Treatment of amebic liver abscess with emetine hydrochloride, niridazole, and metronidazole. A controlled clinical trial.
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Biomedical subjects
Publications and source records attributed to D V Datta.
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In a prospective search to study the occurrence of primary biliary cirrhosis, only one patient with this disease was encountered during the last six years. This is also the first documented case of primary biliary cirrhosis from the Indian subcontinent.
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The present study records haemodynamic studies in three patients with kala-azar, a parasitic disease. All the three patients had high intrasplenic pressure, mild to moderate elevation of wedged hepatic vein pressure, and increased or normal estimated hepatic blood flow. Liver histology showed marked proliferation and swelling of Kupffer cells in the sinusoids. One patient was studied serially for nine months following treatment which showed persistent elevation of intrasplenic pressure though wedge pressure and liver blood flow touched normal levels. Liver biopsy was essentially normal at this stage. These findings may have some relevance to the role of different parasitic infections in the pathogenesis of a heterogeneous group of non-cirrhotic portal fibroses.
Clinical features of obstruction of the intrahepatic portion of the inferior vena cava were observed in five out of the 11 patients with the Budd-Chiari syndrome seen during the last four years. These patients apparently formed a distinct group from the remaining six and resembled in clinical course, biochemical features, haemodynamic findings, and radiological investigations the patients described as cases of membranous obliteration of the intrahepatic portion of the inferior vena cava. The present study reports five such patients diagnosed with the help of venous catheterization, percutaneous hepatography, and haemodynamic studies. The value of distinguishing these patients from those with obstruction due to hepatic vein occlusion is highlighted because of the difference in the prognosis and treatment.
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The thoracic duct was cannulated in six patients who were actively bleeding from varices and had not responded to conservative treatment but draining lymph from the thoracic duct did not control bleeding in five patients. There was no drop in intrasplenic pulp pressure following this procedure when recorded in three of these patients. Bleeding stopped in one patient after lymph had been drained for nine and a half hours, and there was only a modest change in intrasplenic pressure. The therapeutic use of this technique to control oesophageal varices could not be substantiated.
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