The management of ascites using the Rhodiascit Apparatus ("Paris Pump").

The Rhodiascit Apparatus ("Paris Pump") which ultrafilters sodium and water from ascitic fluid allowing reinfusion of a protein-rich concentrate, has been found to be a valuable procedure in the management of ascites associated with liver cirrhosis. The device was evaluated in eight patients with the aim of rapidly controlling ascites with minimum hospitalisation. The duration of the procedure varied from 8.5 to 55 hr (mean 27 hr) and resulted in a mean girth reduction of 13 cm (range 5.7 to 24 cm) and a mean weight loss of 13.6 kg (range 5.7 to 23 kg). Serum electrolytes and total protein were unchanged; a slight but insignificant rise in serum creatinine was observed. Three infective episodes occurred, but these were easily controlled. The procedure was, in general, well tolerated, inexpensive and allowed rapid relief of ascites with few complications.

Diffuse fasciitis with eosinophilia (Shulman's disease).

A case of diffuse fasciitis with eosinophilia (DFE, or Shulman's disease) is presented. A review of the literature of the condition is presented, and the salient features are summarized. Diagnostic criteria and the management of patients with this unusual condition are discussed.

The Newcastle hepatitis B outbreak. Observations on cause, management and prevention.

During December 1983 and January 1984, an outbreak of hepatitis B occurred among health care workers in the Newcastle area. The probable source was the victim of a motor-bicycle accident who was incubating the illness at the time of his accident. The outbreak led to an extensive contact tracing and immunization programme and suggested that ambulance and police officers were at increased risk of contracting hepatitis B.

Urinary thromboxane B2 and prostaglandin E2 in the hepatorenal syndrome: evidence for increased vasoconstrictor and decreased vasodilator factors.

Vasodilatory prostaglandins function to maintain renal perfusion in patients with cirrhosis and ascites. To evaluate the potential contribution of the vasodilator prostaglandin E2 and the vasoconstrictor metabolite thromboxane B2 to the development of the hepatorenal syndrome, we measured urinary excretion of these products in 14 patients with hepatorenal syndrome and in control populations with acute or chronic liver or kidney failure. Radioimmunoassay measurements were confirmed by bioassay and by mass spectrometry. Prostaglandin E2 was decreased compared with healthy controls (2.2 +/- 0.3 vs. 6.3 +/- 0.8 ng/h, p less than 0.01) and compared with acute renal failure (9.6 +/- 2.1 ng/h) and with alcoholic hepatitis (9.2 +/- 3.3 ng/h). Thromboxane B2 concentration was normal in patients with alcoholic hepatitis (0.12 +/- 0.02 vs. 0.15 +/- 0.03 ng/ml) and minimally increased in acute renal failure (0.18 +/- 0.15 ng/ml), but markedly elevated in hepatorenal syndrome (0.69 +/- 0.15 ng/ml, p less than 0.001). Urinary thromboxane B2 concentration fell with improved renal function in 3 patients who survived. These data suggest an imbalance of vasodilator and vasoconstrictor metabolites of arachidonic acid in patients with the hepatorenal syndrome.

Hepatitis B markers in health care workers. The Newcastle study.

Health care workers in the Royal Newcastle Hospital, in surrounding hospitals and pathology services, and in a large mental institution were surveyed to determine the prevalence of hepatitis B markers. The aim of the study was to identify the groups of workers at particular risk of contracting hepatitis B in order to determine which workers would benefit most from a programme of vaccination against hepatitis B. Although the prevalence of hepatitis B markers in the Newcastle health care workers was higher than that in the control subjects, this rate did not approach the high rates previously reported in overseas studies.