Long term results (greater than 5 years) in patients with peritoneovenous shunting for intractable ascites: liver function and cancer mortality

This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted.

Comparison of two sucralfate dosages presented in tablet form in duodenal ulcer healing

Two hundred twenty-two patients with endoscopically proven duodenal ulcers participated in a controlled trial to assess and compare the effects of two dosage regimens of sucralfate tablets on ulcer healing, i.e., 1 g four times daily (group A, n = 131) and 2 g twice daily (group B, n = 128). Healing was defined as complete re-epithelialization. Clinical and endoscopic assessments were performed after four weeks (Day 28) and, if complete healing was not achieved, after four more weeks (Day 56). After four weeks, in group A (n = 114: eight patients were lost and nine were withdrawn), the ulcers had healed in 90 patients (79 percent), and in group B (n = 108: six patients were lost and 14 were withdrawn), the ulcers had healed in 80 patients (74 percent). The cumulative healing rates after eight weeks were 94 percent in group A and 95 percent in group B. No serious adverse effect was observed in either group. These results suggest that sucralfate tablets in a dosage of 2 g twice daily are as effective as 1 g four times daily in the treatment of acute duodenal ulcers and could lead to better patient compliance.

Cholesterol turnover in human plasma lipoproteins: studies with stable and radioactive isotopes

The kinetics of cholesterol labeling was studied in the plasma lipoproteins of three subjects who had received an oral dose of octadeuterated cholesterol and an intravenous administration of 3H-cholesterol and 14C-mevalonate or 13C-acetate. After each labeled cholesterol pulse into the plasma (absorption, exchange, or synthesis), the isotopic concentrations of free and esterified cholesterol became identical after 120 h. Before this time, very low-density lipoprotein free cholesterol appeared more easily exchangeable than high-density and low-density lipoprotein free cholesterol, high-density lipoproteins were shown to be a source for very low-density lipoprotein cholesterol esters and the role of very low-density lipoproteins associated with chylomicrons was demonstrated in the initial transport of dietary cholesterol. The rates of the various processes involved in cholesterol turnover were calculated. The total cholesterol inflow into the plasma by absorption and synthesis, determined by long-term kinetic data (18 or 28 wk) was consistent with the result obtained by sterol balance for the total cholesterol outflow from the plasma (fecal excretion and conversion into bile acids).

[Cholesterolemia and pyrexy (author's transl)]

During pyretic diseases from any origin, total plasma cholesterol level decreases and its values are frequently below 1 g per liter. This observation could be expected because it conforms with the following theory : 1) cholesterol synthesis in an organism is proportional to consumed energy, 2) plasma cholesterol level is the lower as cholesterol synthesis is high.

[Cholesterolemia and pyrexy (author's transl)]

During pyretic diseases from any origin, total plasma cholesterol level decreases and its values are frequently below 1 g per liter. This observation could be expected because it conforms with the following theory: 1) cholesterol synthesis in an organism is proportional to consumed energy, 2) plasma cholesterol level is lower as cholesterol synthesis is high.

Daily elimination of fecal neutral sterols by humans

A study was made of the daily elimination of fetal neutral sterols in 22 healthy subjects and the average proportions of the main sterols were established. These were cholesterol (9.5%), its main bacterial transformation products: coprostanol (65%) and coprostanone (less than 6%), cholestanol (less than 2%), delta7-cholestenol (less than 2%) and phytosterols (18%). Epicoprostanol, which indicates a secondary mean of bacterial degradation of cholesterol has been searched for systematically. In general, traces only are present but in one case it amounts to more than 8% of the neutral sterols. The bulk of neutral sterols eliminated daily is very variable for different subjects and also for a same subject, although the concentration of fecal sterols is relatively constant (6.37 +/- 0.36 mg of sterols/g of feces). For a given subject under controlled diet conditions, differences in fecal elimination of sterols can essentially be ascribed to irregularity of digestive transit.

Effects of dietary fiber and salt mixtures on the cholesterol metabolism of rats

The isotopic dilution method, which permits the in vivo measurements of the rates of the processes involved in cholesterol turnover, has been applied to rats fed a commercial stock diet or a basal semipurified diet in which either the nature and proportions of the source of dietary fiber or the salt mixture were changed. The cholesterolemia was about 100 mg/100 g in rats fed agar-agar, cellulose, bran or the stock diet. Pectin addition (5%) lowered significantly the plasma concentration of cholesterol (70 mg/100 g). Changes in the source of dietary fiber or salt mixture have moderate effects on the absorption coefficient of dietary cholesterol (range 58.2%-82%). In comparison to agar-agar, cellulose at 2.3% in the diet significantly lowered this coefficient, but larger amounts of cellulose (6.8% or 12.3%), or pectin (5%) were without effect, while bran addition (10%) tended to slightly decrease cholesterol absorption. Hence, high levels of cellulose in the diet increased the absorption coefficient in comparison to a low cellulose diet. A decrease of this coefficient was also observed when the calcium content of the diet was increased. Cholesterol biosynthesis and fecal excretion were inversely correlated to the absorption coefficient of dietary cholesterol in rats fed all of the semipurified diets indicating, as previously shown, that the intestine was the major source of biosynthesized cholesterol diverted into the plasma. However, feeding a commercial stock diet greatly increased the cholesterogenesis and the fecal elimination of bile acids, suggesting a high hepatic cholesterogenesis.

[Transient acanthocytosis in a patient with liver cirrhosis. Study of red cell and plasma lipids (author's transl)]

The authors report a case of major acanthocytosis which regressed spontaneously in a cirrhotic patient. The usual lipid abnormalities: considerable rise in free red cell cholesterol and lesser rise in phospholipid, regressed concommitantly to the disappearance of acanthocytes. No change in the main liver function tests was, however, observed. The etiological mechanisms of acanthocytosis in cirrhosis are probably multiple, and their interactions are compplex. The exchange of abnormal lipoproteins between the plasma and the red cell membrane is the last theory to be considered. On the other hand, no argument could explain the disappearance of the acanthocytosis, this phenomenon is considered up to now irreversible and a sign of the gravity of hepatic lesions.

[Plasma and erythrocyte lipids. Relation between globular dystrophies and hepatic lesion in ethylism]

Human red cell and plasma lipids are determined in alcoholic patients with various forms of liver diseases including steatosis, cirrhosis and hepatitis. No relation between serum lipids and red cell lipids content have could be demonstrated. A relation is shown between morphology and lipids red cells content, different anatomopathologic states of liver and erythrocyte morphology. In steatosis red cells phospholipids (specially phosphatidyl choline) are increased. In cirrhosis red cells show an increased of both cholesterol and phospholipids content. Target cells show an inchanged cholesterol-phospholipids ratio when acanthocytes show and increased cholesterol phospholipids ratio by a greater increase of cholesterol than phospholipids.