Effects of hyperthermia therapy on the liver. II. Morphological observations.

Liver biopsy specimens obtained from three patients during treatment of advanced malignant disease by exogenous hyperthermia were studied by light and electron microscopy. In two patients the parenchymal cells showed either slight swelling or nuclear alterations by light microscopy and, at the fine structural level, large numbers of autophagic vacuoles, dilatation of Golgi elements and endoplasmic reticulum, and large cytoplasmic vacuoles. Similar changes, but in much more severe form together with parenchymal cell necrosis and cholestasis, were seen in the liver of case 3, who developed jaundice 24 hours after hyperthermia. The findings are discussed in relation to earlier accounts of liver changes following hyperthermia, and the functional implications are considered.

The metabolism of salicylazosulphapyridine in ulcerative colitis. I. The relationship between metabolites and the response to treatment in inpatients.

The metabolism of salicylazosulphapyridine was studied in 16 patients with ulcerative colitis admitted to hospital. The acetylator phenotype was determined on admission. The mean serum concentration (mug/ml) (at steady state eight +/- two days in patients responding to treatment) of SASP, total SP, and 5-ASA were 18.7 +/- 12.8; 53.7 +/- 23.1; and 1 +/- 0.9 for slow acetylators and 17.6 +/- 7.1; 31 +/- 9.0 and 1 +/- 0.9 for fast acetylators respectively. Twenty-four hour urinary excretion of SASP, total SP, and 5-ASA were 4.6% +/- 3.1; 52% +/- 9.6 and 22.3 +/- 6.7% of the administered dose respectively. Serum total SP concentration of 20 to 50 mug/ml appeared to coincide with clinical improvement in the absence of any side effects related to salicylazosulphapyridine. No such relationship could be shown with serum SASP, individual metabolites, or 5-aminosalicyclic acid.

Role of gastric irradiation in management of peptic ulceration and oesophagitis.

Twenty-four patients with peptic oesophagitis or ulceration of the stomach or duodenum have been treated with irradiation of the stomach. They were selected on the grounds of their unsuitability for surgery because of associated medical conditions or because of failure of repeated gastric surgery. Twenty of the patients (83%) were 60 years of age or over. Of those treated 19 (79%) obtained complete symptomatic relief. Endoscopic improvement occurred in most cases. Acid reduction to an average of 30% of the pretreatment levels was noted at 11 months and 58% at 30 months. No morbidity was observed attributable to the irradiation.

Absorption of penicillin and paracetamol after small intestinal bypass surgery.

Drug absorption was studied in morbidly obese patients before and after jejunoileal bypass. The absorption of phenoxymethyl penicillin was considerably increased whilst that of paracetamol was unchanged.

Arthropathy, ankylosing spondylitis, and clubbing of fingers in ulcerative colitis.

In a retrospective study of 399 patients with ulcerative colitis, 27 patients had colitic arthritis, 17 had ankylosing spondylitis, and 20 had clubbing of the fingers. Colitic arthritis and ankylosing spondylitis were not related to severity, extent of involvement, or duration of colitis. A significant association between colitic arthropathy and other complications of ulcerative colitis, such as pseudopolyposis, perianal disease, eye lesions, skin eruptions, aphthous ulceration, and liver disease has been demonstrated. The outcome of the first referred attack of colitis in the presence of colitic arthritis and ankylosing spondylitis remained uninfluenced. Clubbing of fingers was related to severity, extent of involvement, and length of the history of colitis. A significant association between clubbing of the fingers and carcinoma of the colon, pseudopolyposis, toxic dilatation, and arthropathy has been shown. The frequency of surgical intervention in patients with clubbing was higher but the overall mortality was not significantly different from the patients without clubbing.

Peptic ulcer surgery: selection for operation by 'earning'.

Two groups of patients with chronic peptic ulcer were studied to determine the influence of duration of symptoms and age at operation on the result of surgical treatment. Independent physical and psychiatric assessments were made. Statistical analysis of the findings indicates that selection for operation by ;earning' is unreliable in that it fails to identify that group of patients liable to do badly. In its place, a combined physical and psychiatric preoperative assessment of the peptic ulcer patient is recommended.