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SUMMARY A test to measure the extent of iron overload in patients with idiopathic hæmochromatosis was developed with the chelating agent diethylene triamine penta‐acetic acid (DTPA). One gramme of DTPA in 100 ml. of saline was injected intravenously, and the iron excreted in the urine during the next five hours was measured. Normal subjects excreted less than 0·25 mg. of iron, and six untreated patients who had been diagnosed as suffering from hæmochromatosis excreted between 4·0 and 16·1 mg. The test was also performed on 51 patients who had been treated by removal of blood for varying periods, and who were divided into three groups. Sixteen who still had saturated transferrin excreted between 0·6 and 9·4 mg. of iron in the urine. The second group of 29 patients, whose transferrin had been unsaturated for varying periods, excreted between 0 and 1·5 mg. The remaining six patients had been adequately treated, but had not attended for some time, and the transferrin had again become saturated. Only one excreted less than 0·6 mg. The DTPA test was also performed on 13 asymptomatic relatives of patients with hæmochromatosis, all of whom had saturated transferrin, and some excreted abnormal amounts of iron. It is suggested that the DTPA test provides a measure of iron overload in patients with hæmochromatosis and gives a better guide to the progress of therapy than do serum iron and transferrin values. The test is simple to perform, is safe, and causes little inconvenience to the patient.

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The present study investigates clinical factors associated with decreased survival following Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS). Sixty-seven patients underwent TIPSS for bleeding related to portal hypertension, 42 (63%) on an urgent basis. TIPSS was successfully placed in 65 (97%) patients with no fatal procedural complications. Thirty day mortality was 21%, there being several predictive factors: transfer from another institution, urgency of procedure, sepsis, encephalopathy, higher mean serum bilirubin and low serum albumin. However, using regression analysis, 30 day mortality was predicted independently only by severe liver disease (Child-Pugh C, P= 0.003) and older age (P= 0.003). When stratified by Child-Pugh class, cumulative survival rates at 1 year for class A, B and C were 100, 90 and 34%, respectively. Only three of 25 patient deaths were due to variceal rebleeding. Thirty (46%) patients had a total of 41 rebleeding episodes, with mean time to first rebleed of 4.8 months (range, 3 days-38 months). Cumulative rebleeding rate at 1 year was 25%. Log-rank analysis did not reveal a significant difference in overall survival between rebleeders and non-rebleeders (P= 0.125). When investigated, shunt abnormalities (stenosis, occlusion) were identified in all cases of rebleeding. Our findings confirm TIPSS can be safe and effective in the control of refractory variceal haemorrhage. However, prognosis remains poor for patients with advanced liver disease, particularly if older and in the emergency setting. Vigilant surveillance and high rate of intervention is necessary to maintain shunt patency. Consideration could be given to elective shunt surgery instead of TIPSS for patients with recurrent bleeding and good prognosis liver disease.

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TIPSS is an effective means for control of bleeding from oesophageal and/or gastric varices not responding to other methods. Further follow-up is required with regard to rates of rebleeding, encephalopathy and survival.

SUMMARY Diminution in isotope in the region of the porta hepatis may be observed in normal patients; a similar appearance can be produced by any space‐occupying lesion in this location, the commonest causes being neoplasm, cyst or infection. A typical branching cold area radiating from the porta hepatis has been described in extrahepatic obstructive jaundice. False negatives and positives may occur; these will be less frequent if the scan is interpreted strictly in terms of its clinical context. Such a scan diagnosis may be supported by study of the rate of excretion of 131I‐labelled rose bengal into the intestine. A scan diagnosis made on these premises may justify percutaneous cholangiography or exploratory laparotomy.