Prevention of complications after liver trauma

Treatment of 681 cases of liver trauma during the past ten years at the San Francisco General Hospital was reviewed. The mortality was 14.7 per cent and the morbidity rate 18.9 per cent. The complications relating specifically to liver injury were bleeding subphrenic or subhepatic abscesses, intrahepatic abscess, biliary fistula, and liver failure. These complications and the recommended management of the liver injury are discussed.     

The response of leucocytes of agammaglobulinaemia subjects to phytohaemagglutinin and anti-immunoglobulin antiserum

Leucocytes of three patients with congenital (case 1) or acquired (cases 2 and 3) agammaglobulinaemia were studied in vitro in cell culture for their capacity to undergo blastogenesis and mitosis upon exposure to phytohaemagglutinin (PHA) or anti-immunoglobulin sera. Synthesis of DNA was measured by the incorporation of tritiated thymidine added 16 hr before termination of culture. The lymphocytes of patients Nos. 2 and 3 showed little or no uptake of the labelled thymidine following stimulation by antisera, whereas those of patient No. 1 were at the upper limit of normal. Response to stimulation by PHA was within the normal range for patients Nos. 1 and 3 but subnormal for patient No. 2. The different responses to PHA and anti-immunoglobulin antisera suggest basic heterogeneity of the defects in the lymphocytes of these patients.     

Hypertrophic cardiomyopathy associated with sudden death during marathon racing.

An experienced marathon runner died suddenly during a competitive race. At necropsy, ventricular hypertrophy but no asymmetrical septal hypertrophy was found. Histological studies showed features of hypertrophic cardiomyopathy. The coronary arteries were normal. We propose that the runner died from myocardial ischaemia, precipitated by marathon running on a background of hypertrophic cardiomyopathy. Excess cardiac work, induced by marathon running in the presence of mild congenital cardiac defects, could have contributed to the development of the cardiomyopathy.