60 consecutive patients underwent sclerotherapy for hemorrhage from ruptured esophageal varices. Sclerosis was always started within the first 48 hours. 12 patients (20%) died during initial ...hospitalization, but only 5 from recurrent bleeding. Of 48 survivors, 22 (46%) did not rebleed during a mean 18-month follow-up, whereas 26 (54%) had recurrences, 27 of these bleeding episodes occurred early (within 4 months) and 17 late (mean 16.5 months). Eradication of the varices was achieved in 29 patients (60%) with a mean of 6.2 sessions and within a mean of 6 months. Of these 48 patients 2 have been lost to follow-up, 25 (52%) are alive after a mean follow-up of 29 months, and 21 (44%) died (though only 2 from variceal bleeding). The survival curve (Kaplan-Meier) of these 60 bleeders is 45% and 37% at 2 and 4 years respectively. Sclerotherapy caused no death and only minor adverse effects. These results confirm those in the literature. We advocate endoscopic sclerosis as first choice in the treatment of ruptured esophageal varices.
Glucagon immunoreactivity (IRG) was measured in plasma of 8 duodenopancreatectomized patients with antiserum 30-K. Arginine infusions failed to raise plasma IRG, whereas in control subjects IRG rose ...3-fold. Column chromatography revealed that the basal IRG measured in these plasmas was not due to glucagon (molecular weight 3485) but to other plasma factors, mainly of high molecular weight. This suggests that diabetes mellitus does not require the presence of glucagon to produce the clinical picture, as suggested by other authors. Plasma levels of the amino acids alanine, serine, ornithine, and arginine were significantly (p less than 0.05) elevated, the former two being gluconeogenic substrates and the latter two constituents of the urea cycle. This amino acid abnormality may be a consequence of glucagon deficiency.
