Role of the mesentericocaval shunt in the management of portal hypertension

A series of sixteen mesentericocaval shunts is presented. These mesentericocaval shunts were carried out only in occasional complicated cases in which standard shunts had previously become thrombosed or were no longer possible for other reasons. Eleven of the mesentericocaval shunts were performed as emergency procedures and four of the patients belonged to liver function group C.The operative mortality was 14 per cent. Two of the sixteen mesentericocaval shunts have become thrombosed (12 per cent). Both required reoperation, and the patients have well functioning shunts at follow-up examination.Eleven of the fourteen patients are still alive and none has had any bleeding episodes after the mesentericocaval shunt.On the basis of the results, it is suggested that the range of indications for the mesentericocaval shunt could be widened considerably.     

Acquired pure red-cell aplasia: A consequence of increased natural killer cell activity?

A 19-year-old man with severe pure red-cell aplasia is described. An unusually high proportion of this patient's lymphocytes were large granular lymphocytes (LGL), both in the blood (40%) and in the bone marrow (50%). His blood leukocytes displayed a strongly elevated natural killer (NK) cell activity in vitro against the erythroblastic leukemia line K562. The patient's non-T blood lymphocytes inhibited in vitro erythroid colony formation (BFU-E and CFU-E) but not the granulocyte-monocyte colony growth (CFU-GM) from autologous and allogeneic bone marrow. Neither T-cell-mediated cytotoxicity nor circulating antibodies against erythroid precursors could be demonstrated. The patient's haemoglobin values returned to normal levels after three weeks of glucocorticoid treatment and have since then remained stable with continued prednisone administration. Attempts to reduce the prednisone dose to less than 10 mg/day have led to relapses. It is tempting to suggest that the patient's disease might be caused by hyperactivity of cytotoxic non-T (NK) cells specific for K562 cells and early erythroid precursors.     

Repeated transabdominal renocenteses in a case of fetal hydronephrotic kidney

Reported is a case of fetal hydronephrosis treated by repeated transabdominal punctures, with a favorable outcome.     

Purification and properties of human liver tyrosine aminotransferase

Tyrosine aminotransferase (EC 2.6.1.5) of human liver was purified 2200-fold by successive chromatography on DEAE-cellulose DE-52, Ultrogel AcA-34, CM-Sephadex C-50 and hydroxyapatite to a specific activity of 64 units/mg of protein. The purified enzyme had a molecular mass of 95 500. The Km-values were 1.04 X 10(-3) mol/l, 0.17 X 10(-3) mol/l and 0.69 X 10(-6) mol/l for tyrosine, 2-oxoglutarate and pyridoxal 5'-phosphate, respectively. In the final purification step the enzyme activity was divided into two major fractions and a minor third one. On isoelectric focusing, three distinct fractions of specific tyrosine aminotransferase activity were obtained. The isoelectric points of these fractions were 4.9, 5.1 and 5.3, respectively. These findings imply that the human tyrosine aminotransferase consists of three subforms. No differences in properties studied could be found between the subforms. The coenzyme, pyridoxal 5'-phosphate, could be removed by dialysis.     

Decreased prevalence of gallstones in gastric cancer

The prevalence of gallstones and the frequency of previously performed cholecystectomy were examined in 498 autopsy subjects who had gastric cancer and their age- and sex-matched control subjects. The frequency of gallstones not treated by operation and previous cholecystectomy was significantly (p <0.01) lower in those with gastric cancer than in the matched-control subjects. It is not possible to determine on the basis of this study what the possible factors that cause this phenomenon are.     

Binding of progestins to the glucocorticoid receptor: Correlation to their glucocorticoid-like effects on in vitro functions of human mononuclear leukocytes

A number of physiological and synthetic progestins were tested for their ability to compete with [³H]dexamethasone for the binding to the glucocorticoid receptor of human mononuclear leukocytes and their ability to elicit glucocorticoid-like effects on the same cells. As compared to the reference compound dexamethasone (relative receptor binding affinity defined as 100%), two potent synthetic progestins with a pregnane-type structure, megestrol acetate and medroxyprogesterone acetate, were found to display a considerable binding affinity towards the receptor (46 and 42%, respectively). The relative binding affinity of the naturally occurring ligand, cortisol, to the receptor was clearly lower (25%). The effective binding of medroxyprogesterone acetate to the glucocorticoid receptor was confirmed by direct binding studies utilizing a tritiated derivative of this steroid. No evidence for the existence of a specific progesterone receptor in human mononuclear leukocytes was obtained as judged by the results of competition experiments where a progesterone receptor-specific ligand [³H]Org 2058 was used. Medroxyprogesterone acetate and megestrol acetate also induced glucocorticoid-like effects on the lymphocyte functions. These included inhibition of the proliferative responses to the T-cell mitogens concanavalin A and phytohaemagglutinin and an enhanced accumulation of immunoglobulin secreting cells in pokeweed mitogen-stimulated cultures. The progestin effect appears to be mediated through a radiosensitive (suppressor) subpopulation of T lymphocytes. In contrast, the synthetic progestins related structurally to 19-nortestosterone, norethisterone and d-norgestrel, were virtually devoid of binding affinity towards the glucocorticoid receptor nor did they measurably influence the in vitro lymphocyte functions. These studies demonstrate that certain progestins in common clinical use probably possess inherent glucocorticoid activity and suggest that side effects attributable to this character (e.g. suppression of the pituitary-adrenal axis) might be expected when these compounds are used in pharmacological doses.     

