Hugh R. Butt

SERUM PEPTIDASES IN HEPATIC DISEASE

The number of peptidases occurring in the serum of healthy persons appears to be quite 1arge.l. In acute hepatic necrosis the activity of some oi these enzymes may be greatly increased, while the activity of others may either be increased somewhat or remain essentially unchanged (Fleisher, unpublished data). The present study concerns an investigation of two serum enzymes that are affected by hepatic disease; namely, aminotripeptidase and leucine aminopep t idase.

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.

OCCURRENCE OF MACROCYTIC ANEMIA IN ASSOCIATION WITH LESIONS OF THE BOWEL

Excerpt It is well known that a variety of conditions are often accompanied by a morphologic blood picture resembling, and often indistinguishable from, the blood picture of pernicious anemia. Cons...

To the American internist: 1972.

Excerpt The medical profession, like all special units of society, sees criticism or intervention from without as a threat to its purposes; but certainly the public have a right to demand that thei...