Comparison of the Trucut and Surecut liver biopsy needles.

The Trucut and Surecut liver biopsy needles have been compared in a prospective randomised study. Although the Surecut specimens were longer and heavier they tended to fragment during processing. Trucut specimens were subject to less artefact and were rated more highly by the histopathologist. However, the majority of biopsies obtained by both needles were satisfactory for diagnostic purposes.

Screening for occult gastrointestinal bleeding in hospital patients.

Stools have been tested for occult gastrointestinal bleeding in 278 outpatients and 170 hospital inpatients using the Haemoccult and Haemastix methods. Seventeen outpatients (6.1%) and 42 inpatients (24%) were positive with the Haemoccult technique. Thirty-three outpatients (11.9%) and 93 inpatients (54.7%) were positive with the Haemastix test. Following investigation of the Haemoccult-positive patients, only 2 cases (3.4%) were considered false positive. However, the false positive rate with Haemastix was 22.9% which is unacceptable in a screening test. Haemoccult may be useful as a screening test for asymptomatic general practice patients, but a test of greater sensitivity is needed for hospital patients.

The treatment of obesity with a very-low-calorie liquid-formula diet: an inpatient/outpatient comparison using skimmed-milk protein as the chief protein source.

Fifty obese patients were givena 1.34 MJ (320 kcal) formula diet (containing 44 g/day carbohydrate, milk protein supplying 24--29 g protein/day in a total of 31 g/day, fat 2 g/day and the RDA of minerals and vitamins) for four to 12 weeks, either as inpatients (22) or outpatients (28). This regime was followed by a 3.35 MJ (800 kcal) conventional diet as outpatients. All but six outpatients completed the trial. Substantial weight losses were achieved in all patients with a total mean loss of 8.4 kg at four weeks and 11.0 kg at eight weeks. At four weeks the mean weight loss was 9.6 kg for inpatients and 7.2 kg for outpatients (P less than 0.05). There was no statistical difference in weight between the groups at eight weeks. Patients who continued on the 1.34 MJ formula diet for 12 weeks continued to lose weight but those on the 3.35 MJ conventional diet did not. Nitrogen-balance studies were carried out on the inpatients. During the first four weeks there was a small net loss of nitrogen (56 g, equivalent to 350 g protein) but equilibrium was achieved by the fifth or sixth week. There was no evidence of protein deficiency as judged by unchanged serum total protein, albumin, haemoglobin, RBC and PCV. Equilibrium between intake and excretion of sodium and potassium was also achieved throughout, and serum electrolytes were unchanged. A large number of other routine clinical and laboratory tests showed the treatment was safe. Serum bilirubin was elevated (18--48 per cent) and increased slightly above normal in two outpatients. Serum cholesterol was decreased by 21 per cent and triglycerides by 45 per cent after three weeks. Serum lipids in hyperlipaemic patients were normalised. It is concluded that the very-low-calorie formula diet provides a safe and very effective method of weight reduction, and the advantages of hospital compared with outpatient treatment are small.

Cholangiocarcinoma and oral contraceptives.

PIP: A 21-year-old woman presented with a 12-month history of epigastric pain, and for 3 months she had noticed a mass in the right hypochondrium. She had taken 'Norinyl-1' (norethisterone 1 mg and mestranol 50 mcg) for 5 years. She smoked 20 cigarettes a day but drank little alcohol. Physical examination revealed irregular hard hepatomegaly 10 cm below the right costal margin. Hepatitis B surface antigen was not detected in the serum and alpha fetoprotein levels were normal ( 10 M.R.C. units). A liver scan showed a large space-occupying lesion in the right lobe of the liver, and liver biopsy revealed a cholangicarcinoma with striking fibrous reaction. Multiple shadows consistent with metastases were present on chest X-ray, but no bony deposits were found on radiological skeletal survey or bone scan. The serum calcium was persistently high (2.74-2.92 mmol/l) but fell on prednisolone therapy. Serum parathyroid hormone levels were normal. A causal relation between oral contraceptives and hepatic adenoma is now generally accepted, and several patients with hepatocellular carcinoma have also been reported. We have been able to find only 1 previous report of cholangiocarcinoma in a young female taking oral contraceptives, and there is 1 report of this tumor in a man taking high doses of anabolic steroids for refractory anemia. This tumor has its peak incidence in the 6th decade and is very rare in the 3rd decade. The association with hypercalcemia due to pseudohyperparathyroidism is well recognized. In only some cases are parathyroid hormone levels raised, and the cause of the pseudohypercalcemia in our patient is unknown.^ieng

Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial.

Fifty-eight patients with uncomplicated diverticular disease of the colon took bran crispbread, ispaghula drink, and placebo for four months each in a randomised, cross-over, double-blind controlled trial. Assessments were made subjectively, using a monthly self-administered questionnaire, and objectively, by examining a seven-day stool collection at the end of each treatment period. In terms of a pain score, lower bowel symptom score (the pain score and sensation of incomplete emptying, straining, stool consistency, flatus, and aperients taken), and total symptom score (belching, nausea, vomiting, dyspepsia, and abdominal distension) fibre supplementation conferred no benefit. Symptoms of constipation, however, when assessed alone, were significantly relieved. Both fibre regimens produced the expected changes in stool weight, consistency, and frequency. It is concluded that dietary fibre supplements in the commonly used doses do no more than relieve constipation. Perhaps the impression that fibre helps diverticular disease is simply a manifestation of Western civilisation's obsession with the need for regular frequent defecation.