels in 15 patients with typical acute viral hepatitis and 19 patients with severe acute viral hepatitis with submassive hepatic necrosis. The difference of the Ig-G levels in both groups was statistically significant. By using discriminant analysis we found that it was possible to make the correct diagnosis of submassive hepatic necrosis in 89.5% of patients with acute viral hepatitis when only Ig-G levels were utilized.

The asymptomatic HB6-Ag carrier: auto- and heterologous perils.

The asympatomatic carrier--usually discovered on offering to be a blood donor--presents a complex health problem which to date has received only "guarded" attention. These carriers may be dangerous, because they can transmit the HBs-Ag not only by parenteral but also by "nonparenteral" means, due to its presence in urine, feces, saliva, tears, semen, vaginal discharge, menstrual flow, breast milk, joint, ascitic and cerebrospinal fluids. The transmission by sexual contact is well established. Inapparent transmission may also occur from insufficient sterilization of instruments, by tatooing, ear piercing, by barbers, manicurists, dentists and by mosquitoes and bedbugs. Some of the characteristics of an asymptomatic HBs-Ag carrier seem to be: a young male, most often black, from a poor social and hygienic environment with a possible gene dependent immune deficiency state. Our experiences suggest that all newly admitted patients to the hospital personnel should have determinations of the presence of HBs-Ag in their blood, so that adequate steps can be taken to protect their contacts from infection.

Hepatocellular carcinoma: relation to alcohol, HB-antigen and alpha-fetoprotein.

Thirteen of 16 patients with primary cancer of the liver were heavy alcoholics. Fifty per cent of them had positive alpha-fetoprotein and 25% had HB-Ag in their blood. The association of alcoholism with cancer of the liver is thus very striking and hence alcohol should be proclaimed as a carcinogenic substance.