MAZEN HASSANAIN PORTAL HYPERTENSION. CAUSES Cirrhosis Non-cirrhosis.
Rising or elevated levels of thyroid binding globulin in cirrhosis may be the first serological...
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CONTROLLED TRIAL OF PROPRANOLOL AND ENDOSCOPIC SCLEROSIS IN THE RECURRENCE OF VARICEAL BLEEDING. 5 Paula Alexandrino, M.Martins Alves, J.Pinto Correia,Department of Medicine ll,University Hospital of Santa Maria, Lisbon , Portugal. In a prospective randomized trial 59 patients with previous endoscopically proven oesopha- geal variceal bleeding, were randomized, by separated sealed envelopes for Child's A and B groups, either to oral propranolol (31) or to elective endoscopic sclerosis (28) in order to evaluate the effect on oesophageal variceal rebleeding. The oral propranolol was given in a twice daily dosage reducing the resting pulse rate by 25% and sclerosis was done with etha- nolamine oleate placed intravascu!arly in a three-weeks schedule. During a follow-up period of up to 3 years, 15 of 31 patients in the propranolol group and 6 of 28 in the sclerosis group had rebleeding from oesophageal varices. The cumulative per- centages of patients free of oesophageal variceal rebleeding after inclusion, were 38% in the propranolol group and 77% in the sclerosis group. The difference between the two groups" was statistically significant (p(0.05). However the cumulative percentage of patients free of bleeding of any source were 20% in the propranolol group and 46% in the sclerosis group (N.S.). The number of acute gastric erosions was higher in the sclerosis group. In conclusion long term injection sclerotherapy is significantly more sucessful than oral propranolol in the prevention of recurrent oesophageal variceal bleeding, but not in the pre vention of all bleedings. RISING OR ELEVATED LEVELS OF THYROID BINDING GLOBULIN IN CIRRHOSIS ~Y BE THE FIRST SEROLOGICAL EVIDENCE OF SUBSEQUENTMALIGNANT CHANGE. A. Alexopoulos, J.J. Keating, P.J. Johnson and Roger Williams. Liver Unit, King's College Hospital and School of Medicine & Dentistry, London SE5 8RX. There have been reports that serum levels of thyroid binding globulin, and hence serum thyroxine (T4), are elevated at the time of presentation in some patients with hepato- cellular carcinoma (HCC). At what stage in the development of the tumour or whether these changes are specific for HCC as opposed to other primary tumours, is not known. In the first part of this study we measured TBG and T4 in 28 patients with apparently uncomplicated cirrhosis, 37 with HCC (26 with underlying cirrhosis) and 50 with a variety of other primary tumours (17 with hepatic metastases). T4 was elevated in 15 (41%) of HCC patients but only 2 (7%) of those with uncomplicated cirrhosis and none of those with other malignancies. Elevated T4 levels were directly related to a high TBG, levels of other thyroid binding proteins (albumin and prealbumin) being normal or low. In the second part of the study T4 and TBG were estimated in serial sera from 25 cirrhotic patients which had been stored during follow-up periods of I-5 years. Of these 25 patients, lO had ultimately developed HCC, 8 had died with no evidence of HCC and 7 remain alive without any evidence of HCC. In all the lO developing HCC, TBG apd T4 levels rose from the time of the f i r s t available sample (by 4-24% per annum) and levels became elevated in 5. In sharp contrast, levels fell (-2 to -20% p.a.) in all the cirrhotic patients dying without HCC and have remained stable or fallen in all but one of those still alive. The rise in TBG started before any change in AFP in 5(50%) of HCC patients and elevated levels were present in 2 patients, 3 and 4 years before HCC was diagnosed c l i n i c a l l y . Rising levels of TBG may be the earliest evidence of HCC development in patients with cirrhosis. S181
Transcript of Rising or elevated levels of thyroid binding globulin in cirrhosis may be the first serological...
CONTROLLED TRIAL OF PROPRANOLOL AND ENDOSCOPIC SCLEROSIS IN THE RECURRENCE OF VARICEAL BLEEDING.
5 Paula Alexandrino, M.Martins Alves, J.Pinto Correia,Department of Medicine ll,University Hospital of Santa Maria, Lisbon , Portugal.
In a prospective randomized trial 59 patients with previous endoscopically proven oesopha- geal variceal bleeding, were randomized, by separated sealed envelopes for Child's A and B groups, either to oral propranolol (31) or to elective endoscopic sclerosis (28) in order to evaluate the effect on oesophageal variceal rebleeding. The oral propranolol was given in a twice daily dosage reducing the resting pulse rate by 25% and sclerosis was done with etha- nolamine oleate placed intravascu!arly in a three-weeks schedule.
During a follow-up period of up to 3 years, 15 of 31 patients in the propranolol group and 6 of 28 in the sclerosis group had rebleeding from oesophageal varices. The cumulative per- centages of patients free of oesophageal variceal rebleeding after inclusion, were 38% in the propranolol group and 77% in the sclerosis group. The difference between the two groups" was statistically significant (p(0.05). However the cumulative percentage of patients free of bleeding of any source were 20% in the propranolol group and 46% in the sclerosis group (N.S.). The number of acute gastric erosions was higher in the sclerosis group. In conclusion long term injection sclerotherapy is significantly more sucessful than oral
propranolol in the prevention of recurrent oesophageal variceal bleeding, but not in the pre vention of all bleedings.
RISING OR ELEVATED LEVELS OF THYROID BINDING GLOBULIN IN CIRRHOSIS ~Y BE THE FIRST SEROLOGICAL EVIDENCE OF SUBSEQUENT MALIGNANT CHANGE. A. Alexopoulos, J.J. Keating, P.J. Johnson and Roger Williams. Liver Unit, King's College Hospital and School of Medicine & Dentistry, London SE5 8RX.
There have been reports that serum levels of thyroid binding globulin, and hence serum thyroxine (T4), are elevated at the time of presentation in some patients with hepato- cel lular carcinoma (HCC). At what stage in the development of the tumour or whether these changes are specific for HCC as opposed to other primary tumours, is not known. In the f i r s t part of this study we measured TBG and T4 in 28 patients with apparently uncomplicated cirrhosis, 37 with HCC (26 with underlying cirrhosis) and 50 with a variety of other primary tumours (17 with hepatic metastases). T4 was elevated in 15 (41%) of HCC patients but only 2 (7%) of those with uncomplicated cirrhosis and none of those with other malignancies. Elevated T4 levels were direct ly related to a high TBG, levels of other thyroid binding proteins (albumin and prealbumin) being normal or low. In the second part of the study T4 and TBG were estimated in serial sera from 25 cirrhotic patients which had been stored during follow-up periods of I-5 years. Of these 25 patients, lO had ultimately developed HCC, 8 had died with no evidence of HCC and 7 remain al ive without any evidence of HCC. In al l the lO developing HCC, TBG apd T4 levels rose from the time of the f i r s t available sample (by 4-24% per annum) and levels became elevated in 5. In sharp contrast, levels fe l l (-2 to -20% p.a.) in a l l the cirrhotic patients dying without HCC and have remained stable or fal len in a l l but one of those s t i l l al ive. The rise in TBG started before any change in AFP in 5(50%) of HCC patients and elevated levels were present in 2 patients, 3 and 4 years before HCC was diagnosed c l in ica l l y . Rising levels of TBG may be the earl iest evidence of HCC development in patients with cirrhosis.
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