Effect of fatty acids on thyroid function tests in vitro and in vivo

Addition of long-chain fatty acids to serum increased thyroxine (T₄), measured by a competitive protein binding assay, and triiodothyronine (T₃) uptake by Sephadex or resin (T₃U tests). This is compatible with the assumption that fatty acids compete with thyroxine for binding sites on T₄-binding proteins. When equimolar concentrations of various saturated and unsaturated fatty acids were added to serum it was observed that the effectiveness in raising tests based on protein binding of thyroid hormones increased with the number of double bonds. Unsaturated fatty acids also increased serum T₃ determined by radioimmunoassay (RIA). T₄(RIA) was not significantly influenced by either saturated or unsaturated fatty acids.Serum T₄(CPB) rose during storage at 22°C and 37°C but was stable at 4°C and — 20°C for periods up to two weeks. The proportional increase in T₄(CPB) and free fatty acids (FFA) indicated that this phenomenon was due, at least partly, to the interference from FFA formed during storage of the serum. There was also a small, significant increase in T₃U, T₃(RIA) and CT₄I (a free thyroxine estimate) after storage of serum at room temperature or higher for one to two weeks. Serum T₄(RIA) did not alter during two weeks of storage.In five subjects with raised serum FFA after eating a fat meal followed by a heparin injection an increase in T₄(CPB), T₃U, T₃(RIA) and CT₄I that was proportional to the increase in FFA was observed. This effect on the thyroid tests was small until the increase in FFA concentration exceeded 2 mmol/1. T₄(RIA) did not respond to the increase in FFA. In ten patients with raised levels of FFA due to uncontrolled diabetes T₄(CPB), T₄(RIA) and T₃(RIA) decreased while T₃U increased. These unexpected alterations were probably related to the severe, chronic illness in these patients. Increased FFA in vivo seem to be of little importance for the interpretation of thyroid tests in clinical practice.     

Weight changes after jaw fixation due to sagittal split ramus osteotomy for correction of prognathous

Body weight changes, energy intake and symptoms experienced were studied in 13 patients whose jaws were fixated due to osteotomy for protruding mandible. All except one patient lost weight and the mean weight loss was 7.5 +/- 5.3 kg. The weight reduction was higher in the obese patient (11 +/- 4.2 kg), but also patients of normal weight lost 4.7 +/- 4.6 kg. The reduction of daily energy intake from the preoperative state as 1.5 +/- 1.0 MJ and was in obese patients about twice as much as in the lean ones (2.1 +/- 0.8 MJ and 1.0 +/- 1.0 MJ, respectively). The reduction of energy intake per loss of body weight by 1 kg was in all patients 8.5 +/- 0.67 MJ, in obese 8.3 +/- 0.64 MJ and in lean patients 8.6 +/- 0.75 MJ. The loss of weight was temporary and the patients regained their weights largely or wholly after the fixation period. Ten patients of the 13 felt hunger during fixation period, two had abdominal pains, five constipation and two pollacisuria. Jaw fixation due to osteotomy for protruding mandible decreased the food intake of the patients much and deteriorated their nutritional status by considerable weight loss. Thus advice about fortifying the diet is indicated so that the patients could consume food of high energy content during intermaxillary fixation due to sagittal split ramus osteotomy for correction of prognathous.     

Interdisciplinary teaching of community paediatrics

An experiment of combining decentralized and interdisciplinary teaching is described. Seminars were arranged at a district hospital for medical, nursing and social work students to discuss families with a chronically ill child. The purpose of these seminars was to teach co-operation between different health care workers, and to stress the importance of becoming acquainted with the family situation, and learn what a child's illness means to the whole family.
An evaluation of the first three seminars shows that this type of teaching was very well received by the students, professionals and families concerned. The students considered house calls an important part of their education and felt that more interdisciplinary teaching should be included in their curriculum. In addition to the teaching aspect, the families involved also considered the seminars a positive experience as they received more information about their child's disease, and deficiencies in treatment could be corrected.