Is thrombocytopenia in liver failure dependent on an inadequate synthesis of thrombopoietic stimulating factor by the liver?

Thrombocytopenia in liver diseases has been considered secondary to portal hypertension or to a consumption mechanism associated with fibrinolytic disorders. Several conflicting clinical reports and evidence from experimental models justify the above mentioned mechanisms only in part. We propose that thrombocytopenia may be consequent to an inadequate synthesis of a factor stimulating thrombopoiesis produced by the liver.

Value of two-dimensional echocardiographic detection of incomplete mitral leaflet closure.

The echocardiographic pattern of incomplete mitral leaflet closure (IMLC) is reported to be present in about 90% of patients with acute myocardial infarction and new onset of mitral regurgitation. To determine the significance of this echocardiographic sign, we retrieved all echocardiograms containing this abnormality from a file of 1200 consecutive echocardiograms. Seventy-three echocardiograms manifested IMLC. We also studied a control group consisting of 52 patients without IMLC, but who were matched with the IMLC group with respect to a range of left ventricular (LV) diameters at end diastole and fractional shortening. The following was found in the control group: fewer wall motion abnormalities per patient, less frequent mitral "B bumps," and a smaller LV end-diastolic dimension (LVEDD) (p less than 0.05 for each comparison). By logistic regression, the variable most important to the probability of having IMLC was the presence of mitral valve "B bumps." We conclude that: (1) elevated left ventricular filling pressure is associated with IMLC and (2) IMLC is not specific for the subset of patients with papillary muscle dysfunction due to acute myocardial infarction. Rather, IMLC is commonly seen in association with dilated, usually ischemic cardiomyopathy.

Outcome of patients with rectal cancer treated by stapled anterior resection.

The mortality, morbidity and long-term survival in stapled anterior resection for rectal carcinoma has been analysed in 74 patients. Twelve patients were Dukes' A, 26 B, 29 C, and 7 'D' (submitted to hepatic resection). Operative mortality rate was 3 per cent. Three patients (4 per cent) had clinical anastomotic leakage. Two patients (3 per cent) developed anastomotic stenosis. Local recurrence was present in three patients (4 per cent). The mean (+/- s.e.m.) overall survival rate at 5 years was 67 +/- 6 per cent. There was no significant difference in survival between Dukes' B and C (70 +/- 10 per cent versus 59 +/- 10 per cent, P = 0.209). Patients with absent local spread had a significantly better 5-year survival rate than those with positive local lymph nodes (80 +/- 7 per cent versus 54 +/- 9 per cent, P less than 0.01). The present results confirm the satisfactory use of the EEA stapler device for colorectal anastomoses in rectal cancer and in patients with resectable liver metastasis.

Effect of superoxide dismutase on liver ischemia-reperfusion injury in the rat: a biochemical monitoring.

Oxygen free radicals have been implicated in the pathogenesis of postischemic liver injury. High-dose superoxide dismutase (SOD), a radical scavenging enzyme, has been investigated in a rat model of liver ischemia reperfusion by biochemical monitoring. Blood vessels to the median and left lobe were clamped for 1 h and then reperfusion was allowed. The indices used were serial venous blood levels of AST, ALT, calcium, and ATP determination in liver tissue. In SOD-treated animals (7,5000 U i.v.) a significant attenuation of the rise in enzyme levels was observed as well as the absence of the decrease in calcium level in the early phase after reperfusion as compared with control rats, and furthermore ATP restoration was significantly increased.