SUMMARY Liver biopsy was performed in 38 patients with fulminant hepatitis and coma and repeated in 22. Stereological estimation of hepatocyte volume was correlated with levels of clotting factors.Early liver biopsy allowed prognosis in 55 % of the cases. All patients with a hepatocyte volume of <35% and thromboplastin time <10% died; all patients but two with hepatocyte volume > 350%and thromboplastin time > 10% recovered consciousness (n = 9) or at least showed evidence of marked liver regeneration (n = 2).On serial liver biopsy a significant increase in hepatocyte volume and clotting factors was only observed in patients who recovered consciousness. The estimated liver cell mass after regeneration in patients who recovered consciousness was > 45 and <45 % in the patients who did not.The very sophisticated treatments recently introduced for the treatment of acute hepatic failure point to the need for quantitative parameters of liver function and liver regeneration in order to decide which is the most adequate treatment and the best moment to start it.The aim of this study is to estimate the severity of liver damage by early liver biopsy in patients with acute liver failure; the ability of the liver to regenerate demonstrated by serial liver biopsies; and a correlation of this parameter with liver function reflected in coagulation studies. PatientsDuring the past seven years. 106 patients were admitted in coma and acute liver failure due to viral hepatitis (104 cases), mushroom poisoning (one case), and INH overdose (one case). In 10 patients coma did not exceed grade III and all survived. Of 96 patients in coma grade IV, 24 (25 %) recovered consciousness and 18 (18.7 %) survived.Early liver biopsy (one day before to five days after the onset of coma) was performed in 38 patients (fig 1), using a Menghini 1-4 mm needle. Clotting fractions (PPSB or antihaemophilic concentrated plasma)

No abstract

SummaryA modified plate dialyser (Rhone-Poulenc) was used 318 times to concentrate ascites for reinfusion in 210 patients, most of them having longstanding ascites refractory to diuretic treatment.The advantages of this method of treatment are its rapidity and efficacy, ascites being reduced in a mean time of 21±13 hr. Hyponatraemia is easily corrected by a sodium load during reinfusion. There was improvement in renal function in 11 of 37 cases. Adverse effects are fever, pulmonary oedema, peritoneal infections and coagulation disorders. Ascites recurred in 84 % of the cases, but the procedure shortens hospital stay and reduces the cost of the treatment.AsCITEs reinfusion has been practised for many years. One effect of such treatment is to expand the plasma volume which may result in an improvement of renal function. A problem with ascites reinfusion has been the large intravenous fluid load that the patient receives. In conjunction with Rh6ne-Poulenc an apparatus has therefore been developed in which the ascitic fluid is first passed through a haemodialysis membrane, so that the protein of the fluid can be concentrated by ultrafiltration, before reinfusing (Levy et al., 1971). In this way excessive water and electrolytes can be discarded. PatientsTwo hundred and ten patients have been treated with 318 reinfusions. The underlying pathology was as follows: alcoholic cirrhosis (155 cases), posthepatic cirrhosis (thirty-one), biliary cirrhosis (two), Budd-Chiari syndrome (seven), abdominal tumours (seven), pancreatitis (one), constrictive pericarditis (one) and miscellaneous (six).At the time of reinfusion renal function was often poor, in ninety-eight instances the plasma urea concentration being greater than 50 mg/100 ml, and in fourteen greater than 150 mg/100 ml.

No abstract