Dynamics of albumin in plasma and ascitic fluid in patients with cirrhosis.

BACKGROUND/AIMS: To determine dynamics of albumin in plasma and ascitic fluid of patients with cirrhosis. METHODS: Forty-seven patients were classified in four groups: I--patients without fluid retention; II--patients with ascites not resistant to subsequent diuretic treatment; III--recompensated patients during diuretic treatment; and IV--patients with diuretic-resistant ascites. Transvascular and transperitoneal albumin transports were quantified by 131I-/125I-labelled human albumin. RESULTS: TER(P) (i.e. the fraction of intravascular albumin (IVM) passing from plasma into the interstitial space per hour) was increased in all groups. In group IV patients the transport rate of albumin from plasma into the ascitic fluid (TER(PA)) was significantly higher than the transport rate from the ascitic fluid back into the plasma: TER(AP) (0.45 vs. 0.26% IVM/h, P < 0.002). In group II patients TER(PA) was similar to TER(AP) (0.27 vs. 0.25% IVM/h, ns). A direct correlation was found between TER(PA) and TER(AP) in both groups of patients (r = 0.78, P < 0.001). CONCLUSION: In non-resistant ascites, there is a steady state between the transport of albumin into the peritoneal cavity and back into the plasma, but in resistant ascites the former transport is elevated. Thus, local factors may be important to treatment of ascites.

[Cimetidine treatment of stomach cancer]. / Cimetidinbehandling ved cancer ventriculi.

The effect of cimetidine treatment in cancer of the stomach was investigated in a double-blind, multicentre study comprising eight departments in Greater Copenhagen. Immediately after operation (or the decision not to operate) 181 patients were subdivided at random to treatment with a placebo or cimetidine in a dosage of 400 mg twice daily for two years or until death. Compliance control was carried out every third month. The mean survival in the cimetidine group (450 days, 1-1,826) was significantly longer (p = 0.02) than in the placebo group (316 days, 1-1,653).

Effect of cimetidine on survival after gastric cancer.

The effect of cimetidine on survival was investigated in 181 patients with gastric cancer. Immediately after operation or the decision not to operate, the patients were randomised in double-blind fashion to placebo or cimetidine 400 mg twice daily for two years or until death, with review every three months. Median survival in the cimetidine group was 450 days (range 1-1826) and in the placebo group 316 days (1-1653). The relative survival rates (cimetidine/placebo) were 45%/28% at 1 year, 22%/13% at 2 years, 13%/7% at 3 years, 9%/3% at 4 years, and 2%/0% at 5 years. Survival in the cimetidine group was significantly longer than in the placebo group.

Temporal responses of cutaneous blood flow and plasma catecholamine concentrations to histamine H1- or H2-receptor stimulation in man.

We have studied the effect of histamine and H1- or H2-receptor antagonists on cutaneous blood flow and catecholamine release in man. Histamine was infused alone or in combination with mepyramine, an H1-antagonist or cimetidine, an H2-antagonist for 2 h. Cutaneous blood flow was measured continuously with a laser Doppler flowmeter, and noradrenaline and adrenaline concentrations were determined in blood samples drawn every 15 min. The infusion of histamine caused an immediate and sustained vasodilatation. The Concomitant infusion of mepyramine prevented the immediate vasodilatation, but had no effect on the sustained response. The Concomitant infusion of cimetidine was without effect on the immediate vasodilatation, but abolished the sustained response. Infusion of the antagonists alone had no effect on cutaneous blood flow. Histamine caused a rapid and sustained increase in plasma noradrenaline, while the increase during concomitant H1-receptor blockade was delayed but achieved the level observed during the histamine infusion. The response to histamine during H2-receptor blockade was small and transient. The rise in plasma adrenaline was not significant. These findings suggest that histamine causes an immediate cutaneous vasodilatation through H1-receptors and a more sustained response through H2-receptors. The vasodilatation is accompanied by an increase in plasma catecholamine concentrations. Despite the continuous infusion of histamine, blood flow decreased during the last hour of histamine infusion, while the plasma noradrenaline concentration was still elevated.

Changes in T-lymphocyte subsets after elective surgery.

In seven patients undergoing elective cholecystectomy or vagotomy, helper and suppressor/cytotoxic T-cells were quantified by use of monoclonal antibodies (OKT) preoperatively and on postoperative days 2 and 7. The total number and percentage distribution of T-cells (OKT 3) did not change significantly in the study period and the total number of helper T-cells (OKT 4) was similar in the three tests, but the number of suppressor/cytotoxic T-cells (OKT 8) on postoperative days 2 and 7 showed significant rise from the preoperative value. Consequently, significant decrease in OKT 4/8 ratio was found 2 days (1.47 +/- 0.23) and 7 days (1.80 +/- 0.28) postoperatively, as compared with the preoperative ratio (2.85 +/- 0.44). Since reduced ratio of OKT 4/8 has been shown in disorders associated with diminished immunocompetence, our findings may be related to the increased susceptibility to bacterial infections seen in post-surgery patients.

Effect of soya bean oil on symptoms, gastric emptying and gut hormone release in patients with postvagotomy symptoms.

