A multicentre study of computer aided diagnosis for patients with acute abdominal pain was performed in eight centres with over 250 participating doctors and 16737 patients. Performance in diagnosis and decision making was compared over two periods: a test period (when a small computer system was provided to aid diagnosis) and a baseline period (before the system was installed). The two periods were well matched for type of case and rate of accrual.The system proved reliable and was used in 75-1% of possible cases. User reaction was broadly favourable. During the test period improvements were noted in diagnosis, decision making, and patient outcome. Initial diagnostic accuracy rose from 45-6% to 65 3%. The negative laparotomy rate fell by almost half, as did the perforation rate among patients with appendicitis (from 23.7% to 11-5%). The bad management error rate fell from 0-9% to 0-2%, and the observed mortality fell by 22-0%. The savings made were estimated as amounting to 278 laparotomies and 8516 bed nights during the trial period-equivalent throughout the National Health Service to annual savings in resources worth over £20m and direct cost savings of over £5m.Computer aided diagnosis is a useful system for improving diagnosis and encouraging better clinical practice.
Incubation of normal plasma low-density lipoprotein (LDL) with erythrocytes results in echinocyte formation; the effect is attributed to stimulation of spectrin dephosphorylation through binding of LDL to the cell surface (Hui & Harmony, 1979, Biochimica et Biophysica Acta, 550, 407). No shape change occurs when erythrocytes are incubated with normal highdensity lipoprotein (HDL) and LDL-induced echinocyte formation is inhibited by HDL. We have established that as a consequence of abnormal apoprotein composition (an increased content of ApoE and threonine-poor apoproteins) the HDL of liver disease competes with LD L for binding by the high-affinity receptor on cultured skin fibroblasts. In the present study we have determined whether the abnormal HDL of liver disease (d = 1·063-1·21) will induce echinocyte formation in normal erythrocytes.HDL from several patients which showed the apoprotein abnormalities were tested; all induced marked echinocyte formation when added to a suspension of normal erythrocytes at 37°C (6 x 10 9 cells/ml and 500 ug ofHDL-protein/ml). Patient HDL was 10-100 times more potent than normal LDL and could transform 100% of the cells. Echinocyte formation was rapid (less than 10 s), occurred to a similar extent at 4°C and was also induced by partially delipidated patient HDL. The erythrocyte binding site differed from that on cultured fibroblasts; echinocyte formation was not inhibited by protamine or heparin and also occurred when apoprotein arginine residues were blocked with cyclohexanedione or when erythrocytes from patients with homozygous familial hypercholesterolaemia were used. The morphological changes were associated with increased osmotic resistance and with decreased membrane fluidity as measured by a hydrophobic, fluorescent probe. Attempts to restore biconcave disc morphology by addition of heparin or normal HDL were only moderately successful.Previous studies have implicated changes in erythrocyte membrane lipid composition as underlying the 'spur-cell anaemia' of liver disease (Cooper, Arner, Wiley & Shattil, 1975, Journal of Clinical Investigation, 55, 115); our results suggest that abnormal HDL apoprotein composition may also play a role. DECREASED ER YTHROCYTE MEMBRANE FLUIDITY AND ALTERED LIPID COMPOSITION IN HUMAN LIVER DISEASEAbnormal plasma lipoproteins in patients with liver disease are associated with characteristic changes in erythrocyte membrane lipid composition. The membranes are enriched in cholesterol and lecithin and both the cholesterol/phospholipid (C/P) and lecithin/sphingomyelin (LlSM) molar ratios are increased. Phospholipid fatty acid composition is also abnormal; the proportion of arachidonic acid is decreased and that of palmitic acid raised. In this study we have examined the effects of these membrane lipid abnormalities on membrane fluidity.Erythrocyte membrane fluidity was assessed in 30 patients with a variety of liver diseases, and in 25 normal subjects by using the hydrophobic, fluorescent probe I,6-diphenyl hex a-1,3,5-triene, and the value...
Desmopressin acetate may be useful in correcting defects in primary haemostasis in chronic liver disease.
The treatment of moderate to severe hyponatraemia in patients with decompensated liver disease is unsatisfactory. We report our preliminary experience using intravenous infusion of albumin to treat this condition. Three patients with cirrhosis, ascites, and hyponatraemia responded satisfactorily to treatment; one patient with fulminant hepatitis B did not respond. Intravenous albumin infusion is a safe and effective therapy for patients with cirrhosis complicated by hyponatraemia. Its main role may be in preparing patients for surgery, particularly liver transplantation.
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