Leon Schiff

Budd-Chiari syndrome in women taking oral contraceptives

Abstract Two cases of Budd-Chiari syndrome are described in women taking oral contraceptives. The prominent symptoms were hepatomegaly, ascites and abdominal pain. Diagnosis was established by liver biopsies in the first patient. She recovered after withdrawal of the drug and administration of diuretics. The second patient became progressively worse, with refractory ascites, and she died of bleeding varices. Autopsy confirmed the presence of hepatic vein thrombosis. The risk of venous thrombosis is reportedly increased in women taking oral contraceptives. Although direct evidence is lacking, the possibility of a causal relationship between hepatic vein occlusion and oral contraceptives should be considered.

Familial nonhemolytic jaundice with conjugated bilirubin in the serum; a case study.

CONGENITAL defects in bilirubin metabolism are a relatively infrequent cause of jaundice. If neonatal jaundice is excluded, they can be divided into two groups of cases, depending on whether the in...

Hepatic cholesterol ester storage disease, a familial disorder: I. Clinical aspects

Abstract Cholesterol ester storage disease is described in a brother and a sister whose livers were orange in color and showed excessive deposition of cholesterol ester. A septate cirrhosis was also present. Four younger siblings exhibited similar serum bile acid abnormalities and hepatomegaly. In three of these children studied, the liver, which was grossly normal, showed minimal histologic and ultrastructural abnormalities which suggest a milder expression of a similar inherited defect.

Hepatic sarcoidosis with portal hypertension

Abstract A case of sarcoidosis with portal hypertension is presented. Studies would indicate that the site of the portal hypertension is at the presinusoidal level. Although long-term steroid therapy resulted in symptomatic improvement, improvement in the results of liver function tests and regression of the sarcoid lesions in needle specimens of the liver, it failed to influence the portal hypertension.

The clinical value of needle biopsy of the liver.

Excerpt The following presentation is based on studies carried out during the past six years, by successive fellows and the author, on the Medical Service and in the Gastric Laboratory of the Cinci...

Benign recurrent intrahepatic cholestasis, with response to cholestyramine☆

Abstract A fourteen year old girl who had had recurrent episodes of cholestatic jaundice and itching since the age of nine years is described. Recurrent seasonal pruritus preceded the onset of jaundice by eight years. No evidence of extrahepatic biliary obstruction could be found despite two surgical explorations. A correlation between the patients serum bile acid levels and pruritus was strongly suggested. It was found that cholestyramine, when given in adequate dosage, decreased the patients abnormally increased serum bile acid concentration and relieved the pruritus. These changes were accompanied by a decrease in the serum alkaline phosphatase and total bilirubin; bromsulfalein retention was no longer abnormal and there was no histologic evidence of cholestasis. Following discontinuation of cholestyramine therapy for a period of thirty-four days there was a significant increase in only the serum alkaline phosphatase activity, although there was moderate pruritus in the latter part of this period; this was again observed during a second period of discontinuation of cholestyramine therapy.

Clinical evaluation of liver size and hepatic scintiscan.

SummaryThe clinical estimation of liver size was evaluated with the use of radioisotope scintiscans as a standard of comparison. It was found that the upper border of liver dullness (as delineated by percussion) was almost always too low. The normal liver may frequently extend below the costal margin and the xiphoid process and yet be impalpable. Percussion offers a more accurate means of estimating the lower border of the normal or the acutely diseased liver. A truer estimation of liver size is obtained in patients with chronic liver disease, presumably because the increased consistency of the organ enhances the detection of its lower border by physical examination.

Progression of acute hepatitis to postnecrotic cirrhosis

Abstract Five patients are described in whom progression of acute hepatitis to postnecrotic cirrhosis was documented by serial histologic observations. The hepatitis was assumed to be of viral etiology in view of the characteristic histologic and clinical features and the absence of other known infectious or hepatotoxic agents.

Lactic dehydrogenase activity in gastric juice for the diagnosis of gastric cancer

Serum and gastric juice lactic dehydrogenase (LD) activity has been measured in patients with normal stomachs, with uncomplicated pernicious anemia, with benign gastric ulcer, and with gastric cancer. The measurements were made of specimens containing no free hydrochloric acid. The results of these preliminary studies suggest that the determination of LD activity in gastric juice may be helpful in the diagnosis of gastric cancer. Gastric LD activity appears to be independent of serum LD activity. Further research, especially concerning the relationship of gastric mucosal changes and gastric LD activity, is recommended.

PNEUMOPERITONEUM FOLLOWING USE OF THE FLEXIBLE GASTROSCOPE

Excerpt Perforation of the stomach is said to occur very infrequently following the use of the flexible gastroscope. According to Schindler and Renshaw,1this accident is known to have occurred five...