303 EARLY RADIOACTIVELY LABELED PROTEINS (P) IN DOG BILE (B).

K. Weiqand Department of Clinical Pharmacology, University of Berne, Switzerland.

I t has been demonstrated that the quantitatively most important P in B, albumin and IgA,are derived from plasma.However,it is unknown whether hepatocytes can also secrete P directly into B.If P were exclusively tranferred from plasma into B radioactive P would not be detectable in B earl ier than in plasma after injection of a radioactive precursor amino acid.To determine i f hepatocytes "lose" newly formed P directly into B, we studied the secretion of radioactive P into B and plasma.ldentical experiments were performed in 2 unanesthetized female boxer dogs.A B duct catheter was placed through a Thomas cannula and B was collected at 2 min intervals. B flow was kept constant by infusion of 20 ~mol taurocholate per min. After i .v. injection of 250 ~Ci 1-14-C-leucine (59 mCi/mmol), a dose high enough for measurement of secretion time, plasi~,a samples were drawn every 2 min. Radioactively labeled P was detected in plasma 18 and 20 min resp.,after injection of 14-C-leucine (Mans+ Novelli).Thereafter i t increased exponential]y. In contrast,radioactivel~ labeled P in B was detectable as early as 10 and 14 min after injec- tion with a f i r s t peak after 20 and 30 min (1700 and 950 dpm/ml) and a subsequent decrease. A rapid increase of radioactively labeled P in B,parallel l ing the rise in plasma,was observed af- ter 50 min. B flow,B salt concentration (enzymatic),and b i l ia ry P concentration (adapted Lowry- method) remained constant during the experimental period.The biphasic appearance of radioacti- vely labeled P in B with a minor peak after about 12 min and a steep increase after 50 min in- dicates that most B proteins are derived from plasma,a small amount,however,is secreted by he- patocytes or b i l i a ry epithelium directly into B.An attempt to identi fy these P by SDS gel elec- trophoresis and fluorography was not successful owing to the very small amounts secreted. The secretion time for plasma P is 18 min,the transit time for P from plasma into 8 is about 30min.

304 THE RECURRENCE OF VARICES FOLLOWING INITIAL OBLITERATION BY SCLEROTHERAPY

D Westaby# BRD MacDougall~ Roger Willi-ms

The Liver Unit, King's College Hospital & School of Medicine & Dentistry Denmark Hill, London SE5 9HS

To determine the incidence and signifle~nce of recurrence of varlces following oblitera- tion by sclerotherapy, 147 patients (99 cirrhosis, 48 non-clrrhosis) were prospectively followed for periods up to 6 years after initial obliteration had been achieved. Routine e n d o s c o p i c e x a m i n a t i o n s w e r e u n d e r t a k e n a t i n t e r v a l s o f S - 4 m o n t h s f o r t h e f i r s t y e a r a n d 6 m o n t h l y t h e r e a f t e r . ' N e w ' v a r i o e s d e v e l o p e d i n 99 o a s e s (67%) a l t h o u g h t h e s e w e r e t h e c a u s e o f b l e e d i n g i n o n l y 28 p a t i e n t s o f whom 3 d i e d . T w e n t y - f i v e o f t h e 28 p a t i e n t s r e - b l e e d i n g d i d so w i t h i n 12 m o n t h s o f i n i t i a l o b l i t e r a t i o n o f v a r i c e s . A m e d i a n o f 2 c o u r s e s o f s c l e r o t h e r a p y ( r a n g e 1 - 4) w e r e r e q u i r e d t o a g a i n a c h i e v e o b l i t e r a t i o n . I n 20 p a t i e n t s a s e c o n d r e c u r r e n c e o f v a r i o e s o c c u r r e d w i t h b l e e d i n g i n 8 c a s e s b u t no a s s o c i a t e d d e a t h s . T h e r e was no c o r r e l a t i o n b e t w e e n t h e a e t i o l o g y o f c i r r h o s i s o r t h e s e v e r i t y o f t h e u n d e r - l y i n g l i v e r d i s e a s e a n d t h e d e v e l o p m e n t o f ' n e w ' v a r i o e s . Th e h i g h r a t e o f r e c u r r e n c e o f v a r i c e s a p p l i e d e q u a l l y t o t h o s e w i t h a p o r t a l v e i n t h r o m b o s i s .

The r e s u l t s i n d i c a t e t h a t r e c u r r e n o e o f v a r i c e s c a n b e e x p e c t e d i n t h e m a j o r i t y o f p a t i e n t s f o l l o w i n g i n i t i a l o b l i t e r a t i o n b y s c l e r o t h e r s p y o H o w e v e r , t h e f r e q u e n c y o f b l e e d - i n g may b e m i n i m i s e d b y r e g u l a r f o l l o w up e n d o s c o p y , a n d i n j e c t i o n o f ' n e w ' v a r i c e s , p a r t i c u l a r l y d u r i n g t h e f i r s t 12 m o n t h p e r i o d .

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