Acetazolamide was tested in the extracellular alkalosis of K+ depletion, a metabolic situation which presumably elicits a general intracellular acidosis, demonstrated for both muscle and kidney. The renal effect of drug on HCO3– excretion was markedly less than normal despite elevated plasma HCO3– concentration. These experiments, together with those on metabolic and respiratory acidosis, suggest that with decreased intracellular renal pH, the role of carbonic anhydrase in renal acidification and HCO3– reabsorption is reduced.
A needle guide was used to create a fistula from an obstructed common bile duct to the duodenum in a patient with a large tumor of the head of the pancreas. The tortuosity and severity of the stricture prevented the use of routine guide wire passage. A 5-F hyperalimentation catheter was also placed, in addition to the biliary drainage stent.
During recent years scintillation scanning has proved to be an important tool in the diagnosis of liver disease. This study was undertaken to evaluate this technique for determining the viability and function of canine and human auxiliary hepatic homografts. Methods The same general techniques were used in both the canine and human studies. Intravenously administered rose bengal I 131 was administered to dogs in a dose of 50 microcuries and to patients in a dose of 150 microcuries; scans were obtained at 5 minutes. In the canine experiments employing gold, 50 microcuries of Au 198 were used with scanning at 15 minutes; in 2 adult human beings 200 microcuries were administered and scans obtained at 45 minutes. In a third patient, a 6.4 kilogram child, 11 microcuries of Au 198 were administered and the scan started immediately. Scans were obtained with a 5 by 2 inch crystal and a 5 inch broad focus collimator. The spectrophotometer was set at 0.345 to 0.395 million electron volts for the I 131 and 0.355 to 0.455 million electron volts for the Au 198. Scan speed was 90 cubic centimeters per minute, with a line spacing of 0.45 cubic centimeter. Density was adjusted according to the counts per minute. Background cutoff was 15 per cent plus or minus 5 per cent, and the range differential 60 per cent plus or minus 10 per cent. The time constant was 0.1 second. Canine studies Liver scans were performed under a variety of circumstances. In all groups of dogs, serum glutamic oxalacetic transaminase, serum glutamic pyruvic transaminase, bilirubin, and alkaline phosphatase were determined at regular intervals, and the patency of the vessels to the homograft and the autologous liver was ascertained at autopsy or before death by angiography. The ischemic interval for the cold-perfused homotransplanted livers was never greater than 1 hour. The dogs with homografts all received 1 to 8 milligrams per kilogram per day of azathioprine. Group 1.-Eleven normal dogs were studied. Group 2.-In 5 of the dogs from group 1, scintillation scans were carried out 14 to 29 days after a subsequently constructed Eck fistula. Group 3.-Nine dogs, including 3 from group 2, had an auxiliary liver transplant to a recipient whose own liver was damaged with an Eck fistula. The portacaval anastomosis was performed in advance in 3 experiments and at the same time as the transplant in the other 6. The common bile duct of the host dog was ligated. The auxiliary liver was rearterialized from the right common iliac artery and received its portal venous inflow from the terminal inferior vena cava (Fig. 1A).
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