J.W. Laws

Oral-contraceptive-associated liver tumours: occurrence of malignancy and difficulties in diagnosis.

Seven of ten women with oral-contraceptive-associated liver tumours were found to have hepatocellular carcinoma. The diagnosis was often delayed, although hepatomegaly was always present on examination, and liver-function tests and erythrocyte sedimentation-rates were abnormal in most cases. Other investigations, including routine technetium liver scans and biopsy, were sometimes misleading. There were important differences in alpha-fetoprotein concentration, vascularity on angiography, and survival between liver tumours in pill users and non-users.

Detection and grading of oesophageal varices by fibre-optic endoscopy and barium swallow with and without Buscopan

Detection of oesophageal varices is important in the diagnosis of portal hypertension. We have, therefore, compared the results of fibre-optic endoscopy and barium swallow in 56 patients with chronic liver disease. Oesophageal varices were graded as small, moderate or gross by independent observers for each technique. In 12 patients varices were not detected by either method, and in six cases varices were detected by endoscopy when the barium swallow was negative. In 15 of the remaining 38 patients varices were found to be one grade larger at endoscopy than on barium swallow. Since it is possible that varices appear larger at endoscopy because of the Buscopan (hyoscine N-butyl bromide) used as a relaxant, we carried out barium examinations after Buscopan 20 mg i.v. in 23 of the patients. In eight cases varices were one grade larger after Buscopan than on the standard barium swallow, and in two were only detected after Buscopan had been given. Eight cases negative after Buscopan were also negative at endoscopy. Although emergency endoscopy has particular value in locating the site of bleeding in patients with portal hypertension and acute gastrointestinal haemorrhage, the results of the present study suggest that a barium meal with Buscopan is as accurate as endoscopy in the detection of oesophageal varices.

Pulmonary complications in fulminant hepatic failure: Analysis of serial radiographs from 100 consecutive patients

In 1972 a purpose-built Liver Failure Unit, equipped with a ceiling mounted X-ray tube, was set up at Kings College Hospital, facilitating the present analysis of abnormalities found on serial chest radiography of 100 consecutive patients with fulminant hepatic failure. In 48 patients serial chest X-rays remained normal throughout their illness. Of the remaining 52 patients, 31 developed changes which could largely be attributed to their unconscious state. These included collapse of the right upper lobe after the passage of an endotracheal tube, collapse of other lobes or the whole lung, as well as pneumothorax, lung abscesses and pleural effusions. The frequency of pulmonary oedema appeared to be very much higher than that reported in other metabolic comas and may be related to accumulation of toxic compounds in the blood. The degree of intrapulmonary shunting in patients with normal chest X-rays was a further unexpected finding. Direct arteriovenous communications were not found on wedge angiograms and the most likely cause of such shunting may be inappropriate dilatation throughout the pulmonary vascular tree. The early radiological detection of these serial changes and the prompt initiation of treatment may explain why the mortality was no higher in those patients who developed pulmonary complications.

Comparison between iodamide and iothalamate in intravenous urography

A number of iodinated contrast media such as Iothalamate, whose excretion depends on glomerular filtration are well established for use in intravenous urography. Iodamide, a relatively new iodinated contrast medium, is thought to be actively secreted by the tubules in addition to glomerular filtration. We set out to compare the nephrogram and pyelogram using these two types of contrast medium, injecting each either slowly or rapidly. Only patients with normal plasma urea and creatinine concentrations were included in the assessment. The results, although inconclusive, suggest that the quality of the nephrogram and pyelogram is better with Iodamide than with Iothalamate.