Albert M. Snell

THE EFFECTS OF CHRONIC DISEASE OF THE LIVER ON THE COMPOSITION AND PHYSICOCHEMICAL PROPERTIES OF BLOOD: CHANGES IN THE SERUM PROTEINS; REDUCTION IN THE OXYGEN SATURATION OF THE ARTERIAL BLOOD

Excerpt There are many problems in connection with chronic parenchymatous disease of the liver which have never been satisfactorily explained on an anatomic basis alone. For instance, it is difficu...

Portal Cirrhosis: An Analysis of 444 Cases With Notes on Modern Methods of Treatment

Summary The records of 444 cases of uncomplicated portal cirrhosis have been analyzed, with special attention to distribution, etiologic factors, symptoms, signs, causes of death, laboratory data and survivorship. Confirmation of the diagnosis was available in 146 (32.9 per cent) of the cases. The present paper represents the third such survey since 1930 of cases of portal cirrhosis encountered in the Mayo Clinic. Hemorrhage was the most frequent direct cause of death and hepatic coma was second in frequency. Survival calculations for the group as a whole revealed that of the traced patients, of whom there were 374 (84.2 per cent), more than half (57.5 per cent) survived for one year after date of diagnosis and fewer than half (48.9 per cent) lived as long as two years. Nineteen per cent lived seven years or longer. The 212 ascitic patients presented the least satisfactory survival figures. Only 37.1 per cent lived one year or more and fewer than one-fifth lived as long as five years after date of diagnosis. Small groups of adequately and inadequately treated ascitic patients were selected for comparison of survivorship. No significant differences in longevity were noted. It is reiterated that early diagnosis and enthusiastic treatment under close surveillance are essential if maximal benefit is to result from therapy for portal cirrhosis.

Portal cirrhosis with ascites: An analysis of 200 cases with special reference to prognosis and treatment

In our study, alcohol was the most frequently encountered contributing etiologic factor. Fifty-one per cent of the patients gave a history of the consumption of alcoholic beverages in excessive amounts. The average duration of life for the 158 patients who died after the onset of ascites was 12.9 months; the forty-two patients who were alive at the completion of this study had survived for an average of 45.5 months. The most frequent causes of immediate death were coma, gastro-intestinal hemorrhage and infection. Satisfactory results of treatment were obtained for 30.7 per cent of the patients who received a high carbohydrate diet and diuretic agents, as compared to excellent results for 44 per cent in the group that received a high carbohydrate, high vegetable protein diet and large doses of vitamins. Diuretic remedies, on which so much therapeutic reliance has been placed in the past, probably do more harm than good except in selected cases. Omentopexy for ascites proved to be a failure.

Treatment of the hemorrhagic tendency in jaundice; with special reference to vitamin k

Evidence has been presented to show that oral administration of a fat soluble vitamin and bile salts will increase the concentration of prothrombin and thereby reduce the clotting time of the blood, as measured by both direct and indirect methods. It appears that the vitamin alone will not accomplish this result if bile is excluded from the intestine, while bile or bile salts have some definite effect, presumably because these substances facilitate absorption of the vitamin which is already present in the intestinal tract. The question naturally arises as to why bile alone cannot be used in the preoperative and postoperative treatment. The first reason is, of course, that the prothrombin time may continue to rise postoperatively, even when bile is flowing freely into the intestine. As Warner, Brinkhous and Smith (23) have shown, the administration of Vitamin K greatly accelerates the restoration of prothrombin in such cases. The second is the inadequate food intake which is common to most jaundiced patients and which may of itself lead to depletion of the amount of Vitamin K in the digestive tract. The third factor has to do with the ability of the liver itself to convert the protective material into prothrombin. There is considerable clinical evidence to show that in the presence of injury of the liver larger amounts of Vitamin K are required to achieve the desired effect. Presumably, the chemical laws governing mass action are operative in this connection. A good deal of future experience will be needed before a definite statement as to the indications for and the limitations of this treatment can be established, but for the present it may be said that it offers considerable hope for the ultimate control of the hemorrhagic diathesis in jaundiced persons.

Clinical Aspects of Portal Cirrhosis

Excerpt Studies on the experimental pathology of the liver have thrown light on many obscure clinical features of portal cirrhosis, and have shown the significance of certain points concerning the ...

Clinical Experience With Addison's Disease

Excerpt It is now eighty years since Thomas Addison presented his memorable work on disease of the suprarenal capsules before the South London Medical Society, and described the Syndrome which bear...

Purpuric Skin Manifestations Following the Use of Merbaphen

Excerpt Since the introduction of merbaphen as an antisyphilitic agent and a diuretic much attention has been directed to its toxic effects. These have been, in general, indicative of mercurial poi...

THE TREATMENT OF LIVER DISEASE

Excerpt INTRODUCTION Attempts at treatment of parenchymatous disease of the liver other than those types which are entirely self-limited constitute a somewhat discouraging chapter in medical histor...

THE VALUE TO CLINICAL MEDICINE OF EXPERIMENTAL STUDIES ON THE LIVER

Excerpt It is difficult for the clinician interested in hepatic disease to overestimate the debt owing to laboratory workers who have so diligently studied the pathologic physiology of the liver. C...

Tetany and Chronic Diarrhea

Excerpt The infrequency of tetany as an accompaniment of diarrhea is attested by the fact that most contemporary writers on tetany rarely discuss diarrhea as an etiologic factor. The subject is bar...