In a preliminary study the effect of an aperitif of a stable fat emulsion on symptoms, gastric emptying of a hypertonic glucose meal and associated release of insulin, neurotensin, enteroglucagon, gastric inhibitory polypeptide (GIP) and vasoactive intestinal polypeptide (VIP) was evaluated in 9 patients with postprandial gastrointestinal discomfort after vagotomy. In each patient gastric emptying of the glucose meal was measured twice: 20 min after intake of distilled water and after fat emulsion. On both occasions neurotensin, enteroglucagon and GIP rose significantly from fasting values. In contrast to distilled water, the fat emulsion was able to significantly activate the release of the hormones before ingestion of the glucose meal. All the patients had a rapid emptying of the glucose meal after distilled water and they experienced symptoms that corresponded with the nature of their spontaneous symptoms after ordinary meals. The fat emulsion reduced the early emptying of the meal and relieved the symptoms of the dumping patients, whereas gastric emptying and symptoms were variable in the patients with diarrhoea and other postvagotomy symptoms. The intake of an aperitif of soya bean oil seems to be an effective treatment only in patients with the dumping syndrome.

Peritonitis due to genital tuberculosis.

A case of genital tuberculosis is presented. The diagnosis was made by laparotomy and histological examination of biopsies from peritoneum and the Fallopian tube. The literature is reviewed and the diagnostic approach and treatment discussed.

Mammography is an objective diagnostic method.

Six hundred mammograms from 307 consecutive symptomatic patients with a firm retrospective diagnosis were evaluated blindly and independently by two observers. Each observer identified 43 of 47 tumors (91 per cent) with predictive values of 0.63 and 0.68, respectively, for the positive statement, and 0.98 for the negative statement. The overall interobserver agreement with respect to malignancy was 94 per cent (Kappa 0.84) and concerning the diagnosis of simple cysts 91 per cent (Kappa 0.60). The frequency of subclinical cancer demonstrated by mammography in this material was higher than the prevalence of mammary carcinoma found by screening of risk group populations. Thus, mammography remains an objective and reproducible diagnostic method with distinct complementary value to clinical examination. By utilizing certain mammographic criteria for benign lesions it may be possible to reduce the number of biopsies presently performed on the basis of unspecific palpatory findings.

Primary colon-type adenocarcinoma of the appendix.

A woman, 32 years of age, was admitted with classical symptoms of acute appendicitis. Peroperative findings were typical of the condition. Histology revealed a colloid adenocarcinoma of colon-type, penetrating all layers. A secondary hemicolectomy was performed. One month previously the patient had undergone a conization of the uterine cervix on account of a cancer in situ. The age, sex, and the histological findings, altogether, make this case an extremely rare one. The literature has been perused, and it is concluded that hemicolectomy should still be considered the correct treatment for carcinoma of the appendix. The necessity of all specimens removed by surgery being sent for histological examination is emphasized.

Mammography directed wire marking of nonpalpable breast lesions. A consecutive biopsy study of 100 patients.

Among 665 patients referred for breast complaints, 100 women (15%) had mammographically detected nonpalpable lesions suspected of malignancy. Using a mammography directed hook wire marking, 115 excisional biopsies were carried out. A correct biopsy containing the lesion was obtained in 113 instances. There were 2 failures, due to displacements of the wire in one case and surgical inexperience in another case. Two patients had minor wound complications. Invasive carcinoma was found in 12 and carcinoma in situ in 4 biopsies, i.e., a cancer rate of 16% of patients and 14% of biopsies. The biopsy procedure was simple, time saving, and acceptable of patients. The excisions were small and the cosmetic results excellent. During mammography for control of wire position, and during dressing and surgical manipulations the flexible hooked wire remained as originally placed in all cases but one.

Reliability of axillary lymph node scintiphotography in suspected carcinoma of the breast.

The ability of axillary lymph nodes to take up 99Tcm-labelled antimony sulphide colloid in suspected carcinoma of the breast was investigated in 111 consecutive patients. Eight out of 17 patients with histologically confirmed carcinoma of the breast had a low colloid uptake on the affected side, i.e. a positive scintiphoto. Eighty-two out of 94 patients with benign breast disease had an equal colloid uptake on the two sides or increased uptake on the symptomatic side, i.e. a negative scintiphoto. The reliability of the test is low and the test can neither be recommended for screening to select patients for further investigations nor as a routine examination.

Experience with the deltopectoral flap.

One hundred and three non-delayed deltopectoral flaps were used for head and neck reconstruction in 86 patients. A retrospective analysis to detect factors with negative influence on the reconstruction resulted in two significant risk factors (p less than 0.05): irradiated recipient site and internal location of recipient site. The flap failure rate was not significantly affected by variations in flap length, age, sex or concomitant diseases. The mean stay in hospital was 10 weeks and was significantly prolonged for patients having had radiotherapy, internal reconstructions or flap failure (p less than 0.05).

Hemobilia in haemochromatosis--localized by 99mTechnetium-albumin scintiphotography.

Hemobilia in a patient with haemochromatosis is reported. Preoperatively the bleeding was localized with abdominal scintiphotography after I.V. injection of 99mTechnetium-labelled albumin. The bleeding was ascribed to rupture of a varicose vein into the gallbladder.