SUMMARY Estimates were made of the arsenic concentration in liver specimens from nine patients having idiopathic portal hypertension (IP), and in four livers these were found to be significantly higher than those in patients with cirrhosis and in control subjects. The splenovenogram revealed extensive portosystemic collateral circulation. Corrected sinusoidal pressure and blood flow studies showed higher levels in four patients than in normal subjects. Microscopic examination of liver tissues revealed periportal fibrosis. The higher hepatic arsenic levels that were found were due to the inadvertent drinking of water contaminated with arsenic, adulterated opium, and indigenous medicines. A history of opium intake was not forthcoming but two patients had drunk water contaminated with arsenic and two others had taken bhasams (Ayurvedic medicines prepared by repeated oxidation of ores). Though the aetiology of idiopathic portal hypertension is not known, it is possible that arsenic intake may be one of the factors.Idiopathic portal hypertension (IP) has recently been recognised as a new entity (Ramalingaswami et al., 1962;Boyer et al., 1967;Basu Mallik et al., 1967;Sama et al., 1971;Datta, 1975;Datta, 1976a). In this condition haematemesis and splenic enlargement are common features, and solenovenographic studies reveal collaterals in 80% of cases. The aetiology of the syndrome is unknown and it has been suggested that there may be several causes (Datta, 1975;Mahajan and Datta, 1976 Received for publication 27 February 1979
Methods
SUBJECTSThe livers of nine patients with idiopathic portal hypertension (IP) and seven with cirrhosis were investigated for their content of arsenic. A piece of liver (about 2 g) was obtained by wedge biopsy at laparotomy in six patients and the same quantity from necropsy in three patients. The gross and microscopic examination of 18 patients who showed no evidence of hepatic disease and who died from non-hepatic causes served as controls in our studies.Nine liver tissues were obtained from newborn infants. In addition, 105 livers were obtained through