The profiles of urinary volatiles from patients with phenylketonuria, maple syrup urine disease, isovaleric acidemia, or trimethylaminuria (fish-odor syndrome) were in each case vastly different from the normal urinary volatiles profile. In the maple syrup urine disease case, metabolites that occur distal to the block were found and a mechanism for their formation is suggested. A new major metabolite in isovaleric acidemia was also found. As well as providing a reliable diagnostic tool for diseases characterized by odors, the analysis of urinary volatiles may provide information to help our understanding of still unexplained aspects of the diseases.
In a prospective study of 57 patients coming to elective cholecystectomy for gallstone disease, clinical, biochemical and immunological features have been correlated with the histological changes in core biopsies of the liver obtained at surgery. Only 13 liver biopsies were normal. Ten biopsies showed changes of acute duct obstruction, 16 showed minimal portal tract abnormalities and 10 showed moderate portal tract inflammation and scarring. Histological changes were more marked in male patients. Clinical and biochemical investigations were not useful in predicting histological appearance, apart from cases with jaundice at the time of operation where changes of acute duct obstruction were usually, but not invariably, seen. Atuo-antibodies were present in 50 per cent of cases tested and all persisted for at least 6 months after operation. They were commoner in patients with more marked histological changes. Operative cholangiography was of little use in predicting histological change. These findings suggest that the possibility of gallstones should be considered in the interpretation of any abnormal liver biopsy irrespective of clinical symptoms or biochemical investigations.
SUMMARY A prospective comparative trial is reported between the results of early endoscopy and barium meal examinations in 150 patients admitted with acute upper gastrointestinal haemorrhage. One hundred and thirty-eight patients underwent both investigations within 24 hours of admission. Emergency endoscopy accurately identified the source of haemorrhage in 86% of patients and emergency radiology identified the source in 51 %. Misleading positive reports were given endoscopically in 3 % and by barium meal in 8 %. The identification of the source of haemorrhage was possible in 126 patients (91 %) by the use of both methods. Emergency endoscopy is shown to be superior to emergency barium meal examination, but the examinations are complementary and both should be used for these patients.
P Pl la as sm ma a c co on nc ce en nt tr ra at ti io on n o of f e el la as st ta as se e--α 1 1 --p pr ro ot te ei in na as se e i in nh hi ib bi it to or r c co om mp pl le ex x i in n s su ur rf fa ac ct ta an nt t--t tr re ea at te ed d p pr re et te er rm m n ne eo on na at te es s w wi it th h r re es sp pi ir ra at to or ry y d di is st tr re es ss s s sy yn nd dr ro om me e Since elastase-α 1 -proteinase inhibitor (E-α 1 -PI) has proved to be a sensitive indicator of intravascular PMN activation, we studied E-α 1 -PI plasma concentration in preterm neonates during the treatment of RDS with a bovine surfactant preparation (group I: n=23). Results were compared with those from a retrospective control group treated by ventilation alone (group II: n=13), and with a reference group of 92 newborns (group III). From these results, it is concluded that surfactant may trigger a transient, mainly local, inflammatory response, reflected by increased levels of E-α 1 -PI, and may exert a dose-related pathogenic influence on the course and prognosis of RDS. Under these conditions, the validity of E-α 1 -PI for the diagnosis of early-onset septicaemia may be limited.
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