Stepped care medical treatment for cirrhotic ascites: Analysis of factors influencing the response to treatment

Abstract Thirty-two patients with liver cirrhosis and ascites were treated by stepped care diuretic treatment as follows: step 1, placed on a 35 mEq sodium diet; step 2, given 400 mg/day of potassium canrenoate in addition to step 1 treatment; step 3, given 40-80 mg/day of furosemide in addition to step 2 treatment. Eleven out of 32 patients (34.4%, group 1) and 12 of 21 patients (57.1%, group 2) lost their ascites at step 1 and step 2, respectively. The remaining nine patients (group 3) required step 3 treatment. Basal urinary sodium excretion and creatinine clearance were significantly lower and β₂-microglobulin was significantly higher in group 3 than those in groups 1 and 2. Elevation of basal plasma renin activity and norepinephrine was evident only in group 3. In group 1, urinary sodium excretion decreased after the treatment. In group 2, plasma α-atrial natriuretic polypeptide was lowered and plasma renin activity and norepinephrine were elevated after the treatment. These results suggest that basal renal function and plasma renin activity and norepinephrine levels are useful indices to predict the effect of ascites treatment and that responders to sodium restriction or potassium canrenoate may be in the state of vascular overflow, while non-responders to potassium canrenoate may be in the state of vascular underfilling. In summary, this stepped care treatment is safe without any side effects, although the diuretics themselves may lead to relative vascular underfilling.     

Retroperitoneal haematoma due to ruptured microaneurysm of the pancreaticoduodenal artery

A case of retroperitoneal haematoma due to a ruptured microaneurysm of the posterior superior pancreaticoduodenal artery in a 61 year old man is described. Ultrasonography and computed tomography revealed cystic masses near the gall-bladder. Selective coeliac angiography disclosed a microaneurysm of the posterior superior pancreaticoduodenal artery. Surgical extirpation of the cystic masses was performed, and the histological finding was an encapsulated old haematoma.     

Exanthem subitum (roseola infantum) with vesicular lesions

Summary We report a 7-month-old boy who developed vesicular lesions during the course of exanthem subitum. Human herpesvirus-6 (HHV-6) DNA was detected both in the skin lesions and in the throat, by polymerase chain reaction. IgG and IgM antibodies against HHV-6 were 1:10 and <1:10, respectively on the tenth day of the illness, and >1:640 and 1:10 on the twenty-second day, respectively. These results suggest that this was primary HHV-6 infection.     

The Colon Mucus Test in Comparison with the Fecal Occult Blood Test in the Detection of Gastrointestinal Disease

Abstract: This study was undertaken to assess the diagnostic significance of the colon mucus test (CMT) by which the cancer-associated carbohydrate antigen, β-D-Gal (1 - 3)-D-GalNAc (T antigen) is measured in rectal mucus, chiefly in patients with various alimentary tract diseases. The incidence of a positive CMT was relatively high in colorectal cancer (69%) and gastric cancer (40%), and was similarly high in some benign colorectal diseases such as colonic diverticulum (42%) and colonic polyps (39%), and in gastric polyps (75%). On the other hand, the incidence of a positive CMT in other benign diseases or in healthy controls was less than 10%. A positive CMT was significantly more common in colorectal disease and in gastric tumors (cancer and polyps) than in the other diseases (p < 0.001). Of 28 colonic polyp patients, 20 (71%) had negative fecal occult blood test results (FOBT), and nine of them (45%) had positive CMT results. These results suggest that the CMT may be a useful screening test for alimentary tract disease, particularly colorectal disease and gastric tumors, although its specificity for colorectal cancer is only moderate. Furthermore, a combination assay using FOBT plus CMT may help to improve the diagnostic rate.