James M. Stormont

Increased Concentration of Free Fatty Acids in Liver Disease.

Summary Fasting plasma FFA concentrations were determined in 34 subjects with cirrhosis and 28 without cirrhosis. Mean fasting FFA concentrations were elevated in subjects with cirrhosis and this was most marked in those subjects with acute hepatic failure or hepatic coma. The increased FFA concentrations were not accompanied by a rise in blood ketone concentrations.

The Genesis of Hyponatremia Associated with Marked Overhydration and Water Intoxication

Prolonged overhydration and hyponatremia have been produced in 10 patients with use of Pitressin Tannate in Oil. Balance studies have shown that in patients who developed moderate hyponatremia, the drop in serum sodium could be explained by water retention. In patients who developed severe water intoxication, the very low levels of serum sodium (100-114 mEq./L.) could not be entirely accounted for by changes in salt and water balance. Certain patients failed to develop severe water intoxication although an equivalent degree of overhydration was achieved. In these subjects, further overhydration was limited by intermittent episodes of low solute diuresis. This diuretic escape from Pitressin effect has been evaluated by measurement of U/P osmolar ratio on 24-hour urine specimens as well as TcH2O during hypertonic mannitol infusion. Defects in both aspects of renal concentration were observed, although they were not necessarily coexistent.

BACTERIOLOGIC CULTURE OF THE DISEASED HUMAN LIVER

Excerpt The role of bacteria in the pathogenesis of liver disease is uncertain. In ascending cholangitis, bacteria frequently invade the liver; however, in other types of liver disease, bacterial i...

Colorectal Cancer in IBD Patients

1 Division of Gastroenterology, Department of Medicine, McMaster University , Hamilton , Ontatio , Canada ; 2 Oxford Research Evaluation Unit , Oxford , UK ; 3 Northwestern University , Chicago , Illinois , USA . Correspondence: Grigorios I. Leontiadis, MD , Division of Gastroenterology, Department of Medicine, McMaster University , 1200 Main Street West, Health Sciences Centre, Suite 4W8B, Hamilton, Ontario , Canada L8N3Z5 . E-mail: leontia@mcmaster.ca

Hepatic metabisulfite sensitivity in a patient with sclerosing cholangitis.

BACKGROUND Primary sclerosing cholangitis is an uncommon chronic cholestatic liver disease with a poor prognosis in symptomatic cases. Genetic and immunologic alterations have been identified, and many possible etiologies have been entertained. Most treatments have limited benefit, and primary sclerosing cholangitis is a common cause for liver transplantation. OBJECTIVE To describe a patient with documented primary sclerosing cholangitis associated with chronic ulcerative colitis, who developed hepatic toxicity following ingestion of metabisulfite. RESULTS A placebo-controlled oral challenge suggested metabisulfite hypersensitivity with liver toxicity. He was treated with cobalamin (to prevent sulfite toxicity), low-sulfite diet, steroids, and antibiotics and has had an unusually benign course for 19 years. CONCLUSIONS The hypersensitivity to oral metabisulfite in our patient appeared to be a significant trigger to flare-ups of his disease. Controlling the response to metabisulfite (along with recurrent antibiotic and steroid therapy) may have contributed significantly to the remarkably good outcome in this patient.