Hepatic plasmacytomas: case report and review of imaging features.

Extramedullary plasmacytomas are uncommon and have a better prognosis than disseminated myeloma. We describe the second case of hepatic plasmacytomas (multiple) following a solitary bone plasmacytoma. The imaging characteristics of the few reported cases of these rare hepatic tumours are compared. The value of ultrasound in the assessment of liver lesions is emphasized.

The Newcastle hepatitis B outbreak. Observations on cause, management and prevention.

During December 1983 and January 1984, an outbreak of hepatitis B occurred among health care workers in the Newcastle area. The probable source was the victim of a motor-bicycle accident who was incubating the illness at the time of his accident. The outbreak led to an extensive contact tracing and immunization programme and suggested that ambulance and police officers were at increased risk of contracting hepatitis B.

A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy.

The results of a prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy conducted over a 38-month period are presented. One-hundred twenty patients were randomized following variceal bleeding, 63 to esophageal variceal sclerotherapy and 57 to control. Mean follow-up was similar in both groups (esophageal variceal sclerotherapy, 12.5 +/- 8.8 months; control, 14.9 +/- 6.6 months). Twenty-one percent of the patients in each group were lost to follow-up. Esophageal variceal sclerotherapy decreased rebleeding as evidenced by a decrease in the mean bleeding risk factor, transfusion requirement and by an increase in bleeding free interval; differences between the treated and control groups in these parameters were especially significant after variceal obliteration. A high incidence of asymptomatic ulceration and low frequency of strictures were notable effects of esophageal variceal sclerotherapy. Cumulative life table analysis revealed no differences in survival between esophageal variceal sclerotherapy and control groups. However, when patients who received portal-systemic shunt surgery (esophageal variceal sclerotherapy, 6%; control, 28%) were removed from the analysis at the time the shunt surgery was performed (defining the shunt as an endpoint, a significant difference in survival (p less than 0.05, F ratios) in favor of esophageal variceal sclerotherapy was observed.

Hepatitis B markers in health care workers. The Newcastle study.

Health care workers in the Royal Newcastle Hospital, in surrounding hospitals and pathology services, and in a large mental institution were surveyed to determine the prevalence of hepatitis B markers. The aim of the study was to identify the groups of workers at particular risk of contracting hepatitis B in order to determine which workers would benefit most from a programme of vaccination against hepatitis B. Although the prevalence of hepatitis B markers in the Newcastle health care workers was higher than that in the control subjects, this rate did not approach the high rates previously reported in overseas studies.

High-density lipoprotein cholesterol and liver disease.

To establish whether there is any significant relationship between high-density lipoprotein cholesterol (HDLC) concentrations and biopsy-documented liver disease, 169 patients had needle biopsies, serum cholesterol, and HDLC evaluated. Twenty-four patients had serial cholesterol, HDLC, prothrombin, and aminotransferase levels and activities examined. In both men and women, HDLC decreased strikingly and significantly in acute alcoholic hepatitis and in acute viral hepatitis, compared to controls (p less than 0.001). Men and women with inactive alcoholic liver disease and chronic active hepatitis showed moderate decreased in HDLC (p less than 0.001). Patients with primary and metastatic hepatic neoplasms also had strikingly decreased HDLC (p less than 0.001). Serial testing showed an excellent direct correlation between HDLC and prothrombin activity, r values ranging from 0.71 to 0.98. Although alcohol intake is known to correlate positively with HDLC concentrations, our data shows that this association is not absolute, and in most cases is reversed once liver disease becomes apparent.

Urinary thromboxane B2 and prostaglandin E2 in the hepatorenal syndrome: evidence for increased vasoconstrictor and decreased vasodilator factors.

Vasodilatory prostaglandins function to maintain renal perfusion in patients with cirrhosis and ascites. To evaluate the potential contribution of the vasodilator prostaglandin E2 and the vasoconstrictor metabolite thromboxane B2 to the development of the hepatorenal syndrome, we measured urinary excretion of these products in 14 patients with hepatorenal syndrome and in control populations with acute or chronic liver or kidney failure. Radioimmunoassay measurements were confirmed by bioassay and by mass spectrometry. Prostaglandin E2 was decreased compared with healthy controls (2.2 +/- 0.3 vs. 6.3 +/- 0.8 ng/h, p less than 0.01) and compared with acute renal failure (9.6 +/- 2.1 ng/h) and with alcoholic hepatitis (9.2 +/- 3.3 ng/h). Thromboxane B2 concentration was normal in patients with alcoholic hepatitis (0.12 +/- 0.02 vs. 0.15 +/- 0.03 ng/ml) and minimally increased in acute renal failure (0.18 +/- 0.15 ng/ml), but markedly elevated in hepatorenal syndrome (0.69 +/- 0.15 ng/ml, p less than 0.001). Urinary thromboxane B2 concentration fell with improved renal function in 3 patients who survived. These data suggest an imbalance of vasodilator and vasoconstrictor metabolites of arachidonic acid in patients with the hepatorenal syndrome.

The management of ascites using the Rhodiascit Apparatus ("Paris Pump").

The Rhodiascit Apparatus ("Paris Pump") which ultrafilters sodium and water from ascitic fluid allowing reinfusion of a protein-rich concentrate, has been found to be a valuable procedure in the management of ascites associated with liver cirrhosis. The device was evaluated in eight patients with the aim of rapidly controlling ascites with minimum hospitalisation. The duration of the procedure varied from 8.5 to 55 hr (mean 27 hr) and resulted in a mean girth reduction of 13 cm (range 5.7 to 24 cm) and a mean weight loss of 13.6 kg (range 5.7 to 23 kg). Serum electrolytes and total protein were unchanged; a slight but insignificant rise in serum creatinine was observed. Three infective episodes occurred, but these were easily controlled. The procedure was, in general, well tolerated, inexpensive and allowed rapid relief of ascites with few complications.

Diffuse fasciitis with eosinophilia (Shulman's disease).

A case of diffuse fasciitis with eosinophilia (DFE, or Shulman's disease) is presented. A review of the literature of the condition is presented, and the salient features are summarized. Diagnostic criteria and the management of patients with this unusual condition are discussed.